Legislation was introduced in Congress this week to allow physical therapists to “opt out” of the Medicare program, making it easier for seniors to see the physical therapist of their choice. The Medicare Patient Choice Act (H.R. 4204), sponsored by Reps. Lloyd Smucker, R-Pa., and Don Davis, D-N.C., would add PTs to the list of health care providers who may opt out of Medicare. This change would give patients the flexibility to privately contract with their preferred PT.
Currently, physical therapists seeking payment for services provided to Medicare Part B beneficiaries must enroll as Medicare providers. Therapists may choose to be either a participating provider or a nonparticipating provider under Medicare. However, physical therapists — whether they participate in Medicare or not — are currently prohibited from privately contracting with Medicare beneficiaries. This situation often affects seniors aged 65 and older who are newly enrolled in Medicare. If their preferred therapist is not participating in Medicare, the therapist cannot continue seeing them, even if the patient wishes to privately contract for services.
Physicians and about a dozen other providers are currently eligible to opt out under Medicare. These provider groups may privately contract with Medicare beneficiaries and both deliver services to and directly bill their patients. For some patients, this option is particularly important, as they prefer to continue visiting the health care provider they know and trust, even if that provider is not participating in Medicare.
APTA President Kyle Covington, PT, DPT, PhD, says, “The Medicare Choice Act will ensure that physical therapists can privately contract or opt out of Medicare, which is essential to giving patients a choice in how they receive physical therapy services. Additionally, this legislation will provide options to outpatient physical therapy practices for how they provide services under Medicare Part B. The bottom line is this: Improving payment, reducing administrative burden, and providing more flexibility for PT practices are critical to supporting the physical therapy profession.
“At the heart of this legislation is a simple but powerful principle: patients’ freedom to choose who provides their care,” says Mike Horsfield, PT, MBA, president of APTA Private Practice. “Seniors shouldn’t lose access to the therapist they trust just because they’ve enrolled in Medicare. This bill ensures that continuity of care and patient preference remain central to our health care system.”
The Medicare Patient Choice Act would add physical therapists, occupational therapists, speech-language pathologists, audiologists, and chiropractors to the list of providers who are eligible to opt out under Medicare. Providers choosing to opt out may not treat Medicare or Medicare Advantage patients for at least two years and cannot bill Medicare for any services provided to Medicare beneficiaries.
In addition to delivering much-needed flexibility for patients and providers, the bill could also save Medicare money. A study by the independent consulting firm Dobson and Davanzo projected that this bill would save Medicare over $139.6 million over 10 years.
APTA applauds the bill sponsors for introducing this legislation and will be working to get this measure signed into law.