How Physical Therapy Can Help Confront a Growing Health Crisis

Earlier this year, the Journal of the American Medical Association published an eye-opening report on a deadly yet often overlooked epidemic affecting American seniors: accidental falls.

Over the last decade, fall deaths among elderly citizens have increased at an alarming rate —  a reality that has imposed enormous human and financial costs on our health care system. Accounting for roughly 300,000 hip fractures, 800,000 hospitalizations and 27,000 deaths every year, falls are also the leading cause of injury-related emergency room visits for older Americans. With roughly 40 percent of nursing home admissions driven by fall-related accidents, many seniors sadly have their independence stripped away as a result of these unexpected slips.

Needless to say, the cost burden of this epidemic is enormous. It is estimated that medical expenditures attributable to fatal and nonfatal falls were roughly $50 billion in 2015 alone. According to the Centers for Disease Control and Prevention, fall injuries are “among the 20 most expensive medical conditions” and incur an average hospital cost of more than $30,000 per admission. Hip fractures for elderly Americans are driven almost exclusively by falls and involve a lifetime cost of about $81,300 per patient. The majority of these costs are borne by the Medicare program to the tune of almost $30 billion in 2015.

As September is National Falls Prevention Month, we must ask ourselves how best to confront this growing and deadly epidemic that affects tens of thousands of Americans every year. Fortunately, due to their training, physical therapists are uniquely qualified to reduce the risk of a fall and prevent injuries among the elderly population.

As a physical therapist, I have helped countless Medicare patients improve their balance and strengthen themselves with a series of patient-specific exercises and interventions, which have proven to reduce the risk of an unwanted slip.

Through PT-prescribed treatments such as balance training, strengthening exercises and canalith repositioning to relieve vertigo, our patients are able to move more safely and maintain their independence. Physical therapists also have the knowledge base to conduct patient home assessments, which involve a comprehensive evaluation of a patient’s home in order to identify potential hazards that may induce an unwanted fall. Following this assessment, we make specific recommendations on how best to remove or minimize these hazards and increase the patient’s safety.

Numerous research initiatives and case studies have revealed the myriad benefits of the exercise regimens commonly prescribed by physical therapists in reducing the likelihood of a fall. As America’s population continues to grow demographically older, encouraging wider access to these preventive exercise strategies will become ever more important. Unfortunately, a recently proposed Medicare cut to specialty care services could significantly undermine patient access to physical therapy services.

Issued by the Centers for Medicare and Medicaid Services, the proposed Physician Fee Schedule rule for 2020 threatens to impose an 8 percent, across-the-board cut to physical therapy services in 2021. These arbitrary and harmful cuts would be catastrophic to a health care sector that has already been subject to a string of deep reimbursement cuts.

The proposed 2021 reduction would be on top of a 2011 multiple procedure payment reduction policy cut, which was deepened further in 2013. Just last year, several PT billing codes were slashed in CMS’ National Correct Coding Initiative, including codes that PTs use most frequently for therapeutic exercise and manual therapy. Further, under current policy, physical therapists are set to experience another 15 percent Medicare cut for services provided by a physical therapist assistant in 2022.

Considering the enormity of these cuts, it is clear that physical therapy for Medicare patients is at serious risk. If CMS proceeds with the 2021 cuts as proposed, we will undoubtedly see practice closures and providers opting out of the Medicare program, which would then stifle access to important PT treatments, including key fall prevention tools such as manual and exercise therapy.

With fall deaths increasing every year, undermining beneficiary access to fall prevention treatments offered by physical therapy is both short-sighted and financially ill-advised. As aforementioned, the costs that falls incur on America’s health care system are exorbitant and unsustainable. Siphoning resources away from PT services as the fall epidemic increases in size and scope will only result in more injury-related costs further down the line.

Diminishing access to PT services that save lives and reduce downstream medical costs is counterproductive, plain and simple. I urge CMS to alter its recently proposed rule to ensure beneficiary access to PT is preserved well into the future.


Nikesh Patel, PT, DPT, is a physical therapist and executive director of Alliance for Physical Therapy Quality and Innovation.

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