Deeper Medicare Cuts Won't Reduce the $50B Spending on Older Adult Falls

— Cutting physical therapy reimbursement is bad for patients and bad for spending

A photo of a senior man holding a cane and struggling to get off the floor.
Patel is a physical therapist.

Falls among seniors pose a significant public health challenge, leading to 3 million emergency room visits and more than 36,000 deaths each year. By prioritizing physical therapy as a preventive measure, we can address this issue proactively and promote healthier aging for our senior population.

Helping seniors build strength and balance is not only good for patients, but also, it is cost-effective and helps save the Medicare system money. So, it is alarming that Medicare has proposed yet another round of cuts to physical, occupational, and speech therapy. These cuts, if implemented, would have severe consequences for seniors' access to vital care and threaten the effectiveness and affordability of treatment.

Congress must take immediate action to prevent these cuts and protect the well-being of our aging population as we tackle the immense problem of senior falls.

Over the years, the Centers for Medicare & Medicaid Services (CMS) has consistently announced plans for deep cuts to specialty services, including physical therapy. Planned cuts to physical therapy services have compounded on top of one another, reaching 9% between 2020 and 2024. The Medicare Physician Fee Schedule Proposed Rule for CY2024, released on July 13, continues this trend by proposing to cut payments for these services by at least 3.36% -- and even higher in some parts of the country due to the highly technical formula CMS uses to determine reimbursement. If allowed to go into effect next year, these cuts will place an extraordinary burden on providers and undermine their ability to deliver quality care to older Americans. Even more worrying, the cuts will endanger the ability of seniors to access the community-based therapy services that are essential for their well-being.

The continuous cuts to reimbursement rates jeopardize the stability of all specialty sectors, including physical therapy, and raise concerns about the potential closure of practices and restricted access for Medicare beneficiaries. If Congress does not act, this would profoundly impact seniors who rely on physical therapy to maintain their health, independence, and quality of life.

If cost savings are the most important factor, let's point to the runaway financial burden if the senior falls epidemic is left unaddressed. By CDC estimates, about $50 billion is spent on medical costs related to nonfatal fall injuries each year, and $754 million is spent connected to fatal falls. According to a report by the American Journal of Lifestyle Medicine, the annual cost will skyrocket to $100 billion spent on fall treatment care by 2030.

It doesn't have to be this way. Multiple meta-analyses of randomized control trials show substantial positive impacts of exercise programs and physical therapy to help prevent falls. Research published in the Journal of the American Geriatrics Society shows that seniors who underwent an exercise intervention from a trained healthcare professional saw a 31% reduction in their risk of falls. Moreover, recent analysis conducted by the Moran Company (at the request of APTQI) shows that increased physical therapy access could save nearly $10 billion among the 13.5 million Medicare beneficiaries who currently do not utilize physical therapy. With expanded access to care, the report projects that American seniors will be 50% less likely to need to visit the ER or be hospitalized in the months following the fall, and 39% will be less likely to use opioids in their recovery due to physical therapy treatment. Finally, physical therapy significantly reduces the risk of rehospitalization by helping to enhance older adults' functional abilities including strength and balance.

By incorporating physical therapy into seniors' care plans, we can mitigate the risk of falls, manage pain in healthier, lasting ways, and enhance overall well-being. Keeping seniors healthy and on their feet is not just good for patients; it's good for the Medicare system as a whole. That's why it is essential the Medicare reimbursement system reflects these significant benefits and adequately reimburses physical therapists for the care they provide.

The proposed cuts underscore the urgent need for Congressional intervention. Congress has a responsibility to protect seniors' ability to receive the vital care they need for post-operative recovery, pain management, mobility challenges, and fall prevention. By stabilizing the country's healthcare system and combating Medicare's repeated cuts to specialty care services, lawmakers can ensure seniors receive the care they deserve. It's time to proactively promote healthier aging for our senior population.

Nikesh Patel, PT, is the executive director of the Alliance for Physical Therapy Quality and Innovation (APTQI).