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  • Lawmakers Want Answers From CMS on Planned 2021 Payment Cuts

    Explain yourself: That's the message of a bipartisan letter to CMS signed by 99 members of the U.S. House of Representatives who are concerned about the agency's plan to make cuts to Medicare that include an estimated 8% reduction in payment to PTs. APTA led efforts to inform legislators of the issue.

    And if that's not enough to get CMS to take another look at the planned cut, maybe a letter from a prominent U.S. senator might help.

    In a February 5 letter, the representatives write that their constituents have concerns about whether the planned cuts will reduce access to health services. In order to respond to those concerns, the legislators are asking about the process CMS used to reach the decision to reduce the reimbursement for services furnished by certain providers in 2021 in order to accommodate increases to values of the office/outpatient evaluation and management codes, known as E/M codes.

    The letter specifically asks CMS to explain the methodology and data the agency used to calculate the estimated impact to each specialty level impact associated with the coding change, and to provide a description of the factors the agency considered in deciding how much it would reduce each of the 36 other professions selected for cuts.

    The legislators also pressed CMS on its statement that it would consider additional information before making a final decision, asking what kind of information would be of the most value, and whether CMS considered how the proposed changes could impact access to care — and if so, how.

    The letter requests that CMS respond to Congress by February 21.

    But the pressure on CMS isn't just coming from the House: Thanks to the efforts of Brenda Mahlum, DPT, the APTA Federal Affairs Liaison for the Montana Chapter, Senator John Tester (D) also sent a letter to the agency describing his concerns that the cuts "will compromise patients' access to care, particularly in the most remote areas of my state and across the country."

    "Medicare beneficiaries increasingly rely on physical therapy and occupational therapy services as part of a coordinated model of care," Tester writes, adding that the planned cuts run the risk of drying up access to care in underserved and rural areas that are already struggling to meet health care needs. "Payment decisions like the ones in this final rule will limit provision of services," Tester adds. "The physical therapists and occupational therapists in Montana operate on very narrow margins, and any reimbursement reductions may jeopardize their ability to remain open and serve their patients."

    Justin Elliott, APTA's vice president of government affairs, sees member engagement as the driving force behind the legislators' efforts.

    “We are grateful to Representatives Buddy Carter and Lisa Blunt Rochester for their leadership on this bipartisan House letter to CMS, and even more grateful to the APTA members who urged their legislators to get on board,” Elliott said. “The large number of bipartisan signatories to the letter should demonstrate to CMS that the public needs more information to understand what policy goal this flawed proposal is trying to achieve. We understand and support the desire for increased payment for the E/M codes. However, we believe it's inappropriate to reduce payment to physical therapists and 36 other provider groups as the way to pay for it.”

    Be sure to check out APTA’s resources on this issue. Ready to add your energy to APTA advocacy? Join us for the APTA Federal Advocacy Forum, March 29-31 in Washington, D.C.


    • Good! It's refreshing to see lawmakers doing their job by demanding accountability from CMS. Let's expect honesty from Seema Verma and not the sort of prevaricating, "feel-good" answers to such questions. On the other hand, we as voters should be asking our Congress why they supported legislation which provides more benefits to Medicare recipients on Medicare Advantage plans but not to those with standard Medicare. This creates another two-tiered health system with one being controlled exclusively by the health insurance industry with the better benefits and those with the "public option" with less.

      Posted by Stephen Small on 2/5/2020 7:08 PM

    • Me and my husband are both PTA's and both of us don't have jobs now. We need your help to prevent this from happening. It's very difficult to find a job now. Please don't let this happen

      Posted by Maan Marquez on 2/6/2020 4:11 PM

    • I am in Indiana and have called both my Senators and Representative to alert them to this Information and express my concerns for my profession and patients. I urge others to do the same.

      Posted by Kelly Seyer on 2/7/2020 10:31 AM

    • This is why as long as I can I will be a member of the APTA. Thank you for continuing to fight for our profession and the patients we care for everyday.

      Posted by Cory Hiers -> DNRZBK on 2/9/2020 8:01 PM

    • Please help!!! I'm a PTA in Mississippi. I lost my job in Home Health on Friday along with 3 other PTA's. There are no jobs for me to apply for because of these changes and it seems to be getting worse. What are we to do?

      Posted by Kristi Richards on 2/12/2020 11:47 PM

    • I have provided Home Health Physical Therapy to my county for ten years. It has been a privilege and an honor to provide services to this rural community. As a PTA, I've been able to restore, rehabilitate and keep patients out of the hospital, out of institutions and allow them to remain in their homes while aging in place. It is my professional and personal opinion that not only are my patients being neglected, but patients everywhere are being neglected due to PDGM. It is so disheartening when I have to tell a patient that because of all the changes with PDGM, they are being discharged. WHAT happened to patient care? WHAT happened to doing what's best for the patient and their needs? This is an absolute form of patient abandonment and neglect!! I chose my profession because I wanted to help people in my community be able to receive the tools, skills, and training to allow them to remain in their homes Independently. Basically we have to tell a patient, "I'm sorry, but because of all the changes, we have to discharge you after 7 visits. I know you still have balance issues, can't walk safely, decreased strength, perform unsafe transfers and you are a high fall risk but good luck on your own! Hope you don't fall!" How ridiculous that is!! How inappropriate that is!! Patient abandonment and neglect!! What a disservice it is to WITHHOLD the services that should be available to the people who have paid in all these years to Medicare. Not only are these changes affecting patient care, it is affecting the Home Health agencies that provide services to the rural community I serve. It is affecting my job as well as my colleagues. Is the goal to kick the rural community in the gut? Is the goal to put rural agencies out of business? Is the goal to neglect the needs of our patients due to the limitations and the umbrellaing of nursing and therapy? Is the goal to wipe out the therapy profession? Therapist are losing their jobs daily. These aren't just therapist, we are people! People who have families to support, bills to pay, elderly parents we are taking care of, mortgages, student loans, etc. PDGM has affected patient care, has cost professionals their jobs, both in a very negative way. PDGM has FAILED our community and other communities across the nation. There is still value in therapy beyond 7 visits. Not all patients are a "quick fix"! I respectfully ask that you look into this and examine how this is affecting YOUR community. I promise you, it isnt good. I promise you, it is affecting your loved ones, your neighbors, your staff, and it will eventually affect you when you will need these services. I respectfully ask that you stand up for your community and fight for them, for us, and for you! Sincerely, Alicia Tykol, PTA

      Posted by Alicia Tykol on 2/16/2020 1:24 AM

    • What will happen to the PTA profession in 2022 when Medicare will only reimburse at 85% for services given by a PTA? I realize health care companies need to worry about their bottom line but I see that change affecting PTA jobs.

      Posted by Lori H on 2/16/2020 5:25 PM

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