APTQI Urges CMS to Protect Seniors from Debilitating Falls by Preserving Medicare Reimbursement for Physical Therapy

Recognizing Falls Prevention Awareness Day 2019,
APTQI is advocating for greater patient access to fall prevention tools such as
manual and exercise therapy

Washington, D.C. ––  In observance of Falls Prevention Awareness Day, the Alliance for Physical Therapy Quality and Innovation (APTQI) today calls upon the Centers for Medicare & Medicaid Services (CMS) to eliminate plans to impose an 8 percent, across-the-board cut to physical therapy services in 2021 in the proposed Physician Fee Schedule (PFS) rule for 2020. The cut, if implemented, would put seniors at serious risk by stifling access to important physical therapy treatments, including key fall prevention tools such as manual and exercise

Access to manual and exercise therapy can significantly help patients avoid death, injury, hospitalization, and loss of independence associated with fall-related accidents. By improving seniors’ strength and balance, physical therapy has the potential to help prevent many of the roughly 2.8 million injuries, 800,000 hospitalizations, and 27,000 deaths caused by falls every year in the United States.

CMS’ proposed PFS rule threatens to impose an 8 percent, across-the-board cut to physical therapy services—on top of several previous cuts that are already making it more difficult for physical therapists to serve America’s seniors. Specifically, the proposed reimbursement reduction comes on the heels of the 2011 multiple procedure payment reduction (MPPR) policy cut, which was deepened further in 2013, as well as a 15 percent Medicare cut for services provided by a physical therapist assistant, which will go into effect in 2022.

“Given the debilitating impact falling can have on a senior’s life, preventing falls is paramount for older Americans across the country,” said Nikesh Patel, PT, DPT, Executive Director of APTQI. “In order to equip seniors with the strength, flexibility, and balance necessary to stay healthy and independent, we should be doing everything we can to promote access to fall prevention tools including physical therapy. Unfortunately, at a time when falls are on the rise—leading to more deaths, hospitalizations, and Medicare spending—CMS is considering draconian cuts to physical therapy services, which could exacerbate the epidemic.”

“In order to maintain seniors’ access to the tools and services that can prevent falls, we urge CMS to remove the proposed across-the-board cuts and appropriately reimburse physical therapy services,” continued Patel.

Falling is an epidemic that has unfortunately gone overlooked in the United States. According to a new report in the Journal of the American Medical Association (JAMA), an estimated 28.7 percent of adults aged 65 years or older fell in 2014. The Centers for Disease Control and Prevention (CDC) reports that falls represent the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions amongst America’s senior citizen population.

The cost burden associated with falls is enormous—and growing. It is estimated that medical expenditures related to falls were approximately $50 billion in 2015 alone. According to the CDC, fall injuries are “among the 20 most expensive medical conditions” and lead to an average hospital cost of more than $30,000 per admission. Hip fractures for elderly Americans are driven almost exclusively by falls and involve a lifetime cost of about $81,300 per patient, the majority of which is paid for by the Medicare program. In 2015, Medicare and Medicaid covered 75 percent of the $50 billion costs associated with fall-related incidents. While cuts to physical therapy might appear to save Medicare money in the short term, any savings is likely to be
overshadowed in the long run by substantial spending caused by an increase in the already high cost of falls. This is on top of the human cost of the pain, suffering, and loss of independence that afflict seniors injured in a fall.

“Falling has dangerous consequences for the health of older Americans, as well as the fiscal sustainability of our nation’s healthcare system, primarily the Medicare system,” said Patel. “By imposing substantial reimbursement cuts to the cost-effective physical therapy services that millions of seniors need, CMS risks exacerbating the human and financial costs of the falling epidemic.”

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