We wrote to you earlier in the year that COVID-19 would not be our biggest battle of the year.
Now we know that to be true.
Our therapy associations have advocated tirelessly.
On Tuesday (Dec. 1) the Centers for Medicare & Medicaid Services released the 2021 Medicare Physician Fee Schedule (MPFS) final rule.
The final rule implements a 9% decrease for physical therapy, occupational therapy, and speech-language pathology services beginning in 2021.
We are not alone in our disdain. An ever-growing list of provider types is urging Congress to take action. Stating specifically that, “If Congress fails to mitigate these cuts, decreases in Medicare payments will further exacerbate the problems occurring across the country with practices and institution-based providers furloughing or cutting staff and an increasing number closing their doors in response to the COVID-19 pandemic.”
Even some physician and nonphysician provider groups are also set to see reductions as high as 10%.
Why are these changes occurring, you ask?
These significant rate reductions result from changes to office-based outpatient evaluation and management (E/M) procedure codes that provide payment increases for primary care services.
By law, every year CMS must ensure that rate changes for all procedure codes paid under the MPFS remain budget neutral.
CMS implemented the 2021 reductions to offset the significant increase in value for the new E/M codes and to meet the Medicare program’s budget neutrality mandate.
Additionally, CMS uses a CF to calculate the MPFS payment rates. For 2021, the CF will be $32.41, representing an approximate 10% decrease from the $36.09 CF for 2020. This is due in large part to the increases to the E/M codes necessitating a steep reduction in the CF to meet the budget neutrality mandate.
What can we do to stop the cuts?
Remember that time is of the essence as these cuts will be implemented in 30 days or less.
AOTA, APTA and ASHA urge Congress to include H.R. 8702, the Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020, in any moving legislative vehicle before the end of the year. H.R. 8702 is bipartisan legislation that will address these cuts by providing relief payments in an amount that will ensure parity with current payment for impacted services.
Take-Action websites have been developed by each group in addition to NASL and NARA:
- American Occupational Therapy Association: AOTA’s Take Action Page
- American Physical Therapy Association: APTA’s Take Action Page
- American Speech Language Hearing Association: ASHA’s Take Action Page
- National Association of Rehab Providers and Agencies: NARA Advocacy Page
- National Association for the Support of Long Term Care: NASL Take Action Site
In closing, remember that fighting for the future reimbursement of our professions and the patients we serve, not COVID-19, will be the biggest challenge to the therapy industry in 2020.
Additional Resources and References
ASHA/APTA/AOTA Joint Therapy Groups’ Statement: Therapy Associations Call on Congress to Address Medicare Payment Cuts
American Occupational Therapy Association: Therapy Associations Call on Congress and CMS to Stop Medicare Payment Cuts
American Speech Language Hearing Association: 2021 Medicare Part B Final Rule Includes Significant Payment Cuts Coding Changes (asha.org)
American Physical Therapy Association: CMS Final 2021 Fee Schedule Presses On With Cut
American Physical Therapy Association: Guidance for consumers on how to advocate to stop 9% cut
Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association’s Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).