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  • APTA Advisory: Small Business Paycheck Protection Program to Become More Flexible

    Changes included in a bill likely to be signed into law will relax some use requirements and extend deadlines for repayment and other actions.

    The U.S. Small Business Administration's Paycheck Protection Program is likely to become more flexible for small business owners, thanks to a set of changes that will expand how PPP funds can be used and will extend deadlines for repayment, among other provisions.

    The changes, included in a bill dubbed The Paycheck Protection Flexibility Act, were approved by the U.S. House of Representatives in late May, and passed the Senate on June 4. The bill is now on its way to the president''s deskfor his expected signature. The changes are anticipated to be put into effect relatively quickly after that.

    Here's a rundown of what's changing:

    The loan repayment period will expand from two to five years. PT private practices and small businesses that received the PPP loans and are not eligible for loan forgiveness will have their deadlines for repayment to extended to five years after receiving the loan.

    PPP recipients will get a payroll tax deferral. The CARES Act provides deferment of payments made by employers to the employer’s portion of Social Security taxes; the Paycheck Protection Program Flexibility Act adds PPP recipients to this tax break, thereby providing more cash on hand to keep paying employees.

    The loan forgiveness period will be increased from eight to 24 weeks. The previous deadline of eight weeks to spend the loan and qualify for forgiveness was fast approaching for most recipients of PPP funds. This change allows businesses more time to bounce back while still qualifying for loan forgiveness.

    The percentage of PPP funds that must be devoted to payroll will drop from 75% to 60%. Businesses will be allowed to use 40% of PPP funds for overhead costs including rent and outside loan payments.

    The rehiring deadline will be extended to the end of 2020. In response to concerns that many small businesses need more time to begin rehiring after the pandemic triggered furloughs and layoffs, the bill moves the deadline for using PPP funds to rehire former employees to the end of the year.

    For more information on loan forgiveness and the following changes visit the SBA website.

    Get Proactive: Rethinking Physical Therapy's Role in the Care Continuum

    The 25th annual Maley Lecture from Virtual NEXT makes the case for PTs not to just wait for referrals.

    After taking viewers through her participation in the development of a care strategy that has the potential to become a game-changer in cancer survivor treatment, Nicole Stout, PT, DPT, FAPTA, and a certified lymphedema therapist, winds up her Maley lecture by setting the bar even higher for herself.

    "It's not good enough for me if you leave here today thinking that this was just a lecture about a model of care for individuals with cancer," Stout says. What she's aiming for, she explains, is nothing less than a re-visioning of what physical therapy can do as an agent for societal transformation.

    That potential is laid out in Stout's presentation of the 25th annual H.P. Maley Lecture, normally a highlight of APTA's NEXT Conference and Exposition, and now a marquee event available via the association's Virtual NEXT Conference, which is making more than 20 virtual sessions and special presentations available to members for purchase through July 31.

    Titled "Cancer Rehabilitation: Insights on the Future of our Practice," Stout's address dives into the development of a prospective surveillance model for cancer survivors that integrates rehabilitation from almost the moment of diagnosis. She explains how the model was developed, and its impact on lymphedema, upper quadrant impairment, fatigue, cost, and health care disparities, and she relates the model's journey toward prominence in the cancer rehab community.

    But the lecture isn't just a recounting of the development of a model. Stout says she believes that prospective surveillance is a concept that should be applied much more widely, connecting individuals with therapists acting proactively at the first signs of health conditions and lifestyles that could lead to serious problems in the future. After all, she says, "Nobody wakes up one day as an uncontrolled type 2 diabetic."

    In many ways, the lecture is a call to action — but one built on an extensive evidence base.

    "Why are we waiting for the referrals to come our way?" Stout asks. "'Refer to PT' is not going to transform society."

    Don't miss the Maley Lecture and an extensive range of educational sessions and other events that will inform and inspire: Register for Virtual NEXT before July 31.

    Virtual NEXT Now Open

    APTA is offering more than 20 sessions — including some live events — for an affordable price.

    Are you ready for APTA's NEXT Conference and Exposition? Because it's ready for you —direct to your computer.

    On June 3, APTA launched Virtual NEXT, the online-only version of the popular in-person conference cancelled due to the COVID-19 pandemic. Virtual NEXT sessions — more than 20 courses with related CEUs plus special recorded sessions and live online events—will be available for purchase through July 31. Once purchased, Virtual NEXT access continues until December 31, 2020.

    And you probably won't find another conference this affordable: Thanks to the support of sponsors GEICO, HPSO, and Rusk Rehabilitation, APTA is able to offer the entire experience for a member price of $20. Nonmembers can access Virtual Next for $40.

    Live Events at Virtual Next

    While many sessions have been prerecorded and are ready for viewing at any time, Virtual NEXT is offering live content, too — including events related to telehealth, live Q&A opportunities on payment and post-intensive care syndrome, the Rothstein Roundtable (this year's focus: telehealth), and a virtual town hall with APTA President Sharon Dunn, PT, PhD. Additional live events may be added.

    Here's what you need to know about the live events: You must be a Virtual NEXT registrant 48 hours prior to any live event. Advance registration allows us to create the invitation we'll send to you with instructions on joining the event. And note that live events are limited to 5,000 participants on a first-come, first-served basis, which means that registering for Virtual NEXT doesn't guarantee you'll be able to attend every event.

    Also important to know: CEUs are not provided for the live online events.

    If you can’t make a live online event or find the event has reached capacity, there's an alternative: Recordings of each will be posted to the Virtual NEXT bundle in the APTA Learning Center within two business days and will be available to all registrants.

    APTA 2020 House of Delegates Election Results Announced

    The following members were elected to APTA's Board of Directors and Nominating Committee on Monday, June 1, at the 2020 House of Delegates, conducted virtually.

    Jeanine Gunn, PT, DPT, was elected treasurer.

    William (Bill) McGehee, PT, PhD, was elected speaker of the House of Delegates.

    Dan Mills, PT, MPT, was reelected director, and Skye Donovan, PT, PhD, and Victoria Tilley, PT, were elected director.

    John DeWitt, PT, DPT, ATC, and Leiselle Pilgrim, PT, DPT, MPH, were elected to the Nominating Committee.

    These terms become effective at the close of the House of Delegates on Wednesday.

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    APTA Report on PT, PTA Student Debt Delivers Stark Assessment

    The new report says that education debt limits life choices of PTs and PTAs, and describes potential costs as a "deterrent to promising students." But there may be ways to ease the burdens.

    Education debt among PTs and PTAs is a pervasive problem, and taking on the challenges will require strategies that are just as comprehensive: That's the message of a new APTA report on student debt that asserts there is no single "silver bullet" to undo the damage rising education costs are having on the profession.

    Based largely on an APTA survey of PTs and PTAs, "Impact of Student Debt on the Physical Therapy Profession" reports that more than nine in 10 PT graduates are in debt for an average of nearly $153,000 — an amount that doesn't include mortgage debt. For nearly all of those PTs, most of their debt load is related to their PT education, with an average balance of $116,000 in related debt.

    Other datapoints in the report reveal additional troubling effects of high student debt: For example, the survey found that PTs are putting off or giving up on buying homes or contributing to retirement, limiting their career choices to jobs that pay more but may not be their preferred practice setting, and sacrificing off-hours by taking on additional employment outside the profession. Overall, the impacts are more severe for non-white PTs, PTs with lower household incomes, and those with financial dependents. And the problem isn't limited to PTs: The report finds that nearly half of PTAs' total debt burdens are related to PTA education costs, with an average loan balance of $24,308.

    "The cost of a DPT degree has created a significant barrier to the ability of recent graduates to achieve financial stability," writes APTA President Sharon Dunn, PT, PhD, in a letter introducing the report. "It's a barrier to increasing our profession's diversity, which in turn enhances care to all members of society. It's a barrier to participation in our association, which is essential to strengthening the voice of the profession on behalf of our patients. It's a barrier we must dismantle. Now."

    The report emphasizes that addressing the problem will require work on nearly every front, from more transparency on the cost of PT and PTA education and realistic estimates of the salaries new graduates can expect, to improved financial literacy among students and possible DPT curriculum changes "that could decrease the financial burden on students, keeping in mind that one size does not fit all."

    In addition to those wider recommendations, APTA also has been advocating for more specific and immediate changes on Capitol Hill — namely, inclusion of PTs in the National Health Services Corps Loan Repayment Program, and passage of the Allied Health Workforce Diversity Act, which would expand scholarship opportunities for therapy students from underrepresented backgrounds. APTA also continues to make improvements to its Financial Solutions Center, a suite of online resources that provides financial literacy education and opportunities for refinancing student debt at a discounted rate.

    Win: CMS Says SNFs, Hospitals, HHAs, Rehab Agencies, Other Institutional Settings Can Bill Telehealth Outpatient Therapy Claims

    The clarification from CMS applies to settings that use institutional claims such as UB-04.

    It's settled: Medicare Part B institutional claims for outpatient therapy services furnished through telehealth are permitted for hospitals, skilled nursing facilities, critical-access hospitals, comprehensive outpatient rehab facilities, rehabilitation agencies, and home health agencies. APTA pressed CMS for recognition of institutional settings that provide outpatient therapy for months; CMS' May 27 answer is a clear win for PTs, PTAs, and their patients.

    News of the clarification came by way of an update to CMS' lengthy Frequently Asked Questions resource on fee-for-service billing, a document with a particular focus on so-called 1135 waivers that CMS adopted in response to the COVID-19 public health emergency. Those waivers included allowances for telehealth by PTs, occupational therapists, and speech-language pathologists in certain circumstances, but details of exactly who could do what vis a vis remote care have only emerged over time.

    The specific answer to the institutional setting question appears near the end of the document (page 70 at the time of this article, but citing a specific page number isn't always helpful as CMS updates the FAQs on a regular basis).

    In CMS' own words, "Outpatient therapy services that are furnished via telehealth, and are separately paid and not included as part of a bundled institutional payment, can be reported on institutional claims with the "-95" modifier applied to the service line." The guidance goes on to say that this applies to hospitals for outpatient therapy services (bill type 12X or 13X), SNFs (bill type 22X or 23X), CAHs (bill type 85X), CORFs (bill type 75X), ORFs (rehabilitation agencies) (bill type 74X), and HHAs (bill type 34X).

    When use of the waivers were announced in mid-March, it was unclear to what extent remote services would be permitted for PTs and PTAs. Over the following months, CMS clarified its interpretation of the waivers, first by permitting therapy "e-visits," then clarifying that PTs and PTAs in private practices could engage in real-time video telehealth with patients. In early May, the agency acknowledged a pathway for hospital outpatient department PTs and PTAs to furnish remote services under Medicare. However, the ability of institutional settings to bill outpatient therapy furnished via telehealth was not directly addressed — until this week.

    "Until now, CMS did not specifically address a major area of care that encompasses a large number of PTs and PTAs, so we're grateful that we were able to help spark these clarifications," said Kara Gainer, APTA director of regulatory affairs. "The answer CMS provided is good news for PTs and PTAs in these settings whose primary concern is to be able to safely deliver effective, high-quality services to Medicare beneficiaries."

    The waivers are temporary and will be withdrawn when the public health emergency is officially ended. In the meantime, APTA is advocating to HHS and CMS about the importance of extending the telehealth policy flexibilities after the emergency declaration ends. Supporters can lend their voices to this effort by submitting comments on CMS’ additional policy revisions in response to the COVID-19 public health emergency interim final rule.

    In addition, APTA also continues press Congress for permanent telehealth allowances for PTs and PTAs. That effort includes grassroots opportunities to add your voice to calls for lasting change.

    U.S. Reps Urge House Leadership to Stop Proposed 2021 Payment Cuts

    A letter from 46 U.S. representatives calls the cuts "reckless."

    The push to avoid a proposed 8% cut to therapy payment under Medicare in 2021 has gained significant momentum: Thanks to strong grassroots efforts and advocacy from organizations including APTA, the American Occupational Therapy Association, and the American Speech Language Hearing Association, 46 bipartisan members of the U.S. House of Representatives have signed on to a letter urging House leadership to create a path that would allow CMS to drop the potentially devastating proposed cuts.

    On May 28, Reps. Bobby Rush (D-IL) and Susan Brooks (R-IN) submitted a bipartisan letter to Speaker of the House Nancy Pelosi and Minority Leader Kevin McCarthy decrying the January 1, 2021, proposed cuts to the Medicare Physician Fee Schedule and urging action by the House to prevent them.

    "If these cuts are allowed to go into effect, they will be devastating and will limit access to care for patients, including seniors, who rely on these services," the letter states. "Ultimately, these cuts will force physical and occupational clinics to close, resulting in thousands of qualified professional clinicians, especially those in rural and urban areas in our districts, to lose their jobs." The results, authors write, could lead to large-scale losses in access to care, including "the over 50 million Americans who suffer from acute and chronic pain conditions [that] will be unable to access these important, non-opioid services."

    The letter also points out that the effects of the COVID-19 pandemic "could be felt for years" in the health care system, adding, "Now is not the time to implement these reckless cuts when our health care system is under such tremendous financial strain."

    The proposed cuts are an attempt by CMS to maintain "budget neutrality" while increasing payment for primary care provider evaluation and management codes, referred to as E/M codes. To find the money to pay for the increase without exceeding budget limits, CMS proposed to reduce reimbursement for codes commonly used by more that three dozen health care provider types. Reimbursement cuts to codes associated with physical therapy are estimated to result in an 8% payment drop.

    The letter to House leadership urges enactment of a legislative proposal that would waive budget neutrality requirements so that CMS could move ahead with the E/M increases without putting payment to other professions on the chopping block.

    Since the CMS announcement of the proposed cuts that accompanied the 2020 physician fee schedule, more than 60 health care provider organizations launched advocacy efforts to block or blunt the damage. Those efforts are ongoing at APTA, which offers members and other stakeholders online opportunities to make their voices heard in pushing for elimination of the cuts.

    “We are grateful for the leadership of Representative Rush and Representative Brooks on this important issue,” said Justin Elliott, APTA's vice president of government affairs.“When therapists, clinics, and rehabilitation facilities are struggling, particularly in rural and underserved areas, it's clear that this is no time to implement payment cuts that will negatively hurt patient access to care and exacerbate the instability of health care providers' practices."

    Be sure to check out APTA’s resources on this issue.

    UnitedHealthcare, Aetna Temporarily Drop 2% Cuts in Medicare Advantage Plans

    The insurers are mirroring CARES Act provisions that suspended the sequestration cut in Medicare payments.

    Two of the nation's largest commercial insurers — Aetna and UnitedHealthcare — are following CMS' lead and temporarily suspending this year's 2% sequestration cuts to provider payments in Medicare Advantage plans. For both companies, the suspension applies to payments made between May 1 and December 31.

    The shift comes in the wake of changes brought about through CARES Act COVID-19 relief provisions that temporarily halted a 2% cut in Medicare provider payments. Those annual cuts, mandated through the 2011 Budget Control Act, often have been passed along to providers participating in private insurers' Medicare Advantage plans. Now at least two insurers are following in kind by suspending the reductions for a limited time.

    This isn't the first time commercial payers have mirrored — and even expanded on — CMS coverage and payment changes related to the COVID-19 pandemic. Most major insurers now accept claims for therapy delivered via telehealth, and BlueCross BlueShield Tennessee recently became the first major payer to include telehealth by PTs as a permanent benefit.

    Carmen Elliott, APTA's vice president of payment and practice management, says that continued communications between professional organizations such as APTA and the insurers are helping the payers make informed decisions about coverage during the pandemic and beyond.

    "APTA and other provider associations have continued to share information with insurers to work toward collaborative approaches such as therapy via telehealth, and how the pandemic has impacted individual providers," Elliott said. "We certainly appreciate the ways in which these payers are closely following federal guidelines."

    APTA Advisory: TRICARE Reimbursement for TENS Treatment for LBP Stops on June 1

    The health program used throughout the U.S. Department of Defense announced that it would make the change after questioning the effectiveness of the treatment.

    Are you a provider in the TRICARE system? Don't forget that beginning June 1, the program will no longer pay for transcutaneous electrical nerve stimulation as a treatment for low back pain. The changes are reflected in TRICARE's policy manual.

    This March 6 PT in Motion News story provides more details on TRICARE's stated reasons for the change.

    APTA Report: 44% of PTs, 54% of PTAs Say They Lost Income During Pandemic

    Results of a nationwide APTA survey show how the COVID-19 pandemic is impacting the profession — and sparking changes in care delivery.

    The physical therapy profession has experienced some significant setbacks during the COVID-19 pandemic — many of them on a personal level. But results of a new nationwide survey conducted by APTA also reveal how PTs and PTAs are using their resilience to adapt to a changed professional landscape.

    APTA summarized results of the survey conducted April 24-May 11 in a new report titled "Impact of COVID-19 on the Physical Therapy Profession." The report is also the first resource to be released using APTA’s new logo and brand, which will be officially adopted in June.

    The report, based on a survey results from 6,500 PTs and PTAs across the country, makes it clear that the COVID-19 pandemic has exacted a literal cost on PTs and PTAs, with 44% of PTs and 54% of PTAs reporting decreased income during the health crisis. Furloughs also were disturbingly high, affecting 17% of PTs and 27% of PTAs. Layoffs were less frequent — though no less troubling — with 5% of PTs and 13% of PTAs reporting job loss.

    Although much of the survey was focused on income and employment, respondents also were asked to provide information on the reasons behind clinic closures, use of PPE, telehealth adoption, clinic revenue, and other topics.

    Among the Findings

    Setting made a difference in reduction in work hours and income.
    For PTs, work hour reductions were most common in private outpatient or group practice settings, with 68% of respondents reporting a drop, followed by PTs in home care (65%), and PTs working in hospital-based outpatient facilities or clinics (57%). As for actual income declines, PTAs in home care were hardest hit, with 81% reporting a reduction in income, followed by 66% of PTAs in private outpatient settings. The setting reporting the highest rate of income reduction among PTs was in private outpatient settings, with 65% of respondents reporting a drop.

    PTAs were most affected by furloughs — also depending on setting.
    PTAs reported furloughs in private outpatient or group practice settings at a rate of 37%, with hospital-based outpatient clinics not far behind at 35%. The private practice clinic setting was also the leading setting for PTs who experienced furloughs, at a rate of 23%.

    PTs generally felt they were providing essential treatment.
    Only 16% of PTs felt that their employers had asked them to provide PT services they considered nonessential.

    The use of telehealth rose dramatically.
    According to the report, use of telehealth by PTs was nearly nonexistent prior to the health emergency, with 98% of respondents reporting that they provided no live video consult with patients. The pandemic — and resultant changes to telehealth payment policies and regulations — changed all that. At the time of the survey, 50% of PTs reported using telehealth during the pandemic. The most dramatic change? School system PTs, whose use rose from near 0% levels to a 93% use rate.

    When facilities closed, professional judgment was the most common reason.
    Practice-owner respondents who closed their clinics during the pandemic overwhelmingly cited professional judgment as the primary reason for make the decision, at 76%. The next most-frequently cited reason was patient cancellations and no-shows, at 48%, followed by mandatory state orders, cited by 40% of practice owners as the top reason for the shutdown.

    “This report is a snapshot of a specific moment in time, starting about six weeks after a national emergency was declared,” said APTA CEO Justin Moore, PT, DPT. “We will continue to research this topic, both to measure how this health crisis is affecting our profession and to ensure that our association can respond to pressing needs to support the physical therapy community.” APTA will conduct a follow-up survey sometime in June or July.


    The APTA report also makes recommendations for the profession, and recaps recommendations APTA made to Congress involving legislation related to the pandemic and beyond. The recommendations for the profession include:

    • A "better-leveraged" physical therapy workforce through improved patient access to PTs and PTAs.
    • Elimination of direct access restrictions.
    • Universal PT and PTA access to personal protective equipment.
    • Development of long-term strategies for use of telehealth.

    A New Look

    Readers also may notice something different about the way the report looks. That's because the document is the first to fully reflect APTA's new brand, including use of the association's new logo.

    The report provides a sneak peek into changes that will fully take effect in June, changes that will touch nearly every aspect of APTA's products, communications, and messaging.

    "This health crisis has put a spotlight on APTA's commitment to serving as the trusted leader for the physical therapy profession," Moore said. "Releasing this report under our new logo, ahead of formal adoption of our brand next month, not only helps us maintain consistency as we release more COVID-19 reports in the future but underscores our readiness to live out our brand promise."