House and Senate proposals now on the table would end the sustainable growth rate (SGR) formula that has confounded adequate payment to Medicare providers since its inception. The Senate version also suggests a permanent repeal of the Medicare therapy cap. The proposals are scheduled for discussion this week.
Both proposals—created by the Senate Finance and House Ways and Means committees—repeal the current SGR formula and freeze payment rates for 10 years. During this 10-year period providers are eligible to earn payment above the base level through value-based performance programs and alternative payment models.
The Senate Finance Committee proposal also includes a full and immediate repeal of the Medicare therapy cap. However, manual medical review would remain in place at the $3,700 level through 2014, followed by the development of a modified medical review process beginning in 2015.
The Senate proposal also calls for the creation of a new data collection system to replace the current functional limitation reporting system and includes language directing the Secretary of Health and Human Services to explore new payment models for outpatient therapy. The bill also requires that beginning in 2015, claims for outpatient therapy include data on whether a physical therapist assistant provided the service.
The House Ways and Means proposal focuses solely on repeal of the SGR formula and does not include a repeal of the therapy cap or any Medicare extenders. The House committee is expected to discuss its proposal sometime this week before adjourning on Friday, December 13.
APTA continues to work with legislators and staff on the Senate Finance and House Ways and Means committees as these proposals make their way through the legislative process. APTA will provide additional resources for members and an analysis of the impacts on the physical therapy profession after this week's discussions.
Today's mothers are spending an average of 12.5 hours less per week on physical activity (PA) than mothers in the 1960s—a difference that researchers are describing as a "significant reallocation" of time to sedentary activities that could contribute to a potential public health crisis.
The findings, published in the December Mayo Clinic Proceedings, examined data contained in the American Heritage Time and Use Study, an activity log program that has captured more than 50,000 diary days and 90 behavioral categories from mothers beginning in 1965.
Researchers divided the mothers into 2 groups—those with children between the ages of 5 and 18 (mothers with older children or MOC), and those with children younger than 5 (mothers with younger children, MYC)—and reviewed activity logs over a 45-year period, 1965–2010.What they found, according to the authors, was alarming:
Researchers attributed most of the difference to a significant rise in "screen-based media use" and wrote that "with each passing generation, mothers have become increasingly physically inactive, sedentary, and obese, thereby potentially predisposing children to an increased risk of inactivity, adiposity, and chronic [non-communicable diseases]."
The Centers for Medicare and Medicaid Services (CMS) has issued revised portions of the Medicare Benefits Policy and Claims Processing manuals to clarify coverage of skilled therapy services in maintenance care. The revisions were mandated as a result of the Jimmo v Sibelius settlement agreement reached in US District Court earlier this year.
In the transmittal (.pdf), CMS reiterates its longstanding policy that skilled therapy services still may be covered even in situations where no improvement is possible, including when skilled services are needed to prevent deterioration. The transmittal also contains information on the documentation necessary for coverage determinations in skilled maintenance therapy.
APTA is reviewing the transmittal and will provide a detailed summary in the coming days.
Join CMS from 2:00 pm to 3:00 pm December 19 for a Medicare Learning Network conference call on how the Jimmo v Sibelius agreement will affect the services provided by physical therapists. Registration is open now, but spaces are likely to fill up quickly.
The influential Workgroup for Electronic Data Interchange (WEDI) has released what it calls a new "roadmap" for the future of health care, and a high level of consumer control is one of the primary destinations.
The newest WEDI report (.pdf) comes 20 years after its initial examination of the use of technology in health care. The 1993 report played an influential role in the development of the Health Insurance Portability and Accountability Act (HIPAA) as well as the transition to standardized transaction formats in payment.
The newest report focuses on 4 major areas: patient engagement, payment models, data harmonization and exchange, and "innovative encounter models." Although approaches and priorities differ in each area, the WEDI report emphasizes the need for greater coordination of technologies, both to make information-sharing more efficient and to provide consumers with a high degree of control over their own care and information.
"Health IT is not the cure in and of itself but, when adequately deployed, can serve as a powerful change agent," the report states. "The rise of mobile and other technologies creates many opportunities for the healthcare industry to move forward together to solve many of the challenges that have plagued the American healthcare system."
APTA members now have access to detailed information on how the 2014 Medicare physician fee schedule and the hospital outpatient prospective payment system (OPPS) will affect physical therapist practice. APTA staff has prepared analyses of the final rules that the Centers for Medicare and Medicaid Services (CMS) announced on November 27.
APTA's fee schedule summary (.pdf) covers the new schedule's impact on payment, including the impact of the sustainable growth rate (SGR) and therapy cap. The summary also includes an analysis of the proposed changes to the physician quality reporting system (PQRS).
The OPPS highlights (.pdf) document also addresses payment changes and provides analyses of the final Ambulatory Payment Classifications (APCs) as well as new rules around supervision of outpatient therapeutic services in critical access hospitals (CAHs).
Both resources are free to APTA members, and have been added to the physician fee schedule and Medicare in hospital settings information on the APTA website.
The 2014 Slate of Candidates for APTA national office is now available on the APTA website. It also may be found in the House of Delegates Community documents under "Nominations, Candidacy, and Elections." The candidate webpage, including candidate statements, will be posted on January 31, 2014. Elections for national office will be held at the 2014 House of Delegates on June 9, 2014. Please contact Amber Neil in APTA's Governance and Leadership Department for additional information.
When it comes to marketing your physical therapist practice, don't get so caught up in all the new delivery methods that you forget the basics of knowing your audience, understanding yourself, and figuring out how you'll know when you've succeeded. That's 1 of the guiding principles of a special feature on "Marketing and Public Relations for the Physical Therapist" in the latest issue of PT In Motion, APTA's member magazine.
In the article, APTA Director of Marketing and Creative Services Chanté Sedwick and Senior Public Relations Specialist Jennifer Rondon provide both big-picture considerations and practical tips on how to approach the sometimes-dizzying array of marketing options available. According to the authors, no single approach should be ruled out: social media is hot right now, but seemingly old-fashioned direct mail campaigns are still at least scanned by 78% of recipients.
Sedwick and Rondon warn against rushing into any marketing or public relations effort without first taking the time to assess who the physical therapist (PT) wants to reach and the specific values that differentiate the PT from other providers—and, possibly, other physical therapist practices. While possibly not as exciting as diving into a Facebook-fueled ad campaign, developing a few basic operating assumptions can save time and money, and generate results. The authors offer several tips on how to get started on the process and move on to an overview of delivery methods.
PT in Motion is a monthly magazine focused on hot issues in physical therapy and health care. The magazine is free to APTA members, and available in both hardcopy and online formats.
Additional practical information on marketing your physical therapist practice and yourself can be found in APTA’s
Business Skills in Physical Therapy: Strategic Marketing, 2nd Ed
, a home-study course by Peter Kovacek, PT, DPT, MSA.
Physical therapists (PTs) can get the latest information on how the Jimmo v. Sibelius settlement agreement reached in US District Court will affect the services they provide under Medicare by joining in on a December 19 Medicare Learning Network conference call. Registration is open now, but spaces are likely to fill up quickly.
The agreement reached in January reinforces Medicare's policy that when skilled services are required to provide care to slow or prevent further deterioration, coverage cannot be denied because of the lack of potential for improvement. The agreement has particular relevance to home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and outpatient physical therapy providers.
The call will be held from 2:00 pm-3:00 pm, ET. Participation is limited, and continuing education credits may be available. To register, visit the MLN Connects Upcoming Calls webpage.
When is it safe to drive after an extremity injury? According to a recent article in the New York Times, even when the question is limited to a specific injury such as a broken wrist or sprained ankle, the considered answer from research boils down to a firm "it depends."
NYT reporter Jan Hoffman looked at recent studies of postoperative driving and interviewed several orthopedic surgeons to find out what firm guidelines existed relative to getting back on the road after an injury or surgery. While there were some constants—no driving with a brace on the right leg, no driving if the wrist or elbow is immobilized, for example—there were few hard-and-fast rules, and many complicating factors.
Some of these complicating factors include the kind of car being driven, individual driving habits, and lack of sleep due to pain. Additionally, Hoffman reported that surgeons are sensitive to the potential variations in recovery and often hesitate to make a specific recommendation for fear of legal repercussions should the patient get into an auto accident or aggravate the original injury by driving.
Editor's note: be sure to check out the comments on the article posted by readers, many of whom describe their own experiences with recovery after injury/surgery.
Low participation among physical therapists (PTs), physical therapist assistants (PTAs), and their supporters could diminish legislator interest in permanent repeals of the therapy cap and sustainable growth rate (SGR) formula, which are set to be discussed in Congress. APTA urges its members to take any of the easy steps available to make their voices heard at this critical point in the process.
Though it only takes a few minutes to participate, only 1% of APTA members have joined the grassroots effort to date, and time is running out. The Senate Finance and House Ways and Means Committees will be discussing legislative framework for a permanent solution to the sustainable growth rate (SGR) formula next week. During these committee meetings, legislators will also be reviewing Medicare extenders, like the therapy cap. It is essential that a full repeal of the cap is included in the SGR packages.
Now is the time to contact legislators. If you are tired of the yearly extension system, you can help put an end to this unstable and unpredictable practice by taking action now. If the voices of PTs aren't strong enough, physical therapy could get lost in the shuffle of SGR reform.
Everyone can get involved and help ensure patient access to outpatient therapy services for the long term by e-mailing their legislators. APTA members can use the Legislative Action Center and patients/non-members can use the Patient Action Center. You can also take action from your smart phone by downloading the free APTA Action app.
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