Congress’ ‘Provider Relief Fatigue’ Could Spell Disappointment for Therapy Providers Facing Payment Cut

As therapy providers in the nursing home setting brace for a 4.47% cut in the Physician Fee Schedule in 2023, Congress may not help bridge the gap as much as in the past.

Currently, Congress is toying with a 2% to2.5% boost to help providers dealing with the 4.47% cut, panelists said during a webinar hosted by provider advocacy group Advion on Wednesday. That’s less than the previous two years, with Congress stepping in to mitigate cuts with 3% and 3.5% increases for 2022 and 2021, respectively.

“Congress was not as generous as the first year,” said Cynthia Morton, executive vice president for Advion. “The big question is, will Congress hear our pleas again, as providers under the Physician Fee Schedule? Will they help us for a third year?”


Provider relief fatigue will play a huge role in any definitive answer for the coming years, according to panelists, with providers and their advocates coming back year after year and asking for help in mitigating cuts made by the Centers for Medicare & Medicaid Services (CMS).

The PFS was released by CMS in November and is due to be effective Jan. 1. Any mitigating actions by Congress would be part of year-end packages later this month, likely after Dec.16, according to panelists.

The agency wants a “zero-sum game,” another Advion panelist said, meaning if they give certain specialists a boost to reimbursement codes, that has to be taken from other areas in the PFS.


Under MACRA, or the Medicare Access and CHIP Reauthorization Act, the way that Medicare rewards clinicians for value over time was changed in an effort to streamline quality programs under the Merit Based Incentive Payments System, or MIPS.

It wouldn’t be surprising if Congress started focusing more on MACRA in the years ahead, panelists said, as members try to get out of this situation every year – mitigating CMS cuts after hearing from provider lobbyists.

Work proceeds on SMART Act

As the year draws to a close, Advion Director of Governmental Affairs Michael Barnett said the advocacy group continues to work with the House to further develop the Stabilizing Medicare Access to Rehabilitation and Therapy Act, or SMART Act (H.R. 5536).

The legislation, which focuses on a 15% cut to therapy assistant services in the PFS, suggests rural or medically underserved areas be exempt from this cut – such areas may only have access to a therapy assistant, Morton said.

Advion and other cosponsors of the bill swapped a suggested delay in the cut for a change in supervision requirements. Legislation now suggests a temporary suspension of the payment differential for physical therapist assistants and occupational therapy assistants in all settings, standardizing the supervision requirement for therapy assistants with the exception of rural and medically underserved areas.

In other words, supervision requirements for OTAs and PTAs in a private practice would not be more stringent for purposes of Medicare coverage than under state law.

Coupled with the legislation, Advion and other cosponsors of the bill commissioned health care analytics firm Dobson DaVanzo & Associates to conduct a study released in September delving into cost savings and supervision requirement changes.

Such changes could save Medicare as much as $242 million over 10 years, researchers found.

“That’s a lot of money to bring to the table and it’s something to be taken seriously on the Hill,” said Barnett. “We are currently working to negotiate using those potential savings that result from the supervision change in the SMART Act to pay for either a one or two year exemption to the cut for providers treating patients in rural or medically underserved areas.”

In order to pass the SMART Act and convince Congress to include an overall PFS conversion factor increase, Barnett said, “extremely strong grassroots efforts” are required.

“We really need more help from our advocates to get this done to get our message out there,” he added.

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