Lower Quality, Higher Costs? How Insurance Cuts Can Directly Affect You
In 2021, Center for Medicare and Medicaid Services (CMS) finalized a 9% cut in reimbursement rates for services provided by physical and occupational therapists. Due to the COVID-19 pandemic, the cut has since been reduced to around 3% following the Consolidated Appropriations Act of 2021. Fast forward to 2022 and CMS is at it again with an additional 1% cut for services provided by physical and occupation therapists, and a 15% cut for services provided by physical and occupational therapy assistants.
“But I don’t have Medicare or Medicaid, this shouldn’t affect me right?”
Not necessarily. Unfortunately most insurance plans by third party payers will follow suit because it is more cost effective for them. Although this change may not be felt immediately, over time we will see a decrease in covered visits and an increase in monthly premiums, deductibles, out-of-pocket maximums and copays. This means that you, the consumer, will be paying MORE for monthly/yearly premiums to have LESS coverage.
How does this affect your care?
The new reimbursement cuts for services provided by physical therapists and assistants will eventually result in some major changes. The most significant of them being that clinics will now be financially incentivized to ensure patients are only treated by physical therapists rather than assistants. In the case of the standard insurance-based PT clinic, this means that physical therapists will have to see an even greater volume of patients each day. So what does this mean for your care?
If you typically see your physical therapist one-on-one, you may start to see your sessions overlapped with another person’s as physical therapists will be pressured to see a higher volume caseload. If your physical therapist already manages several clients at once, it means even less face-to-face time with your provider. If you typically have a team of a primary physical therapist and physical therapy assistant, you may now be bounced around between multiple new providers each week instead of having a consistent care team.
In the end, the quality and consistency of care you receive will decrease while the cost of your care will increase. Not really a fair exchange, right?
You deserve better.
Your time is valuable. Why waste it on a system that is more concerned over their bottom line than your health and wellness? You should feel confident that the investment you make in your care is worth your time and financial commitment.
This is why we founded The PATH Rehab & Performance. We believe people deserve holistic, high quality care that is not bound by the time and monetary constraints imposed by insurance companies. We believe that you deserve an individualized rehabilitation program that is based on your goals and physical wellness. Your access to high quality care should not suffer due to yearly changes in reimbursement rates that only benefit large corporations.
Here at The PATH we promise that our 60 minute, one-on-one sessions will never change. We promise to collaborate with you to develop a plan that will get you back to the activities that you love in less time, at a lower overall cost, and through a more fulfilling experience.
Dr. Paulina Tselikis
PT, DPT, ATC, USAW-1
Co-owner | The PATH Rehab & Performance
