Deep Medicare Cuts
Despite unified warnings from lawmakers, specialty providers, and other stakeholders about the potentially devastating impact of these cuts in the midst of a global pandemic, the Centers for Medicare & Medicaid Services’ (CMS) have announced that the Proposed Physician Fee Schedule (PFS) Rule for CY2021 will include deep, across-the-board 9% payment cuts to physical and occupational therapy services.
Now, during the unprecedented COVID-19 crisis, is not the time to implement a severe Medicare reimbursement cut.
This reduction, coupled with a series of payment cuts in recent years, will undermine patient access and lead to negative downstream consequences for American seniors and healthcare delivery system costs. The United States is already in the middle of a national shortage of physical therapists – estimates show that by 2025, an additional 27,000 therapists will be needed to meet demand – and this cut will lead to even greater shortages if practices are forced to close due to dwindling reimbursement.
As the nation comes to grips with the growing health challenges imposed by the COVID-19 outbreak, it is critical that lawmakers take steps to ensure patients who rely on physical and occupational therapy services to manage their chronic and acute pain are able to continue receiving these services.
Strong, decisive and bipartisan action in Congress is needed to offer critical relief to countless physical therapy and specialty practices across the country who face severe reimbursement cuts if the PFS Proposed Rule is implemented in its current form. By waiving the budget neutrality requirement in the PFS rule, lawmakers can protect therapy service reimbursement from the 9% cut while also allowing for other code increases to go into effect.
Fortunately, legislation has been introduced to stop the cut and protect seniors' access to care. The bipartisan Outpatient Therapy Modernization and Stabilization Act (H.R. 7154), introduced by Representatives Brendan Boyle (D-PA) and Vern Buchanan (R-FL), would protect access to therapy by stopping these harmful reimbursement cuts while still allowing Medicare to proceed with the planned increases to other providers. This legislation would also give patients certainty that they may keep the option to receive therapy via telehealth after the emergency period ends.
In addition to in-person visits, physical therapy services can be effectively delivered via videoconference or phone call, allowing therapy specialists to provide high-quality care to patients.
Telehealth can be effective in helping patients overcome many treatment access issues including distance, a lack of nearby specialists, and/or impaired mobility.
Physical therapists currently use telehealth in a variety of ways, including:
- Screening the patient’s home for fall hazards– thereby helping to reduce the risk of fall-related injuries in the home;
- Remotely observing and monitoring patient compliance with their home exercise program and providing verbal and visual feedback and instructions;
- Providing consultative services to other healthcare providers to coordinate care; and,
- Performing screening and assessment services remotely, savings patients a trip to the clinic for therapy that can be performed in the home.
During the COVID-19 crisis, telehealth services have represented a major piece of the puzzle for ensuring continued access to physical therapy. And thanks to a recent rule from the Centers for Medicare & Medicaid Services (CMS), Medicare beneficiaries now have increased access to physical therapy through telehealth-based services.
By providing skilled physical therapy services either via videoconference or phone call, therapists have ensured seniors and other at-risk patient populations can manage their pain, regain strength and enhance mobility — all while minimizing the risk of COVID-19 transmission, preventing costly hospitalizations and reducing unnecessary strain on the healthcare system during this public health crisis.
APTQI urges CMS to make the telehealth waiver expansion permanent as we move beyond the current crisis to continue improving patient access to care.
Current Medicare regulations impose significant burdens on physical therapists. When patients require physical therapy, restrictive rules require physical therapists (PTs) to navigate a lengthy, cumbersome process to be reimbursed for the medically-necessary treatments they provide.
When serving Medicare beneficiaries, physical therapists typically face a frustrating process that forces them to spend vast amounts of time filing paperwork, instead of focusing on what they do best: treating patients.
After Medicare patients, the vast majority of whom already have a referral from their doctors – make an appointment for physical therapy, the physical therapist creates a specialized plan of care tailored to the patient’s medical needs, which then requires the referring provider’s signature - even though they have already referred the patient. Physical therapists then must devote a vast amount of time and resources to following up with referring providers and secure the redundant signatures or their services will not be billable.
The regulatory requirements in place now are redundant and undercut the authority of physicians and other referring providers to recommend appropriate care for Medicare beneficiaries. APTQI is committed to working collaboratively with the Centers for Medicare & Medicaid Services (CMS) to reform Medicare requirements under the Physician Fee Schedule (PFS) to support the timely delivery of and reimbursement for PT services.
The ongoing opioid crisis in the U.S. has led to a growing realization that current pain management strategies have to change. Prescription opioids – which mask, rather than treat the underlying cause of pain – have contributed to widespread opioid misuse and addiction in communities throughout the U.S.
In order to help combat opioid misuse, it is necessary to adopt new approaches to pain management. Physical therapy is a clinically proven, cost-effective pain management alternative that should be leveraged earlier and more often to prevent opioid misuse and addiction.
Promoting access to physical therapy is critical because, unlike, prescription opioids, PT prevents and treats the underlying cause of pain. Research shows the efficacy of physical therapist interventions in preventing, minimizing, and, in some cases, eliminating pain.
In its Guideline for Prescribing Opioids for Chronic Pain, the Centers for Disease Control and Prevention (CDC) recommends physical therapy as an alternative to opioids for the treatment of chronic pain. The CDC notes PT is especially effective at reducing pain and improving function in cases of low back pain, fibromyalgia, and hip and knee osteoarthritis.
The United States is currently in the middle of a national shortage of physical therapists and physical therapy professionals. Estimates show that by 2025, an additional 27,000 PTs will be needed to meet demand. This problem is particularly acute in rural areas because many physical therapists are concentrated in major metropolitan areas. APTQI members are eager to invest in underserved communities if they had the resources to recruit more PTs and expand care.
To address this shortage, bipartisan lawmakers have introduced the Physical Therapist Workforce and Patient Access Act (S.970 and H.R. 2802), which would enable physical therapists to participate in the National Health Service Corps student loan repayment program.
In an attempt to alleviate shortages of medical professionals around the country, the National Health Service Corps provides student loan relief to medical professionals who commit to serve in a medically underserved or designated health care professional shortage area (HPSA). This makes it difficult for physical therapists to deliver services and open centers in critically underserved markets. Under this legislation, the NHSC loan repayment program would allow physical or occupational therapists to participate, thereby improving access to physical therapists in HPSA areas where companies are hoping to establish community-based centers.