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  • Gregory Hicks Appointed to APTA’s Board of Directors

    Gregory Hicks, PT, PhD, FAPTA, has been appointed by the APTA Board of Directors (Board) to complete the leadership term of Sheila K. Nicholson, PT, DPT, MBA, MA, following her death in June this year.

    Hicks, who has been an APTA member for 17 years, is chair of the Department of Physical Therapy at the University of Delaware, where he also is director of the school’s Advancing Diversity in Physical Therapy program, known as ADaPT.

    In 2018, Hicks was named a Catherine Worthingham Fellow, APTA’s highest membership category, for demonstrating unwavering efforts to advance the physical therapy profession through leadership, influence, and achievement. Also that year, he received the University of Delaware College of Health Sciences’ inaugural Diversity Advocate Award.

    “My Board colleagues and I are elated that Greg has consented to serve our association,” said APTA President Sharon Dunn, PT, PhD, board-certified orthopaedic clinical specialist. “Greg will bring wisdom, experience, and leadership to help propel our pursuit of APTA’s 3-year strategic plan.”

    Hicks’ Board service begins immediately and ends with the completion of Nicholson’s 3-year term in June 2020, at which point the vacant seat will be filled through the annual slate of candidates process and election by the House of Delegates.

    Final SNF Rule Sets New Payment System Into Motion October 1

    It's final: the US Centers for Medicare and Medicaid Services (CMS) is moving ahead with a rule governing skilled nursing facilities (SNFs) that's almost identical to what it proposed in April, including a change advocated for by APTA—a revised definition of what constitutes "group therapy" in SNFs. Aside from that alteration, it's a rule that hews to CMS' original plans to dramatically change the payment system for SNFs.

    As anticipated, the final rule proceeds with implementation of the Patient-Driven Payment Model (PDPM). The model is based on a resident's classification among 5 components (including physical therapy) that are case-mix adjusted, and employs a per diem system that adjusts payment rates over the course of the stay. APTA has developed a number of resources on PDPM.

    Other notable elements of the final rule:

    • In a win for APTA and its members, CMS moved away from a rigid 4-person definition and adopted the association's recommendation that the definition of group therapy as 2 to 6 patients doing the same or similar activities—the same definition used in inpatient rehabilitation settings.
    • The final rule adopts a "subregulatory" process to keep up with nonsubstantive updates to the ICD-10 codes used in PDPM, while substantive changes will be made through the traditional notice-and-comment rulemaking process.
    • CMS will implement 2 new quality measures—transfer of health information to the provider-post-acute-care, and transfer of health information to the patient-post-acute-care—to be provided by the SNF at the time of transfer or discharge.
    • The rule also adopts a number of standardized patient assessment data elements that assess cognitive function and mental status; special services, treatments, and interventions; medical conditions and comorbidities; impairments; and social determinants of health.
    • CMS projects aggregate payments to SNFs will increase by $851 million, or 2.4%.

    PT in Motion News covered the PDPM in detail when the rule was proposed. Since that time, APTA has launched an education campaign on the new system that includes a webpage on PDPM as well as a prerecorded webinar and Q and A session. A live webinar with CMS on SNF PDPM and demonstrating value is scheduled for September 4.

    Proposed Outpatient Payment Rule From CMS Continues Previous Trends

    The US Centers for Medicare and Medicaid Services (CMS) is pushing for an outpatient environment in which payments vary less according to who owns a facility, hospitals get a supervision break, and patients have access to clear information on how much they're being charged for items and services. All 3 concepts figure heavily into the proposed 2020 outpatient payment system (OPPS) rule.

    The proposed rule, released July 29, would complete a 2-year CMS effort to move toward a "site neutral" payment model in its reimbursements for physician services, doing away with a system that pays so-called "off campus" hospital-owned facilities more than it does their independent equivalents. Payment for physical therapy services in outpatient settings are paid under the CMS physician fee schedule and so are not impacted by the OPPS site-neutral policies.

    Other trends continue as well, including an APTA-supported move toward easing supervision burdens placed on hospitals. The proposed rule would change supervision requirements for outpatient therapeutic services in all hospitals from "direct" to "general," meaning that while a given procedure would be furnished under a physician's overall direction and control, the physician's physical presence no longer will be required during the performance of the procedure. The change is viewed as a particularly positive one for critical-access hospitals and other facilities in underserved areas.

    A shift toward greater transparency also is reflected in the proposed rule, with CMS aiming to require hospitals to make their standard charges public for all items and services. These standard charge lists—a facility's gross and payer-negotiated charges for supplies, procedures, beds and food, practitioner services, and a host of other items—would also be required for a limited set of so-called "shoppable services" that can be scheduled by a consumer in advance. CMS puts teeth into the requirement through monetary penalties and publication of violations for facilities that don't comply.

    Another trend APTA is watching: prior authorization, which in the proposed rule would be required for several cosmetic procedures including rhinoplasty. While this doesn't directly affect services associated with physical therapy, APTA advocates in general against prior authorization requirements that slow the delivery of care and limit patient access to appropriate interventions.

    Also included in the proposed OPPS:

    • Payment rates for outpatient hospitals and ambulatory surgical centers (ASCs) would increase by 2.7%.
    • CMS is soliciting comments on adding 4 safety measures to the Outpatient Quality Reporting Program that have already been required of ASCs: patient falls, patient burns, wrong site/side/procedure/implant, and all-cause hospital transfers/admissions.

    A CMS fact sheet on the proposed rule is available online. APTA is analyzing the proposed rule and will provide comments to CMS by the September 27 deadline.

    Proposed DMEPOS Rule From CMS Aimed at Predictability, Clarity

    In its proposed 2020 rule for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), the US Centers for Medicare and Medicaid Services (CMS) aims to make payments for devices a little more predictable in light of the ever-increasing—and ever-advancing—range of options available to providers and patients. The agency's solution? A "comparable item analysis" system that CMS thinks will help make it easier to nail down exactly what Medicare will pay for those devices.

    In what a CMS fact sheet describes as an attempt to "improve the transparency and predictability of establishing fees for new DMEPOS items," the proposed rule establishes 5 major categories under which providers can compare older DMEPOS with new ones: physical components, mechanical components, electrical components (when applicable), function and intended use, and "additional attributes and features."

    The idea, according to the proposed rule, is that when the old and new items are comparable, CMS will use the fee schedule amounts for the existing older item in determining payment amounts for the new one. If there are no comparable older items, CMS says it will base payment on commercial pricing data such as internet pricing and supplier invoices. Those prices for the noncomparable items won't necessarily stay fixed: if commercial pricing drops, so will CMS rates.

    In addition to the comparison system, CMS is also proposing to revamp requirements around face-to-face meetings between providers and patients in need of DMEPOS that "may have created unintended confusion for stakeholders." The current requirements—essentially a collection of ad-hoc provisions that have accrued over the past 13 years—would be replaced with what CMS describes as a "single list of DMEPOS items potentially subject to a face-to-face encounter and written orders prior to delivery, and/or prior authorization requirements."

    APTA is analyzing the proposed rule and will provide comments to CMS by the September 27 deadline.