Looking back over 2018, it’s hard to overstate the magnitude of Medicare-related changes experienced by physical therapists (PTs), physical therapist assistants (PTAs), and their patients. It was a year that included the end of the hard cap on therapy services under Medicare and the announcement of the inclusion of qualifying PTs in its Quality Payment Program starting in 2019—a dramatic shift toward value-based payment. And did we mention the launch of new requirements for skilled nursing facilities (SNFs) beginning later in 2019?
While payment news is almost always of interest to PT in Motion News readers, keeping up with the US Centers for Medicare and Medicaid Services (CMS) was apparently top-of-mind in 2018, as Medicare-related stories dominated this year’s list of most-read News items.
As it continues to roll out final payment rules for 2019, the US Centers for Medicare and Medicaid Services (CMS) is sticking to its pattern of mostly following through on its original proposals—this time by ending payment rates that favor hospital-owned outpatient facilities over independent physicians’ offices, and adopting a new supplier bidding system for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
Outpatient Prospective Payment System (OPPS)
As it proposed, CMS will expand the use of a “site-neutral” payment model in its reimbursement for the clinic visit service (HCPCS G0463), the most common service billed under the OPPS. Currently, Medicare and beneficiaries often pay more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting. CMS is doing away with the current system that pays so-called “off-campus” hospital-owned facilities an estimated $75 to $85 more than it does independent counterparts for this service. According to a CMS fact sheet, the agency estimates that the change, implemented over a 2-year period, will save an estimated $380 million in 2019 alone. The change does not directly affect physical therapists (PTs) working in outpatient hospital settings, given that outpatient therapy services delivered by PTs are paid under the physician fee schedule, not OPPS.
APTA-supported legislation that protects physical therapists (PTs) and other health care providers who travel across state lines with a sports team is now just a presidential signature away from becoming law. Known as the Sports Medicine Licensure Clarity Act, the bill met with overwhelming bipartisan support in both the US House of Representatives and the Senate, and is on track to receive approval from President Donald Trump.
When it becomes law the legislation will provide added legal protections for sports medicine professionals when they’re traveling with professional, high school, college, or national sports teams by extending the provider’s “home state” professional liability insurance to any other state the team may visit. The law would apply to licensed health care professionals who travel with professional and collegiate teams or other athletes and teams sanctioned by a national governing body. The bill was introduced in the House by Reps Brett Guthrie (R-KY) and Cedric Richmond (D-LA), and in the Senate by Sens John Thune (R-SD) and Amy Klobuchar (D-MN).
“This is a big win for PTs, but an even bigger step forward in safeguarding the health of athletes,” said Michael Matlack, APTA director of congressional affairs. “Once enacted, this law will help to support the realities of health care among teams that travel across state lines.”
Physical therapists (PTs), physical therapist assistants (PTAs), students, and supporters of the profession shouldn’t wait until National Physical Therapy Month in October to spread the word about the importance of mobility and physical activity—September is Go4Life month, a National Institutes of Health (NIH)-sponsored campaign that provides plenty of opportunities to educate the public on the ways older Americans can stay healthy through maintaining or increasing endurance, strength, balance, and flexibility.
Strongly supported by APTA, Go4Life is an ongoing effort to connect the public and health care providers with information and resources related to healthy aging. In addition to information on how exercise improves health, the Go4Life website includes suggested exercises, workout videos, fitness tracking resources, and access to printed materials including infographics, posters, bookmarks, and postcards, all available for free. The program also offers a free “Speaker’s Toolkit” to help providers develop presentations to target audiences—available by emailing Go4Life@mail.nih.gov.
Apparently, physical therapists (PTs), occupational therapists (OTs), and the outpatient facilities they work for aren’t the only ones adjusting to the new Current Procedural Terminology (CPT) tiered coding set: recently, the Centers for Medicare and Medicaid Services (CMS) informed APTA that it’s revising its National Correct Coding Initiatives “procedure to procedure” edits, a long list of CPT code pairs that should not be reported together. That list of problematic paired codes included PT and OT evaluation and reevaluation codes.
It’s a complicated situation, but the bottom line is, CMS is making changes that should allow for full payment of PT and OT evaluation and reevaluations code combinations that previously resulted in erroneous payment denials or partial payment when the new code set was first adopted in January. Ironically enough, it appears the change is an attempt by CMS to correct an error in its National Correct Coding Initiative. Here’s a breakdown.
Many physical therapists (PTs) know the pattern all too well: a patient makes significant improvement over an episode of care, only to lose ground when the PT’s recommendations for post-treatment care aren’t followed. So what can be done to increase adherence and stop “the revolving door” of physical therapy?
This month in PT in Motion magazine: an exploration of what PTs can do to extend adherence after the conclusion of care. Associate Editor Eric Ries reports on several PTs who share different ways to recognize and remove the roadblocks that can get in the way of patients doing what needs to be done to stay healthy.
The US House of Representatives has passed legislation that helps to protect physical therapists (PTs) and other health care providers who travel across state lines with sports teams.
The Sports Medicine Licensure Clarity Act (HR 921/S 689) aims to provide added legal protections for sports medicine professionals when they’re traveling with professional, high school, college, or national sports teams by extending the provider’s “home state” malpractice and professional liability insurance to any other state the team may visit. On September 12, the House officially passed the bill in a noncontentious vote.
The growth of the physical therapy profession over the past 5 years seems to be bringing another increase with it—the cost of malpractice claims filed against physical therapists (PTs) and physical therapist assistants (PTAs).
According to a new report from Healthcare Providers’ Service Organization (HPSO), between 2011 and 2015, payments for malpractice claims rose to $42 million. The previous HPSO study, published in 2011, reported a total of $44 million in malpractice payments, but the older study period spanned 10 years, not 5.
In terms of the kinds of allegations made against PTs and PTAs, claims of improper management over the course of physical therapy treatment nearly doubled during the study period. Now at 22.5%, the management category represents the largest percentage of closed claims, compared with allegations related to manual therapy, failure to supervise or monitor, improper use of therapeutic exercise, and improper use of a biophysical agent.
Everyone’s entitled to his or her beliefs, so they say. But what happens when those beliefs get in the way of getting better?
This month’s issue of PT in Motion magazine takes on the subject of how physical therapists (PTs) and physical therapist assistants (PTAs) can help their patients and clients overcome misbeliefs that can interfere with achieving optimal outcomes. The feature-length article includes plenty of real-life examples of patients attached to ideas that were barriers to their understanding of their condition and how physical therapy can help—everything from believing that exercising makes multiple sclerosis worse, to a theory that wearing wet jeans causes arthritis.
Keeping in mind that patient values and beliefs are a factor in evidence-based practice, how should a PT or PTA handle off-target patient beliefs? According to the article, there simply isn’t a single best way—it’s all about nuance, about understanding the kind and source of the misinformation the patient holds, and about approaching the issue with genuine sensitivity to the patient’s belief system, culture, personality, and learning style.
A new study of 5 years’ worth of concussion data from NCAA sports reveals that men’s wrestling is the sport with the highest rate of sports-related concussion (SRC), but men’s football remains on top in terms of the sheer number of athletes who experience SRC while in practice or competition. And in men’s and women’s sports that can be directly compared—lacrosse, ice hockey, soccer, and others—female athletes tend to have higher rates of SRC than their male counterparts.
Researchers analyzed statistics from the NCAA Injury Surveillance Program (ISP) and found that between the 2009-2010 and 2013-2014 academic years, the overall SRC rate was 4.47 per 10,000 athlete exposures, or about 10,560 SRCs annually. Among reported SRCs, about 1 in 11 was recurrent. In almost every sport, the majority of SRCs occurred in practice, while the actual rates of SRCs were higher in competition settings.
Topping the list in terms of SRC rates was men’s wrestling, which reported an overall rate of 10.92 per 10,000 athlete exposures. Next was men’s ice hockey at 7.91, followed closely by women’s ice hockey at 7.52. Men’s football had a 6.71 rate of SRCs, but with an estimated 3,417 SRC incidents annually, it took the position as the sport that produced the most SRCs overall. Research results were published in the American Journal of Sports Medicine in September.