Last night, I watched democracy in action. For months, the volunteers of the Legislation and Reimbursement Division, as well as ASHT staff, have followed every step of Sustainable Growth Rate (SGR) repeal legislation. Tuesday evening (April 14) was the long anticipated climax, and it was quite a ride!
For the past four weeks, we monitored C-SPAN and press reports. We poured over the compromise legislation that eventually made its way to the House, only to be disappointed to find the Medicare Therapy Cap repeal had been omitted. We hoped that the House of Representatives would allow amendments before voting and were disappointed when the vote was quickly ushered through without amendments. The Senate’s decision to recess for Spring Break without acting on the House legislation was met with mixed emotions: concern over how to process claims in the interim and hope that the therapy cap repeal might get added in the Senate version.
On Monday, when no action was taken on HR 2, we contacted CMS for advice to pass on to ASHT members. On Tuesday, we waited anxiously to see if the majority leader would allow amendments to be heard and voted on. I was filled with pride when Senator Ben Cardin spoke from the podium on the importance of therapy for Medicare beneficiaries. I was angry when Senator Orrin Hatch provided the dissenting opinion, emphasizing that it was more important to get it passed than to get it passed right. ”We are out of time,” he said, and whose fault was that?
Eight years after being enacted, passage came down to the wire and the deadline was used as the reason for pushing the legislation through without amending it. Five other amendments were brought forward, and one after another fell by significant margins. As I watched the vote on the sixth amendment surge then sputter – standing still at 57-37 for what felt like an eternity –one by one, senators wandered in to add their votes. Then suddenly, it was over: 58-42. Two votes shy of the majority leader mandated required 60 votes. I saw weeks of work, writing e-blasts, tweets, emails and making phone calls flash before my eyes, and I was filled with disappointment.
I watched Senators congratulate each other for legislation that will keep reimbursement rates to Medicare providers artificially below the inflation rate for the next five years and will link our pay to quality metrics that have little or nothing to do with the services we provide. My heart sank as I realized private payers would adjust their reimbursement schedules accordingly. I saw hope of ending the Medicare Therapy Cap and daunting manual medical review process fade, sentencing hand therapists to the uncertain gamble of continuing medically necessary care that may be denied a year down the road.
Yet out of my despair, springs hope: This is an opportunity for hand therapists to become stronger advocates for our profession. It is no longer enough to be the highly skilled providers of intricately balanced care. It is no longer acceptable to leave the advocacy to someone else. We are responsible for the preservation of our profession. It is up to us to make sure that our services will not be relegated to assistants or technicians in the interest of cutting costs. We must not compromise quality in order to “make rate.” While legislators and corporations attempt to reduce us to productivity and “quality “ metrics, we have to fight for the art of therapy.
And we will have another opportunity! The Medicare Therapy Cap exceptions process will expire at the end of 2017. The Legislation and Reimbursement Division is already thinking ahead, exploring new strategies to energize ASHT members and their patients. We have great opportunities ahead to get our message out! The time to begin is now. Take this opportunity to contact your senators and representatives.
Thank them for their support, if applicable, and let them know that this issue is extremely important to you. Keep your patients informed about the consequences of the recent legislation and the opportunities for guiding our legislators on a new path. And, most of all, continue your membership in ASHT! The dedicated volunteers and ASHT staff are our best resources for preserving our future!
