Act Now! Keep Fighting Against Medicare PT Cuts

Policy Agenda

APTQI advocates for legislative and regulatory changes on behalf of physical therapists and the physical therapy community that further our mission of ensuring patient access to value driven physical therapy care. 

Deep Medicare Cuts

In November, the Centers for Medicare & Medicaid Services (CMS) issued the final Physician Fee Schedule (PFS) rule for CY 2020. The finalized rule would impose an eight percent reduction to physical therapy services starting in 2021, which will undermine patient access to vital therapy services.

This deep payment reduction will exacerbate the effects of cuts implemented in recent years:

  • In 2011, CMS implemented a multiple procedure payment reduction policy cut, which was deepened further in 2013.
  • In 2018, two common procedural codes used by physical therapists – Therapeutic Exercise and Manual Therapy – were reduced through Medicare’s National Correct Coding Initiative.
  • Under current policy, physical therapists are set to experience another 15 percent Medicare cut for services provided by a physical therapist assistant in 2022.

Data show physical therapy is a cost-effective first intervention that improves outcomes and reduces spending, especially when utilized early in the treatment process. As the United States continues to confront a series of health challenges, including the opioid crisis and the falls epidemic, patient access to safe, professional physical therapy services must be fortified, not weakened.

Regulatory Relief

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.

Opioid Crisis

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.

In addition to in-person visits, physical therapy services can be effectively delivered over the internet, allowing physical therapy specialists to provide high-quality care to patients. Telehealth can be effective in helping patients overcome many of the barriers they face in accessing physical therapy services 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 and thereby help reduce fall risk 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 center for therapy that can be performed in the home

While commercial insurers are quickly moving to expand coverage for telehealth services the Medicare program has been slow to catch up. Physical therapists are currently prohibited from billing Medicare for telehealth services, which is limited only to a few specialties. As a result, Medicare beneficiaries in need of physical therapy services are unable to access the latest technologies in care delivery.

APTQI strongly supports legislation that would enable broader adoption of telehealth coverage in the Medicare program by easing many of the restrictions currently in place.

Workforce Shortage

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.