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  • APTA Members Asked to Identify Unnecessary Procedures

    APTA's efforts to make physical therapy a leader in fraud and abuse prevention could soon include a public education campaign to encourage informed care decisions based on member input on physical therapy tests and procedures that are unnecessary.

    As part of its Integrity in Practice initiative, APTA is exploring the possibility of participating in the "Choosing Wisely" program, a national American Board of Internal Medicine (ABIM) Foundation-sponsored project that provides the public with lists of health care tests and procedures that may be unnecessary under certain circumstances. APTA would join over 50 medical specialty societies that each contributed a list of "5 Things a Patient Should Question."

    The first step in the process for APTA, according to a recent all-member email, is to hear from as many PTs as possible about commonly used physical therapy procedures "whose necessity should be questioned and discussed." The association is on the lookout for any PT-controlled procedure that tends to be done frequently or carry a significant cost, yet whose usefulness is called into question by evidence. APTA will convene an expert panel to review and rate all member submissions and create a list of approximately 10 potential items that will be narrowed down to 5 by way of an all-member survey. The top 5 questioned procedures will then go to the APTA Board of Directors for final approval.

    If approved for use by the ABIM Foundation, APTA's "5 Things Physical Therapists and Patients Should Question" would join similar lists (.pdf) provided by organizations including the American Geriatrics Society, the North American Spine Society, the American Academy of Family Physicians, and the American College of Occupational and Environmental Medicine. Procedures called into question by these and other organizations include routine imaging of certain patients with inflammatory arthritis, recommending more than 48 hours of bed rest for patients with low back pain, and screening of adolescents for scoliosis.

    PTs can submit their recommendations online. The deadline for submissions is April 4.

    APTA’s version of "5 Things" would become a component in the association's large-scale initiative to highlight physical therapy's role in eliminating fraud and abuse in health care. The effort is the subject of a feature article (members-only access) in the February issue of PT in Motion magazine and will be the focus of future association education efforts.

    SGR Reform, Therapy Cap Repeal Hit Political Road Bumps

    Although permanent solutions are still on the table, the flawed sustainable growth rate (SGR) formula—and the current therapy cap system—may be around for most of 2014, now that the House of Representatives will hold a vote to offset the costs of SGR repeal by delaying implementation of parts of the Affordable Care Act (ACA).

    The bad news: because the proposal is a non-starter in the Senate, the inaction would likely result in another temporary fix to both the SGR and the therapy cap. The good news: a new bill that would end both the SGR and the therapy cap has been introduced in the Senate, though action on the bill may not happen in time to meet a March 31 deadline.

    According to Roll Call, House Republicans will be calling for a delay in implementation of the ACA's individual mandate, using the projected $9 billion in savings per year to offset the anticipated $130 billion cost of ending the SGR. In the Roll Call story, House Ways and Means Ranking Member Sander M. Levin (D-Michigan) described the proposal as a "road to nowhere" and said that the Senate would not take up a vote on whether to delay the individual mandate.

    Instead, on March 12 the Senate introduced an alternate bill similar to an earlier Senate plan to end both the SGR and the therapy cap, a proposal that has support among many legislators. Supporters of SGR and cap repeal view this as a positive step—particularly because of the return of a therapy cap repeal, an element that is missing from the bill now in the House.

    Both the House and Senate bills would eliminate a flawed system that requires a "fix" every year in order to avoid significant cuts to provider payments. Late last year, while lawmakers were hammering out the details of new legislation and looking for offsets to pay for the changes, temporary exceptions to the SGR and therapy cap were extended through March 31, 2014. With that deadline looming passage of a permanent fix before the end of March now seems unlikely.

    In light of the inaction, Congress could agree to extend the exceptions for several more months—possibly until after the November elections—before once again taking up a bill.

    APTA and other organizations have advocated that any Medicare modernization bill include language to end the therapy cap, a position that has support among some legislators. APTA's advocacy team continues to work with members of Congress on passage of a bill that would include repeals of both the SGR and therapy cap, and has been emphasizing the importance of grassroots efforts to make sure legislators hear from supporters of ending both flawed policies. APTA members can take action via the Legislative Action Center and nonmembers and the public can take action via the Patient Action Center.

    APTA will continue to work the members of Congress to ensure the final reform package includes policies that reflect the interests of physical therapists and the patients and clients we serve. Members interested in joining APTA's advocacy efforts to reform SGR and repeal the therapy cap can sign up for PTeam.