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  • Outpatient Payment, Home Health Fact Sheets Now Available From APTA

    Now available to APTA members: context and details to help you understand final 2017 rules from the Centers for Medicare and Medicaid Services (CMS) on the home health (HH PPS) and outpatient (OPPS) prospective payment systems.

    The final OPPS rule, which grabbed headlines earlier this year for its elimination of pain management questions from patient satisfaction surveys, also includes payment increases and changes to the ways hospital-owned off-campus outpatient departments are paid. The APTA fact sheet covers these provisions, as well as comprehensive ambulatory payment classifications, and CMS’ plans for future quality reporting. To access the fact sheet, visit the APTA Medicare Payment and Policies for Hospital Settings webpage. Scroll to the "Outpatient Care" area and look under the "APTA Fact Sheets and Summaries" header.

    The 2017 HH PPS rule continues planned cuts next year, and includes changes to the home health quality reporting program and the way payments are made for negative pressure wound therapy, among other topics. The APTA fact sheet can be accessed on the association's Medicare Payment and Policies for Home Health webpage, under the "APTA Fact Sheets and Summaries" header.

    APTA’s November 9 Insider Intel call-in program included an outline of HH PPS and OPPS provisions. To listen to a recording of the program, visit the Insider Intel webpage and click on the November 9 link under “Archives.” Want even more information on CMS-related changes in store for 2017? Don't miss the December 8 webinar, "Medicare Payment and Compliance: What You Need to Know for the Year Ahead." The program is available at no cost to APTA members.

    Quick Guide and Call-In Q&A Are Latest New Resources to Prepare for Payment in 2017

    A new guide to using the 3 new tiered evaluation codes that come into play January 1, 2017, gives APTA members a quick graphical explanation of the criteria for determining when an evaluation is considered “low,” “moderate,” or “high” complexity. Developed by APTA, the guide is available as a 2-page printable PDF download and, as a bonus, is being included as a printed pocket-sized guide in members’ December 2016-January 2017 issues of PT in Motion magazine.

    The quick guide joins other APTA resources that can help members become familiar with the codes, which were included in the final 2017 Medicare physician fee schedule.

    Among those other resources: the latest recording of APTA’s Insider Intel, APTA’s series of call-in sessions that allow members to pose questions to staff experts on current topics. The November 9 call-in led off with the new evaluation codes, of course, but other need-to-know topics included the review of potentially misvalued CPT codes; provisions to implement the Medicare Access and CHIP Reauthorization Act of 2015 as well as the Improving Medicare Post-Acute Care Transformation Act of 2014—known as MACRA and IMPACT, respectively; and final rules for the home health and outpatient prospective payment systems. A full recording of the November 9 call is available here.

    To see what else APTA offers, visit the association’s New Evaluation and Reevaluation CPT Codes webpage, where new tools are being added regularly in the countdown to January 1.

    Get the Facts on the 2017 Fee Schedule

    Now available to APTA members: context and details to help you understand the final 2017 physician fee schedule rule from the Centers for Medicare and Medicaid Services (CMS).

    The rule covers Medicare Part B services that apply to physical therapists (PTs) and other providers. This year, in addition to the more typical changes, such as adjustments in the conversion factor and updates to the therapy cap amount, the final rule includes a big shift: the new 3-tiered current procedural terminology (CPT) code system for physical therapy evaluations.

    The APTA Fact Sheet now available covers those provisions, as well as the latest on potentially misvalued codes, telehealth services, revisions to self-referral laws, and more. Visit the APTA Medicare Physician Fee Schedule webpage to access the fact sheet (look under the "APTA Summaries and Fact Sheets" header).

    Want more information on the fee schedule and other CMS-related changes in store for 2017? Don't miss the December 8 webinar, "Medicare Payment and Compliance: What You Need to Know for the Year Ahead." The program is available at no cost to APTA members.

    Final Fee Schedule Maintains Tiered CPT Coding System, No Tiers in Payment – With a Few Twists

    As expected, the final 2017 physician fee schedule rule from the Centers for Medicare and Medicaid Services (CMS) doesn't vary much from what was proposed earlier this year—including the new 3-tiered current procedural terminology (CPT) code system for physical therapy evaluations, all with the same payment rate. However, some new developments add a few positive elements to the picture.

    The rule covers Medicare Part B services that apply to physical therapists (PTs), physicians, and other providers. APTA regulatory affairs staff is reviewing the final rule and will develop a more detailed summary in the coming weeks. In the meantime, here are some features of the new rule that affect PTs:

    CMS held to the tiered evaluation codes – and the same reimbursement for each.
    CMS adopted much of the system created by the American Medical Association (AMA) CPT Editorial Panel to retool current procedural terminology (CPT) codes for physical therapy evaluation and reevaluation. The new evaluation code descriptors stratify evaluations by complexity—low (97161), moderate (97162), and high (97163)—but CMS will keep the longstanding relative value unit (RVU) of 1.20 for all 3 levels of evaluation. That decision, opposed by APTA, is a departure from recommendations from the AMA Relative Value Scale Update Committee. These codes replace the existing 97001 and 97002 codes, which will expire on January 1, 2017, when the new codes are implemented.

    CMS reconsidered and will increase payment for reevaluation.
    The rule also includes 1 new reevaluation code (97164). In the proposed rule, this code carried a reevaluation rate of .60, same as for the old reevaluation code. In the final rule, that rate was increased to 0.75.

    Claim reviewers won't be able to use the new codes to "ding" manual medical reviews.
    In an acknowledgment of APTA's concerns for adequate time to educate PTs on the use of the new coding system, CMS decided that no changes will be made to the Medicare benefits policy manual for 2017—that means reviewers won't be able to penalize providers regarding the medical necessity for the new evaluation requirements. This “grace period” won't last, however, which puts pressure on the profession to use the reprieve to work toward consistent, accurate coding.

    The therapy cap gets a $20 increase.
    The Medicare therapy cap will be $1980, up from the 2016 cap of $1960 (the therapy cap exceptions process extends through December 31, 2017, under MACRA).

    The misvalued codes—all 10 of them—will be in play in 2018.
    In the 2016 physician fee schedule, CMS identified multiple potentially misvalued codes, including some commonly used in physical therapy, for review and potential revaluation. CMS has confirmed that all 10 physical therapy-related CPT codes that it identified as potentially misvalued will be revalued in the 2018 fee schedule. A random sample of APTA members recently received a survey on these and other codes, and APTA is urging them to complete the questionnaire to help ensure accurate valuation.

    The conversion factor is up—a little.
    The 2017 Medicare conversion factor is $35.88, slightly higher than last year's conversion factor of $35.83.

    Get all the details on the new fee schedule: join APTA's "Insider Intel" call-in session coming November 9 from 1:00 to 1:30 pm. Space is limited to 100 on a first-come, first served basis.

    If you received the AMA survey on code values recently, it’s critical that you respond by the deadline. Survey input is an important source of data that CMS will use to consider new values for the “misvalued” codes.

    Final Home Health Rule Includes $130 Million Reduction, Changes to Outlier Payment Method

    In its final rule for the 2017 home health prospective payment system (HHPPS), the Centers for Medicare and Medicaid Services (CMS) lightens up ever-so-slightly on planned cuts, but mostly sticks with provisions included in the rule proposed in June. This includes changes to the home health quality reporting program and the way payments are made for negative pressure wound therapy (NPWT). The final rule was released October 31.

    APTA regulatory affairs staff are reviewing the details of the rule and will publish a fact sheet on the HHPPS in the coming weeks. In the meantime, here are a few highlights.

    The final phase of "rebasing adjustments" will result in a $130 million reduction.
    The coming year will mark the final phase of a 4-year adjustment plan mandated by the Affordable Care Act. Originally, CMS proposed a $180 million reduction for 2017, but it lowered that amount to $130 million, or a 0.7% cut, in the final rule. The overall number represents a combination of increases and decreases, with a 2.5% payment rate increase more than offset by an $81 reduction in 60-day episode payment. Other changes include increases in the national per-visit payment amounts (ranging from $1.70 for home health aide services to $6.34 for medical social services), and a 2.82% reduction in the nonroutine medical supply (NRS) conversion factor.

    NPWT payments will be more in line with the Outpatient Prospective Payment System (OPPS).
    Beginning in 2017, CMS will no longer allow time spent furnishing disposable-device NPWT to be a part of the home health visit claim under the HHPPS. Instead, that element of care would be paid for separately and would reflect rates in the Medicare OPPS.

    Payments for nontypical care ("outlier payment") will change.
    The HHPPS for 2017 shifts the way CMS calculates payments for episodes of care that go beyond the typical range of care, moving from a cost-per-visit system to one based on cost-per-unit, with a unit comprising 15 minutes. The rule also includes an increase to the fixed-dollar loss ratio, which will rise to 0.55 in 2017.

    Quality reporting: some measures are in, some are out.
    CMS has removed 6 quality measures from the home health quality reporting program, 2 more than identified in the proposed rule. A total of 4 new measures have been added. CMS eliminated measures that it designates as having "topped out" and now offer limited value as a way of analyzing quality.

    The home health value-based payment model (HHVBP) will continue in 8 states, with some tweaks.
    Home health agencies in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington will continue in the HHVBP program, which will begin tying payment increases or reductions to performance data beginning in 2018 (based on data from 2016). Between 2018 and 2022, payment adjustments could increase or decrease by as much as 5% in 2018, with an 8% upward and downward adjustment in 2021 and 2022.

    Final OPPS Rule Eliminates Pain Management Questions From Patient Surveys; Changes Payment Source for Some Hospital-Owned Off-Campus Facilities

    The Centers for Medicare and Medicaid Services (CMS) is sticking by its plan to eliminate questions about pain management from patient satisfaction surveys, in response to worry that the questions were pressuring providers to overprescribe opioids and other painkillers. That change, which CMS characterized as a shift made in "an abundance of caution," is part of the final 2017 outpatient prospective payment system (OPPS), which also alters payment for hospital-owned off-campus facilities and begins a discussion around whether total knee arthroplasty (TKA) should be performed in outpatient settings for Medicare beneficiaries.

    The final rule is mostly unchanged from the version proposed in July. APTA provided comments to CMS on the proposed rule and will publish a fact sheet on the final OPPS in the coming weeks. Here are few highlights:

    Pain management survey questions are out.
    While CMS says it isn't aware of research that supports an association between patient satisfaction survey questions on pain management and overprescription, the questions will nonetheless be removed from 2017 surveys. The change comes as multiple government agencies attempt to address a nationwide opioid abuse epidemic. According to CMS, alternate questions are being developed for future use.

    Also out: using OPPS to pay hospital-owned off-campus outpatient departments.
    This change, made in response to a congressional mandate to address the off-campus issue, will remove these facilities from payment under OPPS and place them under the Medicare physician fee schedule system, something CMS describes as a "transitional" placement. The change won't be felt directly by physical therapists (PTs), who already bill under the physician fee schedule.

    Payments will increase.
    The final rule increases OPPS payments by 1.65%, and ups ambulatory surgical center payments by 1.9%.

    Quality reporting measures will also increase (but not until 2020).
    Seven new quality-reporting measures will be added for the hospital outpatient quality reporting program beginning in 2020—and they'll affect payment.

    Outpatient TKA is on the table for a future OPPS.
    In the proposed rule, CMS asked for comments on whether to remove TKA from its list of "inpatient-only" procedures—a change that APTA and other therapy groups support. The comments CMS received from the association and others will be taken into consideration for future OPPS development. In its comments, APTA cautioned CMS that such a change should be accompanied by updated payment methodologies.

    #ChoosePT Momentum Continues to Build With National Advertising

    Although National Physical Therapy Month (NPTM) is over, the #ChoosePT campaign continues to generate momentum with another round of national advertising launched in October, featuring the message, "Don’t mask the pain with opioids. Treat it with physical therapy."

    The ads are running on WebMD's "Pain Management Health Center" (desktop and mobile) and on prominent consumer websites such as CBS News, Huffington Post, and Livestrong.com.

    Print ads have also been seen by Major League Baseball fans this year. Two full-page ads ran in the American League and National League Championship Series commemorative programs, and are running in the World Series program. They reach a combined readership of well over 2 million people.

    Radio listeners are beginning to hear the #ChoosePT radio public service announcement (PSA) on stations such as WGN-AM in Chicago, WTAG-AM in Springfield, Mass., and KSL-AM in Salt Lake City. Again, it emphasizes the risks of opioids and a physical therapist's role in treating pain through through movement and exercise. The PSA also has received positive feedback from television station managers and is running on YouTube as an advertisement.

    Don't forget to support #ChoosePT beyond National Physical Therapy Month. If you're looking for ways to incorporate the campaign into events and share on social media, check out the Campaign Toolkit on MoveForwardPT.com/ChoosePT. Also, please send your NPTM event photos and descriptions to public-relations@apta.org.

    New LTC Facility Rule Addresses Respiratory Therapy, Physical Therapy Orders, Compliance, More

    After nearly a quarter-century of leaving things mostly untouched, the Centers for Medicare and Medicaid Services (CMS) has officially updated its rule on long-term care (LTC) facilities, adding provisions around respiratory therapy, physician delegation of therapy orders to physical therapists (PTs), and compliance, among other areas.

    The changes set to take effect November 28 affect both therapy services and facility procedures. APTA has produced a fact sheet that details the changes (look under "APTA Summaries and Fact Sheets"), but here are a few quick takes:

    PTs may be able to write therapy orders—with permission.
    Although the new rule identifies physicians, physician assistants, nurse practitioners, and clinical nurse specialists as the providers empowered to give orders for a new resident's immediate needs, the ability to write therapy orders for PTs or other qualified therapists to carry out may be designated to a PT.

    Respiratory therapy must be provided if it's in the resident's plan of care.
    Respiratory therapy is now included in the CMS list of mandated specialized rehabilitative services. This doesn't necessarily mean that LTC facilities have to hire new staff to provide the therapy—CMS says they can contract with an outside source (provided the source isn't excluded from any federal health care program).

    Compliance and ethics training and monitoring will take a front seat.
    The revised rule implements provisions under the Affordable Care Act that require facilities to establish compliance and ethics programs, with "high-level" individuals overseeing them. The programs will combine educational efforts with disciplinary consequences for violations, and must be in place by November 28, 2017.

    This is the first time CMS has engaged in a major revision of the LTC rule since 1991.

    The Good Stuff: Members and the Profession in Local News, October 2016

    "The Good Stuff" is an occasional series that highlights recent, mostly local 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!

    Colleen Brough, PT, DPT, MS, shows The New York Times what Columbia University Medical Center's RunLab is all about, and how physical therapists prevent injury and improve performance for runners. (New York Times Facebook page video)

    Karen Joubert, PT, explains the benefits of physical therapy for women who are pregnant as well as for those who have recently given birth. (Eyewitness 7 News, Los Angeles)

    Photo gallery: William Carey University (Mississippi) PT students retrofit kids' battery-powered cars for Global PT Day of Service (Hattiesburg, Mississippi, American)

    Renee Midgett, PT, talks about why an annual physical therapy check-up is important. (The Hampton Roads Show, Hampton Roads, Virginia)

    "[Physical therapy] made an incredible difference in my life. This physical therapy … was a necessity and has made me more independent today than I would ever have been without it." – Weightlifter Alex Nicely, whose "Lift With a Purpose" organization sponsors competitions that use earnings to pay for physical therapy for children. (Knoxville, Tennessee, News-Sentinel)

    Lee Dibble, PT, PhD, describes the role of exercise in management of Parkinson disease. (KUTV2, Salt Lake City, Utah)

    Paul Kraushaar, PT, shares his experiences of volunteering in Haiti. (Voice of Muscatine, Muscatine, Iowa)

    Alan Jette, PT, PhD, has been named this year's winner of the American Congress of Rehabilitation Medicine John Stanley Coulter award. (ACRM press release)

    Sandra Saavedra, PT, MS, PhD, discusses her research on children with cerebral palsy. (Cerebral Palsy News Today)

    Veronica Southard, PT, DHSc, explains how the fear of falling can actually contribute to falls. (Medical Life Sciences News)

    Nancy Alexander, PT, describes her move toward a cash-based practice. (Rochester, New York, Democrat and Chronicle)

    "[Physical therapy] is hard (that’s an understatement), but I know for a fact I would still be hobbling along with my trusty walker if it weren't for Dawn [a physical therapist]." – Michaele Duike, who received physical therapist treatment after a leg fracture. (Kingstree, South Carolina, News)

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

    Summer's Over, but Payment Reform is Just Beginning: Tips on Getting Up to Speed

    A new proposed CPT system for evaluation codes, increasing required bundled payment models, the end of the Physician Quality Reporting System (PQRS) in favor of the Merit-Based Incentive Payment System (MIPS)…feeling dizzy yet?

    Health care reform's swift movement toward value-based payment and away from procedural-based, fee-for-service systems is sweeping up physical therapists (PTs) and physical therapist assistants (PTAs) as it continues to gain momentum. And that momentum built over the summer, even while we vacationed, mowed our lawns, and got the kids ready for another school year.

    So now that it's officially fall, why not spend some time getting up to speed on where the profession stands in relation to payment reform? Here are a few suggestions to help you find out what health care did over your summer vacation:

    See the big picture on payment reform.
    The "Compliance Matters" columns, a regular feature of PT in Motion magazine, connect you with what's going on. Check out the August column, which lays out the basics behind the Center for Medicare and Medicaid's proposed system for new CPT evaluation codes (and 1 reevaluation code), as well as the column from March that explains the workings of the new Comprehensive Care for Joint Replacement (CJR) bundling program. For an even bigger-picture view of the road that has led to the CPT and other changes, this article from the April issue of PT in Motion magazine provides 5 concepts that are central to payment reform.

    Dig a little deeper.
    The newly updated APTA Payment Reform webpage is the jumping-off point to 3 major areas that affect—or will soon be affecting—PTs and PTAs: alternative payment models, Medicare postacute care reform (especially the reform efforts reflected in the IMPACT Act), and the changes associated with the Medicare Access and CHIP Reauthorization Act, or MACRA. All 3 areas contain multiple resources and links that can help you see where things stand now, and where they may be headed. Another resource for some in-the-weeds information: APTA's Insider Intel series, a phone-in program that puts you in touch with staff experts on payment reform. Past intel calls are available as recordings or transcripts; look for another installment later this fall.

    Get a handle on where things stand right now.
    The proposed 2017 Medicare physician fee schedule from CMS is the hot topic of the moment. While awaiting the final rule (expected in late October/early November), find out what it's all about and what changes could impact PTs the most through the recording of a sold-out webinar on the payment system held September 22. You can also access the most recent APTA summary of the proposal (look under "APTA Summaries"). And while you're in a summary state of mind, don't miss out on APTA summaries of the final 2017 inpatient prospective payment system (IPPS) rule, the proposed rule for the 2017 home health prospective payment system, and the final rule on the 2017 skilled nursing facility prospective payment system—all can be found under the "APTA Summaries" header on their respective pages. Want a quick video take? These video dispatches from the APTA State Policy and Payment Forum—on bundled care models and the proposed CPT coding system—provide brief overviews.

    Find out what your association has to say.
    APTA registered its "deep disappointment" with the CMS decision to employ a 3-tiered CPT evaluation system that doesn't differentiate payment among those tiers, but that's not all the association had to say about the proposed 2017 physician fee schedule: you can read the association's comments to CMS in their entirety at the APTA Medicare Physician Fee Schedule webpage (look under the "APTA Comments" header). Then be sure to get the perspective of APTA President Sharon L. Dunn, PT, PhD, who issued a recent statement and update that outlines APTA's efforts around payment reform, and urges members to engage in this issue so that the profession can have a role in shaping the future of payment.