Advocacy is Crucial in Times of Crisis!
Everyone is busy trying to figure out how to adjust and plan their response to this unprecedented public health crisis. While three federal laws were passed in March in direct response to the COVID-19 crisis, the work there is far from done. Lawmakers are currently working on a fourth package and they need to hear from you about what you need to weather this storm.
Ask your legislator to delay the 8% cut
In November 2019, the Center for Medicare and Medicaid Services (CMS) finalized their proposal to reduce reimbursement for physical therapy in 2021. On March 20th, PPS and 29 other providers sent a letter to Senate Majority Leader McConnell and Speaker of the House Pelosi urging them to "waive the budget neutrality requirements stipulated in Section 1848(c)(2) of the Social Security Act for the finalized [evaluation and management] code proposal for a period of no less than five years" as they move forward with crafting additional COVID-19 relief packages. Should Congress do as we requested and remove the budget neutrality requirement that the increase in value for evaluation and management (E/M) codes be paid-for, the result would be a five-year delay in the implementation of the upcoming 8% cut. This is because the cut to physical therapy and other specialties who don’t bill E/M codes was earmarked to pay for the increase in the value of the E/M codes.
Advocacy Opportunity #1:
Ask your Representative and both Senators to include a delay in the cut to PT reimbursement in legislation being developed to address COVID-19. Tell them how your small business is being harmed by COVID-19 and explain how an 8% cut to Medicare reimbursement in 2021 will further impact your practice.
Use this template:
Subject line: Include delay of 8% cut in upcoming COVID-19 package
Thank you for your quick response to the COVID-19 pandemic. As a small business owner, I have benefited from the programs that were included in the three laws passed in March. However, I still need help.
My name is _________________ and I am a physical therapist in private practice. My clinic is [near ________________landmark/in ___________ community, Town, State]. There are ___ therapists in my practice. We also employ ___ support staff. We have been an important part of our local economy and small business community for ___ years. [Explain how you have changed staffing, or plan to use the Paycheck Protection Program or Economic Injury Disaster Loans to access emergency funding].
At this time of year, I generally care for _____ patients a week. Instead, since the beginning of March, I have seen an average of ___ patients each week.
Last fall, CMS finalized regulations which would increase the value of E/M codes and pay for it by cutting the reimbursement for specialist providers—physical therapy was cut 8%! Physical therapists don’t bill E/M codes so we are unable to balance out this drastic cut. Even before the COVID-19 crisis, the margins at my private practice physical therapy clinic were tight and an 8% cut in reimbursement in 2021 would [briefly describe impact on your practice—would you lay off an employee, close doors, stop accepting Medicare patients, etc. If you are comfortable disclosing your profit margin and it is at or below 8%, please do.] Please delay this cut by including in the next COVID-19 relief package a waiver of the budget neutrality requirements stipulated in Section 1848(c)(2) of the Social Security Act for CMS’ finalized E/M code proposal for no less than five years.
[Practice phone number]
If you are on social media, follow up your request with a Tweet or Facebook post tagging your legislator as well as PPS using #PPSAdvocacy.
Further efforts to push CMS to use its full waiver authority
Advocacy Opportunity 2:
Since you have already sent CMS a letter yourself, now's the time to ask your Representative and both Senators to reach out to CMS to encourage them to utilize the waiver authority granted to them by the CARES Act so that physical therapists can be reimbursed for care provided via telehealth during the COVID-19 publich health emergency.
Use this template:
Subject line: Compel CMS to use full telehealth waiver authority
My name is _________________ and I am a physical therapist in private practice. My clinic is [near ________________landmark/in ___________ community, Town, State]. There are ___ therapists in my practice. We see _____ patients a year, ___ % of whom are Medicare patients. Through my work with them [share a success story of your work with a Medicare beneficiary patient that could be done via telehealth].
Thank you for including additional waiver authority for CMS in the CARES Act which empowered CMS to further waive restrictions limiting payment for telehealth by providers such as physical therapists.
On March 30th CMS released regulations that expanded the list of digital codes physical therapists can use, however those regulations were written before the CARES Act became law. Therefore, even though CMS now allows PTs to use telehealth codes, it still does not enable physical therapists to be paid for telehealth services. This is because, as CMS noted on page 35 of the rule “that the statutory definition of distant site practitioners under section 1834(m) of the Act does not include physical therapists, occupational therapists, or speech-language pathologists, meaning that it does not provide for payment for these services as Medicare telehealth services when furnished by physical therapists, occupational therapists, or speech-language pathologists.”
Please Representative _____________/Senator _____________, contact CMS and encourage them to use their CARES authority immediately and allow PTs to be classified as distant site practitioners and therefore able to bill for these telehealth codes.
Thank you for your attention to this urgent matter.
[Practice phone number]
If you are on social media, follow up your request with a tweet or Facebook post tagging your legislator as well as PPS using #PPSAdvocacy.
Empower your patients too
Advocacy Opportunity 3:
Thank you for your continued advocacy. Together we can make a difference!
For information on PPS’s legislative priorities and activities,
visit the Advocacy section at www.ppsapta.org