Proposed Medicare payment cuts could restrict needed therapy services for millions of beneficiaries

Millions of America’s seniors could face disruptions to audiology and speech-language pathology therapy services vital to their health and quality of life unless Congress and the Centers for Medicare & Medicaid Services (CMS) act to protect them, the American Speech-Language-Hearing Association (ASHA) have warned

At issue is CMS’s 2021 proposed Medicare Physician Fee Schedule rule, released on August 3, in which the agency recommends significant payment reductions to more than three dozen health care provider groups, including audiologists and speech-language pathologists. This is an effort to offset increasing payments for office/outpatient evaluation and management (E/M) codes typically used by primary care physicians.

Audiologists are facing a 7% cut to Medicare reimbursement, and speech-language pathologists are facing a 9% cut—which would translate into significant reductions in therapy services for a range of communication, cognition, and swallowing problems common in seniors. These problems are often a result of conditions including stroke, brain injury, Alzheimer’s disease, Parkinson’s disease, and head and neck cancers, along with hearing loss—one of the most common health conditions that seniors experience.

“The services provided by audiologists and speech-language pathologists are absolutely essential to our seniors as they recover from serious medical events and live with chronic conditions such as neurological disorders and hearing loss,” said Theresa H. Rodgers, MA, CCC-SLP, ASHA 2020 President. “Medicare cuts are most unfortunate, and especially ill-advised, given the treatable nature of many of these conditions—and the tremendous improvements that our members witness every day when patients have appropriate access to needed diagnostic and rehabilitative services. Our seniors deserve better.”

The proposed cuts are the product of a Medicare statutory requirement known as budget neutrality, which requires that any increase in costs to the Medicare program (in 2021, higher spending on E/M codes) must result in decreased spending elsewhere under Medicare. The cuts will go into effect in 2021, unless Congress and CMS act to waive the budget neutrality requirement.

ASHA, along with the American Occupational Therapy Association (AOTA), the American Physical Therapy Association (APTA), and many other physician and nonphysician provider groups, has engaged in vigorous advocacy efforts over the past several months aimed at Congress, CMS, the Department of Health and Human Services, and the Office of Management and Budget to curtail these cuts and stress the serious impact that such cuts would have on seniors.

While recognizing the importance of funding the services provided by primary care physicians, ASHA notes the equally important value of its members’ diagnostic and rehabilitative services—calling for a holistic reimbursement approach. In a joint statement issued August 4, ASHA, AOTA, and APTA noted: “Our organizations call on Congress and CMS to advance well-reasoned fee schedule payment policies and waive budget neutrality.”

Further reinforcing this approach, ASHA joined with a broad coalition of organizations representing more than 330,000 physicians and 884,000 nonphysician providers. In a collective statement, those groups specified: “Our groups are calling on Congress and CMS to collaborate on developing a solution that will allow the changes to the E/M services to proceed, while at the same time preventing cuts to our health care professionals.”

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