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Why We Need Lobbyists—Not Activists—to Reverse the 9% Cut

September 21, 2020 • Advocacy • Heidi Jannenga

The financial stability of the PT industry is in jeopardy—and we’re running out of time to save it. We’re facing a Medicare payment cut of epic proportions (9%), and it couldn’t come at a worse time. Many clinics have yet to recover from the financial strain of COVID-19, and the combination of the economic downturn, unrecovered patient volume, and an outpatient Medicare payment cut could cripple recovery efforts for years to come. We still have time to put an end to these reductions—but we must act quickly and efficiently.

CMS is planning to cut outpatient therapy payments by 9%.

Before I continue, let’s make sure we’re all on the same page. Here’s a quick rundown of what’s happening in the world of the Centers for Medicare and Medicaid Services (CMS):

  1. In the 2020 final rule, CMS finalized a payment boost for evaluation and management (E/M) CPT codes.
  2. Because CMS is bound by budget neutrality, it had to fund that payment boost by cutting back other parts of its budget.
  3. PT and OT services (along with dozens of other specialties) were slated for payment cuts to fund the E/M changes.
  4. In the 2021 proposed rule, CMS announced that it intended to move forward with these cuts—despite the current economic crisis.
  5. CMS also announced how it planned to enact these E/M cuts, which will ultimately result in a 9% cut to outpatient PT, OT, and SLP Medicare payments.
  6. These cuts will take effect January 1, 2021.

There are two ways out of this situation: Congress can waive CMS’s budget neutrality constraints, or CMS can back off of its proposed E/M payment boost (which it made clear in the 2020 final rule that it doesn’t want to do). The act of Congress would allow the agency to pay more for E/M codes without taking that funding away from other providers—like us.

We must petition congressional leaders.

Usually, if CMS includes language in the proposed rule that hurts PTs, we rally and submit official comments, sending letters to both CMS and Administrator Seema Verma. We did that (and did it well), but we were still unsuccessful. So now Congress—and Congress alone—must step in and stop this cut from taking place.

Unfortunately—as I’m sure we all know—the federal government can move at a glacial pace, and congressional leaders have a lot of competing priorities (especially now, as they’re approaching an election while simultaneously navigating a national crisis). If we want to get on the federal radar, rally bipartisan support, and ensure that a budget neutrality waiver passes through both the House and the Senate, then we need to use every second of our remaining time to act decisively. By the time this article is published, we’ll have three full months left before these cuts take effect. That is enough time to accomplish our goals—with immediate action and the right strategy.

We can’t take our eyes off the prize.

When CMS first proposed the then-8% cut in 2020, PTs were slow to respond. We were preoccupied with the proposed PTA and OTA payment differential, and we dedicated most of our advocacy energy to fighting that instead. At the end of the day, we earned a small victory in the fight against the PTA and OTA cuts—but we lost the war against a detrimental payment change.

I’m worried that history is repeating itself. I see PTs getting distracted and riled up about the recent NCCI edit changes when, in reality, these changes won’t have nearly the same impact as the sweeping 9% payment cut—not even close. I genuinely believe that people are blowing the NCCI changes out of proportion. More importantly, though, it’s drawing our attention away from the prize. Fighting the 9% cut should be our singular advocacy focus—our unifying banner—for the rest of 2020. Victory will not only take time and a heck of a lot of effort; it will also require funding. And our resources need to go directly toward this fight—nowhere else.

Awareness campaigns yield limited results.

We also must be strategic about where our resources go. I’m concerned that PTs and industry leaders are ponying up for advocacy efforts that won’t give us the biggest—or fastest—bang for our buck. Awareness campaigns are helpful, yes. They can rally widespread support; they can encourage people inside and outside of PT to advocate; they can bring awareness to an unrecognized issue; and grassroot efforts are looked at favorably. We should absolutely support the APTA’s awareness campaign and participate in movements like the #9for9Challenge.

However, financing awareness campaigns should not be our only strategy—especially this late in the game. We’re on a very short play clock; we don’t have time to gradually capture the attention of our legislators. We need to go straight to the source, because right now, our grassroots advocacy efforts are not working.

Federal legislators still don’t know what’s happening.

WebPT (and I by proxy) recently joined the Alliance for Physical Therapy Quality and Innovation (APTQI), a PT advocacy organization. Alongside the APTA, the APTQI is working tirelessly to advocate against the 9% cut—but with a focus on lobbying. On recent advocacy update calls with both APTQI and the APTA’s PT-PAC, political insiders cautioned us that—for the most part—legislators are still oblivious to our plight. The lobbyists complimented the work we’ve done so far, but they also noted that—if we want to rally leaders who have the ears of the committee chairs and the speakers of the House and Senate—we’ll have to lean on our PT lobbyists.

Congressional leaders get a lot of information about controversial topics from a lot of different sources. So, in order to raise awareness among the people who can actually take action (i.e., our representatives and senators) our efforts and resources should go toward lobbyists. That is where therapists’ money is best spent in today’s fight.

As constituents, we have more power than we realize.

We also can’t forget that legislators work for us—the constituents. That fact often gets lost in the shuffle, due in part to the depictions of government we see in Hollywood and the news. But at the end of the day, we decide whether they keep their jobs, and they want to know what we care about. They want to hear real stories from people who live in their districts. Without those stories, they don’t know their constituents’ pain points—which means they can’t show effective outcomes for their reelection bid. That’s why developing strong relationships with legislators from your district makes you a pseudo-lobbyist with the best clout.

If you already have a relationship with a legislator, it’s time to call in that big favor you’ve been saving up. If you don’t have a relationship with a legislator, it might be difficult to start one now, but better late than never. Besides, with elections around the corner, legislators are in the market for forging community connections. If you’re not sure how to secure that initial introduction, reach out to your state association or the association’s PAC (political action committee).

We need to partner with people who know how to navigate the federal government.

On the topic of relationships, navigating Washington is all about relationship-building and convincing the right people to act on our behalf. Despite our best efforts to encourage professional advocacy, most PTs don’t know the ins and outs of the House or the Senate; we don’t know the best way to get our representatives’ attention—but lobbyists do. If we’re going to fundraise and dedicate a substantial amount of money to fighting these cuts, then we might as well funnel those dollars directly to the source. We need to empower lobbyists and lobbying organizations to get through to congressional leaders today, because we’re running out of time.

I understand that lobbyists have a bad rap because they often give private industries a huge amount of influence over legislation—but that’s exactly the point! If pharmaceutical companies can lobby the government to promote opioids, then we can (and need to) lobby for our own cause. If we want to win, we have to play the game. So, if you’re in a position to offer monetary support for fighting these cuts, don’t spend it all on general awareness campaigns. Give it to groups like the PT-PAC, the AOTPAC, or ASHA-PAC—rehab therapists’ own lobbying organizations.

There’s power in numbers.

We also don’t have to lobby alone; it’s not rehab therapy against the world. Dozens of other specialties are slated to receive Medicare cuts—and those providers are just as upset as we are. That’s why some PT advocacy groups are forming alliances with lobbying organizations that represent other specialties. I believe this is the way to go. There’s power in numbers, and we have a much better chance of succeeding if we all band together and lobby for a budget neutrality waiver. Together, we could take a stronger stand and even have a voice in the negotiations for the next Medicare payment model change.


This fight is looking tough, but it’s far from over, and I believe we can win. But we must be strategic, decisive, collaborative, and ready to adapt to whatever obstacles are thrown in our way. We must go straight to the source, and right now—due to the political climate and situation—lobbyists are the best way to do that. The clock is ticking, and it’s time for us to act now. Can we count you in?


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Heidi Jannenga

Heidi Jannenga, PT, DPT, ATC, is the co-founder and Chief Clinical Officer of WebPT, the leading practice management solution for physical, occupational, and speech therapists. Heidi advises on WebPT’s product vision, company culture, branding efforts and internal operations, while advocating for the rehab therapy profession on a national and international scale. She’s an APTA member,...

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Paul Leverson

Commented • October 1, 2020

Hey Heidi... I had just a moment to reply. Thanks for your article. This is a conundrum for sure. On the one hand, we'd all like to be reimbursed more for our service. On the other hand, the federal government/CMS is dealing with a $25 trillion debt that continues to expand because of their reluctance -- or indifference -- to trim itself. I don't want to be a part of inflating the national debt. But I also want to be compensated for the valuable service I provide. For years, I've seen the CMS system very similar to situations I ran into on the farm as a young boy. It's called "milking the dry cow". As a farmer, you don't want to do this because it is increasingly less and less profitable for more and more work. ...and the cow doesn't appreciate it either! Instead of continuing to milk this dry (and increasingly more dry) cow, I've moved towards encouraging our clinic to develop "other cows". We need to be more creative in creating alternative revenue streams. This may actually require that we think differently about how we treat our clients in order to improve our reimbursement (ironically, these changes would enhance population health and active coping by the client...producing superior, more economical results). Here's some options... First, the client needs to be a bigger player and participant in their own recovery. Gone are the days of me watching someone do straight leg raises 4 weeks in a row, determining when he should go from 1 lb to 2 lbs. Of course, this is an extreme example, but we continue to do this all over in our profession, whether its seeing someone for 4-6 weeks tiw post THA or 20 manual therapy treatments that get them 50% better. The client needs to be the driver of their own care. We've not done a good job of developing that in our profession. We've made ourselves "the magic". Secondly, if the client is a bigger participant in and driver of their own care, we should set up multiple options all with variable costs for them to consider -- and work towards reducing -- as they gain more and more independence and mastery over their own recovery. I don't need to hold their hand right up till the point they are 100%. My responsibility is clearing obstacles to their recovery, or, better yet, teaching them how to do the same. Thirdly, if we could develop such independence and ownership in a client, then we're allowed all kinds of options to LEVERAGE our expertise and resources and get out of the CMS reimbursement crumb catching model. Scrambling on the floor for a 9% crumb just so we can survive is not how we should be spending our effort and actually is humiliating. Certainly, we can lobby, write letters, but in the end, we're not in control of our own destiny there are we. In fact, we've become enslaved to CMS. I prefer freedom. With an active coping, engaged, informed client, I can develop private pay models that perfectly and seamlessly dovetail my expertise/interventions with the client's independence level. With rising copays and out of pocket costs, it is a perfect opportunity to offer -- as an option -- private pay for the client to choose for their care and likely be more economical to them -- and better reimbursed to me -- in the end. And, then in the end, we have had influence in developing a person who has become more engaged in their own healthcare and is less dependent on the government insurance, or my service to actually live.

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