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  • With Health Care Reform Plan Still Unclear, APTA Signs Onto Coalition Letter to Preserve Rehab Services

    While Congress and the White House discuss what, if anything, will be offered as a replacement for or adjustment to the Affordable Care Act (ACA), APTA and other organizations are staking out their positions on policies that should remain no matter what. At the top of that list: ensuring access to care through the continuation of rehabilitation services and devices as an "essential health benefit" (EHB) that must be provided to patients.

    Recently, APTA joined a group of 46 national clinician, consumer, and membership organizations known as the Coalition to Preserve Rehabilitation (CPR) in a joint letter to Congress expressing opposition to any health care reform effort that would drop rehabilitation as an EHB for Medicaid expansion enrollees and would allow waivers so that states could create their own EHBs for ACA private plans (or eliminate EHBs completely). Both of those provisions, along with a third change that would allow states to waive requirements for community ratings to contain insurance costs—also opposed by CPR—were included in the American Health Care Act (AHCA) that was introduced and then withdrawn in the US House of Representatives.

    "There is little doubt under this scenario that access to rehabilitation services and devices would suffer in many areas of the country," CPR states in its letter. "Americans needing rehabilitation services and devices rely on their health care coverage plan to regain and/or maintain their maximum level of health, independent function, and independent living. This reduces long-term disability and dependency costs to society."

    The letter also urges Congress to maintain the skilled maintenance standard clarified by way of the Jimmo v Sibelius settlement that busted the myth of the "improvement standard."

    "CPR recommends that any legislation reforming the [ACA's] essential health benefits make explicitly clear that a patient need not demonstrate improvement in order for skilled services to be covered as reasonable and necessary," the statement says.

    This isn't APTA's first public statement on ACA reform. In late March, the association clearly laid out its opposition to the elimination of rehabilitation as an EHB, with APTA President Sharon Dunn, PT, PhD, writing that provisions being discussed at that time were "heading in a direction that would create unneeded barriers to care and reduce the access to care for millions of Americans." Ultimately, the plan on the table at that point was withdrawn without a vote. No substitute plan has emerged.

    According to Justin Elliott, APTA's vice president of government affairs, that doesn't mean APTA is sitting back to see what happens next.

    "The political situation on Capitol Hill with ACA continues to be very fluid," Elliott said. "Regardless, we will continue to reiterate our core messages to legislators and policymakers, and to educate them on why affordable access to rehabilitation services is really a cost-effective approach to health care, and one that protects a vulnerable population."

    And for members of CPR, the continuation of rehabilitative services will keep health care moving in the right direction.

    "The … members of CPR firmly believe that failing to replace the Affordable Care Act in a manner that would preserve access to rehabilitative services and devices would turn back the clock on children and adults with injuries, illnesses, disabilities, and chronic conditions," the statement concludes.

    Besides APTA, other members of CPR who signed onto the letter to Congress include the American Heart Association, the National Multiple Sclerosis Society, the Christopher and Dana Reeve Foundation, Disability Rights Education and Defense Fund, Paralyzed Veterans of America, United Cerebral Palsy, United Spinal Association, the Brain Injury Association of America, the Child Welfare League of America, and the Michael J. Fox Foundation for Parkinson’s Research.

    Don't Stop Believin': Multistate Licensure Compact Set to Begin in 2018

    The possibility that physical therapists (PTs) and physical therapist assistants (PTAs) could one day gain practice privileges in multiple states without having to obtain multiple state licenses is now a reality. This week, Washington signed on to the Physical Therapy Licensure Compact (PTLC), bringing the number of participating states to 10, the magic number of states needed to officially establish the system. Next up, actual implementation and an ongoing press for more states to join.

    On April 25, Washington Gov Jan Inslee signed the bill that added Washington to Arizona, Kentucky, Mississippi, Missouri, Montana, North Dakota, Oregon, Tennessee, and Utah as states that have agreed to join a system that will allow PTs and PTAs to apply for privilege to practice in any of the participating states without having to be licensed in each state. It's a milestone for the physical therapy profession that opens the door for increased mobility.

    The PTLC is based on the establishment of a commission—a governing body comprising representatives from every state that participates in the compact—that oversees rules, applications, and the issuing of privileges to practice in other participating states. Once the system is up and running, PTs and PTAs will be able to select the additional participating states in which they'd like to practice and apply for privileges, all while maintaining licensure in only their "home" state (for a more in-depth look at the system, check out this 2016 PT in Motion magazine article).

    Compact arrangements exist in a few other professions, but it was the Federation of State Boards of Physical Therapy (FSBPT) that got the ball rolling for PTs and PTAs. APTA joined FSBPT in a collaborative effort to work out a system that would both protect the public and make sense for the profession. Once the architecture of the system was created, it was time to build the compact through work with individual state APTA chapters, state licensing boards, and the legislatures themselves.

    The hurdle? A minimum of 10 states were necessary to establish the commission and get the ball rolling. Last year, Oregon, Arizona, Tennessee and Missouri adopted PTLC legislation. This year, the addition of 6 more states brought that number to 10. And away we go.

    The waiting is the hardest part
    But hold on: Washington's adoption on PTLC doesn't mean PTs and PTAs can now start practicing in compact states, says Angela Shuman, APTA's director of state affairs.

    "Right now, it's important to understand that nothing has changed in terms of practicing across state lines for anybody, even after Washington," Shuman said. "To participate in the compact, PTs and PTAs will need to apply for privileges with the Physical Therapy Compact Commission, but that commission hasn't been established yet."

    Shuman explained that after the commission is established, with each participating state naming a member, it must create rules for how the system will operate, including establishing fees. At the same time, logistical and technological issues will need to be resolved. These elements probably won't be in place until the first half of 2018, according to Shuman.

    "Until then, it's business as usual," Shuman said. "If you want to work in another state, you have to apply for a license."

    You can't always get what you want
    Even after the commission is up and running, PTs and PTAs should be aware that the compact may not be for everyone.

    "There will be strict criteria for participation in the compact," Shuman said. Among the requirements:

    • The applicant can have no limitation from any state on a license to practice.
    • No adverse licensing board action can have been taken against the applicant for at least 2 years prior to the application.
    • The applicant must meet any jurisprudence requirements (typically an additional examination) that may be required by a compact state for which privileges are requested.
    • The participant must report any adverse regulatory board action from a nonparticipating state within 30 days of the action being taken.

    Don't stop thinkin' about tomorrow
    While the addition of Washington into the PTLC was a landmark event, it’s just the beginning. The ultimate goal of the PTLC is to gain participation from every state, making it possible for PTs and PTAs to gain practice privileges anywhere in US, all while holding only 1 license. According to Shuman, compact legislation is still pending in a few states this year, with the possibility of more states taking on the legislation in 2018.

    "Now that the compact can become operational, we're hoping this inspires even more APTA state chapters to advocate for compact legislation," Shuman said. "Staff at APTA national can help with this effort, and we now have a track record from 10 states to help guide us in the advocacy process." Shuman urges anyone interested in pursuing compact legislation to contact the APTA state affairs staff.

    Want to keep up with what's happening at the state level? Check out APTA's State Legislative Tracker, an interactive map that allows you to select a topic and track legislative status. To learn more about the issues and find out how you can help, visit the association's state advocacy webpage.

    2017 0424 - Compact Act Signing News
    Washington Governor Jay Inslee (seated) signs legislation that makes the state the 10th to join the Physical Therapy Licensure Compact. On hand for the signing were, from left: Rep. Nicole Macri, a sponsor of the bill; Melissa Johnson, lobbyist for the Physical Therapy Association of Washington (PTWA); Mark San Souci from the State Liaison Office of the US Department of Defense; Andy Wodka, PT, DPT, MBA; Emilie Jones, PT, DPT; Ross Baker, lobbyist for Virginia Mason Hospital; Heather Cavaness, PTWA staff member.


    CMS Clears Up Error in Description of Which CPT Code Combinations Won't Receive Full Payment

    Apparently, physical therapists (PTs), occupational therapists (OTs), and the outpatient facilities they work for aren't the only ones adjusting to the new Current Procedural Terminology (CPT) tiered coding set: recently, the Centers for Medicare and Medicaid Services (CMS) informed APTA that it's revising its National Correct Coding Initiatives “procedure to procedure” edits, a long list of CPT code pairs that should not be reported together. That list of problematic paired codes included PT and OT evaluation and reevaluation codes.

    It's a complicated situation, but the bottom line is, CMS is making changes that should allow for full payment of PT and OT evaluation and reevaluations code combinations that previously resulted in erroneous payment denials or partial payment when the new code set was first adopted in January. Ironically enough, it appears the change is an attempt by CMS to correct an error in its National Correct Coding Initiative. Here's a breakdown:

    Who does this affect?
    The change affects PTs, OTs, and institutions in the outpatient arena.

    What was the problem?
    The issue involves something called the National Correct Coding Initiative Procedure to Procedure code pair edits—an automated system that prevents improper payment when certain codes are submitted together for Part B-covered services. The problem was that this list of code sets included combinations frequently used when PTs and OTs conduct evaluations or reevaluations on the same beneficiary on the same day, a not-unusual occurrence in some outpatient facilities. When the facility or provider would attempt to seek payment using a PT/OT evaluation or reevaluation code combination, Medicare would deny the claim.

    What are the code combinations in question?
    The PT and OT CPT codes that were included in the list of "improper" combinations were 97161/97165, 97162/97166, 97163/97167, and 97164/97168.

    Has CMS fixed it?
    Mostly. APTA alerted CMS to the problem earlier in the year, and CMS issued a letter to Medicare administrative contractors to use a workaround that would allow for full payment to institutions that used the PT/OT code combinations. The workaround was a result of CMS agreeing with APTA's recommendation that the code modifier be changed from "0" to "1" for the combinations in question, a shift that tells Medicare to pay out on both codes.

    What still isn't fixed is the edit table itself —that list of code combinations CMS says should not be reported together except when clinical circumstances justify it. The new version, no longer containing the PT/OT evaluation and reevaluation code combinations, is scheduled to be released July 1.

    Do PTs need to do anything differently?
    No. The workaround and changed modifier is allowing for proper payment at present. Once the new version of the coding edit document is released, the glitch should be completely cleaned up. Providers with questions can contact APTA advocacy staff.

    Coming to NEXT? Keep up with all things CMS by attending "Emerging Issues in Medicare and Health Care Reform" on June 23. And coming April 26, don't miss Insider Intel, APTA's phone-in session that connects you with staff experts for the latest in payment.

    Move Forward Radio: Physician for Redskins, Nationals Says Teamwork On and Off the Field Is Key

    Robin West, MD, is an orthopedic and sports medicine surgeon who has "always believed in" collaborative care—both as a physician and as a patient.

    In addition to her role as medical director of the Sports Medicine Institute at Inova, a large health system based in the Washington, DC, area, West is head team physician for the Washington Redskins and lead physician for the Washington Nationals. Recently, West was a guest on Move Forward Radio, APTA's consumer-oriented podcast series from MoveForwardPT.com.

    As head physician for 2 professional sports teams, West leads the medical teams on the sidelines and in the clubhouse. The 29 game-day health care providers for the Washington Redskins include physicians, physical therapists, and athletic trainers, to name a few.

    In the interview, West describes her own experience as a patient recovering from a bicycle accident in which she was unconscious for more than 6 minutes and sustained a 4-part humeral fracture. "I had a lot of injuries," West told Move Forward Radio. "I connected with [my whole health care team] at some point…. It takes a village, really, to reach this maximum in performance. I've not only witnessed it, but I've always believed in it."

    West acknowledged that typical hospital patients don't have the same quick return-to-play treatment or rehabilitation as the professional athletes she works with, due to time or financial constraints. But regardless of setting, she observes, "[Patients] are the consumers, and we have to serve them and serve them well." West advises patients to be strong self-advocates in their health care. "They really have to fight for their care and make sure they are educated about their options," she said, whether that means getting a second opinion, asking about alternative treatment strategies, or reading up on their conditions online.

    In the podcast, West cautions patients to avoid a "quick-fix" mentality when it comes to their health care. Surgery is "not always the right answer" and "has substantial risks." With surgery, she notes, "We're trying to restore your function, we're not trying to improve your function." Physical therapy, especially early on, is what "improves that function," West says.

    While surgical outcomes have improved a lot over the years, observes West, "I think surgery hasn't really changed—it's the rehabilitation techniques. It's a combination, a team approach, that's improved the outcomes."

    APTA members are encouraged to alert their patients and clients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be emailed to consumer@apta.org .

    New Members-Only Financial Resources Aimed at Student Debt

    The student loan debt burden faced by many physical therapists (PTs) and physical therapist assistants (PTAs) can feel overwhelming. APTA is providing new resources that may help members take more control over their financial futures.

    Now available at APTA.org: the APTA Financial Solutions Center, an online resource that offers members opportunities to help deepen their financial knowledge and potentially refinance student debt at a discounted interest rate. The center features 2 new offerings created in partnership with outside providers:

    The APTA Financial Education Program, powered by Enrich
    This customizable online financial education platform uses videos, articles, webinars, quizzes, online communities, live chats, and more to create a personalized experience in financial and debt education. Best of all, it's free.

    The APTA Student Loan Refinancing Program, provided by Darien Rowayton Bank (DRB)
    This loan refinancing solution offers eligible APTA members a 0.25% discount off the competitive interest rate, with an additional 0.25% discount available on electronic funds transfers.

    In addition to the Enrich and DRB offerings, the solutions center also offers links to APTA's "Red Hot Jobs" career center as well as to webpages that provide information on scholarship opportunities and discounts associated with APTA membership, with more resources to come. The new services are in response to a 2016 APTA House of Delegates charge to help address the financial burdens often associated with becoming a PT or PTA.

    "The resources now available expand the benefits of membership and are an excellent start in addressing a complex issue, but there's more to be done," said Justin Moore, PT, DPT, chief executive officer of APTA. "PTs and PTAs work hard to achieve their degrees, and they deserve to enter into our profession without feeling overwhelmed by debt. We're continuing to look at ways to engage education programs, students, and others to help make this possible."

    #ChoosePT Video Wins National Award

    APTA's #ChoosePT opioid awareness campaign has been a well-received effort to promote physical therapy as a safe alternative to prescription opioids for pain management. And now it's a national award winner.

    This week, the American Society of Association Executives (ASAE) announced that the association's public service announcement (PSA) video for #ChoosePT was selected as winner of an ASAE Gold Circle award for best video of the year. Released in September 2016, the video has aired in 27 states, receiving a combined $1.5 million in donated television airtime.

    The video depicts a young mother's struggle with opioids prescribed to her for pain and her journey back to health through physical therapy, featuring the message, "Don't mask the pain with opioids. Treat it with physical therapy." The 30- and 60-second PSAs are part of the ongoing #ChoosePT initiative that has included radio spots, billboards, and ads in venues ranging from the Huffington Post to souvenir programs for the American League and National League Championship Series and World Series. The #ChoosePT effort also features a campaign toolkit for member involvement at MoveForwardPT.com.

    The ASAE Gold Circle awards recognize "excellence, innovation, and achievement in association/nonprofit marketing, membership and communication."

    “Opioids are at the center of an ongoing national public health crisis,” said Justin Moore, PT, DPT, CEO of APTA. “We are extremely proud that APTA’s efforts to raise awareness about this issue have been recognized with this award. The #ChoosePT campaign is perfectly aligned with our vision of transforming society by optimizing movement to improve the human experience.”

    Want to support the #ChoosePT campaign? Access the campaign toolkit  or contact APTA public relations staff  to find out how you can get involved.


    Bill Introduced in House Would End Physician Self-Referral Loophole for Physical Therapy

    Medicare self-referral loopholes—the exception that allows physicians to refer patients for physical therapy and other services to a business that has a financial relationship with the referring provider—is once again in the legislative spotlight on Capitol Hill.

    On April 6, the Promoting Integrity in Medicare Act (PIMA) was reintroduced in the US House of Representatives (HR 2066), in hopes of eliminating the exception to the federal law originally intended to prohibit self-referral. That law, known as the Stark law, does prohibit most self-referral practices, but it also contains language that allows physicians to self-refer for "patient convenience" or same-day treatments—known as in-office ancillary services. Unfortunately those exceptions also include services that are rarely provided on the same day—physical therapy, anatomic pathology, advanced imaging, and radiation oncology.

    PIMA would eliminate this loophole not only as a way to ensure that the exception is used according to its original intent, but also to reduce overutilization and overall health care costs. According to 2016 estimates from the Congressional Budget Office, enacting the changes contained in PIMA would save Medicare an estimated $3.3 billion over 10 years, mostly due to what research points to as overuse of referrals among providers who can direct patients to services with a financial connection. The bill is sponsored by Rep Jackie Speier (D-CA), who introduced a similar bill in 2016.

    APTA is a strong supporter of the legislation, and is a member of the Alliance for Integrity in Medicare (AIM), a coalition of professional groups opposed to the inclusion of the services they represent in the Stark exceptions. AIM isn't alone in the fight: in 2014, the American Association of Retired Persons (AARP) issued a statement in support of PIMA.

    "Physical therapist services should never have been included as an exception to the Stark law," said Michael Hurlbut, APTA senior congressional affairs specialist. "Reasonable exceptions for services such as lab tests and x-rays would still be in place and could be performed during office visits—this legislation would simply correct an obvious problem in the law."

    Find out more about this issue on APTA's self-referral webpage, and take action now by asking your legislators to close the self-referral loophole. Contact APTA advocacy staff for more information.

    Bill Protecting PTs Traveling With Sports Teams Back in Senate, Already Approved in House

    A bill that helps to protect physical therapists (PTs) and other health care providers who travel across state lines with sports teams has been reintroduced in the Senate. Earlier this year, the US House of Representatives passed its version of the same bill.

    Known as the Sports Medicine Licensure Clarity Act (S. 808) 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" professional liability insurance to any other state the team may visit. Senators John Thune (R-SD) and Amy Klobuchar (D-MN) reintroduced the bill.

    When originally introduced, the bill's coverage was restricted to only physicians and athletic trainers. Advocacy staff at APTA worked closely with legislators and staff to add PTs to the list. In 2016, the bill, with language including PTs, was reintroduced in both chambers where it passed in the House but was not taken up by the Senate.

    "This bill is crucial for ensuring success and safeguarding the health and well-being of athletes," said APTA President Sharon Dunn, PT, PhD, in a Senate press release. "Whether it's the management of a concussion or a simple sprain, we appreciate Sen Klobuchar and the bill's cosponsors for tackling this issue that impacts athletes, physical therapists, and the rest of the players and providers who are part of the team." Dunn is a board certified clinical specialist in orthopaedic physical therapy.

    APTA recommends that members visit the association's Legislative Action Center to find out how to contact their legislators about the bill.

    APTA Encouraged by Creation of Commission on Opioid Crisis

    APTA supports a recent executive order responding to the opioid crisis, and is looking forward to opportunities to work with the Trump administration's efforts. The association's position was outlined in a statement released on April 4.

    The statement was issued in response to President Donald Trump's executive order creating a President’s Commission on Combating Drug Addiction and the Opioid Crisis, to be headed by former New Jersey Governor Chris Christie. At a listening session held in conjunction with the signing of the order, Trump described the crisis as "a crippling problem throughout the United States."

    In its statement, APTA voices its support of the executive order and its willingness to continue its work to combat the crisis—work that has included launching the nationwide #ChoosePT campaign to raise awareness of physical therapist treatment as an effective alternative to opioids for the effective management of pain in many cases.

    The association also participated in the Obama administration's opioid working group—and says it's ready to do the same for the new administration.

    "Solving the epidemic of abuse, misuse, and addiction will require teamwork across health care," APTA states. "APTA looks forward to opportunities to work with the administration to tackle this crucial challenge."

    Questions on CPT Codes? APTA Has Answers

    Even though the new Current Procedural Terminology (CPT) coding set that started up on January 1 isn't so new anymore, APTA is continuing its award-winning efforts to educate members on how the 3-tiered evaluation system works—most recently, by way of an FAQ page that includes extensive links to detailed information.

    The new page uses a set of 7 question categories as a springboard to dive into not just the hows, but also the whys behind the new system, which stratifies evaluations by complexity—low (97161), moderate (97162), and high (97163). Among the questions: "Do the new evaluation codes apply to all patients receiving services under Medicare?" "What happens if I use an old code after January 1, 2017?" and "Why did the 3 new codes replace the single evaluation code?"

    The addition of the FAQ further enhances a suite of resources and educational offerings that earned APTA the American Medical Association's 2017 CPT Excellence in Education Award, an honor given in recognition of an organization's efforts to keep its members and nonmembers fully informed of changes and issues related to the CPT code set. APTA's informational outreach includes webinars, quick reference tools, interactive forums, and, now, a set of in-depth FAQs.

    For a quick take on of some of APTA's CPT educational resources, check out this PT in Motion News roundup, which includes links to the resources themselves. And remember, signing up for the Payment edition of APTA's Friday Focus series, a monthly collection of the top payment-related stories from PT in Motion News, helps you stay on top of a range of payment issues including the CPT codes.