Continued Cuts to Medicare Physician Fee Schedule (MPFS) Frustrate Physical Therapy Leaders, Underscore Need for Congress to Act
CY2023 Proposed MPFS Rule again calls for payment cuts to physical, occupational, and speech therapy despite a long history of harmful cuts amidst increased patient need
Washington, D.C. –– The Alliance for Physical Therapy Quality and Innovation (APTQI) today expressed deep disappointment about the inclusion of continued payment cuts to specialty care services in the Centers for Medicare & Medicaid Services’ (CMS) Medicare Physician Fee Schedule (MPFS) Proposed Rule for CY2023. Similar to previous years, the proposed rule calls for deep, across-the-board payment cuts to physical, occupational, and speech therapy despite the serious implications it could have on seniors’ access to community-based care.
The proposed rule released July 7 includes a 4.4 percent cut to providers in CY2023, which signals the sector is projected to experience cuts of approximately 9 percent between 2020 and 2024. Medicare’s proposed payment reductions are a result the expiration of the 3.0 percent increase in the MPFS conversation factor for CY 2022. While conversion factor cuts were reduced in 2022 thanks to Congressional action, CMS still implemented a drastic 15 percent cut to services provided by physical and occupational therapy assistants, which has resulted in a decline in the profession in some of America’s most rural and underserved communities.
“Medicare’s annual proposal to chip away at reimbursement for critically important specialty services, including physical therapy, discredits the work of our profession and the important role we play in the healthcare continuum of aging Americans. Not only does Medicare’s proposed payment reduction undermine our value to our patients and the healthcare system, it will risk generating higher costs to the Medicare program, limit access to safe, nonaddictive pain management techniques, and encourage increased marketplace consolidation, which data show increases spending,” said Nikesh Patel, PT, Executive Director of APTQI. “To ensure timely access to specialty services for Medicare patients is preserved, Congress must intervene to prevent these cuts from going into effect in 2023.”
In 2021, a broad coalition of lawmakers and stakeholders came together to oppose previous cuts and support longer-term reforms to the fee schedule. APTQI and other specialty provider groups will again call on lawmakers to ensure these proposed cuts are properly addressed before the final rule is implemented in 2023. Further, stakeholders including APTQI have been working collaboratively over the last year to craft long-term solutions to Medicare’s fee schedule.
“Continued cuts to physical, occupational, and speech therapy services destabilize the ability of vulnerable seniors to access the vital care they need to manage their post-operative care, pain, mobility challenges, and risk of falling,” added Patel. “We will again need the help of Congress to combat Medicare’s repeated cuts to specialty care services or risk further limiting senior access and choice.”
In addition to the inclusion of across-the-board payment cuts, Medicare’s proposed MPFS rule for 2023 failed to include requested plan of care requirement revisions and flexibilities for PTA supervision which the APTQI and broader physical therapy community have been calling for to strengthen the patient care experience, improve efficiencies, and reduce unnecessary administrative burden.
Data clearly show the value physical therapy offers to patients, the Medicare program, and overall healthcare spending. In fact, one APTQI study found in the year following diagnosis, the difference in average spending between physical therapy and other alternatives was approximately 18 percent savings compared to beneficiaries who received injections and 54 percent savings compared to beneficiaries who received surgery. Further, another study suggests physical therapy decreases the need for prescription pain management, whose misuse is thought to increase healthcare and substance abuse treatment costs by $29 billion every year. Physical therapy is also a vital, safe, and effective treatment to help seniors regain balance and prevent falls––which send more than 3 million seniors to the emergency room every year and result in the deaths of more than 32,000.
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