Folks, we are at a crossroads.
Medicare is planning to reduce Kentuckians access to the most conservative and cost-effective way to treat aches, pains, sprains and strains: your highly skilled physical therapist. Treatment by your physical therapist decreases the likelihood of high-cost imaging and procedures, the use of opioids and medical costs in total. Physical therapists also help people manage chronic diseases that are highly responsive to movement and exercise.
However, only 16% of people who experience one of these issues is stepping foot into a physical therapist’s office. The reason? The short answer is limited access caused by a system that incentivizes the most expensive, invasive care first. In fact, in 2023 Medicare is planning to cut payments to physical therapists by 4.5%, the lowest cost providers in the healthcare system. This is a worrisome reduction that will directly impact the number of seniors able to access their physical therapist even more drastically.
A quick history lesson on Medicare.
In January of 2022, Medicare implemented a 15% cut for care provided by physical and occupational therapy assistants. The result? Medicare beneficiaries have started to experience delays in care while physical therapists overload their schedules to see as many seniors as they can without the hands-on support of therapy assistants.
Now, on top of the cuts seen over the past several years, Medicare just finalized a rule that will slash payments to physical therapists by 4.5% across the board in 2023. The cuts are in addition to other questionable policies like the expiration of the 3% pandemic relief and the imposition of another 4% cut due to the unintended consequences of a balance budgeting law.
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The pending outcome
With inflation at its highest levels in half a century and the cost of care rapidly rising, these cuts make it hard for physical therapy practices to stay afloat. Physical therapists already have to limit the times and number of Medicare patients that are seen in their clinic. Medicare is the most administratively burdensome payer to deal with, meaning it costs a practice more to take care of a patient with Medicare. If these cuts go into effect, these same patients might not be able to be seen by the lowest cost providers in the system or, at best, are met with lengthy wait periods.
Can you imagine having to wait weeks to see your physical therapist while you’re in pain? The combination of lowered access and long waiting times means higher downstream costs for Medicare and an overall cost increase and higher utilization for the entire system. In other words, hindering access to physical therapists means an increase in cost, pain and delays, which, in turn, results in the use of less safe alternatives like prescription pain medications, injections or surgery.
Cuts start January 1
And as these cuts are set to go into effect on January 1, the need for physical therapy continues to grow. In fact, demand for physical therapists and physical therapy assistants is projected to surge by 17% and 27% by 2031. Musculoskeletal conditions have begun to outpace cardiology, oncology and diabetes. At a time of surging demand for care, Medicare cuts will continue to limit physical therapists’ ability to simply meet the needs of a growing population.
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Fair reimbursement must happen
So, what can physical therapists do to help themselves in these times of uncertainty? If we were any other type of business, we could simply raise prices to help the business be sustainable. But because Medicare sets the rates, our industry can’t do that. This means that we rely on Medicare to provide fair reimbursement for the valuable services that we provide. Unless something changes, more practices will shut down, or more physical therapists will decide it’s not worth the hassle of treating the largest population that needs our services, Medicare patients.
What can you do? How can you help? Urge policymakers in Washington to block these across-the-board cuts before they go into effect in January. Right now, Congress is considering a bipartisan bill that would do just that. The Supporting Medicare Providers Act of 2022 (H.R. 8800), introduced by Representatives Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN), would go a long way to ensure the long-term stability of physical therapy providers and other specialty care sectors.
I urge our leaders in Washington to look to your family members, friends, and neighbors to see the tremendous impact that physical therapists have on so many lives––and pass this important bill before the end of the year.
Dr. Larry Benz, PT, DPT, OCS, MBA, MAPP, FAPTA is the co-founder and CEO of Confluent Health.
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