A Message on the PTA Differential: It's Time to Come Together and Act
Yet, despite all the evidence that PTAs are both necessary and cost-effective, the U.S. Centers for Medicare & Medicaid Services is continuing in its plan to impose a payment "differential" on services delivered by a PTA (or OTA). Under the differential, codes would be paid at 85% of their value, depending on the amount of time services were provided by a PTA. The differential is planned to start in 2022.
This plan, once implemented, would place an unnecessary, unfair burden on clinics everywhere, but particularly on those in rural and underserved areas. These clinics, often relatively small-scale operations, would be challenged to provide the level of access and services their patients currently receive and need.
CMS refuses to acknowledge the potential for its plan to create therapy deserts — at exactly the time when many are seeking physical therapy as a pathway to rehabilitation in the wake of COVID-19 and its sometimes-debilitating aftermath. And if the situation weren't problematic enough, CMS has chosen to move ahead with the differential as it imposes sweeping payment cuts on many therapy codes.
We must work together to change this trajectory. Congress needs to intervene to help blunt or delay the potential damage, and CMS needs to more thoroughly examine alternative ways to carry out what it says is a legal mandate.
Please join me and the rest of our APTA community to fight the differential. Educate yourself on how the proposal came to be, get up-to-speed on where the issue stands now, and commit yourself to making your voice heard through APTA-led grassroots advocacy efforts. It's time to speak up for PTAs, because when we do, we speak up for our patients.
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Sharon Dunn, PT, PhD
Board-Certified Orthopaedic Clinical Specialist