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  • New Telehealth Bill Includes PTs, Could Mean Big Changes for Medicare

    A newly introduced bill aimed at expanding the use of telemedicine in the Medicare system would allow reimbursable telehealth services for physical therapy and permit use of the technology in more populated areas.

    Called the Medicare Telehealth Parity Act of 2014 (.pdf), the bill introduced by Reps Mike Thompson (D-CA) and Gregg Harper (R-MI) would gradually roll out changes over 4 years. The changes would eventually remove current limits on the population areas that qualify for Medicare's telehealth reimbursements, allow for much-expanded remote patient monitoring, and include rural health clinics as approved telehealth care sites.

    Another important feature of the bill: a provision that outpatient therapy services, including physical therapy, delivered via telehealth technologies would be reimbursable under Medicare.

    Although Medicare currently allows some telehealth delivery, the system limits reimbursable use to rural areas, and requires beneficiaries to travel to "originating sites," with no provisions for remote patient monitoring. The proposed bill would use a phased-in approach to remove those population-based limits and allow the addition of remote patient monitoring for specific conditions. The bill also requires the General Accountability Office to study the use of remote patient monitoring for outpatient therapy.

    This year, APTA's House of Delegates approved a resolution that supports the adoption of telehealth technologies in physical therapy as "an appropriate model of service delivery" when provided in ways that are "consistent with association positions, standards, guidelines, policies, procedures, Standards of Practice for Physical Therapy, Code of Ethics for the Physical Therapist, Standards of Ethical Conduct for the Physical Therapist Assistant, the Guide to Physical Therapist Practice, and APTA Telehealth Definitions and Guidelines; as well as federal, state, and local regulations."

    APTA will monitor this bill and alert members on its progress.

    APTA offers resources on telehealth in physical therapy—including a link to Board of Directors definition and guidelines--on its telehealth webpage.

    PTNow: Easier, Better, Faster, Stronger

    Think PTNow.org has made it easier to use evidence in patient care? The PTNow Editorial Board has something to say about that: you ain't seen nothin' yet.

    A July 29–31 meeting of the board brought together 22 board members representing acute care, cardiovascular and pulmonary, geriatrics, home health, neurology, oncology, orthopedics, pediatrics, sports, and women’s health with social media and video experts and APTA staff to assess PTNow’s progress and look to the future. PTNow cochairs Judy Deutsch, PT, PhD, FAPTA, and Tara Jo Manal, PT, DPT, OCS, SCS, led discussions and breakout sessions geared toward finding the best and quickest way to help clinicians apply evidence and improve patient and client outcomes.

    In an APTA video dispatch, Deutsch highlighted major developments over the past year, including integration of APTA’s Open Door service, now known as PTNow ArticleSearch, into the PTNow site for seamless access to full-text articles in a variety of literature databases; launch of PTNow’s blog, including features such as "All Evidence Considered," with a primary goal of talking about what to do when evidence is weak or doesn’t exist; and launch of CPG+ (see CPG+ torticollis guidelines for an example), a translation aid that provides highlights of clinical practice guidelines and guidance about what changes clinicians can make immediately based on a guideline.

    According to Deutsch, PTNow users can look forward to more enhancements over the next year, including increased resources on intervention. "That’s one of the areas where PTs probably want the most help," she said. "We’re going to synthesize information about intervention and animate it with videos. Our video repertoire is going to be much richer."

    In addition, Deutsch said, education and outreach efforts will "explode in terms of mini-sessions on the site and targeted presentations to all kinds of audiences—clinicians, educators, and even clinicians in training, [who] are our students."

    When it comes to reactions to PTNow, "people can’t believe that this resource exists," Deutsch said. "People are finding the synthesis products to be very relevant to their practice. They're excited about it, and they always give us suggestions for improving it, and that's exactly what we are doing—we're dynamically trying to change and respond."

    SNF, IRF Final Rules for 2015 Released by CMS

    Rule changes for skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) will increase payments by 2% and 2.2%, respectively in 2015. In addition to the increases, the new rules issued from the Centers for Medicare and Medicaid Services (CMS) will make changes to a host of reporting, coding, and data collection models, as well as establish definitions of various therapy models in IRFs.

    The payment increases amount to an additional $750 million for SNFs, and an increase of $180 million for IRFs.

    IRF rules changes (.pdf) include the following:

    • Removal of 10 status post-amputation diagnoses codes from the list of codes that meet presumptive compliance criteria
    • Beginning October 1, 2015, addition of an item in the IRF patient instrument (PAI) to record the amount and mode of therapy delivered by each therapy discipline for the first 2 weeks of the IRF stay
    • Creation of definitions for "individual therapy," "co-treatment," "concurrent therapy," and "group therapy" in an effort to align with current SNF Part A definitions
    • Addition of a yes/no check off in IRF-PAI that would indicate whether prior treatment and severity requirements have been met for patients with arthritis
    • Addition of IRF quality reporting measures that would include outcome measures related to MRSA and clostridium difficile infection (CDI)

    The final rule changes for SNFs (.pdf) involve a provision that will allow SNFs to use a change of therapy (COT) other Medicare required assessment (OMRA) to reclassify residents formerly but not currently in a therapy resource utilization group (RUG) into a new RUG. CMS will continue to prohibit the use of the COT OMRA for initial classification of patients into a therapy RUG.

    Additionally, the SNF final rule includes a statement from CMS that acknowledges the comments it received around the development of an alternative therapy payment model. The agency states that several models are being explored, and that the changeover to a new model must be timely and incorporate stakeholder feedback that addresses problems in the current SNF payment structure. CMS has not set a date for implementation and is still accepting input on the issue.

    APTA will post a detailed summary of the rules in the coming weeks.

    Want to find out exactly how these rules changes will affect your practice setting? Attend APTA’s Postacute Care Compliance Seminar on November 15, 2014.