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  • Speak Out on Proposed Orthotics and Prosthetics Rule: Here's How

    A proposed rule from the Centers for Medicare and Medicaid Services (CMS) is drawing criticism from physical therapists (PTs) over additional requirements that PTs would need to meet to qualify as providers of custom orthoses and prostheses—and APTA is making it easy for members to let CMS know what they think.

    As reported by PT in Motion News in January, the proposed rule is meant to tighten up requirements around who CMS will work with when it comes to making and furnishing a wide range of devices. For PTs, the most notable parts of the proposed rule involve a requirement that providers must be "licensed by the state [as a qualified provider of prosthetics and custom orthotics], or … certified by the American Board for Certification in Orthotics and Prosthetics … or by the Board for Orthotist/Prosthetist Certification." The additional administrative and financial burdens could affect thousands of PTs across the country.

    APTA will provide CMS with comments on the proposed rule before the March 13 deadline. In the meantime, the association is urging members to get details on the proposal via an APTA fact sheet on the rule, and to make their individual voices heard by providing comments to CMS. APTA has created a member-protected template letter and instructions that make it easy for members to let CMS know why the proposal would increase costs and restrict patient access to PTs already qualified to provide custom devices. The template may be downloaded and shared with colleagues who also may be affected by the proposed rule.

    2017 NEXT Registration Opens

    Groundhog-based prognostication aside, spring is in fact right around the corner and June isn't far behind, which means APTA's NEXT Conference and Exposition is getting ready to arrive on the scene in Boston, Massachusetts.

    APTA has opened up registration for NEXT, set for June 21-24. Again this year, NEXT is shaping up to be a can't-miss event, where the profession's thought leaders and experts come together to offer programming with an emphasis on interactivity and direct engagement.

    Programming highlights for 2017 include sessions on clinical reasoning, creative mobility technology, generational perspectives, and mindfulness in pain treatment. In addition to all the new topics, attendees can still expect annual favorites such as the McMillan and Maley lectures, and the almost-too-much-fun-for-a-conference Oxford Debate, returning to celebrate its 10-year anniversary.

    It all adds up to an event that will ignite your passion for the profession. Register today and experience NEXT 2017 for yourself.

    Think we're just making this stuff up? We're not. Check out news and video from the 2016 NEXT  for a taste of what you missed.

    Stay on Top of Medicare Changes With Latest APTA Fact Sheets

    New, proposed, and revised rules from the Centers for Medicare and Medicaid Services (CMS) can come in waves, and when they do, it's easy to feel awash in a sea of new regulations. Fortunately, APTA has resources to help you navigate your way to safe harbor: fact sheets that provide members with context and details on many of the final and proposed rule changes from CMS.

    Here's a quick rundown of some recent additions. Note: the links will take you to a general webpage on a particular topic—to access the members-only fact sheet, scroll down to the "APTA Fact Sheets and Summaries" header.

    Home Health Conditions of Participation Final Rule
    CMS brought its home health participation rule out of the 1990s by issuing its first revision to the rule in more than 20 years. The new rule establishes minimum standards for home health agencies that want to serve Medicare and Medicaid beneficiaries.

    Episodic Payment Model Final Rule
    "Episodic payment" is CMS-speak for bundled payment systems. The new rule includes requirements for bundling programs related to cardiac care in 98 metropolitan areas, and expands the range of activities covered under the Comprehensive Care for Joint Replacement (CJR) model that required bundling for total knee and total hip arthroplasties.

    Orthotics and Prosthetics Proposed Rule
    This fact sheet covers a proposed rule from CMS that would include physical therapists (PTs) among the providers who could furnish and bill for custom orthotics and prosthetics—provided the PTs meet certain qualifications.

    Medicaid Appeals Final Rule
    CMS has added provisions to improve coordination between Medicaid, the Children's Health Insurance Program (CHIP), and health exchanges under the Affordable Care Act. In turn, the rules governing how consumers contest eligibility decisions have changed.

    The latest APTA fact sheets join information on the 2017 physician fee schedule, outpatient payment, and home health payment. APTA regulatory affairs staff continually monitors developments at CMS and publishes fact sheets as new rules are proposed or implemented.

    Need information on getting through Medicare fraud and abuse probes? Check out this APTA "flipped classroom" course on audits and review—listen to a prerecorded presentation, then join a live Q-and-A session on February 9 to get your questions answered.

    Welcome Back: Therapy Cap Repeal Is Reintroduced in Congress

    After falling short by the narrowest of margins in 2015, an APTA-supported bill to end the Medicare therapy cap has been reintroduced in both houses of Congress. And now it's time for the physical therapy community to make its voice heard.

    The bill, named the Medicare Access to Rehabilitation Services Act (HR 807, S 253) would repeal the therapy cap once and for all, ending a battle that has taken place almost every year since the adoption of the 1997 Balance Budget Act. Representatives Erik Paulsen (R-MN), Ron Kind (D-WI), Marsha Blackburn (R-TN), and Doris Matsui (D-CA) introduced the legislation in the US House of Representatives. In the Senate, the bill was introduced by Sens Ben Cardin (D-MD), Susan Collins (R-ME), Dean Heller (R-NV), and Bob Casey (D-PA).

    The cap, which imposes a $1,980 therapy limit on physical therapy and speech-language pathology services (as well as a separate $1,980 cap on occupational therapy services) provided to Medicare beneficiaries, has remained a central focus of APTA's public policy advocacy efforts since its introduction. In 2015, support for ending the cap reached its highest level yet, when repeal efforts were backed by 238 cosponsors in the House but came up 2 votes short in the Senate. The vote was part of a legislative package that ended the flawed "sustainable growth rate" policy that regularly required damaging payment cuts, avoided only by nearly annual ad-hoc "doc fix" legislation.

    What remained was the cap, accompanied by an exceptions process that is set to end on December 31, 2017. After that—and barring repeal—the full force of the cap returns, and more than 1 million beneficiaries in need of rehabilitation could experience severe limitations to access.

    "We have always viewed the SGR and therapy cap as linked concepts in the sense that both put significant obstacles in the way of providing the best patient care," said Michael Matlack, APTA's director of congressional affairs. "While we had hoped that both would be ended in 2015, the repeal of SGR has cleared a path for success and set the stage for what is truly the next step in improving the lives of people in need of rehabilitation."

    While repeal of the cap gained wide support in Congress in 2015, there is no guarantee that the bill will achieve the same backing in the current Congress. That's where the physical therapy community plays a crucial role, and APTA is urging its members as well as patients and supporters of physical therapy to make their voices heard.

    That effort is made easier thanks to APTA resources. Members can email their legislators by way of APTA's Legislative Action Center, while nonmembers and patients can use the APTA Patient Action Center. Adding to the convenience, APTA's action app can make advocacy as simple as a few taps on your smartphone.

    "The reintroduction of the therapy cap repeal is exciting news, but it's also our cue to focus our energies on seeing to it that members of Congress understand the need for this change," said APTA Chief Executive Officer Justin Moore, PT, DPT. "We must get involved now by contacting our members of Congress, and we need to stay engaged throughout the legislative process and be ready to act quickly as the bill makes its way through the legislative process. We could be on the edge of an historic moment in the profession, but that moment will only arrive if we speak up."

    APTA Pursues Updated Public Policy Priorities With New Administration, New Congress

    Occupants of the White House change. Legislators come and go, and the majority in Congress shifts. But no matter who's in charge, APTA's approach to federal advocacy remains the same: priorities are established with the help of APTA members across the country, and APTA's advocacy efforts seek to protect and advance those issues.

    This week, APTA released its latest public policy priorities, which are updated every 2 years—coinciding with each new session of the US Congress.

    Like previous editions, Transforming Health Care: The public policy priorities of the American Physical Therapy Association 2017-2018, reflects the areas of greatest focus, as determined through member input, review from the association’s Public Policy and Advocacy Committee (PPAC), and approval from the APTA Board of Directors. The priorities are not a comprehensive list of all the issues that APTA will support. Also like before, APTA will continue to be nimble in order to act on new opportunities and challenges as they arise.

    APTA President Sharon L. Dunn, PT, PhD, acknowledged that some dramatic shifts in policy could lie ahead, but she thinks that APTA's most important role will be to continue to provide a source of stability to its members and the profession at large by maintaining consistent positions and strong advocacy efforts.

    "Whenever a new administration takes over, dynamics change, debates change, and political agendas change," Dunn said. "What doesn't change is APTA's commitment to its members, the profession, and ultimately to the public we all serve. The public policy priorities make it clear that APTA won't be distracted in pursuit of our vision to transform society by optimizing movement through physical therapy."

    What is different this time around is the structure of the public policy priorities document, which now aims to give readers—primarily federal legislators and policymakers—a quick take on the ways APTA's advocacy efforts help to address critical challenges, rather than supplying detailed accounts of specific legislative and policy directions. 

    Justin Elliott, APTA's vice president of government affairs, said the revamped approach should help members of Congress, their staffs, and federal policymakers see the big picture.

    "Our advocacy efforts are focused on meeting the 'triple aim' of improving population health, improving the patient’s experience of care, and lowering costs," Elliott said. "The public policy priorities demonstrate that APTA can be a leading voice in mapping the future of health care in this country."

    Six "critical challenges" are identified as priorities. For each challenge, APTA outlines solutions, including a repeal of the Medicare outpatient therapy cap, addressing onerous laws and regulations such as the multiple procedure payment reduction, achieving coverage of and payment for telehealth-delivered physical therapist services, the creation and adoption of functional outcomes measures that show the value of physical therapy, and the addition of PTs to the list of providers who can participate in federal student loan repayment programs, among many others.

    The release of the priorities document, which APTA will hand-deliver to all congressional offices on Capitol Hill next week, comes at a time of transition in Washington, DC, as President Donald J. Trump begins his administration. Policy recommendations are forthcoming from the new administration and Congress on many issues that will impact the profession of physical therapy, likely including the Affordable Care Act, although the scope and form of those changes remain unclear. To best position the physical therapy profession, APTA is already engaged in robust education and advocacy efforts.

    APTA members, their colleagues, and consumers are encouraged to download a copy of Transforming Health Care: The public policy priorities of the American Physical Therapy Association 2017-2018 to share with their members of Congress. APTA members who want to be notified about future advocacy opportunities are encouraged to join PTeam and download the APTA Action App.

    Coding Resources Continue to Grow With New Webinar, Medicare Payment Tools

    With the new tiered Current Procedural Terminology (CPT) evaluation code set now a payment reality for physical therapists (PTs), APTA is keeping watch on the system, and adding to its resources to help members understand the requirements. These resources now include a recording of a special live question-and-answer session on the codes, and the release of the 2017 Medicare Fee Schedule Calculator.

    The free recording is of a January 19 webinar that served as a follow-up to an online presentation made September 22. The earlier webinar introduced the new CPT codes and provided examples of applying them; the latest recording takes the topic to the next level by updating listeners on what's happened since implementation and providing answers to listener questions submitted in advance or at the session. Questions include topics such as whether all elements need to be documented in order to support complexity codes, if the reevaluation code should be used when ending a plan of care, and whether the codes apply to all settings.

    In addition, APTA has updated a key tool in the day-to-day needs of PTs: the Medicare Fee Schedule Calculator. The calculator helps you determine the rate of reimbursement for individual therapy codes paid under Medicare, based on your geographic location. This year in particular, the fee schedule calculator will show you the effects of the 2017 adjustment to the CMS formula for determining payment rates based on the new CPT evaluation codes.

    On the same Medicare Fee Schedule Calculator page is the 2017 MPPR calculator, which helps you determine the impact of the multiple procedure payment reduction (MPPR) policy. This Centers for Medicare and Medicaid Services policy implements reductions to the practice expense value of certain "always therapy services" CPT codes.

    For more resources on the 3 new evaluation codes,  visit APTA’s dedicated webpage .

    APTA’s Public Awareness Efforts Reach Millions in Record-Setting 2016

    APTA’s ongoing public awareness efforts continued a pattern of increasing success in 2016, reaching millions in the process – on TV and radio, online, in the media, on social media, and through paid advertising.

    Here are some highlights:

    • TV and radio public service announcements (PSAs) reached an estimated 40 million Americans in just 2 months. Released in October in support of APTA’s #ChoosePT campaign, the TV ad received free airtime in 19 states and the District of Columbia, while the radio ad received free airtime in 13 states. Both ads will receive additional donated airtime across the country in 2017, as APTA’s opioid awareness campaign proceeds.
    • MoveForwardPT.com served 3 million unique users in 2016, a 262% increase from just 2 years prior. The majority of traffic (64%) to APTA’s official consumer information website came from organic search results, as increasing numbers of Americans turn to Google and Bing for health advice. Of the site’s top 50 most viewed pages, which includes the Find a PT database, 37 were from MoveForwardPT.com’s collection of more than 185 symptoms and conditions guides with physical therapy specific information.
    • APTA media relations staff supported more than 250 media placements, many of them surrounding APTA’s #ChoosePT campaign, which was announced with a billboard in Times Square and generated the Associated Press article that reached news outlets nationwide.
    • Social media engagement with the Move Forward brand continued to increase, highlighted a video profile of a 73-year-old runner who is blind and has completed more than 50 marathons and 8 Ironman triathlons, thanks to support from physical therapists; a Move Forward Radio podcast interview with volleyball icon Gabby Reece, who discussed her decision to recover from knee replacement surgery without opioids; and the 60-second TV PSA for the #ChoosePT campaign, which generated more than 300,000 additional views via social media.
    • Paid advertising for the #ChoosePT campaign appeared on multiple major news outlet websites, several Capitol Hill publications, WebMD, World Series (and ALCS and NLCS) programs, and more. Numerous APTA chapters extended the reach by placing billboards and other advertising in states including Nevada, Iowa, Kentucky, and New Hampshire.

    “The annual increasing success of our public awareness efforts is as exciting as it is unmistakable,” said APTA President Sharon Dunn, PT, PhD. “The MoveForwardPT.com website’s reach was crucial to APTA being the only health care association representing nonprescribers that was invited to participate in the White House’s opioid working group, and the related #ChoosePT campaign has elevated our efforts to new heights. But what makes me most proud is the way our chapters and sections have rallied around these efforts to create a unified, impactful campaign.”

    Bring Your CPT Code Questions to APTA's Upcoming Webinar

    Have questions about the 3 tiered CPT evaluation codes that began on January 1? Here's your chance to get some answers.

    Join a live CPT Q&A webinar on January 19 at 1:00 pm ET , when members Helene Fearon, PT, and Kathleen Picard, PT, will be joined by APTA staff to respond live to questions (submitted in advance) about the new code set. The 1-hour session will also include a quick overview of any updates made since the final rule was released in November. And best of all, it's free to APTA members.

    This Q&A webinar is a follow-up to APTA's webinar from September 22, 2016, which outlined the new codes as proposed in the 2017 Medicare physician fee schedule. To best prepare for the January 19 Q&A, watch the September 22 webinar, then submit any questions you have. If you register before January 12, you'll have time to send in your own questions for the presenters to consider and answer during the session.

    Register now for the January 19 webinar, and submit your questions by January 12 (instructions for submitting questions are included in the Learning Center course description). If you can't attend, the Q&A will be recorded and made available through the Learning Center.

    The January 19 webinar is one of multiple APTA resources to help you navigate the decision processes for using the CPT codes. .For a quick look at more resources, view the association's new 2-minute video "5 Resources for 4 New CPT Codes," and visit the association's webpage dedicated to the new codes.



    Reintroduced Bill Protecting PTs Traveling With Sports Teams Passes in House - Again

    A new year, a new Congress, and, now, new movement on a bill that helps to protect physical therapists (PTs) and other health care providers who travel across state lines with sports teams.

    On January 9, the US House of Representatives passed the Sports Medicine Licensure Clarity Act (HR 302) in a noncontentious vote (view a video clip of the vote and legislators' remarks on the issue here). The legislation aims to provide added legal protections for sports medicine professionals when they're traveling with professional, high school, college, or national sports teams by extending the provider's "home state" malpractice and professional liability insurance to any other state the team may visit.

    When it was first introduced in 2015, the bill's coverage was restricted to only physicians and athletic trainers. Advocacy staff at APTA worked closely with the office of sponsor Rep Brett Guthrie (R-KY) and House Energy and Commerce subcommittee staff to add PTs to the list.

    The bill was introduced in both the House and Senate last year, where it passed in the House but was not taken up by the Senate. Advocates for the bill are hoping that the early action in this Congress will help pave the way for Senate action, yet to be introduced.

    APTA advocacy staff is working with sponsors and Senate staffers to determine next steps.

    Keep the momentum going on Capitol Hill: Join APTA staff and fellow members for this year's Federal Advocacy Forum, March 26-28 in Washington, DC.

    Expanded CMS Bundling Programs – With Payment Incentives – Ready to Launch in 2017

    Amid administrative changeover and potential shifts in the future, the Centers for Medicare and Medicaid (CMS) is moving ahead to expand its mandatory bundled payment programs related to cardiac care and joint replacement. And there's good news for physical therapists (PTs): the new rule will make it possible for PTs to receive incentive bonus payments for joint replacement care provided in 2017 as part of a bundled care program.

    Under an updated Comprehensive Care for Joint Replacement (CJR) program beginning on January 1, 2017, clinicians, including PTs, will receive additional opportunities to qualify for a 5% payment bump through the Advanced Alternative Payment Model (APM) path. Clinicians using the new accountable care organization "Track 1+ Model"—a program with a slightly more limited downside risk, designed for smaller practices—could earn the bonuses for care delivered in 2018. The new avenues to incentives were opened up when CMS decided to include the bundling models in its list of qualified APMs.

    The CJR debuted April 1, 2016, and was the first time CMS implemented a mandatory bundling program, albeit one limited to 67 metropolitan statistical areas. The basic idea: CMS establishes a lump payment target for total episode of knee and hip replacements, from admission to 90 days postdischarge, and compares what hospitals spend in total on care with what Medicare thinks they should be spending. If the total spending is less than the Medicare target, the hospitals may be eligible to receive additional payment from Medicare—but if they spend more than the Medicare target, they could be required to pay back Medicare for some portion of the difference.

    In addition to the increased opportunities for payment incentives, the 2017 version of the CJR will expand bundling provisions beyond hip and knee arthroplasty to include patients undergoing care for hip and femur fractures. That project is set to launch in July 2017 and will last for 5 years.

    CMS will also move ahead with a similar program focused on cardiac care in 98 randomly selected metropolitan areas (which happen to include the 67 areas already covered in the CJR). The cardiac model will be applied to care associated with bypass surgery and heart attacks, and includes provisions that will incentivize the use of cardiac rehabilitation. Like the CJR, participating clinicians will be eligible for incentive payments, but not until the 2018 performance year at the earliest. The program will begin on July 1, 2017, and continue until December 31, 2021.

    Well, maybe it will. According to some media reports, members of the incoming Trump administration—particularly Rep Tom Price, its nominee for Health and Human Services Secretary—aren't particular fans of the ways in which the Centers for Medicare and Medicaid Innovation (CMMI) has mandated the programs. National Public Radio reported that in September, Price was among a group of GOP lawmakers who wrote to CMS urging that CMMI "stop experimenting with Americans' health, and cease all current and future planned mandatory initiatives."

    "Obviously, whenever administrations change over, even when control stays with the same party, you can expect change," said Roshunda Drummond-Dye, APTA director of regulatory affairs. "We will leave the predictions about what will happen to the bundling programs to others, and instead focus our efforts on helping our members understand how to work most effectively within these models. Right now, we're very pleased that CMS listened to our comments and will be including CJR and other bundled payment models in the list of advanced alternative payment models under [the Medicare Access and CHIP Reauthorization Act, or MACRA], which allows PTs to participate in payment incentive programs."

    The association's education efforts on bundling began well before the April 1 startup of CJR, and include 2 webinars (1 on the basics of the CJR program, and 1 that includes insights from PTs participating in bundled care programs), an article in PT in Motion magazine, and an entire webpage that contains background information as well as links to evidence-based clinical information and community programs.

    APTA regulatory affairs staff will review the final rule on the bundling programs and post a summary in the coming weeks.