Letter To The Senator about Medicare

In Pelvic Floor Physical Therapy by Emily Tran4 Comments

Here at PHRC we are not Medicare providers, for good reasons; you may remember that PHRC published a blog post about them. Still, we receive calls almost daily from Medicare patients enquiring about treatment from us, and unfortunately we have to turn them down: the law says, oddly, that we cannot provide treatment to Medicare patients even if they are willing and able to pay for it. This can be very frustrating, and can even feel discriminatory. Jarod Carter, PT, DPT has written many blogs on Medicare laws with regards to physical therapy. If you are a Medicare patient and would like to know more about the laws and your rights, please check out Jarod’s blog. Recently I wrote a letter to my Senator about the unfairness of these laws: you can read it below. If, after reading it, you feel inspired to take action as well, you can sign the American Physical Therapy Association’s advocacy letter here.

 

The Honorable Dianne Feinstein Date: July 18th, 2016

United States Senate

331 Hart Senate Office Building

Washington, D.C. 20510

 

Dear Senator Feinstein,

 

Allow me to introduce myself. My name is Malinda Wright and I am a physical therapist in Los Gatos, CA. I am writing to ask you to please support the Medicare Patient Empowerment Act (H.R.1650/S. 1849), which will allow physical therapists to opt out of Medicare. According to the Medicare Benefit Policy Manual, and also outlined in the Balanced Budget Act of 1997 and Medicare Prescription Drug Improvement and Modernization Act of 2003, physical therapists are not allowed to opt out of Medicare. Other healthcare professionals, such as physicians, nurses, midwives, psychologists, clinical social workers, dietitians, and nutritionists are designated as “providers” and are allowed to opt out.1 Physical therapy is considered a “service,” a distinction that does not sit well with me. We see patients all the time for whom physical therapy is in fact the appropriate course of treatment. They come to us for healthcare provision, not to take advantage of a service.  Because of the distinction the current law makes, however, we are not allowed to treat Medicare patients no matter how much they need it.

 

The non-Medicare practice that I work for specializes in pelvic floor disorders. We treat men and women who have musculoskeletal impairments causing urinary, sexual, and bowel dysfunction, including pudendal neuralgia. It is common for our patients to have seen multiple medical providers (sometimes more than ten) before coming in to see us. Many medical providers are unaware of their conditions and/or do not know how to treat them. This can leave the patients feeling hopeless and abandoned. Many patients turn to the internet for guidance, and find us through our website. Unfortunately, due to Medicare laws, I am unable to treat those patients who have Medicare. It is heartbreaking to have to tell Medicare patients who cannot sit, drive, or work because of their pain that I cannot treat them because the law forbids me to.

 

We recently had a pair of cases that prompted me to write this letter to you. A woman called our office and reported that she has Medicare insurance. As we often have to do, we politely explained to her that we are not Medicare providers, and referred her to a Medicare provider in her area. A few months later, the same woman called again, and this time she reported she did not have Medicare and wished to schedule an appointment with us. Our receptionist recognized her from the previous phone call, and again went over the rules and regulations surrounding Medicare. She was very angry: she could not understand why we were not allowed to treat her, and said that she felt discriminated against because of her age. Later that same day, I evaluated a 72 year old man from India, and was able to treat him for his tailbone pain at his own expense: as an international visitor, the Medicare laws did not apply to him.

 

You see the problem: I am permitted to treat a senior patient visiting from India, but legally I am not allowed to treat a senior US citizen of equal means who has the same medical condition. Because Medicare does not allow physical therapists to opt out of the system, I cannot provide treatment to the men and women in my community who are 65 years old or older. I have to say I agree with the woman who called us: this seems like age discrimination.

 

As well as being saddened that I could not treat her, it bothered me that our caller had felt the need to resort to lying about her insurance in order to qualify for treatment. If the Medicare laws are encouraging patients to lie like this, something is not right and we need to fix it.

 

Please support the Medicare Patient Empowerment Act (H.R.1650/S. 1849) and allow Medicare patients the right to choose an out of network physical therapist for the treatment they need.

 

  • Carter, J. PT, DPT, Medicare and Cash-Pay Physical Therapy A Quick Start Guide to the Regulations on Taking Private Payment from Medicare Beneficiaries. 2015 Carter Physiotherapy PLLC.

FAQ

What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.

Comments

  1. Thank you Malinda!!! The implementation of the Medicare Patient Empowerment Act will change lives, making it possible for men and women who are suffering such hardship to get the treatment they need and to begin to live the lives that, without proper care, seem a desperate dream. Ask me how I know.

  2. Thanks for taking this issue on. Medicare refuses other than pap smears and mammograms to provide any services for women 65 and over. No hormone replacement for starters. And good luck getting your MC advantage plan carrier – Humana, United Healthcare – to cover specific pelvic pain PT specialty therapists. I ended up paying out of pocket, money well spent, but, hard to do on a fixed income.

    Those of us that bring into older age legitimate problems with old episiotomy and hysterectomy scar tissue, in my case add fibromyalgia pelvic trigger points added to the mix, are dead to them. They simply refuse to accept and fund PT pelvic pain treatment. Shame on them.

  3. I am so saddened by this !

    I too have Medicare, but I also have BC/BS .
    The BC/BS is not a supplement , it’s in addition to the Medicare .
    Would that too except me from being seen ?
    This must be a CA law ?
    I will be writing a letter also.
    To deny a portion of the population service based on age or disability … I’m only 53, but have been disabled since 2002.
    I suffer with pudendal neuralgia , and have actually been seriously thinking that perhaps I needed to be seen again by Stephanie.
    So besides being discriminating to the older population, it’s discriminating to the disabled population.
    This condition effects so many areas of my life.

    1. Hi Joan,

      The only Medicare we could accept is Medicare Plan A and if it is a secondary form of insurance.

      Regards,
      Kristin

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