Physical Therapy is a Promising, Cost-Effective Solution to Falls
According to the Centers for Disease Control and Prevention (CDC), 30 million elderly Americans fall every year – a figure representing roughly one-quarter of all seniors. Unfortunately, this problem is only expected to worsen as America’s population grows older: fall injuries and deaths are likely to increase.
The cost burden for this epidemic is immense – and growing:
- $101 Billion: Projected cost of treating falls by 2030
- $50 Billion: Total medical expenditures associated with falls in 2015 alone
- $81,300: Average lifetime costs for patients are caused by a fall-related injury
- $30,000: Average hospital cost for a fall-related injury
In addressing this epidemic, the U.S. healthcare system has an invaluable tool at its disposal: physical therapy.
A new report developed by The Moran Company, an HMA Company, demonstrates that physical therapy is a powerful tool for helping seniors avoid additional falls, reduce pain, and improve their overall wellbeing and quality of life. 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.
Physical therapy prescribed treatments enable patients to remain steady and maintain their independence. Physical therapists are also trained to conduct patient home assessments which evaluate a patient’s living space and identify potential fall hazards. In fact, a recent study showed that older citizens who underwent an exercise intervention from a trained healthcare professional lowered their risk of a fall by 31%.
In short, physical therapy helps improve older Americans’ balance, strength, and independence –– while bolstering patient outcomes and preventing costly (and often avoidable) injuries.
Fortunately, Members of Congress are recognizing the role physical and occupational therapists can play in preventing senior falls.
Congresswoman Carol Miller (R-WV) and Congresswoman Melanie Stansbury (D-NM) have recently introduced the Stopping Addiction and Falls for the Elderly (SAFE) Act (H.R. 7618). The SAFE Act aims to enhance Medicare coverage to a falls assessment provided by a physical therapy or occupational therapist in beneficiary annual wellness visits and initial preventive physical exams, specifically targeting falls prevention.
Continued, Disruptive Medicare Cuts Destabilize Sector
The Centers for Medicare & Medicaid Services (CMS) has once again finalized across-the-board payment cuts to physical, occupational, and speech therapy in the Physician Fee Schedule (PFS) Rule for CY2024.
The final rule, released on Nov. 16, included a cut of at least -3.4 percent to therapy 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. This new cut went into effect on January 1.
This cut comes on the heels of a series of payment reductions by CMS in recent years:
- 2023: CMS finalized a 4.5 percent cut to providers in 2023, which would leave the sector subject to cuts of approximately 9 percent between 2020 and 2024.
- 2022: CMS finalized a 3.75 percent cut to providers in 2022 and a troubling 15 percent cut for services provided by physical and occupational therapy assistants.
After suffering through years of reimbursement cuts, the COVID pandemic, and historically high inflation, physical therapy providers are struggling to maintain operations, hire qualified staff, and ensure access to care for Medicare patients. This latest round of cuts threatens to further destabilize this vital pillar of America’s healthcare system.
Physical therapy can reduce healthcare costs, prevent deadly and debilitating falls, and reduce the use of powerful opioids. APTQI believes the Medicare reimbursement system should reflect these important benefits and appropriately reimburse physical therapists for providing care.
Voices from across the healthcare continuum agree. Fifty-four organizations representing physicians and other health care providers across the United States, as well as APTQI, recently sent a letter to Congress urging lawmakers to act immediately.
Fortunately, Congress is taking action to partially mitigate these cuts.
Congress recently took action to mitigate the across-the-board -3.4% cut included in the Medicare Physician Fee Schedule (MPFS) Final Rule for CY2024, which went into effect on January 1, with a partial fix – an adjustment of 1.68%. This adjustment will provide some relief to cuts that threaten to disrupt the stability of the nation’s healthcare system and make it more difficult for patients to access the care they need, including physical therapy.
Though short of fully addressing the cut, APTQI commends Congress for working to stabilize the system and maintain access to care.
APTQI remains committed to working with Congress to advance long-term Medicare reform that links the MPFS to a measure of inflation, thereby stabilizing the system.
Administrative Burden
Current Medicare regulations impose significant burdens on physical therapists. When senior patients need physical therapy (PT), restrictive rules require physical therapists to navigate a lengthy, cumbersome process to receive reimbursement for the medically necessary treatments they provide.
When a physician refers a patient to PT, they create and sign a referral. Upon seeing the patient for the first time, the physical therapist will conduct an examination and create a plan of care. But, despite already having a signed referral from the physician, Medicare requires therapists to secure another signature from the referring provider on the plan of care, which can take weeks and dedicated sta to track down approvals even when the physician has already recommended PT. If the physician fails to sign the paperwork within 30 days, the therapist is at risk for not receiving reimbursement by Medicare.
Paperwork should not get in the way of providing medically necessary care. Fortunately, Congress has taken notice and is working to address this problem. The Remove Duplicative Unnecessary Clerical Exchanges (REDUCE) Act (H.R. 7279) would allow the plan of care to be deemed certified as long as it is submitted to the physician within 30 days.
Opioid Crisis
The ongoing opioid crisis in the U.S. has led to a growing realization that current pain management strategies have to change. Prescription opioids – which mask, rather than treat the underlying cause of pain – have contributed to widespread opioid misuse and addiction in communities throughout the U.S.
In order to help combat opioid misuse, it is necessary to adopt new approaches to pain management. Physical therapy is a clinically proven, cost-effective pain management alternative that should be leveraged earlier and more often to prevent opioid misuse and addiction.
Promoting access to physical therapy is critical because, unlike, prescription opioids, PT prevents and treats the underlying cause of pain. Research shows the efficacy of physical therapist interventions in preventing, minimizing, and, in some cases, eliminating pain.
In its Guideline for Prescribing Opioids for Chronic Pain, the Centers for Disease Control and Prevention (CDC) recommends physical therapy as an alternative to opioids for the treatment of chronic pain. The CDC notes PT is especially effective at reducing pain and improving function in cases of low back pain, fibromyalgia, and hip and knee osteoarthritis.
Workforce Shortage
The United States is currently in the middle of a national shortage of physical therapists and physical therapy professionals. Estimates show that by 2025, an additional 27,000 PTs will be needed to meet demand. This problem is particularly acute in rural areas because many physical therapists are concentrated in major metropolitan areas. APTQI members are eager to invest in underserved communities if they had the resources to recruit more PTs and expand care.
To address this shortage, Senator Jon Tester (D-MT), Senator Roger Wicker (R-MI), Rep. Diana DeGette (D-CO), and Rep. Kelly Armstrong (R-ND) introduced the Physical Therapist Workforce and Patient Access Act (S. 2676/H.R. 3759), which would enable physical therapists to participate in the National Health Service Corps student loan repayment program.
In an attempt to alleviate shortages of medical professionals around the country, the National Health Service Corps provides student loan relief to medical professionals who commit to serve in a medically underserved or designated health care professional shortage area (HPSA). This makes it difficult for physical therapists to deliver services and open centers in critically underserved markets. Under this legislation, the NHSC loan repayment program would allow physical or occupational therapists to participate, thereby improving access to physical therapists in HPSA areas where companies are hoping to establish community-based centers.
Physical & Occupational
Therapy Assistant Cuts
Physical and occupational therapist assistants (PTAs/OTAs) are an essential part of the therapy profession, providing direct patient care services to patients under the guidance and supervision of licensed physical therapists.
Despite the incredible value therapy assistants offer to patients, the Centers for Medicare & Medicaid Services (CMS) imposed a 15% Medicare payment cut on the direct patient care services provided by PTAs and OTAs starting January 1st.
This is in addition to a number of Medicare cuts to therapy services in recent years. This additional 15% cut will only further restrict the ability of the profession to meet patients’ pain management and recovery needs using the safest, most cost-effective care path.
If these cuts remain, our patients, especially those living in rural and underserved areas, may face new barriers to care when trying to access the treatment they need.
To protect Medicare beneficiaries’ access to care, Representatives Bobby Rush (D-IL) and Jason Smith (R-MO) have introduced the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act (H.R. 5536).
Specifically, the bill would:
- Delay the implementation of payment cuts until January 1, 2023, to allow providers more time to prepare.
- Permanently prevent the 15% Medicare cuts to services provided by PTAs and OTAs in rural and medically underserved areas.
- Reduce requirements for direct supervision of therapy assistants in private practice settings – shifting from direct to general supervision in states with licensure laws that allow for general supervision – helping to ensure continued patient access and giving small therapy practices more flexibility.