APTA Private Practice Annual Report— Advocate: Promote an advantageous payment, regulatory, and business environment.

Fiscal Year 2022 (July 1, 2022-June 30, 2023)

The APTA Private Practice's legislative and advocacy priorities for the 118th Congress (2023 and 2024) were determined in January 2023 by the Board of Directors and the Government Affairs Committee (GAC). The Section’s lobbyist uses these priorities to guide advocacy efforts on behalf of APTA Private Practice’s membership. We also urge policy makers to consider physical therapists as a primary care provider for neuromusculoskeletal dysfunction while we promote the physical therapy profession as a point of entry into the medical model for movement disorders.  

Lobbying and advocacy efforts focus on the needs of small business owners who are physical therapists in private practice. This is achieved by advocating for policies that build healthy communities through sustainable economic policy that empowers physical therapists in business to provide accessible, cost-effective, high-quality care to their neighbors. 

To that end, the Section focused on legislation to:

1. Ensure patients have timely access to physical therapy by protecting the financial viability of physical therapists in small businesses who provide crucial community-based care.

2. Enable patients to utilize physical therapy first and early to improve outcomes while reducing healthcare spending and downstream economic costs.

3. Enable reliable patient access to care by ensuring that the therapy workforce is robust enough to meet patient needs in every community

Lobbying for legislation which would:

Improve payment 

• Achieved a 2.5% boost to the Medicare conversion factor for CY2023 and a 1.25% boost to the conversion factor for CY2024.  

• The Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act in the 117th Congress to mitigate the impact of the PTA differential by exempting PTAs and OTAs working in rural and medically underserved areas from the payment differential. 

• The Prevent Interruptions in Physical Therapy Act to expand the locum tenens provision of Medicare to allow physical therapists practicing all communities to hire a qualified substitute on a per-diem basis; this would enable practices to maintain cash flow even if they couldn’t be in the office and builds on our 2016 success of enacting a law to enable the use of locum tenens in rural, medically underserved, and health professional shortage areas. 

Reduce administrative burdens

• Improving Seniors’ Timely Access to Care Act in the 117th Congress sought to reduce administrative burden and increase transparency by requiring a streamlined and standardized process by which MA plans use prior authorization. CMS then made some regulatory updates so the legislative effort in the 118th Congress version seeks codify those updates and pursue additional transparency, streamlined processes and to reduce the administrative burden upon providers.

• In the 117th Congress, the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act sought to reduce administrative burden and increase practice flexibility by requiring Medicare to change its direct supervision requirement of therapy assistants in private practice settings to general supervision. Because CMS has failed to respond to our requests to exercise its authority to allow for general supervision of PTAs in all settings, this Congress is considering the EMPOWER Act which would provide for a standard general supervision requirement across all outpatient settings in states with licensure laws that allow for it. The 118th Congress’ EMPOWER Act also directs the Government Accountability Office analyze how the Medicare Part B 15% payment differential for services provided by OTAs and PTAs, which went into effect in 2022, has impacted access to physical and occupational therapy services in rural and medically underserved areas, across all Medicare Part B settings. 

• The Medicare Patient Empowerment Act sought to increase patient choice of both providers and settings for Medicare beneficiaries; enactment of this legislation would achieve APTA Private Practice’s goal of allowing physical therapists in private practice to opt-out of Medicare.

Future Medicare reform efforts, some of which have been introduced as stand-alone bills

• To reduce the MPPR cut so that it is based upon data and also doesn’t apply across the board to all disciplines of therapy received by a patient on a single day.

• To empower physical therapists to opt out of Medicare.

• Reduce the administrative burden of the plan of care signature requirement by removing the requirement that a referring provider sign and return the plan of care (POC) to the therapist and instead accept the therapists’ submission of a POC to a referring physician as sufficient to demonstrate physician involvement. There would be no change to the requirements for direct access patients.

• To implement a standard “general supervision” requirement across all outpatient settings in states with licensure laws that allow for it. 

• To address the current shortcomings of the Quality Payment Program (QPP) including limited opportunities for therapists to participate in the program, CMS should seek insight from a stakeholder workgroup to identify barriers and develop recommendations for rulemaking to ensure that the QPP comprehensively measures the impact of all care received by Medicare beneficiaries and provides appropriate and achievable access points for physical therapists to meaningfully participate in the program.

• Provide an annual inflationary payment update to the Medicare Physician Fee Schedule’s conversion factor (CF) based on the Medicare Economic Index (MEI) in order to provide much-needed stability to the Medicare payment system. 

Communicating the Section’s Advocacy Priorities to Congress

In addition to one-on-one meetings with Members of Congress and their staff, between July 2021 and June 2022, APTA Private Practice joined with coalitions to send 4 advocacy letters to lawmakers:

• APTA Private Practice is one of more than 100 members of the Medicare Physician Fee Schedule Coalition calling for Congress to pass legislation to provide another buffer to the Conversion Factor and other economic supports of Medicare reimbursement (July 2022)

• Letter sent to Congressional leadership by APTA Private Practice and 100 other provider groups requesting a 4.5% funding boost to completely offset the Medicare Physician Fee Schedule conversion factor cuts in 2023 (December 2022)

• APTA Private Practice and 103 other physician and non-physician providers point out the need for substantive Medicare payment reform and call on Congress to hold hearings and begin long-term payment reform efforts. (January 2023)

• APTA Private Practice is one of 106 non-physician and physician stakeholder organizations who wrote to Congress in support of the Strengthening Medicare for Patients and Providers Act (H.R.2474) which seeks to create an annual inflationary update to Medicare's reimbursement rate. (May 2023)

APTA Private Practice and other stakeholders joined forces to advocate for policies which will impact the rehabilitation therapy sector and the patients we serve.

• APTA Private Practice and other rehabilitation therapy organizations thank Senator Carper (D-DE) for introducing S.5 to remove Medicare's direct supervision requirement for PTAs and OTAs in private practice settings (November 2022)

• Medicare Physician Fee Schedule: A Joint Statement From AOTA, APTA, ASHA, and APTA Private Practice on Outpatient Therapy Reform (June 2023)

APTA Private Practice’s strong relationships on Capitol Hill have inspired Members of Congress to weigh in on behalf of physical therapists:

• 46 Senators declared support for Congressional action to prevent deep cuts to the physician fee schedule's conversion factor (November 2022)

• 83 Republicans call on House leadership to avert Medicare reimbursement cuts while noting that economic challenges of providers are putting patient access at risk (December 2022) 

• 113 Representatives sent a bipartisan letter to House and Senate leadership as well as President Biden calling for a total mitigation of the CY2023 Medicare payment cuts (December 2022)