Overview
This policy seeks to address critical issues in the physical therapy profession, including outdated Medicare and Medicaid rules that limit patient access and reduce therapist efficiency, as well as the ongoing problem of reimbursement cuts. These challenges not only contribute to burnout among physical therapists (PTs) but also threaten the sustainability of the profession and hinder its cost-saving potential for the U.S. healthcare system.
Objectives
- Expand Patient Access:
Remove restrictive Medicare and Medicaid rules to allow PTs to treat more patients without compromising quality.
- Ensure Fair Reimbursement:
Halt reimbursement cuts for physical therapy services under both Medicare and Medicaid.
- Strengthen the Profession:
Improve working conditions for PTs, reduce burnout, and attract more professionals to the field.
- Leverage Physical Therapy for Cost Savings:
Use PT as a frontline strategy to prevent surgeries, hospitalizations, and chronic conditions, ultimately reducing healthcare spending.
Proposed Changes
1. Eliminate the “One Patient Per Hour” Rule for Medicare and Medicaid:
• Allow PTs to treat multiple patients in overlapping sessions under Medicare and Medicaid, as long as care is individualized and high quality.
• Permit efficient workflows, such as supervising exercises for one patient while performing manual therapy on another.
2. Permit Mixed-Payer Caseloads:
• Remove restrictions preventing Medicare and Medicaid patients from being treated alongside commercial insurance patients.
• Ensure documentation and billing standards remain compliant with federal guidelines.
3. Stop Medicare and Medicaid Reimbursement Cuts:
• Enact a freeze on reimbursement cuts for physical therapy services under both programs, with a 5-year moratorium on further reductions.
• Establish reimbursement rates that reflect the complexity, skill, and measurable outcomes provided by PTs.
4. Enhance Medicaid Reimbursement Rates:
• Bring Medicaid reimbursement rates for physical therapy services in line with Medicare rates, ensuring parity and reducing the financial strain on providers.
5. Implement a Value-Based Care Model:
• Provide incentives for PT clinics that demonstrate high patient outcomes, satisfaction, and efficiency, rewarding value rather than volume.
Key Benefits
1. Improved Patient Access:
• Removing treatment restrictions will allow more patients to receive timely care, reducing delays and preventing conditions from worsening.
2. Fair Compensation for PTs:
• Stabilizing reimbursement rates under Medicare and Medicaid ensures PTs are paid fairly for their expertise and contributions to public health.
3. Support for Low-Income Patients:
• Increasing Medicaid reimbursement will encourage more providers to accept Medicaid patients, improving access for underserved populations.
4. Cost Savings for the Healthcare System:
• Physical therapy reduces the need for expensive surgeries, hospitalizations, and long-term opioid use, saving Medicare, Medicaid, and taxpayers significant costs.
5. Sustainability of the PT Profession:
• Addressing burnout and improving pay will make physical therapy a more attractive career, increasing the workforce and ensuring the profession’s future viability.
Call to Action
1. Medicare and Medicaid Reform:
• Remove restrictive rules that limit PT efficiency and patient access.
• Align Medicaid reimbursement rates with Medicare to ensure parity.
2. Legislative Advocacy:
• Pass federal legislation to halt reimbursement cuts and create value-based incentives for PT services.
3. Unify the Profession:
• Mobilize physical therapists nationwide to advocate for these reforms under the shared mission of “Making America Healthy Again.”
Conclusion
The “Modernized Therapy Access and Fair Reimbursement Act” is a necessary reform to ensure physical therapists can provide the care America needs without sacrificing their well-being. Addressing reimbursement cuts and outdated rules under Medicare and Medicaid will not only sustain the profession but also improve patient outcomes, reduce healthcare costs, and create a healthier nation. It’s time to invest in physical therapy—not undermine it.