Are Physical Therapist Assistants Being Phased Out
The COVID-19 pandemic has placed unprecedented strain on the U.S. health care system, and that’s no secret. But one industry is taking it harder than most — or at least more publicly — with its trade group calling for a congressional hearing about how this crisis affects therapists who provide vital mental healthcare to Americans.
When President Joe Biden signed his $2 trillion federal stimulus package into law in March, he included a provision that would force Medicare to pay physical therapist assistants (PTAs) and other similar medical professionals on average just over $20 per hour in 2021, down from nearly double their current rate of roughly $40 per hour. This was supposed to help cover costs associated with providing telehealth treatment for patients during the coronavirus outbreak, but some experts fear it could also have unintended consequences.
“It seems like a lot,” says Dr. William Stokes, president of the American Association of Occupational Therapy (AAOT), which represents occupational therapists, PTs and PTA, among others. “And I think part of it is because we’ve never seen anything like this.”
Stokes worries that the cuts could eliminate thousands of jobs in the field nationwide. In fact, the number of people employed as PTAs is expected to decline by 20 percent between 2019 and 2024. That’s not only due to the reduction in hours worked; it’s also because many employers are choosing to hire new employees directly instead of hiring existing ones.
Meanwhile, the number of Americans seeking mental healthcare increased dramatically during the pandemic. And while there’s debate over whether those increases represent a real increase in need, it’s undeniable that the demand for mental health resources is far greater right now than it was before the pandemic began. As psychologist Sara Ahern put it in a recent article for Psychology Today, “For millions of people, having nowhere else to go feels normal.”
That’s where PTA come in. They’re licensed clinicians who work under the supervision of full-time occupational or physical therapists treating everything from lower back pain to burn rehabilitation. While they may perform administrative duties, such as scheduling appointments and managing billing systems, PTA typically aren’t responsible for diagnosing clients’ conditions or making clinical decisions. Their job is simply to offer assistance so that their supervising therapists can focus on helping patients recover fully.
But if the Biden administration’s proposed cuts go through, that won’t change. Instead, both therapists and their assistants will see their salaries decrease by around 10% in 2021. Then next year, when the government reopens, things get even worse.
Under the terms of the bill passed last month, the federal Centers For Medicare & Medicaid Services must reduce payments to therapists and assistants by 1.5 times what the agency normally pays them in 2020 levels. So in 2022, the amount therapists receive will drop to $21.45 per hour, while their assistants’ wages fall to $18.50 per hour. To make up for those cuts, CMS plans to increase its reimbursement rates by 2% each year starting in 2025.
Those proposals came amid widespread anger over the Trump administration’s decision to slash billions from the state budgets of several states, including California, New York and Illinois, all of which rely heavily on Medicaid funding from Washington.
In response, AAOT sent a letter to House Speaker Nancy Pelosi expressing concerns over the cuts to PTA salaries. It argued that eliminating their wages altogether would cause serious harm to vulnerable populations, especially those dealing with chronic illnesses, injuries and disabilities.
On April 28, Pelosi announced that she had invited the association to participate in a conference call regarding the issue. On May 18, she responded with a memo saying that although she understood AAOT’s position, she felt the salary reductions were necessary given the dire financial situation caused by the pandemic. She added that she hoped to find a way to enact the changes without cutting too much.
However, some experts say the White House proposal is still too steep. Michael Siegel, a physician specializing in addiction medicine and professor of public health sciences at Stanford University, told us via email that the cuts would likely result in fewer therapists working, thereby limiting access to needed treatments. He noted that studies show that good quality programs designed to treat complex problems often require long sessions led by well-trained specialists.
“If those workers become discouraged and leave their positions, then obviously that reduces availability of these treatments,” he wrote.
According to Stokes, this isn’t the first time that PTA salaries have been targeted for budget savings. During the Obama administration, the Affordable Care Act required insurers to cover certain types of mental health treatment at parity with physical health care. At the same time, though, the ACA limited federal spending on Medicaid reimbursements to PTA salaries. So if the Biden administration wanted to save money, it appeared to be inevitable that something would eventually have to give.
Stokes notes that PTA salaries have already decreased in the past decade, from an average hourly wage of $35.75 in 2008 to $29.90 in 2018. If the latest cuts go through, that figure could continue downward.
He says the profession’s members want lawmakers to take steps to avoid that outcome. One possibility might include increasing the minimum wage for PTA to $15 per hour, which would boost their income significantly. Another idea would be to exempt PTA from the ACA limits entirely, allowing them to charge whatever prices they deem appropriate.
A third option, according to Stokes, would be to let Medicare negotiate prices with individual clinics rather than setting predetermined rates. That approach currently applies to hospitals and doctors’ offices, but it doesn’t seem to apply to therapy businesses.
While Stokes acknowledges that the field needs qualified staff, he argues that the solution shouldn’t involve slashing their salaries. After all, the problem is not necessarily a shortage of therapists themselves. Rather, it’s the lack of affordable housing and transportation options that keep many potential patients away.
“We have plenty of therapists out there,” he said. “What we don’t have enough of is places to send our patients.”
Congressional Democrats introduced a plan Thursday to increase funding for mental health by 50%. Under the proposal, the Substance Abuse and Mental Health Services Administration would distribute $1 billion annually to states for mental health grants. States would use the funds to develop and implement evidence-based practices to prevent suicide and improve mental health outcomes.
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