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  • Members-Only Webinar Will Focus on Demonstrating Value in New Home Health Payment System

    Physical therapists (PTs) and other providers who furnish services through home health agencies that bill Medicare will face an entirely new payment system beginning in January, 2020—one in which demonstrating the value of a particular intervention will be key. A new multidisciplinary webinar that includes experts from the US Centers for Medicare and Medicaid Services (CMS) can help you prepare for the shift.

    APTA has joined with the American Occupational Therapy Association, the American Speech-Language-Hearing Association and CMS to offer a free members-only live webinar on how therapy providers can best navigate the new Medicare Patient-Driven Groupings Model planned to go into effect January 1, 2020. The collaborative presentation is set for August 5 at 2:00 pm ET. Advanced registration is required.

    A recording of the webinar will be made available at later date. For more information on the presentation, contact advocacy@apta.org.

    [Editor's note: want to get up to speed before the webinar? This  PT in Motion News story summarizes the biggest elements in the CMS proposed home health rule, and an APTA webpage devoted to the PDGM includes recordings of presentations held earlier in the year.]

    APTA Working for You: Commercial Payer Updates, July 2019

    The commercial payer world is varied and continually evolving. APTA helps its members by staying on top of changes and bringing the physical therapy profession's voice to the table on a wide range of private payer-related issues. Here's a quick rundown of some of the latest news and APTA activities.

    The results of an APTA survey on administrative burden are in
    APTA highlights the results of a 2018/2019 survey on administrative burden in a new infographic. The survey revealed significant concerns from PTs and PTAs, particularly around the impact excessive requirements are having on clinical outcomes. A summary report on the findings is also in the works.

    The survey and infographic will be the subject of a presentation on administrative burden at the 2019 APTA Insurers' Forum. APTA encourages members to review the infographic and summary (when it's released) and use the resources in discussions with payers and other stakeholders.

    OSHA responds to APTA by affirming the PT's role in first aid
    In response to a meeting with APTA and our subsequent request for clarification, the US Department of Labor Occupational Safety and Health Administration (OSHA) issued a statement affirming that in workplace injury incidents, soft tissue massage is considered first aid for recordkeeping purposes, regardless of whether the health professional providing the treatment holds a certification in Active Release Techniques (ART). Details on the clarification, which is good news for physical therapists, can be found in this PT in Motion News story.  

    Use of third-party administrators is growing—and staying on top of the changes will require communication
    APTA continues to track the increased use of third-party administrators to manage the physical therapy benefit as national payers implement systems regionally with the intent to include all states and lines of business over time.

    APTA and its chapters collaborate and coordinate efforts to mitigate adverse patient impacts and provider administrative burden related to utilization management (UM) vendors. At the same time, the association seeks to develop a working relationship with payers and UM vendors to advocate for members when issues arise. Those efforts are strengthened through members' ongoing communication with APTA. Download this step-by-step guide for tips on when and how to report new or significantly changed UM programs.

    APTA's work with eviCore is increasing provider access to information
    Utilization management firm eviCore has made it easier for providers to find provider engagement staff assigned to their geographic area. The list, available as a pdf document on the eviCore website, is among the resources available on the company's "training resources" webpage.

    Front-end claim edits are on the rise
    Front-end edits—when a payer automatically denies a claim with a certain profile, forcing the provider to appeal the denial and provide documentation supporting the appeal—are being implemented by several payers and third-party administrators. For PTs, the most frequent trigger for a front-end edit is the use of the 59 modifier.

    APTA has taken several steps to address this issue, including asking the US Centers for Medicare and Medicaid Services (CMS) to remove edits associated with codes commonly used by PTs, engaging commercial payers in discussions about challenges associated with these edits, and providing resources to providers, including this infographic on use of the 59 modifier. APTA urges providers to consult with the association about appropriate use of the 59 modifier, and to follow through with the appeals process if documentation supports its use. Appeals can make a difference—Aetna has already indicated that if the turnover rate on appeals is high for a particular type of claim, the front-end edit will be removed.

    An APTA-sponsored session at a self-insurers' conference focused on the PT's role in population health
    APTA member Michael Eisenhart, PT, presented an APTA-sponsored session titled “Population Health: How Physical Therapists Can Help Your Employees” at the 2019 National Council of Self Insurers annual conference in June. Eisenhart's presentation showcased the role of physical therapy in the workplace and emphasized its potential for employers who self-insure their workers' compensation programs.

    Workers' Compensation programs are evolving in positive ways
    APTA has observed a greater recognition among workers' compensation (WC) programs that physical medicine not only helps address musculoskeletal issues, it also promotes patient participation in recovery and self-management and reduces the risk of reinjury. While overall injury rates and frequency have been declining, the percent of claims with physical medicine involvement have increased by 13%.

    Ohio is an example of the how this shift is playing out. In 2018, the Ohio Bureau of Workers’ Compensation mandated 60 days of conservative care before the authorization of lumbar fusion surgery. Accordingly, a national WC third-party administrator reported a rise in nonsurgical physical therapy referrals, with an attendant drop in surgical referrals—from 11% in 2017 to 5% in 2018.

    New York is also embracing the value of physical therapy in WC. The New York Workers’ Compensation Bureau (NYWCB) adopted a revised fee schedule in October 2018 that became effective on April 1, 2019. NYWCB increased the relative value units (RVUs) to 18 for evaluations and 15 for reevaluations. The bureau also raised RVUs from 8 to 12 for follow-ups. The net result of this change, plus the fee schedule increase, will result in payment increases. APTA's New York Chapter provides a detailed accounting of the changes.

    APTA, AOTA, and ASHA create a guide to assessing habilitation and rehabilitation benefits
    APTA, together with the American Occupational Therapy Association (AOTA) and American Speech-Language-Hearing Association (ASHA), collaborated to create a guide to assessing habilitation and rehabilitation benefit adequacy that emphasizes transparency, access, and affordability. Available on APTA's Essential Health Benefits webpage, the guide forgoes offering a laundry list of specific benefits in favor of establishing a set of principles that the associations believe lead to appropriate coverage of habilitative and rehabilitative services.

    Anthem's transition to a new UM vendor in 13 states is still on, but delayed
    Anthem Blue Cross-BlueShield is moving ahead with its use of utilization management (UM) vendor AIM Specialty Health in 13 states, but technical issues have delayed implementation.

    Providers who bill Anthem in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, and Wisconsin can still expect to be required to use the new vendor in the near future—Anthem says it will update providers toward the end of July on when actual implementation will occur

    In the meantime, APTA urges providers in the impacted states to participate in vendor-sponsored training available through the AIM Rehabilitation Provider Portal. If you experience difficulty enrolling in training or other problems, inform your APTA chapter.

    APTA offers a range of resources for learning more about commercial payment and staying connected: sign up for the Coding, Billing, and Payment online community to join the conversation and share experiences; stay informed by visiting APTA's commercial insurance webpage to access information and download tools including customizable appeals letters; and subscribe to the Payment edition of APTA's Friday Focus newsletter series to receive a monthly compilation of payment-related news and resources. Have questions or want to make your voice heard in local, state, and national advocacy? Email advocacy@apta.org.

    APTA, Alliance for Physical Therapy Quality and Innovation Report Explores Relationship of 'Baseline' Patient Factors and Patient-Reported Outcomes

    Many patients who see a physical therapist (PT) bring more than just a movement system issue to the clinic: they bring a host of "baseline" factors that can impact patient-reported outcomes (PROs). That reality raises a big question: given a patient's individual mix of comorbidities, socioeconomic status, payer type, and other elements at the onset of treatment, how can PTs, payers, and patients know what constitutes a "typical" amount of improvement—and can currently available data provide any insight?

    APTA and the Alliance for Physical Therapy Quality and Innovation (Alliance) are aiming to get a handle on those questions and already have taken a significant step forward in the release of a report that explores benchmarks of quality care. In a joint news release, the 2 organizations describe the document as "the largest multipractice analysis of open-source, risk-adjusted clinical outcomes in the outpatient physical therapy industry."

    To tackle this project, APTA and the Alliance contracted with the Center for Effectiveness Research in Orthopaedics to take a close look at baseline and PRO data from 375,000 patient episodes in 50 states, all related to outpatient orthopedic physical therapy involving spine, shoulder, and knee care. The data were supplied by WebPT, Intermountain, ATI, and PTNorthwest. Those 4 companies, along with APTA, the Alliance, Select Medical, BMS Practice Solutions, ATI Physical Therapy, and US Physical Therapy compose the Physical Therapy Industry Outcome Workgroup responsible for developing the final report

    Among the workgroup's findings:

    Baseline patient data currently available through typical electronic medical records (EMRs) can explain a lot.
    "Payer type, patient socio demographic factors, and comorbidities at baseline all had strong effects on PRO changes over episodes of care," the report states. "Differences in these baseline patient factors must be accounted for to ensure fair performance comparisons of physical therapists."

    Despite baseline patient factors, physical therapists are making an overall difference in patients' lives.
    Researchers found that clinically important improvements in PROs were achieved in all 3 body regions over 12-14 visits.

    When it comes to risk adjustment, the data are there...
    The project also explored just how much patient baseline data are needed to establish risk-adjustment algorithms, labeled "minimal," "practical," and "optimal." In the end, researchers found that the "practical" dataset—commonly available EMR data that include payer source, weight, BMI, sex, patient zip code, and the presence of comorbidities and history of smoking—were sufficient to provide insight on variation in PROs.

    …The data can be put to use right now…
    The report includes risk-adjusted regression models for neck, shoulder, and spine patients that estimate levels of PRO change for every baseline variable in all 3 dataset models: "minimal," "practical," and "optimal."

    …And more is always better.
    "The completeness of data necessary for risk adjustment was a limitation of this project with only 8.8% of the patient episodes received [having] appropriate baseline and discharge PROs and only 6.3% [having] measures of the appropriate set of risk-adjustment factors," the report states. "Physical therapy organizations must be committed to institutional strategies that promote the collection of PROs at baseline and baseline patient factors into existing EMRs."

    Heather Smith, PT, MPH, APTA's director of quality, believes the report sheds light on 2 important issues: the value of physical therapy no matter the patient baseline characteristics, and the crucial need for consistent and thorough data that can help drive that point home.

    "The findings in this report add more depth to what we already know—that physical therapy improves patients' lives in ways patients can see and feel, even when other factors affect outcomes," Smith said. "But just as important, it points to the absolute necessity of widespread, standardized data collection and outcomes reporting throughout the profession. The more data we compile, the more we can help our patients and make the case for the effectiveness of our interventions."

    [Editor's note: APTA's Physical Therapy Outcomes Registry is a key player in the collection of data to improve patient care and strengthen the profession, and actively collects PROs as well as risk variables. Find out how you can participate in the Registry.]

    The Good Stuff: Members and the Profession in the Media, July 2019

    "The Good Stuff" is an occasional series that highlights recent media coverage of physical therapy and APTA members, with an emphasis on good news and stories of how individual PTs and PTAs are transforming health care and society every day. Enjoy!

    "Life is always going to find a way": Dakota Kay, PT, DPT, who grew up in the Navajo Nation in Kayenta, Arizona, endured hunger and homelessness in pursuit of his undergraduate degree and DPT. (Inside Edition)

    Back to basics: Theresa Marko, PT, DPT, MS, explains the importance of exercise that strengthens the lower back. (livestrong.com)

    Staying strong and giving back: Nelson Almeida, PT, DPT, describes how he doesn't allowing speaking with a stutter to stand in the way of being a great PT, and how he's helping other individuals with stutters become confident in their abilities. (WLRN News, Miami)

    The hip new thing: Karena Wu, PT, DPT, shares her perspectives on how to choose the best pillow for hip pain. (bustle.com)

    Mythbuster: Chris Wilson, PT, debunks 6 common myths about back pain and how to treat it. (Wasilla, Alaska, Frontiersman)

    Gaining in the poles: Jon Schultz. PT, MPT, has launched a Nordic urban poling program at his clinic. (WFLA News 8, Tampa, Florida)

    A song of ice and…heat: Robert Gillanders, PT, DPT, evaluates the pros and cons of ice baths and hot therapy for recovery. (Yahoo! Lifestyle)

    Hanging leg tuck and overhead throw, anyone? Amy Schultz, PT, DPT, explains why the hardest exercises in the US Army's new fitness test may be good for cyclists. (Bicycling)

    PT Ninja Warrior: Conor Galvin, SPT, has been wowing viewers across the country with his skills on "American Ninja Warrior." (Riverhead, New York, Times-Review)

    Water you waiting for? Patrice Hazan, PT, DPT, MA, provides tips on exercises that can be performed while in the pool with family and friends. ("Your Carolina," WSPA TV, Spartanburg, South Carolina)

    Rising falls numbers, and what to do about them: Mindy Renfro, PT, DPT, PhD, and Leslie Allison, PT, PhD, editor of the Journal of Geriatric Physical Therapy, discuss recent research into rising rates of falls-related deaths among Americans who are older, and how falls prevention programs can help made a positive change. (Kaiser Health News)

    Physical therapy's role in addressing developmental delays: Beth Ennis, PT, EdD, explores the role pediatric physical therapy can play in helping children develop. (MD-Update)

    Finding that tweet spot for phone-viewing: Eric Robertson, PT, DPT, has some suggestions for avoiding neck pain from overuse of handheld devices. (Popular Science)

    Exercise after giving birth: Susan Clinton, PT, DScPT, and Marianne Ryan, PT, BS, offer advice for women who are ready to begin (or restart) exercise postpartum. (New York Times)

    Quotable: "With physical therapy, you can see patients make so many strides, and miracles happen," she said. "I've been in PT, and I've witnessed these miracles, and I believe that physical therapy is a field through which I can make a difference in the world. I believe I can help people realize, during their worst times, the strengths they may not know they have and watch as they make amazing progress." Heather Callahan-Williams, University of North Georgia student, on her plans to pursue a degree in physical therapy. (University of North Georgia News)

    Got some good stuff? Let us know. Send a link to troyelliott@apta.org.

    2019 ELI Fellows Graduate From What's Now a National Award-Winning Program

    The 18 seasoned physical therapy educators who have honed their knowledge and skills over the past year through the APTA Education Leadership Institute (ELI) Fellowship program know they've been a part of something special. Apparently, the American Society of Association Executives (ASAE) agrees—it named the program as a recipient of a national award for leadership and innovation.

    The graduates of the program in July were the eighth cohort of fellows from ELI, a program that provides developing and aspiring program directors in physical therapist and physical therapist assistant education programs with the skills and resources they need to be innovative, influential, and visionary leaders.

    The final in-person gathering was held at APTA headquarters in Alexandria, Virginia, and capped off a yearlong program that included:

    • 9 online modules provided by content expert faculty;
    • 3 2-day face-to-face mentorship sessions and ongoing mentorship provided by experienced physical therapy program directors;
    • mentorship provided by higher education leaders; and
    • implementation of a personal leadership plan and an institution-based leadership project.

    This year, program faculty and participants learned that the program has earned an ASAE "Power of A" Silver Award for its leadership in "advancing society and improving the economy." The Power of A awards, according to ASAE, bestow "the highest recognition an association can receive for any program they conduct with their members."

    Partners who help promote and support the ELI Fellowship include the American Physical Therapy Association, American Council of Academic Physical Therapy, Academy of Physical Therapy Education, and PTA Educators Special Interest Group. Find out more about the ELI Fellowship on APTA's website, and view video testimonials of previous ELI graduates. Questions about the program? Contact eli@apta.org.

    The program was first accredited in 2012 by the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE), the accrediting body for postprofessional residency and fellowship programs in physical therapy, and it was reaccredited in 2017 for a 10-year period.

    2019 ELI Graduates
    This year's ELI fellows were the 8th cohort in the award-winning program.

     

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    APTA Programs Earn National Recognition

    APTA has once again received national honors from the American Society of Association Executives (ASAE)—this year, for APTA resources on financial literacy and student debt management, as well as for a collaborative program that helps aspiring physical therapist (PT) and physical therapist assistant (PTA) education program directors hone their leadership skills.

    ASAE announced that APTA was the recipient of 2 "Power of A" awards: a Gold Award for the association's Financial Solutions Center, and a Silver Award for its Education Leadership Institute (ELI) fellowship program. ASAE's Power of A (the A stands for "association") Awards are the industry's highest honor, recognizing the association community's valuable contributions on local, national, and global levels.

    Launched in 2017, the APTA Financial Solutions Center is a free online financial resource that includes a customizable financial education platform featuring learning on topics such as student loan debt, repayment options, loan consolidation, budgeting, and mortgages. The center also features a student loan refinancing provider that offers eligible members a discounted interest rate. In addition, the center links to certified financial planner information, scholarships, awards, grants, and the APTA Career Center, among other resources. APTA has identified student debt burden and career earning potential as challenges to the long-term sustainability of the physical therapy profession, a key element in the association's strategic plan.

    APTA's ELI program is a yearlong educational experience that includes online learning, direct mentorship, and 3 in-person meetings focused on helping PT and PTA program directors connect with resources and develop the skills they need to be innovative, influential and visionary leaders. Partners who help APTA promote and support the ELI Fellowship include the American Council of Academic Physical Therapy, Academy of Physical Therapy Education, and PTA Educators Special Interest Group.

    "We're proud to be recognized by ASAE this year, but it's even more gratifying to know that members see the value in these programs," said APTA CEO Justin Moore, PT, DPT. "Just like the awards we've received in previous years, this year's honors are a testimony to our members' level of engagement with their association, and their investment in building a professional community."

    The most recent ASAE awards marks the third consecutive year APTA has been recognized by the association industry group. In 2018, APTA, the American Occupational Therapy Association, and the American Speech-Language-Hearing Association received a joint Power of A Gold Award for their collaborative effort to end the hard payment cap on therapy services under Medicare, and APTA's membership renewal efforts earned the association a Gold Circle award for an outstanding member retention campaign. In 2017, ASAE recognized APTA's public service announcement video for its #ChoosePT campaign as the winner for best video of the year, as well as the entire #ChoosePT campaign as one of the nation's top public awareness campaigns.

    APTA Centennial Website Makes Its Debut

    Since its beginnings, APTA has shown what can be accomplished when members are connected and engaged—it's a sense of community at the heart of the association's greatest achievements, and now it's a key element in plans to celebrate APTA's 100th anniversary in 2021. That's where a new APTA centennial website—and you—come in.

    This week, APTA launched what will become the definitive online resource highlighting the association's first century, complete with multiple opportunities for members to contribute to the effort.

    The easy-to-navigate site will evolve over time, serving as a destination not only for gaining a better understanding of the association's history but for sharing artifacts, stories, and memories, learning about opportunities for centennial-related public service initiatives, and keeping up with the latest on just how APTA plans to mark its birthday in 2021.

    In fact, right now APTA is asking members to contribute ideas, photos, and thoughts via a submission form at the bottom of the webpage. Of particular interest: members' opinions on the most important milestones in the physical therapy profession.

    Check out the new site and find out how you can get involved, then be sure to revisit in the coming months for more opportunities and announcements.

    Summer Reading: 8 Great APTA Blog Posts You Might've Missed

    Graduations, vacations, family reunions, binge-watching season 3 of "Stranger Things"…it's entirely understandable if you've been a little distracted over the past few months.

    Not to worry—PT in Motion News can help, when it comes to catching up on some engaging reads. While you were out dominating the Slip 'n Slide, contributors to both the #PTTransforms and APTA Pulse Blog were exploring a range of issues, from the personal to the societal.

    Wondering what you missed? Here are quotes from 8 notable posts, with links to the articles.

    "It's the path we take when we embrace the idea that every day deserves our heartfelt best effort—not just to live that day to the fullest but to shape the future more than it shapes us. Because we want to pay it forward. Because we demand that we leave something better than we had for ourselves." -2019 Presidential Address  

    "Many black professionals have been conditioned to mask parts of their natural selves in order to avoid exclusion from professional and academic opportunities, whether in school or in a career setting." -Pressure: A Commentary on the Black Physical Therapy Student Experience  

    "When [patients] leave the hospital, they're weaker and more likely to have a fall at home. This is an unintended consequence of falls regulation and misaligned incentives." -'Bedrest is Bad': New #everyBODYmoves Campaign Is Combatting Hospital Immobility  

    "Sometimes we need to take a step back and look at things from above the ground and see that one therapist over here seems to be getting patients a little bit better, a little bit quicker… The data that the Registry will collect will help us better direct patient care, as well as identify continuing education needs." -Notes From the Field: MIPS, Quality Improvement, and the Physical Therapy Outcomes Registry  

    "After having my first academic year and clinical rotation under my belt, I sought to shift gears and get back into what made me the most happy: involvement. I decided to extend myself beyond the classroom by applying for a leadership position in my state's student special interest group." -Why Doing More Than Studying Made Me a Better Student  

    "When conducting focus groups in medically underserved communities in Chicago about residents' knowledge and use of physical therapy, my colleague and I heard several things. Two statements in particular stuck with me: 'Physical therapy is for the rich and famous,' and, 'Why don't you put a physical therapy clinic in our community?'" -Our Profession Should Be Community-Minded—and Community-Invested  

    "A few days later my grade was posted. I nonchalantly logged into the grading portal to find a 65%. Was I seriously that bad at this whole physical therapist thing? Am I just walking through life overly confident in my abilities?" -I Don't Care About My Grades  

    "Witnessing the patient's request and partaking in his end-of-life directive really forced me to contemplate and consider our physical therapist scope of practice and our role in complex situations." -Reflecting and Coping With End-of-Life Care: A Student Perspective

    Proposed Home Health Rule Moves Ahead With New Payment System, Allows Therapist Assistants to Furnish Maintenance Therapy

    The US Centers for Medicare and Medicaid Services (CMS) intends to go full steam ahead with its plans to shift to a new payment system for home health beginning in 2020. The plans are accompanied by other changes that include allowing maintenance therapy to be furnished by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs), providing a payment "add on" for rural home health care, and adopting an APTA-supported "notice of admission" requirement to avoid duplicate billing. The new provisions, which include a 1.3% payment increase, are included in CMS’ proposed rule released on July 11.

    The biggest shift has been more than a year in the making: a transition to a new payment system known as the Patient-Driven Groupings Model (PDGM). The PDGM moves care from 60-day to 30-day episodes and eliminates therapy service-use thresholds from case-mix parameters. Instead, the system classifies 30-day care episodes according to a set of 5 major buckets and subsets within those buckets. Patients are assigned a status within the 5 major areas, and within some of those areas they can be assigned to more detailed clinical categories—the combination of categories assigned to a patient generates a particular case-mix grouping. APTA offers extensive information on the new system and will participate in a live August 5 webinar on the model jointly hosted by APTA, CMS, the American Occupational Therapy Association, and the American Speech-Language-Hearing Association. APTA members can participate in this webinar (free to APTA members, login required APTA members can participate in this webinar).

    But that's not all in the proposed rule (.pdf). CMS also plans to allow PTAs and OTAs to perform maintenance therapy services under a maintenance program established by a qualified therapist, as long as the services fall within scopes of practice in state licensure laws. In addition to supervising the services provided by the therapist assistant, the qualified therapist still would be responsible for the initial assessment; plan of care; maintenance program development and modifications; and reassessment every 30 days. CMS believes the change would bring home health in line with other care settings and give home health agencies (HHAs) more latitude in how they allocate resources.

    The rule also would phase out the split payment approach that requires HHAs to submit a Request for Anticipated Payment (RAP) at the beginning of the initial episode for 60% of the anticipated final claim payment amount. A final bill for the remaining 40% is submitted at the end of the 60-day episode. RAP submissions are operationally significant, as they establish the beneficiary’s primary HHA by alerting the claims processing system that the beneficiary is under a home health plan of care and home health services are subject to consolidated billing, meaning Medicare makes payment for all home health items and services to the single HHA overseeing the plan of care.

    Instead, CMS proposes requiring HHAs to submit a notice of admission to alert the claims processing arm of CMS that a beneficiary is under a home health episode of care. The new system is a direct result of APTA advocacy, which was fueled by members in private practice settings who shared data with the association to help APTA make its case. The change will be phased in next year and fully implemented in 2021.

    APTA and its members successfully argued that the split percentage approach is fraught with logistical inefficiencies that often result in confusion for CMS and therapy providers in outpatient settings. The proposal to replace the RAP with the notice of admission, to be submitted within 5 days of the start of care, would be needed to establish the primary HHA so the claims processing system would be alerted to a home health period of care, helping to eliminate the possibility of any lag time between a beneficiary's admission in home health and the HHA's notice of the admission to CMS. This too-common delay trips up outpatient providers who begin treatment (and billing) before CMS knows that the beneficiary has transitioned to home health. CMS describes the change as "an important step in paying responsibly and appropriately for home health services," according to an agency fact sheet on the proposed rule.

    As for payment, home health would see an overall 1.3% boost—about $250 million. The increase, initially targeted at 1.5% to comply with the Bipartisan Budget Act of 2018, was decreased by .2% to accommodate a rural add-on policy.

    Among other elements of the proposed rule:

    SPADE requirements are expanding. CMS is continuing its efforts to increase the range of standardized patient assessment data (SPADE) reported by HHAs. The use of SPADE in home health was instituted to bring HHAs up to speed with provisions of the 2014 IMPACT Act, a law that mandated more uniformity in reporting across postacute care settings. The proposed rule would follow through with the expansions, but it also includes requirements for reporting on cognitive function and mental status, comorbidities, and social determinants of health, among other categories. HHAs would be required to report these additional elements beginning in 2022 for admissions and discharges that occur between January 1 and June 30, 2021.

    A pain measure would be discontinued. Partially in response to concerns about the potential for overprescription of opioids, CMS is proposing to remove the Improvement in Pain Interfering with Activity Measure (NQF #0177) from the Home Health Quality Reporting Program (HH QRP) beginning in 2022. Under this proposal, HHAs would no longer be required to submit OASIS Item M1242, "Frequency of Pain Interfering with Patient’s Activity or Movement" for quality reporting purposes beginning in 2021.

    A pain-related question would be deleted from patient surveys. CMS proposes to remove a patient survey question that asks whether the patient and provider talked about pain in the past 2 months. The question, currently in the "Special Care Issues" composite measure, would be dropped beginning July 1, 2020. Similar to the pain measure being proposed for deletion, the survey question is being eliminated due to concerns about the ways it might influence unnecessary drug prescriptions. The changes are consistent with an earlier CMS decision to eliminate pain-related items from hospital patient surveys.

    APTA continues to review the proposed rule and will provide comments to CMS by the September 9 deadline. In the coming weeks, APTA also will post a unique template letter on its Regulatory Take Action webpage for individuals to use to submit their own comments on the proposed rule.

    APTA-Backed Bill to Provide Diversity-Based Scholarships, Stipends Introduced in House

    APTA's efforts to create a physical therapy profession as diverse as the society it serves could be getting a significant legislative boost: a new bill introduced in the US House of Representatives seeks to provide $5 million per year in scholarships and stipends aimed at increasing the number of students from underrepresented populations in physical therapy and other allied health education programs.

    Introduced by Reps Bobby Rush (IL) and Cathy McMorris Rogers (WA), the Allied Health Workforce Diversity Act of 2019 would set aside money in the Health Resources and Services Administration specifically for use by accredited education programs in physical therapy, occupational therapy, audiology, and speech-language pathology. Those programs would in turn issue scholarships or stipends to students from underrepresented populations including racial or ethnic minorities and students from disadvantaged backgrounds including economic status and disability. APTA, the American Occupational Therapy Association (AOTA), the American Speech-Language-Hearing Association (ASHA), and the American Academy of Audiology (AAA) were instrumental in crafting language for the bill.

    The legislation falls squarely in line with APTA's strategic plan, which identifies greater provider diversity as necessary to ensure the long-term sustainability of the physical therapy profession.

    "We must build a diverse profession by ensuring there are opportunities that allow for inclusion of all individuals who want to become physical therapists and physical therapist assistants," said APTA President Sharon Dunn, PT, PhD, in a joint news release issued by APTA, AOTA, ASHA, and AAA. "The population we serve is evolving and becoming more diverse. We know that patients who receive care from providers who share their racial and ethnic backgrounds tend to respond better to treatment. That's one reason this legislation is so important, and we applaud the representatives who have introduced it."

    APTA government affairs staff will track the bill's progress and share opportunities for grassroots advocacy. The association will add information to its Legislative Action Center later this week for members to use to support the legislation.