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December 2003

By Sarah Schmelling

The passage of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 earlier this month capped off a year of roller-coaster changes for the rehabilitation industry, as well as for the medical community in general. We saw the first stages of Health Insurance Portability and Accountability Act (HIPAA) compliance implementation, for better and for worse. We saw the effects of the economy and job market on facilities and hospitals, and witnessed controversy over such legislation as the proposed changes to the “75% rule.” With the aforementioned Prescription Drug Act, we have heard a wide range of opinions on its positive and negative implications. The American Physical Therapy Association applauded the Act’s passage, because, among other things, it suspends the implementation of the $1,590 Medicare cap on physical therapy services through 2005 and prevents the scheduled 4.5% cut in Medicare payments to PTs, replacing it with a 1.5% increase for the next 2 years. Still, like many of these issues, it remains to be seen how most therapists and, more important, their clients are affected by the specific details of the new regulation (for more, see Legislative Watch, “In With the New,” page 40). Changes in this field have also come in more unexpected ways this year. In early January, a writer approached me with a story idea on the “history of physical therapy and war.” I turned it down, mostly because, with the war in Iraq still months away, I didn’t see how it could have big implications for rehab professionals. Obviously, almost a year later, much has changed. In just the last month alone, in-depth articles on the physical rehabilitation of soldiers injured in Iraq have made the news in several national publications.

Of course, it will not be news to any of you that working with soldiers poses its own set of challenges for physical and occupational therapists. According to an article in the Los Angeles Times,1 at the Walter Reed Army Medical Center in Washington, where many soldiers receive treatment, the physical therapy unit long ago ran out of room. In addition to this greater demand, Walter Reed’s therapists also must cope with soldiers who are frustrated and often stubborn. In an article in The New York Times,2 Isatta Kanu, a PT assistant at the hospital, said of one soldier, “It’s hard for a young guy. He may not be conscious of his anger.” As more PTs and OTs work with soldiers, it will be important to keep these special considerations in mind.

We know that the coming year will also bring challenges, and we hope to continue to provide you with information on the issues that affect rehab professionals the most. As always, if there are topics on which you would like to see more coverage, or if you have questions regarding anything you see in Rehab Management, we would love to hear about it. After all, if we have learned anything in 2003, it is that there isn’t much—regulation, legislation, new types of injury, and new treatments—that the professionals in this industry cannot take on. Here’s to a healthy and happy 2004.

Sarah Schmelling
cwolski@medpubs.com

References

Schrader E. Wounds of war. Los Angeles Times. Available at: http:// www.latimes.com/news/printedition/la-na-wounded9nov09000512,1,2036318.story. Accessed November 11, 2003.
Banerjee N. Rebuilding bodies, and lives, maimed by war. The New York Times. Available at: http://www.nytimes.com/2003/11/16/national/16WOUN.html. Accessed November17, 2003.

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