Issues & Insights

Congress Must Provide Long-Term Relief To Specialty Providers

As the United States emerged from the winter months of early 2021, it seemed – at last – that the nation had finally turned the corner on the darkest chapter of the COVID-19 pandemic. For specialty providers hit hard by the crisis, this sense of guarded optimism grew as Congress and the administration undertook a series of actions to provide crucial support and relief to health care workers across the country.

These actions included the passage of legislation extending the Medicare sequester suspension, signed into law by President Joe Biden on April 14, as well as recent steps undertaken by Congress to mitigate deep cuts to more than 30 health care specialties that were included in the 2021 Medicare Physician Fee Schedule (MPFS) Final Rule. These short-term legislative “fixes” received broad acclaim from a vast coalition of provider associations and patient advocacy groups.

But for many providers – including physical, occupational, and speech therapists – our sense of temporary relief should not be misconstrued as a final victory lap. Instead, the necessary short-term help from Washington fails to address broader structural problems facing our nation’s specialty health care infrastructure.

To better understand the long-term threats to specialty care, look no further than physical therapy.

As highly trained professionals who treat patients of all ages and abilities, our goal is to maximize patients’ mobility and help them improve or maintain their independence and quality of life. Each year, our community provides quality and cost-efficient outcomes to millions of Americans in the health care system. Our value is evidenced by a growing body of research showing that physical therapy not only reduces short- and long-term health care costs, but can also mitigate pain, improve function, and help patients return to normal life. As America’s patient populations become demographically older, the services provided by physical therapists will become increasingly important.

Despite physical therapy’s clear value proposition, our profession has been on Medicare’s chopping block for almost a decade. Starting in 2011, physical therapy was hit with a multiple procedure payment reduction (MPPR), which was further deepened in 2013, as well as a payment reduction for two common procedural codes utilized by physical therapists in 2018.

The impact of these cuts was exacerbated – dramatically – when COVID-19 swept across the country in early 2020. Like a wide range of specialty providers, we experienced precipitous drops in patient volumes and growing operational costs associated with PPE and other infection control measures. Amid all of this historic turmoil, Medicare imposed draconian cuts across more that 30 healthcare specialties, including a staggering 9 percent reimbursement reduction to physical, occupational, and speech therapy.

Following pleas from concerned stakeholders about the urgent need for relief, Congress intervened to temporarily suspend the Medicare sequester cuts, reduce the severity of the reimbursement reductions, and provide more funding to the Medicare program to maintain fair payment rates for embattled providers.

These steps were applauded, but they were not comprehensive. For example, the Medicare Physician Fee Schedule (MPFS) cuts are still scheduled to be fully implemented over the course of the next few years. As a result, the main structural defects of the MPFS – namely the budget neutrality requirement which exacts arbitrary cuts to provider reimbursement unrelated to the cost of providing care – remain intact.

The principal goal of the fee schedule should be to support broad participation from health care providers across the spectrum of care, ensuring the delivery of timely, quality treatment to Medicare beneficiaries. Yet, this aim is severely undermined when policymakers impose harsh cuts to medical specialties unrelated to the reality of care-delivery on the ground. Without further intervention, arbitrary cuts to specialty care will undermine patient access, stifle the financial viability of practitioners (especially small businesses), and slow America’s health and economic recovery from the pandemic.

As a country, we must do better. I urge Congress to reconsider its approach to specialty care relief, examine the long-term ramifications of the budget neutrality requirement included in the Medicare fee schedule, and implement policies to shore up our health care infrastructure now and in the future.

Nikesh Patel, PT, is the executive director of the Alliance for Physical Therapy Quality & Innovation.

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