By Nikesh Patel, PT, Executive Director, APTQI, and Terrence D. Sims, President of Strategic Growth and Marketing, Raintree Systems

The COVID-19 pandemic has already dealt a major financial blow to physical, occupational, and speech therapists and other specialty healthcare providers. But things are going to get substantially worse in 2021 if Congress does not act to stop the Medicare cuts to 33 specialty services set to go into effect on January 1.

In its CY2021 Medicare Physician Fee Schedule Final Rule, CMS stated it was moving forward with across-the-board cuts of 9% to physical and occupational therapy services, and reductions ranging from 4% to 11% in other specialties ranging from pathology to anesthesiology to radiology. To understand why requires a little bit of background. 

In 2019, CMS announced a substantial increase in the value of the Evaluation and Management (E/M) office visit codes and introduced a new “complexity” add-on code which carried a substantial payment. The goal was to reflect changes in care practices and patient needs by increasing pay for office-based clinicians who spend substantial face time with patients, such as those who provide primary care and chronic disease management.

But here’s the catch: Congressional statute requires CMS to maintain budget neutrality. So in a nutshell, CMS is offsetting these E/M increases by reducing payments to providers – like physical therapists – who don’t bill E/M codes.

The cuts keep on coming

To make matters worse, these proposed cuts are only the latest in a series of reductions affecting physical therapists. The multiple procedure payment (MPPR) payment was reduced in 2011 and again in 2013. In 2018, the frequently used Therapeutic Exercise and Manual Therapy codes were reduced as part of Medicare’s National Correct Coding Initiative. And in 2022, a 15% physical therapy assistant cut is slated to go into effect.

The cumulative effect of these changes has had a significant impact on physical therapist reimbursement, beyond that affecting other specialty healthcare professions. The diminished patient volume and increased costs related to the ongoing pandemic have, of course, exacerbated the financial challenge, as the government’s own figures indicate. Part B Medicare payments, which cover physical therapy, were down 55% for the week of April 8, 2020, compared to three months earlier. And through the first half of 2020, total payments were down 19%.

Limiting patient access impacts health 

This dwindling reimbursement has already resulted in many physical therapist furloughs and clinic closures. More practices will likely face financial instability or be forced to close if the proposed cuts are implemented, since workers’ compensation, military and private payer payments are frequently pegged to Medicare fee schedules, magnifying the negative impact. 

The United States is already facing a physical therapist shortage, with an estimated 27,000 additional therapists needed by 2025 to meet demand. Many seniors depend on physical and occupational therapy services to prevent and manage chronic pain, avoid surgery, and improve quality of life. Further compromising access to these services will have detrimental consequences for patient health, resulting in more falls, ER visits, and longer hospital stays. As patients are pushed from lower-cost options into higher cost-of-care services, health care delivery system costs will also rise. 

Spurring Congress to take action

Vocal opposition to the rule changes from medical, physician and specialty groups, including the Alliance for Physical Therapy Quality and Innovation (APTQI), may be paying dividends. In mid-October, a bipartisan group of 229 members of the House of Representatives co-signed a letter to Speaker Nancy Pelosi and Minority Leader Kevin McCarthy urging Congress to act before the end of the year to find a solution to prevent the steep cuts that would “…surely strain a health care system that is already stressed by the COVID-19 pandemic and jeopardize patient access to medically necessary services.” Soon after, Representatives Ami Bera, MD, (D-CA) and Larry Bucshon, MD, (R-IN) introduced H.R. 8702, the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020.” 

The bill would freeze payments at 2020 rates for two years for services scheduled to be cut in 2021, while leaving the E/M increases in place. This would provide much-needed stability for Medicare providers striving to care for patients during the ongoing pandemic. 

Help protect patient access to care

APTQI joined more than 70 other medical organizations in signing a letter to Congressional leaders supporting H.R. 8702 and continues to advocate to avert the cuts, advance policy solutions, and protect patient access to care. Raintree Systems, an APTQI at-large board member that provides practice management and EHR solutions for physical therapists and other specialty practices, has also been actively advocating for positive legislative change and encouraging their clients to join the effort. 

To keep up the pressure on Congress, APTQI urges physical therapists to email and – even better – call their members of Congress, and to encourage their patients to do so also. Raintree Systems has customized its specialty practice RCM, Billings and Collections software to make it especially easy for patients to support these advocacy efforts. As soon as patients complete payment for their physical therapy visit, a built-in software feature automatically offers them an option to electronically sign a petition opposing the cuts.

A recent poll of voters older than age 65 years indicates that most Medicare beneficiaries are concerned that access to critical therapy services are threatened by the cuts and support Congressional intervention to prevent them. Ninety-three percent of respondents believe it is important to have access to Physical Therapy Centers, and more than three-quarters would support Congress taking action to pass long-term reform to stabilize funding for primary care and medical specialists.

At www.aptqi.com/take-action/, therapists and patients can complete a short form and automatically generate a message that will be sent directly to their legislators. APTQI also encourages physical therapists to raise public awareness about the devastating impact of the proposed cuts by posting short videos or educational comments on social media and writing letters to their local newspapers.

As America continues to grapple with the health challenges imposed by the unabating COVID-19 crisis, it is more crucial than ever for Congress to take strong, bipartisan action to avert the proposed cuts and provide critical relief to physical therapy and specialty practices nationwide. Now is the time to fortify patient access to safe, professional physical therapy services – not weaken it.

Nikesh Patel, PT, DPT, is the Executive Director of the APTQI.  He received his Doctorate of Physical Therapy from the Arizona School of Health Sciences.  

Terrence Sims is the President of Strategic Growth & Marketing for Raintree Systems and is a career healthcare technology and operations executive with more nearly 30 years of senior leadership experience in both early-stage and Fortune 500 environments.