Consumer / Employer, MedCity Influencers, Physicians

Short-term fixes underscore the need for long-term Medicare reform

What specialty providers and seniors need is a sustainable solution to preserve the federal health insurance program and properly reimburse providers.

Medicare

Lawmakers and stakeholders often rely on short-term polices that extend financial relief to help struggling providers and confront the mounting healthcare workforce crisis. But, especially as it remains unclear when the Covid public health emergency will end, I worry that we are at great risk of missing the forest for the trees.

Look, for example, at the series of serious Medicare cuts the federal government has made to specialty services, including physical and occupational therapy. During a time of unprecedented stress and skyrocketing labor costs, Medicare cuts threaten the stability of many providers, which could ultimately harm patient access. While Congress has stepped up to make temporary “fixes” in the past, significant cuts are still slated for the future unless long-term solutions are put in place.

In theory, Medicare cuts are supposed to save taxpayer dollars; but in practice, they make it harder for seniors to access the care they need. In response, lawmakers step in and pass laws to enact short-term solutions to kick the can a little further down the road until we repeat the process all over again just a few months later. As a result, it is extremely difficult for Medicare providers to stay afloat, adapt to severe workforce challenges, and invest in expanding practices and services. The effects of temporary “solutions” ultimately are felt by those most in need: our patients.

Instead, what specialty providers need is a long-term, sustainable solution to preserve our nation’s Medicare program. Absent a more permanent fix, continued payment cuts will keep undermining providers and make it harder for seniors to access the treatments they need to heal from serious illness and injury.  In that scenario, seniors’ conditions will inevitably deteriorate, driving up costs that could ultimately push Medicare off a fiscal cliff.

Is there an easy solution? No. Is it absolutely necessary to address this? Yes.

Let’s consider the importance of early intervention as an example. Putting off care usually causes problems to become worse, more complex and potentially irreversible—necessitating even more expensive interventions. Case in point: Physical therapists develop unique training plans for seniors every day to help them build strength, maintain balance and live more independently. This is especially important after being hospitalized because patients tend to lose muscle mass. 

But, without access to therapy services, seniors are more likely to suffer a debilitating slip or fall. Every year, the Centers for Disease Control and Prevention estimates that 36 million older Americans will fall, resulting in 3 million emergency room visits, 300,000 hip fractures and 32,000 deaths. Not only does this cause tremendous pain and suffering, it is also incredibly expensive. Each year, falls cost the U.S. healthcare system, including Medicare, over $50 billion. By 2030, that number is expected to surge past $100 billion as more older Americans fall. 

At the individual level, data show Medicare spending is lower for patients who receive physical therapy as the first treatment option. This underscores the tremendous value of investing in specialty care and preventive healthcare solutions.

Falls represent an escalating financial burden on taxpayers, so it would be wise for Medicare to invest in proven solutions to help seniors remain stable and safely independent. If Medicare continues to levy cuts on specialty providers like physical and occupational therapists, that could force some practices to reduce the number of Medicare beneficiaries they treat in order to stay afloat, while others may be forced to shut their doors for good. 

It is now time for Congress and Medicare to act. After years of Medicare payment cuts, America’s specialty providers need long-term stability and a reliable reimbursement structure instead of the annual chipping away of Medicare specialty payments. It is time for a permanent solution to be put in place.

As a physical therapist, my experience shows you can improve health outcomes and save taxpayer dollars without arbitrarily reducing reimbursement year after year.  

We cannot ignore what lies right around the corner. America’s specialty care providers stand ready to work with Medicare and Congress to find the long-term solutions needed to stabilize our nation’s senior care program and ensure the longevity of this vital system. The future of America’s senior care system depends on it.

Photo: designer491, Getty Images

Nikesh Patel, PT, DPT is the Executive Director of the Alliance for Physical Therapy Quality & Innovation (APTQI), a coalition that unites community-based physical therapy practices to advocate for the profession in the areas of payment reform, quality initiatives, patient outcomes and innovation. Patel also serves as the National Director of Clinical Services and Regulatory Affairs for US Physical Therapy based in Houston, Texas, which operates more than 570 outpatient clinics in 39 states. Patel holds degrees from the Arizona School of Health Sciences and UT Health San Antonio.

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