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  • 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.

    Now Law, Locum Tenens Win Was Years in the Making

    In signing the 21st Century Care Act into law on December 13, President Barack Obama not only set in motion a series of broad changes that could step up cancer research and improve responses to the opioid crisis, he also ensured that physical therapists (PTs) would gain something APTA has been working on for several years—the ability to provide care continuity for patients in the PT's absence through a provision known as "locum tenens."

    Mike Matlack, APTA's director of congressional affairs, says it's a win worth celebrating. But he adds that it's also an object lesson in the work sometimes required to get Congress to sit up and take notice.

    "Locum tenens has been among APTA's top public policy priorities for some time, so the passage of the Cures Act, with locum tenens for PTs included, is a big deal," Matlack said. "The advocacy effort wasn't easy, but we had a strong partner in our Private Practice Section, and we were fortunate to get buy-in early on from some influential members of the Senate and House."

    Now the law of the land, the Cures act contains a provision that includes PTs among the health care professionals who may use locum tenens, allowing a PT to bring in another licensed physical therapist to treat Medicare patients and bill Medicare through the practice provider number during temporary absences for illness, pregnancy, vacation, or continuing medical education.

    The original legislation introduced in 2015 was freestanding, called the "Prevent Interruptions in Physical Therapy Act." Sens Charles Grassley (R-IA) and Bob Casey (D-PA) introduced the bill in the Senate, with Reps Gus Bilirakis (R-FL) and Ben Ray Lujan (D-NM) doing the same in the House. During Senate Finance Committee hearings at the time, Grassley stated that "physical therapists provide important and much needed services to their patients, and should have the ability to ensure continuous care for their patients when a period of short-term care is needed."

    As the bill made its way through House and Senate Committees, APTA and the Private Practice Section (PPS) kept up the advocacy drumbeat. APTA and PPS were able to provide PT testimony at a House subcommittee hearing in October of 2015 by way of Sandra Norby, PT, who told legislators that "Any interruption … is going to be very very detrimental to the progress of [a patient's] care," and that "if continuity is interrupted, [patients] are literally going to have more visits to achieve that goal we set up in the first place."

    In 2016, locum tenens was 1 of the core messages brought to Capitol Hill when more than 250 PTs, physical therapist assistants, and students from 46 states participated in APTA's federal advocacy forum. Aided by representatives from PPS, the association's congressional affairs staff kept the momentum going through the year, and, eventually, the bill was rolled into the Cures Act legislation passed by both the Senate and House in early December in a rare show of bipartisan support.

    As is usually the case, compromise was part of the process. While APTA originally pressed for locum tenens to be extended to all PTs, the final version of the legislation applies only to PTs in non-Metropolitan Statistical Areas, Medically Underserved Areas, and Health Professions Shortage Areas as defined by the US Department of Health and Human Services. The scaling back happened after some legislators voiced concerns about a Congressional Budget Office report on the potential costs of implementing the law as written.

    "Of course we would have preferred that Congress gave us everything we asked for," Matlack said, "but the locum tenens provisions we were able to achieve will allow us to make the case for extensions in the future."

    PPS President Terence Brown, PT, agrees with Matlack. “The Private Practice Section is excited about the passage of locum tenens provisions for some of our members, and we look forward to expanding the provision to include all private practices in the future," he said. "This issue has long been championed by the section, and the grassroots efforts of our members were instrumental in its passage. It provides needed relief for small private practices and allows for consistency in the care of Medicare beneficiaries.”

    APTA will monitor implementation of the law, and will provide updates and information on how qualified PTs can make use of locum tenens provisions.

    APTA, NIH Celebrate Rehab Research Plan

    Has rehabilitation research arrived at a turning point? Very possibly, according to speakers who helped APTA celebrate the completion of the National Institutes of Health's (NIH) rehabilitation research plan, a comprehensive reset of approaches and priorities that supporters believe will help to power up investigations into restoring function.

    2016 - 12 - 13 - NIH 1
    APTA CEO Justin Moore, PT, DPT, welcomed the audience at the briefing.

    The celebration came in the form of a congressional briefing held on Capitol Hill December 8. Sponsored by APTA and other members of the Disability Rehabilitation Research Coalition, the event featured remarks from Rep Greg Harper (MS–3rd), Rep Jim Langevin (RI-2nd), Allison Cernich, director of the National Center for Medical Rehabilitation Research (NCMRR) at NIH, and Rebecca Craik, PT, PhD, FAPTA, co-chair of the NIH blue ribbon panel that guided the creation of the 5-year plan. Craik is a former editor in chief of Physical Therapy, APTA's scientific journal.

    2016 - 12 - 13 - NIH 2
    Rep Jim Langevin, from Rhode Island, speaks at the congressional
    briefing on NIH rehabilitation research.

    Craik described the factors that led to the creation of the new plan, telling the audience about a 2011 review of the NCMRR research plan that hadn't been updated since its creation in 1993, as well as a general environmental scan of research taking place. Despite the age of the plan, reviewers found the state of rehabilitation research to be "pretty good," Craik said, but agreed that much more could be done to create and support an up-to-date, well-coordinated research effort.

    "NCMRR was functioning, but it certainly wasn't thriving," Craik said. "And we thought it had incredible opportunities to thrive."

    Cernich told attendees that the recommendations of the blue ribbon panel around an updated plan have led to the creation of a roadmap that will not only allow NCMRR to thrive, but will set the stage for a new era of collaboration across NIH institutes and other centers.

    "We're making efforts to understand gaps in the field," Cernich said. "We will talk across institutes and centers about the state of the science, where we are going together, and how we can use the science we're doing at each of these institutes to inform the work of the other—and then how do we let the community know what the opportunities are across the NIH."

    The plan was unveiled in September, and was given a boost by way of the 21st Century Cures Act recently approved by both the House and Senate. APTA was a strong supporter of both the plan and increased funding for rehabilitation research.

    The December 8 briefing also included a presentation from Josh Rouch, a patient who shared his rehabilitation journey after suffering a traumatic brain injury. In describing what worked and what didn't, Rouch pointed to the value of rehabilitation research as a way to identify patient-centered paths to regaining function.

    Rouch's story underscored what both Cernich and Craik reminded the audience: this isn't highly theoretical, ivory tower stuff. Rehabilitation researchers are often engaged in projects with immediate applications that make a difference in people's lives in the here-and-now. As an example, Cernich cited the GoBabyGo! initiative founded by Cole Galloway, PT, PhD, FAPTA, which "hacks" commonly available children's ride-on cars to create devices that can help even very young children achieve greater mobility.

    "This project is not only about mobility…what Cole's done is put them in the driver's seat, literally," Cernich said. "They have the social, cognitive, and emotional curiosity of any other child, and what his research is doing is putting them with their peers. They get to drive, and kids are running after them. That's where we want children with disabilities to be."

    Craik pointed to the ways that rehab research enriches overall efforts to understand diseases and conditions, using colon cancer research as an example. Some researchers look into the mechanisms related to the disease, while others research treatment—what she called a "bench to bedside" approach.

    "But what's missing?" Craik asked the audience. "You don't want to stay in the bed. After you've had a cure from colon cancer what's going to happen? How do we restore the function that the person had prior to the colon cancer?" Those are the kinds of questions rehab research investigates, she said.

    Cernich said that the boost to rehabilitation research couldn't have happened without the support of NIH efforts from stakeholders, including APTA.

    "You're going to be the ones that represent the 20% of the American population that lives with a disability, and the 40% that care for them," Cernich said. "We cherish that and we appreciate you being their voice."

    Cosponsors of the briefing included the Brain Injury Association, the Association of Rehabilitation Nurses, the American Occupational Therapy Association, the American Speech Language Pathology Association, the American Academy of Physical Medicine and Rehabilitation, the United Spinal Association, the American Congress of Rehabilitation Medicine, the American Music Therapy Association, and the American Therapeutic Recreation Association.




    Outpatient Payment, Home Health Fact Sheets Now Available From APTA

    Now available to APTA members: context and details to help you understand final 2017 rules from the Centers for Medicare and Medicaid Services (CMS) on the home health (HH PPS) and outpatient (OPPS) prospective payment systems.

    The final OPPS rule, which grabbed headlines earlier this year for its elimination of pain management questions from patient satisfaction surveys, also includes payment increases and changes to the ways hospital-owned off-campus outpatient departments are paid. The APTA fact sheet covers these provisions, as well as comprehensive ambulatory payment classifications, and CMS’ plans for future quality reporting. To access the fact sheet, visit the APTA Medicare Payment and Policies for Hospital Settings webpage. Scroll to the "Outpatient Care" area and look under the "APTA Fact Sheets and Summaries" header.

    The 2017 HH PPS rule continues planned cuts next year, and includes changes to the home health quality reporting program and the way payments are made for negative pressure wound therapy, among other topics. The APTA fact sheet can be accessed on the association's Medicare Payment and Policies for Home Health webpage, under the "APTA Fact Sheets and Summaries" header.

    APTA’s November 9 Insider Intel call-in program included an outline of HH PPS and OPPS provisions. To listen to a recording of the program, visit the Insider Intel webpage and click on the November 9 link under “Archives.” Want even more information on CMS-related changes in store for 2017? Don't miss the December 8 webinar, "Medicare Payment and Compliance: What You Need to Know for the Year Ahead." The program is available at no cost to APTA members.

    Quick Guide and Call-In Q&A Are Latest New Resources to Prepare for Payment in 2017

    A new guide to using the 3 new tiered evaluation codes that come into play January 1, 2017, gives APTA members a quick graphical explanation of the criteria for determining when an evaluation is considered “low,” “moderate,” or “high” complexity. Developed by APTA, the guide is available as a 2-page printable PDF download and, as a bonus, is being included as a printed pocket-sized guide in members’ December 2016-January 2017 issues of PT in Motion magazine.

    The quick guide joins other APTA resources that can help members become familiar with the codes, which were included in the final 2017 Medicare physician fee schedule.

    Among those other resources: the latest recording of APTA’s Insider Intel, APTA’s series of call-in sessions that allow members to pose questions to staff experts on current topics. The November 9 call-in led off with the new evaluation codes, of course, but other need-to-know topics included the review of potentially misvalued CPT codes; provisions to implement the Medicare Access and CHIP Reauthorization Act of 2015 as well as the Improving Medicare Post-Acute Care Transformation Act of 2014—known as MACRA and IMPACT, respectively; and final rules for the home health and outpatient prospective payment systems. A full recording of the November 9 call is available here.

    To see what else APTA offers, visit the association’s New Evaluation and Reevaluation CPT Codes webpage, where new tools are being added regularly in the countdown to January 1.

    Get the Facts on the 2017 Fee Schedule

    Now available to APTA members: context and details to help you understand the final 2017 physician fee schedule rule from the Centers for Medicare and Medicaid Services (CMS).

    The rule covers Medicare Part B services that apply to physical therapists (PTs) and other providers. This year, in addition to the more typical changes, such as adjustments in the conversion factor and updates to the therapy cap amount, the final rule includes a big shift: the new 3-tiered current procedural terminology (CPT) code system for physical therapy evaluations.

    The APTA Fact Sheet now available covers those provisions, as well as the latest on potentially misvalued codes, telehealth services, revisions to self-referral laws, and more. Visit the APTA Medicare Physician Fee Schedule webpage to access the fact sheet (look under the "APTA Summaries and Fact Sheets" header).

    Want more information on the fee schedule and other CMS-related changes in store for 2017? Don't miss the December 8 webinar, "Medicare Payment and Compliance: What You Need to Know for the Year Ahead." The program is available at no cost to APTA members.

    Final Fee Schedule Maintains Tiered CPT Coding System, No Tiers in Payment – With a Few Twists

    As expected, the final 2017 physician fee schedule rule from the Centers for Medicare and Medicaid Services (CMS) doesn't vary much from what was proposed earlier this year—including the new 3-tiered current procedural terminology (CPT) code system for physical therapy evaluations, all with the same payment rate. However, some new developments add a few positive elements to the picture.

    The rule covers Medicare Part B services that apply to physical therapists (PTs), physicians, and other providers. APTA regulatory affairs staff is reviewing the final rule and will develop a more detailed summary in the coming weeks. In the meantime, here are some features of the new rule that affect PTs:

    CMS held to the tiered evaluation codes – and the same reimbursement for each.
    CMS adopted much of the system created by the American Medical Association (AMA) CPT Editorial Panel to retool current procedural terminology (CPT) codes for physical therapy evaluation and reevaluation. The new evaluation code descriptors stratify evaluations by complexity—low (97161), moderate (97162), and high (97163)—but CMS will keep the longstanding relative value unit (RVU) of 1.20 for all 3 levels of evaluation. That decision, opposed by APTA, is a departure from recommendations from the AMA Relative Value Scale Update Committee. These codes replace the existing 97001 and 97002 codes, which will expire on January 1, 2017, when the new codes are implemented.

    CMS reconsidered and will increase payment for reevaluation.
    The rule also includes 1 new reevaluation code (97164). In the proposed rule, this code carried a reevaluation rate of .60, same as for the old reevaluation code. In the final rule, that rate was increased to 0.75.

    Claim reviewers won't be able to use the new codes to "ding" manual medical reviews.
    In an acknowledgment of APTA's concerns for adequate time to educate PTs on the use of the new coding system, CMS decided that no changes will be made to the Medicare benefits policy manual for 2017—that means reviewers won't be able to penalize providers regarding the medical necessity for the new evaluation requirements. This “grace period” won't last, however, which puts pressure on the profession to use the reprieve to work toward consistent, accurate coding.

    The therapy cap gets a $20 increase.
    The Medicare therapy cap will be $1980, up from the 2016 cap of $1960 (the therapy cap exceptions process extends through December 31, 2017, under MACRA).

    The misvalued codes—all 10 of them—will be in play in 2018.
    In the 2016 physician fee schedule, CMS identified multiple potentially misvalued codes, including some commonly used in physical therapy, for review and potential revaluation. CMS has confirmed that all 10 physical therapy-related CPT codes that it identified as potentially misvalued will be revalued in the 2018 fee schedule. A random sample of APTA members recently received a survey on these and other codes, and APTA is urging them to complete the questionnaire to help ensure accurate valuation.

    The conversion factor is up—a little.
    The 2017 Medicare conversion factor is $35.88, slightly higher than last year's conversion factor of $35.83.

    Get all the details on the new fee schedule: join APTA's "Insider Intel" call-in session coming November 9 from 1:00 to 1:30 pm. Space is limited to 100 on a first-come, first served basis.

    If you received the AMA survey on code values recently, it’s critical that you respond by the deadline. Survey input is an important source of data that CMS will use to consider new values for the “misvalued” codes.