Issues & Insights
U.S. Air Force, Tech. Sgt. Jonathan Hehnly

Medicare Cuts Threaten Jobs, Opioid Abuse, And Rural Health Access

Creating good jobs that keep up with inflation. Increasing rural access to health care. Fighting the opioid epidemic. These are all major priorities because we all want to live in healthy, prosperous communities.

Having traveled from my hometown in West Virginia to meet with members of Congress recently, I know lawmakers get it. Unfortunately, federal regulators continue to cut payments to health care providers that threaten to undo the progress we’ve made in all three areas.  

The decisions made in Washington have huge impacts on small towns – and businesses – like mine. Case in point: Medicare implemented a devastating 15% cut for services provided by physical therapy assistants (PTAs) on Jan. 1, putting enormous pressure on the physical therapy practices I operate. Understandably, most people don’t think about these highly technical rules, but they affect the livelihoods of vital health professionals and make it harder for patients – especially Americans living in our most rural communities – to access a key type of non-opioid pain management treatment.

As millions of Americans already know, physical therapy is a safe, effective way to build strength, maintain balance, and regain mobility. If you have ever badly broken a bone, torn a ligament, had a stroke, or suffered from muscle atrophy after a hospital stay, you have probably seen a physical therapist to help you recover. Physical therapy is especially important for older Americans because it helps them stay active, remain independent, and avoid dangerous falls, which send more than 3 million seniors to the emergency room every year. 

Physical therapy is also crucial for managing patient pain without potentially addictive painkillers. According to the Centers for Disease Control and Prevention, the nation recorded an average of 43.3 prescriptions per 100 people in 2020, with some counties seeing rates that were an alarming nine times higher than that. Opioid over-prescription helped fuel the current overdose crisis, which has tragically taken the lives of more than 1 million Americans since 1999. Sadly, a record 108,000 Americans died from a drug overdose last year.

With this in mind, lawmakers should be doing anything they can to curb addiction and prevent deaths – including supporting care practices that offer a safe alternative.

While the benefits of physical therapy are clear, we cannot make a difference if we do not have the necessary resources. Physical therapy assistants are a vital resource for making all this possible, especially in remote parts of the country where there may only be one physical therapy practice for many miles. 

Unfortunately, Medicare’s severe cut to physical therapy assistants threatens to force many out of the profession. Because PTAs are at the front lines of care, these cuts would have serious ramifications for patients, especially rural ones. Already, the 15% Medicare cut is negatively impacting my practices and our workforce. The PTA profession is not just a crucial part of my team as a business owner, it is a solid middle-class job-creator for many Americans, particularly in rural areas where good jobs are sometimes hard to come by. By cutting their pay at a time of record inflation, Medicare is causing some PTAs to rethink their futures or choose other career paths.

Furthermore, I fear that decreased earnings potential could cause the nation’s PTA pipeline to completely dry up as more people decide that earning the degree isn’t worth it. Even before the cuts went into effect, one school near me saw its PTA enrollment drop from 30 students to just six. Even more dramatically, the school announced recently that the class of 2022 will be its last graduating class because it is putting its PTA program on hiatus starting next year.

Fortunately, Congress is taking action. Reps. Bobby Rush, Illinois Democrat, and Jason Smith, Missouri Republican, have introduced the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act to help protect patient access to physical therapy. If enacted the legislation will temporarily suspend the PTA cuts and permanently exempt practices in rural and underserved communities from these cuts. 

For the sake of protecting middle-class jobs, fighting the opioid crisis, and ensuring rural access to health care, I urge our lawmakers in Congress to pass the SMART Act.

Simon Hargus PT, DPT, OCS, MBA is a physical therapist and owner of First Settlement Physical Therapy, a family-owned private practice with more than 30 clinics throughout West Virginia and Ohio.

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