APTA's effort to stop a proposed 9% cut in Medicare payment, which began more than a year ago, has galvanized the profession around an historic grassroots effort that's gaining traction in Congress.

But whether that effort is enough to change the course that CMS believes it's required to follow remains to be seen.

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CMS is nearing the deadline for release of the final Medicare Physician Fee Schedule, anticipated to be dropped by Dec. 1. The proposed rule included dramatic payment cuts to some 37 professions including physical therapy. Those cuts come in the form of reductions in payment rates for a host of services that CMS says were required to offset needed increases in payment for evaluation and management services most often associated with physicians. This APTA post from August explains not only the history of the proposal, but the mechanics of the fee schedule itself and what APTA has done to advocate against the cuts.

The battle against the cuts began immediately after CMS first proposed them in 2019, not only through individual efforts from affected professional organizations but by way of new coalitions of those professions. The arrival of the coronavirus pandemic in early 2020 gave the proposed rule an additional destructive edge that caught the attention of lawmakers: They were concerned about the potential devastation the cuts would cause as the health care system struggles to deal with COVID-19, and they made those concerns known to CMS.

Why CMS Seems So Tone-Deaf

The problem, according to Kara Gainer, APTA director of regulatory affairs, is that CMS sees its hands as tied: A statutory budget neutrality requirement makes it impossible for the agency to increase funding in one area without offsetting the increase elsewhere. That makes it difficult for admonishments from any group — be it the more than 25,000 PTs, PTAs, and supporters who wrote to CMS, or the 151 bipartisan members of the House of Representatives who told HHS that the cuts were a bad idea — to trigger a change of course.

"CMS is pursuing a budget neutral approach to rebalance the fee schedule that would increase payment for office/outpatient E/M codes," Gainer said. "The problem is that because they operate under tight budget restrictions, it makes it extremely difficult to correct one payment problem without creating another. That's what happened here."

Although physical therapy advocacy to CMS set records, Gainer believes that the final rule will still include the cuts — if not as proposed, perhaps reduced somewhat.

The remedy, she says, is in the hands of Congress, another focus of APTA efforts since 2019, and now the center of an intense push to support a bill that could  effectively buffer the proposed changes.

A Way Out?

Both the organizations advocating for elimination of the cuts and federal lawmakers who were paying attention recognized early on that the legislature might be the key to blunting the damage to health care should CMS continue on its path. And that's what's happening now.

APTA, its members and supporters, and multiple other professional organizations were tenacious in drawing lawmakers' attention to the CMS proposal: APTA's efforts alone generated more than 100,000 communications to Congress, making the issue a hard one for legislators to ignore. The result: a steady buildup of concern over the cuts and support for developing a solution, even if temporary.

That potential solution has arrived in the form of H.R. 8702, the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020. The legislation, introduced in the U.S. House of Representatives by Reps. Ami Bera, MD, D-Calif., and Larry Bucshon, MD, R-Ind., would keep Medicare payment levels stable for the next two years through temporary additional relief payments.

Justin Elliott, APTA vice president of government affairs, says that action on Capitol Hill could be the best bet for avoiding — or at least reducing — the damage.

"We've educated Congress over the past year and have achieved a solid bipartisan understanding of how devastating these cuts would be, especially during a pandemic, and now there's a bipartisan bill that could make a real difference," Elliott said. "It's crucial that the bill be taken up during the lame duck session. We've been fighting hard together. We need to push even harder."

APTA Grassroots Power — And Next Steps

"We're seeing such movement in Congress largely because our members and members of other professional organizations spoke up, and didn't stop speaking," said Laura Keivel, APTA grassroots and political affairs specialist. "CMS may have its own perceived restrictions on what it can do in the face of overwhelming grassroots efforts, but Congress has much more leeway to address problems, provided you get their attention. We succeeded in doing that in no uncertain terms."

But there's no time to rest on those laurels, says Keivel, who will be joining Gainer and Elliott in a Nov. 17 APTA Live event to dive deeper in to the proposed cuts, the status of current efforts to fight the cuts, and the possible paths forward. That presentation will happen amid renewed calls for members, physical therapy patients, and supporters to ramp up communications to Congress.

"The pandemic changed the way we communicate with Congress," Keivel said. "But we were able to come together with a unified voice that has put us on the edge of stopping a cut that would truly harm patients. Now we need to take the ball over the goal line."