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In the face of a proposed Medicare physician feel schedule rule that would impose significant payment cuts to physical therapy providers and a host of other professions, APTA and multiple other organizations are once again taking the fight to Congress. There's much hard work ahead, but the organizations already have taken one important step — laying out their concerns and requests as directly as possible to members of the U.S. Senate and House of Representatives from both parties.

The advocacy for congressional help comes by way of a July 23 letter sent to legislative leadership addressing the proposed cuts to payment that affect some three dozen professions. The letter — signed by 110 organizations in a call for both short-term and long-term assistance — is part history lesson, part call for immediate action, and part critique of the current fee schedule system's overall budget neutrality requirements.

Targeted Help Now, Wholesale Revaluation in the Long Term

The organizations that signed onto the letter, which include the American Medical Association, the American Academy of Family Physicians, and the Society of Thoracic Surgeons as well as APTA, the American Occupational Therapy Association, and the American Speech-Language-Hearing Association, call for Congress to do what it did last year: increase funding to CMS that would allow it to mitigate the severity of the proposed cuts. Specifically, the groups ask lawmakers to provide enough funding for CMS to increase the conversion factor — the mechanism by which the agency is enacting the reductions.

But that's not where the group stops. The letter also urges Congress to reconsider requirements that CMS must maintain budget neutrality — the mandate that CMS says made the cuts necessary in the first place. The letter states that budget neutrality undermines the central goals of the fee schedule to ensure appropriate and timely care and to do it in ways that involve collaborative work among providers.

"Instead, physicians, therapists, and other health care providers are forced into an adversarial role," the letter states. "The result is that patients suffer as providers adjust to unpredictable and excessive reductions to reimbursement that inhibit their ability to ensure beneficiaries have access to the care they need; services that improve outcomes."

The letter also points out that, historically, provider services have been "perennial targets for cuts when policymakers seek to limit spending," even though these services "represent a very modest portion of the overall growth in health care costs." The result, according to the coalition, is provider payment policies that haven't kept up with inflation and practice costs, often resulting in an overall decline in payment over time, once adjusted for inflation.

Part of a Larger Strategy

The letter is just one of the more recent and visible elements of what APTA Vice President of Government Affairs Justin Elliott describes as a multifaceted advocacy effort being conducted on two important fronts: regulatory and legislative.

"We are in full swing with our grassroots push to get members, patients, and other stakeholders to contact CMS to directly address the many problems in the proposed physician fee schedule, and we make that as easy to do as possible," Elliott said. "But we also realize that Congress most likely has a crucial role to play in these issues, so it's imperative that we educate lawmakers now on the need for the changes we describe. The next few months will be critical."

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