Physical Therapy is a Promising, Cost-Effective Solution to Falls
According to the Centers for Disease Control and Prevention (CDC), more than 1 in 4 elderly Americans fall every year – resulting in 41,000 deaths and 3.6 million emergency department visits. 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
- $80 Billion: Total medical expenditures associated with falls every year
- $81,300: Average lifetime costs for patients 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 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.
- 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.
APTQI strongly supports legislation like the Stopping Addiction and Falls for the Elderly (SAFE) Act. The SAFE Act—which is also supported by 87% of older Americans—would allow Medicare beneficiaries to receive a no cost fall risk assessment from a physical or occupational therapist as part of their wellness benefit.
Continued, Disruptive Medicare Cuts Destabilize the 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) Final Rule for CY2025.
The final rule included a -2.8% cut to therapy providers in CY2025.
This cut comes on the heels of a series of payment reductions by CMS in recent years:
- 2024: CMS finalized 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.
- 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, rising costs, and historically high inflation, physical therapy providers are struggling to maintain operations, hire qualified staff, and ensure access to care for Medicare patients. While Congress has partially mitigated past cuts, Medicare providers like physical and occupational therapists have been forced to incur cuts for the previous five years. 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.
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.
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. According to The Moran Company, Medicare beneficiaries who received physical therapy after a fall were 39% less likely to use opioids in the six months following the fall.
Moreover, a recent report published in Journal of the American Geriatrics Society found that older adults who are frail are less likely to stop taking opioids after these medications are initially prescribed to treat pain after a fracture. And, older adults who engage in physical and occupational therapy show lower risk for long-term opioid usage, according to the Journal of the American Medical Association.
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 2033, an additional 36,800 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.
APTQI supports the Physical Therapist Workforce and Patient Access Act, 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.