Take Action to Oppose the 9% Medicare Cut
A Timeline of Regulatory Activity Leading up to This Cut
June 2018 MedPAC report to Congress stated: For illustration, we modeled the impact of a 10 percent increase in the payment rate for ambulatory E&M services (higher or lower increases could be considered). A 10 percent increase would raise annual spending for ambulatory E&M services by $2.4 billion. To maintain budget neutrality, payment rates for all other fee schedule services would be reduced by 3.8 percent.
Certain specialties would receive a large increase in their total fee schedule payments (on net) as a result of this change. The three specialties that would receive the highest proportional increases in payments are endocrinology, rheumatology, and family practice.
Other specialties-including diagnostic radiology, pathology, physical therapy, and occupational therapy—would experience reductions in their fee schedule payments of about 3.8 percent because they provide very few ambulatory E&M services.
This change would be a one-time adjustment to the fee schedule to address several years of passive devaluation of ambulatory E&M services. Even if this approach is adopted, we urge CMS to accelerate its efforts to improve the accuracy of the fee schedule by developing a better mechanism to identify overpriced services and adjust their payment rates.
If successful, these efforts would improve the accuracy of prices for ambulatory E&M and other services going forward and could reduce the need for future significant adjustments to the prices of E&M services. Together, these actions will help reduce the risk of beneficiaries experiencing problems accessing these services and will send a more positive signal to medical students and residents contemplating careers in specialties that provide large shares of these services.
July 2019: CMS 2020 MPFS proposed rule proposed increases to E&M codes in 2021 which would result in those providers who do not bill E&M codes experiencing an overall reduction in payment. PT/OT was projected to be cut by 8%.
November 2019: CMS 2020 MPFS Final Rule finalized the proposal to increase E&M codes and maintained the same projected cut of 8% for PT/OT; CMS offered no explanation or rationale for the cuts or amounts of cuts-despite repeated inquiries from stakeholders and Members of Congress.
August 2020: CMS, despite strong and unequivocal pushback since August 2019, released the 2021 MPFS proposed rule which included plans to move forward with the E&M code payment boost ranging between 1% and 17%, while also increasing the depth of the cut to 9% for PT/OT. 35 specialists are projected to receive cuts raging from -1% to -11%.
What exactly are E&M codes and why did CMS elevate primary care?
E&M stands for "evaluation and management". E&M coding is used when a patient encounter includes notation of relevant history, physical examination findings, and prior diagnostic test results; assessment, clinical impression, or diagnosis; and medical decision making. Effective January 1, 2021, CMS is planning to increase payment for office/outpatient E&M visits for primary care and non-procedural specialty care for work associated with visits that are part of ongoing, comprehensive primary care and/or ongoing visits related to a patient's serious or complex chronic condition. This is happening in part because in 2017 it was determined that in about 60% of visits Current Procedural Terminology (CPT) codes used for medical billing did not account for all the care provided by primary care physicians; therefore, this adjustment is intended to make payment to primary care better reflect the time spent on evaluation and management since they are less likely to be performing specific procedures.
PPS Lobbying Efforts to date
PPS has been lobbying on this issue since it arose in 2018. Following is a timeline of actions and letters.
Current
- 50 Senators publicly implore Senate leaders McConnell and Schumer to address 9% cut before the end of the year (December 2020)
- 66 organizations call on Congress to include H.R.8702, the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, in a legislative package before the end of the year
- PPS and 73 other organizations write in support of H.R.8702 which would prevent the 9% cut to PT slated for January 1, 2021 (November 2020)
- 229 Members of Congress are now on record asking Speaker Pelosi and Minority Leader McCarthy to pass legislation before the end of the year in order to mitigate the 9% cut (October 2020)
- PPS submitted public comment to CMS challenging the 9% cut (deadline October 5, 2020)
- Helped achieve record-breaking 158 Members of Congress joining a Congressional sign-on letter in the form of public comment to CMS challenging the cuts to specialists to pay for E&M code increases (September 2020)
Aug'20
- PPS and 35 other stakeholders call on Congress to prevent CMS from implementing drastic cuts to physical therapy
- PPS endorsed Outpatient Therapy Modernization and Stabilization Act (H.R. 7154) in order to prevent the 9% cuts, permanently extend Medicare coverage of telehealth to PTs, and reduce administrative burdens.
Jun'20
- PPS and 52 other organizations request Congress waive budget neutrality requirements in order to prevent cuts to specialties (8% to PT) to pay for E/M code increases on January 1, 2021 (June 2020)
- PPS and APTA joint letter to HHS requesting regulatory changes to make telehealth for PT permanent, prevent the 8% cut, modify plan of care signature requirement, change PTA supervision from direct to general, and allow for PTAs to perform maintenance therapy (June 2020)
Jan'20
- 99 Representatives ask CMS for transparency about the methodology and considerations it used to determine which specialties to cut and by how much in order to pay for an increase in E/M codes (January 2020)
- Per PPS request, Senator Tester (Montana) sends letter to CMS on behalf of physical therapists, sharing concerns about the impact of 8% cut to reimbursement rates on rural communities (January 2020)
- PPS, APTA, and APTQI letter requesting MedPAC evaluate current inadequacies of Medicare's physical therapy reimbursement and future impact of an 8% cut (January 2020)
Sep'19
What Can You Do?
Advocate
- Ask your Member of Congress to Include in upcoming legislation a waiver of the budget neutrality requirement that is forcing CMS to pay for an increase in Evaluation and Management (E/M) codes. If CMS proceeds to cut physical therapy reimbursement by 9% as planned, many community-based outpatient physical therapy clinics who are barely hanging on through the joint impact of the public health emergency and economic crisis will go out of business.
Engage your staff
Ask your staff to send their own letters con Congress! Send them through the APTA Action Center, or use the templates below to email or call their members of congress.
Engage your patients, friends, and family in advocacy!
Every voice counts! Ask your Medicare patients to call or email their Senators and Representatives. Consider engaging your office staff to help them take action while in your office.
Use the Patient Advocacy Center on the APTA website, or give them this template to send their own email or phone call.
Patient Advocacy Works! Watch this video from PPS member Anthony DiFilippo and see how easy and effective it can be!
Social Media Resources – download these images provided by APTA and post them to your social media account. Be sure to include a link to the Action Center.
Download Package of All AdsPost these images on social media and tag your legislator
Use these images to encourage your patients, friends, and family to advocate. Post these with a link to the Patient Action Center
