Unconscionable’ CMS services cuts may hamstring providers, LTC advocates say

Long-term care advocates are seeking relief from Congress after a new round of pay cuts to Medicare therapy reimbursement threatens to hamstring providers. 

The Centers for Medicare & Medicaid Services disclosed this week that it has finalized its calendar 2021 physician pay rule, which cuts physical and occupational therapy payments for nursing homes patients by 9%. Last year, therapy providers took an 8% cut.

Because of a budget neutrality mandate, CMS must offset a boost in pay to primary care physicians with a cut elsewhere. Besides primary care doctors, nurse practitioner services will also get a pay increase (7%) but only in an office setting; when billed in a nursing facility, there will be a decrease. 

Advocates have said they will appeal to lawmakers for relief. And some are questioning the timing of the cuts. AMDA-The Society for Post-Acute and Long-Term Care Medicine called the change in payments to long-term care clinicians “unconscionable.”

“It is inexplicable, in light of the surging COVID-19 crisis, that CMS has chosen to impose this drastic cut on the very clinicians who, at great risk to themselves and their families, have been battling this deadly virus at ground zero for the past nine months,” said AMDA Executive Director Christopher E. Laxton, CAE.

“The action that CMS took to finalize these policies that impact nursing facility patients is shocking in that CMS is significantly cutting services that help our patients recover from COVID or keep themselves healthy and hopefully not succumb to COVID-19,” agreed Cynthia Morton, executive vice president of the National Association of Support for Long Term Care.

More than 17,000 clinicians practice exclusively in the nursing home setting, and CMS’s decision could force “hard choices” that could worsen the current workforce crisis, AMDA stated Wednesday. 

“As a consequence, veterans, frail elderly, disabled individuals, and many others may not have access to adequate care. Many will end up being rehospitalized, which will impose significant additional costs to Medicare, reversing the significant progress made on reducing rehospitalizations,” the group added.

AMDA is currently working with Congress on legislation to suspend the budget neutrality requirements that resulted in this cut, it said.