The proposed 2022 Medicare Physician Fee Schedule is likely to be released soon, and APTA staff familiar with the workings of the U.S. Centers for Medicare & Medicaid Services aren't expecting any big surprises — which is exactly the problem. Given that CMS aims to implement a payment differential for PTAs and OTAs in 2022 and intends to continue with payment cuts to three dozen professions including physical therapy, a surprise change of course might be nice.
But don't count on it , says Kate Gilliard, APTA senior policy and regulatory affairs specialist. Be ready to take action instead.
"Given the transition with the new administration and changes to CMS staff, it's unlikely we'll see many major variations this year from the direction taken by CMS in its fee schedules over the past few years," Gilliard said. "But that doesn't mean the fight's over — in fact, the release of the proposed fee schedule gives us an opportunity to make an even stronger case to both CMS and Congress to blunt the damaging effects of any cuts or differential systems."
The key word here, according to Gilliard, is "proposed." Once CMS releases its proposed fee schedule, a 60-day window is opened for public comment to press the agency to back off some of its most damaging plans. At the same time, the emergence of an actual legislative proposal gives advocates for physical therapy something tangible to discuss with lawmakers, just as members of Congress return to their home districts for the August recess.
Where Things Stand: The Payment Cuts
Physical therapy and multiple other professions are continuing to fight the effects of a CMS decision to cut payment to many providers in order to subsidize an increase to office outpatient evaluation and management codes. In the 2020 fee schedule, CMS announced its plans to implement the cuts in 2021. For physical therapy, the average cut was estimated to hover around 9%. (This blog post from August 2020 provides a detailed account of the cut's origins; this blog post from January 2021 takes a look at how the cuts were implemented, and their effects on PTs.)
Thanks to a powerful grassroots advocacy effort by APTA, our members, and other professional organizations, Congress stepped in late in 2020 to authorize a $3 billion infusion to CMS, which reduced the severity of the cuts from an estimated 9% to 3.3%. The help, however, was only for 2021 — without further congressional action and additional funding, another round of cuts could occur in 2022.
Where Things Stand: The PTA Differential
As CMS attempted to implement cuts to various providers, it also rolled out a plan to reduce payment for outpatient services delivered by a PTA by 15% beginning in 2022. Occupational therapy assistants are also subject to the differential, which CMS says it was required to implement under the Bipartisan Budget Act of 2018. (This blog post from early 2020 tracks the origins of the differential and APTA's advocacy efforts around it.)
Much like the cuts to payment codes, the differential has captured the attention of members of Congress, who sent a letter to CMS in May urging the agency to take steps to lessen the harm of the differential, which they argue will be especially hard on rural communities. Among their suggestions: establishing a "class specific geographic index" that would offset the cuts in certain rural areas, or creating "incentive payments" for certain relative value unit data collected from providers in targeted areas.
Another recommendation supported by APTA: change supervision requirements to allow for general supervision of PTAs and OTAs instead of current requirements that all supervision be direct, which requires the supervising PT or OT to be in the office and immediately available. Medicare currently allows for general supervision in all areas except private practice.
For APTA, an Ongoing Fight
While the emergence of the proposed rule opens an important advocacy window, APTA has been working with both CMS and members of Congress on a continuous basis, says Justin Elliott, APTA’s vice president of government affairs.
"We have not been waiting for the rule to drop to advocate," Elliott said. "We started early to build up momentum in anticipation of the proposed rule. APTA has already met with the office of the new HHS Secretary and CMS officials, and we've been holding numerous meetings with Capitol Hill offices, Congressional leadership, and key committees to lay the groundwork on proposed legislation."
At the same time, APTA continues to participate in a coalition with other impacted provider groups including the American Medical Association, the American Academy of Orthopaedic Surgeons, the American College of Radiology and others, as well as with its therapy partners including the American Occupational Therapy Association and the American Speech-Language-Hearing Association, to have a unified voice and get Congress to intervene once again via legislation. Elliott describes the collaboration as "as critical to present a unified voice to Congress on any legislative proposal.”
A Two-Track Strategy
There are steps CMS could take via the 2022 rule to mitigate the effects of both the fee schedule cuts and the PTA differential, but Elliott believes the advocacy work shouldn't end there — Congress must play a major role in pressuring CMS to make changes to the rule, and intervening through legislation in anticipation that CMS won’t.
"The reality is that without congressional pressure and intervention again this year, a whole host of providers including PTs and PTAs, will face fee schedule cuts in 2022," Elliott said. "Congress could also be of tremendous help with the PTA differential. While we're working with CMS to make rulemaking changes that would carve out exemptions or simply delay implementation of the differential system, we're meeting with legislative staff to discuss ways that Congress could intervene as well. This is a full-court press."
The recent turmoil in Medicare payment has made one thing clear to policymakers – major reforms are needed to the Medicare Fee Schedule to reduce administrative burden and ensure the system recognizes providers for their value.
APTA supports a full-scale reevaluation of the fee schedule approach, which APTA President Sharon Dunn, PT, PhD, described in a statement as 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."
As it has in the past, APTA will make it easy to make your voice heard. Soon after the proposed fee schedule is released, the association will provide template letters to send to CMS on both the payment cuts and the PTA differential.
On the congressional front, Elliott says that the upcoming August recess will provide a timely opportunity for PTs, PTAs, and other stakeholders to meet in-person with their legislators in town halls or other events. In addition, APTA is in the planning stages for an APTA Advocacy Day on Capitol Hill in September, to coincide with the association's centennial celebrations.
"The most important thing members can do right now is prepare to take action by learning about the issues and connecting with APTA," Elliott said. "Advocacy by APTA members has made the difference in the past, and that's what we will do again in the coming weeks and months."
What You Can Do Right Now
Getting involved and keeping up with advocacy for the profession is not only important, it's a great way to connect with a community of engaged PTs, PTAs, and students from all over the country. And it's easy. Here are a few ways to get involved.
Join the APTA Advocacy Network. Formerly known as PTeam, the APTA Advocacy Network is a member benefit that helps you stay connected and engaged. Sign up to receive important legislative updates and action alerts.
Download the APTA advocacy app. APTA's free advocacy app allows you to find legislators, send prewritten messages to them with a few screen taps, and view talking points on legislative issues. You can even donate to PT-PAC from the app. Just search "APTA Advocacy" in the Apple or Google app stores.
Find out what's on APTA's advocacy list — and add your voice. The APTA Patient Action Center is a one-stop resource that provides an overview of all the major federal issues and bills that APTA is focused on. The center also allows you to quickly and easily contact your legislator to urge action.