Today, the House of Representatives released language of the health care provisions in the Middle Class Tax Relief and Job Creation Act. The bill updates the Medicare Physician Fee Schedule Sustainable Growth Rate (SGR) for 2012 and 2013 by 1% -- negating a scheduled 27.4% reduction in payments to providers, including physical therapists who bill under the fee schedule. The bill also provides a 2-year extension of the therapy cap exceptions process with modifications. As currently written, the bill creates a 2-stage exceptions process. In this 2-stage process, physical therapists would submit claims using the KX modifier when the $1,880 cap is reached. At $3,700 a manual review would be required to ensure that the plan of care is medically necessary. APTA is reviewing this and other provisions of the bill, including the application of these provisions in the outpatient hospital setting and federal agency reporting on the new process.

The House is expected to vote on the bill next week. Early next week the Senate is expected to release its version of the bill. Both chambers need to pass their respective bills and send them to conference for a final bill to be drafted and sent back to both the House and Senate for full votes. Thus, today's action by the House is just the beginning of what promises to be a long and uncertain week on Capitol Hill.

Registration closes December 12 for APTA's Medicare 2012 - The Year Ahead for Outpatient Physical Therapy audio conference, which will be held December 15, 2pm-3:30pm, ET.

New Medicare payment policies that will take effect in 2012 can have a significant impact on physical therapist practice and payment for outpatient therapy services. Find out the latest information on the new 2012 Medicare fee schedule payment rates, the therapy cap, the Physician Quality Reporting System, provider enrollment, Medicare Administrative Contractor activities, and more.

Coding and payment policy expert Steve Levine, PT, DPT, MSHA, joins Gayle Lee, JD, APTA’s director of federal payment policy and regulatory affairs, to provide critical information about Medicare’s new rules affecting coverage and payment for physical therapy services in 2012. During a Q&A session following the overview, participants may ask questions directly to the experts. Learn more.

Registration ends December 12 at 11:00 pm, ET, or as soon as all available spaces are filled. Register online today, or call APTA Member Services at 800/999-2782, ext 3395.

If you can't participate live in the live event, you may purchase the downloadable file, which includes the audio conference recording and handouts, for the same price. The file will be available after January 1, 2012.

In PTJ's December Craikcast, Editor in Chief Rebecca Craik, PT, PhD, FAPTA, discusses the special issue "Advances in Disability Research" with its co-editors, Alan Jette, PT, PhD, FAPTA, and Nancy Latham, PT, PhD. Themes in this month's issue include the movement in disability research that celebrates disability as a form of diversity, the development of measures for people with disabilities toward quality of life or participation, and the need to for physical therapists to think beyond impairments when considering outcomes and quality of life for patients. 

The Centers for Medicare and Medicaid Services has released the updated measures specifications for the Physician Quality Reporting System (PQRS) for the 2012 reporting year, which include 2 major changes of importance to physical therapists—the ability to participate in reporting for the Functional Outcome Assessment Measure (#182) and changes to the existing Pain Assessment Measure (#131). The measure specifications provide program participants with important information regarding such as the measure definition, reporting instructions, and the qualifying case information (numerator and denomination definitions), which include the relevant quality data codes for reporting.

Physical therapists will be eligible to participate in reporting for an additional individual measure in the 2012 reporting year—Measure #182: Functional Outcome Assessment. The Functional Outcomes Assessment measure requires documentation of a current functional outcome assessment using a standardized functional outcome assessment and documentation of a care plan based on identified functional outcome deficiencies. APTA will create a new podcast before the year's end to provide practitioners with additional details around reporting for this measure.

Practitioners also should note that major changes have been made to the quality data reporting codes for Measure #131, the Pain Assessment Measure. The quality data codes for this measure have been changed for 2012; the 2011 quality data codes for this measure cannot be used in the 2012 reporting year. 

See the new 2012 measures specifications for further details located on APTA's PQRS Web site under the "2012 PQRS Measure Details" section.

There are growing national concerns regarding the increasing financial burden of out-of-pocket expense for the health care consumer, especially as it relates to physical therapy services. Under certain health plans, copayments for physical therapy services, some as high as $60 per visit, exceed the reimbursement paid by the plan to the provider of care. In addition, in many states and health insurance contracts, the physical therapist (PT) is classified under the specialist designation, which increases the financial burden to the patient by imposing higher copayments and thus restricts access to physical therapy services. High copayments for physical therapy have recently been cited as a reason that some consumers opt to reduce their frequency of care or forgo medically necessary care—running the risk of worsening the underlying condition and/or risking reinjury, thus potentially negatively impacting patient care outcomes.

APTA supports state legislation that provides for fair physical therapy copays and prevents cost-shifting to the patient as a result of categorizing physical therapists under the specialist designation. Building on the successful legislative effort earlier this year by the Kentucky Chapter to enact fair PT copays legislation in that state, APTA's Government Affairs and Payment Advocacy Unit has begun developing resources for chapters to advocate on this issue at the state level. A number of state chapters are currently coordinating with APTA State Government Affairs on possible 2012 state legislation. Be sure to check out the new resource Web page.  

One in 3 adult patients aged 21 and older who are discharged from a hospital to the community does not see a physician within 30 days of discharge, according to a new national study by the Center for Studying Health System Change (HSC). Even 90 days after discharge, 17.6% still had not seen a physician, nurse practitioner, or physician assistant.  

Many adults who do not see a physician after discharge are at high risk of readmission because of chronic conditions or physical activity limitations, according to the study, which used 2000-2008 data from the nationally representative Medical Expenditure Panel Survey to estimate the prevalence of hospital readmissions for all causes—other than obstetrical care—for adults aged 21 and older.

About 1 in 12 adults (8.2%) aged 21 and older discharged from a hospital to the community was readmitted within 30 days, according to the study, and 1 in 3 adults (32.9%) was rehospitalized within 1 year of discharge.

Other key findings include:

• Thirty-day readmission rates are much higher for people who are sicker.
• Among adults aged 21 to 64, readmission rates were highest for people with public coverage, mainly Medicare or Medicaid.
• The vast majority of people admitted to a hospital reported having a usual source of care (90%). Only about a third of people with a usual source of care reported that after-hours care was available, and about one-fifth said it was difficult to contact their usual source of care by phone about a health problem. One in 10 reported difficulty getting to their usual source of care, which may reflect long travel times or lack of transportation.

On an annual basis, expenditures were $16.3 billion for hospital readmissions up to 30 days after discharge. While much of the policy focus has been on changing payment incentives in Medicare to decrease readmissions, private insurance pays for a greater share of 30-day readmissions (about 47%) than does Medicare (about 40%).