CUTTING HEALTH CARE COSTS
CAN BE EXPENSIVE
Journal of Healing – May 28, 2003

By Mary Koch

You'll be hearing a lot this summer about the congressional debate over Medicare. The pressure is on to get a prescription drug bill passed before the presidential campaign begins in earnest.

What you won't be hearing so much about is the cap on out-patient Medicare rehabilitation benefits, scheduled to go into effect July 1. And that's a dirty, rotten shame.

I knew nothing about rehabilitation therapy nine-and-a-half years ago when my husband had a stroke. Now I know just enough to be dangerous – just enough to make me fight with every resource I can muster so that John can continue therapy.

I know enough to realize that rehabilitation therapy is as much art as medicine, a life-sustaining, hope-fulfilling art that has been the focus of our lives.

One of the most important components of therapy is work. A therapy patient is not a passive participant. It is not a matter of simply swallowing a pill or stretching out on an operating table while someone else does the work. In therapy, the patient heals herself with the skilled guidance of a therapist. It's slow, labor-intensive and grueling work.

* * *

WHEN JOHN had the stroke, we were given the prevailing wisdom – the six-month prediction: "By the end of six months," the experts said, "whatever function John has recovered will be pretty much all he will recover." Was that science or self-fulfilling prophecy? Could it have been that stroke patients stopped recovering after six months because that's when their rehab benefits ran out?

There's plenty of research around to show that some people are still recovering function 10 and even 20 years after their strokes. In the tenth year since his stroke, John has regained more function than he did the first nine years combined. That's the result of week after week of continuous therapy – a luxury too few stroke patients are allowed.

John's stroke in 1993 was followed by five months in rehabilitation facilities before he returned home. Since then, rehab has been caught in the squeeze to reduce medical costs. I doubt he'd get that much intensive therapy now.

The April issue of "Advance," a journal for rehabilitation professionals, notes that people who once received as much as a year of in-patient treatment are now released within four to six weeks – as soon as they're medically stable. "But that doesn't mean they've met their functional potential," a physical therapist observes in the Advance article.

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WITH PATIENTS given the bum's rush from rehabilitation facilities, there's more need than ever for out-patient therapy. For many people, that therapy has been funded through Medicare Part B. As of July 1, the out-patient therapy benefit will be capped at $1,500.

The cap is the result of a complex goulash of legislative efforts to contain medical costs. But according to Advance, some patients could use their $1,500 worth of therapy in a single week.

"And a week, by anyone's standards, is simply not enough time for patients with severe impairments," argues the journal.

Therapy is an ignored step-child in a health care system that dotes on pills and scalpels.

"Yes, therapy is good," a doctor once said to me, "but it's too slow, and that makes it too expensive."

Compared to what, I want to know. What kind of a price tag do you put on self-esteem, on independence, on hope?

(Mary Koch writes about health care issues and her experiences as a family caregiver. Her husband, retired newspaper publisher John E. Andrist, was severely disabled by a stroke in 1993. They welcome your letters at P.O. Box 3346, Omak WA 98841 or e-mail them: marykoch@marykoch.com.)