American Society for the Advancement of Lymphedema Management, Inc.
ASALM
Lymphokinetics USA Branch
Newsletter
No.15 May 2000
From the President:
Last January, I had the opportunity to attend a course organized by the APTA about " Balanced Budget Act, Reimbursement and Coding Update". We had an explanation about the way our profession is regulated. We were told that by Jan 1, 2001 the PT, OT ST $1500.00 cap will be suspended for 2000 & 2001. I am not going to report all that was presented at this course; we received an impressive manual containing all the information. APTA showed its will to assist PTs with their daily practice.
On the agenda of this course was: " Fraud and Abuse Compliance Program". I was impressed by this program and hoped that it would be implemented.
This victory of the APTA made me hope that we will soon get some attention in the field of lymphedema management. The APTA has been working on some aspects of reimbursement of lymphedema treatments. We need more to be done in order to be able to provide our patients with the necessary number of sessions.
I encourage you to ask for the following document: "Medical Policy" Medicare B Issue 177: 14-16. I suppose that you may get this document from Medicare. Read it attentively. Tell me or tell APTA or AOTA what you think about statements like:
"PURPOSE FOR POLICY: The management of lymphedema is becoming more organized in this country following the reduction of decongestive therapy techniques from Europe. In many of these situations, the use of "lymphedema pumps" may not provide benefit and actually worsen the condition. The National Health Services in Germany no longer pays for pump therapy for lymphedema."
I would like to highlight this statement saying that Germany alone does not represent Europe and the treatments provided in Europe. You may read numerous articles from Italy, Sweden, Denmark…, U.K., Belgium, France where the use of a compression device is promoted. With respect to the last sentence we may say that "It is not because Medicare does not reimburse compression garments that they are not used in USA" The same way of thinking applies to Germany and compressions devices.
"The goal of this therapy is to promptly transfer responsibility for the on-going care from the clinic, hospital or doctor, to home care by the patient, patient family or patient caregiver. Maximum volume reduction during therapy is not the goal"…
Who is the patient care giver? Could it be his/her PT or OT? In this case we should feel more comfortable. If the goal of therapy is such, then we do not need to worry about writing functional goals…
"Medicare also covers Pneumatic Compression Devices for the treatment of lymphedema. However, their use is not considered to be a part of CDP. A patient requiring both modes of treatment should be rare."
What is the rationale behind this: a device qualified as dangerous in the introduction is suddenly reconsidered.
I will not comment on the following statements. They speak for themselves:
"Treatment designed principally for temporary benefit will be denied as not reasonable and necessary."
"Patients who do not have the capacity or support system to supply self treatment within a reasonable time are not candidates for this therapy."
"A CDP course of treatment is generally expected no more than once per lifetime."
" The PT services billed as CDP are subject to all national and local policies for physical therapy. Other services such as skin care and the supplies associated with the compression wrapping are included in the services and are not separately paid."
" CPD services performed incident to a physician or physical therapist requires direct supervision" I am anxious for the physicians having several employees; They are not going to be able to perform their consultations.
I would like you to write to APTA to highlight this problem. We could ask APTA and AOTA to open a dialog with Medicare in order to obtain that lymphedema management could be performed by PTs and OTs only. How could a massage therapist, even closely supervised by a physician perform a frozen shoulder rehab, or a gait training? This means that if lymphedema management is performed by persons other than PTs and OTs, Medicare will have to pay for additional treatments addressing the lymphedema -associated problems treated by PTs and OTs.
I would like to highlight also that: PTs need to request from the APTA the exclusivity for their activities: why do Nurse Practitioners, Physicians, Chiropractors and others use the PT codes?
One of the best comments that one of you made at the end of a course was: " It is great to hear from somebody who cares so much about the future of our profession" Yes , I do care. But.. I cannot fight alone and be the only one to write to the APTA. Work for your future express your concerns to the APTA, request an intervention in favor of your field of expertise.
Thank you for your attention. Call me for more details.
Do not forget, that Professor Albert Leduc and Olivier Leduc will offer the Confirmation and Advanced courses at Princeton, NJ from June 3 to June 6, 2000. Brochures enclosed. Visit the website for more information: http://www.lymphedemamanagement.com
Under "Newsletter" you will find the comments of your colleagues who attended these two courses last year. Do not miss the opportunity to review manual and bandaging techniques with Prof. Leduc and to learn about the most recent research. Imagine listening to O. Leduc about clinical issues. Come with your questions. See you at Princeton.
I would like to end this newsletter with two optimistic comments that David, PT and Bill, PT wrote:
"It’s been almost a year since I took the first Leduc course in Lymphedema Management in Florida. The impact on patients with this condition has been amazing, and , for me as a therapist gratifying. My thanks to you and Albert and Olivier Leduc for your tireless efforts sharing this knowledge with health professionals. You ARE making a big difference! Happy Easter!"
David Ogden, PT
"…I wanted to thank you for the instruction and report to you some of my results. I have worked with only 2 patients to date who decided during the treatment not to comply. Obviously they did poorly. All the others have shown remarkable success. One patient …had lymphedema since she was 9, she is now 47. We reduced her leg circumference 3 inches in just seven treatments and she is still doing exceptionally well in her garments. She is thrilled. I have had many similar successes and am very pleased with the skills I received during your instruction…"
Bill Melchione, PT
Thank you David and Bill. Every body could use the bulletin board or my Email to transmit messages of success, questions, suggestions; all this is how a network works!!! Let’s do it.
Thanks to all of you . I expect you to make your voice heard, ask questions and achieve a bright future.
Best regards. Anne-Marie Vaillant-Newman.