Episode 81: What’s Really Going on With Medicare Cuts?

This week we’re talking about what is going on with these routine cuts in reimbursement against our profession as physical therapists. Take a non-bias view of our political climate and you can see, clear as day, that many are set on government-run universal health care. According to the Advisory Board – an organization of 350 health care professionals with a network of 4,400 members – health care spending will become greater than 20% of the US GDP by 2025, topping more than $5.5 trillion annually. The government could raise billions, if not trillions, of dollars each year in fees and taxes by wedging themselves into this sector of the market. 

 KEY TAKEAWAYS 

  • CMS has been passing over-burdensome regulations resulting in greater complexity and added cost to the small private practice owner. All the while, cutting reimbursement to make it more difficult for the private owner to survive such as the physical therapy assistant cut of 15% coming in 2022 and the current proposed 8% cut.  Meanwhile, those working for hospital systems are getting 3-4 times what the private practice groups are for the same services delivered. Not to mention, they’ve been exempt from the therapy cap since its inception twenty years ago. 
  • These cuts have created an environment that larger corporations, franchises and hospital systems thrive in. They have also quietly allowed private insurance carriers to increase costs on the patient, forcing them to give up access to the care they need by reducing weekly visits and overall number of allowed visits.
  • Ten years ago, 75% of your patients visited three times per week, now we’re lucky to have 35% of patients visiting three times per week. Yet, we know people have better results with more frequent, and earlier, interventions.
  • Why did you go to Physical Therapy School? Was it to bring an abundance of care to your patients so that you can help as many people as possible?
  • In NJ and NY alone, ground zero for these slashed reimbursement rates, they are receiving reimbursements averaging as low as $35-56 per visit. The average reimbursement is $85/visit nationwide. Hospital systems meanwhile are making upwards of $300/visit for physical therapy.
  • Insurance companies have also adjusted out of network benefits to pay out at in-network rates.
  • Physical therapists can not form Clinically Integrated Networks (CIN) unlike Physicians, hospitals, and other healthcare providers.

Worth Checking Out

We are doing everything we can to continue to advocate for our profession including helping owners learn what they can do to counteract these efforts. If you want to learn more about how MEG can help your practice, contact us today or schedule a free, no obligation, practice assessment. We hope to see you all at PPS later this month!

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