Partnering in Support of Vulnerable Patients
When a monetary cap on therapy services threatened patient health, AOTA, ASHA, and APTA launched a “Stop the Cap” campaign and coalesced 40 groups in a sustained grassroots advocacy effort, ultimately achieving the goal.
More than 700,000 people suffer from a stroke each year in the United States. Nearly one million people are living with Parkinson’s disease in the United States, with an additional 60,000 being diagnosed each year. Many of these individuals, as well as those recovering from physical injuries, require rehabilitation services to regain their independence and attain the best possible quality of life. Some, including the most vulnerable of these patients, rely on outpatient Medicare for therapy services provided by occupational therapists, speech-language pathologists, and physical therapists. In 1997, an amendment was introduced in Congress that capped these therapy services for Medicare patients at an arbitrary monetary level, putting the necessary treatment of a significant number of patients at risk and introducing difficult administrative burdens for providers in these professions.
Recognizing the threat of the Medicare cap on patients and their rehabilitation, the American Occupational Therapy Association Inc. (AOTA), the American Speech-Language-Hearing Association (ASHA), and the American Physical Therapy Association (APTA) quickly assembled a grassroots initiative to repeal the monetary cap in Medicare therapy services. In time, the “Stop the Cap” initiative gained the support of more than 40 different associations and patient groups. Throughout a 20-year period, the coalition employed targeted lobbying, development of influential policy resources, messaging, media campaigns, congressional briefings and visits, and strategic partnership building to address its goal.
The Stop the Cap campaign tapped into the talents, voices, and resources of dozens of lobbyists, communication professionals, and senior leadership of participating associations. The association membership from the three leadership associations spearheading this campaign was more than 350,000 in 2018. Other partner associations and patient groups brought the total to more than 1 million voices to advocate for stopping the cap.
During this same timeframe, Congress recognized that the cap was not an effective policy approach and acted more than a dozen times to delay its implementation, raise the monetary cap, or authorize the Centers for Medicare & Medicaid Services to identify alternative payment models. Finally, through the persistent and collective efforts of the Stop the Cap campaign, the 2018 Bipartisan Budget Act eliminated the monetary cap on outpatient physical therapy services under Medicare Part B.
Passage of the 2018 Bipartisan Budget Act presented a permanent solution to the problematic hard cap on outpatient physical therapy services under Medicare Part B, ending a 20-year cycle of patient uncertainty and short-term fixes. The act also represented one of the few major health policies that Congress adopted in the 2017-2018 session.
Repealing the cap on therapy services was critical for the more than 1 million Medicare beneficiaries who used therapy services in a calendar year. Without the repeal, health care coverage would have been disrupted or discontinued for these vulnerable patients, thus limiting their ability to lead independent, high-function lives and resulting in a decline in independence, increased hospitalization, and significant economic and personal costs. The Stop the Cap campaign preserved coverage for this important but often vulnerable audience.