With Yet Another Round of Serious Medicare Cuts, the Physical Therapy Community Calls on Congress to Act to Protect Seniors’ Access to Care

Following years of continued cuts, CMS is once again proposed slashing reimbursement rates to physical, occupational, and speech therapy in its Medicare Physician Fee Schedule (MPFS) Proposed Rule for CY2024. Unless Congress acts, the cuts will put extraordinary pressure on providers and ultimately threaten patient access to a safe, effective, and cost-effective treatment approach.

Washington, D.C. –– The Alliance for Physical Therapy Quality and Innovation (APTQI) today expressed deep disappointment about the Centers for Medicare & Medicaid Services’ (CMS) decision to include deep, across-the-board payment cuts to physical, occupational, and speech therapy in the Medicare Physician Fee Schedule (MPFS) Proposed Rule for CY2024. The cuts announced today represent the latest in an alarming trend that has seen CMS announce plans for steep cuts to specialty services, including physical therapy, in recent years. If allowed to go into effect, the cuts in the proposed rule will seriously affect seniors’ ability to access community-based therapy services that can help seniors remain independent, prevent falls, reduce opioid use, and lower healthcare costs.

The proposed rule includes a cut of at least 3.36 percent to providers in CY2024, and the highly technical formula CMS uses to determine reimbursement suggests the cuts could be even higher – as high as over 4 percent – in certain geographic locations. 

With physical therapy providers facing a litany of cuts in recent years and historically high inflation, the proposed cuts threaten to destabilize this important pillar of America’s healthcare system. As reimbursement continues to drop, the likelihood of practice closures and restricted access for Medicare beneficiaries grows to the alarm of seniors and therapy providers alike.

“Specialty services like physical therapy are absolutely critical for keeping seniors healthy, strong, and independent,” said Nikesh Patel, PT, Executive Director of APTQI. “Unfortunately, years of cuts to therapy services have seriously undermined the ability for therapy providers to keep their doors open to care for Medicare beneficiaries who represent one of the most vulnerable patient populations. Recognizing that physical therapy can reduce healthcare costs, prevent deadly and debilitating falls, and reduce the use of powerful opioids, we strongly believe the Medicare reimbursement system should reflect these important benefits and appropriately reimburse physical therapists for providing care. To ensure that timely access to specialty services for Medicare patients is preserved, Congress must intervene to prevent these cuts from going into effect in 2024.”

In recent years, a broad coalition of lawmakers and stakeholders came together to oppose previous cuts and support longer-term reforms to the fee schedule. APTQI and other specialty provider groups will again call on lawmakers to ensure these proposed cuts are properly addressed before the final rule is implemented in 2024. Moreover, stakeholders, including APTQI, have been working collaboratively to craft long-term solutions to Medicare’s fee schedule, a goal we share with leaders on Capitol Hill and beyond.

“Continued cuts to physical, occupational, and speech therapy services threaten seniors’ ability to receive the vital care they need to manage their post-operative care, pain, mobility challenges, and risk of falling,” added Patel. “Congress has long recognized the benefits of physical therapy and questioned the wisdom of cutting Medicare reimbursement for such a cost-effective and powerful approach to care. We look forward to working with lawmakers in Washington to stabilize the country’s healthcare system by combating Medicare’s repeated cuts to specialty care services.”

Despite the proposed cuts, the proposed rule also included several provisions that would help expand patient access, including allowing physical therapy assistants (PTAs) and occupational therapy assistants (OTAs) to operate under general supervision of PTs and OTs when it comes to Remote Therapeutic Monitoring (RTM). The proposed rule also opened the door for an expansion of general supervision for PTAs and OTAs for all physical therapy and occupational therapy services furnished in private practices, and CMS is soliciting comments on this idea. If general supervision is expanded, it would empower PTAs and OTAs to perform vital services for more patients, which is particularly important in rural parts of the country.

A recent report by The Moran Company, an HMA Company, suggests that physical therapy is a powerful tool for helping seniors avoid additional falls, reduce pain, and improve their overall wellbeing and quality of life. By helping seniors stay out of costly sites of service such as inpatient hospitals or emergency rooms, physical therapy leads to a measurable reduction in total healthcare spending.

Specifically, the researchers found:

• Increased physical therapy use by Medicare beneficiaries prone to falls could measurably reduce total healthcare spending.
  • Increased physical therapy use by 100 beneficiaries prone to falls could result in an offsetting reduction in total healthcare spending of as much as $61,400-$91,900, creating a potential savings of an estimated $10 billion among the 13.5 million Medicare beneficiaries* who are PT Non-Users.
• Medicare beneficiaries who received physical therapy after a fall were 50% less likely to visit the emergency room or be hospitalized for a follow-up injury in the six months following the fall.
• Medicare beneficiaries who received physical therapy after a fall were 39% less likely to use opioids in the six months following the fall.

Utilizing physical therapy to prevent falls is an important objective. Falls send more than 3 million seniors to the emergency room every year and result in over 32,000 senior deaths every year.

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About Alliance for Physical Therapy Quality and Innovation (APTQI)

The Alliance for Physical Therapy Quality and Innovation (APTQI) unites small, medium and large physical therapy practices to advocate for the physical therapy profession in the areas of payment reform, quality initiatives, outcomes and innovation projects. We are an aligned group of therapists and practices who share a common vision for the future of our profession. Our goal is to establish physical therapy as the treatment of choice and the best value for patients and payers. Learn more at aptqi.com.

*Taking the midpoint of these numbers ($76,650) and dividing by 100 beneficiaries, you get a potential savings of $766 per year per Medicare beneficiary.