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  • Washington Post: End of Therapy Cap a 'Long-Awaited Gift'

    The end of the hard cap on payment for therapy services under Medicare was big news for patients and the profession—a fact that hasn't escaped the notice of The Washington Post.

    The March 1 edition of the Post featured a story from Kaiser Health News on the elimination of the cap, which is described as a change "buried" in the federal spending plan approved by Congress in February, albeit one that "reveals much about how health care financing often gets done—or undone—in Washington."

    The article recounts the birth of the cap in 1997, efforts to repeal it, and the regular scrambles to apply temporary exceptions to the policy. And to help illustrate the long slog that finally led to repeal, Kaiser reporter Shefali Luthra retells the story of an ambitious physical therapist who left his practice in Michigan and headed to Washington, DC, nearly 20 years ago to help advocate for an end to the cap. His name: Justin Moore, PT, DPT—as it happens, the same Justin Moore who's now CEO of APTA.

    The unceasing advocacy efforts of "a small but impassioned therapy contingent" of APTA members, association staff, and patients is what "laid the groundwork" for the cap fix, according to the Post article. As for Moore, he's quoted as saying "I've got to figure out what to do next." Insider tip: he's joking.

    Humana Coverage Limitations: More of the Same

    Humana’s latest list of physical therapy services it won't cover may not have changed much, but that doesn't mean the limitations should continue, according to APTA. The association recently voiced its concerns over the ways the health insurer characterizes physical therapy, its imprecise terminology, and its continued noncoverage of aquatic physical therapy and group physical therapy.

    The APTA letter was sparked by the release of the latest updates to Humana's medical coverage policy, which has drawn attention in the physical therapy community because of a list of services it says it may not cover. That list includes aquatic therapy, group therapy sessions, sensory integration, community/work reintegration, and work hardening/conditioning.

    While disappointing for physical therapists (PTs) and their patients, the coverage limitations themselves aren't new, according to Alice Bell, PT, DPT, senior payment specialist at APTA. Bell was part of a payment and practice management staff team that reviewed the policy.

    "The latest update from Humana changed very little from the policy in place in 2017 and earlier," Bell said. "Noncoverage of aquatic therapy, group therapy, and work hardening dates back to at least 2014."

    Still, that doesn't mean the policy is acceptable, in APTA's view. Earlier this month, APTA sent a letter to Humana that specifically cites aquatic therapy and group therapy as services that should be covered.

    "Evidence demonstrates that for some patients the progression to land-based exercise and functional movement is effectively facilitated through the use of aquatic therapy," the letter states. When it comes to group therapy, APTA asserts that for certain conditions and patient populations, "the psychosocial benefits of peer support and group interaction can serve to enhance the therapeutic experience and impact," adding that it's distinct from group exercise in its integration into an overall skilled plan of care aimed at optimizing the effectiveness of therapy.

    The APTA letter also points out other areas in which Humana uses sloppy language or just plain gets it wrong. One example: Humana's description of exercise as a modality. "Modalities are passive interventions," the association reminds Humana. "Therapeutic exercise is an active aspect of therapy."

    APTA also describes Humana's statement that "[physical therapy] procedures in general include therapeutic exercises and joint mobilization" as an "extremely narrow" characterization of the profession.

    "Representing the interventions in such a limited way in the description of the practice fails to acknowledge the breadth and depth of the profession, the therapeutic benefit to the patient, and the services covered under the current policy," the letter states. "APTA would like to highlight that the core of skilled physical therapist practice lies in the evaluation, reevaluation, and implementation of therapeutic procedures."

    "Humana has taken some positive steps, particularly when it lifted prior authorization requirements for physical therapy earlier in the year," Bell said. "The latest coverage policy updates do not move any issues forward—or backward for that matter. That's why APTA will continue to advocate for changes that better serve patients."

    #PTTransforms Blog: Keeping the Patient at the Center of Pain Management

    Although APTA’s recent “Beyond Opioids” panelists were diverse in experience and profession—including patient advocacy, health care provision, government, and business—several common themes arose around pain management. A new #PTTransforms blog post goes beyond the opioid statistics to highlight patient-centered strategies suggested by the guests.

    Several participants urged improved provider-patient communication, including patient advocate Joan Maxwell, who was prescribed opioids after each of 9 surgeries, without a single discussion about the risks and alternatives. In a Washington Post/Kaiser Family Foundation survey, only 65% of respondents said their doctor talked with them about the possibility of addiction when prescribing the drugs, and only 62% received education from their physician about other ways to manage pain.

    Read the full blog post here, and keep an eye out for upcoming posts on a variety of topics.

    APTA’s award-winning #ChoosePT awareness campaign focuses on physical therapy as a safe alternative to opioids for pain management. To learn more, visit the association’s consumer website, www.MoveForwardPT.com/ChoosePT/.

    APTA's Updated Defensible Documentation Resource Provides Insight, Practical Tips, and More

    Physical therapists (PTs) and physical therapist assistants (PTAs) know they can't take their eyes off the ball when it comes to properly documenting care. That's why APTA has revamped and updated its collection of online resources supporting defensible documentation.

    APTA's retooled webpage includes the latest on best practices in documentation, presented in an easy-to-navigate format. Extensive resources include an overview of the defensible documentation concept, elements of documentation within the patient/client management model, setting-specific considerations, risk management, and additional resources such as publications from the US Centers for Medicare and Medicaid Services (CMS) and relevant articles from PT in Motion magazine.

    Also included: tips on defensible documentation and a sample documentation checklist that outlines the process from initial examination and evaluation to completion of the episode of care.

    The webpage advises visitors that while the resources offered provide information "as comprehensive as APTA can reasonably make it," PTs and PTAs also need to check specific compliance requirements of payers, state laws, third-party administrators, and other organizations.

    Want more on defensible documentation? Check out "Defensible Documentation: Critical Documentation from the Payer Perspective," a recording of a January 16, 2018 webinar. Also, coming this summer: a 2-part webinar series on Medicare documentation, August 9 and August 23.

    Now Available: Recording of 'Insider Intel' Session on Therapy Cap, Home Health, More

    The budget deal reached by Congress earlier this month included changes that affected not only the hard cap on therapy services under Medicare but also a host of other health care-related issues, including home health. Are you ready for what's coming?

    "Insider Intel" to the rescue.

    Now available: a recording of an APTA "Insider Intel" phone-in session devoted to the Medicare landscape since the budget deal. Hosted by staff from the APTA regulatory affairs unit, the 30-minute session covered where things stand and included a question-and-answer session.

    New APTA Podcast Series Explores Big Picture and Details of Value-Based Care

    Everyone's talking about "value-based care," but what does the concept really mean, and how will it affect your practice? That's the subject of a new 21-part podcast series now available for download from APTA.

    The free series, delivered in easily digestible 5- to 7-minute presentations, moves from big-picture questions such as "What is value?" and "Why do we need quality measures?" to the nitty-gritty of the Merit-based Incentive Payment System (MIPS) and advanced Alternative Payment Models (APMs). Both MIPS and advanced APMs are pillars of the US Centers for Medicare and Medicaid Service's Quality Payment Program (QPP), a comprehensive shift away from the fee-for-service model of care.

    The series is part of APTA's efforts to educate physical therapists and physical therapist assistants on changes that currently are voluntary, but could be mandatory as early as 2019 and merit attention now. A link to the podcasts, as well as a wide range of other resources on value-based care, can be found on the association's Value-Based Care webpage.

    A Permanent Fix to the Therapy Cap: Improved Access for Medicare Patients Comes With Pending APTA-Opposed Cut to PTA Payment

    The looming threat of a hard cap on physical therapy services under Medicare has been eliminated.

    As part of a sprawling bipartisan budget deal passed today, Congress enacted a permanent solution to the problematic hard cap on outpatient physical therapy services under Medicare Part B, ending a 20-year cycle of patient uncertainty and wasteful short-term fixes.

    Ending the hard cap has been a high priority for APTA since its introduction in 1997 as part of the Balanced Budget Act. Legislators' backing for repeal reached a tipping point in 2017, when lawmakers developed a bipartisan, bicameral agreement to end the cap. Congress failed to enact that deal in 2017, but elements of the plan are included in the 2-year budget that was approved today.

    That's the good news. The bad news is that Congress chose to offset the cost of the permanent fix (estimated at $6.47 billion) with a last-minute addition of a payment differential for services provided by physical therapist assistants (PTAs) and certified occupational therapy assistants (COTAs) compared with payment for the same services provided by physical therapists (PTs) and occupational therapists (OTs), respectively. The payment differential, which was strongly opposed by APTA and other stakeholders, states that PTAs and OTAs will be paid at 85% of the Medicare physician fee schedule beginning in 2022.

    That pending payment differential under Medicare is somewhat comparable to that between physician assistants and physicians, but it was added to the budget bill late and without warning. It wasn’t part of the 2017 bipartisan agreement legislators reached, nor was it part of any discussions or negotiations on Capitol Hill since then.

    When the proposed differential was added to the budget deal late Monday night, the association quickly reached out to congressional offices with proposed amendments. None were accepted. Friday morning, Congress passed the massive budget legislation that includes increases for military and domestic spending, adding an estimated $320 billion to the federal budget deficit.

    “Stopping the hard cap is a victory for our patients, and for our dedicated advocates,” said APTA President Sharon L. Dunn, PT, PhD, board-certified orthopaedic clinical specialist. “For 2 decades we have held back the hard cap through repeated short-term fixes—17 in total—that were achieved each time only through significant lobbying efforts by APTA and other members of the Therapy Cap Coalition. In that time, the hard cap was a genuine and persistent threat to our most vulnerable patients, a threat we saw realized earlier this year when Congress failed to extend the therapy cap exceptions process. Today that threat has been eliminated.”

    Dunn said the January 1, 2022, implementation date for the opposed PTA payment cut provides time to explore solutions with the Centers for Medicare and Medicaid Services (CMS) as it develops proposed rules.

    “APTA will leverage its congressional champions, the APTA Public Policy and Advocacy Committee, and the PTA Caucus on strategies to address the CMS activities,” Dunn said. “Our collective efforts will drive the association’s work to ensure that guidance to implement the new policy is favorable to PTAs and the profession, while ensuring access is not limited for those in need of our services.”

    The legislation enacted today provides a fix for the therapy cap by permanently extending the current exceptions process, eliminating the need to address this issue from year to year. Among the provisions included in the new policy:

    • Claims that go above $2,010 (adjusted annually) still will require the use of the KX modifier for attestation that services are medically necessary.
    • The threshold for targeted medical review will be lowered from the current $3,700 to $3,000 through 2027; however, CMS will not receive any increased funding to pursue expanded medical review, and the overall number of targeted medical reviews is not expected to increase.
    • Claims that go above $3,000 will not automatically be subject to targeted medical review. Instead, only a percentage of providers who meet certain criteria will be targeted, such as those who have had a high claims denial percentage or have aberrant billing patterns compared with their peers.

    Over the coming days, APTA will provide additional details on the budget deal, including the impact on home health. For home health, the deal includes positives related to rural add-ons, a market basket update increase of 1.5% in 2020, and use of home health medical records for determining eligibility. However, it also requires a switch from a 60-day to a 30-day episode in 2020 and eliminates the use of therapy thresholds in case-mix adjustment factors.

    “While this package does not afford APTA with everything we would have liked, we should take a moment to celebrate closing the door on a 20-year advocacy effort that has challenged our ability to ensure timely and appropriate services to patients,” Dunn said. "Reaching this milestone affords APTA the opportunity to expand our advocacy agenda to implement more fully our vision to transform society by optimizing movement to improve the human experience.”

    APTA Learning Center Offerings Will be Included in aPTitude CE Resource

    APTA's Learning Center courses will soon become a lot more accessible, thanks to a partnership with the Federation of State Boards of Physical Therapy (FSBPT) that will add the association's continuing education (CE) offerings to a widely used online system.

    In the coming months, APTA will add its complete catalog of Learning Center courses to aPTitude, FSBPT's online system that allows physical therapists (PTs) and physical therapist assistants (PTAs) to search for CE courses and track attendance. The resource is also available to state physical therapy licensing boards, which can use aPTitude for evaluation of CE compliance for purposes of licensure renewal.

    "APTA is excited to build on its established relationship with FSBPT by utilizing aPTitude," said APTA CEO Justin Moore, PT, DPT, in an association news release. "We look forward to mutually helping our members more easily navigate [CE] courses and activities."

    APTA already has loaded preconference and educational sessions for the 2018 Combined Sections Meeting into aPTitude. More courses and conference content will be added through the spring.

    The aPTitude arrangement was achieved by way of a formal partnership with FSBPT. Launched in 2017, the APTA partnership program is an initiative aimed at enhancing and developing mutually supportive and collaborative relationships with other organizations that have common interests and objectives.

    With Deadline Looming, APTA Members, Patients, Multiple Organizations Press on for Therapy Cap Repeal

    Congress has until February 8 to act on funding the federal government, and between then and now, APTA, its members, patients, and other organizations are making sure that legislators and their staff receive an earful on the need to include a permanent repeal of the Medicare therapy cap as a part of any agreement.

    Here's a quick rundown of what the association and others have been doing to call attention to therapy cap repeal and other crucial health care issues left unresolved by Congress.

    APTA members make a difference
    The association's members continue to deliver the kind of grassroots advocacy that can grab the attention of legislators, with more than 15,000 member emails sent to Capitol Hill, along with nearly that many sent by nonmembers who support repeal of the cap. In addition, more than 20,000 emails have been sent by patients and non-member supporters through APTA's Patient Action Center, a resource that makes it easy to take action on the cap.

    At the same time, members and their patients enthusiastically responded to APTA's call for patient videos urging Congress to repeal the cap. Those videos are being featured on APTA's Facebook page, and will be used as APTA staff and volunteers continue the push for repeal up to the February 8 deadline for congressional action.

    Multiple organizations, 1 voice
    In addition to its work with the Therapy Cap Coalition, which includes the American Occupational Therapy Association (AOTA) and the American Speech-Language Hearing Association (ASHA), APTA has joined forces with other organizations by signing on to 2 letters to members of Congress.

    On February 1, APTA announced that it has joined more than 70 national provider organizations in urging Congress to reauthorize and fund multiple health care programs and policies, including action on the therapy cap. Participating organizations include the American Nurses Association, the American Psychological Association, the Child Welfare League of America, and the National Association of County and City Health Officials.

    “These programs and policies are core to this country’s health care and essential to ensuring that patients have access to the care they need,” said APTA CEO Justin Moore, PT, DPT, in an APTA news release. “We are better together, and APTA did not hesitate to sign on to this letter in hopes that Congress will hear us and take swift and decisive action not only to provide a permanent fix to the therapy cap, but to also address these other critical issues impacting our health care system.”

    The association also joined 50 other organizations, including the Alzheimer's Foundation, the Brain Injury Association, MedStar Health, and the National Rural Health Association, in a letter to Congress urging action on multiple Medicare fronts.

    "We write on behalf of some of the most vulnerable Medicare seniors, disabled, and critically ill patients across America who are now facing serious health consequences if Congress does not pass a Medicare package soon," the letter states. "Now that we are well into 2018, Congress' inaction on these important Medicare policies could mean real harm to the vulnerable patients we serve."

    AARP and the Therapy Cap Coalition meet the press
    AARP, a longtime supporter of therapy cap repeal, joined representatives from APTA, AOTA, and ASHA to take the repeal message directly to the press.

    During a February 1 press conference, AARP spokespersons made the case that time is quickly running out for beneficiaries—many of whom are elderly—who are subject to the $2,010 cap on what AARP Executive Vice President and Chief Advocacy and Engagement Officer Nancy LeaMond described as "vital services."

    "Two thousand dollars doesn't go very far for these treatments," LeaMond said. "And seniors need them after a stroke or a fall to talk, walk, or do other everyday tasks."

    Justin Elliott, APTA's vice president of government affairs, added that access to therapy also allows patients to pursue nondrug approaches to treatment.

    "The caps impact a wide spectrum of patients needing rehabilitation services, from patients who are recovering from a stroke or traumatic brain injury, to those who are suffering from chronic and often painful conditions and would prefer to choose therapy to address their pain instead of taking opioids to mask it," Elliott said. "Patients cannot hit the pause button on their rehabilitation as they wait for Congress to fix this problem."

    APTA-Hosted Panel Discussion on Opioid Epidemic and Pain to Be Broadcast Live Via Facebook

    The opioid crisis needs more action and attention. APTA continues to engage.

    Monday, February 5, APTA will convene a panel of experts to discuss how pain management in America can be transformed to move beyond opioids and improve the health of society. The discussion will be broadcast live from APTA’s Facebook page and will include the premiere of the association’s second public service announcement about the crisis.

    “Despite intensive media coverage over the past 2 years, there are aspects of the opioid epidemic that need significantly more discussion, understanding, and awareness,” said APTA President Sharon L. Dunn, PT, DPT, board-certified orthopaedic clinical specialist. “This crisis is not just about fentanyl, overdose, and addiction, it’s also about educating Americans so they know they have options in pain management and the prevention of chronic disease. We hope this event can advance the national conversation in a way that’s beneficial to both the public and health care providers.”

    The approximately 1-hour event, titled "Beyond Opioids: Transforming Pain Management to Improve Health," will be streamed live via APTA’s official Facebook page beginning at 8:00 pm ET. APTA encourages members to tune in and share the video via Facebook and Twitter using the #ChoosePT hashtag.

    Panelists for the discussion are:

    • Grant Baldwin, director of the division of unintentional injury prevention for the Centers for Disease Control and Prevention
    • Bill Hanlon, PT, DPT, board-certified clinical specialist in orthopaedic physical therapy, staff physical therapist working in addiction recovery at St Joseph Institute in Port Matilda, Pennsylvania
    • Joan Maxwell, patient and family advisor for John Muir Health, and patient-member of Patient & Family Centered Care Partners Inc
    • Tiffany L. McCaslin, senior policy analyst, public policy, for National Business Group on Health
    • Donald Norcross (D-NJ), US congressman, vice chair of the Bipartisan Task Force to Combat the Heroin Epidemic
    • Steven Stanos, DO, medical director, Swedish Pain Services; medical director, occupational medicine services, Swedish Medical Center; and president of the American Academy of Pain Medicine
    • Sarah Wenger, PT, DPT, board-certified clinical specialist in orthopaedic physical therapy, associate clinical professor at Drexel University’s College of Nursing and Health Professions, and contributor to an upcoming issue of Physical Therapy (PTJ) devoted to pain management

    The public service announcement is part of the association's national public awareness campaign, #ChoosePT, which has won multiple national awards, including best video for the first public service announcement.

    That public service announcement reached more than 377 million Americans via television and radio in its first year of release, and APTA’s official consumer information website, MoveForwardPT.com, was visited by more than 3.2 million users in 2017.

    Monday’s panel discussion will be archived on Facebook and YouTube.