Report Shows Rise in Health Care Spending According to a new report by the Centers for Medicare & Medicaid Services (CMS), health care spending is increasing faster than economic growth, possibly spelling the end to a long run of affordable health care cost growth. The report, "Inflation Spurs Health Spending in 2000," also hints that in addition to spending being on the rise, there could be additional fallout, including employers placing more of the financial burden on employees, increasing unemployment, and shrinking tax revenue. "The report does not have any immediate concerns for physical therapists or other rehabilitation professionals," says Katharine Levit, one of the report's authors and an economist at the National Health Statistics Group, Office of the Actuary, CMS, Baltimore. "However, we did look at that industry as a whole, under the heading ‘other professional care,' in the report, which we define as any licensed therapist. Among other things we could see that might have an effect on this group, as well as the other groups, is that the shrinking tax base may force the government to evaluate health care priorities. That is not good news at a time when the need for coverage continues to grow." According to the report, spending in 2000 was the biggest jump seen since 1988. Public spending increased 7%, up from 5.4% in 1999, while private spending rose from 6% in 1999 to 6.9% in 2000, a figure that was led by 8.4% growth in private health insurance premiums. Medicare expenditures of $224 billion played a large role in bolstering all health care spending in 2000. On the whole, health care spending in the United States increased to $1.3 trillion in 2000, which amounted to a 6.9% increase over the previous year. That figure marks the biggest year-to-year increase since 1993. "It is the first sign that the 9-year stability in health spending's share of the gross domestic product (GDP) may be coming to an end," says the report. Spinal Ruling to Have Little Effect on PTs Although the Centers for Medicare & Medicaid Services (CMS) recently revised an Operational Policy Letter stating that Medicare+Choice organizations can no longer use physical therapists to perform manual manipulation of the spine to correct a subluxation (partial dislocation), some in the industry do not foresee massive changes as a result. An original 1994 policy specified that only physicians can be allowed to perform the service, which CMS says should include chiropractors, but not physical therapists. However, representatives at the American Physical Therapy Association (APTA) say that the ruling does not in fact prevent therapists from manual manipulation of the spine, for which therapists have billed Medicare all along. "The ruling only applies to subluxations," says APTA. "Also, Medicare+Choice Organizations may continue using physical therapists to treat patients for conditions that do not require physician services. In addition, the ruling only applies to Medicare+Choice, and not to traditional fee-for-service Medicare." "This is not meant to take away opportunities from physical therapists," says Don McLoud, spokesperson for CMS. "We are simply attempting to clarify the ruling and make it clearer." Taken as a whole, the ruling is being viewed by APTA as a "simple clarification of existing policy, rather than a change in policy that would affect the scope of physical therapy practice under Medicare+Choice," according to a statement by the organization on its Web site. "Physical therapists may continue to furnish manual manipulation of the spine for any other purpose to Medicare+Choice beneficiaries, so long as physical therapists practice within the scope of their state licensure." The statement also points out that the current case is still pending, and that PTs will continue to furnish manual manipulation of the spine for any other purpose. Hip Replacement Open to Younger Patients Research findings presented at a recent conference of the American Academy of Orthopaedic Surgeons (AAOS) suggest that new prostheses are making it increasingly possible for younger patients to receive hip replacement surgery. John Callaghan, MD, professor of orthopedics at the University of Iowa, Iowa City, reported the findings of a study of 70 patients at the 69th AAOS meeting in mid-February in Dallas. According to Callaghan's research, the prostheses of 65% of patients who underwent total hip replacement surgery before age 50 remained intact 25 years later. "That is good news for younger patients," he says. "A lot of recent improvements have been made in surgical materials that are extending the life span of the prostheses." Only 5% to 10% of the 150,000-200,000 total hip replacements performed each year are done on patients under the age of 50. Until recently, most prostheses have been manufactured from a metal ball and a socket lined with plastic. However, says Callaghan, a variety of new prostheses combine metal with metal or ceramic with ceramic, and metal on more durable plastics, all with the potential of cutting down the wear and tear on the prosthesis, thereby producing joints with the potential for less wear problems. "Some of the prostheses we have seen this year allow surgeons to replace a worn liner on the socket component of the prosthesis, rather than the entire prosthesis," says Callaghan. "The process can almost be likened to getting new tires on a car, as opposed to an entire new car." The fusion process involved with hip replacement can eliminate pain, but it also makes the joint immobile and can lead to back pain as the patient compensates for the restricted range of motion, according to Callaghan. He also says that orthopedic surgeons have long avoided hip replacement for younger patients, fearing complications such as deterioration or loosening of the prosthesis and an increased risk of further injury.
