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  • APTA Resource Makes it Easy to Deliver Personalized Comments On Proposed Home Health Rule

    If a rule from the US Centers for Medicare and Medicaid Services (CMS) is adopted as proposed, physical therapists (PTs) and physical therapist assistants (PTAs) who work in home health could find themselves in a very different payment environment as early as 2019. That new environment could include a shift from 60- to 30-day episodes of care, and the startup of a new way to make case-mix adjustments that removes physical therapy service-use thresholds from the mix. All told, the changes being proposed could result in a $950 million payment reduction to home health, according to CMS.

    But the rule won't be finalized until later this year, and CMS is asking for public comments on its proposal. Ready to fire up your computer?

    APTA offers a template letter for PTs and PTAs who want to comment on the proposed 2018 home health prospective payment system (HH PPS) and the plans for changes to the case-mix adjustment methodology being considered for 2019. Among other positions, the letter encourages CMS to approach the new case-mix model, part of what's known as the Home Health Grouping Model (HHGM), in a budget-neutral manner and to audition the program by way of a limited demonstration project before making system-wide changes.

    Posted as a Microsoft Word file, the letter was created with the technical formatting that CMS is accustomed to, but it also includes areas that can be personalized with details and examples from the individual PT's or PTA's practice. Those personal touches can help to underscore the messages that the letter's shared elements deliver to CMS with a unified voice—namely, the concern that the HHGM "severely devalues the clinical importance of physical therapy" and negatively affects the most vulnerable patients who have the greatest need for rehabilitation.

    APTA outlined the basics of the proposed rule in a PT in Motion News story and will submit its own comments to CMS by the September 25 deadline. More information on the proposed rule is available through a CMS fact sheet.

    APTA just completed a live webinar on the proposed home health changes. PT in Motion News will alert readers when a recording of that session becomes available.

    APTA, Women's Section Help Clear Up Misinformation in NPR 'Mummy Tummy' Report

    Despite what you may have heard, if the idea of a single, daily, 10-minute exercise being the solution to diastasis recti, aka "mummy tummy," seems too good to be true, that's because it probably is. APTA and its Section on Women's Health, attempted to set the record straight.

    During the August 7 broadcast of NPR's Morning Edition, correspondent Michaeleen Doucleff reported on her experiences with a daily 10-minute abdominal exercise whose proponent, Leah Keller, a personal trainer, claims will close separated abdominal muscles often associated with women postpartum. The text version of the story that appeared on NPR's website under the rosy headline: "Flattening The 'Mummy Tummy' With 1 Exercise, 10 Minutes a Day."

    According to the story, Michaeleen reduced the separation in her abdominal muscles from 1.2 inches to .6 inches over 6 weeks, and other women in her exercise group did the same or better through the exercise. NPR reported that the program was supported by a pilot study of 63 women who all saw their diastasis recti fixed after 12 weeks.

    Not so fast, said APTA and the Section on Women's Health (SOWH). After the story aired, SOWH Vice President Carrie J. Pagliano, PT, DPT, contacted APTA with a suggestion that the section and the association point out some of the misinformation in the story. Together, SOWH President Patricia Wolfe, PT, MS, and APTA President Sharon Dunn, PT, PhD, drafted a letter to NPR describing several elements of the story that were "misleading to women seeking out help for diastasis recti." Pagliano also holds clinical specialist certifications in both orthopaedics and women's health; Dunn is a board-certified specialist in orthopaedics.

    The letter explained that besides the idea that a single short-duration exercise could be the quick-fix solution to diastasis recti, the story also contained factual errors about the kinds of exercises women postpartum should and shouldn't do. In the story, Keller tells these women to "please don't ever again in your life do crossover crunches or bicycle crunches," claiming that "they splay your abs in so many ways."

    In reality, the opposite could be the case, according to Dunn and Wolfe: contracting the rectus abdominis with a curl-up exercise has been shown to decrease muscle separation, while the exercise described in the story—a contraction of just the transverse abdominal muscle—has been associated with increased muscle separation while potentially improving how well the abdominals handle load. "It's not as simple as the '1 muscle-1 exercise approach' proposed by Keller," they write.

    Further, the authors point out, the study on which the program is based has several flaws, including the fact that only 29 of the 63 women in the study were postpartum, no explanation was provided for how diastasis recti was measured initially, and no control group was used.

    "Diastasis recti is not well understood and more research, including standardization of assessment, etiology, and clinical practice guidelines, is required," write Dunn and Wolfe. "In the meantime, a women's health physical therapist trained in the assessment and treatment of patients concerned about diastasis recti can be beneficial both during and after pregnancy to guide participation in exercise."

    In a follow-up report aired August 20, NPR acknowledged that the story received a "huge" response and included quotes from the Dunn and Wolfe letter. In that story, NPR described the criticism it had received, provided more information on the exercise in question, and included descriptions of other exercises that could be helpful, as well as advice from Dunn and Wolfe that "if done properly, the crossover crunches and bicycle crunches would actually help a woman restore the strength to all of her abdominal muscles."

    What's the Latest at CMS? Your Guide to Recent Proposed and Final CMS Rules

    The US Centers for Medicare and Medicaid Services (CMS) spent its spring and summer issuing proposed and final rules on areas ranging from the Medicare physician fee schedule, to what skilled nursing facilities will be paid and what they'll have to report, to inpatient reimbursement and home health episodes of care.

    Here's a quick guide to where some of these rules stand, and resources available from APTA—including an August 23 webinar focused on big changes CMS is eyeing for home health beginning in 2019 (11:30 am – 1:00 pm, ET). To register for the webinar email advocacy@apta.org.

    Medicare Physician Fee Schedule (MPFS)
    Status: Proposed; comments due September 11
    Resources: CMS fact sheet; PT in Motion News coverage
    The big news from the proposed MPFS for 2018 is that values for current procedural terminology (CPT) codes will be maintained—and a few even increased—after talk of the possibility that some of these codes were "misvalued." APTA is preparing comments on the proposed rule and has created a template letter for individual physical therapists (PTs) to send to CMS that covers both the proposed MPFS and more general Medicare issues.

    Home Health Prospective Payment System (HH PPS)
    Status: Proposed; comments due September 25
    Resources: CMS fact sheet; PT in Motion News coverage; August 23 webinar
    The fact that CMS will further reduce payment in 2018 by an estimated $80 million isn't exactly news—that cut is part of a series of reductions mandated by the Affordable Care Act (ACA). What is news is the CMS plan to reduce the unit of home health payments from 60-day to 30-day episodes of care, and to remove therapy service-use thresholds to make case-mix adjustments to HH payments in favor of "clinical characteristics and other patient information." Both of those changes would begin in 2019 under the proposed rule. APTA is preparing comments and is offering a webinar on August 23 from 11:30 am – 1:00 pm (ET) to outline the basics of the proposal and how to engage with CMS on the rule. To register for the webinar email advocacy@apta.org.

    Inpatient Prospective Payment System (IPPS)
    Status: Final; effective October 1, 2017
    Resources: APTA summary; CMS fact sheet; PT in Motion News coverage
    Acute care hospitals (ACHs) will see an estimated $2.4 billion increase in fiscal year 2018 (which begins October 1, 2017), while long-term care hospitals (LTCHs) will see a $110 million drop. Other highlights of the final rule include a CMS announcement that it will make medical record reviews a "low priority" when it comes to the requirement that physicians must certify that a patient admitted to a critical access hospital (CAH) will be discharged or transferred within 96 hours of admission, and the implementation of a 1-year moratorium on a policy that ties LTCH payment rates to ACH rates if an LTCH admits more than 25% of its patients from a single ACH. Another change: beginning in fiscal year 2019, CMS will include dual-eligibility status as a component in calculating penalties under the readmissions reduction program.

    Skilled nursing facility prospective payment system (SNF PPS)
    Status: Final; effective October 1, 2017
    Resources: APTA summary; CMS fact sheet; PT in Motion News coverage
    The final SNF PPS includes an overall 1% payment increase, changes to reporting requirements, and updates to the list of quality measures related to skin integrity, self-care, and mobility. CMS also will expand the window for its review of claims data related to potentially preventable 30-day readmissions. Previously CMS used a single year's worth of claims data; the rule expands that window to 2 years, an increase that CMS says will increase the number of SNFs with sufficient numbers of cases for public reporting.

    Inpatient Rehabilitation Facility Proposed Payment System (IRF PPS)
    Status: Final rule – effective October 1, 2017
    Resources: APTA summary, CMS fact sheet, PT in Motion News coverage
    Like SNFs, IRFs will see a 1.9% payment increase—about $75 million—for fiscal year 2018. The "60% rule"—a requirement that for an IRF to receive payment, 60% of its patients must require treatment for 1 or more of 13 conditions—has been adjusted to address diagnoses for patients with traumatic brain injury and hip fracture, as well as multiple trauma codes that didn't translate between ICD-9 and ICD-10. The new rule also requires IRFs to report standardized patient assessment data across 5 categories: functional status; cognitive functions; impairments; medical conditions and comorbidities; and special services, treatments, and interventions. Additionally, beginning in FY 2020, CMS will replace the current pressure ulcer measure with an updated version of the measure, an action that APTA supported in its comments.

    CMS Wants to Scale Back CJR Bundling Program for TKA, THA; Proposes Cancelling Bundle Program for Cardiac Care, Eliminating Expansion of CJR to Hip, Femur Fractures

    In brief:

    • Proposed rule would reduce the number of geographic areas required to participate in the Comprehensive Care for Joint Replacement (CJR) bundling model from 67 to 34
    • Low-volume and rural hospitals in all 67 areas would not be required to participate in CJR, but could do so voluntarily
    • Plans to implement a bundling model for cardiac care have been shelved, as are plans to expand CJR to include care of hip and femur fractures
    • Requirements for becoming a qualified provider in the CJR as an advanced alternative payment model would be broadened to include clinicians who don't have a financial arrangement with a facility but who are employed by the facility or have a contractual agreement

    The US Centers for Medicare and Medicaid Services (CMS) wants to significantly scale back the knee and hip joint replacement bundled care model and plans to cancel expansion of bundled care models to cardiac care and hip/femur fractures. The announcements were made as part of a package of proposals unveiled on August 15 that also includes some loosening of requirements for a provider to be considered as a "qualifying provider" under the joint replacement bundle program.

    The hip and knee bundle program, known as the Comprehensive Care for Joint Replacement (CJR) model, launched in 2016 as the first-ever attempt by CMS to mandate bundled care—in the case of CJR, that requirement applies to 67 different geographic areas covering some 800 hospitals. Under the proposed rule change, the number of geographic areas required to participate in CJR would drop to 34, leaving participation voluntary for all hospitals in the other 33 areas, or about 350 facilities. CMS estimates that 60 to 80 hospitals will choose to voluntarily participate. Hospitals that can and do decide to opt out of the program will have episodes beginning at any point during 2018 cancelled.

    In addition to reducing the number of geographic areas required to participate in the CJR, CMS is proposing that low-volume and rural hospitals in the remaining 34 areas also be switched from mandatory to voluntary participation.

    Per the same proposed rule, CMS would cancel a planned expansion of mandatory bundling to cardiac care, as well as expansion of the CJR to include care for hip and femur fractures. Those expansions originally were set to be put in place in February of this year but were later delayed until October 1, and then pushed back again to a January 2018 startup date. The proposed rule effectively would cancel the programs.

    As CMS taps the brakes on the CJR, it also proposes making it easier for clinicians to be included as qualifying participants in the bundling program. Under the proposed rule, providers—including physical therapists—who don't have a financial arrangement with a facility in the CJR program, but who are either directly employed or contractually engaged with a participating hospital, would be accepted into the program. It would be up to the hospitals to supply CMS with an "engagement list" of those providers, and CMS would take it from there, using Medicare Part B claims data to decide whether a clinician can be considered an advanced alternative payment model qualifying provider. Clinicians who get the nod from CMS would not be required to report to under Merit-Based Incentive Payment System (MIPS) and could be eligible for payment bonuses up to 5%. (Because physical therapists are solely voluntary participants in MIPS as of now, they wouldn’t be subject to the MIPS reporting requirement even if they don’t participate in an advanced APM—but that could, and is expected to, change in future years.)

    CMS has issued a fact sheet on the proposal. APTA staff are reviewing the proposed rule and will provide comments by the October 15 deadline.

    Population Health Resources Help PTs, PTAs Make the Case for Employer-Sponsored Programs

    Increasingly, employers are warming to an idea already familiar to many physical therapists (PTs) and physical therapist assistants (PTAs): investing in prevention and wellness efforts makes sense both in terms of overall health care and company bottom lines. Now APTA is helping PTs and PTAs interested in making that idea a reality for more employers.

    The "Working With Employers Toward Population Health" webpage is an area devoted to providing PTs and PTAs with resources to help them make the case to employers that preventing noncommunicable diseases among employees—or addressing them before they become symptomatic, disabling, and costly—is a smart move, and one that the physical therapy profession is poised to lead in collaboration with other disciplines.

    The webpage offers a perspective paper and recorded webinar on direct-to-employer physical therapy, and includes past articles from PT in Motion magazine that explore how employer self-insurance opens up opportunities for PTs and PTAs in the population health space. The page also features an inspiring blog post from Mike Eisenhart, PT, that challenges the profession to "actually deliver on the mandate of our vision and, in so doing, deliver on the essential promise that we help individuals and populations alike move away from disease and toward improved health and quality of life."

    The association will continue adding resources as they become available as part of larger efforts by APTA to support PTs and PTAs in promoting population health to transform society. Those efforts include an upcoming webinar looking at the social determinants of health and how they're measured across populations. The webinar itself is set for September 21, 1:00 pm–2:00 pm (ET), but registrants will be provided material to read in advance.

    APTA Formalizes Partnerships with Special Olympics, Move Together, AAOMPT

    There are some great organizations out there doing things that align with APTA's vision to transform society, many of which have worked with APTA informally for years. So what would happen if those organizations took the next step and formally combined forces with APTA to seize on opportunities to work together?

    We're about to find out. 

    APTA has established an "APTA Partners" program aimed at developing formal connections with organizations with shared goals. The first 3 official APTA partners are organizations that already have a history of working with the association. They are:

    The American Academy of Orthopaedic Manual Physical Therapy
    Also known as AAOMPT, the academy is a national organization committed to excellence in orthopedic manual physical therapy, with Fellows who provide the highest level of musculoskeletal care through advanced manual therapy practice. 

    AAOMPT and APTA have enjoyed a strong collaborative relationship for more than 20 years, working together on legislative efforts, advocacy campaigns, and initiatives in education and research. For many years APTA has designated AAOMPT as the US representatives to the International Federation of Orthopaedic Manipulative Physical Therapists, a subgroup of the World Confederation for Physical Therapy. Read more about the partnership in this APTA news release.

    Move Together
    Founded by Efosa Goubadia, PT, DPT, and Josh D'Angelo, PT, DPT, Move Together aims to increase access to quality rehabilitation medicine "around the corner and around the world." Its programs are focused on increasing the quality and quantity of clinics, empowering clinicians, and inspiring leaders. 

    APTA and Move Together have collaborated around the PT Day of Service, an initiative that Goubadia and De'Angelo began in 2015 and that has grown rapidly since. More recently, Move Together launched its Clinic Development Program, where volunteers work side-by-side with local community members, PTs, and municipalities to build rehabilitation clinics from the ground up and then equip and operationalize the facilities for sustainability. Read more about the partnership in this APTA news release.

    Special Olympics International
    This well-known global movement is centered on creating a new world of inclusion and community, where all people are welcomed and accepted regardless of ability or disability. Special Olympics provides year-round sport training and athletic competition in a variety of Olympic-type sports for children and adults with intellectual disabilities, giving them continued opportunities for physical fitness. 

    The Special Olympics-APTA partnership builds on the longstanding relationship that already exists between the 2 organizations, opening up possibilities to team up on joint advocacy initiatives and collaborative research. Read more about the partnership in this APTA news release.

    APTA has a well-established Strategic Business Partners program focused on relationships with for-profit companies, but this is the first time the association has formalized relationships with nonprofit organizations that share many of APTA's values.

    Shaping the Future of PT Clinical Education: Your Perspective Needed

    A sweeping effort to create a shared vision for physical therapist (PT) clinical education has led to a set of recommendations that could help shape the future of the profession. Now your input is needed.

    Launched by the APTA House of Delegates in 2014, the effort is guided by the Education Leadership Partnership, a group including representatives from The American Council of Academic Physical Therapy (ACAPT), APTA, and the Education Section of APTA. The interrelated recommendations now up for input were created by the Best Practices for Physical Therapist Clinical Education Task Force, a group charged with "proposing potential courses of action for a doctoring profession to move toward practice that best meets the evolving needs of society."

    The task force recommendations were reviewed and modified by the APTA Board of Directors and presented in a report to the 2017 House of Delegates.

    The partnership is offering 2 opportunities for feedback: a virtual town hall on August 17, 8:00 pm–9:30 pm (ET), and an in-person town hall on October 12 held as part of the APTA Education Leadership Conference in Columbus, Ohio. Registration information and instructions for preparing for the town halls are available on the task force webpage. That webpage also includes an informational video on the recommendations.

    Can't make either event? Stay tuned for an online survey about the recommendations coming in mid-August. PT in Motion News will announce the survey's launch date when it becomes available.

    Letter Helps PTs Send Unified Message to CMS on 2018 Fee Schedule, More Broad Medicare Changes

    The US Centers for Medicare and Medicaid (CMS) is looking for comments on the proposed 2018 Medicare physician fee schedule—and on Medicare as a whole. Now APTA is making it easy to seize the opportunity for the profession to speak with a unified voice.

    Just added to the APTA website: a template letter to CMS that covers both the proposed fee schedule and more general Medicare issues. The letter supports the CMS decision to make no changes to current procedural terminology (CPT) codes that were identified as possibly "misvalued," and recommends that the agency do more to increase patient access to physical therapist (PT) services, particularly in the areas of prevention, preoperative rehabilitation, and pain management.

    The letter, a Microsoft Word file, includes areas for the sender to fill in information about specific services she or he provides, practice setting, and other information. Instructions for getting the letter to CMS—electronically or by regular or express mail—are provided.

    APTA also will submit comments on the fee schedule. As in past comments on proposed rules delivered to CMS this year, the association will in its fee schedule comments include its perspective on broader changes to Medicare.

    Deadline for comments to CMS on the fee schedule is September 11.

    'Insider Intel' Covers Fee Schedule, SNFs, Outpatient Payment, More

    While the proposed rule for the 2018 Medicare physician fee schedule may have grabbed the attention of physical therapists (PTs) for taking a light touch to potentially "misvalued" current procedural terminology (CPT) codes, there's more to the proposed rule than that. And there's a host of other actions from the US Centers for Medicare and Medicaid Services (CMS) that PTs need to know about as well. Are you up on all the changes?

    "Insider Intel" to the rescue.

    Now available: a free recording of the latest Insider Intel session, the call-in program that provides APTA members with the latest on payment and regulatory issues. The July 19 program covers a very active period for CMS by diving into not only the fee schedule but also news related to skilled nursing facilities, home health, hospital outpatient payment, and the status of a controversial CMS plan for prosthetics and orthotics.

    The recorded session, hosted by APTA regulatory affairs staff, includes a question-and-answer session with attendees.

    #ChoosePT Receives Commendation from KY House

    APTA's #ChoosePT opioid awareness campaign once again has been recognized—this time by the Kentucky House of Representatives, which issued a statement honoring APTA and its Kentucky Chapter for providing "an important opportunity" for public education on the "tremendous benefits of physical therapy."

    The commendation, issued on July 11, describes the #ChoosePT campaign as a "vital initiative" that is helping the public see the dangers of opioid use and understand that pain can be managed safely through physical therapy.

    Given that Kentucky “has suffered greatly from the effects of opioid addiction among its citizens, the #ChoosePT initiative sponsored by APTA and with the full support of the Kentucky Physical Therapy Association … is recognized as an important opportunity for citizens … to educate themselves on the tremendous benefits of physical therapy as a tool for pain management and to opt for a much safer alternative to prescription opioids," the document states.

    The House citation was made about 5 weeks after a similar recognition was issued by the Kentucky Senate. The House version was sponsored by Rep Daniel Elliott.

    In addition to state kudos, the #ChoosePT campaign also has received national attention this year, with the American Society of Association Executives honoring the entire campaign through a "Power of A" award for excellence in public awareness initiatives, and singling out the campaign's public service announcement video for a Gold Circle award as best association video of the year.