Patients' Rights Legislation Faces Hurdles The different versions of patients' rights legislation passed by the House and Senate prior to Congress' summer recess contain several major differences that will make hammering out a compromise a challenge for lawmakers when they once again turn their attention to the issue. According to health care lawyer Corrine Parver, JD, PT, of the law firm Dickstein, Shapiro, Morin and Oshinsky, in Washington, DC, "the area [of the legislation] in which you have a marked difference is the liability section." The venue in which patients can bring lawsuits, for example, differs considerably in each bill. "Under the Senate bill," she says, "patients can sue health maintenance organizations [HMOs] and health plans for damages in state court when there's a medical judgment dispute, and federal court when there's a contractual dispute. Under the House bill, patients can sue health plans in state court if care was denied-but it has to be under the new federal standards that were added to ERISA [Employee Retirement Income Security Act]." Whether to impose limits on how much can be awarded in damages, and how stringent any limits should be, is also expected to be a major sticking point. "The Senate bill, for example," Parver says, "allows for up to $5 million in punitive damages, but in the House bill, punitive damages are limited to a maximum of $1.5 million, and that's only under the condition that whoever made the decision for a health plan to deny a patient's claim failed to comply with the decision of an independent medical reviewer." Parver added that other issues of liability on which lawmakers must reach a compromise include different limits the House and Senate would like to impose on class action lawsuits, as well as how strict the standard in negligence liability should be. Non-liability-related points of contention are expected to be whether to include Medicare, Medicaid, and other federal programs under the legislation, which the Senate supports, as well as disagreement over who can choose the reviewer in the independent review process. Parver recommends that rehabilitation professionals should keep a close eye on the debate and familiarize themselves with what finally emerges to be signed into law. "If therapists are employers in a private practice setting," she says, "then all the provisions that allow patients to sue employers will affect them." And, as health care providers, Parver thinks it essential for rehab professionals "to be aware of what ends up being the final law because their patients will ask them about it. Patients will come to them and say, ‘What can I do? I want this therapy but my health plan is denying it. How can I go about making sure I get the care I need?' The therapist should be able to say, ‘Well, under the new patient protection legislation, here is what you can do.'" OIG Supports Therapy Cap The Department of Health and Human Services' Office of Inspector General (OIG) concluded in a report issued in August that the Centers for Medicare and Medicaid Services (CMS) $1,500 therapy cap, currently on moratorium, "did not prevent Medicare SNF [skilled nursing facility] beneficiaries from receiving necessary and appropriate therapy" when it was in effect. The report, entitled "Physical, Occupational, and Speech Therapy for Medicare Nursing Home Patients," states that "less than 2% of Medicare beneficiaries reached" the cap, and of that 2%, 80% "received some [medically] unnecessary therapy." According to the report, the average Medicare allowance needed for most types of therapy was about $500. The report goes on to blame some instances in which the therapy caps were exceeded because of ignorance of CMS regulations. It states that "staff in more than half of the facilities we interviewed reported not receiving training from fiscal intermediaries on Part B therapy...[which] left them unclear on new billing requirements, including the therapy caps." But according to Jeff Finn, director of communications for the American Occupational Therapy Association (AOTA), changes in billing procedures that were being implemented at the time when the data were collected may have skewed the OIG's findings. The data were collected in 1999, "and this was a particularly volatile period," he says. "Due to the prospective payment system (PPS), billing for therapy was being conducted in a whole new way. It was a difficult time, and there was a steep learning curve. We also saw tremendous variants [in billing] as contractors moved over to the new system." Finn adds that "the critical thing is to get better data before anyone comes to any firm conclusions." He says that he is nonetheless pleased by CMS' efforts to apply "more consistent standards of coverage to therapy plans." Copies of the OIG report are available on the Web at www.dhhs.gov/progorg/oei. Donations Sought for Disaster Relief In the wake of the September 11 terrorist attacks on New York City and Washington, DC, a variety of organizations are accepting contributions to the relief effort. According to information available on September 12 at the Red Cross Web site (www.redcross.org), medical professionals wishing to support rescue efforts should contact the following: physicians may call (212) 604-3850; nurses may call (212) 604-847; emergency medical technicians and nurses aides may call (800) 628-0193; and search and rescue professionals may call (703) 222-6277. To make a donation to the Red Cross Disaster Relief Fund, call (800) HELP NOW or visit www.redcross.org. Donations may also be made through Web-based retailer Amazon.com at its Web site, www.amazon.com. To donate blood, Call (800) GIVE LIFE or contact your local hospital or health care system. The Red Cross is urging those who wish to donate blood to call to make an appointment first. CMS: Dovetailing Not a Policy Violation According to an analysis released by Chapel Hill, NC-based health care industry researchers Eli Research, therapists in skilled nursing facilities who practice "dovetailing"-treating multiple patients with different problems at the same time-will not be in violation of Centers for Medicare and Medicaid Services (CMS) policy, "so long as it's done for the right reasons and within limits." According to the analysis, CMS had expressed reservations "about ‘concurrent therapy,' a new term" that CMS was using to refer to dovetailing. But in recent statements, the analysis notes, CMS has softened its stance, stating in the July 31, 2001, Federal Register that "concurrent therapy has a legitimate place in the spectrum of care options," and that earlier statements were issued "in order to alert providers to the inappropriate uses of this practice in certain areas of the country." The Eli report goes on to state that CMS has taken the further step of clarifying "how therapists should bill for certain ‘concurrent' treatments." Karolyn Bauer Added to EAB of Rehab Management Karolyn Bauer, MSPT, has joined the editorial advisory board (EAB) of Rehab Management magazine. Bauer, an aquatics program manager and staff physical therapist at Long Island Orthopaedic and Sports Physical Therapy in Douglaston, NY, has 10 years' professional experience, and specializes in the areas of orthopedic physical therapy, aquatic physical therapy, balance rehabilitation, and yoga. "I'm looking forward to finding out what I can contribute," she says, adding that she is "very grateful for the opportunity to contribute to the publication and to serve the aquatic and rehab fields." A member of the American Physical Therapy Association, Aquatic Therapy and Rehabilitation Institute, and Aquatic Resources Network, Bauer received her BA from Hampshire College, Amherst, Mass in 1991 and her MS in physical therapy from Columbia University, New York City, in 1998. Paraplegic to Attempt Second Yosemite Climb Mark Wellman, who gained international acclaim by successfully completing the first paraplegic ascent of Half Dome in Yosemite National Park, will celebrate the 10th anniversary of his climb by ascending the monolith once again. Wellman and his long-time climbing partner Mike Corbett will tackle their second ascent on September 4, exactly 10 years to the day after their first successful climb. A 1982 climbing accident left Wellman paralyzed from the waist down. Following treatment at the regional Kaiser Foundation Rehabilitation Center, Wellman gained international attention by becoming the first paraplegic to conquer the 3,000-foot El Capitan in Yosemite and the treacherous 2,200-foot vertical Tis-sa-ack route on Half Dome. He is also the first paraplegic to sit-ski 50 miles across the Sierra Nevada using only his arms.
