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  • 2019 Federal Advocacy Forum Coming March 31; Registration Open Through March 18

    When it comes to federal advocacy for the physical therapy profession, the watchword is "new"—new priorities after the end of the hard cap on therapy services under Medicare last year, new challenges that have surfaced in the wake of rulemaking and other changes, and a new Congress that needs to be well-acquainted with the profession's message of patient-centered, transformative care. APTA's 2019 Federal Advocacy Forum, set for March 31-April 2, promises to help attendees navigate all those new twists and more.

    Registration is now open for the annual event, which brings together physical therapists (PTs), physical therapist assistants (PTAs) and students together in Washington, DC, for a 3-day conference that provides the latest on regulatory and legislative issues affecting the profession, and ends with an opportunity for attendees to apply what they've learned by making in-person visits to Senate and House offices. Registration deadline is March 18.

    Other activities at the Forum include an evening reception, awards presentations, and breakout sessions on state and federal advocacy, regulatory affairs, and student action.

    "While 2018 was a year of real accomplishment, much more needs to be done with the new Congress that started this month," said Michael Matlack, APTA director of congressional affairs. "There are now almost 100 new members of Congress who need to learn about the essential role that physical therapy plays in the nation’s health care system—and in the lives of their constituents."

    [Editor's note: Want to get a feel for what the Federal Advocacy Forum is all about? Check out the video recap of the 2018 Forum on the Federal Advocacy Forum webpage.]

    From Move Forward Radio: Retreat Helps Veterans With Amputation—and Their Families

    Adjusting to life after an amputation can affect a veteran’s entire family, not just the individual. That reality wasn't lost on the Travis Mills Foundation, which offers a retreat program that aims to help veterans and their families bond with one another and participate in traditional activities that are adapted to teach new skills and strategies to ensure participation for everyone.

    Now available from APTA's Move Forward Radio: a conversation with APTA member Kelly Roseberry, PT, DPT. Roseberry is program director of the Travis Mills Foundation, which was founded by a veteran who had a quadruple amputation. Roseberry describes what this unique program means to veterans, families, and to her personally. "To be able to see a service member do something they never thought they would do again, or to see how happy their family is to watch them get to do that and to share in those moments together is…priceless," Roseberry says.

    Since 2017, selected veterans who have been injured in active duty or as a result of their service have come to Maine in the summer, along with their families, for an all-expenses-paid vacation. They participate in activities such as swimming, biking, kayaking, and a ropes course.

    “We take a great deal of pride in being able to serve the whole family," Roseberry tells Move Forward Radio. "We recognize that rehab is a lifetime process, and when someone is injured or goes through some sort of trauma, not only is the service member injured, but the injury affects the entire family. They may not think they can get on the floor with their kids or take them for a bike ride. We want to be able to not only encourage them but give them the tools to reach outside their comfort zone and do things with their family, because at the end of the day their family is their support system.”

    Move Forward Radio is hosted at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online or downloaded as a podcast via iTunes, Google Play, or Spotify.

    Other recent Move Forward Radio episodes include:

    Maintaining an Active Lifestyle and Avoiding Pain
    Surfing legend and fitness and nutrition expert Laird Hamilton applied lessons he learned through his surfing injuries to his preparation for—and recovery from—hip replacement surgery. In the podcast, he describes how he avoided pain medicine of any kind during the process, and how he surprised his health care team with one of the fastest recoveries they had ever seen.

    A Primer on Sciatica and Physical Therapy
    As many as 40% of people will experience sciatica in their lifetime. APTA member Mark Bishop, PT, DPT, PhD, breaks down sciatica’s symptoms and causes for consumers, and explains how physical therapy can help relieve pain.

    Navigating the Health Care System With Chronic Pain
    APTA member Jen Bambrough, SPT, was in car accident at age 19 but seemed to sustain no initial apparent injuries. Over time, though, a physical toll revealed itself as chronic pain, limiting her activities and compromising her quality of life. Because the root of her pain couldn’t be readily detected, however, she faced skepticism in the medical community and experienced misdiagnoses. Bambrough, now a third-year DPT student, discusses how she became a strong self-advocate and how physical therapy is an important piece of the pain management puzzle.

    A PT With Breast Cancer Turns to Her Peers to Make Life-Saving Decisions
    When APTA member Gwen Simons, PT, felt what she thought might be a lump in her left breast in 2010, it set in motion a series of decisions and scans that led to surgery. Simons shares her story of unexpected mammogram results, a strategically timed lecture, consultations with colleagues in the physical therapy profession, and a decision by Simons that may have saved her life.

    Cancer-Related Falls
    Cancer survivors have a higher prevalence of falls than do people who haven’t been treated for the disease. Even worse, various significant health consequences of falls may be more likely and extensive in cancer survivors. APTA member Elizabeth Hile, PT, PhD, discusses the reasons for increased falls susceptibility in cancer survivors, red flags to heed, and how physical therapy and certain types of community resources can help.

    Using Physical Therapy to Treat Pain in Addiction Treatment Centers
    America is in the grips of an opioid addiction crisis. APTA members Ahmed Rashwan, PT, DPT, and Eric Chaconas, PT, PhD, discuss the treatment for addiction to opioid pain medication. They are working with addiction treatment centers to help medically stabilized patients learn more about their pain and show them how they can use physical therapy to participate in managing it, making relapse less likely.

    APTA members are encouraged to alert their patients 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.

    APTA Outcomes Registry Earns Key QCDR Designation for Use With MIPS

    APTA's Physical Therapy Outcomes Registry (Registry) has been approved again by the US Centers for Medicare and Medicaid Services (CMS) as a qualified clinical data registry (QCDR). The designation for 2019 means that physical therapists (PTs) who participate in the Merit-based Incentive Payment System (MIPS) can submit their measures data directly from the Registry—including new measures supported by APTA that now position the Registry as the leading physical therapy registry in terms of the number of QCDR measures offered.

    The approval comes as many PTs are facing a new reporting and payment world, the result of a CMS decision to include physical therapy in its Quality Payment Program (QPP) beginning in 2019. That program, with MIPS as its centerpiece, puts a heavy emphasis on outcomes reporting and ties that reporting to potential payment adjustments.

    That's where the number of measures offered through the Registry comes into play. Basically, more measures mean more data points to report, and more data points mean more opportunities for PTs to meet CMS requirements—and possibly receive payment increases in the future. The Physical Therapy Outcomes Registry now offers more QCDR-related measures than any other physical therapy-only option.

    According to Heather Smith, PT, MPH, APTA's director of quality, while the Registry's role in helping PTs comply with MIPS is important, it's far from the only benefit of the resource.

    "With the Physical Therapy Outcomes Registry, APTA is looking forward, beyond MIPS data submission," Smith stated in an APTA news release. "Because the Registry gives users continual feedback on performance throughout the year, physical therapists can better understand their treatment patterns, interventions, and outcomes for specific patient populations, and apply that information to improve their practice. Ultimately, this will benefit the profession as a whole."

    Headed to the APTA Combined Sections Meeting this month? Check out the Registry booth at the APTA Pavilion. For a detailed look at MIPS and QPP, be sure to attend " Emerging Issues in Medicare: Quality Programs and Alternative Payment Models," on Friday, January 25 at 11:00 am. CMS representatives will be on hand to discuss the programs.

    2019 MPPR Calculator Now Available

    It's back: APTA's members-only multiple procedure payment reduction (MPPR) calculator for 2019 is now live.

    This year's calculator incorporates both the MPPR 50% reduction as well as the overall 2% cut to Medicare payments implemented through sequestration. The calculator, delivered by way of an Excel spreadsheet, calculates Medicare physician fee schedule payment for procedures provided to a beneficiary on a given day.

    Added features this year include options for selecting your Medicare participation status—participating, nonparticipating but accepting assignment, or nonparticipating and not accepting assignment—as well as the ability to compare the 2019 payment rate with the rate in 2018. The calculator also includes a Merit-based Incentive Payment System (MIPS) adjustment feature, which isn't applicable to physical therapists this year but will become a useful tool beginning in the 2021 payment year.

    What's New at PTNow? More Guidelines and Systematic Reviews Enrich an Already-Robust Resource

    The range of conditions that physical therapists (PTs) and physical therapist assistants (PTAs) face every day can be expansive, and staying on top of the latest effective treatment approaches can seem like an impossible task. PTNow is helping to change all that by bringing members the evidence they need in just a few clicks.

    Best of all, the association's flagship site for evidence-based practice resources continues to expand in ways that help PTs and PTAs easily find an even wider array of information. If you haven't visited the site lately, check it out soon. Here's a quick take on the latest additions.

    Recently added clinical practice guidelines

    New Cochrane Systematic Reviews
    Cochrane reviews provide some of the most reliable information on evidence-based health care—thoroughly researched, carefully evaluated, and presented in a way that makes it easy to understand the effects of interventions on rehabilitation, treatment, and prevention.

    PTNow has added access to an additional 65 Cochrane reviews—too many to list here—that address areas including wound care, musculoskeletal conditions, pediatrics, neurology, prevention, geriatrics, women's health, cardiovascular and pulmonary issues, oncology, acute care, and more. Visit the Cochrane review section of PTNow to browse or search for specific articles.

    New Resource Page Helps PT, PTA Students Explore Options for Financial Aid, Loan Forgiveness, Post-Degree Loan Repayment, and More

    Students in physical therapist (PT) and physical therapist assistant (PTA) education programs have a lot on their plates. They must keep up with classes, of course, but on top of that, they have to figure out exactly how they're going to pay for those classes. And, oh yeah, they probably should be thinking about how they'll approach student loan repayments they may face once they’ve earned their degree. At the same time, they need to keep up with related actions from the profession and their association.

    It's not easy. But APTA is helping to make life for PT and PTA students a bit less overwhelming.

    Recently, the association unveiled a completely revamped Education and Financial Resources for Students webpage—a 1-stop source for information on everything from association and component-sponsored awards to federal student loan forgiveness opportunities. Also included: links to evidence-based practice resources, APTA policies, and the association's Financial Solutions Center—which focuses specifically on financial education and student loan refinancing.

    Have suggestions for resources to add to the page? Contact the APTA Student Assembly with your ideas.

    APTA Working for You: Federal Advocacy Updates, October 2018

    Advocacy for patients and the profession never stops. APTA helps its members by staying on top of changes and bringing the physical therapy profession's voice to the table on a wide range of payment and care-related issues. Here's a quick rundown of some of the latest news and APTA activities.

    Recent Advocacy Wins

    • Diagnostic services furnished by PTs: APTA staff and 3 members of the Academy of Clinical Electrophysiology and Wound Management met with the Centers for Medicare and Medicaid Services (CMS) in January to discuss Medicare Administrative Contractors’ inconsistencies between the local coverage determinations and Medicare guidelines, specifically related to reimbursement for electromyography/nerve conduction studies by qualified physical therapists (PTs). As a result of the meeting and ongoing follow-up, CMS in early October clarified its policy that PTs should be fully paid for these services.
    • Use of pulse oximetry in the home: After APTA staff met with CMS to urge the agency to clarify whether a physician’s order is required when using pulse oximetry in the home, CMS issued a clarification. An additional clarification was issued by The Joint Commission.


    APTA at the Table

    • APTA participates in a technical expert panel on postacute care
      In late September, an APTA member and staff participated in a technical expert panel (TEP) convened by CMS and consultant RTI International to discuss development of a unified postacute care prospective payment system. APTA will continue to represent the profession on future postacute care TEPs. Check out recent Medicare Payment Advisory Commission Reports to Congress on the unified postacute care payment system, including the most recent June 2018 Report to Congress.
    • APTA provides public comments at HHS Pain Management Task Force Meeting
      APTA staff provided public comments at the US Department of Health and Human Services (HHS) Pain Management Interagency Best Practices Task Force, highlighting the role of physical therapy in pain management.
    • CMS provider compliance meeting includes APTA representation
      APTA staff participated in a meeting with CMS Program Integrity staff to discuss concerns and offer recommendations on improvements to the targeted probe-and-educate program, an initiative that provides personal help to providers interested in reducing claim denials and appeals. APTA will continue to represent the physical therapy profession at future provider compliance meetings.
    • APTA maintains ongoing contact with MedPAC and the Medicaid and CHIP Payment and Access Commission (MACPAC)
      APTA staff attends MedPAC and MACPAC meetings on a monthly basis, monitoring topics that impact the physical therapy profession.

      * APTA nominee added to Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) APTA member Meghan Warren, PT, PhD, recently was appointed to MACPAC after being nominated by the association.

    Coalitions and Other Stakeholder Meetings

    • Rehabilitation providers and agencies: APTA staff attended and presented on the Merit-based Incentive Payment System (MIPS) at the National Association of Rehabilitation Providers and Agencies 2018 Fall Conference.
    • Patient-centered care: APTA staff participated in the Agency for Healthcare Research and Quality Patient-Centered Clinical Decision Support Learning Network (PCCDS-LN) conference. The conference brought together diverse stakeholders from industry, government, and academia to learn about and discuss key issues in drafting a National Opioid Action Plan. Attendees also set an agenda for developing, disseminating, and applying PCCDS in other domains.


    More Advocacy and Collaboration

    • National Institutes of Health (NIH): APTA member Julie Schwertfeger, PT, DPT, MBA, will represent APTA on the Disability Rehabilitation Research Coalition (DRRC) when it meets with NIH on October 23.
    • White House: APTA staff and members participated in a conference call with White House staff regarding the opioid epidemic and continued pain management collaboration, a follow-up to an in-person meeting held in August.
    • US Centers for Disease Control and Prevention (CDC): APTA staff participated in a conference call with the CDC to discuss ongoing collaboration on topics including the opioid crisis, traumatic brain injury, and falls prevention. Several immediate opportunities were identified.


    APTA offers a range of resources for learning more about Medicare and Medicaid reimbursement and staying connected with advocacy efforts: check out APTA Regulatory Issues: Take Action to stay on top of the federal agency comment opportunities; stay informed by visiting APTA's Medicare Payment and Reimbursement webpage and Medicaid webpage to access information and download tools including customizable appeals letters and Medicare fee schedule calculator; and subscribe to the Payment edition of APTA's Friday Focus newsletter series to receive a monthly compilation of payment-related news and resources. Questions? Email advocacy@apta.org.

    [Editor's note: This the article has been updated from an earlier version to correct an item stating that Meghan Warren was named to MACPAC.]

    US House Members Echo APTA, Coalition Members' Call for Reduced Use of Prior Authorization by Medicare Advantage Plans

    Calling the requirements "onerous and often unnecessary," more than 100 members of the US House of Representatives are pressing for improvements to the way prior authorization (PA) is used—and often misused—in Medicare Advantage (MA) plans. The lawmakers' call for changes echoes concerns voiced earlier this year by a coalition that includes APTA.

    A bipartisan group of 103 legislators signed on to the October 10 letter to US Centers for Medicare and Medicaid Services (CMS) administrator Seema Verma, requesting that Verma direct the agency to conduct investigations around the use of prior authorization in MA, and to issue guidance "dissuading" MA plans from including requirements that include unnecessary barriers to care.

    "It is our understanding that some plans require repetitive prior approvals for patients that are not based on evidence and may delay medically necessary care," the lawmakers write. "Many of these PA requirements are for services or procedures performed in accordance with an already-approved plan of care, as part of appropriate, ongoing therapy for chronic conditions, or for services with low PA denial rates."

    The letter underscores the message delivered to Verma earlier this year by way of a letter from the Coalition to Preserve Rehabilitation (CPR), a group of 28 health provider, patient, and care professional and advocacy groups that includes APTA, the American Association of People with Disabilities, the American Occupational Therapy Association, the Brain Injury Association of America, the Epilepsy Foundation, the Michael J. Fox Foundation for Parkinson's Research, and the Paralyzed Veterans of America, among others.

    The CPR letter suggests that CMS take its cue from the private insurance industry, which has been moving away from prior authorization, or at least investigate which prior authorization policies get in the way of medically necessary care. The coalition also recommends that CMS impose greater oversight of MA plans, with "stronger directives to MA plans to limit the use of prior authorization to services that are demonstrably overutilized."

    The legislators' letter to Verma makes reference to the efforts of "key stakeholders"—presumably, CPR and other groups—and requests that "you and your staff engage with these organizations on additional opportunities to improve the PA process for all stakeholders."

    APTA will continue to monitor this issue and share developments as they arise.

    APTA Advocacy for EMG, Other Diagnostic Services Results in Payment Clarification from CMS

    Good news for physical therapists (PTs) certified by the American Board of Physical Therapy Specialties in electrophysiologic physical therapy: the US Centers for Medicare and Medicaid Services (CMS) has stated in no uncertain terms that those PTs are permitted to perform certain diagnostic services without the need for physician supervision where those services are allowed by state law. The announcement was made after APTA and other stakeholders pressed the agency to clear the air in order to end payment reductions or outright denials to PTs providing the services.

    According to the CMS statement, board-certified clinical specialists in electrophysiology physical therapy are qualified to provide services involving electromyography (EMG), nerve conduction velocity (NCV), and sensory evoked potentials (SEPs) without physician supervision, and should be paid for those services. It's a provision that's been around since 2001, according to CMS; however, the message wasn't always getting through to some Medicare Administrative Contractors and other payers, who would pay only for the technical component of the service, for some codes but not others, or nothing at all.

    In its statement, CMS reminds stakeholders that it assigns a Physician Supervision Indicator (PSI) of “09” to its collection of PT-designated diagnostic services codes, making it clear that physician supervision is not required for the global and professional component codes of these services.

    "APTA was concerned when it became clear to us that PTs weren't receiving appropriate recognition for these services, but grateful that the issue could be resolved through clear communications from CMS," said Kara Gainer, APTA director of regulatory affairs. "We hope that this statement will erase all doubts about whether a qualified PT can receive full payment for the delivery of services that have been permitted for nearly 2 decades."

    APTA-Backed Bill Protecting PTs Traveling With Sports Teams Likely to Become Law

    APTA-supported legislation that protects physical therapists (PTs) and other health care providers who travel across state lines with a sports team is now just a presidential signature away from becoming law. Known as the Sports Medicine Licensure Clarity Act, the bill met with overwhelming bipartisan support in both the US House of Representatives and the Senate, and is on track to receive approval from President Donald Trump.

    When it becomes law the legislation will 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. The law would apply to licensed health care professionals who travel with professional and collegiate teams or other athletes and teams sanctioned by a national governing body. The bill was introduced in the House by Reps Brett Guthrie (R-KY) and Cedric Richmond (D-LA), and in the Senate by Sens John Thune (R-SD) and Amy Klobuchar (D-MN).

    "This is a big win for PTs, but an even bigger step forward in safeguarding the health of athletes," said Michael Matlack, APTA director of congressional affairs. "Once enacted, this law will help to support the realities of health care among teams that travel across state lines."

    In its original form, the bill's coverage was restricted to only physicians and athletic trainers. Advocacy staff at APTA and representatives from the American Academy of Sports Physical Therapy (AASPT) worked closely with legislators and staff to ensure PTs and PTAs working under the supervision of a PT would also be included. Once the bill was introduced, APTA and section representatives worked in conjunction with other stakeholder groups to ensure support from as many legislators as possible. The final version of the legislation passed the House easily in 2017, and it received approval from the Senate by a 93-6 margin on October 3.

    "We are grateful not only for the support of the legislators who introduced this bill, but for the sustained hard work of APTA members and members of the American Academy of Sports Physical Therapy to help achieve overwhelming backing in Congress," said Jennica Sims, APTA's congressional affairs and grassroots specialist. "Our success with this legislation shows what happens when individual member voices are part of a collaborative advocacy effort."