Dr. Moore,

Although a stated legislative priority of the APTA and despite meaningful advocacy, Medicare’s reimbursement cap for rehabilitation services has gone into effect with the new year. This will, as you’ve pointed out, present a barrier to delivering impactful care to older adults. Although our arguments are straightforward, asking congress not to limit reimbursement might become easier if our profession could better demonstrate the value of the work that we do.

As reimbursement for many services shifts towards a bundled payment for each care episode, physical therapy’s value to health systems will grow. PTs help patients achieve good outcomes at significantly lower cost and with less risk than surgeries and opioids, which will further establish PTs as integral providers to systems competing to provide quality, cost-effective care. In the face of systemic payment reform, this is the time to show how much we can contribute to a healthcare system in need of cheap and effective intervention.

As fee-for-service fades and organizational incentives shift away from maximizing revenues with high-cost procedures towards instead keeping costs of care low with conservative treatments that achieve the same outcomes, physical therapist referrals could become ubiquitous for hospitalized older adults, for outpatients with chronic pain, and for preventative wellness.

Our profession and the ideas that it represents are fundamentally aligned with the needs of our healthcare system. Prevention is not just less expensive than treating disease – pain, diabetes or arthritis – after it’s progressed; it’s a better strategy for minimizing the impact those conditions have on quality of life. The active engagement of PT treatment stimulates change that is more productive and sustainable than a passive, procedure-oriented approach.

A shift towards bundled payments and value-based care presents an opportunity to demonstrate that low-cost, conservative treatments should not be viewed as ancillary because of their low revenue, but instead as central pieces of healthcare for the very same reasons that they are relegated to a lower tier of importance under fee-for-service.

Capturing the value of rehab intervention is complicated, but the problems we can help solve are equally so. Opportunities for improvement that benefit patients, health systems and insurers at the same time are unusual, but we have a clear one. While repeal of Medicare’s therapy cap is a worthwhile goal, my belief as a PT is that demonstrating the value which rehab services offer to health systems should be our highest priority in anticipation of payment reform.