• News New Blog Banner

  • World Physical Therapy Day Emphasizes Different Life Stages

    Physical therapists can help people become fit and active contributors to society, whatever their physical limitations or stage of life. This is the message that thousands of physical therapists will send out on World Physical Therapy Day, September 8.

    The World Confederation for Physical Therapy (WCPT) offers a toolkit, clinical resource booklet, and archive of past years’ events on its website. The message for this year is "Fit for the Future."

    In a press release announcing the upcoming event, WCPT President Marilyn Moffat, PT, DPT, PhD, FAPTA, GCS, said that because of their specialist knowledge physical therapists can help all children, adults, and older people participate in physical activity. "Physical therapists can help them overcome physical problems that may restrict their ability to move,” she said. “Physical activity doesn’t just mean more healthy people, but happier, more productive people, whether young or aging. It's time for all of us to be fit for the future."

    2013 National Physical Therapy Month Resources Available Now

    Check out APTA's National Physical Therapy Month webpage at www.apta.org/NPTM, where you can see a video announcement by President Paul Rockar Jr, PT, DPT, MS, about this year's exciting media initiative, the "Top 10 Fittest Baby Boomer Cities in America." Download the members-only 2013 NPTM Event Planning Guide for all the ideas, tools, and resources you will need to promote healthy lifestyles for boomers in your city!

    Professional Component of EMG Now Billable by PTs in MAC Jurisdictions H, L

    Qualified physical therapists in jurisdictions H and L, under the Medicare Administrative Contractor (MAC) Novitas Solutions, now can perform and bill for both the technical and professional components of electromyography (EMG). The MAC's policy revision, which brings it into alignment with national Medicare policy, is the result of APTA's advocacy efforts.

    Jurisdiction L covers Pennsylvania, New Jersey, Maryland, Delaware, the District of Columbia, and certain counties of Virginia (Arlington, Alexandria, and Fairfax); Jurisdiction H covers Arkansas, Louisiana, Mississippi, Colorado, New Mexico, Oklahoma, and Texas. The revisions are to local coverage determinations (LCDs) L29547 and L32723 for nerve conduction studies and EMG.

    Previously, the LCD policies stated that physical therapists could bill only for the technical component of EMG services. However, APTA sent a reconsideration letter expressing our concerns with the policies and urging Novitas Solutions to revise the language so that it would be consistent with national Medicare policy. APTA staff received correspondence from Novitas Solutions that these LCDs will be revised shortly to allow qualified physical therapists to perform and bill for both the technical and professional components of EMG services.

    Novitas Solutions has indicated that the updated LCDs will be on its website soon. For questions or more information, please e-mail advocacy@apta.org.

    September 23 HIPAA Deadline Approaches

    Practitioners have until September 23 to comply with provisions of the final rule that earlier this year extensively modified the privacy, security, and enforcement regulations established under the Health Insurance Portability and Accountability Act of 1996, or HIPAA.

    The final rule expanded many of the requirements to business associates of covered entities that receive protected health information, such as contractors and subcontractors. If a covered entity did not have a business associate agreement in place by January 25 this year that was compliant with the previous HIPAA regulations, it must enter into one by September 23. However, entities that did have HIPAA-compliant business agreements place as of January 25 may get a 1-year extension to revise their agreements, as long as they did not or do not renew those agreements between March 26 (the date the new rule took effect) and September 23. Any agreement that is renewed after September 23 must comply with the new rule, which also increases the penalties for noncompliance to a maximum of $1.5 million per violation.

    The changes also strengthen the Health Information Technology for Economic and Clinical Health (HITECH) Breach Notification requirements by clarifying when breaches of unsecured health information must be reported to HHS.

    The new rule also expands individual rights under HIPAA, and by September 23 these rights must be added to the Notice of Privacy Practices (NPP) that providers give to new patients. For example, patients can ask for a copy of their electronic medical record in an electronic form, and they can instruct their provider to restrict disclosures to a health plan concerning treatment for which the individual has paid out of pocket in full. The rule also sets new limits on how information is used and disclosed for marketing and fundraising purposes and prohibits the sale of individuals' health information without their permission.

    Association members can access the document on the Health Information Technology webpage under "APTA Summaries" and APTA's HIPAA webpage.

    National Registry on Patient Outcomes Moves Forward

    APTA plans to have a national registry of physical therapy patient outcomes ready for widespread use by 2015, as health care requirements for quality reporting and outcomes reporting increasingly dictate payment for services.

    APTA says the registry will be an organized system to collect uniform data on patient outcomes that can offer clinical guidance to promote best practices; provide a reporting mechanism that meets regulatory requirements; generate benchmarking quality reports at the individual, clinic, regional, and national levels; and collect data to advance research, inform policy, and contribute to emerging payment models. At the same time, the data collected will demonstrate the value of physical therapist practice and its impact on patients and clients.

    The APTA Board of Directors at its meeting last week enthusiastically reaffirmed its stance that the national registry is a top priority. The board voted to proceed with ongoing efforts toward the registry, further clarifying its purpose, structure, and scope. Concerning the sustainability of such a huge undertaking, in terms of financial investment and time commitments by staff and members, the Board agreed that a business plan will be developed by the December 2013 board meeting based on the premise that the registry will be self-sustainable within 10 years.

    A new National Registry webpage includes a video dispatch that followed the board’s deliberations; APTA will post updates and further information on the registry there as they become available. To view the entire discussion that led to the board’s decision on the registry, and to see all of the open proceedings from the August meeting, visit APTA’s livestream page, where video of the meeting is archived.

    APTA CEO Search Under Way

    Executive search firm Isaacson, Miller has developed a scope document that describes the position for APTA’s chief executive officer (CEO) and is seeking candidates for individuals to fill the position, which became open in July. As the firm conducting the search, Isaacson, Miller will accept all inquiries, candidate recommendations, and self-nominations, via the e-mail address 4849@IMSearch.com.

    The scope document is available on the APTA Staff webpage, where other information and updates about the CEO transition appear. On Isaacson, Miller’s webpage that lists the position, click on the 4849@IMSearch.com e-mail link to receive an automatic reply that includes the scope document.

    APTA Exhibits at National Conference of State Legislatures

    APTA's sponsorship and participation in the eighth annual NCSL "Walk for Wellness" and the APTA physical therapy information booth were prominent features at the National Conference of State Legislatures (NCSL) annual Legislative Summit last week, where the association was again a leading exhibitor.

    Also at this year's event in Atlanta's Georgia World Congress Center, conference attendees took the "PT Challenge" at the APTA booth—they answered quiz questions on direct access, protection for the term "physical therapy," and the detrimental effect of high patient copays for physical therapist services. Winners were eligible for a drawing for a Kindle Fire. This and other activities drew numerous state lawmakers from across the country to the APTA booth, where APTA State Government Affairs staff and Physical Therapy Association of Georgia (PTAG) volunteers educated them about direct access to physical therapist services, term protection for physical therapy, copays, infringement concerns, payment challenges, and other issues important to the physical therapy profession at the state level. See highlights from this year's event.

    MoveForwardPT.com Seeks Applicants for Editorial Board Positions

    APTA is seeking members to help develop and review content for MoveForwardPT.com, the association’s official consumer website. Two vacant positions on the MoveForwardPT.com Editorial Board are waiting to be filled.

    New members will join the current editorial board, which helps write, edit, and review content, such as the detailed symptoms and conditions guides, according to their area of expertise. Board members also facilitate content development and review with other physical therapist experts in the field.

    Applicants must be APTA members with a strong clinical background, proven writing skills, and a keen interest in developing evidence-based, consumer-friendly content. Read the full position description.

    If interested, send a curriculum vitae, letter of intent, and appropriate writing samples to Katie Kissal, senior web content specialist. Please do not volunteer for this position in the comments section of this article.

    The application deadline is September 21.

    Labels: None

    Patient Stories Sought for Move Forward Radio

    Do you have any current or former patients or clients who would be willing to share their physical therapy success stories? If so, MoveForwardPT.com may be interested in interviewing those patients, and their physical therapist, for upcoming episodes of Move Forward Radio, APTA's official consumer-oriented online radio show and podcast.

    If you know of an inspirational physical therapy patient story, e-mail Katie Kissal with a basic description. Do not include in the e-mail your patient’s name or any other identifiable information that would violate HIPAA’s patient privacy protections. Also, do not use the comments section of this post to volunteer for this opportunity.

    If your suggested patient story is selected, APTA staff will contact you to arrange an interview with you and your patient.

    Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as podcasts via iTunes.

    APTA Urges Increase in Payment for NCS and EMG Tests

    The values of the CPT codes describing nerve conduction studies (NCS) and electromyography (EMG) tests should be increased to more accurately reflect the intensity of the work involved, APTA and others contended yesterday. In particular, APTA member John Palazzo, PT, DSc, ECS, represented APTA in the NCS refinement panel that the Centers for Medicare and Medicaid Services (CMS) conducted at the request of APTA and the other groups.

    These groups have urged CMS to reconsider Medicare payment cuts that were made to NCS and EMG services for 2013.

    During the discussions, presenters provided CMS staff, carrier medical directors, and several other panel members a detailed explanation of the intensity of the work involved in performing NCS and EMG tests to support an increase in payment for these services.

    APTA anticipates that a decision will be made on or around November 1, 2013, when the 2014 physician fee schedule is released, regarding whether the work values and therefore payment for EMG codes (95886 and 95887) and NCS (95908-95913) will increase in 2014. APTA will share any information when it becomes available.

    Payment for NCS and EMG was cut more than 50% beginning January 1, and APTA says it has a catastrophic effect on patients who depend on their health care providers to care for complex and often chronic neurologic diseases.

    Other organizations that participated in the refinement panel yesterday along with APTA were the American Academy of Neurology, American Clinical Neurophysiology Society, American Academy of Physical Medicine & Rehabilitation, American Association of Neuromuscular & Electrodiagnostic Medicine, and American Academy of Otolaryngology - Head and Neck Surgery.

    Older Adults Encouraged to Check for Fall Hazards

    In recognition of Falls Prevention Awareness Day on September 22, the American Physical Therapy Association (APTA) is urging older adults to take a moment to complete a room-by-room checklist to identify and repair possible fall hazards in their homes.

    "Hazards in the home are one of the leading causes of falls in older adults," says APTA spokesperson Patrice Winter, PT, DPT. "Removing throw rugs, rerouting electrical cords, and installing handrails are simple ways in which one can make a home safer."

    According to the Centers for Disease Control and Prevention, more than one-third of adults ages 65 and older fall each year in the United States. Falls are the leading cause of deaths due to injuries and the most common cause of nonfatal injuries and hospital admissions for trauma for the aging population.

    APTA is a member of The Falls Free™ Coalition of the National Council on Aging's (NCOA's) Center for Healthy Aging, and it supports the goals of that coalition, including Falls Prevention Awareness Day. Resources for clinicians and the public are available on APTA's Balance and Falls webpage, including a video on home hazards. Additional resources are available on the NCOA Falls Free Coalition website. APTA members are encouraged to share and send their Falls Prevention Awareness Day activities and suggestions for additional APTA resources to practice-dept@apta.org.

    What Does Professionalism Look Like? Hear What Your Fellow PTs Have to Say

    What constitutes "professionalism" in physical therapy? How does APTA define the term, and, more important, what does professionalism look like in actual physical therapist (PT) practice? How best can it be fostered in both new and veteran PTs?

    For the answers to those questions and for additional insights on this important subject, view a video roundtable discussion in which 3 PTs share their thoughts and observations. Jean Miles, PT, DPT, discusses her personal journey in professionalism from the 1970s to today. Laura Lee "Dolly" Swisher, PT, MDiv, PhD, who literally (co)wrote the book Professionalism in Physical Therapy, shares historic context and practical applications. Stacey Zeigler, PT, DPT, MS, GCS, outlines her university's comprehensive approach to instilling professionalism in DPT students.

    The moderator is Jody Frost, PT, DPT, PhD, lead academic affairs specialist at APTA, who facilitates a lively exploration of the subject.

    The video discussion, posted on YouTube, had its origins in “The Power of Professionalism,” the cover story in the upcoming September 2013 issue of PT in Motion magazine. Look for it on September 1 at www.apta.org/PTinMotion/. The article takes a comprehensive look at professionalism in physical therapy, quotes additional PTs who are not featured in the video discussion, looks specifically at the physical therapist assistant and professionalism, and lists an array of resources for additional information.

    Healthy People 2020 Adds Web Resources

    You can find new tools and resources for Healthy People 2020, the national initiative to improve the health of all Americans. The website HealthyPeople.gov has added the following:

    • DATA2020: A tool for finding current data on the objectives that Healthy People is tracking, to support work that you and your colleagues are doing in your communities.
    • Evidence-Based Resources: A searchable database that continually adds new resources as the research becomes available. Users can browse resources by topic area, conduct a tailored search, or use menus and boxes to choose evidence-based resources of interest.
    • Sharing Library: A repository of successful implementation stories of strategies and programs that impact Healthy People 2020 objectives. Users are encouraged to read about others’ experiences and submit their own.

    APTA is a member of the Healthy People Consortium.

    Take the APTA Search Challenge

    Help improve the user experience at APTA.org, and earn a chance to win a free year of APTA national membership.

    Now through the end of August, APTA members can take the "APTA Search Challenge," which asks you to list at least 1 example of hard-to-find content at the association website, along with the term(s) you entered into the APTA.org search engine to try to locate that content.

    Participating in the challenge takes only a few minutes. Data gathered from the exercise will inform future improvements to the site’s search engine optimization and architecture. If you have general feedback about the site, there’s a field for that, too.

    APTA will contact the winner from the random drawing of APTA Search Challenge participants by September 6.

    Study: OA Pain Improved by Supervised Physical Therapy Programs

    Manual therapy or exercise therapy programs provided by a physical therapist is a cost-effective way to relieve pain in people with osteoarthritis (OA) in the knee and hip joints, new research from New Zealand’s University of Otago shows.

    The randomized clinical trial involved 206 patients with hip or knee OA over 1 year and used 3 protocols of treatment provided by physical therapists in addition to usual care by their family practice physician.

    One group was given 7 manual physical therapy sessions in addition to usual care, for 40-50 minutes over 9 weeks, followed by 2 boosters after a further 7 weeks. The second group involved a program of exercise both in the clinic and at home, involving stationary cycling, muscle strengthening, stretching and balance, and agility exercises. The third group was treated with a combination of manual and exercise therapy. A control group received only usual medical care from their family practice doctor or other health care providers.

    Researchers say the results showed that individually supervised exercise therapy or manual therapy provided by a physical therapist, in addition to usual care, improved pain and physical function for at least 1 year. Given the time limits of the therapy sessions, the researchers added that there doesn’t appear to be additional benefit gained from providing both manual and exercise therapy on top of usual care for OA.

    A further study, also published in the journal Osteoarthritis and Cartilage, looked at the economics of the additional treatment in this trial. It found that both additional exercise therapy and manual therapy are more cost effective for the health system and for individuals than applying only the usual OA care management.

    "Exercise therapy provided the best cost-effectiveness from a health system perspective, while manual therapy was best, and was actually cost-saving, from a societal perspective," said lead author Haxby Abbott.

    "On our main measure, we found that additional manual therapy provided the best symptom relief of the 3 treatments we studied. On the other hand, the exercise program also produced very good results on physical tests and on quality of life gains. So each has its strengths; there is no clear best choice for everyone. What’s clear is that either is better than usual care only."

    "These results suggest that family practice doctors should refer patients with hip or knee arthritis for individually supervised exercise or manual therapy provided by a physical therapist, in addition to continuing to provide usual medical care."

    Speak Up on Requirements for Care of Patients With Dementia in Nursing and Rehab Centers

    The Joint Commission’s (TJC) proposed accreditation requirements on care for patients with dementia in skilled nursing and long-term rehabilitation facilities will impact physical therapists and physical therapist assistants who manage these patients. TJC wants your feedback on the requirements before they are made final.

    The deadline for input is September 3. To comment, visit The Joint Commission webpage, read the proposed requirements, and respond by online survey, an online form, or mail. Instructions for responding are on the webpage.

    TJC says the intent of the requirements is to address the prevalence of dementia without creating unintended consequences for those in the nursing home who do not have dementia. The requirements focus on activity programming, the physical environment, and alternatives to medication use for managing behaviors.

    If you have questions, contact Beth Ann Brehm, RN, LNHA, SPHR, MBA, MSN, TJC associate project director and specialist, at 630/792-5951 or bbrehm@jointcommission.org.

    Move Forward Radio Discusses the Effects of Pregnancy on Running

    Today’s episode of Move Forward Radio focused on a study published in the Journal of Orthopaedic & Sports Physical Therapy examining the effects of pregnancy on the biomechanics of runners.

    Study coauthors Bryan Heiderscheit, PT, PhD, and Liz Chumanov, PT, DPT, PhD, of the University of Wisconsin-Madison, explain their findings and offer advice for women who want to continue to run during pregnancy and after.

    Also interviewed is one of the study’s participants, who shared her personal experiences of running during and after pregnancy.

    Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as a podcast via iTunes.

    Recent episodes have examined stress induced urinary incontinence, pulmonary conditions, and cycling performance and injuries.

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

    APTA 'Insider Intel' Call-Ins Debut With Discussion of Therapy Cap Exceptions

    APTA's new "Insider Intel" monthly Q&A call-in program starts August 13, 2:00 pm–2:30 pm, ET, with the topic of the Medicare therapy cap exceptions process.

    To register for a spot, e-mail advocacy@apta.org with "August 13 Call" in the subject line.

    Based on high demand for information on emerging policy and payment topics, APTA staff will host monthly "Insider Intel" Q&A call-ins dedicated to specific hot topics in policy and payment on the second Tuesday of every month, 2:00 pm–3:00 pm, ET, free to APTA members. If you're unable to participate live, these calls will be recorded and posted afterward.

    Therapists are experiencing a fast paced and changing policy and payment environment with the implementation of the health care reform and refinements to payment. These calls will provide you with the latest information you need to know to keep up-to-date and adapt your practice to comply with these policies.

    Medicare Call-In to Focus on ICD-10 Basics and CMS Implementation

    Are you ready to transition to ICD-10 on October 1, 2014? The Centers for Medicare and Medicaid (CMS) Medicare Learning Network will host a free call-in on August 22, 1:30 pm–3:00 pm, ET featuring a presentation on ICD-10 basics by Sue Bowman from the American Health Information Management Association (AHIMA) and an implementation update by CMS. A Q&A session will follow the presentation.

    To register, visit MLN Connects™ Upcoming Calls. Space may be limited, so register early.

    The agenda includes:

    • Benefits of ICD-10
    • Similarities and differences from ICD-9
    • Coding
    • Basics of finding a diagnosis code
    • Placeholder "x"
    • Unspecified codes
    • External cause of injury codes
    • Type of encounter
    • Training needs and timelines
    • Resources for coding and training
    • National implementation issues

    DCoE to Host Webinar on TBI Screening and Assessment

    An upcoming webinar hosted by the Defense Centers of Excellence (DCoE) will review traumatic brain injury (TBI), explain how military TBI presents in clinical practice settings, compare TBI with posttraumatic stress disorder, and describe screening and assessment methods.

    Click here to register for the August 15 event, which takes place 1:00 pm–2:30 pm, ET.

    Presenter is Sherray L. Holland, PA-C, TBI clinical educator and contractor with the Defense and Veterans Brain Injury Center; moderator is Lt Cmdr Cathleen Shields, MS, CCC-SLP, acting director of the Division of Education and Multimedia Education Materials and office chief for the Defense and Veterans Brain Injury Center.

    The 9 Areas of Most Interest for WCPT Congress in 2015

    If you're considering presenting a focused symposium at the 2015 World Confederation of Physical Therapy (WCPT) Congress in Singapore, look to these 9 topics that the International Scientific Committee is most interested in:

    • Emerging therapies
    • Innovation in delivery of high-quality, cost-effective services
    • Exercise for populations, patients, and clients
    • New educational strategies
    • Lifespan approaches to health promotion and disease and disability prevention
    • Professional leadership, strategy, and policy development
    • Topics that cross populations, specialties, services, or settings
    • Human movement analysis
    • Individualized program planning

    The Congress will be held May 1-4, 2015, and the deadline for focused symposia submissions is September 30, 2013. See the Call for Focused Symposia for details. A general call for abstracts for platform and poster presentations will go out January 2014, with a tentative deadline of August 15, 2014.

    Ultrasound Patch Heals Venous Ulcers in Human Trial

    In a small clinical study, researchers administered a new method for treating chronic wounds using a novel ultrasound applicator that can be worn like a band-aid, the National Institutes of Health (NIH) reported last week. The applicator delivers low-frequency, low-intensity ultrasound directly to wounds, and was found to significantly accelerate healing in 5 patients with venous ulcers. The technology was developed with funding from NIH's National Institute of Biomedical Imaging and Bioengineering (NIBIB).

    In an article to be published in the Journal of the Acoustical Society of America, researchers at Drexel University report that patients who received low-frequency, low-intensity ultrasound treatment during their weekly check-up, in addition to standard compression therapy, showed a net reduction in wound size after 4 weeks. Patients who didn't receive ultrasound treatment had an average increase in wound size during the same time period.

    The team's clinical findings were corroborated by their in vitro studies in which mouse fibroblasts—cells that play an active role in wound healing—experienced on average a 32% increase in cell metabolism and a 40% increase in cell proliferation compared with control cells 24 hours after receiving 20 kHz ultrasound for 15 minutes.

    The researchers noted that studies with larger numbers of patients are needed to confirm that the technology is both effective and safe to use. If it is deemed so, patients with other types of chronic wounds such as diabetic or pressure ulcers may also benefit from therapeutic ultrasound.

    Venous ulcers account for 80% of all chronic wounds found on lower extremities, NIH said, and affect approximately 500,000 US patients annually, a number that's expected to increase as obesity rates climb. It's estimated that treatment for venous ulcers costs the US health care system over $1 billion dollars per year. Standard treatment for venous ulcers involves controlling swelling, taking care of the wound by keeping it moist, preventing infection, and compression therapy.

    Inconsistent and Burdensome Documentation Rules Removed From NY, CT LCD Policy

    New York and Connecticut physical therapists no longer have to follow certain burdensome documentation requirements that were in conflict with national Medicare policy.

    Thanks to efforts by APTA and the New York and Connecticut chapters, the Medicare administrative contractor (MAC) for those states removed 2 requirements from its local coverage determination policy: (1) for progress reports to jump from a frequency of every 10 treatment days to every 5 treatment days after services exceeded the therapy cap, and (2) for documentation of a physician reexamination for services that exceeded either 90 days or the therapy cap. Both requirements directly conflicted with national Medicare policy.

    APTA sent a letter on May 6 to the MAC, National Government Services Inc (NGS), expressing concerns about the documentation requirements and urging NGS to make them consistent with national Medicare policy. In response, NGS is removing these requirements in a revised policy that is effective for dates of service on or after August 1, 2013.

    For questions or more information, please e-mail advocacy@apta.org.

    New Publication Explains Key EHR Contract Terms

    A new resource gives physical therapists and other health care providers explanations of key terms and provisions used in contracts with EHR technology developers.

    The new EHR Contracts: Key Contract Terms for Users to Understand from the Office of the National Coordinator for Health Information Technology (ONC) provides an overview of commonly used contract provisions and technical insight. The guide defines and explains such terms as "indemnification and hold harmless," "limitation of liability," and "termination and wind down," which ONC says can help providers choose an appropriate EHR system and help protect practices from safety risks that may arise from EHR adoption.

    The guide notes, however, that it is not legal advice, and it's wise to have an experienced attorney review the terms of any specific contract and situation.

    More resources are available on APTA's EHR webpage.

    New and Updated Resources on Functional Limitation Reporting Under Medicare

    FAQ updates and new podcasts offer members the latest information on issues most top-of-mind related to functional limitation reporting (FLR).

    The FAQ lists on APTA's FLR webpage now reflect items from recent call-in discussions. In addition, 3 new podcasts address hot topics within functional limitation reporting: the involvement of physical therapist assistants in FLR, reporting on patients in "observation status," and reporting on patients with multiple diagnoses and plans of care. The first podcast on PTAs is available today on the FLR webpage. Look for the release of the next 2 podcasts in upcoming weeks.

    To see all of APTA's member resources on functional limitation reporting, visit www.apta.org/FLR.

    APTA Summary of Final Rule on Medicaid and CHIP Posted

    APTA has reviewed the final rule on Medicaid and the Children's Health Insurance Programs (CHIP) that was released July 5 as a supplement to the final rule on health care exchanges. Among other things, under this rule CMS clarifies that any individuals eligible to enroll in Alternative Benefit Plans (ABPs) must be provided the 10 mandatory benefits that the Accountable Care Act deemed "essential health benefits," one of which includes rehabilitative and habilitative services.

    A summary of the ruling is available to members on the APTA website on both the Medicaid and the Health Insurance Exchanges webpage.

    Congressional Committee Takes First Steps on Payment Reform

    Addressing the flawed sustainable growth rate (SGR) brings Congress 1 step closer to overhauling the Medicare Part B payment system out of its current fee-for-service model. On July 31, the House Energy and Commerce Committee unanimously passed HR 2810, the Medicare Patient Access and Quality Improvement Act of 2013, to repeal the SGR.

    The committee's first move, in what is expected to be a months' long process, was to pass the specific policy provisions relating to repealing and reforming the SGR. In its current form the bill does not address Medicare "extenders," Medicare therapy cap repeal, or how to pay for the $139 billion cost of the legislation. Congressional indications are that the House and the Senate will begin to discuss these items following the planned congressional August recess. During deliberations of the legislation within the committee, several congressional champions for therapy pushed for inclusion of therapy cap repeal in the final legislation.

    HR 2810 includes 3 phases for payment reform:

    • Phase I repeals the current SGR formula and provides for a period of stable provider payments.
    • Phase II establishes a Quality Update Incentive Program (QUIP) to tie quality measures to payment.
    • Phase III analyzes new payment models to move providers out of the current fee-for-service system.

    With the February announcement from the Congressional Budget Office that the cost to repeal the flawed SGR formula had decreased from $243 to $139 billion, legislators have shown increased interest in repeal and reforming the current Medicare payment system. APTA has worked with the committee and provided feedback based on our SGR priorities as this legislation was being created. APTA continues to advocate for inclusion of a long-term solution to the therapy cap as this moves forward and will keep members informed as proposals move forward through Congress this fall. Members are encouraged to sign up for APTA's advocacy network, PTeam, to show support for APTA's policy priorities in this and other pieces of key legislation.

    Latest GAO Report on Self-Referral Bolsters Argument for Closing Loophole

    Yet another report from the Government Accountability Office (GAO) concludes that when physicians provide certain services in their own facilities instead of referring the service to an outside lab, the number of procedures increases, and costs go up. GAO released "Higher Use of Costly Prostate Cancer Treatment by Providers Who Self-Refer Warrants Scrutiny" yesterday.

    This third of 4 reports in GAO's self-referral investigation covered prostate cancer–related intensity-modulated radiation therapy (IMRT) services between 2006 and 2010. Among the findings are that self-referred services grew by 46% annually, from 80,000 in 2006 to 366,000 in 2010, while non-self-referred services decreased by 1% each year, from 490,000 to 466,000. In 2009, providers who self-referred Medicare patients with prostate cancer were 53% more likely to refer the patients for IMRT than for other less costly treatments. GAO estimated that, even including a $91 million decrease in expenditures by the non-self-referring provider groups, the higher rate of IMRT by self-referrers led to an overall increase in IMRT Medicare costs of $47 million between 2006 and 2010. The report also suggested that financial interest in one type of treatment over other less costly procedures may negatively affect a provider's decision-making process and, ultimately, patient care. Additional findings and conclusions are in the report.

    Studies such as this have prompted at least 1 member of Congress to act. Yesterday Rep Jackie Speier (D-CA) introduced the Promoting Integrity in Medicare Act, announcing during a press conference that it is intended to remove physical therapy and other health care services from the in-office ancillary services (IOAS) exception, which allows for self-referral. APTA and its partners in the Alliance for Integrity in Medicare, or AIM Coalition, strongly support this move to exclude these services from the IOAS exception.

    In its first 2 reports, GAO investigated self-referral in advanced imaging services and anatomic pathology, also concluding financial self-interest was driving the increases in referrals and spending.

    APTA anticipates the last—and most telling for our profession—report in the series, on physical therapist services, later this year.

    New Law Averts Doubling of Federal Student Loan Rates

    Instead of jumping to 6.8%, federal undergraduate student loan interest rates rise this year from 3.4% to 3.9%, as a result of the Bipartisan Student Loan Certainty Act. Graduate rates drop from 6.8% to 5.4% and Parent PLUS rates to 6.4%. For all 3 programs, the interest rate is fixed for the life of the loan.

    After a month of negotiations, US House of Representatives passed the bill on July 31, and the President Obama now is expected to sign it. (The Senate passed the bill earlier in July.) This legislation lowers interest rates for undergraduate and graduate Stafford loans and for Parent PLUS loans beginning July 1, 2013.

    Interest rates will be calculated using a formula based on the 10-year Treasury note. Students lock in the rate in effect at the time they take out a loan, but future rates could vary based on the market. With this in mind, this legislation also puts a cap on interest rates in the future: 8.25% for undergraduates, 9.5% for graduates, and 10.5% for PLUS loans.

    APTA Applauds New Legislation Seeking to Curb Physician Referral-for-Profit

    Mounting evidence that physician self-referral encourages unnecessarily higher use of certain services more than justifies the introduction of the Promoting Integrity in Medicare Act today in Congress.

    Rep Jackie Speier (D-CA) introduced the bill, announcing during a press conference that it is intended to remove physical therapy and other health care services from the in-office ancillary services (IOAS) exception, which allows for self-referral.

    APTA and its partners in the Alliance for Integrity in Medicare, or AIM Coalition, strongly support this move to exclude these services from the IOAS exception. The exception—originally intended for same-day services, such as x-rays or blood draws, that are integral to the physician's services and convenient for the patient—has instead encouraged misapplication for financial self-interest. The result is overuse and hundreds of millions of Medicare dollars in unneeded treatments.

    A series of reports from the Government Accountability Office (GAO) is but one source of evidence that supports this claim. Two published reports have concluded that when physicians provide certain services in their own facilities instead of referring the service to an outside lab, the number of procedures increases, and costs go up. GAO so far has investigated self-referral in advanced imaging services and anatomic pathology. GAO is expected to release a third report, on radiation oncology, any day now, and APTA anticipates the last—and most telling for our profession—report in the series, on physical therapist services, later this year.

    "APTA strongly supports all efforts to eliminate self-referral situations and relationships that compromise patient access and quality or add cost," said APTA President Paul A. Rockar Jr, PT, DPT, MS. "APTA has worked hard to reach a solution to close this loophole, and we are pleased to see this important legislation introduced."

    View APTA's Self-Referral webpage for more information and background.

    2014 Prospective Payment System Raises SNF and IRF Payments

    The 2014 prospective payment system (PPS) final rules for skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) call for market basket updates of 1.3% and 2.3% respectively. The Centers for Medicare and Medicaid Services (CMS) released the final PPS rules for these facilities July 31, and the Federal Register will publish both rules August 6.

    Also for SNFs, an item is added to the Minimum Data Set to permit SNFs to record the number of distinct calendar days of therapy provided by all rehab disciplines—physical therapy, occupational therapy, and speech-language pathology—over the 7-day look-back period. The final rule clarifies that classification into the Medium Rehab category requires 5 distinct calendar days of therapy, and classification into the Low Rehab category requires 3 distinct calendar days.

    For IRFs, the rule revises the list of diagnosis codes that may be counted toward the threshold to determine "presumptive compliance" (the "60% Rule"), removing nonspecific, arthritis, unilateral upper extremity, some congenital anomaly, and miscellaneous diagnosis codes. However, in response to stakeholder comments regarding implementation of these changes, the effective date is delayed for 1 year. Therefore, these codes will be removed for compliance review periods beginning October 1, 2014.

    Under the IRF Quality Reporting Program, CMS adopts the following quality measures:

    • NQF-endorsed version of the Percent of Residents or Patients with Pressure Ulcers that are New or Worsened (Short-Stay)
    • Percent of Residents or Patients Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine (Short-Stay)
    • Influenza Vaccination Coverage among Healthcare Personnel
    • All-Cause Unplanned Readmission Measure for 30 Days Post Discharge from Inpatient Rehabilitation Facilities

    Both final rules become effective October 1, 2013. APTA will analyze them and provide summaries in the coming weeks.