Prevent Devastating Cuts to Medicare

The Centers for Medicare and Medicaid Services recent proposal for the 2021 PFS has therapists concerned due to an estimated 9% reduction.

Where is this 9% coming from?

To understand this, you must know about RVUs (relative value units) which are a measure of value used in the United States Medicare reimbursement formula for physician services.

Components of the fee schedule: work, practice expense, and malpractice. CMS adds each geographically-adjusted component RVU to arrive at a total RVU for every CPT code. After that, a conversion factor, which is a national value that converts the RVU into a dollar amount, is used to get to the final amount. The current conversion factor is $36.0986 and in 2021 it will change to $32.2605. Basically it is the conversion factor that is causing that estimated 9% in cuts.

Why did CMS revise the RVUs?

If the revision to RVUs causes the expenditure for the year to increase to more than $20 million, CMS has to adjust the conversion factor in order to increase payment for E/M (evaluation and management- used by physician-patient encounters) codes.

While the APTA, AOTA, and ASHA do not oppose budget increases for PCPs, they are still strongly opposing the cuts.

We all know that there is so much more to patient care than the initial physician office visit. For patients who live in rural areas and have trouble accessing PT services already, if those clinics are closing down due to payment cuts, where will those patients go?

Time to Take Action

The easiest way to advocate for this would be to send an email to your legislators and share this post/other posts related to it to educate your fellow colleagues.