Until you receive further notice, keep on using the 59 modifier in reimbursement claims to indicate that a health care common procedural code (HCPCS) represents a service that is separate and distinct from another service to which it is paired under the Correct Coding Initiative (CCI) program—that's the bottom line from the Centers for Medicare and Medicaid Services (CMS), which recently responded to an inquiry from APTA as to when—and whether—physical therapists should use a set of new modifiers announced by CMS in August.
The clarification was forwarded to APTA by CMS after some physical therapists questioned whether they should begin using the new modifiers. The CMS answer: not yet.
In August, CMS issued a transmittal describing new modifiers—XE, XS, XP, and XU—intended to be used to define subsets of the 59 modifier. The new modifier codes have not been implemented, and CMS has advised that PTs should not use the modifiers until they receive further notice.
The Medicare "Pioneer" program that targets more sophisticated health systems to foster the development of accountable care organizations (ACOs) has now lost about 40% of the systems that signed on initially. According to an article in Modern Healthcare (access available via free one-time registration) the most recent withdrawals "suggest even the most sophisticated health systems may be unwilling to take losses as policymakers test new payment and delivery models."
The most recent exits—Franciscan Alliance, Genesys PHO, and Renaissance Health Network—bring the Pioneer list from its original 32 members to 19. The Modern Healthcare article reports that 9 of the 13 ACOs that dropped out did so within the first year of the program's launch in 2012, opting instead to join the "less risky" shared savings program, the traditional Medicare program that allows other entities to form ACO. Unlike the Pioneer program, the number of entities joining the shared savings program has been steadily increasing.
The Pioneer program was designed to help ACOs transition from a fee-for-service payment structure to improve patient care, increase Medicare savings, lower costs, and to test alternative program designs to inform future rulemaking for the Medicare Shared Savings Program. The ACOs in the Pioneer program were generally considered ones that were willing to withstand potential losses in hopes of achieving bonuses for meeting various quality and spending metrics.
Modern Healthcare reports that while the ACO program is generally helping to set the stage for more widespread use, critics of the Pioneer program contend that Medicare's bonus formulas are "skewed in favor of [ACOs] that operate in markets that have above-average health spending, where hospitals and doctors have more opportunities for savings." The article describes how Medicare announced that its ACO initiatives saved $817 million through 2013, and how "dozens" of program participants shared in $445 million in bonuses, "but three-quarters saw nothing after failing to do sufficiently well against the financial benchmarks."
APTA members can learn more about a physical therapist's role in an ACO by visiting APTA's webpage, FAQ: Accountable Care Organizations (ACOs): Medicare Shared Savings Program and Pioneer Models.
When it comes to deciding on art for PT in Motion magazine, APTA members have it covered.
It's time once again for members to help PT in Motion magazine decide the design to be used on the cover of the upcoming issue. For November, editorial staff is proposing 2 designs and asking members to vote on their favorite cover to illustrate the concept of physical therapy across the lifespan The design that receives the most votes will be the next cover.
Take the quick and simple survey by October 1. Just pick the design you think is likely to get you to open up the magazine, and then check out the November issue to see which cover was most popular.
As APTA continues to grow, so does its need for exceptional leaders. Anyone come to mind? Maybe you?
The APTA Nominating Committee is seeking recommendations for the 2015 slate of candidates for elected positions. Positions open for election are Board of Directors president, vice president, and 3 directors; and 1 Nominating Committee member.
Use the online nomination form to submit the names of qualified members who would be willing to be considered for the upcoming election cycle. Deadline is November 3.
Now's the time. Reach out to a leader you think should take those talents to a national level for APTA, and who's ready to guide the association through some exciting years ahead.
Physical therapists have long been aware of the importance of early mobilization and rehabilitation for patients in a hospital intensive care unit (ICU). Now a new program is recruiting hospitals to participate in a project to spread that understanding by facilitating practices that can more quickly liberate patients from mechanical ventilation and move them out of the ICU.
The Comprehensive Unit-Based Safety Program (CUSP) for Mechanically Ventilated Patients (MVP) and Ventilator Associated Pneumonia (VAP) is seeking so-called "coordinating entities" interested in participating in a 2-year program to prevent ventilator-associated events including VAP. A free 90-minute informational webinar on the program will be held on Monday, September 29, at 1:00 pm ET.
The program focuses on improvement in staff teamwork and communication, analysis of daily process measures, efforts to mobilize patients earlier, and employment of low tidal volume ventilation strategies. Project content will be delivered through webinars, e-mail, and as online resources, and all materials are available on the CUSP 4MVP VAP project website.
The initiative is funded by the Agency for Healthcare Research and Quality, and is being delivered in partnership with the Johns Hopkins Institute for Patient Safety and Quality, the Michigan Health and Hospital Association, the Department of Population Medicine at Harvard Medical School, and the Harvard Pilgrim Health Care Institute. APTA and its Acute Care Section provided consultation on the development of this program.
For more information, contact the project helpdesk at firstname.lastname@example.org.
With National Physical Therapy Month (NPTM) coming in October, now's a perfect time to begin making plans to celebrate the profession and increase understanding of how physical therapy can transform society.
Visit the APTA NPTM webpage for everything you need to create your own NPTM activities. Resources include the 2014 NPTM logo, fact sheet, event planning guide, sample news releases and proclamations, and much more. Even more resources can be found at MoveForwardPT.com, APTA’s official consumer information website.
NPTM is a great opportunity to give communities a "hands on" experience of physical therapy by demonstrating what physical therapists and physical therapist assistants really do, and how the profession keeps people fit, active, healthy, and mobile.
This year's APTA focus: a public education campaign to debunk 7 of the most common myths about physical therapy, set to launch during the second week of October. Stay tuned to learn how you can participate!
APTA members have an opportunity to contribute to the first-ever revision of the National Physical Activity Plan (NPAP), a high-profile effort to create a comprehensive set of policies, programs, and initiatives to increase physical activity in all segments of the American population.
The NPAP Alliance has released an online survey that it will use to guide changes to the plan, which was released in 2010. The Alliance is particularly interested in views on how Americans' physical activity levels can be increased, what strategies could be effective in this promotion, and how the success of the NPAP can be ensured. Deadline for responses is October 31.
Respondents can comment on and rate strategies in 8 areas: business; education; health care; mass media; parks, recreation, fitness, and sports; public health; transportation, land use, and community design; and volunteers and nonprofits.
APTA is a member of the NPAP Alliance board of directors.
Survey tip: the survey form includes many optional "free text" opportunities—if you prefer you can leave any or all free text areas blank.
Newly adopted or amended APTA policies and bylaws passed by the 2014 House of Delegates (House) are now posted at the Policies and Bylaws area of the APTA website.
Minutes of the 2014 House can be found in the 2014 Archive folder of the House community, and videos of all 2014 House sessions are available for viewing by APTA members.
The latest PTNow blog explores the complicated dynamics involved when mainstream media covers sometimes-complex health care issues, and uses coverage of APTA's Choosing Wisely® list as an example.
"As great as it is when mainstream media outlets bring new health care research to the consumer forefront, sometimes the arrow doesn't quite hit the target," is how the blog describes what happened when National Public Radio (NPR) picked up on the association's list of "5 Things Physical Therapists and Patients Should Question."
APTA's recommendation was, "Don't employ passive physical agents except when necessary to facilitate participation in an active treatment program," and like all items on the list, the recommendation included citations to evidence supporting the statement.
NPR's headline? "Farewell, Heating Pad: Physical Therapists Say It Doesn't Help."
"While NPR correctly emphasized that physical activity is stressed over passive physical agents, 'farewell, heating pad' is an over-reaching interpretation of APTA's recommendation," the blog says. The PTNow post opens up a discussion about how physical therapists and physical therapist assistants might respond to patients who have read the headlines, but haven't heard the full story.
Have thoughts or experiences in sharing context in ways that patients can understand? Read the blog, and join the conversation.
The Wall Street Journal is bullish on gait analysis.
Describing gait analysis as a way "to identify the root of an injury, or a bad habit that may lead to one," an article in the September 22 WSJ attempts to explain the relationship between common runners' injuries and how those runners move.
"Increasingly, the runner's road to healthy joints starts with gait analysis," writes WSJ reporter Matthew Futterman. "Medical boots, cortisone shots or even surgeries never solved runners' problems the way 20 minutes of being filmed on a treadmill can, experts say."
The article interviews athletes who have benefitted from the analyses and health care professionals who perform them, including Michael Silverman, PT, of the Hospital for Special Surgery, in New York City. The online version of the article also includes an infographic that describes which gait-related problems can contribute to runner's knee, stress fractures, proximal hamstring tendinosis, and plantar fasciitis.
Tip: be sure to check out the reader comments posted at the end of the article for insights on what the running public thinks about gait analysis. And don't forget to share consumer-focused information on running from MoveForwardPT.com—including a Physical Therapist's Guide to Running (.pdf).
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