As of this article’s publication date, we are less than one month away from the 2020 presidential election, but I’m sure I don’t have to tell you that. Unless you’ve completely unplugged from all forms of media and resettled in the middle of nowhere, you’ve undoubtedly been confronted with phone calls, advertisements, and mailers reminding you when to vote—and for whom. In fact, with the constant bombardment of attack ads and social media posts about this candidate or that one, logging off and leaving civilization behind sounds like a very tempting option. But here’s the thing: there’s a reason we’re all being reminded to vote at every turn. This election is a monumental moment for our entire country. No matter what your politics are, there is so much at stake for each and every one of us—especially as rehab therapists.
Before I go any further, I want to make it very clear that this is in no way a political endorsement—nor am I advising you on which candidates to vote for, regardless of your political leaning. But there is something that I think every individual working in the rehab therapy field—from clinic owners and providers to billers and front office staff—can agree on: the candidates that earn our votes should be aware of the issues we face as an industry and have an open mind to collaborate on a plan to help us combat them. More importantly, one of their agenda priorities must be the quality of health care our patients receive.
What’s at stake?
So, which issues should PTs, OTs, and SLPs consider as they research candidates and head to the polls? The list is lengthy, but below are four issues that—in my opinion—every rehab therapist should think about as they cast their ballots:
The 9% Cut to Medicare Reimbursements
As I discussed in my last founder letter, perhaps the most urgent issue facing the entire rehab therapy industry is the 9% cut to Medicare reimbursements for PTs, OTs, and SLPs. To be completely clear, this cut is not a proposal. It has been finalized and is slated to go into effect January 1, 2021.
While 9% may not sound like much, a payment cut of this magnitude will have a severe and immediate impact on all rehab therapy providers who treat Medicare patients. But, the situation grows even more dire when you consider the fact that many commercial payers base their reimbursement rules and fee schedules on Medicare standards. As a result, we could be staring down a major decline in all reimbursements across the entire healthcare system. And with many rehab therapy practices still struggling to find a financial foothold in the wake of COVID-19, any additional drop in revenue could prove disastrous.
There’s hope on the horizon.
Hot off the press this week, Representatives Michael C. Burgess (R-TX) and Bobby L. Rush (D-IL) filed bill H.R.8505 to reallocate unused money from the provider relief fund to pay for a one-year fee schedule budget waiver. This would allow Congress to delay the 9% cuts for one year while also allowing the scheduled Medicare budget provider increases to go through. In other words, it’s essentially a one-year reprieve that would give us adequate time to come up with an alternative way to satisfy Medicare’s budget-neutral status requirement.
This is amazing news for our industry. But perhaps more importantly, it’s a heartening sign that our advocacy is working! Providers and patients alike sent close to 70,000 letters to CMS and Congress—16,000 of which were generated from all of you who participated in our advocacy campaigns, either via the WebPT Blog or WebPT Reach! It's absolutely incredible what we can accomplish when we put our intentions squarely on a target, so thank you—but be sure to keep the pressure on until we get our wanted results. Your advocacy is making a difference!
The Continuation of Telehealth Privileges
Even with all the chaos and uncertainty brought forth in 2020, there have been a few positive developments. Chief among them is the way rehab therapists have embraced new technologies to better serve their patients and provide them with safe—and effective—alternatives to onsite care. For years, telehealth advocates have pushed for CMS to include rehab therapists on its list of eligible providers and to cover the virtual services they deliver to Medicare patients. This year, following an immense advocacy push, CMS finally added PTs, OTs, and SLPs as eligible telehealth providers on a temporary basis—and many private payers soon followed suit. Since then, we’ve seen rehab therapists not only adapt to using this new technology remarkably fast, but also deliver consistent, positive patient outcomes via virtual treatment.
That said, Medicare reimbursement for telerehab is only allowable because of an emergency executive order, which is set to expire once the national state of emergency has been lifted. (This is also the case for many state-level executive orders that currently allow rehab therapists to provide and receive payment for telehealth services.) Currently, two bills sit before the House of Representatives—APTQI-sponsored H.R.7154: Outpatient Therapy Modernization and Stabilization Act and APTA-sponsored S.2741: CONNECT for Health Act—both of which include language to establish rehab therapists as eligible telehealth providers permanently.
While this may not seem as pressing as the looming 9% cut, losing out on this valuable treatment option would be a huge blow to the rehab industry, as it would retract incredible gains in therapy accessibility. And timing-wise, this issue actually is incredibly pressing, because it will be much easier for us to advocate to make our current privileges permanent than it would be to start over from scratch after they are rolled back. Plus, getting this passed will be the impetus needed at the state level to make permanent pro-telehealth changes to state practice acts.
The Interstate Licensure Compact
Another ongoing legal initiative to consider is the interstate licensure compact. At the time of this article’s publication, 28 states have enacted compact legislation, which means that a physical therapist licensed to practice in any one of those 28 states is also authorized to practice in the other 27. This not only gives PTs the ability to provide treatment wherever their skills are needed, but also allows patients greater access to the providers of their choosing. This is another issue that is incredibly relevant at the moment due to its tie-in with telehealth. After all, if therapists are able to secure permanent telehealth privileges, then those practicing in compact states would presumably be able to deliver telehealth services across state lines—which would open up all sorts of opportunities for therapists (especially those who serve super-niche populations).
The Student Debt Crisis
Chances are, your chosen candidates have taken some kind of stance on student debt and access to higher education—and their positions on this critical issue could play a huge role in the future of rehab therapy.
I discussed in detail the ever-growing student loan debt bubble in a past founder letter, which you can read here. And while this particular crisis isn’t exclusive to PT students, its ubiquitous nature actually makes it an even more important issue for us to consider—because with so many constituents having a stake in student debt, there’s an even greater chance that our elected leaders in Washington will actually take action.
During our 2018 industry survey, more than 50% of physical therapy students reported owing $70,000-plus in student loans upon graduation—and more than a third owed over $100,000. Despite these staggering numbers, the overwhelming majority of PT grads expected to earn between $60,001–$80,000 annually in 2018. Thanks to the ongoing public health crisis, the job market is even more competitive in 2020, which means the average starting salary is likely on the lower end. (ZipRecruiter estimates the annual starting salary for physical therapists in 2020 is $63,465.) These numbers are similar in the occupational therapy field.
Still, with an aging population and the rise in musculoskeletal disease in the United States, the need for rehab therapists will only grow. But with such a staggering gap between student debt and income potential, attracting quality applicants into DPT programs is increasingly challenging. With that in mind, it’s essential that PTs and OTs have access to debt relief and/or assistance programs to help them overcome this massive hurdle.
Is your candidate listening?
The issues I mentioned above are just the tip of the iceberg when it comes to legislative matters impacting rehab therapy, and I encourage all of you to take a look at APTA’s, AOTA’s, and ASHA’s advocacy pages to learn more about the policy issues facing each therapy profession. Then, research candidates’ positions and actions on the healthcare front. Do they align with what’s best for rehab therapists and their patients? Have these candidates supported pro-rehab therapy legislation? Have they been endorsed by other pro-rehab politicians or advocacy groups? I think we tend to vote for politicians whose stances on other healthcare issues lead us to assume they have our best interests at heart, only to end up getting the short end of the policy stick. (The 9% cut is a perfect example of this.)
Consider the full implication of this election season.
As we move into the final days leading up to the election, it’s easy to focus our attention on the presidential race. That’s what is garnering the most air time, and it’s certainly a contentious battle. But, the 2020 election isn’t just about naming our next President; it’s also about congressional seats. As we are seeing now with the 9% cut, having friends in the US Senate and the House of Representatives is absolutely crucial to the future of our industry. As health care becomes more intimately entwined with government and politics—a connection that has only strengthened in the wake of the pandemic—having a voice at the federal level will be critical.
That’s not to say politicians simply do not care about rehab therapists. In fact, considering the number of policy issues they’re asked to review on a daily basis, it’s more likely they’re not even aware of the problems our profession faces. For that reason, we must align ourselves with, and vocally support, professional groups that can get these issues in front of the right political leaders—and we must rally our patients to do the same.
If you’re not sure where to start, here are a few jumping-off points:
The bottom line is this: Vote. Vote for candidates at every level of government, because it’s your right, privilege, and duty to do so. But beyond that, vote for those you believe will effect positive change for rehab therapy providers. This isn’t about Democrat versus Republican or conservative versus liberal; it’s about securing the best possible future for ourselves and our patients.