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The (virtual) rallies may be over, and Medicare may have closed its window for accepting comments, but the fight to stop a disastrous proposed 9% cut to physical therapy payment continues. APTA, its members and stakeholders, federal lawmakers, and other professions that stand to be hurt by the cut haven't let up — and the pressure to do something is mounting.

Here's an update on APTA's more recent advocacy activities and a quick look at other developments in the growing movement to #FightTheCut.

What We've Done — And What We're Doing

Our virtual rallies were landmark events that got noticed. APTA organized two virtual #FightTheCut rallies — a Sept. 10 event that focused on letters to members of Congress, and an Oct. 1 rally that turned the attention to Medicare, specifically, the U.S. Centers for Medicare & Medicaid Services, which issued the proposed 2021 physician fee schedule that includes the 9% cut.

The rallies weren't just well-attended — they were highly productive. The push to Congress generated more than 50,000 communications to lawmakers, and the CMS-targeted event resulted in more than 25,000 letters from the physical therapy profession and their supporters. Since August, more than 100,000 letters have been sent to Capitol Hill from APTA members and their supporters. The vast majority of the communications to Congress and CMS were facilitated by easy-to-use template letters created by APTA—including template letters specifically designed for use by patients.

We've spelled out our detailed position to CMS. Before the Oct. 5 deadline, APTA delivered two formal comment letters to CMS: one 23-page letter that solely addresses the proposed cut, and a second 55-page letter that addresses both the cut and other policy proposals contained in the proposed fee schedule.

We're joining with other provider groups to drive home the message to CMS. APTA signed on to a  letter from 47 provider groups that provides recommendations on how CMS could stop or mitigate the cuts. The letter argues that it's counterintuitive to make drastic reductions to payment while both Congress and HHS are focused on engaging patients, increasing the delivery of integrated, teamā€based care, expanding chronic disease management, and reducing hospital admission/readmission rates for beneficiaries; instead, CMS needs to recognize how the proposed cuts fail to align with the agency’s efforts to drive better patient access to care and management.

We had a sit-down with CMS. Near the end of September, APTA, the American Occupational Therapy Association, and the American Speech-Language-Hearing Association combined forces to arrange for a virtual meeting with CMS representatives to more fully explain the damaging effects of the proposed cuts.

We're getting the word out to other federal agencies. The proposed cuts have far-reaching effects that need to be understood outside of Medicare. We sent letters to the U.S. Department of Veterans Affairs and the U.S. Defense Health Agency explaining how the cuts will affect access to services for veterans and active duty military personnel.

We continue to build support on Capitol Hill. Thanks to the advocacy efforts of APTA and other committed organizations, a growing number of lawmakers are recognizing the devastating impact the cuts could have on patient access to care, and they’re calling for CMS to halt or postpone its plan.

We're combining our voice with a host of other organizations to get lawmakers' attention. The proposed cuts don't affect physical therapy alone — some three dozen professions are slated for payment cuts, from pathology to emergency medicine. The far-reaching damage that could ensue is understood well beyond organizations representing the professions that would be affected —patient advocacy groups, affiliated professions, and even some physician groups are joining the fight.

Since the cuts were first proposed, we've joined with other organizations when appropriate to intensify our message. Most recently, we joined a coalition of organizations that includes the American Health Care Association, American College of Radiology, National Center for Assisted Living, and 57 other organizations in a letter to U.S. Reps. Michael Burgess, R-Texas, and Bobby Rush, D-Ill., voicing support for H.R. 8505, a bill they introduced that would halt implementation of the cuts.

Growing Support on Capitol Hill

A bill has been introduced to delay the cuts, and additional bills could be introduced soon. As mentioned above, Reps. Burgess and Rush have introduced H.R. 8505, a bill that would establish a one-year delay of implementation of the cuts, paid for through the Pandemic Provider Relief Fund. Both House members have been strong supporters of physical therapy.

More than one in three bipartisan members of the House told HHS that the cuts are a bad idea. A House sign-on letter led by Reps. Roger Marshall, R-Kan., Brad Wenstrup, R-Ohio, Terri Sewell, D-Ala., David McKinley, (R-W.Va., Tom O’Halleran, D-Ariz., and Rush, and co-signed by 151 bipartisan House members, was sent to HHS Secretary Alex Azar and CMS Administrator Seema Verma outlining the damage that the cuts would do.

More than 200 House Members want their leadership to do something. A total of 229 bipartisan Representatives signed on to new House letter, this one aimed at House leadership, urging the House to include a fix to the proposed fee schedule cuts in any upcoming legislative vehicle. The letter was launched by Reps. Larry Bucshon (R-Ind.) and Ami Bera (D-Cal.); co-leads include Abby Finkenauer (D-Iowa), George Holding (R-N.C.), Brendon Boyle (D-Penn.), Brad Wenstrup, DPM, (R-Ohio), Roger Marshall, MD, (R-Kan.), and Raul Ruiz, MD, (D-Cal.). On the Senate side, Susan Collins, R-Maine, issued a letter to senate leadership on the need for the U.S. Senate to act to prevent the cuts from being implemented.

Congressional committees have the cuts in their sights. The House Ways & Means Committee and Energy & Commerce Committees, as well as the Senate Finance Committee, continue to seek possible policy options for legislative intervention. Any policy solution would likely be considered by Congress after the Nov. 3 election.

Where Things Stand

According to APTA staff leaders in government affairs, regulatory affairs, and grassroots advocacy, engagement in the #FightTheCut effort has been unprecedented — and level of participation makes a big difference on both Capitol Hill and at CMS.

"The fact that we've been able to generate more than 100,000 letters to Congress makes a huge statement to lawmakers about the profession's commitment to patient care," said Laura Keivel, APTA grassroots and political affairs specialist. "The fact that there's so much movement on Capitol Hill, in the middle of an election cycle, makes it clear that our message is getting through — and getting support."

Kara Gainer, APTA director of regulatory affairs, said the engagement could also make a difference at CMS.

"It's so important that we engage in proposed rules' comment periods. Federal agencies such as CMS are required to base their reasoning and conclusions on the rulemaking record — the comments, scientific data, expert opinions, and facts accumulated during the proposed rule stage,” Gainer said. “A significant number of comments also speaks volumes to Congress as lawmakers consider taking legislative action on policies initiated by CMS. I am proud to say that with our combined voice, we made it abundantly clear to CMS that the physical therapy profession does not stand for arbitrary and penalizing cuts that only serve to harm patients and providers in the short and long term.”

APTA Vice President of Government Affairs Justin Elliott is hopeful that Congress will address the cuts during its lame-duck session after the election, and he thinks there's strong support in the House for the needed change. The key at this point, according to Elliott? Keeping up the pressure.

"Together, APTA members and their patients have done a fantastic job of grassroots advocacy, but the fight is far from over," Elliott said. "Contacting members of Congress is not a one-and-done thing — we need to continue sending them regular messages to remind them that this country faces a serious threat to the effectiveness of Medicare in the middle of a pandemic that has already damaged health care systems. The advocacy campaign to date is historic for the physical therapy profession—we need to keep the momentum going."

What's Next

It's simple: keep up the pressure, and get others to do the same. Visit our Physician Fee Schedule advocacy page to take action. It's easy, and there are options for nonmembers and the public to join in the fight as well.

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