PPS's $1,500 cap: hope for the best…plan for the worst - interview with National Assn of Rehabilitation Agencies Pres Larry P. Fronheiser - prospective payment system - Interview

Nursing Homes, April, 1998 by Linda Zinn

How would you characterize lawmakers' response to these efforts?

Fronheiser: The responses that individual association members have been getting from individual members of Congress, when they've contacted them as constituents, have been relatively sympathetic to the problem. I don't think, however, that the level of contact has reached the point where one could say that Congress in general, or even a certain percentage, would vote for the cap's repeal. That would be premature.

Despite the absence of a clear consensus among legislators one way or another on this issue, do you think repeal is remotely possible?

Fronheiser: I think we have a shot, but there are so many obstacles in the way - political, demographic and monetary - that it's probably a long shot. The number one obstacle is that Congress isn't terribly interested in revisiting the whole Medicare issue less than a year after they passed the BBA.

In order to prompt Congress to change this law, we really need to have some sort of plan or alternative to suggest. If Congress eliminates the cap, that will cost money. Where will that money be derived from? We as a group aren't clear yet on the best options. We're still in the study and data-collection phase. We're working diligently to formulate alternatives and to make sure our members can live with whatever suggestions the coalition comes up with.

Can you project when those data might be compiled?

Fronheiser: Some data have been generated, but they are extremely difficult to obtain regarding the implications of the $1,500 cap. One reason for this difficulty is that the fee schedule, which will be in effect for skilled nursing facilities July 1, 1998, and rehab agencies as of Jan. 1, 1999, has not yet been released. If we knew that it would be the same as the existing Medicare fee schedule, our task would be easier, but the regulations have not yet been written. Therefore, it's very hard for us to propose a plan.

We simply can't formulate a plan without having all the pieces needed to put the puzzle together, even though we know what we want the picture to look like in the end.

The fee schedule is supposed to be issued in May, but the Health Care Financing Administration (HCFA) has a ton of regulations to issue. They may or may not be on time, so every day brings on a new set of discussions and questions that remain unanswered because of the lack of regulations.

Larry P. Fronheiser, PT, is president of the National Association of Rehabilitation Agencies and president of the private practice section of the American Physical Therapy Association. For more information about NARA, phone (703) 437-4377.