When the Centers for Medicare and Medicaid Services (CMS) finalized a 9% cut to Medicare payments for rehab therapy services, the industry exploded. Therapy organizations leapt into action, firing up advocacy efforts to convince Congress to intervene. Meanwhile, therapists took to the Internet to condemn the cuts, highlighting the devastating financial ramifications of such a drastic reduction—as well as the potential domino effect on other insurance carrier policies.
While the energy behind this advocacy push is truly amazing, it would be a disservice to the movement to overlook the other people who stand to suffer at the hands of this cut: patients. Patients—especially Medicare beneficiaries—face serious repercussions come January 1.
What is the 9% cut?
Here’s a quick refresher: beginning January 1, 2021, the Centers for Medicare and Medicaid Services (CMS) will reduce payments for certain provider types. Physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs), for instance, will face a 9% cut to their reimbursements for Medicare Part B services.
But that’s only the beginning. Medicare is a payment trendsetter, and many other commercial insurance carriers (e.g., BCBS, Humana, and United Healthcare) follow its lead. So, it’s very possible that commercial payers will copy this 9% cut to PT, OT, and SLP services. This, in turn, could lead to a massive decrease in revenue for already-struggling therapy providers across the country. And to survive that decrease, providers will be forced to make some difficult decisions.
1. Clinics may decline to treat Medicare patients.
If this cut comes to fruition, Medicare beneficiaries may lose access to skilled, medically necessary therapy care. Compared to their peers in other specialties, rehab therapists already receive ridiculously low reimbursements. Payments for rehab therapy services have consistently declined over time, and many rehab therapy clinic margins are already razor-thin. If Medicare goes forth with a reduction of this magnitude, then some clinics may have to stop treating Medicare patients altogether in order to remain financially viable. This could put a serious strain on the therapy supply curve—and many Medicare beneficiaries may be unable to obtain needed care as a result. Ultimately, this threatens the health and wellbeing of the entire Medicare population.
And there’s no easy out-of-pocket workaround to this problem. Medicare beneficiaries can’t pay cash for services that are usually covered by Medicare (i.e., pretty much everything except dry needling and wellness services)—no matter how much they want to.
2. Therapy clinics may shut down due to financial strain.
The strain of the COVID-19 pandemic has already weakened the financial condition of many clinics across the country. Another substantial blow (like, say, a 9% payment cut) could be enough to force some clinics to close their doors for good. This is especially true for clinics that serve predominantly older populations, as well as clinics that are in rural and underserved areas. If these facilities close, then patients will have fewer options (or in some cases, no options) to receive the rehabilitation treatment they need to live full, functional lives.
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3. Patients may receive rushed, lower-quality care.
Some clinics may be equipped to handle the financial strain of a 9% Medicare cut—but many others will have to adjust their operations to weather the storm. For example, clinics may try to make up for lower payments by increasing the number of patients they see each day and reducing the time therapists spend with each. But ramping up productivity quotas isn’t a great option; after all, such requirements tend to burn out clinicians. And overworked, disengaged therapists are a recipe for disaster in terms of care quality and outcomes. No one wants that.
4. Patients may struggle to book timely appointments.
If these cuts force clinics to permanently close, turn away patients, or stuff provider schedules to the gills, then it’ll be tougher than ever for patients to find accessible, high-quality therapy care. The best clinics will likely book up very quickly, making it difficult for patients to schedule timely appointments. And even if they’re able to secure an initial evaluation, they’ll find it increasingly harder to book follow-up appointments at an appropriate cadence—which ultimately compromises their ability to complete their courses of care and meet their therapy goals on time. On a long enough timeline, this could lead patients to seek other, more readily available—and also more risky—treatment options, including prescription painkillers.
Whew—that’s a lot of doom and gloom. The good news is that this doesn’t have to come to pass! There is still time to fight these cuts and preserve the accessibility and viability of rehab therapy. All you have to do is take 15 minutes to download and send your free congressional letter template. Then, encourage your patients to do the same with patient advocacy letters. Together, we can halt this devastating payment cut—but we have to act fast, because time is running out. Don’t wait another moment to contribute to this historic advocacy push. Your peers—and your patients—are counting on you.