Physical & Occupational Assistant Therapy 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.
Continued, Disruptive Medicare Cuts
Despite unified warnings from lawmakers, specialty providers, and other stakeholders about the potentially devastating impact of reimbursement cuts, the Centers for Medicare & Medicaid Services’ (CMS) finalized deep, across-the-board payment cuts to physical, occupational and speech therapy in the Physician Fee Schedule (PFS) Rule for CY2022. After years of reducing reimbursement for therapy services, the final rule includes a 3.75 percent cut to providers in 2022, eventually adding up to a steep 9 percent payment cut by 2024. The final rule also includes a troubling 15 percent cut for services provided by physical and occupational therapy assistants.
In a letter to CMS Administrator Chiquita Brooks-LaSure, APTQI detailed the serious impact these cuts will have on patients and providers—including an uptick in practice closures, an increase in opioid misuse, and a rise in the number of senior falls that cause serious injury and hospitalization.
Fortunately, lawmakers in Congress took action to avert cuts to physical, occupational, and speech therapy in the CY 2022 by passing the Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610), which includes a partial extension of the Medicare conversion factor payment increase in 2022 and sequester relief for another six months.
On December 10, President Biden signed this bill into law. This legislation provides a one-year increase in the Medicare PFS of three percent to support specialty providers through 2022. The bill also includes another three-month delay of the two percent Medicare sequestration cuts and a three-month, one percent reduction in Medicare sequestration.
A broad coalition of lawmakers other stakeholders including APTQI across the healthcare continuum worked collectively to achieve this intervention to mitigate Medicare cuts in 2022:
- In total, APTQI advocates sent more than 37,000 letters to lawmakers in Congress urging legislative action to avert additional payment reductions in the year ahead.
- On November 29, APTQI, American Physical Therapy Association (APTA), the Private Practice Section of the APTA, the American Medical Association (AMA), and hundreds of other groups sent a letter to Congressional leadership urging action to avert the cuts before the end of 2021.
- On October 15, 247 Members of Congress led by Reps. Ami Bera (D-CA) and Larry Bucshon (R-IN) sent a letter to House leadership urging them to begin working on long-term reform to prevent impending cuts and bring stability to the Medicare payment system.
- On September 7, APTQI joined 14 healthcare organizations urging CMS to not finalize the 2022 MPFS proposed rule that would see payment cuts of more than 20 percent for specialty providers as a result of Medicare’s clinical labor policy.
While we commend this legislation and the efforts of lawmakers to protect Medicare patients and specialty care providers in the coming year, we know that the relief is temporary, and we will continue to work with regulators and Congress next year to find long term solutions for the Medicare Physician Fee Schedule.
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, saving patients a trip to the clinic for therapy that can be performed in the home
During the COVID-19 pandemic, telehealth services have been critical to enabling continued patient access to physical therapy.
By providing physical therapy services via telehealth, 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 the public health emergency (PHE)
In response to the PHE, the Centers for Medicare & Medicaid Services (CMS) increase access to physical therapy by reimbursing providers for telehealth-based services delivered to Medicare beneficiaries. However, this expansion is not permanent
The Expanded Telehealth Access Act of 2021 (H.R. 2168/S. 3193) would make permanent the temporary policy that allows physical therapists and physical therapist assistants to deliver and bill for services provided via telehealth under Medicare. This bipartisan legislation specifically includes physical therapists and physical therapist assistants.
APTQI urges Congress to pass this important legislation so the physical therapy community can continue their important work of caring for seniors in need despite their location.
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, 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.