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Physical Therapy - 4 Essential Points to Understand about the 2023 Proposed Fee Schedule

Helping Acupuncturists, Chiropractors, Physical Therapists

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While the proposed cuts are undoubtedly significant, there are also substantial opportunities for effecting change and having your say.



While the proposed 2023 Medicare Physician Fee Schedule from the U.S. Centers for Medicare & Medicaid Services spans over 2,000 pages and isn't exactly a top pick for beach reading, it includes vital proposals that the physical therapy community must comprehend. Additionally, the proposal presents at least two opportunities for the profession to garner attention. APTA has already released two reviews of the proposal, a podcast, a recorded webinar, and an issue brief on one of the payment provisions. With the proposed fee schedule now published, it's crucial to concentrate on advocacy targets. Here are four essential factors to consider.


1. A reduction of 4.4% to the conversion factor could impact various providers and jeopardize patients' access to necessary services.


As anticipated, CMS has proposed a reduction in the conversion factor, which is one of the factors used to calculate final payment amounts for different codes. The proposed conversion factor for 2023 is $33.0775, which represents a 4.42% decrease from the $34.6062 conversion factor used in 2022.


The exact impact of the proposed cut on PTs as a whole is difficult to determine due to various factors such as the mix of codes used and geographic adjustments by CMS. However, it is likely that the cuts will be noticeable as they would bring the conversion factor to levels lower than those seen in the early 1990s. This could increase the burden on PTs to provide more services with fewer resources, potentially putting patient access to care in jeopardy.


CMS is aiming to offset the increased payment for certain evaluation and management codes and the adoption of a new add-on code (G2211) by physicians. Due to the legal requirement of budget neutrality, the increases must be offset by decreases elsewhere. CMS has chosen to target the conversion factor to distribute the impact of the cuts as broadly as possible.


CMS has targeted the conversion factor before. In its proposed rules for 2021 and 2022, the agency followed a similar approach. However, Congress intervened with additional funding at the last minute, which reduced the impact of the cuts.


Lawmakers suspended the annual 2% sequestration cuts mandated by the 2011 Budget Control Act, which has been a regular feature of Medicare budgets since 2013. In 2021, a complete suspension was enacted; in 2022, sequestration cuts returned but were phased in, with the full 2% cut implemented in the beginning of July. It is currently unclear whether Congress will take similar actions to buffer the cuts to the conversion factor, and it appears improbable that the sequestration cuts will be suspended again.


What actions should be taken next? The proposed cuts should be contested, and APTA intends to submit comments to CMS by the Sept. 6 deadline, explaining why the cuts are unwise. The association is also encouraging members and stakeholders to submit their own comment letters. In writing these letters, it's crucial to describe how the cuts could affect your practice, particularly with regards to your ability to offer essential services to patients.
APTA is not only advocating to CMS but also working with lawmakers on Capitol Hill to draw their attention to the cuts and advocate for additional funding. Additionally, APTA and other organizations are urging Congress to reconsider the outdated and flawed physician fee schedule.

2. CMS is requesting information on underutilized services in Medicare, which presents a notable chance to advocate for the value of physical therapy.


CMS regularly seeks input on specific areas of various rules, but recently, the agency has been requesting feedback on more comprehensive issues, such as healthcare disparities and social determinants of health. Now, CMS is inviting input on high-value services that are underutilized in Medicare, presenting an excellent opportunity to advocate for physical therapy services.


CMS stated in the proposed rule that due to concerns about the potential underutilization of high-value health services, especially among underserved communities, they are committed to promoting these services in the Medicare program. CMS aims to advance health equity and address health disparities by identifying and improving access to high-value, potentially underutilized services for Medicare beneficiaries. They seek to engage with interested parties and solicit comments on this matter.


Next course of action: The CMS request for comments is a crucial opportunity that must not be overlooked. By submitting comments through APTA and individual PTs, PTAs, and advocates, we can present a persuasive case for physical therapy as an affordable path to patient-focused care that delivers superior outcomes. The evidence supporting this argument is compelling, and first-hand accounts from practitioners will provide the valuable perspectives that CMS is seeking in feedback.
Suggestion: When submitting comments to CMS, make sure to include your personal experiences and expertise in the physical therapy field. Be specific about the services you offer, the populations you serve, and the cost savings to Medicare. It's also important to identify any barriers to care, such as low reimbursement rates or a lack of awareness among physicians and patients about physical therapy as a preventive care option. This is an opportunity to showcase the valuable role that PTs and PTAs play in reducing falls, avoiding unnecessary surgeries, combating opioid dependence, and more.

3. CMS is evaluating the possibility of establishing permanent policies that allow virtual direct supervision of PTAs and is requesting feedback on the matter. This presents an advantageous chance that we should take advantage of.


CMS has requested input on whether the virtual direct supervision of PTAs, which was temporarily allowed during the public health emergency, should be made permanent for some.


"While we are not proposing to make the temporary exception to allow immediate availability for direct supervision through virtual presence permanent, as with last year's rulemaking (86 FR 39149-50), we continue to seek information on whether the flexibility … should potentially be made permanent," CMS writes in the proposed rule. "We also seek comment regarding the possibility of permanently allowing immediate availability for direct supervision through virtual presence … for only a subset of services, as we recognize that it may be inappropriate to allow direct supervision without physical presence for some services due to potential concerns over patient safety."


APTA has been advocating for the reduction of burdensome supervision requirements, particularly in outpatient settings where direct face-to-face supervision of PTAs is mandated even outside of the public health emergency.


Action item: APTA sees CMS's request for input on making virtual direct supervision of PTAs permanent as a significant chance to improve supervision requirements. APTA will provide its stance and encourage its members and advocates to share their personal experiences and opinions to support the change and how it can enhance patient care.


4. CMS is interested in receiving feedback from individual healthcare providers, and APTA has developed new resources to facilitate the creation of personalized comment letters.





Although not stated in the proposed fee schedule, CMS is altering its approach to individual comments by focusing more on personal perspectives rather than form letters that only have a few personalized details. While comments from APTA and other groups will be important, CMS is increasingly emphasizing the value of unique provider insights on proposed policies.


APTA has introduced new resources to aid members and supporters in creating personalized comment letters that are more likely to be effective with CMS. While the agency is increasingly interested in personal perspectives rather than form letters, APTA still offers ways for its members and supporters to easily participate in the comment process.



Tip: To help individuals create personalized comment letters that will be more effective with CMS, APTA has provided instructions and tips. A standard template comment letter, which can be customized to some extent, is also available. Both resources can be found on the APTA Regulatory Action Center.




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