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  • CMS Proposed 2015 Fee Schedule Adjusts Payment Rates, Updates PQRS

    The proposed 2015 Medicare physician fee schedule (PFS) rule released July 3 would result in an estimated 20.9% reduction in payments beginning April 1, 2015, unless congressional action is taken to avert sustainable growth rate (SGR) reductions. If those reductions are avoided, the rule’s aggregate impact on payment is a positive 1% for outpatient physical therapy services. Either way, the first quarter of 2015 would see no change in payment rate due to the Protecting Access to Medicare Act (PAMA) of 2014, provides for 0% PFS update for services furnished between January 1, 2015 and March 31, 2015.

    Additional proposed policies that will impact physical therapists include updates to the Physician Quality Reporting System (PQRS) program, CMS’s proposal to review the values that determine payment for a number of CPT codes reported by physical therapists, and a proposal for a new process for establishing PFS payment rates that is more transparent.

    • CMS proposes to retain the 12-month calendar year reporting period for the PQRS program in 2015 and beyond. The 2015 reporting period data will be used to inform the 2017 payment adjustment of -2.0%. CMS is proposing to make the following changes to the reporting requirements for 2015:
    • Increase the number of measures that an eligible professional must report via the claims and registry-based reporting mechanisms to at least 9 measures, covering at least 3 of the NQS domains, or, if fewer than 9 measures apply to the eligible professional, he or she must report as many as do apply and report each measure for at least 50% of the Medicare Part B fee for service. Of the measures reported, some must be included from the new crosscutting measure set.
    • Make 2015 PQRS data available in 2016 on the Physician Compare website for all providers participating as eligible professionals and for those reporting under the Group Practice Reporting Option (GPRO).
    • Change measures reported by physical therapists for the remainder of 2014 , including the removal of measure #245 Use of Wound Surface Culture Technique in Patients with Chronic Skin Ulcers and the Back Pain Measures Group (#148-#151).

    The proposed rule will be published in the July 11, 2014, Federal Register. The public will have until September 2, 2014, to submit comments in response to this rule, and APTA will submit comments on behalf of its members. After reviewing public comments, CMS will publish a final rule on or about November 1, which will become effective for services furnished during 2015. APTA will provide a more detailed summary of the rule in the upcoming week.

    CMS Issues Proposed Rule on Outpatient Prospective Payment

    The rule proposed July 3 by the Centers for Medicare and Medicaid Services (CMS) includes a 2.1% increase in payment rates for 2015 under the outpatient prospective payment system (OPPS) and changes to hospital admissions requirements.

    The proposed rules affect hospital outpatient departments and ambulatory surgical centers beginning January 1, 2015. Proposals include the implementation of comprehensive payments for certain services, clarification of the requirement for an admission order for all hospital inpatient admissions, and a change that will require physician certification for hospital inpatient admissions only for long-stay cases and outlier cases, not short stays.

    Informed by comments received regarding the requirements for a physician certification of hospital short stays, CMS clarifies that admission orders are a condition of payment for all inpatient hospital admissions. However, CMS will require a physician certification only for long-stay cases (20 days or more) and outlier cases. CMS states that the admission order, medical record, and progress notes must contain sufficient information to support the medical necessity of an inpatient admission without a separate requirement of an additional, formal, physician certification for shorter stays.

    The rule also proposes the implementation of the 2014 OPPS final rule policy creating 28 comprehensive ambulatory payment classifications (APCs) to handle payment for the most costly device-dependent services. The policy would treat all individually reported codes as components of a comprehensive service, resulting in a single prospective payment based on the cost of all individually reported codes. CMS will make a single payment for the comprehensive service based on all charges on the claim, and charges for services that cannot be covered separately by Medicare Part B or that are not payable under the OPPS will not be reimbursed. Further, CMS proposes to conditionally package certain ancillary services when they are integral, ancillary, supportive, dependent, or adjunctive to a primary service.

    In addition, CMS proposes to change its consideration of requests the expansion of physician-owned hospitals under the physician self-referral regulations and establishes an appeal process for Medicare Advantage organizations regarding CMS-identified overpayments.

    Most physical therapy services provided in the outpatient hospital department are not paid under the OPPS and are paid instead under the Medicare Physician Fee Schedule (PFS) (see related news story on the proposed PFS for 2015), though a small subset of ‘‘sometimes therapy’’ physical therapy services are paid under the OPPS when they are not furnished as therapy, meaning not under a certified therapy plan of care. CMS provides an annual update of these “sometimes therapy” services subject to direct supervision requirements. The update can be found at http://www.cms.gov/Medicare/Billing/TherapyServices/AnnualTherapyUpdate.html.

    The proposed rule will be published in the July 11, 2014, Federal Register. Comments on the rule are due September 2, 2014. APTA will submit comments on behalf of its members. A detailed summary of the rule will be available for APTA members shortly.

    A Revolutionary Way to Have Family Fun

    The 4th of July weekend is a great time for fireworks, overcooked meat, and finally getting around to learning to whistle the piccolo part to "The Stars and Stripes Forever," but it's also the perfect time for families to get active—and possibly win a Fitbit, courtesy of APTA and its Section on Pediatrics.

    The APTA Summer Fit Family Challenge is now in full swing, and members are encouraged to get their patients and clients—and their own families—involved in this fun way to stay active as a family.

    It's easy to do. Simply visit the Fit Family Challenge webpage on MoveForwardPT.com, download the challenge list, and get moving. Take family photos and share your progress and while doing the activities, then post to #FitFam14 on Twitter, Facebook, or Instagram, and you'll be automatically entered to win a Fitbit. You can even practice that piccolo thing over and over while you're doing stuff, which your family is sure to enjoy.

    Get moving! And get posting! Next prize winners will be announced July 15 and 31.

    Early Career Dues Discount Program Extended Through 2018

    As if new graduates need another reason to make sure they renew their APTA membership every year, eligible early-career physical therapists (PTs) and physical therapist assistants (PTAs) will continue to benefit from reduced APTA dues under a program that provides discounted rates for members up to 4 years after graduation. The decision to extend the program until 2018 was approved by the Board of Directors at its June 7 meeting in Charlotte, North Carolina.

    APTA created the pilot program earlier this year to extend dues reductions to eligible members in years 2, 3, and 4 postgraduation, so that members receive 40%, 30%, and 20%, respectively off national and participating chapter dues—as long as their membership doesn’t lapse any time during the 4 years. APTA bylaws already stipulate that members receive 50% off national and chapter dues at their first renewal postgraduation.

    The program is optional for chapters, which are being asked to confirm their participation in 2015 by August 31 of this year.

    See APTA's Career Starter Dues webpage for frequently asked questions and more information.