What Effect Will 2021’s Medicare Cuts Have on Older Patients?

By Kenneth Heil, PT
Physical Therapist

Someone once said, “take care of your body. If you don’t, you will not have a place to live.” Unfortunately, caring for our bodies sometimes comes with an overwhelming cost — especially if we are recovering from an illness or injury. And for older adults, Medicare cuts affecting rehabilitation services circumvent such idealism.

In 2021, CMS implemented cuts to Medicare part B rehabilitation services to offset increases in reimbursement for primary care physicians according to the physician fee schedule. After writing numerous letters to Congress refuting the cuts, rehab professionals learned, to their relief, that a Covid relief package reduced the cuts from 9% to 3.6%. Did Covid temporarily and ironically save our profession from devastation?

What Medicare Cuts Mean for Our Patients

From a clinical perspective, Medicare cuts are relevant in that they impact our ability to provide quality care to patients who need our services. In addition, high copays for commercial/secondary insurances significantly impact patients — especially those with serious medical comorbidities. Such comorbidities put our patients at risk for admissions to hospitals, which for one night may cost more than an entire rehab plan of care!

In my own experience, dosing patients is vital to achieving optimal outcomes and reducing hospital admissions. Patients with certain comorbidities are more likely to succeed in therapy if the frequency, intensity, and time are appropriate. However, many patients have difficulty adhering to such frequencies due to financial hardships. Imagine being retired and on a fixed income of $3,000 per month from Social Security. Can you fathom paying 10-15% per discipline for rehab services alone? It is a devastating blow to our older adult population as well as our clinicians.

What Medicare Cuts Mean for Clinicians

Many clinicians have 6 figures of student loan debt on top of their basic living expenses, which tragically have deterred many from pursuing careers in rehab. In addition, many therapists are experiencing burnout from increasing documentation requirements, decreasing reimbursements, stagnant or even decreasing salaries, and in many cases, unrealistic productivity expectations. As a result, many clinicians are pursuing other clinical and non-clinical paths (including cash-based clinics, Utilization Review, or sales positions to name a few).

Unfortunately, these alternative careers for rehab professionals only exacerbate the problem for our patients. As physical therapists, our time presence with patients far exceeds that of many other healthcare professionals. We have the ability to perceive our patients as a whole and detect underlying issues that other healthcare professionals may overlook.

Physical therapists consistently monitor patient vital signs throughout a treatment session, which may create an opportunity for a life-saving intervention. In my own personal experience, I treated a patient who lived alone, unaware that her blood pressure was consistently too low, causing her dizziness and shortness of breath. After referring her back to her physician, it was discovered that she was taking too much of a beta-blocker medication, which could have possibly gone undetected, leading to further medical complications or hospitalization. If we are not in the field to decipher such potential serious side effects or issues, these seemingly insignificant occurrences lead to poor patient outcomes and higher healthcare costs.

What Can Clinicians Do

Fortunately, not all hope is lost at this time. What can we do to continue to advocate for our profession? As we continue to move forward in these uncertain times, we must continue to write to our leaders in Congress as well as diligently educate others on our vital role in healthcare. In addition, we must remain focused on what is most important above all — good quality patient care. Such care not only improves patient satisfaction and provides a vehicle for more referrals, but it also leads to better clinical outcomes, which will reduce additional healthcare costs, thereby saving Medicare money in the long run.

I have written multiple letters to our leaders in Congress advocating for therapy services. I have also witnessed numerous positive patient outcomes including reduction in hospital readmissions, avoidance of surgeries, and reduction in the use of opioids. Education is perhaps our most powerful tool when advocating for our profession. Many healthcare providers and third-party payers are unaware of our abilities to assist patients with medication management, fall reduction, medical assessments, and reductions in hospital readmissions.

To put it into perspective, one night in the hospital can cost more than an entire physical therapy, occupational therapy, or speech-language pathology plan of care! Communicating our services to physicians, nurses, case managers, politicians, and insurance providers while delivering substantial data as evidence of the effectiveness of our interventions are also excellent strategies to advocate for a reduction in Medicare cuts for our profession. Hopefully, our voices are heard in the future as we continue this journey towards fighting the cuts!