Medicare Cuts & Opportunities

Earn 1 hour of continuing education by joining OT Potential after taking this course.

When you adjust for inflation, OT and PT reimbursement is down around 40% since 2002 on our key CPT codes. 

Now the 2026 Physician Fee Schedule proposed rule has ANOTHER cut to OT written in pencil. We simply cannot sustain continued cuts to the value of our services. 

So, we clearly need to reconsider our advocacy approach and identify key opportunities to help influence meaningful change.. 

At OT Potential we are equipping YOU to raise your voice. In this live webinar and course, we are going to spend an hour diving deep into the relevant parts of the new proposed rule, so you can understand the challenges and opportunities. We’ll be led by The incredible Dana Strauss, a doctor of physical therapy and healthcare public policy expert.

See the comment letter template and visuals mentioned in this episode.

Learning Objectives

• You will identify the proposed cuts to occupational therapy and physical therapy in the 2026 proposed physician fee schedule. 
• You will be able to identify the opportunity that exists for you to comment on proposed changes.

Agenda

Intro (5 minutes)

Discussion on Medicare cuts & opportunities (45 minutes)

• What is the physician fee schedule? Why is it important?
• What cuts have OT/PT sustained over the past 20 years? How does this compare to other providers like PCPs and behavioral health providers? How about medical specialists?
• What new cut is being proposed?
• What is the difference between time-based reimbursement codes and non-time based reimbursement codes?
  • Which providers typically bill time-based codes at least some of the time and why?
  • Why might OT/PT be being viewed differently than other time-based providers? 
• How to OTs/PTs comment on this proposal and why does that matter? What do other providers often do? 
• Do comments really matter? 
• A template for commenting on the proposed rule, and what steps you ended up taking to comment by Sept. 12th. 

Live Q&A (10 minutes)

Supporting Research and Journal Articles

• Exploring Reimbursement Pathways for Lifestyle Medicine and Health Promotion Services in Occupational Therapy
• Higher Frequency of Acute Occupational Therapy Services Is Associated With Reduced Hospital Readmissions
• Comprehensive analysis of trends in Medicare utilization and reimbursement in Physical Medicine & Rehabilitation: 2012 to 2017

Target Audience/Educational Level

Our target audience is occupational therapy practitioners who are looking to learn about Medicare cuts and opportunities.  The educational level is introductory.

Financial and Non-financial Disclosures

It is the policy of OT Potential to disclose any financial and non-financial interest the provider or instructor may have in a product or service mentioned during an activity. This is to ensure that the audience is made aware of any bias of the speaker.

We here at OT Potential have no financial stake in this topic. 

Speakers

Dana Strauss, PT, DPT

Dana took her clinical experience as a doctor of physical therapy and expertise in the health care continuum and transitioned her career to value based care and policy analysis and expertise. She believes the healthcare system can meet everyone’s needs better. Her passion is moving towards the optimal patient experience and outcomes wherever an individual is in the spectrum of wellness, illness or injury, chronic care, or serious illness. She is optimistic about payer/provider synergistic relationships making healthcare better for everyone along the care continuum and is confident that innovative re-imagining of the roles and responsibilities of sites of care, including the home, can lead to higher value and superior quality of care for all. She recognizes there is a common imperative of a culture shift to dismantle the barriers and unlock the possibilities that lead to true care transformation. She uses insights gleaned from close collaboration with data analytics to demonstrate opportunity to providers and sites of care delivery, moving the needle on change.

Dana is a subject matter expert in care transitions, care coordination, all sites of the acute and post-acute care continuum and their payment incentives and structures, case management, and alternative payment models. She has worked directly with hospitals and physician partners successfully implementing BPCI, CJR, BPCI-A, accountable care organizations, and other alternative payment models. She has strong experience in leadership, strategic partnerships, business development, rehabilitation, and mentoring clinicians and budding leaders. Her special interests are palliative care and home-based care, and how they can strengthen new care delivery models and the shift to value.

Sarah Lyon, OTR/L

Sarah’s passion is helping fellow OT practitioners translate evidence into daily practice. Sarah earned her BA in religion from St. Olaf College, then earned her master’s degree in occupational therapy from New York University in 2011.

Since then, she’s worked in numerous facilities, including a critical access hospital, an acute trauma hospital, and a state inpatient psychiatric hospital. Sarah is the founder/owner of OT Potential. Read more about OT Potential here.

This course was designed to meet your continuing education requirements

We designed the courses in the Club to meet the requirements for “online” and “independent/self-study” courses. To verify the requirements from your specific state (within the US), check out our post, OT Continuing Education Requirements. If you are outside of the United States and have questions, please contact us.

We are proud to be an AOTA Approved Provider and to meet the requirements for your NBCOT renewal.

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