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WELCOME! 2012
KPTA Town Meeting
Kansas Physical Therapy AssociationTopeka, Kansas 66603
785-233-5400 Fax: 785-290-0476Email: [email protected]
www.kpta.com
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2012 TOWN MEETING SCHEDULE
K.C. at Shawnee Mission Medical Center – 11/6 Topeka at Rebound Physical Therapy – 11/6 K.C. at Olathe Medical Center – 11/8 Colby at Colby Community College – 11/15 (7-9pm) Great Bend at Advance Therapy & Sports Med. – 11/8
(6:15-8:15 pm) Manhattan at Mercy Regional Health Center – 11/13
(6:30-8:30 pm) Salina at Southwind PT – 11/14 (6:30-8:30 pm) Wichita at Via Christi - St. Francis Campus – 11/8 Pittsburg at Via Christi Hospital – 11/5
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AGENDA
Welcome/Introduction Payment/Reimbursement Issues
Update2012 KPTA Legislative Plan UpdateHouse of Delegates UpdateKPTA Strategic Plan 2011-2013
AGENDA
(aka) WHAT KPTA/APTA HAS DONE FOR YOU (as a member)…
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INITIATIVES
UPDATE FROM APTA
PURPOSEDefine the current status of developing
and implementing regulatory and payer policies.
Identify barriers and opportunities.
Increase your involvement in and knowledge of issues that have an impact on the practice of physical therapy.
Improve your advocacy efforts.
LEARNER OBJECTIVES
The audience members will identify and discuss the varied regulatory and payment policies related to physical therapy services.
The audience members will outline strategies for barriers and opportunities.
The audience will discuss and develop strategies for advocacy efforts.
PRACTICEChallenges
AMA Challenges The Scope of Practice Partnership (SOPP) formed and officially
rolled out in January, 2006.
Comprised of various physician organizations that engage in tracking scope of practice legislative and regulatory efforts.
Targeted professions: Nurses, Psychologists, Podiatrists, Naturopaths, Optometrists, Pharmacists, Audiologists, Oral Surgeons, and Physical Therapists.
In 2006 the Coalition for Patients Rights (CPR) was formed to counteract the SOPP and consists of more than 35 organizations representing a variety of licensed healthcare professionals. APTA is a member.
AMA Challenges AMA published a white paper entitled “AMA
Scope of Practice Data Series”. APTA responds
http://www.apta.org/uploadedFiles/APTAorg/Advocacy/State/News/CPR/Statement_122209.pdf
January, 2011, the APTA publishes “Today’s Physical Therapist: A Comprehensive Review of a 21st Century Health Care Profession”.
AMA Challenges 2011 AMA House of Delegates publishes a statement:
“Physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health.
“Whereas, Based on education and training, this is beyond the appropriate scope of practice of physical therapy; and
“Whereas, Instead, this would constitute the practice of medicine.”
AMA Challenges AMA Document, “Creation of State-based
Scope-of-Practice Review Committees Legislative Template”.
Idea is to review scope practice changes before they are allowed to be brought to legislation.
Many physician practice acts are broad and would probably preclude physicians from this type of process.
AMA Challenges Dry needling is also referred to as Intramuscular
needling (IMS) and/or trigger point dry needling.
APTA does not currently have any HOD or BOD policies or positions on this technique.
AMA fights this based on “invasive” = practice medicine.
Infringement issues Athletic trainers’ legislative agenda has shifted
from securing professional regulation to: Expanding scope of practice beyond treatment of
athletic injuries in athletes. Changing language on population from “athlete” to “individual,”
“person,” or “patient.”
Mandating payment for services provided by athletic trainers.
Others looking at expanding scope: massage therapists, exercise physiologists, and personal trainers.
Term Protection Language included in the FSBPT Model Practice Act.
18 states have explicit language protecting “physical therapy.”
14 states have explicit language protecting “physiotherapy.”
A number of state PT Acts contain vague language.
Key to enforcement is strength of term protection language + exemption language found in PT Act.
Term Protection Chiropractic Practice Acts
17 states + DC use the term “physiotherapy”
2 states contain the term “physical therapy”
2 states explicitly restrict use of term “physical therapy” (AR + OH)
Practice Act Revisions
State practice acts should reflect current state of the profession, including scope of practice and education requirements.
May need to be updated to include emerging areas of PT practice.
Fifth Edition of the FSBPT Model Practice Act: Released in August, 2011.
MEDICARE
Physical Therapists in Private Practice (PTPPs) placed in moderate risk category.
PTPPs must have a site visit prior to enrollment as of March 25, 2011.
“HOW CAN I HELP?”
DES MOINES UNIVERSITY “A Comparison of Health Care Use
for Physician-Referred and Self-Referred Episodes of Outpatient”
Jane Pendergast,Stephanie A. Kliethermes,
Janet K. Freburger,Pamela A. Duffy
© Health Research and Education Trust DOI: 10.1111/j.1475-6773.2011.01324.xHealth Services Research
DES MOINES UNIVERSITY Collaboration: Agreement between
University of Iowa and Wellmark, Inc.
Compare patient profiles and health care use for physician-referred and self-referred episodes of PT on large, non-Medicare population.
DES MOINES UNIVERSITY Results: Comparison
Physician Referred Self-Referred
Average Age 45.9 43.5
Average visits / episode 7.0 5.9
Allowable amount / episode
$420 $347
DES MOINES UNIVERSITY Results similar to previous studies, and
differences may be due to controlling for case-mix.
Role of physician as gatekeeper may be overstated.
Health care use in self-referred groups 86% of physician-referred groups.
DES MOINES UNIVERSITYAllowable amount for self-referred PT episode
87% of physician-referred episode of care
Health care use before and after PT episode similar in both groups.
Both PT and related non-PT claims/episode were less in self-referred vs. physician-referred group.
PAYMENTISSUES
State Regulation of Premium Hikes
Beginning to see states develop more regulations related to premium hikes.
U.S. Department of Health and Human Services awarded 45 states and DC $1M each to help them improve their oversight of health insurance premium increases.
Prompt Payment Laws Prompt payment laws have been enacted in
50 states and the District of Columbia.
Prompt payment laws require “clean claims” to be submitted.
Payers may still delay and/or deny claims as a result of what the payer considers to be an improper, incomplete, or inaccurate. claim.
Payment Recovery Retrospective recovery of previously paid
claims. Review state law regarding prompt
payment and payment recovery. Review individual payer contracts. Inform patients of collections policy and
financial responsibility.
Private Insurers Audit Activity Estimates by government and law
enforcement agencies place the loss due to health care fraud as high as 10% of U.S. annual health care expenditure—or $226 billion / year.
Blue Cross And Blue Shield Companies' Anti-Fraud Efforts Collect More Than Half A Billion Dollars In 2009 Physical therapist assistants may provide
services under the direction and supervision of a physical therapist.
GET INVOLVED!
MEDICARE
For fiscal year 2010, HHS reported almost $48 billion in Medicare improper payments, (38 percent of the total $125.4 billion estimate for the federal government).
Medicare Fee for Service error rate in 2010 was around 10.5% ($34.3 billion).
Government’s goal is to reduce the Medicare FFS improper payment rate to: 8.5% by Nov., 2011, and 6.2% by Nov., 2012.
MEDICARE Post Payment Review
Reviews are being conducted by Office of Inspector General, ZPICs, MACs, Recovery Audit Contractors
RACs identify Medicare underpayments & overpayments & recover overpayments. (Part A & B-so any provider can be subject to RAC review)
KANSAS = Region D –HealthDataInsights, Inc. of Las Vegas, NV
MEDICARE RACs
Can reopen claims up to three years from the date the claim was paid.
RACs cannot review claims prior to October 1, 2007.
The RAC Program is required to follow all applicable Medicare regulations such as payment policies, reopening timeframes, and appeal rights for providers.
RACs required to have a medical director on staff, and to use nurses, therapists, and certified coders.
Cannot collect contingency fee if claim is being appealed at any level of appeal.
MEDICARE RACs
RACs choose issues to review based on data mining techniques, OIG and GAO reports and experience of staff.
Two types of review
Automated (no medical record)
Complex (medical records)
New issues for review will be posted on RAC’s website.
MEDICARE RACs
RACs will send request for medical records.
If provider does not submit requested record in 45 days, the service will be denied.
Records may be submitted via mailed paper copy, fax, or mailed CD/DVD
CMS has established medical record limits.
MEDICARE RACs
Medical Record Request Limits
inpatient hospital, IRF, SNF, hospice =10% of avg monthly Medicare claims (max of 45 days) per NPI
Other Part A Billers (outpatient hospital, home health)=1% of avg monthly Medicare services (max of 200) per 45 days per NPI
Physicians, Physical therapists in private practice Solo practitioner = 10 medical records per 45 days per NPI
Partnership of 2-5 individuals: 20 medical records per 45 days per NPI
Group of 6-15 individuals=30 medical records per 45 days per NPI
Large Group (16+ individuals)=50 medical records per 45 days per NPI.
STAY UP TO DATE !
MULTIPLE PROCEDURE PAYMENT “CASCADING”
BCBS of KC: eff. 3/15/11, reimburse at 100% of the first unit of each service and 20% reduction to the PE.
Wellmark: eff. 7/1/11, the highest priced procedure (PE) will be paid at 100% and subsequent procedures are subject to 20% reduction of PE.
Aetna: eff. 11/14/11, the procedure with the highest practice expense RVU will be allowed at 100%. Each additional therapy service performed by the same provider group on the same date of service will be allowed at 80%.
More to come???
Growth of Co-pays Cost Sharing
Costs for deductibles, copayments, and other cost sharing rise significantly.
Employers are shifting more responsibility for health-care decisions to employees.
The Kentucky Law went into effect on June 8, 2011. This means that a patient that renews his or her plan or gets a new plan on or after June 8th will have the benefit of these reduced co-pays.
PTA Payment Issues & Differentials: Know & Understand Policies & Contracts
United Health Care / Optum Health UHC certificates of coverage all read that PM&R
services must be performed by a physician, licensed therapy provider, or provider duly licensed to provide said services.
Anthem BCBS – Indiana Providers of PT Services…”Physical therapy assistants
may provide services under the direction and supervision of a physical therapist. Benefits for services provided by these practitioners are dependent upon the member's contract language.”
http://www.anthem.com/medicalpolicies/guidelines/gl_pw_a051172.htm
PTA PAYMENT ISSUES & DIFFERENTIALS:
TRICARE Does not cover services provided by PTAs
goes back to the regulations (32 CFR 199.6).
Missouri HealthNet Therapy treatment services that may be
billed to MO HealthNet are treatment services provided directly to the patient by the therapist.
SUPER COMMITTEE Joint Congressional Committee Created to Identify
$1.2-$1.5 trillion in spending cuts
12 Members of Congress – 3 Republicans & 3 Democrats from each chamber.
Must produce savings package by November 23rd.
House and Senate must approve package by December 23rd
Without action, process known as sequestration goes into effect.
January 15th with impact on 2013 budget.
SUPER COMMITTEE Scenario #1
Super Committee and Congress approve debt reduction package
Cuts could affect Medicare, Medicaid and provider specific accounts
Cuts could be greater than $1.5 trillion
SUPER COMMITTEE Scenario #2
Super Committee and Congress fail to produce a package
Sequestration goes into affect
Medicaid is sheltered from cuts
Medicare receives 2% across the board cut which cannot not touch benefits
SUPER COMMITTEE Scenario #3
Super Committee produces partial package.
Cuts could affect Medicare, Medicaid and provider specific accounts.
Sequestration still goes into affect- across the board cuts occur.
SUPER COMMITTEE Opportunities
May be the only vehicle for SGR / Therapy Cap exceptions extension before end of year deadline.
APTA will propose long-term fix for Therapy Cap.
CALL YOUR SENATOR
OR CONGRESSPERSON!
SNF PPS FY 2012 Final Rule See APTA website:
http://www.apta.org/Payment/Medicare/CodingBilling/SNF/
DIAGNOSIS CODING:TRANSITION TO ICD‐10 (OCTOBER 2013)
Identify all facility / practice stakeholders and provide education materials and develop training plans for all levels of staff (admin. and clinical).
Develop plan for discussing with information technologyvendors and billing clearinghouses to determine their readiness and plans for updating systems.
Access private sector/or professional resources to provide for smooth and informed transitions.
CPT will continue to be used on claims when ICD-10 isimplemented.
When appropriate; test, re-test and test some more!
REFORMING PAYMENT FOROUTPATIENT PHYSICAL THERAPY
Alternative to the Therapy Cap
Regulatory Activism MPPR Shrinking of “Skilled” Therapy
Trends in Payment Increasing Consumer Responsibility
Consistent with Policy Changes
REFORMING PAYMENT FOROUTPATIENT PHYSICAL THERAPY
Based on Clinical Judgment of the PT rather than selection of intervention and time Clinical Reasoning Value over sole selection of
procedures
Consolidation of the Code Set
Re-valuing services at a visit level vs. procedural level
More Consistent with Future Models (Bundling/Integrated Models)
REFORMING PAYMENT FOROUTPATIENT PHYSICAL THERAPY
2-level “Severity and Intensity” system
Evaluation Severity: Patient Need Over Episode of Care
Intensity: Tiered Evaluation
Examination and Intervention System: Visit Base Severity: Patient Presentation at Visit
Intensity: Intervention Needed to Address Visit’s Contribution to Treatment Plan
REFORMING PAYMENT FOROUTPATIENT PHYSICAL THERAPY
Potential Coding System – 18 new codes?
Time LineStage Timeline Member Action Board Action Stakeholders
Concept March ’11 Board AppointedExperts to CPT/RUC
Member Survey
Presentation
Recommendation
AMA Meeting
CPT / RUC Meetings
Comment / Support
June ’11 Member Commentson Concept Paper
Education / Information
Education / Information AMA Meeting
CPT / RUC Meetings
Refinement July ’11 –October
‘11
Education Endorsement / Recommendation
AMA Workgroup
Refinement Fall ’11 Education Potential BudgetImplications
Consultant
Proposal /Implementation
2012 Education Education /Information
AMACMSCongressPrivate PayersWorkers Comp
Speaking of Reimbursement… Presentation on Reimbursement news Summary:
$3700 counts for outpatient part B services (not inpatient/not swing bed) 1850 for SLP+PT and 1850 for OT
$3700 is for the reimbursed total The cap is per calendar year based on start of
Medicare (usually around the birthdate) Need a physician signature or NPP on all
Plans of Care (90 days) per Medicare and by law/practice act every 30 days
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CHALLENGE:Join a KPTA committee today
& Recruit at least 1 member!
2012 KPTA LEGISLATIVE PLAN
MOVE FORWARD!
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KPTA LEGISLATIVE DAY
In Topeka on JANUARY 30, 2013
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HB 2159Direct Patient Access to PT Services
KPTA will ask that HB 2159 be worked this legislative session
UPDATE
On Sept. 27, 2011, representatives from the KPTA met with groups opposing our efforts to gain direct patient access to PT services.
OPPOSITION TALKING POINTS
PTs do not have enough education to practice without doctor referral
There are significant differences between physician and PT education
Without physician evaluation, underlying medical diagnoses will missed (i.e. PTs will miss cancer diagnoses)
KPTA RESPONSE“ONE VOICE”
Nebraska has had unrestricted DA since 1957, Arizona since 1983, and Colorado since 1988
If PTs are not educated well enough, if PTs are missing cancer diagnoses because we are not trained well enough, if the public was indeed being harmed…..
THEN THE LAWS IN THE ABOVE NOTED STATES WOULD HAVE BEEN REVOKED BY NOW
KPTA RESPONSE“ONE VOICE”
In addition, if the public was being harmed because of direct patient access to PT services, then PTs would have higher malpractice rates in states with DA
BUT VERIFICATION FROM HPSO (leading carrier of malpractice insurance for PTs) SHOWS THIS NOT
TO BE TRUE
WHAT YOU CAN DO!
PLEASE CONTACT THE KPTA IF YOU WOULD LIKE TO BE A LEGISLATOR P0INT
OF CONTACT
WE ARE LOOKING FOR PEOPLE TO SHARE OUR
“ONE VOICE”
MESSAGE TO LEGISLATORS
KPTA House of Delegates Report
APTA House of DelegatesJune 2012
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RC 2-12 PHYSICAL THERAPIST RESPONSIBILITY AND ACCOUNTABILITY FOR THE DELIVERY OF CARE
Position statement that physical therapy is provided by or under the direction of the physical therapist. Evaluation remains the complete responsibility of the physical therapist.
Proviso that the position becomes effective when all necessary changes are in place, including approval of new policies by the House.
Annual reports beginning in 2013PASSED as Amended
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RC 2-12 PHYSICAL THERAPIST RESPONSIBILITY AND ACCOUNTABILITY FOR THE DELIVERY OF CARE (Continued)
Charge to explore practice models responsive to society’s needs by Identifying changes needed Amending any APTA documents as
necessary Approval of the model by the House
Interim report in 2013, final report in 2014PASSED as Amended
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RC 13-12 AMEND DIAGNOSIS BY PHYSICAL THERAPISTS
Physical therapists may order imaging and other studies
Physical therapists may perform or interpret selected imaging and other studies
PASSED as Amended
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RC 14-12 PHYSICAL THERAPIST’S ROLE IN MANAGEMENT OF THE PERSON WITH CONCUSSION
Physical therapists participate with a multidisciplinary team in education, prevention and management of concussion
Individuals with concussion should not return to organized activity
without written clearance of a health care professional trained in concussion management
should not return to selected activities until a health care professional trained in concussion management has determined they should return to the activity
PASSED as Amended 68
RC 18-12 AMEND: EDUCATIONAL DEGREE QUALIFICATION FOR PHYSICAL THERAPISTS
Amend policy to show that, effective 2018, the Doctor of Physical Therapy Degree is the minimal educational qualification for graduation
PASSED (Consent)
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RC 20-12 EXPLORE FEASIBILITY OF TRANSITIONING TO AN ENTRY-LEVEL BACCALAUREATE PTA DEGREE
Conduct a feasibility study including Content of a potential 4 yr. curriculum Models for baccalaureate education Mechanisms for 2 yr institutions to grant
baccalaureate degree Models for PTAs with AA degrees to earn
the baccalaureate degree Any necessary practice act changes
Interim report in 2013, final report in 2014 PASSED as Amended
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RC 22-12 RESOURCE MATERIALS FOR PHYSICAL THERAPISTS AS EXPERT OR FACTUAL WITNESSES
Make available resources for use by physical therapists (PT), physical therapist assistants (PTA), and PT and PTA students to serve as expert or factual witnesses.
PASSED as Amended
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RC 23-12 STANDARDS OF CONDUCT IN THE USE OF SOCIAL MEDIA
Adoption of a position that, in using social media, PTs and PTAs should Consider whether and how to interact with
patients through social media Be clear when speaking as an individual as
opposed to a representative of an organization
Identify and correct mistakes Apply the Code of Ethics for PTs and
Standards of Ethical Conduct for PTAs to their engagement in social media
PASSED as Amended
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RC 26-12 RESOURCE MATERIALS FOR PHYSICAL THERAPISTS PRACTICING IN THE EMERGENCY DEPARTMENT
That APTA develop additional resources supporting the role of the physical therapist in the Emergency Department
PASSED
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RC 27-12 PHYSICAL THERAPISTS AS EXPERT PROVIDERS OF EXERCISE AND PHYSICAL ACTIVITY PRESCRIPTION
Position that APTA promotes as providers of choice for
exercise and physical activity prescription for persons with noncommunicable diseases (NCD) (eg, heart disease, stroke, chronic respiratory diseases, diabetes, certain cancers)
APTA seeks participation in development of exercise and activity guidelines for these NCDs
PASSED (Content)
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KPTASTRATEGIC PLAN 2011-2013
KPTA STRATEGIC PLANNING
Held in Topeka on July 23, 2011Facilitated by Rich DrinonUpdated/revised via webinar on
September 12, 2011Approved by BOD on Sept. 22, 2011Approved by membership on Sept.
24, 2011
KPTA MISSION
The Kansas Physical Therapy Association is the member organization of physical therapists and
physical therapist assistants that represents, promotes, and advocates for the profession of
physical therapy, promotes evidence-based practice, and assists members in addressing the health and
wellness needs of individuals in Kansas.
KPTA VISION
Consumers have unrestricted access to physical therapists as the practitioner of choice for diagnosis,
evidence-based interventions, prevention of functional limitations and disabilities related to body function
and structure, and promotion of physical activity and life participation. Physical therapists and physical therapist assistants, under the direction of physical therapists, are recognized and valued as the only
providers of physical therapy.
KPTA STRATEGIC GOALS
Objective #1: Key contacts will be in place for 100% of the House HHS Committee and Senate PHW Committees and 50% of all other legislative districts.
Objective #2: Conduct one (1) KPTA Legislative Day prior to February 28, 2012, with a minimum of 125 participants.
Objective #3: Collect PAC funds to $30,000 by May 31, 2012, and $35,000 by May 31, 2014.
Objective #4: Conduct five (5) activities every year to promote policymaker awareness of barriers to patient/client access to physical therapy services.
1. Statutory, regulatory, and policy barriers to patient/client access to physical therapy services
provided by the PT and PTA, under the direction and supervision of the PT, are reduced and, where possible,
eliminated.
KPTA STRATEGIC GOALS
Objective #1: Educate members on how to brand themselves and their work settings with follow-up surveys to track implementation over two years.
Objective #2: Utilize the KPTA website more effectively by adding a consumer component and track user hits to the website quarterly for two years.
Objective #3: Facilitate 2 interdisciplinary speaking opportunities to other professional organizations or referral sources in two years.
2. Physical therapists are recognized as the practitioners of choice in maximizing movement and function.
KPTA STRATEGIC GOALS
Objective #1: Educate PTs and PTAs about the APTA elements of defensible documentation through educational sessions at all KPTA conferences for the year 2011-2012.
Objective #2: Develop and disseminate virtual and real time educational programming tools reflecting the physical therapy brand to educate stakeholders (members, consumers, payers, legislators, regulators, employers) about the scope of physical therapy practice and clinical outcomes with the goal of utilization by 5% of the membership by July 2013 measured through electronic tracking and /or submission of brief reports.
3. Payment accurately reflects the resources and professional competency of PTs and PTAs required for
achieving efficient and effective patient/client outcomes.
KPTA STRATEGIC GOALS
Objective #3: Develop collaborative relationships with referral and payment sources through proactive involvement of designated KPTA representatives as liaisons to identified payers through quarterly contact with payers and annual reports to the reimbursement committee.
Objective #4: Establish a KPTA survey tool to gather data related to outcomes for dissemination to our stakeholders(members, consumers, payers, legislators, regulators, employers).
3. Payment accurately reflects the resources and professional competency of PTs and PTAs required for
achieving efficient and effective patient/client outcomes.
KPTA STRATEGIC GOALS
Objective # 1: Create a user-friendly, technology-savvy website that allows for easy navigation, access to resources, and ecommerce as needed to promote best practice by June 2012.
Objective # 2: Programming committee will make online resources (including webinars) accessible as part of the updated website to KPTA members by 2012.
4. Best practice principles of physical therapy are identified, applied, and integrated by PTs and PTAs.
KPTA STRATEGIC GOALS
Objective # 1: Coordinate Regional Membership Representatives to present to clinics by April, 2012.
Objective # 2: Incentivize membership to increase overall membership to 40% of total PT/PTA representation in Kansas within two (2) years.
5. Current and future members embrace membership and active participation in the organization.
Speaking of Membership! PTs - 613 PTAs - 119 Students - 353 Overall - 1085
Never cracked 1000 until this year!
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Thank you
for attending the KPTA Town Meeting.
If you have any questions regarding membership or any of the issues discussed
tonight please contact the KPTA office at 785.233.5400 or [email protected].
