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The Cut is Coming: A Call to Arms for PTs and OTs

August 31, 2020 • Advocacy • Heidi Jannenga

I am angry. Frankly, I’m mad as hell. Physical and occupational therapists have been dealt a bad hand yet again—and I’m not talking about the pandemic. COVID-19 wrought havoc on the healthcare industry, sure, but providers across all specialties and locations were hit hard (if perhaps for different reasons) and everyone had to learn how to adapt. No, I’m angry because despite the healthcare industry’s precarious position—despite all the work we’ve dedicated toward staying open and available to our patients—we are facing a reimbursement crisis that could cripple our industry for years to come.

CMS will cut PT and OT Medicare payments by 9%.

I hope this information doesn’t come as a surprise to you, because it has circled around the industry since August 2019. In the 2020 Medicare Physician Fee Schedule, the Centers for Medicare and Medicaid Services (CMS) finalized a cut to PT and OT Medicare payments in order to help fund payment changes for E/M services. At that time, CMS estimated that the cuts to PT and OT payments would ring in at 8%.

When CMS announced its intentions to cut payments, it didn’t go without heavy criticism. Several industry organizations (e.g., the APTA, AOTA, APTQI, and WebPT) rallied PTs and OTs and encouraged them to advocate against this financial threat. We definitely made a ruckus—the APTA reported that its members sent in 10,000 comments to CMS alone—but it wasn’t enough to stop the cuts.

We took our eyes off the ball.

To be honest, I think we dropped the ball last year. Though we dedicated a lot of energy toward fighting these cuts, our focus was split. The entire industry was fixated, for a long time, on the proposed PTA and OTA payment cuts. We wrote condemnations and think-pieces galore about the proposed assistant pay differential—when in reality, the 8% cut represented a much more serious and widespread threat to our financial viability. Our advocacy efforts around the assistant differential were somewhat fruitful, but ultimately, we still face a 15% cut in payment that will go into effect in 2022.

In any case, hindsight is 20/20. We can only move forward. In the 2021 proposed rule, CMS indicated that it plans to move forward with what is now a 9% reduction to PT and OT payments. As it currently stands, these cuts will take effect on January 1, 2021—about four months from now.

The PT and OT industries cannot sustain these payment cuts.

It’s no secret that the rehab therapy industry has fallen on hard times. Elective surgeries are not occurring at the volume they were pre-COVID, and patients are not venturing out to see their providers as often. Many clinics have had to make the difficult decision to furlough or lay off staff members, and some clinics have even been forced to shut their doors for good. According to WebPT’s data, July patient volume was still down 27.6% from pre-pandemic levels. Our industry has not recovered. We’re missing 30% of our normal revenue.

Clinics are still struggling to recover from COVID-related revenue disruptions.

The point I’m trying to make is that the rehab therapy industry is not in a position to withstand significant payment cuts—and please understand that these Medicare cuts will be significant. WebPT’s data shows that 25.7% of outpatient rehab therapy patients are Medicare beneficiaries, which means that this payment cut stands to affect, on average, a quarter of practice revenue. Clinics’ belts are already pulled tight enough. Another blow to their revenue streams could be enough to halt their financial recovery indefinitely—and eventually shut them down.

Commercial payers often follow Medicare’s lead.

Even if you believe that your practice can withstand a sizable Medicare payment reduction, the cuts may not stop there. CMS is typically a payer trendsetter. Many commercial payers follow its lead, often implementing CMS’s payment and billing changes within months of the final rule’s publication. If you think that these 9% cuts will stop with Medicare, I implore you to think again. It’s very possible that we will see echoes of the 9% cut ripple through commercial payer policy.

We only have four months to take action.

So, what do we do? I recognize that I’ve painted a pretty dire picture of our situation, but I don’t want to discourage anyone from taking action to change it. There is still time, and I don’t want you to believe that all hope is lost—because it’s not! The clock is ticking furiously, but we have four months to reverse CMS’s decision before the cuts take effect. We can do this, but we must work together. This is not a problem that any of us can fix on our own.

Federal congressional leaders must step in on our behalf.

At this time, CMS cannot (and will not) reverse the 9% payment cuts, because it’s bound by legislation that forces it to stay budget neutral. (Remember, that 9% will directly fund increases in payments for other providers.) That means the only people who can step in and stop the cuts from happening are the members of the US House of Representatives and the US Senate. These federal congressional leaders must waive, adjust, or postpone CMS’s budget neutrality requirements for the 2021 fiscal year.

If you have 10–15 minutes to spare, then you have time to advocate.

The good news is that even though getting congressional leaders to step in is a tall order, taking action and becoming an advocate has never been easier. Many different industry organizations have leaped at the opportunity to support the advocacy efforts of therapists and patients alike; nearly 60 other healthcare specialties will also be affected by these cuts. The APTA and AOTA have both created legislative action centers that are open to members and nonmembers. The Alliance for Physical Therapy Quality and Innovation (APTQI) has also created a no-fuss publicly available advocacy system. And WebPT has written customizable letter templates that therapists and patients can fill out and send to their representatives.

All you have to do is pick an organization and follow its instructions. It won’t take you more than 10 or 15 minutes.

Your profession is counting on you to rally your peers, your social circle, and your patients.

The success of any advocacy effort hinges on spreading the word and making a call to action. News of the 9% cuts has reached the far corners of the therapy community, but rehab therapists aren’t the only people who can take action against this potentially devastating reduction. Your colleagues—including billers and front office staffers—can advocate. Your referring physicians can advocate. Your friends, family, or old college friends can advocate. You can even ask patients to advocate. If we want to successfully stave off these changes and convince legislators to stand behind our cause, then we need to let them know how many voices care about this issue. We need to communicate the breadth of impact that these cuts will have.

#9for9Challenge

That’s why WebPT is spearheading a social media campaign to drive awareness and action. We’re calling it the #9for9Challenge: a call for rehab therapists to talk about the 9% cut, share advocacy resources, and encourage others to spread the word by tagging nine other people in their posts. Keep an eye on our social media accounts in the coming days as we roll out this campaign (and if you haven’t already, be sure to follow us!).

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We still have a chance to mitigate these cuts—but we have to fight for it. We must join forces to raise our voices and make waves in our federal government. I believe we can do it. Are you with me?

Heidi Jannenga

Heidi Jannenga, PT, DPT, ATC/L, is the president and co-founder of WebPT, the leading practice management solution for physical, occupational, and speech therapists. Heidi leads WebPT’s product vision, company culture, and branding efforts, while advocating for the physical therapy profession on a national scale. She co-founded WebPT after recognizing the need for a more sophisticated...

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