In an effort that comes up short for PTs, other providers, and the patients they serve, Congress has approved a new omnibus and COVID-19 relief package that reduces — but doesn't eliminate — planned cuts to the Medicare fee schedule. The bill includes provisions that, combined, will reduce the magnitude of the cuts from a projected 9% drop to something closer to 3.6% for physical therapy in 2021.
Congressional intervention was the last avenue in 2020 for a fix to the cuts that CMS finalized early this month in the 2021 Medicare Physician Fee Schedule, and was the focus of intense advocacy efforts by APTA and organizations affiliated with the 36 other professions also slated for cuts. The reduced payment rates will go into effect on Jan. 1, 2021.
The limited help provided to PTs comes through two main channels: a $3 billion infusion that gives CMS more money in 2021 to offset a boost to evaluation and management visit codes while maintaining budget neutrality, and a three-year delay of a costly "add-on code" that physicians could use to reflect the additional complexity of a visit and receive additional payment. Combined, the relief totals some $6 billion in mitigation.
The presence of any relief from the cuts was brought about in large part due to intense advocacy by provider organizations, including historic levels of participation by APTA members and supporters, who generated more than 120,000 communications to members of Congress. Efforts to fight the cut were supported by large groups of bipartisan lawmakers in both chambers.
While APTA acknowledges the provisions as an improvement over the potentially devastating scenario of a 9% cut, the association maintains that the cuts now in place will threaten the viability of providers and patient access to needed services.
"Cuts of this nature are unsustainable for the physical therapy profession, and the knowledge that three dozen other health care providers also are facing cuts doesn't make them easier to withstand," said APTA President Sharon Dunn, PT, PhD, in a statement issued Dec. 21. "At the same time Medicare improved payment for physical therapist evaluation and reevaluation, it has made it more difficult for PTs to actually treat their patients."
From a practical standpoint, it's worth noting that CMS claims systems are already set for the payment rates finalized in the fee schedule rule earlier this month. That means it could take some time for CMS’ claims processing systems to be updated to reflect the payment rates associated with the latest relief bill. APTA will monitor progress and keep members informed as to the status of these updates. We'll also release our 2021 physician fee schedule calculator once final instructions and rates have been released by CMS.
Another important note: The 3.6% figure is an estimated average cut. PTs will likely experience individual variation based on practice, billing patterns, and locality.
The finalization of the relief package means that cuts will take place in the near-term, but it doesn't close off the possibility for additional help in 2021; many in Congress are signaling the need to take up more pandemic-related measures in the new year. APTA will continue to advocate for relief during the year ahead.
Beyond its advocacy for short-term solutions, APTA is also looking at the big picture, and challenging the viability of the entire Medicare Physician Fee Schedule as the best approach to establishing payment.
In her statement, Dunn calls the fee schedule a "clearly outdated" system that "fails to adequately support or recognize a modern health care delivery system in which multiple health care professionals work collaboratively to advance appropriate health outcomes for their patients."