Physical and Occupational Therapy Are on the Medicare Chopping Block

Americans expect the best care from their doctors. Decades of experience, thoughtful interdisciplinary planning, and evidence-based research mean providers are treating them based on widely accepted standards of care.

For example, someone who has experienced a heart attack would never be discharged from a hospital without being prescribed medications to mitigate future cardiac events. A patient with acute pulmonary issues would receive medications and resources for oxygen therapy, if appropriate. Stroke patients receive the acute hospital-based care they need to save their lives, as well as a constellation of other types of care and services to decrease complications and enhance recovery — pharmacological, dietary, and rehabilitative.

Physical therapy and occupational therapy are among the critical standards of care that would be included for all of these patients. These services help form the bedrock of ensuring good outcomes, decreasing secondary injury and complications, and reducing rehospitalizations.

In addition to serving as an important part of post-acute care, physical and occupational therapy provided by licensed therapists can help improve balance and mobility, improve cardiovascular function, reduce pain, and decrease falls. In fact, healthcare associated with falls costs the healthcare system tens of billions of dollars each year — and exercise interventions by physical therapists have helped to lower the risk of falls by 31%.

Eliminating or reducing access to physical and occupational therapy due to Medicare cuts would be devastating to patients’ health outcomes. Not only would it undermine the standards of care for many conditions, it would also complicate the lives and tenuous health situations of the millions of Americans who depend upon it.

Seniors nationwide, therefore, are extremely concerned about the 4.5% cut to their therapy providers in 2023 under the Medicare Physician Fee Schedule. If this cut is implemented, the physical and occupational therapy community will experience cuts totaling approximately 9% by 2024. The continued practice of annual Medicare cuts threatens the sustainability of the country’s physical and occupational providers, especially in rural and underserved areas where they are needed most.

Our nation’s Medicare beneficiaries understand how integral physical and occupational therapy are to standards of care — and they value it deeply. According to a recent survey, 9 out of 10 Americans over the age of 65 have favorable views of physical therapists, and the majority see considerable value in the services they provide. Nearly the same number (88%) expressed concerns that proposed Medicare payment cuts may eliminate alternatives for therapy outside of nursing homes and eliminate seniors’ ability to age in place. More than three in four respondents (76%) say it is important for them to be able to access their physical therapist when they cannot come into the office for an in-person appointment.

Care professionals across the healthcare continuum — from skilled therapists to physicians to nurse practitioners and physicians’ assistants — recognize the negative impact these cuts would have on their patients, and support efforts in Congress to address these cuts in the year ahead.

Bipartisan lawmakers in Congress have introduced legislation to block these harmful cuts from taking effect in 2023, an essential step toward ensuring all Americans can access quality physical therapy and other specialty services. The Supporting Medicare Providers Act of 2022 (H.R. 8800) would block Medicare’s Physician Fee Schedule cuts by providing an additional 4.42% to the conversion factor for 2023.

It’s inconceivable to think we can continue to provide thorough care without one of the most essential elements — therapy. We hope that Congress will act — and quickly before the end of the year — so that our critically important healthcare standards for patients suffering from a multitude of diseases, injuries, and conditions are not irrevocably undermined.

CMS rolls back more Medicare, telehealth regs for providers working through pandemic

https://www.healthcaredive.com/news/CMS-second-round-COVID-rollbacks/577199/

 

How Telemedicine Is Changing Healthcare

Dive Brief:

  • CMS issued a another round of sweeping regulatory rollbacks Thursday that will temporarily change how some providers care for patients and get compensated during the ongoing pandemic.
  • Practitioners such as therapists previously restricted from providing telehealth services for reimbursement can now do so, and CMS is also upping payments for telephone-only telehealth visits. Accountable care organizations also scored a major win in the Thursday rule drop, with CMS pledging they wouldn’t be dinged financially for lower-than-expected health outcomes in their patient populations from COVID-19.​
  • Other major changes are related to COVID-19 testing for Medicare and Medicaid beneficiaries. A written practitioner’s order is no longer needed for diagnostic testing for Medicare payment purposes. The agency also said it will cover serology, or antibody testing, including certain FDA-authorized tests that patients self-collect at home.

Dive Insight:

The new rules come out of the recent public health emergency declaration, building on others announced in late March and early April. This round of changes, which take effect immediately, focuses on expanding testing capacity to help reopen the U.S. economy, according to CMS, along with delivering expanded care to seniors.

Major provider lobbies the American Hospital Association and American Medical Association praised the changes, noting that Medicare patients have been canceling needed medical appointments because of physical distancing and transportation challenges.

The Trump administration, which allowed traditional Medicare to temporarily cover telehealth in March, continues to expand virtual care access. CMS is expanding the types of specialists allowed to provide telehealth services for reimbursement to include physical therapists, occupational therapists, speech language pathologists and others. In the past, only doctors, nurse practitioners, physician assistants and certain others could do so.

Earlier changes included waiving the video requirement for telehealth patients without access to interactive audio-video technology – particularly those in rural areas. CMS is increasing payments for telephone visits from a range of about $14-$41 to about $46-$110, according to the release.

The rollbacks are a “major victory for medicine that will enable physicians to care for their patients, especially their elderly patients with chronic conditions who may not have access to audio-visual technology or high-speed Internet,” the AMA said.

Michael Abrams, managing partner of Numerof & Associates, a healthcare consulting firm, said the current, rapid adoption of telehealth is an experiment, and depending on the results, waivers could eventually become permanent.

“Once you increase pricing, you almost never roll it back,” Abrams said. “If this new pricing on telehealth visits makes it more attractive, attractive enough to substitute telehealth for in-office visits, that not only lowers the cost of care, but makes it very much more accessible, particularly for those whose ability to see a physician is limited.”

In a victory for ACOs, CMS said the value-based organizations wouldn’t incur any financial penalties because of COVID-19 testing and treatment for their patient populations. Roughly 60% of ACOs said previously they were likely to drop out of their risk-based model to avoid potential losses, according to the National Association of ACOs.

CMS is also allowing ACOs to remain at the same level of risk for another year, instead of bumping them up to the next risk level. NAACOs said it was “appreciative” of the changes in a statement, though they asked for additional relief for providers in two-sided risk arrangements.

Other loosened restrictions include those on who can administer COVID-19 diagnostic tests for payment to include any healthcare professional authorized to do so under state law, including pharmacists. Medicare and Medicaid recipients can now get tested at parking lot sites operated by pharmacies and other entities for reimbursement.

Outpatient hospital services such as wound care, drug administration, and behavioral health services can now be delivered in temporary expansion locations, including parking lot tents, converted hotels or patients’ homes for reimbursement, so long as they’re temporarily designated as part of a hospital.

Hospital outpatient departments that relocate off-campus are paid at lower rates under current law, but CMS is making a temporary exception to continue paying those physicians at their standard rates.

The agency will also pay for certain partial hospitalization services – that is, individual psychotherapy, patient education, and group psychotherapy – that are delivered in temporary expansion locations, including patient homes.

CMS is also now requiring nursing homes to inform residents, their families, and representatives of COVID-19 outbreaks in their facilities.