Worrying 4.4% Cut Leaves Nursing Home Therapy Providers in Limbo 

As therapy providers in the nursing home setting, among other health care workers, are expected to absorb a finalized 4.4% cut to the 2023 Physician Fee Schedule (PFS), those impacted aren’t so sure Congress will help offset the decrease like they’ve done in years past.

The Department of Health and Human Services (HHS) finalized the PFS final rule on Tuesday after proposing 4.5% to 5% in cuts in July to health care providers that fall under Medicare Part B. Overall payment rates decreased $1.55 to land at $33.06, according to CMS.

Therapy providers got some breathing room in 2021 when Congress approved supplemental funding to balance a 3% cut proposed by the Centers for Medicare & Medicaid Services (CMS) in 2021. In 2020, lobbying efforts brought a heavy 9% cut for therapy providers to 3%.


The 3% supplemental increase in PFS payments for 2022 was removed in the most recent PFS to achieve budget neutrality.

“We’re going to be fighting this battle every year,” said Cynthia Morton, executive vice president for provider advocacy group Advion. “Congress is starting to show signs of provider fatigue. They’re getting a little tired of this 100-plus provider group coming up and saying, ‘we need major help.’ Medicare providers are really looking at some very scary cuts.”

It’s getting to the point where, from a rehab therapy standpoint, it’s getting harder to deliver care, Morton added. That’s especially true in rural settings, where it’s difficult to attract therapists for less pay.


“CMS wants to give us less for that service – that didn’t work out very well,” she said. “It’s hard to know what has CMS in mind. Putting money into primary care is great, but it’s really difficult when everybody else is cut to offset that. We would argue our needs are just as great as primary care.”

Morton is referring to 1.4% of the 4.4% cut being diverted to boost primary care funding.

Rumblings of potential PFS reform next year give providers hope — efforts are spearheaded by two U.S. senators who are both doctors.

Reform implications

There are indicators that Congress could consider PFS reform some time next year, Morton added, with Sens. Debbie Stabenow of Michigan and John Barrasso of Wyoming sending a letter dated Nov. 2 to Majority Leader Chuck Schumer and Minority Leader Mitch McConnell on the matter.

Stabenow and Barrasso, both doctors, urge Senate leaders to address payment challenges before the end of the year as the “stability” of Medicare payments wane.

“Failure to act in the coming weeks could result in reduced staffing levels and office closures, jeopardizing patient access to care,” the Senators wrote. “We are especially concerned about this impact in rural and underserved communities. Failure to act on longer-term reforms will undermine Medicare’s ability to deliver on its promises to future seniors and generations.”

Since the PFS is budget neutral, it’s implied that any long-term reforms would have to involve an increase to the PFS budget.

The bipartisan duo has garnered 39 signatures of other senators so far.

“Reform of the fee schedule really does mean adding more value to it. I don’t want to kid anybody on that. It means adding more dollars,” said Morton. “That makes the job of Congress very difficult … they’ve done it before with some of the Covid relief, but there’s political consequences if you don’t pay for a certain program.”

Major win in remote patient monitoring, expansion in telehealth codes

Despite worrying cuts and Congress fatigue, Morton said updates to remote therapeutic monitoring (RTM) was one win for the nursing home sector coming out of the finalized PFS.

In the proposed fee schedule, codes linked to RTM were set to be reduced in value by almost 50% – CMS walked back that change in its finalized rule after hearing feedback from the therapy provider community.

If RTM devaluation was finalized, Morton said, that would decrease the possibility that these new technologies would actually be used in the long-term care setting – the codes would be “practically unusable.”

It contradicts previous CMS moves toward incentivizing digital health utilization about two years ago, she said, with the adoption of codes tied to remote physiologic monitoring.

“It’s a win for patients because we need to move toward this idea of digital health; it’s more efficient … it’s the future,” said Morton. “That’s really a growing interest within long-term care.”

Another major update nursing home operators must review is related to telehealth codes, she said. Namely, keeping reimbursement codes for rehab therapy telehealth services.

“They added some therapy services that were on a temporary list to a more permanent list. That’s a positive move,” said Morton.

The service codes were originally added as part of the public health emergency (PHE), which is currently set to expire at the beginning of January 2023.

Physical therapists, occupational therapists, speech-language pathologists and audiologists will continue administering services via telehealth for 151 days after the PHE ends, according to the PFS final rule.

Other finalized telehealth policies include allowing telehealth services in any geographic location and in any originating site setting, including the patient’s home; allowing certain services to be delivered with audio only; and allowing delays for in-person mental health services in favor of telehealth.

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