What happened in 1997?

[engmedpt]

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Like.....play by play.....
what happened to the physical therapy profession

 

[Mad Jack]

http://www.apta.org/FederalIssues/TherapyCap/History/

Not very familiar with the issue myself, but maybe this'll give you an idea of what's happened since.

 

[Bluecase]

https://en.m.wikipedia.org/wiki/Balanced_Budget_Act_of_1997


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[beestrng]

Can anyone comment on how often clinics exceed the initial therapy cap? The one that is up to $3700.

 

[engmedpt]

http://www.apta.org/FederalIssues/TherapyCap/History/

Not very familiar with the issue myself, but maybe this'll give you an idea of what's happened since.

Thanks MadJack. I knew about BBA but had heard the market was awful or something then as well. Didn't know how it all connected or if it did.

Can anyone comment on how often clinics exceed the initial therapy cap? The one that is up to $3700.

Not on clinicals yet :/

That's the cap til 2017 I believe. The temp one right?......which is perpetually extended

 

[beestrng]

The $3700 is after the initial cap of $1950 or something like that. After that there are manual reviews.

I have been seeing a lot of post $1950 cap clients in a outpatient clinic...

 

[jesspt]

Like.....play by play.....
what happened to the physical therapy profession

Well, I can tell you that the job market suffered considerably. Starting salaries were very low and it was much more difficult to find a job, in my opinion primarily because a lot of employers were tightening their vests due to concerns about the financial impact of the cap.

 

[Trex123]

I actually remember 1997 . My wife got 20 K a year cut. That was a year of gradual decline of PT field which continues till today. The best times for PT's were prior to that date.

 

[jesspt]

I actually remember 1997 . My wife got 20 K a year cut. That was a year of gradual decline of PT field which continues till today. The best times for PT's were prior to that date.

Yup. I graduated in 1998. Took my first job making $19.00/hr because that's what I could get. My wife (also a PT) was unemployed as a PT for over 4 months after graduation, and during that time was working for a temp agency that hired her out to answer phones for a home shopping network wannabe.

This is why I use this forum as a platform to try to encourage prospective PT students to choose their school wisely. You never know what can happen to the job market. When I applied to school, PT's were being given loan repayment options from their employers all the while making $10-$15,000 more per year than what we ended up making in 1998.

However, you can be certain of is how much it costs to obtain your degree.

 

[Azimuthal]

Yup. I graduated in 1998. Took my first job making $19.00/hr because that's what I could get. My wife (also a PT) was unemployed as a PT for over 4 months after graduation, and during that time was working for a temp agency that hired her out to answer phones for a home shopping network wannabe.

This is why I use this forum as a platform to try to encourage prospective PT students to choose their school wisely. You never know what can happen to the job market. When I applied to school, PT's were being given loan repayment options from their employers all the while making $10-$15,000 more per year than what we ended up making in 1998. You can be certain of is how much it costs you to obtain your degree.

Well, there goes a good chunk of my feeling of security.

 

[jblil]

Well, there goes a good chunk of my feeling of security.

I have been in the workforce a long time, before coming to PT. One thing that I learned over the years and after multiple layoffs: try to have multiple streams of income, esp. if you have several different skills. It's like investing, you have to have a diversified portfolio to weather the inevitable up-and-downs of the market.

 

[ptisfun2]

Well, I can tell you that the job market suffered considerably. Starting salaries were very low and it was much more difficult to find a job, in my opinion primarily because a lot of employers were tightening their vests due to concerns about the financial impact of the cap.

I think this is right. I was working before 1997, and my job (and my colleagues' jobs) were safe.. no layoffs, normal raises, but we were a little slower in hiring open positions just prior to 1997. This was in the northeast. All positions got filled, but I think my boss had to justify necessity a bit to the higher ups. So for new grads that would have been tough. I knew no one who got laid off or got a salary cut, but no one I knew was a new graduate, so that may have something to do with it.

I started grad school later in 1997 (not for PT, something else), and I found per diem jobs easily that paid very well, but I think there was considerable geographic variability. I was in the southeast by then.

 

[ptisfun2]

Can anyone comment on how often clinics exceed the initial therapy cap? The one that is up to $3700.

I know people are researching this now. The initial therapy cap is about $1,940, but there is an exception process. The issue is that above $3,700 a medical audit is automatically triggered, and no one wants that! So in my discussions with clinicians ~ $3,700 is the de facto absolute max for patients with Medicare (combined with SLP of course). Medicare billing shows that as well; MedPAC has a bunch of reports/white papers that reported this.

 

[beestrng]

Yeah the manual medical review. I just see that many clients seem to exceed the $3700 and it almost seems routine where I am at.

 

[abynormal]

What does initial therapy cap mean?

 

[Trex123]

I agree with Jess. After practicing PT for over 20 years I see gradual decline in benefits , increased number of Pt. to see and stagnant salaries. If you like PT choose your schools and amount of loans very carefully.

 

[abynormal]

It means Medicare has payment caps; once you exceed them you must appeal for services, and at $3700 you get an automatic audit. It really dents our profession (I'm in OT). The AOTA and APTA are lobbying to pass repeal of the therapy cap, and they got it through the senate, but it's yet to go anywhere. It doesn't seem like it will ever happen honestly.

Thank you for the response. It would seem to be limiting especially with the nature of aging and the amount of therapy they might need.

 

[Bluecase]

It's not that limiting if people bill honestly and treat using evidence. 3700 can translate to something like 24 visits which at twice a week is three months. Also there are programs which Medicare supplemental programs offer like silver sneakers so ppl can continue to exercise. The trick is to be ethical and stop when it isn't skilled care anymore and then transition to independence on the patients own


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[NewDPT31]

It's not that limiting if people bill honestly and treat using evidence. 3700 can translate to something like 24 visits which at twice a week is three months. Also there are programs which Medicare supplemental programs offer like silver sneakers so ppl can continue to exercise. The trick is to be ethical and stop when it isn't skilled care anymore and then transition to independence on the patients own


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3700 is way more than 24 visits, even at 4 units(think mandatory reduction when billing same code more than 1x). Honestly, with most OP med b patients, I like to just do 30-45 min sessions. They usually can't handle an hour of exercises nor do I think that much is more beneficial. I'd rather see someone 3x/week for 30 mins each than 2x 1hr. Geriatrics don't need to do 3 sets of 20 for each exercise. Plus if you crush them with exercises for an hour they are much more likely to be sore. And sore to them can be a lot more miserable and affect their life than a 30 year old.

 

[Bluecase]

Wouldn't want to push our patients too hard, then they might actually get better. Also 65 years old doesn't mean they can't do an hour of therex. I don't care if they're 100, I'm still going to give them skilled care if it's safe for 60 minutes. Most likely they're not doing **** for the other 166 hours in the week


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[Azimuthal]

Our average salary is not so great. 75k is our national average salary (in OT), and we top out quickly there after. Trying to raise a family on 75k is really hard.

My parents raised 3 kids on minimum wage. I know times have changed, but if $75k is "hard", you're doing it wrong.

 

[Azimuthal]

With respect to your parents, I don't set my baseline on minimum wage. How can I send my kids to college on minimum wage? Get a car? A mortgage? You can't. Further, 75k is not a lot of money in this country - especially in more expensive parts of the country. At 90k (avg OT/PT salary in SF) you are "poor" you can't possibly get a mortgage to buy a house, or even dream about having a family. New York metro area? Anywhere coastal? LA/SD? Not happening unless you're comfortable living a less than optimal life.
I think it's funny that anyone would think an OT salary is a LOT when I have a LOT of debt and I'll be making (optimally 75k) in Middle America.

If you think 75k is a lot of money what do you think about doctors' salaries often in the 400ks as many in my family are making?

A modest wage 30 years ago could go a lot further than today.

With respects to your kids, they can pay for their own college, or make a respectable living with no college at all. It may even make them humble. It's hilarious how you use the word "poor" so sparingly, even more so choosing a profession knowing the salary and debt it entails. I don't think you have experienced poor. You're right, $75k may not be a lot of money in 'some' parts of the country, however, it still is in most.

Physicians making $400k? Most kind of deserve it. Was I suppose to say something a long the lines of, "a super-duper gigantic amount of money?" I think you were over thinking it. The point was not to say that a certain amount is 'a lot', but that it's relative. To be clear, $75k is not 'a lot' (your words), but it is decent.

I live in the suburbs of SF. House, 2 cars, 2 college savings accounts, 2 happy kids. Dude, it sucks being so poor. I didn't win the Powerball

 

[NewDPT31]

Wouldn't want to push our patients too hard, then they might actually get better. Also 65 years old doesn't mean they can't do an hour of therex. I don't care if they're 100, I'm still going to give them skilled care if it's safe for 60 minutes. Most likely they're not doing **** for the other 166 hours in the week


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I get what you're saying. It all depends on the patient and what their level is-I see a lot more low level patients on the south side of chicago than I did in Scottsdale, AZ. Since they have to be 1 on 1, you can still push them pretty hard in 40 minutes because there's none of the the normal sitting around while the therapist manages 4 patients thing. I like 3x too because, like you said they aren't doing ***** the rest of the week, so it gives them another day of social interaction, exercise and something to do. Also depends on the schedule and how close to the cap they are getting. Lot's of factors.

 

[Azimuthal]

I'm still curious as to how a "," was overlooked to allow PT and SLP to be lumped together, and how it was not interpreted that these are two distinct professions requiring their own accruals as intended by the original bill.

 

[beestrng]

Never bought into the , thing.

I say conspiracy

 

[Mtru6]

yes, I agree the lack of a comma between PT and SLP goes to show that the government and "the system" gets in its own way from accomplishing anything productive. How many hoops do you have to jump through to amend one punctuation mark?