On the Reimbursement Front The following column is the opinion of the author. We welcome other views and comments on this topic. (Write to Dean Garstecki, Northwestern University, 2299 North Campus Dr., Evanston, IL 60208-3550.) Tell the elderly or soon to be, not to grow old and expect the federal government to have an ... Viewpoint
Viewpoint  |   May 01, 1998
On the Reimbursement Front
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Older Adults & Aging / Viewpoint
Viewpoint   |   May 01, 1998
On the Reimbursement Front
SIG 15 Perspectives on Gerontology, May 1998, Vol. 3, 26-27. doi:10.1044/gero3.1.26
SIG 15 Perspectives on Gerontology, May 1998, Vol. 3, 26-27. doi:10.1044/gero3.1.26
The following column is the opinion of the author. We welcome other views and comments on this topic. (Write to Dean Garstecki, Northwestern University, 2299 North Campus Dr., Evanston, IL 60208-3550.)
Tell the elderly or soon to be, not to grow old and expect the federal government to have an insurance program that will pay for the care they will need at the time of their greatest need. HCFA just released the Salary Equivalency rates for physical, occupational, speech, and respiratory therapy. DOOM and GLOOM. The rates are not significantly different from those published over one and half years ago, if you consider an inflationary rate of 3% annually. The rates do not consider the current costs of providing therapy in the various elder care environments (skilled nursing facilities, adult living facilities, and rural areas). The rates included an upward adjustment to mean hospital salaries in order to partially account for higher nursing home salaries that were underrepresented in the salary surveys. HCFA played a game with all of us. The providers and the beneficiaries will soon see the treachery that HCFA and Congress and the President are conducting. First, the salary equivalency issue is really just a drop in the well, it will soon go away because of Prospective Payment in nursing homes, bundled billing and the $1500 cap soon to be imposed on the beneficiary. However, in the wake of Salary Equivalency and its disappearance will be a lot of unhappy clinicians and patients. “Why?” you might ask. Well, salaries and benefits will have to be reduced. No one is mentioning this fact, but it will happen. The large companies have merged themselves into a corner. They have increased the salaries for therapists over the past 10 years, captivating a large share of the available therapists and passed the higher costs along to the consumer, as does any business. The small companies that survived merger and acquisitions and the independent clinician benefited from the salary increases of the larger companies, because the market now allowed for greater costs. I do not blame the big business environment for the increased cost or the increased utilization of therapy services. The services, for the most part, were indeed necessary. Our government mandated by law (OBRA 87) no more warehouses for the elderly. Rehabilitation had always been a necessary part of the health care for the geriatric population. It was just not easy to convince doctors, health care administrators, and HCFA that the elderly did need rehab and that the elderly were not in nursing homes just to die. Now the rub: Costs go up, utilization goes up, and the elder population increases. HCFA and Congress blame low-life, sleazy, corrupt, criminal-type health care providers for bankrupting the Medicare system. The amazing thing is that the associations of health care providers (ASHA included) are agreeing with the misperceptions of Congress and HCFA and don’t mention how irrational the assumptions are that are being made. So now we get these salary rates that do not reflect a current market, because HCFA did not want to go to the trouble of analyzing current data appropriately. HCFA says only the inefficient providers will be hurt: wrong assumption again. Everyone will eventually be hurt by these outrageous and arbitrary rates. Therapists will have to be willing to work for less and struggle with ethical decisions about patient care. Quality will be a thing of the past. One clinician for every three or four or five aides will be the norm for treatment. Patients will not know that the person providing them with treatment for language problems or dysphagia is not a trained, licensed, college educated Master Degree level therapist—not, that is, until the lawsuits start for malpractice, unethical practice, billing for services rendered under false pretenses. However, HCFA will be happy, because they saved the system $160 million and got rid of those inefficient providers that cared about giving 110% in a treatment session. The patient won’t care, because according to HFCA and intermediaries, the patient was going to die any way. Hard way to look at it, but guess where we are heading: caps for beneficiaries of perhaps $1,500 per year? Who gets therapy and who does not? Who decides? The $1,500 decides. In terms of prospective payment, who gets therapy, who decides? The nursing home’s case manager decides, not a therapist, not a doctor, but a clerk with little if any medical background. Why? COST!!! The nursing home has to keep its costs down in order to make a profit. PROFIT is not a bad word. The system devised by Congress and HCFA is bad. Every one will feel the pain, except for the President. He is not 65 yet and his health care will be taken care of with no thought to cost.
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