APTA’s next steps in overhauling the flawed payment system for physical therapist services include a 2014 pilot program to investigate the impact of APTA’s proposed model and a 2015 campaign to educate members on new payment systems in health care. Both were adopted by the Board of Directors at its April meeting, in preparation for a targeted 2016 implementation of a new system.
APTA began in 2012 to draft and refine an alternative to the current fee-for-service Medicare payment system, in part responding to a Board policy adopted in 2011 that endorsed the development of an alternative payment system, and in part as a response to calls from the Centers for Medicare and Medicaid Services (CMS) for a new methodology—the goal of both being a system that would fairly compensate health care providers while doing away with the sustained growth rate (SGR) and arbitrary therapy caps that have confounded providers and CMS alike for more than a decade.
The Physical Therapy Classification and Payment System (PTCPS) is the result of extensive member evaluation of the initial draft. Members provided input on a severity-intensity framework as a basis for payment, the appropriate unit on which to base payment, the proposed evaluation levels, the examination and intervention levels, overall value of the proposed system, supplemental support needed to implement the system, and whether the system effectively reflects the clinical judgment of the physical therapist.
Most recently, during the February 2014 meeting of the AMA CPT Editorial Panel, APTA proposed a new CPT code structure reflecting the PTCPS. While the panel complimented APTA on the proposal, it postponed voting on it, saying the magnitude of the changes to the existing physical medicine and rehabilitation (PMR) code family warranted more time and a pilot test to provide more support and validation for the new codes.
The Board in April committed up to $500,000 to fund the pilot, and APTA will seek collaborative partners to help offset costs. For the pilot, PTs will seek to determine appropriate per-session CPT codes to describe physical therapist services in 2 ways: review of clinical vignettes and chart review of existing medical records of patients.
On the education side, APTA will develop a comprehensive plan to educate members on the new outpatient physical therapy model and other payment models emerging from health care reform, such as collaborative care models, bundling, and new postacute payment models.
To see the full discussion on this and other topics from the April Board of Directors meeting, watch the archived livestream of all open sessions.
In what some Board members described as a "maturation" of the relationship between physical therapist assistants (PTAs) and association governance, the APTA Board of Directors voted to bring bylaw amendments to the 2015 House of Delegates that would enable chapters to allow PTAs to serve as delegates in the House, grant PTAs a full vote at the component level, and enable PTAs to run for non-officer Board of Directors positions.
These decisions and others intended to increase the value of APTA membership to PTAs came after a lengthy discussion of recommendations made to the Board by the Physical Therapist Assistant Board Work Group, which was charged with exploring issues related to the goals of the Physical Therapist Assistant Caucus. The work group focused on 3 major issues: postgraduate development of the PTA, promotion and protection of the work performed by a PTA when a PTA is involved in a plan of care, and active participation in association activities relating to the PTA, including decision-making.
The majority of the Board's discussion was related to 3 major recommendations that addressed PTA participation in their components and in the House of Delegates. The work group's recommendations were intended to make it possible for PTAs to have a full vote within their components (currently PTAs eligible to vote are allotted a half-vote), and to create a way for PTAs to serve as voting chapter delegates in the House (currently only sections, which cannot vote in the House, can choose to have PTAs serve as delegates). Within each recommendation, the Board was presented with an option—basically, to create a bylaws amendment that would mandate the change at the component level, or to offer an amendment that would make the change optional for components. In the end, the Board voted for options that allowed for more choice.
Before taking the votes on the most significant recommendations, APTA President Paul Rockar Jr, PT, DPT, MS, called for an "open forum" to allow Board members to discuss their perspectives on the broad issues of PTA involvement. Board members generally agreed with the sentiment expressed by Director Mary C. Sinnott, PT, DPT, MEd, who said that "it's about time we look at realities" and "take down some of the walls" that have prevented PTA members from full participation.
At the same time, directors questioned 1 recommendation option that called for a seat on the Board of Directors to be set aside for a PTA only. That particular option was ruled out by the Board early on as an approach that would run counter to the idea that Board members serve at-large and not as representatives of constituent groups. PTA Caucus Chief Delegate Amy Smith, PTA, BS, agreed, noting that "Eligibility to serve is a greater equality."
In deliberating the recommendations, the Board repeatedly came back to 2 considerations: the distinction between the PT-PTA relationship in practice and the PT-PTA relationship in association governance; and the distinction between having a PTAs represent their components in the House and having them represent the PTA as its own component.
In the end, the Board voted to draft bylaw amendment proposals for the 2015 House of Delegates that would allow components to provide PTA members a full vote at the component level, make PTAs eligible to serve as chapter delegates at the discretion of each component, and makes PTAs eligible to run for nonofficer positions on the Board . The eligibility proposals will also contain language that would eliminate the PTA caucus by 2020. The Board also agreed to explore the possibility of creating a "Section-like" component for PTAs in 2015.
Other work group recommendations approved by the Board include an effort to collect better data on the value of the PT/PTA team regarding utilization, and that a PT/PTA team toolkit communicating the value of the relationship be "actively supported" and promoted to APTA components.
In another discussion related to the PTA, the Board heard a report on the feasibility of transitioning to a PTA entry-level baccalaureate degree. The report is the result of RC 20-12, a charge from the 2012 House to explore a PTA baccalaureate degree.
In reviewing the implications of the baccalaureate option, the report calls for a practice analysis and identification of best practices to help inform any decision abut changes in degree level.
Editor's note: this article was changed from its originally-released version to reflect the Board's discussion of a "Section-like" component for PTAs.
A new wave of myostatin drugs in or nearing clinical-stage testing could make a significant impact on the ability to build muscle in patients who are elderly or suffering from muscle-wasting diseases, according to a recent article in the Wall Street Journal.
In the April 27 edition of WSJ, reporters Hester Plumridge and Marta Falconi describe the progress being made by several drug companies interested in refining myostatins for human use. These drugs are designed to block the production or detection of myostatin, a protein that slows muscle growth.
According to the article, researchers believe that myostatin drugs could counter sarcopenia as well as muscle-wasting diseases such as sporadic inclusion-body myositis and muscle loss related to chronic illnesses including cancer. Earlier versions of myostatins were attempted in the late 2000s as a treatment for muscular dystrophy but were discontinued after reports of unexplained nose and gum bleeding. The WSJ article reports that the new drugs "work in a slightly different way."
Sarcopenia can be managed through resistance exercises and dietary changes. APTA offers a consumer guide to sarcopenia and frailty at MoveForwardPT.com and features courses on frailty and mobility in the APTA Leaning Center (search "frailty" and "mobility").
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