Explain yourself: That's the message of a bipartisan letter to CMS signed by 99 members of the U.S. House of Representatives who are concerned about the agency's plan to make cuts to Medicare that include an estimated 8% reduction in payment to PTs. APTA led efforts to inform legislators of the issue.
And if that's not enough to get CMS to take another look at the planned cut, maybe a letter from a prominent U.S. senator might help.
In a February 5 letter, the representatives write that their constituents have concerns about whether the planned cuts will reduce access to health services. In order to respond to those concerns, the legislators are asking about the process CMS used to reach the decision to reduce the reimbursement for services furnished by certain providers in 2021 in order to accommodate increases to values of the office/outpatient evaluation and management codes, known as E/M codes.
The letter specifically asks CMS to explain the methodology and data the agency used to calculate the estimated impact to each specialty level impact associated with the coding change, and to provide a description of the factors the agency considered in deciding how much it would reduce each of the 36 other professions selected for cuts.
The legislators also pressed CMS on its statement that it would consider additional information before making a final decision, asking what kind of information would be of the most value, and whether CMS considered how the proposed changes could impact access to care — and if so, how.
The letter requests that CMS respond to Congress by February 21.
But the pressure on CMS isn't just coming from the House: Thanks to the efforts of Brenda Mahlum, DPT, the APTA Federal Affairs Liaison for the Montana Chapter, Senator John Tester (D) also sent a letter to the agency describing his concerns that the cuts "will compromise patients' access to care, particularly in the most remote areas of my state and across the country."
"Medicare beneficiaries increasingly rely on physical therapy and occupational therapy services as part of a coordinated model of care," Tester writes, adding that the planned cuts run the risk of drying up access to care in underserved and rural areas that are already struggling to meet health care needs. "Payment decisions like the ones in this final rule will limit provision of services," Tester adds. "The physical therapists and occupational therapists in Montana operate on very narrow margins, and any reimbursement reductions may jeopardize their ability to remain open and serve their patients."
Justin Elliott, APTA's vice president of government affairs, sees member engagement as the driving force behind the legislators' efforts.
“We are grateful to Representatives Buddy Carter and Lisa Blunt Rochester for their leadership on this bipartisan House letter to CMS, and even more grateful to the APTA members who urged their legislators to get on board,” Elliott said. “The large number of bipartisan signatories to the letter should demonstrate to CMS that the public needs more information to understand what policy goal this flawed proposal is trying to achieve. We understand and support the desire for increased payment for the E/M codes. However, we believe it's inappropriate to reduce payment to physical therapists and 36 other provider groups as the way to pay for it.”
Be sure to check out APTA’s resources on this issue.