Physical Therapy is a Promising, Cost-Effective Solution to Falls
According to the Centers for Disease Control and Prevention (CDC), 30 million elderly Americans fall every year – a figure representing roughly one-quarter of all seniors. Unfortunately, this problem is only expected to worsen as America’s population grows older: fall injuries and deaths are likely to increase.
The cost burden for this epidemic is immense – and growing:
- $101 Billion: Projected cost of treating falls by 2030
- $50 Billion: Total medical expenditures associated with falls in 2015 alone
- $81,300: Average lifetime costs for patients are caused by a fall-related injury
- $30,000: Average hospital cost for a fall-related injury
In addressing this epidemic, the U.S. healthcare system has an invaluable tool at its disposal: physical therapy. According to the National Institute on Aging, patient-specific exercise regimens, utilized in combination with regular physical activity, are evidence-based solutions that can significantly reduce the likelihood of an accidental fall.
Physical therapy prescribed treatments enable patients to remain steady and maintain their independence. Physical therapists are also trained to conduct patient home assessments which evaluate a patient’s living space and identify potential fall hazards. In fact, a recent study showed that older citizens who underwent an exercise intervention from a trained healthcare professional lowered their risk of a fall by 31%.
In short, physical therapy helps improve older Americans’ balance, strength, and independence –– while bolstering patient outcomes and preventing costly (and often avoidable) injuries.
Continued, Disruptive Medicare Cuts Destabilize Sector
The Centers for Medicare & Medicaid Services (CMS) finalized another set of deep, across-the-board payment cuts to physical, occupational, and speech therapy in the Physician Fee Schedule (PFS) Rule for CY2023.
The final rule included a 4.5 percent cut to providers in 2023, which would leave the sector subject to cuts of approximately 9 percent between 2020 and 2024.
This cut comes on the heels of a series of payment reductions by CMS in recent years.
In the Physician Fee Schedule (PFS) Rule for CY2022, CMS finalized a 3.75 percent cut to providers in 2022 and a troubling 15 percent cut for services provided by physical and occupational therapy assistants. A broad coalition of lawmakers and stakeholders came together to oppose and support reforms to the fee schedule, and fortunately, lawmakers in Congress took action.
As part of the 2022 end-of-year government spending omnibus package, Congress provided partial relief to the scheduled -4.5% Medicare cuts to physicians and other Medicare providers by reducing the cut to -2.5% in 2023, which went into effect January 1. Congress also delayed the implementation of the -4% PAYGO sequestration cut, providing a temporary reprieve to providers under serious financial pressure amid rising inflation, high labor costs, and the continued negative impacts of the COVID-19 pandemic.
While APTQI is grateful that Congress took action to mitigate the cuts in the short-term, Congress failed to address the urgent need for more long-term solutions to Medicare payment stability for the good of patients and their care providers.
It is incumbent upon the new Congress to advance the long-term Medicare reforms the broader healthcare community has been calling for since the conversation rate policy was originally applied.
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.
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 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, Senator Jon Tester (D-MT), Senator Roger Wicker (R-MI), Rep. Diana DeGette (D-CO), and Rep. Kelly Armstrong (R-ND) introduced the Physical Therapist Workforce and Patient Access Act (S. 2676/H.R. 3759), 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.
Physical & Occupational
Therapy Assistant Cuts
Physical and occupational therapist assistants (PTAs/OTAs) are an essential part of the therapy profession, providing direct patient care services to patients under the guidance and supervision of licensed physical therapists.
Despite the incredible value therapy assistants offer to patients, the Centers for Medicare & Medicaid Services (CMS) imposed a 15% Medicare payment cut on the direct patient care services provided by PTAs and OTAs starting January 1st.
This is in addition to a number of Medicare cuts to therapy services in recent years. This additional 15% cut will only further restrict the ability of the profession to meet patients’ pain management and recovery needs using the safest, most cost-effective care path.
If these cuts remain, our patients, especially those living in rural and underserved areas, may face new barriers to care when trying to access the treatment they need.
To protect Medicare beneficiaries’ access to care, Representatives Bobby Rush (D-IL) and Jason Smith (R-MO) have introduced the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act (H.R. 5536).
Specifically, the bill would:
- Delay the implementation of payment cuts until January 1, 2023, to allow providers more time to prepare.
- Permanently prevent the 15% Medicare cuts to services provided by PTAs and OTAs in rural and medically underserved areas.
- Reduce requirements for direct supervision of therapy assistants in private practice settings – shifting from direct to general supervision in states with licensure laws that allow for general supervision – helping to ensure continued patient access and giving small therapy practices more flexibility.