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America’s specialty care providers need a reprieve from payment cuts

Ever since Medicare first proposed significant cuts to specialty providers in order to pay for an increase to physician payment for evaluation and management services, the therapy community — including physical, occupational and speech therapists — has been working with lawmakers in Congress to reverse the unfair and steep level of payment cuts levied on the specialty provider community.

In anticipation of the Medicare payment rules for 2022, specialty care providers again asked Congress for assistance in preventing destabilizing Medicare policies. Now that the Medicare Physician Fee Schedule (PFS) Proposed Rule for CY2022 rule is out, and again includes deep cuts to physical therapy, we need congressional help to avert these dangerous cuts.

Despite broad opposition from stakeholders, the proposed PFS rule includes plans to impose a 3.5 percent cut to physical and occupational therapists in 2022. Taken together with the compounding impact of successive cuts to our specialty, physical and occupational therapists will eventually face a steep 9 percent payment cut by 2024, some of the largest cuts planned for the Medicare program. 

As more older Americans who depend on Medicare are becoming dependent on specialty care services, these continued cuts threaten the sustainability of America’s shaken health care system and, ultimately, patient access to critical services.

For millions of patients, physical therapy services are critical for helping individuals recover from serious injury or illness; building strength, balance, and independence; and managing pain without the use of opioids. By creating an individual treatment plan for each patient, physical therapists not only help address patients’ immediate needs (e.g., joint pain, limited range of motion and mobility), they also amplify the value of care by lowering the risk of more serious conditions.

For example, physical therapy empowers seniors to regain balance in order to prevent dangerous falls. According to the latest data released by the Centers for Disease Control and Prevention (CDC) in May, falls caused more than 90 percent of the country’s 2.4 million emergency department visits and 700,000 hospitalizations due to unintentional injuries to older adults.

Patient-specific exercise regimens facilitated by trained health care professionals can significantly reduce seniors’ risk of a fall. Not only does this help older Americans live longer, healthier lives, it also helps save Medicare money. With the average lifetime costs for a patient experiencing a fall-related hip fracture topping over $81,000, and the projected annual cost of treating falls expected to surge past $100 billion by 2030, fall prevention strategies are desperately needed.

Moreover, physical therapy is a safe, non-addictive pain management approach. Unlike prescription opioids, which simply mask physical discomfort, physical therapy prevents and treats the underlying cause of each patient’s pain. Since 1999, over half a million Americans have died due to an opioid overdose, originally driven by an over prescription of these powerful painkillers. While medications may be appropriate for some, physical therapy has shown to be a valuable tool in reducing seniors’ aches, pains, and inflammation — without the risk of addiction, diversion, or overdose.

Finally, physical therapy is well-positioned to help long-haul COVID patients recover from complications related to their disease. Because lengthy hospital stays often cause muscle deterioration, access to therapies to support strength, balance, and mobility is vital to this patient population.

Unfortunately, if the additional cuts proposed by CMS are finalized, it will be harder for Medicare beneficiaries to access the physical therapy services they need to recover. Last year, Congress acted to avert devastating cuts for 2021 with just days to spare. We need Congress to again lead the way in addressing these serious threats caused by the current Medicare payment system. Doing so will ensure continued patient access and financial sustainability for America’s specialty healthcare providers. 

Nikesh Patel, PT, DPT, is the executive director of the Alliance for Physical Therapy Quality & Innovation.

Tags Medicare

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