California physical therapists (PTs) have been infuriated by the legislatively wrangling that California SB 924 has been subject to during the past 2 weeks, made all the more frustrating because the bill is stalled in the Assembly Rules Committee during this last week of the California legislative session. 

The legislation, a compromise bill brokered by California Senate President Darrell Steinberg and sponsored by state Sen Curren Price, was intended to end a long and bitter battle in the state legislature between the California Chapter and the California Medical Association (CMA) over the issues of direct access to physical therapist services, and whether PTs may be employed by, or be shareholders of, medical corporations, and alternatively whether physicians may be employed by or shareholders of PT corporations. While the chapter supported the direct access elements of SB 924, it was not in favor of the corporation aspect of the bill. Conversely, CMA supported the corporation language in the bill and remained adamantly opposed to allowing direct access.

For the most part, the legislation had been moving without major incident through the California legislature; SB 924 passed the Senate unanimously on January 30, and passed the Assembly Business & Professions Committee on June 26. 

The flare-up started on Thursday, August 16, when SB 924 passed unanimously out of the Assembly Appropriations Committee, but not before the committee made hostile amendments to the direct access aspects of the bill behind closed doors, without input from the California Chapter or the bill’s chief sponsor, Sen Price. Under the prior compromise version of SB 924, a signed plan of care from a physician or podiatrist was required to continue treatment after the initial 30 business days or 12 visits provided via direct access; the physical therapist also needed to provide written disclosure to the patient explaining the provisions tied to the direct access law. As amended by the Assembly Appropriations Committee, a diagnosis from a physician or podiatrist must be obtained after the initial 30 business days or 12 visits via direct access in order to continue treatment. The disclosure language the PT must provide to the patient also was amended to add language stating the private insurance may not pay for the services without a physician referral. The amendments made by the Appropriation Committee were held from the public for 5 days before being released, causing an uproar.

The bill took another turn on Friday, August 24, when the amendments that were placed into SB 924 during the Assembly Appropriations Committee hearing were removed on the Assembly floor, while new unwelcome amendments were added. But shortly thereafter Assembly Speaker John A. Pérez referred SB 924 to the Assembly Rules Committee, a procedural stall tactic, where SB 924 may stay until the end of the legislative session. If SB 924 is not moved from the Assembly Rules Committee and sent to the Assembly floor for a full vote by midnight Friday, August 31, SB 924 will die. The California Chapter is urging its members to contact their Assembly member to ask for an up–or-down vote on SB 924 by the full Assembly before the midnight deadline this Friday. The full text of the current version of SB 924 is available here.

To provide members opportunities for conversation related to the governance proposal and garner feedback about the elements that members support, are uncertain about, or do not support, a series of virtual town hall discussions centered on House of Delegates processes have been scheduled. The first town hall will be held on September 18. To offer members on both coasts ample opportunity to take part in the conversation, APTA has scheduled 2 town halls for that evening, 6 pm-7:30 pm Eastern Time and 10 pm-11:30 pm Eastern Time. Contact Amber Neil if you are interested in attending. Additional town halls will be held on September 20 and 27 at the times indicated above.

Minutes of the 2012 House of Delegates (House) now are available. The minutes provide information on how the House revised and voted on all motions and bylaw amendments brought forward this year. The document is housed in the House of Delegates community's archive folder. In addition, the Policies and Bylaws page on APTA's website also has been updated to reflect policies that were adopted or amended at the 2012 House.

In communication with New York Chapter leaders, Aetna has clarified that 97001 and 97002 are not included in a policy change published on page 2 in its September 2012 OfficeLink Updates™.

The publication includes an updated policy for evaluation and management codes billed by certain nonphysician provider types, which becomes effective December 1. The policy states that evaluation and management codes will not be allowed for physical therapists, occupational therapists, speech therapists, audiologists, dieticians, and nutritionists. Aetna representatives have confirmed that the policy applies to codes in the 992xx series, and will not be billable by physical therapists. However, physical therapists will continue to be able to report 97001 and 97002 for evaluation and reevaluation.

A new APTA podcast and transcript provide an overview of the manual medical review process for Medicare claims for beneficiaries who reach $3,700 in outpatient therapy expenditures in a calendar year.

Under the new therapy cap exceptions process, outpatient therapy patients will still be eligible for an automatic exception at the 2012 therapy cap level of $1,880. Therapists will follow the same process of applying the KX modifier on the claim form when a patient exceeds the cap amount. Claims for patients who then meet or exceed $3,700 in therapy expenditures will be subject to a manual medical review process that will be implemented in 3 distinct phases beginning October 1, November 1, and December 1. (See last week's News Now  article for more information about provider assignment to the phases.)

Additional information regarding the therapy cap and the manual medical review process is available on APTA's website. CMS also provides a fact sheet and question-and-answer document regarding the process. Next week, APTA will record a webinar that will address the therapy cap and the manual medical review process. News Now will provide a link to the recording, which will be free to members, when it is available.

Earlier this summer, APTA served on an expert panel as part of the American Nurses Association's (ANA) broad-based effort to develop national standards to guide hospitals and other health care facilities in their implementation of policies and equipment to safely lift and move patients.

Ken Harwood, PT, PhD, CIE, represented APTA on the panel that included 26 specialists with expertise in nursing, physical therapy, occupational therapy, ergonomics, architecture, health care systems, and other disciplines to create overarching standards for implementing safe patient handling programs and detailed guidelines for making them work effectively in practice. The Safe Patient Handling National Standards Working Group plans to distribute the standards and guidelines to their professional memberships for comment in October, with publication and release set for March 2013.

The panel is seeking to build a consensus of evidence-based best practices in safe patient handling that will apply to multiple health care professions and settings. The panel's goal is to develop language that can be incorporated nationwide into practices, policies, procedures, and regulations and become the basis for resource toolkits and certifications.

Currently, there are no broadly recognized government or private industry national standards for safe patient handling. Health care facility programs lack consistency, as do regulations in 10 states that have enacted safe patient handling laws. In the meantime, health care professionals continue getting injured, and musculoskeletal injury remains a top concern, says ANA.

Physical therapy interventions for back care in children and adolescents are successful in significantly increasing healthy behaviors and knowledge acquired both in the posttest and in the follow-up, say authors of a meta-analysis published in BMC Musculoskeletal Disorders. The combined treatment of postural hygiene with physical therapy exercise exhibits the best results. The small number of studies limits the generalizability of the results, they add.

The authors located studies from the Cochrane Library, Medline, PEDro, Web of Science and IME, and other sources. The search period extended to May 2012. To be included in the meta-analysis, studies had to use physical therapy methodologies of preventive treatment on children and adolescents and compare a treatment and a control group. Treatment, participant, methodological, and extrinsic characteristics of the studies were coded. Two researchers independently coded all of the studies. As effect size indices, standardized mean differences were calculated for measures of behaviors and knowledge, both in the posttest and in the follow-up. The random and mixed-effects models were used for the statistical analyses. Sensitivity analyses were carried out to check the robustness of the meta-analytic results.

A total of 19 papers fulfilled the selection criteria, producing 23 independent studies. On average, the treatments reached a statistically significant effectiveness in the behaviors acquired, both in the posttest and in the follow-up (d+ = 1.33 and d+ = 1.80, respectively), as well as in measures of knowledge (posttest: d+ = 1.29; follow-up: d+ = 0.76). Depending on the outcome measure, the effect sizes were affected by different moderator variables, such as the type of treatment, the type of postural hygiene, the teaching method, or the use of paraprofessionals as cotherapists.