APTQI Applauds Bipartisan Lawmakers for Asking CMS to Clarify Justifications for Provider Reimbursement Cuts

Bipartisan letter comes after CMS issued its 2020 Medicare Physician Fee Schedule (PFS) final rule, which calls for deep cuts to therapy services in 2021

Washington, D.C. –– Today the Alliance for Physical Therapy Quality and Innovation (APTQI) applauded 99 bipartisan lawmakers in Congress for sending a letter to the Centers for Medicare & Medicaid Services (CMS) asking the agency to provide additional information about its decision to cut payment for important healthcare services in its 2020 Medicare Physician Fee Schedule (PFS) final rule.

The letter, which was signed by a bipartisan group of lawmakers, asks CMS to clarify its methodologies and justifications for the severe reimbursement reductions imposed on a variety of treatment specialties, among them physical therapy. Addressed directly to CMS Administrator Seema Verma, the letter also asks whether or not CMS will consider how its proposed changes may impact beneficiary access to important services, including the calculation mechanism behind such considerations. 

“This document represents a united front of lawmakers from both sides of the aisle who, supported by a wide range of provider and patient stakeholders, are urging CMS to provide justification for its decision to limit beneficiary access to important care services,” said Nikesh Patel, Executive Director of APTQI. “Decisions that heavily impact the delivery of healthcare to countless individuals must be underscored by transparency and public collaboration. I applaud these lawmakers for standing on behalf of the patient and provider communities impacted by these steep payment cuts.”

Issued in November of last year, CMS’ Physician Fee Schedule final rule for CY 2020 imposed across-the-board 8 percent cuts to physical therapy services starting in 2021. If implemented in its current form, the reductions would worsen the effects of previous cuts implemented in recent years, including a 2011 multiple procedure payment reduction (MPPR), which was increased in 2013, as well as the reduction of two common procedural codes used by physical therapists in 2018.

In commending the recent lawmaker letter, APTQI is continuing its effort to prevent injurious cuts to physical therapy services.

“We are requesting additional information regarding the process by which CMS reached the decision to reduce the reimbursement for services furnished by certain providers in 2021 to accommodate for the increases in the values of the office/outpatient evaluation and management (E/M) codes,” the lawmakers wrote.

Specifically, they ask two clarifying questions:

• What methodology and data did CMS use to calculate each estimated specialty level impact associated with implementing the changes to the office/outpatient E/M code set, including an individual breakdown for each specialty included in the “Other” category?
• CMS indicated it would consider additional information when preparing the final 2021 fee schedule. What additional information is most valuable to CMS? Will CMS take into consideration how these changes may impact beneficiary access to each specialty?

Other stakeholder groups supporting this bipartisan letter include the Academy of Nutrition and Dietetics, American Academy of Audiology, American Chiropractic Association, American Health Care Association, American Occupational Therapy Association, American Physical Therapy Association, American Psychological Association, American Speech-Language-Hearing Association, National Association for the Support of Long Term Care, National Association of Rehabilitation Providers and Agencies, National Association of Social Workers and National Center for Assisted Living.

To read the bipartisan lawmaker letter, click here.

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