Healthcare providers, including doctors and therapists who treat nursing home patients, continue to find more troubling details in the 2023 Medicare Physician Fee Schedule.
The Centers for Medicare & Medicaid Services published the 2,066-page proposed pay schedule Thursday. At first glance, it looked less painful fiscally than the 2022 rule. That one instituted a 15% pay differential for physical and occupational therapy assistants, and included conversion factor changes that resulted in a cut of about 2%. The previous year, providers were hit with a 9% cut.
However, while this year’s proposed cuts appear to be milder, changes to Current Procedural Terminology, or CPT, codes and other details would add up substantially, according to an early read-through by Cynthia Morton, executive vice president of the National Association for the Support of Long Term Care.
“Our initial analysis shows that rehab therapy services for seniors in nursing homes and other settings where Part B rehab therapy is provided are being reduced by CMS ranging from 3% to 6%,” Morton told McKnight’s Long-Term Care News. “This is significant given that we have taken cuts every year for the last couple of years.”
The 2023 fee schedule conversion factor proposed by CMS is $33.08 for each relative unit, a slight decline from the 2022 factor of $34.61. The government previously boosted the rate as a reflection of COVID operating conditions, but that expired this year.
While the fee schedule must remain budget neutral under federal law, Morton expressed concern that there was no consideration of staff shortages and the rates therapy providers must pay to hire.
“We are being paid less for our staff which is costing us more right now,” Morton said. “CMS is setting up a dangerous situation where access to rehab therapy is very difficult, especially in areas of the country where we can’t recruit therapists very well, like rural areas.”
Many leading physician groups since Friday have also blasted the pay schedule. Many are noting an additional 4% pay cut could occur under PAYGO, a federal law that triggers mandatory cuts when federal spending exceeds certain levels.
“The rule not only fails to account for inflation in practice costs and COVID-related challenges to practice sustainability, but also includes a significant and damaging across-the-board reduction in payment rates,” said Jack Resneck Jr., MD, president of the American Medical Association. “Such a move would create long-term financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians. We will be working with Congress to prevent this harmful outcome.”
The fee schedule also redefines participation and benefits of provider participation in accountable care organizations, makes some adjustments to covered telehealth services and expands slightly the types of dental services covered by Medicare.
In addition, it would recategorize nursing homes as high-risk facilities, forcing new owners to be fingerprinted and undergo background checks.
The American Health Care Association / National Center for Assisted Living said the new rule amounts to a bandage on an unrepairable system.
“Any proposed payment cut, especially during these challenging times, is extremely disappointing,” the association said in a statement to McKnight’s. “The Medicare Physician Fee Schedule design in statute is broken and unsustainable. The proposed cut to Medicare will make it even more difficult for therapists to meet beneficiary care needs. Public health officials should be directing more support and resources to our providers, not taking it away.
“Additionally, while we appreciate the CMS proposal to extend many procedure codes used by therapists through at least the end of 2023, Congressional action will still be needed to use the codes through the duration as therapists will no longer be recognized as telehealth practitioners after the COVID-19 public health emergency has expired.”
Association leaders will be delving further into the new federal plans in the coming days, the AHCA/NCAL statement noted. Of particular interest will be measures pertaining to “expanded behavioral health flexibilities, improvements to chronic pain management, and expanded oral health dental services that may be beneficial for our residents.”
Editor’s note: This article has been modified from its original form to include AHCA/NCAL’s updated comments.