Therapists worry reimbursement cuts would harm Medicare beneficiaries

Therapists and long-term care providers roundly criticized CMS’ proposal to cut reimbursement for therapy services by 9%, which caregivers described as a “double-whammy” as they cope with the COVID-19 pandemic.

While the proposed 2021 physician fee schedule would increase the work relative value units of the evaluation and re-evaluation codes, therapists claim that it would not be enough to offset the across-the-board cut to accommodate that change under a budget-neutral framework. The reallocation of Medicare payments would benefit some specialists like family practitioners and rheumatologists but reduce the payment rates for others including certain surgeons, anesthesiologists and therapists.

More Medicare beneficiaries have used occupational, physical and speech therapy, which has resulted in fewer emergency visits and hospitalizations, one physical therapist wrote in comments to CMS due Monday.

“However, because physicians frequently order therapy to carry out their patient’s rehabilitation plans of care, a 9% cut would be devastating and result in closures of the very practices that work hand in glove with those physicians,” they wrote.

The cumulative effect of the payment reductions regarding occupational therapy assistants, multiple procedure payments and sequestration has already disadvantaged practitioners in underserved areas, wrote Ruth Chase, an occupational therapy student at St. Catherine University.

A 9% reduction in payment across 40% of Agile Physical Therapy’s business would be devastating, wrote Chris Reed, chief financial officer of the Palo Alto, Calif.-based facility. Costs for health insurance, utilities, staffing, rent, equipment and supplies have increased while reimbursement for physical therapy has remained stagnant for more than 20 years, he said.

“We are doing more with less decade after decade. Continued cuts to reimbursement layered on top of increased regulatory burdens is only leading to consolidation of the marketplace, reduced access to services, and care being driven by cost reduction measures, not by quality,” he wrote.

A Medicare beneficiary wrote that physical therapy providers will likely close or limit capacity as a result of the cuts, which would slow their recovery.

“CMS is putting my health and the health of other Medicare beneficiaries at risk while also causing detrimental harm to the integrity of the Medicare program. I have serious concerns that my inability to receive care in a timely manner will have a compounding negative effect on my health and quality of life,” they wrote.

Practitioners were largely supportive of the proposal’s permanent expansion of telehealth services, which would in part allow Medicare providers to use telehealth to carry out home visits for evaluation and management services and some visits for people with cognitive impairments. But they urged CMS to expand allowable telehealth services, remove the site-of-service requirements and allow the services for new patients.

CMS also proposed expanding the scope of practice for nurse practitioners, physicians assistants and other non-physician clinicians to supervise diagnostic testing if state laws allow it, which caregivers generally supported.