MEDICARE IS CHANGING IN 2021: HOW THIS IMPACTS EVERYONE UNDER 65

The Centers for Medicare and Medicaid Services (CMS) is a federal agency that administers the Medicare program in the United States. Back in October of this year CMS issued its final ruling to reduce Medicare reimbursements to physical and occupational therapy by ~8% beginning January 2021. In other words, rehab specialists will be paid less in the future for the same amount of work when treating Medicare patients.

These decisions are not made on a whim nor are they uncommon. In fact, CMS has a history of either reducing reimbursements, requiring more documentation or proof of medical necessity, redefining medical necessity, or some combination of the aforementioned policy changes all in the name of recouping the increased medical spending by the growing population of citizens over the age of 65. And per Medicare’s requirements, not all of that spending is warranted. According to the Office of Inspector General, in 2013 Medicare paid an estimated $367 million in outpatient physical therapy services that did not comply with Medicare requirements. But here’s the thing, Medicare’s requirements do not pertain to someone’s quality of life so much as they do the basic needs of life. There are simply too many people to take care of with a limited supply of funds to reimburse physical therapists to help our aging citizens enjoy the things they love. Instead, the reimbursement requirements are reserved for preserving basic life and independence functions.

Why should I care if I’m not eligible for Medicare anyway?

Because Medicare sets the precedent. The moves that Medicare makes tend to find their way downstream eventually. Third party payers (Blue Cross Blue Shield, United, Aetna, etc) are typically quick to follow suit in cost-cutting methods shortly after Medicare cuts reimbursements (“In the Shadow of a Giant: Medicare’s Influence on Private Physician Payments”). We’ve written about this before (Why You Should See a Cash Based Physical Therapist), but the main reason why this change in Medicare should concern everyone under the age of 65 is this:

Reduced reimbursements will change the quality of care you receive

This can come in the form of the insurance company saying they will no longer reimburse particular billing codes at a certain rate, restricting the amount of billing codes allowed, or placing in-network providers on lower reimbursement tiers based on the average amount of billing codes used. While a few may find creative ways to prevent this from impacting their practice, most companies will be forced to decrease treatment times or increase the amount of patients seen at any given time. In short, quality of care will be diluted and providers will be drowning in more paperwork.

The challenge for the public is going to be finding healthcare providers that are still able to provide a high level of care without being affected by these changes. In order to do so, patients will need to do a good deal of research to find the providers that can give them the type of value they desire.

This is exactly why we decided to be a cash-based physical therapy company - to be able to provide a high value to patients without being swayed by the ever changing tides of insurance reimbursement. By removing ourselves from the headache of in-network care we are able to focus solely on the patient and their experience while working with us.

Give us a call, shoot us an email, or fill out the contact form below to speak to a doctor if you want to take your healthcare back into your own hands.