Industry Voices—Decisions to slash Medicare lack transparency while putting patients at risk

Last November, the agency issued its Physician Fee Schedule final rule for Calendar Year 2020 which imposed across-the-board cuts of 8 percent to physical therapy services starting in 2021. (Getty/SDI Productions)

Physical therapy is a safe, effective, and preferred treatment for millions of American seniors. But unfortunately, a series of new federal policies threaten to dramatically reduce access to the valuable services Medicare beneficiaries rely on.  

Medicare beneficiaries need physical therapy to address injury, chronic pain, or restricted mobility.

Physical therapy is patient-preferred and a less-invasive approach than surgery or pharmaceutical approaches. Not only does it help patients regain or maintain important function, it can help reduce the likelihood of an accidental fall, saving Medicare millions of dollars in associated costs. Already, Medicare spending is significantly less for patients who receive physical therapy first—prior to interventions like surgery or pain-relieving injections.

In short: it’s a valuable service for improving patients’ health outcomes and advancing cost-efficiencies in the Medicare system.

RELATED: CMS finalizes physician fee schedule rule with cuts to physical therapists, psychologists

Unfortunately, older Americans who depend on physical therapy are among those who could suffer if the Centers for Medicare & Medicaid Services (CMS) moves forward with planned Medicare reimbursement cuts without sharing its rationale with stakeholders. Last November, the agency issued its Physician Fee Schedule final rule for Calendar Year 2020 which imposed across-the-board cuts of 8 percent to physical therapy services starting in 2021.

This policy would dramatically worsen the effects of previous cuts implemented in recent years, including a 2011 multiple procedure payment reduction (MPPR), as well as the reduction of two common procedural codes used by physical therapists in 2018. These are not minor changes––they are significant shifts in policy that, taken together, compound and create obstacles to high-quality care. Rightfully so, physical therapists (among other specialties) are worried about the potentially harmful impact on patients. 

The downstream effects of additional cuts to physical therapy would be significant. Without access to care, we are likely to see an increase in adverse events like senior falls and infections that result in more emergency room visits and longer hospital stays. We also risk seeing more patients turn to pharmaceutical remedies like opioids. Taken together, these are very real threats that will equal higher costs to patients and America’s healthcare system.

What’s worse, CMS is falling short when it comes to sharing the process behind some of its most important policy changes—changes that stand to impact the care of millions of Medicare beneficiaries. Not only did the agency fail to make its rationale for this significant cut public, it seemingly overlooked a loud torrent of provider feedback. This has not only left providers feeling frustrated and unheard but has also troubled members of Congress. Earlier this month, 99 bipartisan lawmakers asked CMS to clarify its methodology and the potential effect on patient access.

It’s important for CMS to clarify its methodologies and justifications for these severe reimbursement reductions imposed on a variety of treatment specialties—among them physical therapy. CMS also needs to address whether or not it will consider how its proposed changes may impact beneficiary access to important services, including the calculation mechanism behind such considerations.

RELATED: Physical therapists hope CMS will take another look at planned cut to Medicare reimbursement

As a physical therapist, I always explain to each patient why I feel their individual treatment plan is most appropriate. Patients depend on full disclosure from healthcare providers so that we can make the best decisions together. Americans should expect no less from policymakers—who are making critical decisions affecting the future of our nation’s healthcare.

With this spirit of transparency in mind, I urge CMS to explain its decisions to further cut valuable specialty services and clarify how cuts of this magnitude will not put patient care at risk. It’s the right thing to do. 

Nikesh Patel, PT, DPT, is a physical therapist and executive director of Alliance for Physical Therapy Quality and Innovation.