Industry Voices—Congress: Stop Medicare cuts to specialty healthcare providers

With providers and their patients already reeling from the unprecedented impact of COVID-19, imposing draconian cuts to specialty care is counterproductive and potentially dangerous. For the physical therapy provider community, these cuts would be devastating. (Getty/DNY59)

As businesses began reopening across the country, some remained optimistic that the worst of COVID-19 was behind us. But now, with cases surging, this positive outlook seems to have been misplaced. Healthcare workers—many already beleaguered by the public health emergency—are now bracing for another surge of Americans stricken by this deadly virus.

With the public health emergency extended, specialty providers—a key pillar of America’s healthcare system—find themselves in dire straits. Representing a broad swath of the care delivery chain, specialty providers include fields such as cardiology, radiology, neurology, and physical and occupational therapy. Although these specialties deliver critical care to patients, doing so has become increasingly more difficult amidst the pandemic.

Many Americans, particularly those who are elderly and suffer from underlying conditions, remain afraid of contracting the virus when visiting a specialty provider—even if that means delaying medically necessary care. In response to these concerns, specialties have augmented infection control measures and increased utilization of telehealth to reduce the potential for exposure.

But, despite these measures, help is still desperately needed from policymakers in Washington to ensure specialty providers can outlast the crisis, maintain operations, and continue reaching patients who rely on their treatment services.

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Unfortunately, instead of supporting struggling providers and their patients, federal policy threatens to have the opposite effect. In early August, the Centers for Medicare & Medicaid Services (CMS) issued its proposed Physician Fee Schedule rule for 2021, which solidified Medicare’s plans to dramatically reduce payments to many specialty providers. Despite broad opposition from stakeholders and lawmakers, CMS’ most recent proposal actually cuts many providers more than previously proposed. As a result, specialties such as physical and occupational therapy will experience a reimbursement reduction of 9% in 2021 if implemented as written.

With providers and their patients already reeling from the unprecedented impact of COVID-19, imposing draconian cuts to specialty care is counterproductive and potentially dangerous.

For the physical therapy provider community, these cuts would be devastating. Even before the pandemic began, our profession was already coping with a series of reimbursement reductions, including a 2011 multiple procedure payment reduction (MPPR), which was deepened in 2013, as well as the reduction of two common procedural codes used by physical therapists in 2018. This slippery slope of constant reimbursement reductions makes it harder and harder for us to keep serving America’s Medicare population.

Therapy professionals will continue to do everything within their power to reach patients in need, but without relief from these cuts, the sector will face unprecedented destabilization. The Americans who rely on our services are among the oldest and most vulnerable patients in the country. They depend on us to help manage their chronic and acute pain, recover from injuries, and reduce the rate of falls, which are a leading cause of injury and hospitalization for seniors in the U.S. Imposing deep cuts on these services amidst a public health emergency would be a devastating error.

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Although the driving impetus behind CMS’ proposal—to increase payment for “evaluation and management” (E/M) services—is understandable, these goals were established using a pre-pandemic outlook of our healthcare ecosystem. The dramatic changes brought on by COVID-19 must be accounted for in any federal policy going forward, including CMS’ Medicare payment rule.

Promisingly, many stakeholders and associations, including the Alliance for Physical Therapy Quality and Innovation, have repeatedly urged federal policymakers to reverse course and stop these harmful cuts. Most recently, a bipartisan group of lawmakers led by Rep. Bobby Rush, D-Illinois, submitted a letter to House leadership decrying the cuts to specialty providers and urging legislative solutions.

We urge Congress to take immediate action and block these damaging specialty cuts legislatively. Doing so would provide stability to healthcare providers and ensure continued access to specialty care for Medicare beneficiaries.

Nikesh Patel is the executive director of the Alliance for Physical Therapy Quality and Innovation.

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