APTA's efforts to avoid proposed cuts to payment for physical therapy and a host of other services under Medicare has just received a big boost by way of a new bipartisan bill that would provide a 4.42% increase to funding in the 2023 Physician Fee Schedule proposed by the U.S. Centers for Medicare & Medicaid Services. If adopted, the legislation would once again provide relief from Medicare cuts that APTA and other organizations say will severely damage patient access to needed care.
Known as the "Supporting Medicare Providers Act of 2022" (H.R. 8800), the bill introduced in the U.S. House of Representatives by Reps. Ami Bera, D-Calif., and Larry Bucshon, R-Ind., on Sept. 13 would add additional funding to the fee schedule's conversion factor through the end of 2023, theoretically returning that factor to its current level. In another positive development, the bill also contains language that acknowledges the need to address the long-term stability of the payment system.
Reductions to the conversion factor — part of the calculation used to determine payment for codes under Medicare — are at the heart of a CMS attempt to find money to cover payment increases for codes related to patient evaluation and management. The cuts proposed by CMS impact more than 27 specialties including physical therapy.
Although CMS has not released the final fee schedule rule, if past behavior is any guide, the agency isn't likely to alter course relative to payment cuts. Without a significant change to the proposed rule, it will be up to Congress to step in with additional funding, as it did in 2020 and 2021 when CMS implemented similar conversion factor cuts. The introduction of H.R. 8800 sets the table for Congress to intervene yet again to prevent cuts in 2023.
The announcement of the bill is welcome news to APTA and other organizations that were forced to turn to Congress for relief in previous years. And while it's important that the legislation be passed as a crucial short-term fix, APTA Vice President of Government Affairs Justin Elliott says that the action by Congress will help APTA and other advocates in their pursuit of large-scale changes.
In terms of that larger picture, the bill includes so-called “sense of the Congress” language stating that the Secretary of the U.S. Department of Health and Human Services and Congress should take action to ensure the financial stability and predictability of Medicare payment, reward value-based care, safeguard timely access to high-quality care, and reduce disparities.
"APTA applauds Reps. Bera and Bucshon for their continued commitment to patient care and assisting providers during these challenging times," Elliott said. "We will continue to join with members of Congress and other provider organizations to work for passage of this bill, which could help to facilitate a broader conversation about the need for reform of the entire fee schedule."
APTA government and regulatory affairs staff will continue to monitor the progress of both the proposed fee schedule and the funding bill, and will provide updates as issues develop — including calls for advocacy action by members and supporters at the appropriate times.