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  • Time to Act: CMS Proposes Significant 8% Cut to Physical Therapy in 2021

    [Editor’s Note: Response to CMS about the proposed PFS has been strong, and the more comments CMS receives the more likely they are to consider our recommendations. Use this prewritten template letter to add your voice by the September 27 deadline and strengthen our message even more.]

    In this review: APTA's response to a CMS plan to cut Medicare physician fee schedule (PFS) reimbursement for physical therapy providers by 8% beginning in 2021. The reduction for 2021 is included in the proposed 2020 PFS.
    Proposed 2020 Physician Fee Schedule (see table 111, p 1187)
    CMS Fact Sheet
    CMS press release

    The big picture: a proposed 8% cut in Medicare reimbursement for physical therapy providers in 2021
    Deep within the proposed 2020 PFS, CMS reveals a plan that puts Medicare beneficiary access to physical therapy at risk by way of an estimated 8% 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's message to CMS: 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.

    "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. "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."

    What we're doing—and what you can do (before September 27)
    We're preparing a formal comment letter to CMS, but that's just a part of APTA's efforts. Because the proposal affects multiple providers, from PTs and occupational therapists to clinical social workers, clinical psychologists, ophthalmologists, optometrists, and chiropractors, we're circulating a provider organization sign-on letter objecting to the cuts, and we're working with the American Occupational Therapy Association to develop an additional sign-on letter to be circulated among members of Congress.

    Even more important, we're urging APTA members to bring their individual voices to bear on this issue. We've created a customizable template letter that makes it easy to let CMS know how these proposed cuts will pose a real danger to Medicare beneficiaries and negatively impact PTs' ability to practice under Medicare. Make sure you get your comments to CMS by the September 27 deadline (the template letter includes instructions on how to submit to CMS).

    Tip: this letter is the second template letter we've created in response to the 2020 PFS. The first addresses the problematic physical therapist assistant/occupational therapy assistant coding modifier plan, and is still available for download. If you haven't yet completed and submitted that letter, you can combine it with the letter on the reimbursement cuts.

    What's next
    Deadline for comments is September 27, and the final rule will likely be issued by November 1. In addition to the sign-on letters described above, APTA and several other provider associations will meet with CMS officials in mid-September to share concerns and provide recommendations on a range of issues related to the PFS.


    • Physical therapy deserves significant investment, not cuts. It is the safest, cheapest way to return to health and function and reduce future healthcare costs. Promoting health rather than treating disease, and human interaction is the future of medicine. Physical therapy will be the direction the healthcare field moves, going forward. We should be investing in improving access to physical therapy and education for our doctors of physical therapy, to provide the best care possible for our patients to reduce long term health cost.

      Posted by Michael Smith on 9/16/2019 9:23 PM

    • They need first hand experience if what it looks like when someone is denied services during the crucial neuroplasticity periods yet due to payor deficiencies service are not available. See what the value of that is.

      Posted by Aaron on 9/16/2019 9:37 PM

    • These cuts will kill the profession. It will decrease salaries of therapists and assistants, decrease services to patients especially in rural areas, de-value the profession of physical therapy. Potential Students will not be able to pay off student loans due to salary decreases. Patients already can not afford PT services due to large deductibles and copays. Medicare reimbursement is the worst payor. We are not being reimbursed properly for our level of education and contribution to patient recovery .

      Posted by Ilene Larson on 9/16/2019 9:39 PM

    • As a low volume, quality care clinic owner, we would be forced not to accept Medicare patients. This would in turn push them only to the high volume, poorer quality cookie cutter therapy clinics. This, in turn, would lead to higher surgical rates when patients do not ‘improve’ with conservative care which means more Medicare funds, in an attempt to reduce fund usage.

      Posted by Amber schlemmer on 9/16/2019 9:51 PM

    • My daughter is a physical Therapist. And she is a wonderful person. If you don’t have people like her, this world will be in such disarray!

      Posted by Sharon Fouke on 9/16/2019 9:52 PM

    • I would like to have the template

      Posted by Cara on 9/16/2019 9:57 PM

    • My name is Jonathan Bebey and I am a recent graduate of Temple University Physical Therapy Program in May of 2019. I recently started working in an inpatient rehabilitation hospital called Paradise Valley Hospital in San Diego, California. I have been eager and excited for my opportunity to begin to start serving the community and treating my patients. I work with a large majority of Medicare and MediCal patients with severe impairments and functional deficits. Reimbursement and length of stay is already a major challenge for my practice setting, but my coworkers and I are always working diligently to create the best patient outcomes.

      Posted by Jonathan Bebey on 9/16/2019 9:59 PM

    • I am so very thankful that I was given such good PT and OT In Madonna, Ashland CareCenter, at home from PhysMed and finely at Stodden Physical therapy in Gretna Nebraska after my bout with Guillain Barre Syndrome. I am not sure how far my recovery would be at this point but I can assure you I have been given the very best care and I am still struggling due to poor nerve functioning in my hands and feet. I am so very thankful for all my PT and OT’s I sure needed you all.

      Posted by Robert Self on 9/16/2019 10:09 PM

    • Physical therapy is more safe and cost effective than nearly all other medical treatments, including surgery, pain medication, long term disability etc. It should be being promoted in the wake of the opioid epidemic rather than limited. It saves lives, promotes self sufficiency and reduced dependence on the health care system. INCREASE PT COVERAGE AND REIMBURSEMENT

      Posted by Alana on 9/16/2019 11:23 PM

    • I do not understand why you are cutting our fees. We help more people across more diagnoses than any other field. Cutting back our fees makes it difficult to keep our doors open as we have a lot of overhead which includes capitol equipment and space and personnel. Essentially, you are asking us to give our services away. Perhaps you need to look at the unnecessary diagnostic tests and surgeries, meds, imaging and hospital charges. Physical therapy is so very important to seniors in that it helps to prevent unnecessary surgeries and excessive administration of opioids.

      Posted by Dr. William H. O'Grady on 9/17/2019 12:05 AM

    • So disappointing to see quick action for this 8% cut while the APTA lets PTAs twist in the wind with the 15% cut snuck in 2 years ago.

      Posted by Betsy Vozary on 9/17/2019 5:44 AM

    • This type of reimbursement cut will be the death of this profession -especially in states which already reimburse poorly like much of the Northeast. I’m already struggling to live in tnhe north east - this would certainly force the hand to either leave to profession and/or leave Upstate New York.

      Posted by John Longo on 9/17/2019 6:19 AM

    • This proposed cut is really more than 8% if you factor in inflation. While it’s good for members of Congress to hear from PTs and providers, what about the patients? Have they heard real testimonials from real people; how a patient canceled expensive surgery after 6 visits of pelvic floor therapy? How she was empowered to help herself and has the tools to avoid medication and further costs? If this goes through, we will have no option but to discontinue our relationship with Medicare. It’s already difficult enough for women to find a pelvic PT. We are in serious trouble when we do not value life or quality of life beyond a certain age. Socialized medicine is not the answer!

      Posted by Janine Laughlin on 9/17/2019 6:36 AM

    • With all the advances we have made in modern medicine the aging population lives longer and longer. Our focus cannot simply be on longevity of life rather on quality of life. The ability to move and participate and have less pain and to do so without the risk of falling and lower risk of hospitalization is what physical therapy provides to patients. I beg of you to think of your mother and ask what you would want for her and then realize that ever person deserves that. This is a basic need. Please reconsider this legislation for the quality of life for all.

      Posted by Christina Darrah on 9/17/2019 6:52 AM

    • I have been practicing in private outpatient clinics for the past 10 years. During this time frame our reimbursement has been the same despite yearly increased costs of living and facility expenses. Now they decide to make drastic reductions in reimbursement? How does that make and sense and why should we allow it?

      Posted by Joe Checchi on 9/17/2019 7:13 AM

    • Medicare patients are one of the largest populations of PT patients. Cutting would only hurt patient care. If anything, we should be providing more funding for PT’s/PTA’s with Medicare patients to help raise awareness for things like the opioid epidemic, the effects of exercise, student loan repayment, etc. We are a profession that goes outside the “status quo” and provides a more wholistic and individualized approach to functionality and health independence. If we start cutting back, we start losing the ability to give the adequate care to our Medicare patients.

      Posted by Kathryn King on 9/17/2019 7:27 AM

    • A little bit worried about my career that I love so much.

      Posted by Aimi Amalfitano on 9/17/2019 7:28 AM

    • It doesn't make sense to cut funding toward physical therapy when it is the back bone of healing for many people. If anything funding should be increased, as this is the area that could save more money in insurance costs for treating patients to help them become self sustaining again. I personally have benefited from physical therapy. The only problem I encountered was that fact that the insurance company cut me off from my treatments(even after my physical therapist and orthopedic doctor sent letters), so now I am experiencing complications and have had to search for other medical treatments to help with pain I am still having. Mine is just one example of how physical therapy benefits physical and mental healing.

      Posted by Barbara S Reader on 9/17/2019 7:40 AM

    • I have been a PTA since 2010. I have been in a small outpatient setting for the majority my career. Hearing first that PTA’s will be reimbursed 15% less and now an additional 8% cut on top of that is devastating to both the profession in general and the patients I see. My career as a PTA has been very rewarding from assisting patients with daily tasks to getting the athlete back on the field. Our profession assists with the healing phase without drugs or surgery- just proper function to restore the body. I believe the Physical Therapy profession is very crucial to PROPER restoration of the human body after injury, surgery or illness. It is much more than to “just slap an exercise or stretch on them” and move on. We are professionals! We have been through the classes LICENSED and continue to further our education with required and a lot of the time NON REQUIRED CEUs just because we want to learn more for larger group of patients. The PTs now are graduating with their DOCTORATE in Physical therapy. This should help others realize exactly what the profession knows and the amount of education we go through. Physical Therapists are movement experts that emphasize on quality of life through specific exercise plans, hands-on care, and patient education. Being a professional, educated and licensed part of the healthcare system and huge asset to successful healing should not be DISRESPECTED to the level of less reimbursement than what we already get. We should be reimbursed MORE for what we do.

      Posted by Aleesha Angstrom on 9/17/2019 8:05 AM

    • I agree with Betsy. It isn't right how PTA concerns are pushed to the side by PTs because it doesn't affect them. This is what happens when you don't stick up for your own team.

      Posted by Jerry on 9/17/2019 8:18 AM

    • Perhaps it is time for better representation

      Posted by Michelle Biel on 9/17/2019 8:22 AM

    • As long as we stay unorganized our fee schedule will always be intertwined with the “physician fee schedule.” We need to fight to be separated and for national recognition. As long as we keep in our lane and choose to remain silent, we can never get out of the doctor’s shadow and gain our own footing. We really need to strike! “A day without a physical therapist” strike would start a national dialogue...

      Posted by Trevor D’Souza, DPT on 9/17/2019 8:22 AM

    • How can we get rid of the opioid epidemic when there are cuts like this for conservative treatments? It is already difficult to get reimbursed, why make cuts for this profession??

      Posted by Hanna Netherton on 9/17/2019 8:54 AM

    • Increase Physical Therapy coverage to prevent more seriously long term problems such as fall results, pain medication dependency, surgery, injections, and other costly treatments.

      Posted by rhonda smothers on 9/17/2019 9:07 AM

    • Seniors pay for their Medicare. Now CMS gets to decide how much physical therapy is worth. Why cut reimbursement on a profession that is responsible for getting people back functioning in society to live more productive, enjoyable lives?

      Posted by Ginny Dobbins on 9/17/2019 9:11 AM

    • In a time where MDs are cutting back on opioids and looking into different methods of pain management, PT has been a great option for patients. We are able to help patients reduce pain/ discomfort, in order for them to participate in their normal lives again. Our profession also helps patients after they have surgery to restore function, or to help someone simply walk again. Before coming a therapist I did not realize how hard it was to teach a 70 year old how to walk, you may think it’s as easy as “just stand up and take a few steps.” We’ll its not, but the people that run the insurance companies have never worked with with a patient and that’s one of the main problems. Not only will this pay cut affect the care that goes to our patients, but it will also affect the workers and their families they are producing for. Currently I am the main provider for our family, I work while my wife stays at home to take care of our child. Daycare is too expensive in our area so this was the best option for us. It would not be far to us if prices become inflated but our salaries go in the opposite direction, when we are the providers making a positive impact on someone’s life.

      Posted by Stephen Boretzky on 9/17/2019 9:20 AM

    • CMS wants people off pain killers then they turn around and cut reimbursement to services that would mitigate pain and limit disability through addressing the source of pain,. Are there any clinicians at CMS who truly understand the long term benefits of these services vs the cost of prescription relief?

      Posted by Josie Merrell on 9/17/2019 9:38 AM

    • Physical therapy has been my saving grace! I underwent lower lumbar surgery to replace two discs and fusion to stabilize the back in February. It has been a nightmare of a recovery and while pain medications were definitely needed, just as important was the physical therapy. In fact, I think it is the only thing that has enabled me to cut down to a bare minimum of the meds. If you’re really interested in getting people off opioids, then you should increase their access to pt, not lower it! The average person has no idea of exactly what exercises are beneficial and which ones will actually hurt them and pt fills that need. Personally I feel I would benefit from even more pt but I wasn’t eligible for it and although I was willing to pay for it out of pocket, I couldn’t find any agency that took private patients. I’m still in need of more therapy to know how to safely progress. While I can join a gym, I don’t trust a personal trainer not to hurt me. Physical therapists that have my medical records are more inclined to help me reach my goal of making a full recovery. You would do well to increase rather than decrease the amount of physical therapy one is eligible for, especially seniors. We are living longer and the quality of life that pt brings to us is absolutely essential. Please reconsider what you’re doing to give us back our lives! Don’t cut the funding. It is the future of medicine if you truly want to improve the health of the elderly!

      Posted by Julia Bienek on 9/17/2019 9:40 AM

    • Meanwhile greedy universities keep pumping out more PTs with crushing student loan debt. PTs are taught to make the proper clinical decisions for the benefit of their patients. Under the current and proposed reimbursement system that is not possible. Unattainable productivity standards is the main driver for patient care or should I say non care. I never see APTA ever addressing these issues.

      Posted by FBN on 9/17/2019 10:00 AM

    • This is ridiculous. PT has already taken numerous cuts over the last 20 years. We currently get reimbursed 1/3 of billed charges from Medicare at best.

      Posted by Jon G on 9/17/2019 10:54 AM

    • With a huge population of over 65, the most of the patients we see at our clinic is from medicare. With 8% reduction, it will be hard to accept patients from medicare and stays break even at the same time.

      Posted by Sayem Sharif on 9/17/2019 11:17 AM

    • So disappointing, this is not right.

      Posted by Amanda Langford on 9/17/2019 11:36 AM

    • Cutting reimbursements from Medicare beneficiaries will lead to less neutrality when accepting new patients. Anybody with advanced college degrees has had or currently has debt that needs to be paid off. When accepting patients, there will be a negative bias to accept Medicare patients, when they usually are in need of the most help. I believe there should not be a cut in services given to Medicare patients. Healthcare providers are here to help society, but we still have to support ourselves and our families.

      Posted by Noah Dickerson on 9/17/2019 12:06 PM

    • I can call a home cleaning service and they will charge almost twice the amount my physical therapists gets reimbursed from Medicare. I will be sent someone who only has a high school diploma. This is here on Long Island, N.Y. I've been to various physical therapy over the past 28 years....car accidents, a degenerative disease, an auto immune disease, spine surgeries and total knee replacement surgery. Without physical therapy...I would have been stuck in bed all these years. As more and more cuts are being made there are less and less top notch physical therapists who are available. I've already have seen some that were driven out of business by the last cuts that were made. You need to reevaluate this and figure out a way to reimburse the people in this profession at a better rate of pay. Sincerely, Sherri Z.

      Posted by Sherri Zellman on 9/17/2019 1:50 PM

    • Taking away funding is an unethical way of doing business and is not seen to be a fair trade off in respect to the amount of "good" this profession does for society and people in need. If anything, we need to see more funding for evidence based research and create more portals of opportunity to better our industry to provide the BEST care available worldwide. Cut funding is just down right foolish and preposterous in which the direct effect would be damaging to an industry that should be encouraged to grow beyond where it needs to be. Fund cutting coming from the "top" is a discouragement and will spread throughout the entire industry that we need so much. Clinicians are at the front lines caring for individuals directly while creating an encouraging environment for those about to walk through our doors to find a place that will help them carry out with a plan to better themselves. Speaking of which, why do these people have so many issues in the first place? A lot has been offered to them that was NOT successful and the final result is there's nothing left to do, but be abandoned by our healthcare industry. Physical therapy and Occupational therapy both provide care to people that have been abandonded by an industry managed by legislation and popularity vote. Maybe before cutting a fund that is proven by evidence to best serve individual needs, make corrections within the industry that DOESN'T work. My wish is to have the "power's from the top" to work with us, who are clinician's involved in the industry making differences in people's lives. These people, who walk through our doors with serious debilitating conditions and hardships, turn to seek our help to give them hope and encouragement through it all. The plan has been put in place, lets carry out what we've started and finish strong!

      Posted by James R Jackson, PTA on 9/17/2019 2:00 PM

    • PT is the most rewarding when they teach people how to function with their disabilities. Also teaching us patients how to combat pain with exercise instead of medication. PTs work hard, they deserve recognition and respect.

      Posted by Joanne on 9/17/2019 2:15 PM

    • Cutting reimbursement will continually lead to substandard one on one care to the patients who arguably need it the most. The skill required to help those in need should not be questioned. What we do helps reduce cost of overall healthcare for that patient and we shouldn’t be paid less in the process.

      Posted by Dylan Mascarenas on 9/17/2019 2:17 PM

    • As a senior citizen patient who has benefited more than once from PT, including keeping me from potential needless surgery and stopping things that I love to do (run, hike and ski as examples), I think this cut is much too significant and arguably should not be done at all. PT, as I said, is a great alternative to other, more severe treatments and once you've learned the techniques that help you the most, you can do that at home or in a gym. I do not support this cut in reimbursement for PT services.

      Posted by Robert Goodman on 9/17/2019 5:36 PM

    • With decreasing Medicare reimbursement rates for physical therapy, there will be a major negative impact on the rehospitilization rates. Companies will be financial incentivized to encourage employees to discharge patients earlier than what is appropriate leading to falls, hospitalizations, and decline in self care. Quality of life will be decreased for those utilizing Medicare due to being discharged prior to all goals being met, simply in order to cut costs.

      Posted by Emily Joslin on 9/17/2019 7:38 PM

    • I am a recent DPT graduate from Florida International University. Physical therapy has been statistically proven to save tremendous costs in healthcare . As rewarding as the beloved profession is, it is already a known fact that PTs (especially newer ones) are experiencing outrageous income to debt situations. To have an 8% cut will only place us practitioners and future practitioners in a much worse situation from being able to provide the quality, life-changing care for those desperately in need as well having a stable, comfortable lifestyle for ourselves. We should be investing in improving access to physical therapy and education for all physical therapists to provide the best care possible for our patients to reduce long term health cost.

      Posted by James on 9/17/2019 8:08 PM

    • With an aging population and shortened hospital stays, home health physical therapy helps reduce falls, dependence on medications, preserve independence in the home, and overall decrease costs of healthcare. Physical therapy funding needs to be increased, not decreased, as the baby boomers age.

      Posted by Amy Gray on 9/17/2019 8:17 PM

    • I understand Medicare has to make changes but the cuts that they propose could put a lot of people out of a job and increase a lot of financial debt. I thought we were working towards creating more jobs and deferring from another recession.

      Posted by Tina Demers on 9/17/2019 8:26 PM

    • In the age of the opiod epidemic to cut those entities that supply the safest and most scientifically proven alternatives for pain management and overall conditioning I question the motives behind cuts. While the government sees dollar signs I see Medicare recipients being ripped off yet again when convient access is stolen. How dare the government opt to line their own pocket books with money paid into by these Medicare recipients only to rob them of benefits. I wonder how those making these cuts sleep at night....perhaps those hours should be spent reviewing the massive research evidence that supports PT benefits. Do the right thing for our paying citizens. It isn't money meant for year end bonuses for making cuts....you don't need that second beach house over someone's care

      Posted by Lindsey Buches-Cann on 9/17/2019 8:29 PM

    • I’ve been the recipient of physical therapy and chiropractic help. P.T. was so beneficial and professional. I’ve seen three chiropractors and was disappointed with each one. We need our physical therapists! There have been attempts to limit physical therapists since the 1980s. Glad to see you working so diligently.

      Posted by Cathy Kranz on 9/17/2019 8:32 PM

    • Should I drop out of PT school now?

      Posted by Cody on 9/17/2019 8:33 PM

    • There is nobility in this profession. We are working above and beyond our means, devoted our lives to our career to help other people and earn a living. We cannot sell ourselves short. There had been many cuts before and healthcare and health worker doesnt deserve cuts. It is not luxury to cut on, this is a necessity. Please give the therapists and patients what they deserve!

      Posted by Ellaine De Guzman on 9/17/2019 9:07 PM

    • I work in home health. The topic of our meeting today was pay cut effective Oct 1. We will get PTA rates on treating patients. I just finished my Doctorate. It’s a blow in the gut why this is happening.

      Posted by Sarah Martee Almis-Lynch on 9/17/2019 10:01 PM

    • An 8% reduction in Medicare’s outpatient PT fee schedule is absolutely insane. PTs are needed now more than ever as debilitating neurolologic conditions exponentially rise, opioid addiction continues to take more lives, and countless unnecessary surgical procedures are performed. Reimbursement cuts like this will close clinic doors, dilute quality, and raise healthcare costs, while propagating an ineffective and broken U.S. Sick Care System.

      Posted by Ashley Lorch on 9/17/2019 10:05 PM

    • Decreasing reimbursement rates is only hurting our communities. Insurance companies need to look at the evidence and realize that the facts point to physical exercise and movement specialists (physical therapists) to provide effective care. PTs are extremely undervalued doctors who have been found to be the second most knowledgeable doctor only behind orthopedic surgeons in treating musculoskeletal issues! Pushing back against a profession that is already undervalued is a terrible idea. If you can answer why surgeons are reimbursed significantly more for certain surgeries that have no scientific support while PTs are reimbursed at embarrassingly low rates with significantly more evidence to support its effectiveness then, and only then can you decrease reimbursement. The real thing that should be done is to increase reimbursement. The only thing that will come of this will be patients being forced to pay out of pocket because PTs will only accept cash. PTs already arent making the money they deserve for the knowledge, effectiveness and time they put in. It's time to listen to the evidence and start giving PTs the money they are worth! The demand for PTs are sky rocketing... but it doesnt matter how many patients need help if reimbursement is only getting worse. This will lead to a tremendous disservice to our communities health, which at the end of the day is the most important part of this conversation. Don't make the wrong decision.

      Posted by Kyle on 9/17/2019 10:26 PM

    • No PT cuts

      Posted by Mary Ahern on 9/17/2019 10:39 PM

    • Physical therapy has helped me with my scoliosis all my life. Now that I’m older it has helped me in my time of acute pain. To cut these benefits from Medicare will make many lives miserable. It’s not right or fair. I’m a retired nurse of 30 years and I have seen first hand of what pt can do to help people.

      Posted by Connie Hosler on 9/17/2019 10:56 PM

    • I am a new grad physical therapist in a SNF/Sub acute setting where our primary concerns are returning individuals safely to home, improving function and reducing readmissions, further complications of comorbidities. Cuts to therapy services would only serve to increase hospital readmissions, opioid use and further hinder the ability to utilize safe, conservative management of medical issues. We need not rely on medications to attempt to solve patient issues. We have seen time and time again what occurs with this mentality and the permanent and lasting damage it has caused in our nation—not to mention the thousands upon thousands of further healthcare dollars spent to care for these individuals affected. With cuts to PT services, we are reinforcing that we as a nation have no desire to prevent declines and readmissions in a proactive fashion, but rather waste more money to work in a reactive fashion. It is a heinous way to function and will not assist in healing the healthcare system in America. We need professionals to keep people at their highest level of function to PARTICIPATE meaningfully in society, as well as improve quality of life for all individuals.

      Posted by Liz on 9/17/2019 11:08 PM

    • Physical therapy is such a proven positive method to combatting age related medical maladies. We cannot allow a system to whittle away the benefits that seniors have come to realize are vital to their mobility and health.

      Posted by Lynda calder on 9/18/2019 2:37 AM

    • We are already towards the bottom of the totem pole when it comes to reimbursement. Why would CMS lower our rates some more? Why are they lowering down the value of our profession when we do so much for the patients?

      Posted by Karren on 9/18/2019 2:48 AM

    • This news is just awful! At this point I am a student getting ready to apply for the PTA program. Now, I'm not sure what to do! I don't want to come into a profession that that is cutting it's employees right out of the gate. I didn't sign up for this, and I surely don't feel comfortable paying for a degree where I'll be laid off, or take a pay cut. I've been in healthcare for 18 years, and decided to go this route because being a Nursing Assistant isn't where I want to be. I want a career where I can finally take care of my child without anyone else's aid. I'll be thinking hard about whether or not I apply for the program!!

      Posted by Sarah Holder on 9/18/2019 6:54 AM

    • While the comments above mirror my own and many others, what every person needs to do is contact their Congressional representative and voice these opinions. APTA (this website) knows this is a travesty. PLEASE write letters/email those who make these decisions, especially those of you that are recipients of physical therapy (they prefer to hear from you, not those of us working in the profession). Thank you!

      Posted by Michelle Criss -> =IU^CJ on 9/18/2019 7:33 AM

    • No more cuts!

      Posted by Tamara Ragon on 9/18/2019 7:59 AM

    • This proposal is soo unfair for the pts age 65 and above and for the PTAs and OTAs

      Posted by Jessy Taylor on 9/18/2019 8:19 AM

    • Do not cut pay for Physical Therapists. The work that they do is very vital to people's health. It is unfair to the Physical Therapists who do such important work to make people better. Better to give them raises. I have benefited from Physical Therapy, and so many more people will need Physical Therapy. I repeat, "Do not cut pay to Physical Therapists

      Posted by Sandra Zellman on 9/18/2019 9:14 AM

    • This is not the best decision to make for the best professionals who provide the best service to the population who will become advanced in their level of function in leading a better life style. This proposal should be definitely reconsidered.

      Posted by Aparajithan Sabapathy on 9/18/2019 9:17 AM

    • Bottom line, with the time requirements for MIPS reporting and continued significant cuts to reimbursement there should be an APTA recommendation to no longer participate with Medicare in our profession until they respect what we do and reimburse for our services accordingly. Maybe that will get their attention because everything we have tried to date has failed.

      Posted by Jon Waxham -> >GP]<L on 9/18/2019 9:55 AM

    • As lower rates trickle down to lower pay, it will push PT's toward "mills". I have been in this field for 30 years and am dismayed at where it's been going. I will not compromise my ethics and need to provide quality care, but I fear that new therapists with their expensive DPT degrees will be forced to. SAD

      Posted by Eden T on 9/18/2019 10:31 AM

    • Cutting funds by 8% is a terrible idea. This is going to force some clinics not to accept Medicare patients at all... making it hard for these people to seek care. Also with the opioid crisis.. why does cutting funds for PT make sense? PT is a safe and effective way to help people manage pain and improve overall quality of life.

      Posted by Hannah Leffew on 9/18/2019 12:19 PM

    • Physical therapy needs MORE funding, not less! It is by far the safest, least invasive form of healing with the least side effects, and already vastly underutilized as is. As a physician assistant, I advocate for PT constantly to my own patients. Do not go through with this legislation!!

      Posted by Andrea Bunker on 9/18/2019 2:20 PM

    • This would be devastating to the profession and patients that receive physical therapy.

      Posted by Dominic on 9/18/2019 2:51 PM

    • I truly get up each day and enjoy what I do. This profession has meant a lot to me and continues to mean a lot to me. There is life changing value in what Physical Therapists do each day. The proposed cut will only limit those who need this skill and this is not a good decision for public healthcare.

      Posted by Douglas Lopeman on 9/18/2019 3:02 PM

    • I don’t like the proposed cuts of 8% and am Holding out hope that APTA will reverse this trend of our pay being reduced instead of increased. Also I do not like the emergence of TPA ( third party administrators) getting involved in our reimbursement with workers comp cases. It’s our profession and we need to head butt these agencies that are taking away our livelihood. Is there anyone in APTA that can stop TPAs ? Do we need a legal representation to take back contracts with wcomp carriers that returns our money back to us instead of the TPA? Why do we allow a TPA that essentially is a mediator take more than 150$ a claim and we get paid 88$ a visit? Someone that knows more than I do should be able to form some type of organization or legal team to stand up together in this

      Posted by Don on 9/18/2019 4:44 PM

    • As a PT I have always believed and worked towards adding “Life to the Patients’ Years, by helping them alleviate pain, gain strength to improve function, prevent falls and to assist them to stay/get back in their own environments. With the reduction in payment and in turn decrease services will affect the mobility of our aging population and increase the overall cost of Medicare. In addition to increasing the cost of healthcare services for the patients.

      Posted by Sucheta on 9/18/2019 4:58 PM

    • As a senior citizen who has had to use PT to help me get back to living a normal lifestyle - and I am sure that down the line I will have to have PT again. PLEASE DO NOT DECREASE THE AVAILABILITY OF THIS IMPORTANT MEDICAL NEED, ESPECIALLY FOR SENIORS.

      Posted by Janet Bromberg on 9/18/2019 5:18 PM

    • Many years ago we decided to go to a cash practice and bill all commercial insurances, OON, except M.C. M.C. paid a reasonable reimbursement within a known time frame with certain parameters to insure progress. It was a formula that worked for us. We got paid up front for all other insurances and we then billed clients' insurances and THEY waited for reimbursement, not us. We are receiving electronic M.C. reimbursements in 14 days now. However, an 8% cut in M.C. would again move the goal posts back for us. We would probably have to go private pay and bill M.C. as a non-accepting provider. The client would pay us up front and they would wait for their M.C. payment. In the end, if you have built a solid niche, and excellent reputation in your community, you can survive on private pay. Your outcomes and service has to be better than clients can get elsewhere in your community, and ours is. This will have to be a way of life for P.T.'s or you'll be buried under rules, regs, decreased reimbursement. We gave up slow, low and no pay from insurers. Now it may come to that with M.C. And that, my colleagues/friends, will be a sad affair indeed to the millions of clients who benefit from our services. But we will do what we need to do to survive, which in my opinion after 40+ years of practice, will be a total cash practice, and electronic billing for clients. We get paid up front and clients wait for their reimbursement, not us. Good luck everyone!

      Posted by Larry Greenberg on 9/18/2019 5:45 PM

    • It is ridiculous that PT has to accept another cut from CMS. We are barely hanging on with business as it is. On the one hand insurance companies are insisting that clients go to PT before they get MRIs etc and we are clearly showing we can help reduce the use of pain medication. On the other hand, they are telling us we are not worth existing costs. It makes no sense. This is certainly not the way to encourage young people to join the profession. Soon, there may be no therapists to absorb the growing population of the aged. Then what???

      Posted by Deborah Cook on 9/18/2019 6:08 PM

    • We cannot continue to accept reduction in payments while cost of living skyrockets. Management has no where else to cut without significantly impacting quality. Private practice to large medical systems will go under and close their doors. It is a true crisis and a revolution of change is needed to support value and pay what is deserving of the service that we provide.

      Posted by Melanie Brennan on 9/18/2019 6:21 PM

    • To the PTAs who feel APTA is neglecting them I’m terms of the new PTA modifier. First of all, if you are upset, contact your respective Senator and Representative since they are the ones that passed this bill, not CMS. CMS is required to implement the change. In addition, APTA can’t stop the modifier from going into effect but can influence CMS with how to implement it and they are doing that. APTA has created templates for members and non-members to complete and submit to CMS. As a PTA, have you submitted your comments to CMS? If no, why? If no, you have until September 27, 2019 to do so.

      Posted by Rick Gawenda on 9/18/2019 6:24 PM

    • Reduction of physical therapy services reimbursement will only create increase cost for surgeries, physician visits and increase risk of medication abuse. As we try to elevate the profession, this proposed change will kill it instead.

      Posted by Geraldine Pentinio on 9/18/2019 7:21 PM

    • Hands on treatment gives the best outcomes. Both financial and physiological. As a clinic owner and practitioner I will be making decisions I don't want to make. But I have to keep our doors open. But for how long?

      Posted by Charles H. on 9/18/2019 7:39 PM

    • I’m so disgusted by the “APTA” and their “Working for You” slogan..For years it should have said, “The APTA, Helping Ourselves by pretending we’re helping our members”. The APTA is supposed to be advocates for and protective of our profession. Instead, they supported and lobbied for the most disastrous health care law in our countries history. Now the PT profession continues to be eviscerated through reduced reimbursements, job cuts and a worsening outlook. Does the APTA plan to cut their salaries by 8% in 2021? While the leadership at the APTA have secure jobs with excellent benefits and great compensation in the Washington / Virginia corridor, the rest of us IN THE REAL WORLD ACTUALLY HAVE TO WORK REALLY HARD TO EARN A LIVING. This 8% pay cut etc. would never be happening if the APTA had actually listened to its paying members that understand how the health care profession functions instead of buying into the propaganda sold to us by our former President who stated, “you could keep your doctor, your benefits would cost $2500.00 less and your health care coverage would increase”. We now know based upon an admission from Obamacare’s architect that this was all a lie based upon the “stupidity of the American people”. Members of the APTA did warn you that this would happen however since you have such nice jobs with paying members, it’s obvious that you don’t feel like you have any real skin in the game. As the profession continues to be affected by dwindling reimbursements and reduced job availability, it is my sincerest hope that the since the APTA did everything they could to lobby for and enact “Obamacare”....THE LEADERSHIP OF APTA should now lead by example and cut their pay, benefits, and professional opportunities so they can demonstrate true leadership by example. It’s time to recognize that this bill which was “SUPPOSED TO FIX HEALTH CARE” has done nothing except continue to hurt the Physical Therapy profession since its inception almost 10 years ago. The APTA should provide true leadership for our profession instead of siding with lobbyists and politicians in Washington that have little or no interest in our Physical Therapy Profession. Can we have some adults that actually understand how healthcare works please take over the leadership roles at the APTA? If not now, when?

      Posted by David Zuflacht on 9/18/2019 8:53 PM

    • This is injustice to PTs and patients. Fewer clinics will accept Medicare which will make it difficult for Patients under Medicare to get the quality care the require.

      Posted by Laurel Boyd on 9/18/2019 9:40 PM

    • If you don’t value the medical professionals that specialize in movement, we will further burden economically our health care system with a sicker, more sedentary population

      Posted by Drew S. on 9/18/2019 10:06 PM

    • You are driving more and more people out of this profession. With 6 figures of student loan debt, there's no possible way that any student coming out of PT school can afford to stay in this profession long-term. The APTA does a miserable job advocating for our profession.

      Posted by J. Wilson on 9/18/2019 10:15 PM

    • Cutting reimbursements will leave people in more pain and less mobile which leads to a more poor quality of life! Many people see value in physical therapy! Please reconsider.

      Posted by Terra on 9/18/2019 10:56 PM

    • Why do people want to cut out things most elderly people use ? Elderly are more likely to fall need this service

      Posted by Carolyn Crowley on 9/19/2019 12:01 AM

    • Ladies and gentlemen PT’s PTA’s and DPT’s. It’s sad that it takes such crisis to wake up and see the problem. As long as we are part of the ancillary group we will always be pushed, undervalued and disrespected like this. Profession has evolved but the practice act hasn’t nationwide. While the state associations are wasting time and money passing dry needling which is not paid or recognized by insurance companies, our rates are being slashed and other professions are stealing our turf. Did you know that Chiropractors are already playing PT’s with just 6CEUs exposure in Physio1&2??? Did you know that we are the only profession that has no loan reimbursement for joining the armed forces and working in rural areas?? Did you know that we are considered “low level providers”? When PA’s with only a masters are considered mid level providers?? Did you know that car insurance companies such as USAA are using Chiropractors to review and approve our cases???? Did you know that private insurance companies use nurses to review and approve our cases?? Did you know that when you call provider enrollment chiropractors have a special line just to process their credentialing?? Meanwhile we are not acceptable in majority of networks since the hospitals have purchased the insurance portion forcing patients to use it within their hospital. Did you know that a RN can invest $40k and within 2 years they can a NP and start making $125k per year??? Did you know that a DPT degree costs between $150-200k?? Hospital salary is $65k. Did you know that BCBS reimburses the same for a PT and a DPT with residency and fellowship?? Did you know that we can’t perform a disability evaluation for a patient in a wheelchair but a speech therapist can??? Did you know that AMA is running a special campaign to smear our hard earned DPT title??? Did you know that hospital systems are sponsoring legislations to enable Athletic trainers to treat and Bill our codes?? This enables them to only pay the ATC’s $20-25/hr vs a PT $35-40??? Did you know that Chiropractors can bill 97140 untimed and manipulate the patient for 30secs and charge and collect the same as we do for 8 minutes??? 97140 is some states is reimbursed at $45. So do the math!!! Did you know that I’m some policies the therapy benefits are shared with chiropractic services?? So if they adjust the patient in AM and u schedule them in PM then u don’t get paid???? DO YOU UNDERSTAND THE MAGNITUDE OF THE PROBLEM NOW????

      Posted by Tom on 9/19/2019 12:52 AM

    • So much money is saved in the long run because of Therapy. We get patients more independent before they return home, after a hospital stay, decreasing the amount of money Medicare has to spend to care for them at home long term. It doesn’t make financial sense to cut therapy. Most therapists I know are drowning in student loan debt and if we have to take a pay cut, they will probably have to find other means to support themselves. Also, schools need to limit how many students they graduate a year because the market is flooded as it is. This is just adding to the student loan problem. Therapy companies will just increase our productivity even more and have us treating patients in groups which I’m already hearing. Most of us already have to be 90-95% productive now. Therapists are burning out and getting injured themselves and patients will get poor treatments. How does this benefit anyone except government?

      Posted by Kim on 9/19/2019 5:00 AM

    • With rate cuts and lack of keeping reimbursement in line with inflation I can’t afford to give PT staff (with doctorate degrees!) raises nor can I afford to provide a high standard of care. PT is the lowest cost to entry in the healthcare market this would be a huge mistake by Medicare. How about targeting the DME market?

      Posted by Sean Lordan on 9/19/2019 7:24 AM

    • PDPM changes haven’t even started yet and my company has already cut PT rates by 5%. Physical Therapists are already significantly underpaid. With continued cuts who is going to want to go through a Doctorate program for a career that won’t support a family or the repayment of a large student loan. It is sad that those in power don’t realize the value of our profession.

      Posted by Dr. Thomas C. Osborne on 9/19/2019 8:27 AM

    • With the majority of the population being the "baby boomers " we need to increase Physical Therapy coverage to prevent more serious long term problems such as fall results, pain medication dependency, surgery, injections, other costly treatments and repeated hospitalizations.

      Posted by Trisha Ard on 9/19/2019 9:46 AM

    • Reimbursement for PT should be growing and not get cut as it is a proven source to reduce pain and eliminate the use of pharm that has contributed to the opioid epidemic! Clearly, cutting reimbursement for PT and conservative care further influences the power that big pharma has over the country. This is the same situation that has prevented many Americans from getting direct access as a primary source for pain. Texas was the 2nd to last state to obtain direct access and only because any politicians who fought against it were portrayed to support opioids.

      Posted by Mark on 9/19/2019 10:13 AM

    • The past 26 years have been a downward spiral for our profession. Maybe payers will wake up when poor outcomes cost them more money. I doubt it. When mediocrity is the norm and patients do not want to pay for quality care. Clinics providing quality care will have to make some hard decisions. Run patients through like cattle or go out of business. I am glad I am at the twilight of my career. I feel for the young grads with high debt. Maybe work the loans off in the military or VA and get out of the profession when you loans are paid off.

      Posted by Charles Hollier on 9/19/2019 10:38 AM

    • Lets call this exactly what it is. Medicare pays insane amounts of money for prescription drugs and allows BIG PHARMA to jack their prices up with no stopping. Their call to create and pay for treatments for those who get addicted to opioids is their cop out to make it look like they care about the "opioid crisis". But do the policy writers and politicians that propose these cuts really care about the opioid crisis? NO. They care about 1 singular thing. TO GET RE-ELECTED. Big pharma has the means to get them re-elected. If they truly cared about the opioid crisis they wouldn't make cuts in the one of the most cost effective, conservative, and health effective ways for treatment (PHYSICAL THERAPY). Its time to wake the public up. Writing to the regulations committee is not enough. We need to show up on capital hill angry, with patients behind us just as angry.

      Posted by Emilio Galis -> BIRaBN on 9/19/2019 12:06 PM

    • If this is going to go through then individuals don't need to go to school to get their DPT. Ending school with that much debt for a salary that does not reflect that much time and effort does not make sense. Also, the world of opioid prescription and chronic pain is growing. PT can make a huge impact and turn with this. Cutting reimbursement for PT will lead to more surgeries, more pain medication, more concern for addiction. PT is just as much a mental outlet for individuals as well. Sometimes the best form of therapy is to talk to someone who will listen along with physical treatment. This is where we come in.

      Posted by Danielle Fuhrman on 9/19/2019 4:51 PM

    • I am totally against any cut! While they try to cut the congress enjoy their Cadillac healthcare plan!

      Posted by Rudy Halbart on 9/19/2019 5:09 PM

    • Patients pay their whole life for their Medicare benefits! First Medicare practically took their right to have good therapy in the nursing home, now they want to ruin the industry and take it away altogether?? Ridiculous!! Therapy is a vital piece of health care. It has helped millions of people who would have otherwise declined to a bed to chair existance! I am a registered nurse and I see firsthand the benefits of therapy!! Shame on you CMS!! LET'S GET MAD AND RAISE OUR VOICES AND TRY TO MAKE A CHANGE!!!

      Posted by Carol Towery on 9/19/2019 5:26 PM

    • I know some folks get confused out there in government land and some times come up with irrational ideas to move money around, either to get reelected or satisfy some lobbiest Thatt said the 8% cut to Pt and other services it covers is a rediculous idea at best.. As an older citizen having access to the programs that this cut will affect is so very important.. You folks in congress have insurance that is the caddy of all programs so I fine your callus attiude in this matter disgusting to be blunt.. what if it affected your parents.. or child how would you feel then.. there are a lot of places you can save money folks and this should not and need not be one of them.. cut the waste by not voting for contracts with companies that rape the voters pocketbooks.. cut the fat in your budgets .. We the voters are watching for sure.

      Posted by Edward Brien on 9/19/2019 6:34 PM

    • Our Medicare fees in New Mexico have already been reduced 16% over the past 10 years. Our therapist is a dedicated manuel therapist who has massive education under his belt and is proficient in craniosacral, lymphedema (the only PT who does so in our rural community), neuromobilization, and visceral, as well as orthopedics. We are really starting to struggle to keep our doors open. This would put us out of business. Physical therapists save Medicare a lot of money by helping patients avoid expensive surgeries, and giving them a better quality of life. Another cut is outrageous! McFal

      Posted by Amy McFasll on 9/19/2019 7:23 PM

    • September 18, 2016 I had an acute ischemic stroke of my right thalamus. It was totally blocked. Only half of it is functional now. Following the stroke I had many high level balance issues which made me a high risk for falls. I was referred to physical therapy for 6 weeks and it drastically changed my balance. Had it not been for the therapy I would not have had such a remarkable recovery. PLEASE do NOT cut funding for Physical Therapy! It is vital for recovery!

      Posted by Mary Blough on 9/19/2019 8:14 PM

    • CMS is cutting our rates because they can. We are a weak profession as a whole, and it is our fault. Everyone wants to complain now because a cut is coming, but where were you before this? We have created this. PT’s working for hospitals, nursing homes, schools, home health, and worst of all, for POPTS!!!! We gave away our autonomy a long time ago. How many chiros work for someone else for 50k a year? Zero. They are all members of their national organizations and they fight and give money. We are at the bottom. You can’t expect a new grad PT on a starting ridiculous salary to give back. We need business minded PTs running the show! We need new grads to realize that this is a career and there is a business component to it, and the fact that we are the best at helping people is a perk. Too many PTs think that it is our responsibility to provide patient care as a Good Samaritan service. We should get paid for what we do so well.

      Posted by Jason on 9/19/2019 9:43 PM

    • Cutting pay rates for PT's will do harm to many people, especial the older patients. I am in my 80's and am very grateful that I was able to have physical therapy several different times in the last few years, which I definitely think has been the reason I am still able to walk and to exercise and to be active, in short, the reason I am able to have a happy life. Also, the therapists have spent years in training and working toward their career in PT. In my opinion, they should have the same payment scale as MD,s. Please reconsider this proposed cut. It is NOT FAIR!

      Posted by Polly Welch on 9/19/2019 10:41 PM

    • One consideration with all of the recent reductions in PT reimbursement. Will therapists be able to afford APTA dues? As a show of good faith and solidarity every cut we practitioners take should be shared by reducing our APTA dues accordingly. Just a thought...

      Posted by Charles Hollier on 9/20/2019 4:26 AM

    • I've had nerve, bone and muscle pain issues for decades and over the years I've seen good doctors quit being doctors, I imagine for reasons similar to this. PT's have never been compensated for what they're worth and they shouldn't be made to take an 8% cut in pay. It's not fair to the patients as well, patients suffer when there are cuts, and over the years there have been more than enough cuts. Getting medical attention shouldn't be a privilege or limited. All doctors should get the respect they deserve and not have to take cuts in their pay.

      Posted by Corine Mitsue Chang on 9/20/2019 6:50 AM

    • Charles, a very good thought, but with a “new” APTA headquarters, the APTA will need every dollar of our dues.

      Posted by Honani on 9/20/2019 11:46 AM

    • I can only think that this is just another way to deprive the American Public of Health Care. If you cannot deliver the Health insurance benefits that you receive as politicians from the American Taxpayers then please step down as you represent nobody but your selves. This is an Absolute disgrace.

      Posted by salvadore J Cannatella on 9/20/2019 12:41 PM

    • I worry about how this will affect patients' access to care. Many PT offices in our area have dropped MC and if there is an 8% decrease in reimbursement we will have to bow out as well. It is illegal for us to see MC patients privately whether we are contracted c MC or not. Where will these patients go?

      Posted by Kristin Corzine on 9/20/2019 2:23 PM

    • I can't think of anything more crucial to Seniors like myself than to have PT available. And it must be made affordable. Preventative care, taking care of our bodies to function fully for as long as possible is crucial. Victoria Karlin, Lafayette Colorado 78 years old

      Posted by Victoria E Karlin on 9/20/2019 4:31 PM

    • As a physical therapist who treats Medicare patients, I have serious concerns with CMS’ proposal to impose a significant reimbursement reduction for physical therapy services in 2021. The cuts, if finalized, will cause a serious financial strain on outpatient physical therapy providers; as demonstrated in Table 111 in the PFS proposed rule, physical therapy (and occupational therapy) providers would see a combined impact of negative 8% in 2021. It is critical that CMS reimburse outpatient physical therapy providers at a level that will continue to allow them to deliver high-quality care to their patients. I acknowledge that CMS must maintain budget neutrality with the fee schedule. However, I do not believe CMS has given thorough consideration to the work and PE requirements for outpatient physical therapy providers. The significant reduction in reimbursement for physical therapy services will result in a decreased workforce and an inability to meet the needs of the Medicare population. Rising debt and shrinking reimbursement provide the perfect storm for discouraging individuals from choosing to enter these professions. Potential shortages would be problematic as the baby boomers reach Medicare age and more individuals seek access to services as health care reform provisions become effective. Don’t hurt our business Don’t hurt our patients Do the right thing and Don’t cut reimbursement for Medicare patients who need physical therapy. Thank you Diana Reiss PT, DPT, OCS

      Posted by Diana Reiss on 9/20/2019 4:32 PM

    • As a speech therapist who works closely with physical and occupational therapists, I see a high value in their services as a stand alone service and in conjunction with mine. The level of training that they require, in addition to the ongoing education they need to keep up with current best practices, is all supportive of a high rate of reimbursement to support their ongoing specialization and quality of care to patients.

      Posted by Heathe on 9/20/2019 6:00 PM

    • PT's must reduce their exposure to CMS patients immediately. Since 2005, the cuts in reimbursement to this profession are well in excess of 50%. At the same time, CMS patients in most outpatient settings usually constitute 40% or more of the patient mix. Continuing to see this case mix is financial suicide. Dr. Brian P. D'Orazio DPT

      Posted by Brian P. D'Orazio on 9/20/2019 6:17 PM

    • I see this as mainly oppression to our older population who needs physical therapy treatments more than anybody else. Medicare patients should get more not less CAP, here in New York I've seen a lot of doors closing out on Medicare patients and going for out of network or cash base practice. It breaks my heart for our baby boomers...

      Posted by Maria Yabut on 9/20/2019 7:03 PM

    • Deja Vu! I was a student in PT school soon to graduate when the balance budget act decimated our profession around 1998. As I agree with Jason that it is our fault for a weak profession. I completely disagree that the business model for healthcare that Jason describes; Chiropractic medicine, is the correct direction. Jason, do you really think the chiropractic profession has it together with insurance companies? They are reimbursed worse than us with Medicare, why do you think some of them try to entice a PT to work in there office? Do you think “business healthcare” is the direction we should go?....like hospitals being managed by private equity firms cutting all the staff to the level of deficiency and maximizing their profits? My private practice of over 13 years is a Medicare part b only faculty because private insurances reimburse less than Medicare....therefore this 8% cut will drastically kill my practice. Other alternatives, step out of Medicare gracefully and find a method of reimbursement from Medicare patients that keeps me legal, keeps me living, and keeps my integrity with the community in which I live and work. We are only worth what our patients see in our effectiveness. If you work in a busy practice seeing multiple patients at once and thinking you are serving your community well...you are living a delusion...try working one on one and really putting your education into taking care of the patient in front of you. I hope the APTA puts out an article about surviving continued cuts in Medicare and provide helpful advice to providers instead of wasting their time with sending letters and talking with Congress people (I know we must try but...). Congress and government agencies are all corrupted by special interest and money of special interest which our profession has neither. I love being a Physical Therapist and I will work to find a way to continue to practice with integrity despite our profession, professional organization, and insurance companies.

      Posted by James on 9/20/2019 8:35 PM

    • PT is a special profession without which many Medicare beneficiaries are not going to fare well. We are in the midst of the greatest medical crisis in the history of western medicine on multiple levels from obesity to opiods. Now is not the time to cut benefits CMS. Our seniors will suffer the consequences since many exclusively rely on Medicare to meet a multitude of thier medical needs.

      Posted by Comet Mekonen on 9/20/2019 8:56 PM

    • Reducing physical therapy is detrimental to helping people regain their mobility. The less able people are, the more they decline and become more dependent. I should think we would be working towards more INDEPENDENCE. Ultimately, the independent ones contribute more than the people who have not been able to fully recover. Penny wise and pound foolish.

      Posted by Rusti Leivestad on 9/20/2019 10:42 PM

    • This is outrageous! I am currently going for physical therapy for a knee injury. I didn't think it would ever feel right again, let alone have good mobility. But through my therapy I am doing great. I didn't need an MRI or costly knee injections, which only work temporarily. While going for therapy, I saw many older adults doing therapy for knee replacements and from other various procedures. These people were working hard to get their mobility back and their quality of life back. If we make cuts it will impact their access to these therapist. Which will impact their other healthcare. If older adults can't move around they don't get exercise and will become sedintary. This will lead to even bigger Heath issues for these adults. So, please reconsider these cuts, because physical therapy provides an invaluable service to these patients!

      Posted by Joan Greenwood on 9/21/2019 8:12 AM

    • Our patients need our services and these cuts would be detrimental to them. We are an important aspect to help keep patients moving and out of the hospitals and rehab facilities.

      Posted by Jennifer DeMaria on 9/21/2019 10:25 AM

    • The requirements to get involved in Physical Therapy have become more strict and require higher level education compared to just a few years ago. The 8% cut will diminish the Career Outcome for those employed through Physical Therapy. How can you justify reimbursement cuts when it is becoming harder and harder for individuals to get involved? I am a current student that is sincerely worried about my Career Outcome, due to these policy changes. When a plane is going down, we know that we must secure our own oxygen mask before assisting our loved ones. Based on these reimbursement changes, our “oxygen mask” is placed further away from us. Our ability to care for and treat patients will be impacted by these changes.

      Posted by Reilly D. Sullivan on 9/21/2019 5:49 PM

    • As a physical therapist I have seen the struggles my patients go through with getting the help they need. I also have seen how this translates to the care that we can offer. People struggle for good care and it is. With cuts like they're proposing everyone loses; patients, clinicians and clinics.

      Posted by Esther on 9/22/2019 12:38 AM

    • Please re-consider this proposal. Not good for physical therapy profession and not good for patients. This is not a way to promote quality care.

      Posted by Robert on 9/22/2019 8:37 AM

    • Physical Therapy is wonderful for all ages. Cutting it would mean cutting PT's Do not do this

      Posted by Beverly Carter on 9/22/2019 12:14 PM

    • If CMS truly wants to cut costs, they should be flowing more money to conservative treatments, such as physical therapy, not cutting it. Physical therapy has a proven track record of decreasing overall health care expenditures. In addition, allied health services only account for roughly 2.6% of CMS expenditures. In order to fix our broken healthcare system, we need to put much more focus on conservative treatments and start cracking down in invasive and expensive medications, injections, surgery, and diagnostic imaging which are often times not necessary.

      Posted by Daniel Hinnerschitz on 9/22/2019 2:44 PM

    • As a physical therapist and baby-boomer, I believe this proposed 8% cut to physical therapy in 2021 will be tragedy for providers and Medicare benefactors. I will not accept this proposal. Today, I began my search for a new presidential candidate for 2020, who will lead and make healthcare a priority for this nation, have congress address our current sick healthcare system and have CMS implement a Physician Fee Schedule that will be equitable for providers and keep our services accessible to all. I believe the 2020 election will be my/our chance to make change and begin a new era, with a healthier healthcare system.

      Posted by Chief on 9/22/2019 5:50 PM

    • My name is Reilly Allen and I am a student Physical Therapist Assistant. For as long as I can remember I have always wanted to help people, I never knew the specific avenue I wanted to take, just that I was excited for the day where I could help others live the best life possible. I was eventually referred to a PTA program in my area and was fortunate enough to be chosen as one of its students. Even though the program has just started I am learning everything I can while eagerly awaiting the day I can help others while also supporting myself and being a benefit to society. I can’t wait to start providing my help to my community as soon as possible and finally feeling like I have some agency and financial freedom in my future endeavors. I am now worried though that because of these new changes to PTA reimbursement I will struggle significantly with my aspirations before I've even begun.

      Posted by Reilly Allen -> DLVZEH on 9/22/2019 7:30 PM

    • The profession is already taking cut with part B reimbursement for 2020 for PTA’s. 8% is significant, this would effect patient care, some clinics near me have already stopped taking Medicare, I fear this would cause other clinics to follow suit. If more clinics stop accepting Medicare, some areas maybe very limited in serving this population.

      Posted by Kimberly Sharp on 9/22/2019 7:49 PM

    • This 8% cut will put even more unrealistic pressure on current therapists and overall result in a downfall in the community. Patients will lose access to therapy, a proven cheaper and safer medical option, and this is not a win. This will be detrimental for many of our patient populations who benefit from therapy the most.

      Posted by Allison McKenna on 9/22/2019 8:41 PM

    • The services provided by the occupational therapy assistants and physical therapy assistants are no less than those provided by the therapists. We work as a team and to reduce the fee for one provider suggests they are less involved in the critical thinking and application of care. Please continue to accept the same fee schedule for both types of providers.

      Posted by Nancy Krolikowski on 9/23/2019 7:05 AM

    • Physical Therapy provides a critical piece in a person's ability to stay safe,healthy, and independent over a lifetime. Cutting PT reimbursement will diminish the level of service needed to provide the quality of care needed to keep people close to their family and close to their home and will ultimately increase cost for the healthcare system and for individuals. Please do not cut reimbursement.

      Posted by Kathleen Lauer on 9/23/2019 9:05 AM

    • This is bare bone compensation, if I call any contractor to perform work(electrical, plumbing, HVAC, trade skill) they charge anywhere from $125-$150/hour and they do not have degrees like we do!! This is absurd that people (therapist) who help patients and population get better suffers like this. Not a smart move!! Also giving new generation a false hope that therapists are in very high demand.

      Posted by Mehul Vaidya -> @FT[>I on 9/23/2019 3:44 PM

    • This is why we need physical therapists elected to the US senate and house. Until we can better play the game of money and politics we will continue to have problems such as this. Last I looked there are 16 MDs in the US senate and house. We have 0 physical therapists. The APTA needs to identify individuals who want to run and support vision 2020 and then put resources behind them.

      Posted by Bob on 9/23/2019 7:26 PM

    • I was in a car accident (rear ended and received a concussion) and my physical therapists have been invaluable in supporting me as I treat the symptoms after the accident (vestibular and pain throughout my back/shoulders/neck/etc) with exercises and a treatment plan focused on long term health. Supporting PTs is supporting people in every walk of life get their life back!

      Posted by Alexia Lee on 9/24/2019 12:14 AM

    • PTs have a high education and this does not seem right or fair. Patients need physical therapy and we do not want this profession to die.

      Posted by Daisy on 9/24/2019 10:58 AM

    • Cutting Medicare benefits for PT and OT will dramatically affect so many (not only patients but those that serve our seniors). Many patients benefit from PT and OT for pain mgmt (without medications) and improving functional act's so that patients can remain active and contributing members to society. Many of my clients are caring for their grandchildren and the help PT can give them is so valuable. Many of my clients are still working or voluteering, thanks to help from PT. Cutting reimbursements will limit my ability to provide one on one care and education (I do not use aides) and I provide DN (extensive training and education) to provide these highly skilled services (which you do not want to reimburse fairly). I am able to keep my patients active, healthy and able to deal with pain in healthy sustainable ways (without medication). I would welcome the opportunity to talk to you in depth about how I run my clinic and how a clinic should be run. I have been practicing 30 years and I can tell you I have seen quality in healthcare decline over 30 years due to insurance driven reimbursements.

      Posted by Kimberley Holt -> >GU\? on 9/24/2019 12:15 PM

    • Please reconsider this 8% cut. Older populations needs PT so does everybody any more. This is just going to frustrate our patients even more because they are not receiving the care they need.

      Posted by Suchitra Menon on 9/24/2019 12:57 PM

    • Most of us have been through cuts in therapy services. We know this is not showing real and long term solutions but a move toward regression and counterproductive.. I had higher hopes that some of the new people would have sensible long term solutions but highly disappointed in seeing more of the same failure of our government.

      Posted by Brad Love on 9/24/2019 1:22 PM

    • My 16 year old son was able to avoid knee surgery for a PCL tear by doing intensive physical therapy. He has fully returned to sports and did not need to have surgery and risk becoming addicted to addictive pain medication.

      Posted by Amy Low on 9/24/2019 4:04 PM

    • Referencing the Fact sheet paragraph 2 of Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2020- it states “create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.” Physical therapy is all the above: innovative, quality, more affordable and empowers the patient to improve there quality of life without surgery or pharmaceuticals. Don’t make cuts that contradicts what CMS strategies are for our Healthcare System. Physical therapy is a valuable tool for multiple conditions: neuro, ortho, women’s health, lymphedema, sports, wound care and the list goes on.

      Posted by Andrea on 9/24/2019 7:48 PM

    • As a Doctorate of Physical Therapy student, this concerns me deeply. Medicare patients benefit the most from physical therapy. Cutting reimbursements means they may not be seen as frequently as they may need to. As someone going into this field, I see the benefit it has on the older adult population. I am very disappointed that this cut was proposed as it is a major disrespect to our senior citizen population, to our profession, and to those who need PT in order to function again properly.

      Posted by Noman on 9/24/2019 9:50 PM

    • As a Current Physical Therapist Assistant Student at Bishop State Community College, this is very concerning for me and my peers. We are currently in our fifth week of school and everything is obviously challenging but has been going well. I am not sure what my future holds but I would love to pursue my career in inpatient.

      Posted by Laken Lambert -> DLW\AK on 9/25/2019 12:01 AM

    • This 8% cut to physical therapy is not looking out for patients number one interest, getting better and living an active life. I urge you to reconsider. 8% cut means less pay for companies, therapists, and in turn less individuals seeking the field. Which of course finishes with quality care being harder to come by for those who need physical therapy.

      Posted by Dylan on 9/25/2019 9:41 AM

    • This is not right. Cutting reimbursemnt will effect the bottom line for so many people, especially with the cost of living increases.

      Posted by Catherine on 9/25/2019 2:41 PM

    • This is a slap in the face of assistant ls. We are licensed professionals and with the burnout on DPTs, Assistants couldn't be more needed to facilitate case loads. These cuts will lead to eventual layoffs and most importantly quality of care for patients will be highly impacted.

      Posted by Harrison Shuneh on 9/25/2019 3:06 PM

    • It has been proven, scientifically, time and again that physical therapy has the potential to treat a variety of patient conditions for the long term. Unlike pharmaceuticals or surgery, it is cost-effective and provides long term results in the least invasive and most comprehensive way. Less and less people are opting for surgery and drugs as their first choice and treatment, and in a society that is experiencing aging along with lifestyle changes that contribute to a greater need for more therapy, cutting funds goes against everything Medicare is supposedly for. If nothing else, physical therapy saves healthcare thousands of dollars per patient because if that patient decided to have surgery instead or long term pain management through pharmaceuticals, it would cost much more and would be less effective. Cutting reimbursement for physical therapy would only strain everyone involved in the profession, including citizens of the country.

      Posted by A on 9/25/2019 3:51 PM

    • No more cuts!

      Posted by Deborah Magnani on 9/25/2019 7:05 PM

    • I am an Occupational Therapist who works with aging adults. I have worked in urban and rural areas and the thought of therapy getting more cuts it is a scary thought. Our customers will suffer so much from lack of services needed for quality of life and well being. We need to advocate for our profession and skills in order to help our patients and their caregivers. We need to stay strong and keep fighting for what right

      Posted by Aili Filippi-Johns on 9/25/2019 7:07 PM

    • The profession of physical therapy is going downhill. Seeing these reimbursement cuts is slowly going to force any small private practice out of business. Not only will we see a decrease in payment by 8%, but if you employ PTAs, there will be an additional 15% reduction in payment. Soon enough, PTAs may become obsolete. Then after that, private practice may be driven to the point of not accepting Medicare patients, and how long can a small practice survive without Medicare? I'm sure some can withstand it but at what cost? Laying off employees because private insurance reimbursement rates are not that great either. Soon enough, physical therapy will be physician owned clinics, and it is only a matter of time before CMS decides to attack physicians and physical therapy. We have to take a stand. I love this profession, and I wouldn't change my career path, and it is sad to see it go this way, especially when I have a LONG way to go till retirement.

      Posted by Robert on 9/25/2019 8:06 PM

    • I support OT, PT, and ST.

      Posted by Christina Smith on 9/25/2019 8:21 PM

    • Physical Therapy is the most cost efficient method of patient care. No other specialist enables patients to treat, prevent and heal themselves. Virtually the most non passive method of treatment.

      Posted by Pam on 9/25/2019 9:20 PM

    • I am a licensed PTA. I’ve been treating for 19 years giving people the skilled care they need to return to life and function without medications. I educate, instruct and provide the best care I could to ensure that all of my patients, no matter the payor, receive the care they need. We are an I tegral part to people’s well being. Stop the pain meds, choose PT!

      Posted by Stephanie on 9/25/2019 10:58 PM

    • Just look at what cutting reimbursement rates has done to physicians and you have your answer Medicare! Average of 8 minute pt contact nationwide, significant increase in malpractice cases mostly due to insufficient time to properly examine the whole patient and perform adequate chart reviews. Lack of availability in skilled clinical time and instead of seeing 10-20 patients a day, having to see 30,40,50,60+ patients a day to make the same amount. Cutting reimbursement rates is not investing back towards the patients who have paid their fair share all through out their working days and it directly decreases quality of care. Physical Therapists do not have the luxury of spending less time with their patients. I, like many others personally provide direct hands on treatments during most of my sessions and for most cases I wish I had more time to work with my patients and so do they. I wish I could see some of these patients 4-5x/week rather than 2-3x/week. Increase!, do not decrease, our reimbursement rates. Promote conservative treatments, promote life style changes, promote health with less pharmaceutical intervention when possible. Evidence based research has proven over and over again that our profession is incredibly successful in injury prevention, reducing re-hospitalization, reducing fall risks and decreasing acute, subacute and chronic pain. All of which save you more money than perhaps any other profession within the healthcare field. Physicians appreciate the lengthy times we spend with these patients. We are right there at the front lines, detecting red flags, getting to know the whole patient, providing direct and accurate recommendations to physicians and other primary providers. I just don't understand why any institution would not want to invest more into our profession.

      Posted by Logan Gorgulu on 9/25/2019 11:17 PM

    • I want to be in this profession to best serve my patients. However, this budget cut will very likely hinder my ability to do this for a number of reasons. First, this will create a barrier to care for patients since facilities will very likely limit the number of Medicare patients they take into their clinic. There is already a substantial problem for quality facilities for our geriatric population Thus, by limiting the compensation is going to worsen this issue as it is already not easy to stay in business as a health care facility. Secondly, this would influence the pay for physical therapists, potentially discouraging students like myself to go into geriatric care. The most fair action is to NOT cut compensation to this population. We need to respect the geriatric population by financially supporting both the professionals and the facilities that are trying to best take care of these Medical recipients. Melody K. Mo Student Physical Therapist CSU Fresno

      Posted by Melody Mo -> DLT`?K on 9/26/2019 1:14 AM

    • Cutting is the opposite way we need to go! With the aging population Geriatric care will continue to grow. There is already an Opioid epidemic. Less PT means more Opioids for pain. #ChoosePT

      Posted by Adrienne B on 9/26/2019 8:23 AM

    • As a recent grad, it feels as if we’re not getting a fair chance to treat our patients to the best of our ability if we’re being limited. This cut would greatly affect our POC’s and our chance to improve our patients back to their PLOF and achieve goals they never thought they would be able to. As a PT who is just beginning his career if feel as if I’m already behind the 8 ball trying to learn and educate on the go and this is something that is making it even harder for me to grow and expand my career.

      Posted by Rob Anderson on 9/26/2019 8:28 AM

    • This consideration to cut payment in Physical Therapy is short sighted. As people age they need desperately to maintain their function and independence. This is what PTs do. We help people maintain a lifestyle that is preventative so many healthcare expenditures. If more PT clinics drop Medicare who will help that population? The diabetic who has knee pain who could be helped but instead becomes more sedentary has complications with her disease and ends up with a high risk surgery. This is one example but I see Medicare patients daily who I have helped keep them running, hiking, babysitting the grandkids. These are vital life activities that keep them healthy mentally and physically and reduce higher cost medical interventions.

      Posted by Rebecca on 9/26/2019 8:34 AM

    • NO MORE CUTS! We deserve better, our patients deserve better, and this country deserves better. What will happen when PTs aren't given their fair wages and are forced to not accept Medicare? Our patients will be left in the dust when instead they should be getting our treatment!

      Posted by Isis M. on 9/26/2019 9:20 AM

    • Physical Therapy is the most cost efficient method of patient care. No other specialist enables patients to treat, prevent and heal themselves. Patients deserve to have the choice of PT instead of pain medications.

      Posted by Abraham Perdomo, PTA on 9/26/2019 10:59 AM

    • Please tell consider the reimbursement rates. By decreasing them would decrease care along with job opportunities, and not to mention putting a serious strain on my business.

      Posted by Jamie Rockwin on 9/26/2019 11:47 AM

    • Would the politicians who are proposing this bill take a cut in their salary as well? We get less service from them and have to pay for it. I believe when they eventually need these services, they may not be available. Hurts doesn’t it!

      Posted by Dale Piacentine on 9/26/2019 12:47 PM

    • You are killing the practice, proofession and livelihood CMS. What is more left for our practice. We offer skilled PT services treament to our elderly and it’s all hands on. Every minute we provide is a one on one and personal approach. We don’t see patients just 2-3 minutes and charge for the whole fee. Also, you are depriving elderly people of the care do they deserve. Go ask the patient’s in nursing home, hospitals and outpatient what do they look forward in a daily basis? THERAPY!. The reason, we care! For the most part we are their liason to other helath care professional and we are able to determine a problem 95% of the time before other fields does because we listen and we spend quality time. Without mobility there is no improvement. Without therapy, rest assured your budget will further deplete providing respite care and treating chrinic health problems. Therapy offers prevention and early recognition of the disease even before they become fully blown. I do hope you (CMS) will think about this move multiple times. We are all going to get old and we all deserve to have a therapy standby benefit that is there to help us and not limit us.

      Posted by Niccolo Panlilio PT, DPT on 9/26/2019 6:14 PM

    • Patients deserve the best healthcare and cutting costs will hurt them tremendously! PTA’s were created for a reason: to help and assist the PT in providing exceptional service and therapy to patients.

      Posted by Chloe Stone on 9/26/2019 7:56 PM

    • I have been a practicing PTA for 15 years, and have seen my pay cut drastically the last 7 years. An associates degree in Nursing (RN) being cut the same as a PTAs, wouldn't even be considered by CMS. In SNFs LPNs are used as Nurses even though they don't even have a college degree, its a certificate. CMS could save by reducing their pay. I worked hard for my Associates of Science in PTA degree license, years of CEUs and yearly state license fee, $120.00( the same as a PT/DPT) Who is going to pay for me to go back to school; have a new career? Without physical therapy, our patients will fill the long term care facilities instead of going home. So, CMS why are you planning to pay more for seniors (or younger individuals with brain injuries, nerve impairments...) to be permanently disabled, laying in bed, covered in their own feces all day, at a cost of $16,000.+ per month? SNFs already are not reimbursed enough physical therapy to rehabilitate its patients. Where I work, the rehab companies are already starting to hire, CNAs (restorative aids) to replace PTAs, even though it would violate our practice act. Its an insult to PTs and PTAs, not to mention inhumane for patients who will have no quality of life.

      Posted by Paula P Mo on 9/26/2019 9:23 PM

    • My name is Laken Lambert, As a Current Physical Therapist Assistant Student at Bishop State Community College, this is very concerning for me and my peers. For as long as I can remember I have always wanted to help people. Even though the program has just started I am learning everything I can while eagerly awaiting the day I can help others while also supporting myself and being a benefit to society. I can’t wait to start providing my help to my community as soon as possible and finally feeling like I have some agency and financial freedom in my future endeavors. I am now worried though that because of these new changes to PTA reimbursement I will struggle with my aspirations before I've even begun. We are currently in our fifth week of school and everything is obviously challenging but has been going well. I am not sure what my future holds but I would love to pursue my career in inpatient.

      Posted by Laken Lambert -> DLW\AK on 9/26/2019 10:18 PM

    • I LOVE my work. I LOVE working with my patients. I LOVE seeing the progress that my patients make with therapy. Without therapy and with the cut backs, the patients are losing out in the long run. Patients will decline without therapy or be limited with their progress as I perceive. I worry about the outcomes on the patients. I worry about the direct care for each of them. I care about who I see and how they are treated. Please refocus and think about the patients so they can recover and reach their highest level of function. This is what therapy is all about, quality care is what everyone deserves.

      Posted by Theresa S on 9/26/2019 11:01 PM

    • As a PTA student, this information is very alarming and concerning. I am spending money, time, and energy in getting myself through the COS PTA program so I can have financial stability for myself and my family. I believe this 8% cut to physical therapy will do more harm than good.

      Posted by Paul Hansen on 9/27/2019 2:47 AM

    • PT is needed after many medical treatments. It is sorely needed to get back to a normal life.

      Posted by Ed on 9/27/2019 7:20 AM

    • I have been a PTA for 9 years. I love seeing the progress my patients make on a daily basis. Giving my patients an improved quality of life is so rewarding. I see less falls and fewer hospitalizations with in the medicare population who attend PT. If these cuts are made the hospital visits and stays will exponentially increase. These cuts will not only increase hospitalization costs but also decrease the quality of life in the Medicare population.

      Posted by Amanda Clement on 9/27/2019 11:34 AM

    • I am a recent physical therapist assistant graduate and work in an outpatient orthopedic setting. In this clinic, we treat a high Medicare population, all of whom benefit significantly from the treatment provided under our care. I have had the pleasure of working with patients managing a wide variety of conditions, including and not limited to orthopedic surgical post-operative care, deconditioning due to age-related illnesses and hospitalization, and osteoarthritic progressions limiting patients’ ability to participate in their necessary ADLs and desired recreational activities. Through the manual therapy techniques, therapeutic exercise, neuro-muscular reeducation exercises and therapeutic modalities utilized in our treatments, we are able to improve our patients’ functional mobility and safety, and therefore their quality of life. If this billing cut progressing and is approved, my job will be affected, our clinic will be affected, and our patients will be affected because they will no receive that they deserve and require.

      Posted by Alexandra Stech on 9/27/2019 12:58 PM

    • My brother is a PT and he is relied on by the majority of the community around Denver CO, his days are filled with a variety of people needing his assistance to get back to work, heal from a surgery/injury, or prevent future injury from happening. Minimizing the funding for people to go and receive care from him as well as the many other amazing PT’s across this nation is wrong Reducing funding for access to physical therapy is a mistake with the increasing elderly population of our nation and the health of our nation’s overall population moving forward

      Posted by Bryan w on 9/27/2019 2:49 PM

    • As a PTA student, this concerns me tremendously! Not only because of the job availability, but because of our patients. PTAs work along side the PT to provide the best care to the patient. If this cut were to be made it would not only hurt the profession but decrease the quality of life of our patients!

      Posted by Madeline Willis on 9/27/2019 4:11 PM

    • One of the main goals all physical therapists share is striving to help others help themselves. A cut like this may negatively impact future students to want to become physical therapists. The more therapists we have practicing the more people we can potentially help, therefore this cut may decrease our ability to help as many people as possible!

      Posted by Tess Humberston on 9/27/2019 4:52 PM

    • Many Medicare patients are in desperate need for therapy and would not progress and lead independent lives if they didn't get the therapy they needed. It would be a detriment to our older population to make cuts to their benefits they deserve. 8% cut would impact them negatively....would you like to do that to your mother or father? I don't think so

      Posted by Christina Lewis on 9/27/2019 5:14 PM

    • These Medicare cuts will cut into PT businesses and drive up costs in hospitalization stay. Physical Therapy helps patients return to their ADLs and to be able to function independently. Hospitalization will cost more for medicare to pay in the long run. Doesn't make sense. Eleanor O'Connell, PTA

      Posted by Eleanor O'Connell on 9/27/2019 5:41 PM

    • I am a current DPT student and this is alarming. After finishing my first clinical experience this past summer, and working with Medicare patients, this cut is doing them and others a major disservice. The physical therapy profession is aimed at serving others, and helping them get better. A cut in resources means people that need therapy won't receive the proper standard of care they require. This will diminish their overall standard of care, which leads to a decreased quality of life. Also, I would like to be reimbursed appropriately for services after I graduate school. School is not cheap, and I'd like to not add additional years for my loan repayments. Along with the cut, there will most likely be a drop in applicants to PT programs due to loan vs. income discrepancies. In short, this cut will be negatively affecting real people, not just numbers.

      Posted by Ashlie Brewer -> DKT`DM on 9/27/2019 6:13 PM

    • I am a current DPT student and this is alarming. After finishing my first clinical experience this past summer, and working with Medicare patients, this cut is doing them and others a major disservice. The physical therapy profession is aimed at serving others, and helping them get better. A cut in resources means people that need therapy won't receive the proper standard of care they require. This will diminish their overall standard of care, which leads to a decreased quality of life. Also, I would like to be reimbursed appropriately for services after I graduate school. School is not cheap, and I'd like to not add additional years for my loan repayments. Along with the cut, there will most likely be a drop in applicants to PT programs due to loan vs. income discrepancies. In short, this cut will be negatively affecting real people, not just numbers.

      Posted by Ashlie Brewer -> DKT`DM on 9/27/2019 6:14 PM

    • As a current student I am still trying to figure everything out and going through the works considering I just started. I feel that physical therapy is one of the best if not the best way to get a patient back out there and being able to do their daily tasks that they once have before. It's a good way to be able to communicate with people and encourage them to push through the pain. I've always wanted to be able to help people and push them through to their goals and expectations. Now with this cutback I have a fear and doubts about my future career before it has even started.

      Posted by Cody Hodo on 9/27/2019 6:36 PM

    • Dear Administrator Verma: I am writing in response to the request for comments on the Centers for Medicare and Medicaid Services’ (CMS) Calendar Year (CY) 2020 Revisions to Payment Policies under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B proposed rule. Purpose can sometimes be hard to find. It isn’t discovered over night or revealed right in front of one’s face. I believe that finding purpose comes with both good and bad experiences, hard work, and prayer. I thought I was struggling to find my purpose, but really I just had to see that what I love to do is in fact, my purpose. I love to help others and be active. A career in physical therapy is an opportune profession to fulfill my purpose. I am currently pursuing a degree as a Physical Therapist Assistant at Jefferson State Community College in Birmingham, Alabama. I am in my second semester and will graduate in May 2020. There have been several motivating factors that have led me to pursue the profession of a physical therapist assistant. Since I was thirteen years old, I have spent my summers volunteering at a camp for individuals with special needs. As a PTA, I know I will work with special needs patients throughout my career, and I want to help them reach their full potential, adapt and overcome, and to truly be happy -- despite their physical limitations. Another motivating factor that has led me to pursue the profession of physical therapy is my athletic background. I have played multiple sports since I was four years old including softball, soccer, basketball, volleyball, and cheerleading. I was a three sport athlete in high school, played collegiate softball, and professional softball. After being so active and health conscious for the majority of my life, I thought I was invincible until I discovered a pars fracture in my lower spine that put my active life on pause. During my several months of rehabilitation I saw the many benefits of a career in physical therapy firsthand. I observed how they treated me and other patients with genuine care, how they worked as a team, and how they share their knowledge with others. I am very grateful for the athletic abilities that God has given me, and even more grateful that physical therapy is an option to help me and others continue doing what we love to do, even when adversity arises. I believe that my years of various experience have given me the skills and qualities to be a successful PTA. I have developed strong communication skills, dedication, and discipline. I consider myself a leader, both vocal and by example. I want my voice to be heard so that I can continue to be an example. As a Physical Therapist Assistant student, I appreciate the opportunity to provide feedback to CMS on the proposed rule. Specifically, I am writing in response to CMS’ proposed application of the CQ/CO modifier when outpatient physical therapy and occupational therapy services are furnished in whole or in part by a physical therapist assistant (PTA) or occupational therapy assistant (OTA) and how this policy, if finalized as proposed, will negatively affect Medicare beneficiary access. If this proposal stands, access to vital outpatient physical therapy services will be at grave risk. Proposed Payment for Outpatient Physical Therapy and Occupational Therapy Services Furnished by PTAs and OTAs The proposed policy will negatively impact the quality of patient care and patient access to physical therapist services. The PT-PTA model allows for high quality, low cost physical therapist services. With this model, physical therapists evaluate, differentially diagnose, and develop a physical therapy plan of care. Physical therapist assistants carry out the plan of care through skilled assessment and interventions. Physical Therapist Assistants (PTAs) complete higher education programming that results in degree completion and the ability to obtain certification or licensing in the state in which they are practicing through successful completion of a National Board Examination. PTAs are healthcare professionals who are the only professionals qualified, outside of the physical therapist to provide rehabilitation services that require physical therapy interventions. Below are concerns regarding the reduction in payment for services provided by physical therapist assistants: • This policy will result in overutilization of physical therapy technicians/aides. Only physical therapists and physical therapist assistants have the educational training to provide skilled physical therapist services. Overutilization of physical therapy technicians/aides will negatively impact patient outcomes and increase risk of harm to patients. • This policy will result in reduced access to care which will delay the delivery of care, resulting in increased risk of harm to patients and negatively impacting patient outcomes. It is imperative that patients access physical therapy in acute stages of healing to reduce chronic pain and long term disability. • This policy will result in layoffs. Fewer providers will be available to see patients, particularly in rural and underserved populations. Impact of Policy on Rural and Underserved Areas Access to health care services is critical to good health, yet Medicare beneficiaries, particularly who reside in rural areas, face a variety of access barriers. Access to physical therapist services in rural, medically underserved, and health professional shortage areas often depends on the availability of physical therapists and PTAs. Payment decisions that limit the provision of services by PTAs are even more detrimental in rural health care. Physical therapists and PTAs often work as a team to ensure early and uninterrupted access to care. A physical therapist evaluates the patient, develops the plan of care and treatment goals in collaboration with the patient and family, and may engage a PTA to deliver some of the necessary interventions. This team approach is even more critical in rural areas, where a physical therapist may need to cover a larger geography. Working together with a PTA, the physical therapist can ensure that the patient’s care is not interrupted when the physical therapist needs to evaluate and/or update the plan of care for a patient in another location. Unfortunately, the 15% Medicare PFS payment reduction for services furnished “in whole or in part” by the PTA will have a detrimental impact on the ability of rural physical therapy providers to continue to deliver care. The payment reduction coupled with application of the geographic indices will unfairly penalize providers in rural, medically underserved, and health professional shortage areas. Moreover, the 15% reduction will be on top of payment reductions in rural areas resulting from the fee schedule’s geographic indices in addition to the reduction imposed as a result of the multiple procedure payment reduction (MPPR), which reduces the practice expense RVUs for physical therapist services. Access to medical care is already dwindling in rural localities. Physical therapists and their assistants play a crucial role in bridging these gaps in access to care. But the therapist assistant payment reduction puts the financial viability of rural physical therapy practices at risk. Absent action by CMS, the therapist assistant payment reduction will exacerbate the growing problem of limited access to medical care throughout much of rural America. Thank you for the opportunity to comment on the CY 2020 Medicare Physician Fee Schedule and QPP proposed rule. Sincerely, Jenna Charnock Student Physical Therapist Assistant (SPTA)

      Posted by Jenna Charnock on 9/27/2019 6:42 PM

    • As a future PT, I am concerned with the idea that I may have to choose between fair compensation and providing care to all populations. Cutbacks force healthcare providers to navigate an ethical dilemma which isn't necessary. Additionally, the PT & PTA professions provide valuable prevention, early detection of impairments that could lead to much more debilitating and costly conditions. No cuts.

      Posted by Stephanie Soleil on 9/27/2019 9:02 PM

    • September 27, 2019   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   Submitted electronically   RE: Medicare Program; CY 2020 Revisions to Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Medicaid Promoting Interoperability Program Requirements for Eligible Professionals; Establishment of an Ambulance Data Collection System; Updates to the Quality Payment Program; Medicare Enrollment of Opioid Treatment Programs and Enhancements to Provider Enrollment Regulations Concerning Improper Prescribing and Patient Harm; and Amendments to Physician Self-Referral Law Advisory Opinion Regulations [CMS-1715-P]   Dear Administrator Verma:   I am writing in response to the request for comments on the Centers for Medicare and Medicaid Services’ (CMS) Calendar Year (CY) 2020 Revisions to Payment Policies under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B proposed rule.   I have only been in school for 5 months now, but I love what I am doing and know that so many can benefit from physical therapy just as I did two years ago when I shattered my wrist in a sport accident and had to have reconstructive surgery. If it had not been for the small locally owned PT site my recovery experience may have been drastically different. I want to help as many people as I can and I would love every opportunity to do so. I have had many family members who have benefited from and been thankful for the services and care they received and I think everyone should have the same opportunity to those services no matter where they live. I hope you will stop looking at the charts and line graphs and look at your own family and think what would happen if they needed therapy and couldn’t receive it. In the end, the smile of a patient is worth more than the penny saved.   As a Physical Therapist Assistant student, I appreciate the opportunity to provide feedback to CMS on the proposed rule. Specifically, I am writing in response to CMS’ proposal to significantly reduce reimbursement for physical/occupational therapy services beginning in CY 2021, and how this policy, if finalized as proposed, will negatively affect Medicare beneficiary access.   Estimated Specialty Level Impacts of Proposed E/M Payment and Coding Policies if Implemented for CY 2021   I have serious concerns with CMS’ proposal to impose a significant reimbursement reduction for physical therapy services in 2021. The cuts, if finalized, will cause a serious financial strain on outpatient physical therapy providers; as demonstrated in Table 111 in the PFS proposed rule, physical therapy (and occupational therapy) providers would see a combined impact of negative 8% in 2021.   It is critical that CMS reimburse outpatient physical therapy providers at a level that will continue to allow them to deliver high-quality care to their patients. I acknowledge that CMS must maintain budget neutrality with the fee schedule. However, I do not believe CMS has given thorough consideration to the work and PE requirements for outpatient physical therapy providers. The significant reduction in reimbursement for physical therapy services will result in a decreased workforce and an inability to meet the needs of the Medicare population. Rising debt and shrinking reimbursement provide the perfect storm for discouraging individuals from choosing to enter these professions. Potential shortages would be problematic as the baby boomers reach Medicare age and more individuals seek access to services as health care reform provisions become effective.     Over the last several years, the number of Medicare beneficiaries accessing physical therapy through physical therapists in private practice has increased: • 2013: 2,091,751 • 2014: 2,198,616 • 2015: 2,354,958 • 2016: 2,546,041 • 2017: 2,673,120 Between 2011 and 2020, CMS has put forward reimbursement changes for physical/occupational therapy that ranged between -5% to +4%, whereas, during that same time period, CMS put forward reimbursement changes for specific physician specialties, such as family practice and general practice, that ranged between 0% to +7%. For 2021, CMS proposes to impose an 8% reimbursement reduction for physical/occupational therapy, whereas, for example, general practice and family practice physician specialties will experience an 8% and 12% increase in reimbursement, respectively. Medicare margins for physical therapy providers are already low and have challenged the sustainability of practices; severe and arbitrary reimbursement reductions will create challenging and likely unsustainable financial circumstances that may adversely impact patients’ access to care and the ability of physical therapy providers to continue to furnish care to beneficiaries. Unfortunately, I foresee that many physical therapists, particularly those in rural and underserved areas, will be unable to sustain these lower Medicare payments and be forced to reduce essential staff or even close their doors as a result of this change, thus restricting beneficiary access to necessary physical therapy services. The proposed drastic reduction in payment is an arbitrary, across-the-board cut, which, if implemented, would be in addition to the 2% sequestration reduction, thereby amounting to a 10% cut in reimbursement. This 10% reduction is in addition to the 50% multiple procedure payment reduction (MPPR) policy for the practice expense (PE) relative value units (RVUs) for “always therapy” services and NCCI edits that impose a significant penalty on code combinations that represent standard and necessary care, which have decimated reimbursement for skilled physical therapy services. I also urge CMS to recognize that outpatient physical therapy providers will be faced with a 15% reimbursement reduction for services furnished in whole or in part by the physical therapist assistant (PTA) beginning in 2022. Consequently, if the proposed 8% cut is implemented in 2021, there is a strong likelihood that some practices will need to close while others may choose not to continue to treat Medicare beneficiaries and/or refuse to accept new Medicare beneficiaries.   It is unfair for CMS to expect physical therapy providers, including hospital outpatient departments, rehabilitation agencies, physical therapist private practices, skilled nursing facilities (SNFs), and home health agencies (HHAs) to deliver high-quality, efficient, and cost-effective care without affording them sufficient payment. Because physical therapists in private practice are not currently a provider type that may opt out of Medicare, physical therapists will simply choose to stop treating Medicare beneficiaries. Thus, I question how CMS intends to reconcile what likely will result in a significant decline in beneficiary access if the agency adopts the proposed 8% reimbursement reduction. If CMS intends to move forward with significant payment reductions for physical therapists, then I recommend that CMS increase the Medicare conversion factor. I also suggest that the agency work with Congress to add physical therapists to the list of providers that may opt out; otherwise, beneficiary access to physical therapy will be severely limited.   Consequently, due to inadequate access, beneficiaries will be forced to delay or forgo necessary care, leading to negative health outcomes and greater overall cost to the system. The federal government, as well as patients and tax payers, are better served in the long run by ensuring that the Medicare program promotes efficient treatment of beneficiaries. This cannot happen unless there are enough providers to do so. The proposed reimbursement reduction would fail to ensure Medicare beneficiaries’ adequate access to care. Therefore, I urge CMS to recognize the magnitude that an 8% cut would have on certain providers, including physical therapists, and strongly recommend that CMS not adopt the proposed 8% reimbursement reduction to physical/occupational therapy providers in 2021. Please find my more detailed comments below.   CMS should promote access to physical therapist services in order to 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. Research shows that individuals who received outpatient physical therapy in the first 30 days after discharge home from the hospital following stroke were less likely to be readmitted in the subsequent 30 days than were individuals who received no therapy. Hospital-based physical therapist services also are associated with lower risk of 30-day hospital readmission in patients with ischemic stroke.   Further, CMS should adopt reimbursement methodologies that promote early access for patients with musculoskeletal disorders to physical therapists for primary assessment in primary care. Early access to a physical therapist for musculoskeletal assessment or pain management results in lower downstream costs to the payer and patient. Studies have shown that patients who seek primary care for musculoskeletal disorders and are triaged to a physical therapist report slightly better patient-reported outcomes related to pain, disability, and health-related quality of care. Moreover, patients with low back pain (LBP) who received care from a physical therapist first experienced lower out-of-pocket, pharmacy, and outpatient costs after 1 year and reduced their likelihood of receiving an opioid prescription by 87% compared with patients who never visited a physical therapist. The physical therapist-first group also was associated with a 28% lower probability of having imaging services and 15% lower odds of making a visit to an emergency department. Additionally, research has shown that early mobilization after cervical spine surgery has the potential to significantly decrease adverse events and early physical rehabilitation programs for acutely hospitalized older adults have the potential to improve physical functioning.   Moreover, at a time when both Congress and HHS are focused on expanding chronic disease management and addressing potential falls risks, conditions that impact millions of patients across the country, it is nonsensical to propose to reduce the reimbursement for those health care professionals who are movement experts, particularly physical therapists, who have knowledge and skills in identifying, measuring and improving balance system deficits, functional limitations, and strength and flexibility deficits that have been shown to contribute to falls. The role of physical therapists in falls prevention includes assessing risk for falling; designing an individualized plan for a patient’s fall-prevention needs; providing appropriate exercises and balance training; working with other health care professionals to address any underlying medical conditions that could increase fall risk; and providing recommendations on evidence-based community programs. I urge CMS to recognize how its proposed reimbursement cuts for physical therapy is in fact counterintuitive to CMS’ efforts to drive better patient access to care and management.   CMS should advance reimbursement models that promote access to nonpharmacological pain management treatment options The presence of pain is one of the most common reasons people seek health care. The source of pain for any individual can vary, whether it is an injury or an underlying condition such as arthritis, heart disease, or cancer. Because pain can be so difficult to treat and presents differently in every individual, its prevention and management require an integrated, multidisciplinary effort that takes into consideration the many variables that contribute to it, including the underlying cause(s) of the pain and the anticipated course of that condition; the options that are available for pain prevention and treatment, and patient access to these options; and the patient’s personal goals, and their values and expectations around health care. That evidence, in fact, was the driving force behind recent recommendations by the CDC in its Guideline for Prescribing Opioids for Chronic Pain. “Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred for chronic pain,” the CDC states. The report goes on to explain that “many non-pharmacologic therapies, including physical therapy…can ameliorate chronic pain.” The CDC concluded that there is insufficient evidence that opioid usage alone improves functional outcomes for those in pain.   Here, CMS is proposing an 8% cut to physical/occupational therapy services for 2021, while other pain management specialties, such as Interventional Pain Management, will experience a reimbursement increase of 8%. With the strong support of literature proving the efficacy of nonpharmacological therapies, I request that CMS clarify in final rulemaking how an 8% payment reduction for physical therapy supports the use of nonpharmacological physical therapist services for preventing, treating, and managing Medicare beneficiaries’ acute and chronic pain.   Early access to physical therapy holds the promise of reducing opioid use among patients with musculoskeletal pain. Researchers recently examined claims data to assess whether early physical therapy was associated with decreases in long-term opioid use. The results suggest that early physical therapy is associated with an approximate 10% reduction in the probability of any opioid use long term for patients with shoulder, neck, knee, and/or LBP. Evidence also shows that when patients with LBP see a physical therapist first, there is lower utilization of high-cost medical services as well as lower opioid use, and cost shifts reflecting the change in utilization.   It is critical that CMS provide appropriate payment for a broad range of pain management and treatment services, including physical therapy. This sentiment was expressed by the President’s Commission on Combating Drug Addiction and the Opioid Crisis in its final report, recommending that “CMS review and modify rate-setting policies that discourage the use of non-opioid treatments for pain, such as certain bundled payments that make alternative treatment options cost prohibitive for hospitals and doctors, particularly those options for treating immediate post-surgical pain.”   A recent study published in the American Journal of Managed Care that examined the association between health insurance design features and choice of physical therapy or chiropractic care by patients with new-onset LBP affirmed that higher copays and payer restrictions on provider access may steer patients away from more conservative treatments for LBP, including physical therapy and chiropractic services. Authors wrote that “innovative modifications to insurance benefits…offer an opportunity for increased alignment with clinical practice guidelines and greater value.” The study concluded that modification of health insurance benefit design offers an opportunity for creating greater value in treatment of new-onset LBP by encouraging patients to choose noninvasive conservative management that will result in long-term economic and social benefits.   Moving forward, it is imperative that CMS acknowledge the important role physical therapists play in the prevention and treatment of acute and chronic pain. Moreover, physical therapists should be included within the primary care team to increase access to best practice pain management care. Rather than significantly cut reimbursement for physical therapists, I encourage CMS to promote coverage and payment models that eliminate access barriers to physical therapy and other nonpharmacological therapies that have proven to be effective for the prevention or treatment of pain. Until such barriers are addressed, access to nonpharmacological therapies will continue to be limited, and opioids will remain a go-to quick fix for pain despite their dangerous side effects and, in some instances, long-term ineffectiveness. To truly be effective in improving care for Medicare beneficiaries suffering from pain, for example, there must be adequate payment and coverage of nonpharmacological pain management treatments, which pose one of the biggest challenges in ensuring patient access to such treatments. Thus, in conjunction with CMS’ current efforts to promote access to physicians who help address pain and arthritis, CMS must also develop and promote accompanying policies that increase access to nonpharmacological alternatives, including physical therapy.   CMS should be transparent in rulemaking Considering the magnitude of the cuts proposed in this rule for 2021, it is essential for CMS to ensure that the process it uses to develop policies is transparent and that decisions are based on accurate information. The information provided in the rule is very limited and does not provide enough information regarding the data and analysis used to determine the cuts to specialty providers. CMS is proposing these cuts to specialty providers, including physical therapists, without seeking the input of any health care professionals and providers who furnish outpatient therapy services. Further, CMS has offered no explanation regarding how the agency may redistribute the cuts across the code set.   Because the American Physical Therapy Association (APTA) is extensively involved in the establishment and valuation of most of the Current Procedural Terminology (CPT) codes billed by physical therapists through the CPT, RUC, and PE Subcommittee process, I find it disturbing that CMS did not contact APTA to obtain further clarification regarding the provision of physical therapy services and the current state of physical therapist practice. Given the absence of any input from health care professionals who furnish these services, it is apparent that CMS may have made many flawed assumptions regarding practice.     PE values should align with current physical therapist practice The RVUs for PE are based on the expenses that providers incur when they rent office space, buy supplies and equipment, and hire nonphysician clinical and administrative staff. Starting a private physical therapy practice is a major decision that requires considerable thought, special skills, and a significant financial and administrative commitment. Physical therapy providers must purchase numerous types of equipment, including treatment tables, body-weight-support systems, transfer slings, exercise bikes, and/or parallel bars, and treatment modalities including electric muscle stimulation and ultrasound. I oppose the proposed reductions to the PE value and recommend that CMS redistribute the expenses across health care providers who do not have as demonstrable costs for equipment and supplies.   Further, since 2011, CMS has applied the MPPR to the PE part of payment to outpatient physical therapy services. MPPR is designed to avoid duplicate payment for PE when multiple procedures are delivered to the same patient on the same date of service. The rationale for this policy is that efficiencies in PE occur when multiple therapy services are furnished in a single session because certain clinical staff activities are only performed once per session. CMS started applying this policy to "always therapy" services on January 1, 2011. From January 1, 2011, to March 31, 2013, MPPR as applied by CMS included a 20% reduction on the PE for nonfacility providers and a 25% reduction for facility providers. The MPPR increased to 50% for all Medicare therapy providers in all settings on April 1, 2013.   The application of MPPR to physical therapist services is inappropriate, given that the PE values for these CPT codes were already reduced to avoid duplication. Efficiencies that exist when multiple therapy services are provided in a single session were explicitly considered when relative values were established for these codes.   In many instances, reducing the PE on the second and subsequent codes results in underpayments. If CMS adopts an 8% cut to codes billed by physical therapists, which includes a 3% reduction in the PE value, there will be an even greater underpayment for physical therapy services, because the PE amount—which has already been reduced—would be reduced even further. Rather than taking the time to ensure that individual services are based on the resources required to deliver them, CMS is calling for arbitrary across-the-board cuts that put expediency ahead of equity. This proposal makes further reductions where duplication of PE has already been addressed, through both revaluation of the codes and application of MPPR. Conclusion   Thank you for the opportunity to comment on the CY 2020 Medicare Physician Fee Schedule and QPP proposed rule. I stand ready to work with CMS to identify a solution that will safeguard the financial health of the Medicare program while ensuring that beneficiaries have adequate access to high-quality physical therapy services.   Sincerely,     Jason Chandler Russell Student Physical Therapist Assistant Jefferson State Community College

      Posted by Jason Russell on 9/27/2019 10:03 PM

    • The need for physical therapy isn’t getting cut, nether should the pay! Help the people who help us.

      Posted by Abby on 9/27/2019 11:29 PM

    • As a current DPT student, I wholeheartedly believe that a reimbursement cut is unwarranted. The diagnoses/differentials we are being trained to find in our patients, and the high level skills we are learning should be enough reason not to reduce reimbursement. The autonomy we could potentially have and the lifesaving ability we have whether it’s truly life-threatening diseases or just drastically affecting and improving our patients’ lives is worth so much to our patients and ourselves.

      Posted by Taylor Randle on 9/27/2019 11:30 PM

    • I LOVE my profession, it is one of the BEST MEDICINE and treatment methods. Now if you are going to cut reimbursement costs this will effect the patients and the professionals. Working with geriatric population for 4 years who get sick being in the hospital for 1-3 days and cannot nearly do anything they were able to do prior to hospitalization. Drugs with cure the disease but will not make them able to go home. This population drastically loses their strength and ability and without Physical therapy there is higher risk of falls and functional decline. This will affect majority of population and if they are sent home earlier than needed, they will end up with broken back/hip/any joints. These changes are putting people lives at risk. All the medicare taxes and benefits deducted from our salary is not being used for the most necessary treatments is sickening to hear. PLEASE RETHINK THIS DECISION AND STOP THIS CHANGE. Physical therapy is the best medicine to improve quality of life.

      Posted by NAVYA SOMA on 9/28/2019 12:16 AM

    • I, Olivia Robinson, am a Physical Therapist. I graduated in 2018 at the University of Mississippi Medical Center. I’m currently working in the settings of swingbed, outpatient and a skilled nursing facility in Mississippi. I cannot tell you the amount of success I’ve had along with my professional counterparts from fall prevention, pain management, post CVA or post surgical procedure. Therapy works! Choosing therapy first for pain rather than medication or surgery absolutely works. Therapy makes a difference in different peoples’ lives and diagnoses. During my time during school, clinical work, and my 1st year of becoming a professional, I’ve encountered first hand what I and other professionals like myself hold valuable to this area in the medical field.

      Posted by Olivia Robinson on 9/28/2019 12:58 AM

    • Physical therapy has saved me from severe and debilitating back pain. I was unable to do my job, just unable to live comfortably at all. I tried many things, chiropractor, medication, injections, etc, but they were insufficient and weren't actual solutions. When I went to physical therapy I was actually rehabilitated. They didn't treat me and then tell me to keep coming back. They wanted me to get better and get back to my life. I don't know why or how something as beneficial as Physical Therapy could be getting cut. This is absolutely asinine.

      Posted by Grace on 9/28/2019 10:38 AM

    • This is what happens when you have an industry that almost exclusively works for one payoff source: the government. I hope you guys realize how much worse therapists will be if socialized medicine eve comes around in this country. I left the profession a month ago and am so happy to be done with the crap therapists put up with. And I feel sorry for the students being sold a false future.

      Posted by Kyle on 9/29/2019 3:59 AM

    • Dear Administrator Verma: I am writing in response to the request for comments on the Centers for Medicare and Medicaid Services’ (CMS) Calendar Year (CY) 2020 Payment Policies under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B proposed rule. I consider your revisions to be shortsighted in regards to an attempt in increasing Medicare cost savings. the savings created in paying private Physical Therapists will only lead to significant increase and larger and larger payments to hospitals for more intense and longer treatments for health issues that requires costly hospital stays exacerbated by delayed treatment due to patient's hesitancy to hospital stays rather than just go to a physical therapist in their neighborhood that was driven out of business by your proposed pay cuts to private physical therapists. Short term savings to be replaced by much larger cost is an affliction well known to corporations and citizens that wind up in bankruptcy and Chapter 11 Court proceedings. I suggest that you don't contribute false savings to our cherished Medicare system. Robert Kolb 259 8th Street, Staten Island NY 10306 917 582-1066 - robkolb0@gmail.com

      Posted by Robert Kolb on 9/29/2019 10:14 AM

    • https://www.linkedin.com/feed/update/urn:li:activity:6540684244287569920 I posted this article back in June to LinkedIn. It demonstrates why cuts to therapy are the wrong step if cost-savings is the subjective. The average cost of treating a fall related injury is around $10,000. The average cost of an episode of therapy is around $1,000. If we identify patients at risk and intervene before the incident occurs, we can help to preserve health and save money.

      Posted by Michael W Worley on 9/30/2019 4:52 AM

    • The company that I have just been laid off from, after almost 5 years with 34 years experience, began implementing concurrent and groups 2 months ago. We are being laid off and patients minutes are down. The system they put the information into tells them how many minutes per week. Some have as low as 400 minutes. This is not helping patients and I personally know 15 people laid off and there are more to come. If you are working and want to keep your job or get your hours you have to flex and work a weekend day also but take a day during the week. The work place is even more stressful and concurrent and groups make it hard to focus on some patients needs. Getting the people into the group or concurrent and timing it with other therapy staff and rehab center staff to be able to do it with shorter hours and no one to help gather the people exhausts us. The paper work has increased and even PTAs (that shouldnt be) are doing DCs and upgrading goals. Jobs that were advertised are now stating hiring is on hold. Hoping I am able to find work. Sad after 34 years in the field and loving this job I am now with many others discarded. I have not had a raise in 7 years. Made less now then I did before PPS. No appreciation from companies what so ever any more. So sad what this career has become.

      Posted by Denise Shepherd on 10/3/2019 11:29 PM

    • I have been a PT for a little over 30 years and I have a memory of the days when physical therapists use to work for the hospitals and then moonlight at Nursing homes at night. In the hospital, we treated wound patients, outpatients and inpatients all together which was a recipe for spread of infection. Then we moved to treating inpatients in the hospital and outpatients in satellite clinics. When inpatients were discharged, they had to go somewhere and thats when SNF exploded. This is the time in the late 80s, early 90s when we had big corporations such as HealthSouth and other vultures we cannot name, came in and destroyed physical therapy as we knew it then. Of course, we also had doctors who had physical therapy in their offices provided by Aides and billed as physical therapy. What has always surprised me was how little APTA did to protect our profession. During the PPS years, PTAs because Rehab Directors and Regional Presidents and dictated to physical therapists how to evaluate and treat patients. Once again, toothless APTA has done absolutely nothing. The state boards have done a much better job in holding therapists accountable in their practice. Fast forward to today with PDPM. There is absolutely nothing "patient driven" about the new system. Once again, physical therapists are being told by somebody from corporate to treat patients in a group and dovetailing and they are just going along with it. The only thing that will stop this nonsense and irrationality is the day that physical therapist can act like other professionals and treat patients one on one PERIOD. Nurses, doctors, pharmacists, respiratory therapists, psychotherapists, and even CNAs don't treat patients in groups. The only people that treat patients in groups are Recreational Therapists. So, the big question the APTA needs to answer is: Whats the difference between what physical therapists are doing and what Recreational Therapists are doing in a nursing home. In both cases, the patients are sitting in a circle and the exercises looks similar. Why should Medicare pay physical therapists for something that can be done by a recreational therapists? What happened to the skill being of advanced, complicated and cannot be done by someone who is not trained as a physical therapist? If you all want Medicare to pay for sophisticated and complex physical therapy, then stop providing recreational therapy and try to bill it as physical therapy.

      Posted by Gao on 10/15/2019 3:46 PM

    • I propose an 8% cut to CMS employees!

      Posted by Mary Beth Foret, PT on 10/19/2019 6:26 PM

    • Physical therapy is more safe and cost effective than nearly all other medical treatments, including surgery, pain medication, long term disability etc. It should be being promoted in the wake of the opioid epidemic rather than limited. It saves lives, promotes self sufficiency and reduced dependence on the health care system. INCREASE PT COVERAGE AND REIMBURSEMENT Medicare patients are one of the largest populations of PT patients. Cutting would only hurt patient care. If anything, we should be providing more funding for PT’s/PTA’s with Medicare patients to help raise awareness for things like the opioid epidemic, the effects of exercise, student loan repayment, etc. We are a profession that goes outside the “status quo” and provides a more wholistic and individualized approach to functionality and health independence. If we start cutting back, we start losing the ability to give the adequate care to our Medicare patients. I do not understand why you are cutting our fees. We help more people across more diagnoses than any other field. Cutting back our fees makes it difficult to keep our doors open as we have a lot of overhead which includes capitol equipment and space and personnel. Essentially, you are asking us to give our services away. Perhaps you need to look at the unnecessary diagnostic tests and surgeries, meds, imaging and hospital charges. Physical therapy is so very important to seniors in that it helps to prevent unnecessary surgeries and excessive administration of opioids.

      Posted by eric huynh on 10/24/2019 9:04 AM

    • This cut is so wrong, it hurts the patients and the therapists. Do the right thing and Don’t cut reimbursement for Medicare patients who need physical therapy.

      Posted by Lane Briggs on 11/9/2019 12:09 AM

    • When I was working in the Philippines as a PT back in the day (mid 80s), 90% of my patients have no insurance, mostly charity or self pay. I was employed by a large Philippine hospital that provides PT for the poor. Patients abound, we were 10 PTs and about 5-7 sutdents and each staff has a caseload of 5-10 patients on a daily basis. We were never out of patients. The patients come because they need us (majority without secondary gain). Since the patients pay out of pocket, they call the shots in terms of how long they want to be seen. Most of them can only afford to be out of work about 2-3 weeks. Most of them do their home program diligently. And most of them go back to work or follow up on their home exercises. Here in the US, the healthcare providers have become so dependent on insurance system that it provided so much care in terms of quality and quantity however, many people have taken advantage of the system. So there were so many corrections made in the last 20-30 years to curtail fraud and financial abuses made from many parties involved (patients, healthcare providers, politicians) while the silent majority who follow the rules, provide quality care and just want to help people becomes casualties of this never ending fight to balance the budget of the insurances. Somewhere in this battle is a better system like eliminating or reducing the middle men who milks the system by making tons of money (why this is allowed I don't understand) there should also be a cap in making profits for these companies. You add all the waste and expenditures up and the viability of payors are gonna dry up! Can Medicare just directly sub contract PTs, OTs and STs just like what they are doing with Medicaid patients? I believe there is a better way to have a win win situation. We have to be more vocal and active in showing that the care our profession provides is vital and very relevant today and in the future.

      Posted by N. Relampagos on 12/8/2019 5:00 AM

    • Quite frankly, I don’t agree with that one! NO!

      Posted by Johnny Chostabascol on 12/12/2019 8:39 PM

    • Will these new laws affect the Acute Care settings??

      Posted by Maggie on 1/4/2020 10:18 PM

    • If this holds true massive layoffs are around the corner. If things don't change the therapy field will be desimated. I have been a PTA for 26 years and have been through all the changes. The North East is already struggling with salaries and reimbursement. All the advice I can give is look at different career opportunities as I have lost many friends who were good PTs and PTAs. Have a backup plan and if you stay in the profession make sure it's what you want because the money won't be there anymore as salaries will plummit and make sure it's what you want to do in your heart and not for the money. I have my backup plan in place so good luck to all my brother's and sisters in therapy.

      Posted by william on 1/12/2020 1:47 PM

    • CMS needs to understand that this is about pay now or pay later. By cutting reimbursement for needed therapy they will in turn reduce the amount of visits a patient receives or make it so that patient is unable to get therapy at all when some clinics close their doors. CMS will think they are then saving money. However we all know that these patients will cost CMS more in the long run because they did not have early intervention, resulting in prolonged medical care or poor outcomes. Let’s just take a pain patient as an example. If this type of patient has early intervention often they will not turn into a chronic pain patient. They will get the needed therapy and be able to return to a productive life. However, if they do not get the needed therapy initially, then they will possibly end up with Chronic pain resulting in multiple prescriptions for pain control. With these types of prescriptions there are horrible side effects, with a poor chance of returning to a productive life. Some of these patients have to go on disability. They are often called drug seekers but they just truly want the pain gone and their life back. This route is much more costly to the medical system as that patient will need significant continued care. Where is the savings there?

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      Posted by Mr.Stephen Nowell on 3/18/2020 6:58 AM

    • I am not a Physical Therapist, but my daughter is. Medicare can not cut your pay, I have so many problems since I turned 51, CABG x 3. I need treatment in cardiac rehab, then as years went on I developed Pulmonary Fibrosis and Rheumatoid Arthritis in my lungs and body, I have received more help from my Physical Therapists than any medical doctor I encountered except the doctor that ordered physical therapy for me. I have some good years because of this, but I can not afford to pay for my treatment, even if it is my daughter's clinic, I truly would not expect her therapists to treat me for free, which is going to happen with the Medicare cuts. I cannot think of anyone that would benefit from Physical Therapy more than us, athletes and accident patients. Who do I relay my concerns to help the government see what they are doing to a group of health givers that are so valuable to the elderly generation? Thank you

      Posted by Marti Brooks on 3/18/2020 2:06 PM

    • I became physical therapist assistant 22 years ago. About 16 of those years I have spent as a home healthcare worker. I watch my income steadily declined over the last five years and productivity requirements increase. My salary last year was sad. I made more money grooming dogs which Is what I did for 9 years Before becoming a PTA. I’m slowly replacing my worn out clippers, scissors, and blades so that I can go back to THAT profession. Nowadays taxes are held out of your check, medical insurance and other benefits are offered and affordable, And there’s no paperwork to bring home taking further time away from family, and further disrupting the work-life balance that so many companies promise But can’t seem to deliver. Over the years our mileage reimbursement has disappeared, company cars are a thing of the past, cell phone recent reimbursement is gone, if you were one of the lucky ones that got any kind of a bonus that’s gone now too. Most most recently benefits of disappeared or are unaffordable because too much of the cost is passed to the employee. I figure it’ will take about 5 to 7 years for Medicare Medicaid and the private insurers to figure out the error they have made when they have to pay billions of dollars in hospital bills for people that have fallen and broken bones, on power chairs and other equipment because people will no longer be walking, they will have to hire extra personnel to handle all of the appeal letters from their constant denials for medical care and equipment. The amount of medications required to keep somebody functioning will be significantly more than what is required today and that will be an additional cost for the insurers as well as the patient. I imagine we will see a decline worse than what we already see, in the quality of healthcare delivered simply because for every 1 healthcare worker still working in actuality there needs to be 3 of that 1 person. People won’t be applying for nursing school or the other allied health professions like they are today. The pay will be too low, the hours will be too long, and the BS will be entirely too much. I hope to only live long enough to either 1. say “I told you so” when all of this happens, or 2. Watch all of the elderly, career politicians die off and younger more realistic human beings take their places and reverse all of this.

      Posted by Laura on 4/3/2020 6:29 AM

    • During my life, I have had many occasions to need physical therapy for my shoulder,knees, foot, hand, and after a lengthy Hospital stay for pneumonia. Physical therapy is a guided, Natural way for the body to heal itself under a physical therapist's guidance. These educated therapists work with the Doctors to give patients back the strength and movement they Need after a medical problem presents itself. DO NOT REDUCE THE PAY FOR PHYSICAL THERAPISTS AND THEIR ASSISTANTS!!! They are a valuable part of America's Health System. PHYSICAL THERAPISTS' AND THEIR ASSISTANTS'

      Posted by Margaret Kill on 5/2/2020 7:13 PM

    • Physical therapists have a crucial job. They help patients with physical health AND mental health. A lot of these people confide in their physical therapist and look to them to heal them. Instead of getting paid more for doing more than they are asked to, they are getting paid less. They deserve better pay for being DOCTORS who are serving a population in a NATURAL way. Our aging populations deserve more from these companies to get access to some wonderful people.

      Posted by Vaidika P. on 5/15/2020 12:52 AM

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