Tuesday, May 29, 2012

Hoops & Red Tape

Jim began physical therapy (PT) with Ryan in the Comprehensive Outpatient Rehabilitation Facility (CORF) on Wendell Foster’s Campus (WFC) in June 2011.  His PT goals:  climb and descend the stairs at least once with only minimum (25%) assistance; walk eight roundtrips in the parallel bars with little assistance, and walk ten roundtrips with a walker with 50% assistance.  Jim’s commitment is evident because within only a few months, Jim exceeded his initial goals.  As a “person-centered” facility, therapists seek to understand what their clients want to accomplish for their life and together discuss what is involved in that process.  Goals are developed; and our therapists create the “therapeutic plan” that facilitates goal achievement.  A goal can simply be “I want to easily move from my wheelchair into my bed;” a simple task to you and me, yet huge to someone with a physical disability.

But our therapists and more significantly, our outpatients face the hurdles of red tape, hoops and bureaucracy in their efforts to reach their goals.  Therapists in all the therapeutic areas share stories of how insurance, Medicare and Medicaid limit patients’ access to these needed therapies.  For example, Medicare sets a dollar amount on how much one can spend per year on therapy.  Some insurance limits the number of therapy sessions a patient can have within a year.  In one case, a child with significant developmental disabilities would benefit long term from weekly therapy session, but his coverage authorizes only twelve therapy sessions for the year, the equivalent to one appointment per month. Reasons vary for these limitations, and understandably our therapists become frustrated.  For most of our outpatients, therapy is an on-going process, not a set number of visits and “be healed” experience.  For those with developmental disabilities, therapy may be a lifelong treatment.  Just as pharmaceuticals are indefinitely prescribed and accessible to offset serious and/or debilitating health challenges such as high blood pressure and diabetes for most of one’s life, therapy treatment offsets serious physical limitations for those with cerebral palsy, promoting and facilitating healthful and functional independence.

Then there’s the red tape and hoops.  One speech therapist tells the story of how a request for coverage for a patient’s therapy was denied because it lacked appropriate information.  She highlighted with a highlighter the “missing” info within the originally submitted text of the paperwork and returned it.  The request was approved.  Another outpatient challenged an insurance hearing panel’s decision to deny additional PT coverage.  His request was finally approved after a third-party neuro-specialist reviewed his case, and deemed it not only justifiable but a necessary treatment to address his condition.  Hoops.  Red tape.  Bureaucracy.

Jim now stands before these hurdles.  He recently became eligible for Medicare, which places a maximum dollar amount per year combined for both speech and physical therapy.  His supplemental plan has a deductible; once met, it covers 80% of his therapy costs.  Since January, Jim had two physical therapy sessions a week, but recently changed to once a week because he’s closing in on his “Medicare allowable amount” for the year.  Healthcare is a big topic in today’s news, and Jim’s situation isn’t unique.  Our therapists constantly battle “the system” to ensure our outpatients receive the necessary therapeutic treatments and equipment needed to empower them to the maximum functionality in their lives.  To limit opportunities of therapy only strips these individuals’ ability and potential. I wonder how limiting its availability isn’t discrimination against those with disabilities, when opportunities abound for those of us without disabilities to reach our fullest health potential. Therapy offers those with developmental disabilities a chance to overcome limitation, and more importantly hope in the face of physical challenges.  It empowers individuals to become more independent so they may do the simplest of things they want to do.

Especially impacted are children; early intervention gives them a chance to manage and overcome long-term limitations their developmental disabilities create.  Therapy increases a young patient’s chance and ability for greater independence and mobility so he or she may thrive into their adolescence and adult life. Early intervention also develops a mindset of “where there is a will, there is a way”; they can do whatever they want with determination.  They learn at a young age not to give up on themselves when many around them, seemingly including the healthcare system, have already given up on them from the get-go.  They learn how to get around any limitation to achieve anything that any one of us can do in our daily life.

One little boy I observe proves the power of early intervention and its worth in my next PT and speech outpatient observations.  Goals can be simple:  “I want to play T-ball this spring” and “I want to eat at Chuckie Cheese.”   This observation introduces me to a six-year-old boy who started physical therapy shortly after birth and speech therapy when he was one.  I learn how important early intervention is, and my entire perception of physical and speech therapy and its value in the life of a young child drastically changes, as does my life and my outlook on it, when I meet a little boy named Nicholas.

In the Next Blog Entry: Against All Odds: Nicholas was taken to an Evansville hospital’s neo-natal care unit for more intensive care for his medical needs.  He wasn’t expected to survive . . . . . he proved doctors wrong . . .”
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