Patients, Clinics Decry Medicare Ruling; Government to Stop Paying for Lymphedema Therapy Given by Massage Therapists and Nurses

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Byline: URVAKSH KARKARIA

The federal government's decision to stop paying for lymphedema therapy provided by massage therapists and nurses could shut down a major Jacksonville lymphedema clinic -- stranding Cheryl Bogacki and 300 other patients without treatment.

Starting in June, the Centers for Medicare & Medicaid Services decided to quit paying for lymphedema therapy provided by massage therapists and nurses, even though they account for 34 percent of the providers nationwide, according to Cheri Hoskins, president of the Lymphedema Stakeholders Political Action Committee, a non-profit that protects lymphedema patients' rights.

The ruling means that the Jacksonville Lymphedema Clinic, staffed by four certified massage therapists, cannot treat its Medicare patients -- who account for 40 percent of business.

"It's a medical atrocity that these patients can't be treated for a condition that there's no cure for," said Preston Parkerson, president of the Jacksonville Lymphedema Clinic.

Lymphedema is a chronic swelling of the body most often because of cancer treatment when lymph nodes and vessels are surgically removed or damaged by radiation. The disease -- which affects up to 5 million nationwide -- if not treated properly, can immobilize the patient and require hospitalization.

The CMS ruling prohibits Medicare reimbursement for therapy services provided "incident to a physician's services" by anyone other than a physical therapist, occupational therapist or speech and language pathologist. Such "incident to" therapy services are those services provided by qualified, certified and usually state-licensed health care personnel under the supervision of a physician while in his or her office. In issuing the ruling, CMS said the change was mandated by the Medicare law adopted in 1997 as part of the Balanced Budget Act.

Critics of the ruling are fighting back.

The Coalition to Preserve Patient Access to Physical Medicine and Rehabilitation Services, which includes 23 health care organizations including the National Athletic Trainers' Association (NATA) and Hoskins group, is encouraging Congress to overturn the ruling.

The group has found a sponsor to introduce a bill in Congress, Hoskins said, adding: "We've probably got a 65 to 70 percent chance of having it reversed."

Medicare's decision will have much wider implications because private insurers typically follow Medicare's playbook on what treatments they cover, Parkerson said.

If private insurers decide not to reimburse massage therapists for lymphedema therapy, Parkerson said he could be out business within six to 12 months.

Parkerson, who said he was blind-sided by the Medicare ruling, just last fall relocated his business into a larger building to keep up with demand that grew two-thirds in 2004 compared with the previous year. …

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