The Centers for Medicare and Medicaid Services (CMS) calls for cuts to its Medicare physician fee schedule (PFS) reimbursement for physical therapy providers by 8 percent beginning in 2021. The reduction for 2021 is included in the proposed 2020 PFS.
According to the American Physical Therapy Association (APTA), hidden with the proposed 2020 PFS, CMS reveals a plan that puts Medicare beneficiary access to physical therapy at risk by way of an estimated 8 percent cut to fee schedule reimbursement in 2021. CMS says the reductions, which affect multiple providers to different extents, are driven by changes to reimbursement formulas for evaluation and management (E/M) services furnished by physicians and some other providers.
APTA warns that CMS’s significant cuts to fee schedule reimbursement for physical therapy providers will put challenging and likely unsustainable financial pressures on physical therapists (PTs), particularly in rural and underserved areas where access is already limited. As more PTs feel this pressure and opt out of, treating Medicare beneficiaries—or close their doors altogether—patient access to care will suffer, says APTA.
“The changes to reimbursement for office/outpatient E/M codes itself are positive ones and we fully support access to primary care services, but the idea that these changes must be accompanied by deep cuts to other crucial services is outrageous,” said Kara Gainer, APTA’s director of regulatory affairs in a September 15th statement. “At a time when our aging population is in need of greater access to physical therapy, with its proven benefits and track record for reducing overall costs, CMS has instead decided to turn its back on the facts and put patients at risk,” she says.
APTA calls on CMS to promote access to physical therapy services that will reduce downstream costs. Physical therapists can help to reduce downstream costs, including avoidable hospital readmissions, by contributing to existing care transition models and collaborating with other health care disciplines, says APTA.
Make Your Voice Heard
CMS says deadline for comments is September 27, 2019 and the final rule is expected to be issued by November 1. Send your comments to: Seema Verma, MPH, Administrator, Centers for Medicare and Medicaid Services, Department of Health and Human Services, CMS-1715-P, Room 445-G, Hubert Humphrey Building, 200 Independence Ave, SW, Washington, DC 20201.