• Tuesday, May 26, 2015RSS Feed

    Legislation Would Expand PT Workforce in Underserved Areas, Extend Student Loan Repayment Program to PTs

    Legislation that would include physical therapists (PTs) among the professions included in a federal program to provide greater patient access to health care in underserved areas was introduced in both the US House of Representatives and Senate, just in time to be included in the grassroots advocacy efforts taking place during PT Day on Capitol Hill June 3-4.

    The Physical Therapist Workforce and Patient Access Act (H.R. 2342/S. 1426) was reintroduced late last week and, if passed, would allow PTs to participate in the National Health Service Corps (NHSC) loan repayment program, an initiative that repays up to $50,000 in outstanding student loans to certain health care professionals who agree to work for at least 2 years in a designated Health Professional Shortage Area (HPSA).

    The bill was introduced in the House by John Shimkus (R-IL) and Diana DeGette (D-CO), and in the US Senate by John Tester (D-MT) and Roger Wicker (R-MS). The timing of the reintroduction couldn't be better, as an estimated 1,000 PTs, physical therapist assistants (PTAs), and students from PT and PTA programs descend on Washington, DC, to join in PT Day on Capitol Hill on June 4. Events will begin with a rally before participants fan out across the halls of Congress to advocate for increased patient access to PTs, loan forgiveness, the Medicare therapy cap, and other issues.

    APTA is a strong supporter of legislation that extends student loan forgiveness to PTs, particularly as a way to improve access to physical therapist services in areas already experiencing shortages.

    "Based on current trends in the physical therapist workforce, the shortage of physical therapists could potentially reach over 27,000 in the United States by 2020, greater than other primary care disciplines recognized by the [NHSC]," APTA notes in a position paper on the legislation (.pdf). "The inclusion of physical therapists in the NHSC Loan Repayment Program will help to ensure that rehabilitation services are available to underserved communities."

    Find out more about PT workforce legislation—including details about the NHSC loan repayment program and what you can do to advocate for the profession—at APTA's Education and Workforce Legislation webpage.

    Thursday, May 21, 2015RSS Feed

    New Postacute Care Webpage Makes an IMPACT

    Work in a postacute care setting? Brace yourself for IMPACT.

    New to the APTA website: a webpage exclusively devoted to providing you with everything you need to know about postacute care reform in Medicare, including information on how the Improving Post-Acute Care Transformation (IMPACT) Act will change the types and quantity of data provided to the Centers for Medicare and Medicaid Services (CMS).

    The new webpage provides a basic outline of the principles behind postacute care reforms, resources from CMS, summaries of proposed rules, and highlights of APTA's involvement in the process.

    The reach of IMPACT and other postacute care reforms extends to skilled nursing facilities, home health, inpatient rehabilitation facilities, and long-term care hospitals. APTA is a strong supporter of the reform initiatives, including the provisions of the IMPACT Act.

    Wednesday, May 20, 2015RSS Feed

    Last Chance to Test ICD-10 Reporting System

    With no further delays on the horizon, the shift to the new International Classification of Diseases, 10th Revision (ICD-10) is set for October 1. Physical therapists (PTs) have one more chance to capitalize on an opportunity to test the new system before actual implementation, but only if they act quickly.

    The last of 3 ICD-10 test programs that the Centers for Medicare and Medicaid Services (CMS) has conducted for health care providers is scheduled for July 20-24, and the deadline to apply is May 22. APTA is encouraging members to sign up for the program to gauge their own practice's readiness for the change.

    Bonus for any PTs who already participated in the January or April end-to-end tests: you can participate again in July without reapplying.

    The testing program will allow a sample group of providers to work with Medicare administrative contractors (MACs) and Common Electronic Data Interchange (CEDI) contractors to evaluate the system for processing the new codes, from submission to remittance advice. That testing process will include submission of claims with ICD-10 codes to the fee-for-service claims system, adjudication of claims, and the production of accurate remittance advices.

    CMS is targeting a broad cross-section of providers and will select testing participants based on needs for the study. Volunteers can apply through their MAC's website but must do so by May 22. The MACs and CEDI will notify the volunteers selected by June 12 with information needed for the testing.

    More information on the testing process is available online (.pdf).

    Need more information on what the change to ICD-10 means for your practice? Visit the APTA ICD-10 webpage, which includes background and resources.

    Tuesday, May 05, 2015RSS Feed

    Ready for the Post-SGR World? APTA Offers Highlights of New Medicare Law

    If you think the new Medicare legislation is only about ending the sustainable growth rate (SGR) and extending therapy cap exceptions for 2 years, think again: the new authorization act also contains some substantial changes around manual medical review, quality reporting, and incentives for participation in alternative payment models, to name a few.

    Highlights of the changes (.pdf) taking place through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) are now available on the APTA website. Some of the changes were imposed immediately; others will be implemented over time. The bottom line: MACRA is laying the groundwork for a significant transformation in how physical therapists (PTs) and other health professionals are paid.

    Among the changes:

    Manual medical reviews of therapy cap exceptions won't be based solely on dollar amounts.
    Sometime around mid-July, the $3,700 trigger for manual medical review (MMR) will be replaced with a system that links MMR to provider behavior and other factors. CMS will look at whether a provider has a pattern of "aberrant" billing practices, the provider's claims denial percentage, whether the provider is newly enrolled, what types of medical conditions are being treated, and whether the provider is part of a group that includes another provider who has been identified in terms of the those factors. The new process will apply to exception reviews that have not been conducted by the anticipated July startup date. APTA will meet with CMS to discuss implementation, and will share details with members over the coming months.

    PQRS, value-based modifiers, and electronic health records meaningful use may be consolidated into a single new quality program.
    These quality programs stay in place for now, but prepare for MIPS—the Merit-Based Incentive Payment System—set to be launched in the future. MIPS will evaluate performance according to quality, resource use, meaningful use, and clinical practice improvement. There are still many details that need to be worked out in terms of the reach of these programs in the future.

    Participation in alternative payment models (APMs) could be a rewarding experience.
    CMS will offer 5% bonuses to PTs and other health care professionals involved in APMs such as accountable care organizations, medical homes, and bundled care systems. Beginning in 2026, CMS will stratify annual updates, providing a .75% annual update to health care professionals engaged in APMs, and .25% for those who aren't.

    Other changes in the new law include a new 1% payment update factor for postacute care providers; the inclusion of physician assistants, nurse practitioners, and nurse clinical specialists as professionals qualified to provide documentation for certain types of durable medical equipment; and requirements that Medicare administrative contractors (MACs) provide ongoing outreach, education, training, and technical assistance to providers.

    Want more information on how the therapy cap exceptions process will work under MACRA? Check out the newly revised therapy cap FAQs.

    Tuesday, April 21, 2015RSS Feed

    Legislation Introduced in Both Chambers Aims to Improve Rehabilitation Research

    Significant improvements to research on rehabilitation—a longstanding policy priority for APTA, and an important element in accomplishing the association's transformative vision—are at the center of proposed bipartisan legislation on Capitol Hill that aims to foster and better coordinate this type of research at the National Institutes of Health (NIH).

    Titled the Enhancing the Stature and Visibility of Medical Rehabilitation Research at the NIH Act (S. 800; H.R. 1469), the companion bills were introduced in the Senate by Sens Mark Kirk (R-IL) and Michael Bennett (D-CO), and in the House by Reps Jim Langevin (D-RI) and Gregg Harper (R-MS) on March 19. The legislation would reform practices at NIH around how rehabilitation research is integrated across the Institute's research centers, and how often research plans are reviewed and updated.

    Among the proposals in the legislation:

    • The creation of stronger links within NIH to coordinate rehabilitation research across the NIH's 27 institutes and centers
    • The adoption of a standard definition of medical rehabilitation research as "the science of mechanisms and interventions that prevent, improve, restore, or replace lost, underdeveloped, or deteriorating function"
    • The establishment of a rehabilitation research plan that would be updated every 5 years and used as a way to gauge co-funding opportunities
    • A requirement for an annual progress report on medical rehabilitation research

    The proposed changes build on recommendations from an NIH blue ribbon panel that was co-chaired by Rebecca Craik, PT, PhD, with members that included Anthony Delitto, PT, PhD, and Alan M. Jette, PT, PhD. The panel's recommendations, issued in 2013, were supported by APTA, with APTA President Paul A. Rockar Jr, PT, DPT, MS, characterizing the findings as ones that reflect APTA's "core principles," and are "critical to meeting the NIH's mission and impacting society in a positive manner."

    Improvements to rehabilitation research and support of NIH work in this area are among APTA's public policy priorities. In addition to its individual advocacy efforts, the association is a member of the Disability and Rehabilitation Research Coalition, a group of more than 40 organizations working together to promote this type of research.

    "Along with our fellow members in the coalition, we are extremely happy about the introduction of these bills," said Justin Moore, PT, DPT, APTA executive vice president of public affairs. "We fully supported the NIH blue ribbon panel's recommendations, which are clearly reflected in this legislation. If passed into law, these changes would represent a real move forward for rehabilitation research and its ability to transform lives."

    APTA will continue to monitor and report on the progress of these bills.

    Wednesday, April 15, 2015RSS Feed

    Senate Approves SGR Repeal, Keeps Therapy Cap and Exceptions Process

    The US Senate voted Tuesday to approve a bill that repeals the flawed sustainable growth rate (SGR) and moves toward payment systems based on quality, but, despite a concerted, historic grassroots advocacy effort, does not end the Medicare outpatient therapy cap. The therapy cap repeal amendment was defeated by a 58-42 vote, coming up just short of the 60 votes needed for passage.

    Instead of a full repeal, the therapy cap exceptions process will extend until December 31, 2017.

    The vote on the SGR ends a flawed system for payment that would have resulted in 21% reductions in Medicare payments to providers. The bill approved by the Senate passed with an overwhelming 92-8 vote, and President Barack Obama has stated that he will sign it into law. The bill was approved by the House in late March.

    Among the most significant features of the bill are the ways it sets the stage for a transition to value-based health care services, and away from the fee-for-service model—a shift strongly supported by APTA.

    The effort to include an amendment to end the therapy cap was championed by Sen Ben Cardin (D-MD) along with Sen David Vitter (R-LA), and was the focus of an intensive effort by APTA, its members, supporters, and other organizations to urge senators to vote in favor. In the end, the amendment was 1 of only 6 allowed to be considered, and among those 6, garnered 1 of the highest number of votes in favor.

    "Ending the SGR is good news not just because it ends a flawed policy, but because it's helping to transform payment models," said Justin Moore, PT, DPT, APTA executive vice president of public affairs. "We are of course disappointed that the therapy cap repeal effort was not successful, but thanks to the hard work of APTA members and supporters, we were able to seize an historic moment and move this issue closer to the goal line than at any time in the 18-year history of the cap. We will capitalize on this energy, unity, and momentum, and will never stop working for the best interests of patients."

    APTA will provide further information and resources on the provisions passed in the SGR bill over the coming weeks and will continue to influence its implementation with the Centers for Medicare and Medicaid Services.

    Wednesday, April 08, 2015RSS Feed

    Blogs and Tweets and Posts Oh, My: Support for Therapy Cap Repeal Gets Creative

    APTA members and supporters are keeping the pressure on the US Senate to consider an amendment that would end the therapy cap, and, true to the profession, doing it with plenty of energy and creativity.

    In addition to APTA’s own grassroots efforts to ensure that a therapy cap repeal amendment is included in legislation to end the sustainable growth rate (SGR), Joseph Brence, PT, DPT, FAAOMPT, used his "Forward Thinking PT" blog to urge physical therapists (PTs) to contact their senators, and he compiled a list of social media handles that makes it easy to post to legislators' and staffers' Twitter accounts. The list also includes links to each senator's Facebook page.

    Many PT and physical therapist assistant (PTA) students are answering APTA's request for phone calls, but with a twist: yesterday, they began answering a challenge from APTA to document their phone calls to senators by posting photos on Twitter. You can check out the photos through this Storify page. Great stuff.

    The grassroots efforts are aimed at capitalizing on what has been described as the best chance of obtaining a permanent repeal of the Medicare outpatient therapy cap since it was imposed 18 years ago. This chance, in the form of an amendment from Sen Ben Cardin (D-MD), would end the cap in the same legislation that ends the SGR.

    But the Senate needs to allow the amendment to be put up for consideration first. Visit APTA's Medicare Therapy Cap webpage for more information, and make 2 calls today.

    Not sure how to get in touch with your senator? The US Senate's website offers a contact lookup feature for phone numbers and email addresses. When you call, consider sharing the following message:

    "Senator Cardin is pushing for an opportunity to offer an amendment to fully repeal the therapy cap. I strongly urge you to (1) support his efforts to get a vote on the amendment and (2) then to vote for this critical amendment. Since Congress established the arbitrary cap on Medicare outpatient therapy services, Congress has acted 12 times to prevent the cap's implementation. Continual extensions of the therapy cap exceptions process costs significantly more in the long run than addressing a permanent solution NOW."

    Tuesday, April 07, 2015RSS Feed

    Wide Support for Therapy Cap Repeal; Your Voice Needed Now

    With friends like this, you could make therapy cap history.

    As APTA, its members, and supporters continue to engage in a full-court press to urge US senators to allow an amendment to permanently repeal the Medicare outpatient therapy cap, they can take heart in one important fact: they're not alone. According to APTA, no fewer than 24 other organizations also back the idea of putting an end to the cap.

    The combined efforts are now being applied to an historic opportunity to end the cap as part of a bill that would repeal the flawed sustainable growth rate (SGR); specifically, to convince the Senate to allow consideration of an amendment from Sen Ben Cardin (D-MD) to put permanent repeal of the cap in the bill. APTA is urging members and patients to contact their senators using the messaging available on the Medicare Therapy Cap webpage.

    For APTA, the fight to end the cap began almost as soon as it was created nearly 18 years ago. Along the way, other groups have recognized that temporary "fixes" that allow exceptions to the cap should be replaced with a once-and-for-all approach that truly serves people in need of care.

    The list of groups supporting therapy cap repeal now includes the American Association of Retired Persons, the ALS Association, the American Heart Association/American Stroke Association, the Arthritis Foundation, Easter Seals, the National Disability Rights Network, the Brain Injury Association of America, Parkinson's Action Network, and the National Multiple Sclerosis Society. In addition, several years ago APTA, the American Speech-Language-Hearing Association, and the American Occupational Therapy Association created a coalition to work together for repeal.

    "It's wonderful to have such widespread support, and it's great that we all share the opinion that the therapy cap is not in the best interest of patients," said Mandy Frohlich, APTA's vice president of governmental affairs. "But what makes a difference on Capitol Hill is when individual members take personal action and call legislators. Now more than ever, that's what needs to happen."

    Not sure how to get in touch with your senator? The US Senate's website offers a contact lookup feature for phone numbers and email addresses. Consider sharing the following message:

    "Senator Cardin is pushing for an opportunity to offer an amendment to fully repeal the therapy cap. I strongly urge you to (1) support his efforts to get a vote on the amendment and (2) then to vote for this critical amendment. Since Congress established the arbitrary cap on Medicare outpatient therapy services, Congress has acted 12 times to prevent the cap's implementation. Continual extensions of the therapy cap exceptions process costs significantly more in the long run than addressing a permanent solution NOW."

    Monday, April 06, 2015RSS Feed

    Possible Therapy Cap Repeal Amendment Could Make History; Every PT Can Help Shape the Vote

    A permanent repeal of the Medicare outpatient therapy cap could be closer than ever if Congress allows one senator's proposed amendment to be considered. Now it's time to make that possibility a reality, according to APTA.

    Last week, Sen Ben Cardin (D-MD) announced that he is prepared to lead the way in the fight to end 18 years of temporary fixes to the therapy cap by ending the cap completely. The historic change would come through an amendment to a bill, passed by the House of Representatives and awaiting Senate consideration, that seeks to end the flawed sustainable growth rate (SGR).

    The challenge? Senators need to agree to allow a vote on Cardin's amendment. APTA is calling on its members and supporters to contact their senators as soon as possible to urge them to support Cardin's effort to get a vote on the amendment—and then to vote in favor of it. The Senate is anticipated to take up the entire SGR repeal bill early next week after it returns from adjournment on April 13.

    APTA is urging members and patients to contact their senators using the messaging available on the Medicare Therapy Cap webpage. The US Senate's website offers a contact lookup feature for phone numbers and email addresses.

    APTA isn't the only organization working for an end to the therapy cap: in addition to coalition partners the American Speech-Language-Hearing Association and the American Occupational Therapy Association, the long list of supporters includes the American Association of Retired Persons (AARP) and the American Heart Association.

    Friday, April 03, 2015RSS Feed

    CMS Offers Update on Therapy Cap, SGR in Wake of March 31 Expirations

    While APTA, its members, and supporters continue to press legislators to include a permanent repeal of the Medicare therapy cap in a proposed bill to end the flawed sustainable growth rate (SGR), the US Centers for Medicare and Medicaid Services (CMS) has posted an update on where things stand now that an important deadline has passed.

    A special edition of the Medicare Learning Network's provider enews recaps changes that kicked in when SGR and therapy cap exceptions expired on March 31.

    In the newsletter, CMS states that it is "taking steps to limit the impact on Medicare providers and beneficiaries by holding claims for a short period of time." The resource also outlines the current state of the therapy cap, ambulance services, and other areas.

    Congress adjourned before the Senate voted on a measure, passed by the House of Representatives, that would repeal the SGR but does not contain a permanent end to the therapy cap. Senate leaders have promised that the bill will be taken up soon after Congress reconvenes on April 13.

    APTA urges members to take action to advocate for therapy cap repeal through both the association's legislative action center and the APTA Action App. The association also encourages members to reach out to patients and colleagues to make contacts as well, and provides a patient action center to help them.

    To add real-life urgency to the issue, APTA is also asking for members to contact its advocacy staff with their stories of how the therapy cap impacts their ability to provide adequate services to patients, and the risks involved with arbitrary limits on outpatient therapy reimbursements. Send your stories to advocacy@apta.org.