Sure, the biggest news from the 2019 Medicare physician fee schedule is the new reporting and payment system for many physical therapists (PTs), but that’s not the whole story: the 2019 rule also includes new current procedural terminology (CPT) codes that allow PTs to conduct and bill Medicare for remote monitoring of patient factors such as weight, blood pressure, and pulse oximetry.
Many questions remain as to how the US Centers for Medicare and Medicaid (CMS) will implement the new codes, and APTA is developing online resources that will supply further details as they become available.
Here’s what APTA knows so far: the new CPT codes apply to chronic care, and they allow physicians, clinical staff, or “other qualified healthcare professionals” to conduct remote monitoring in certain circumstances. Because PTs are included in the American Medical Association’s definition of “qualified healthcare professionals” they are able to participate in the remote monitoring to the extent allowed by state and scope-of-practice laws.
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.
The range of conditions that physical therapists (PTs) and physical therapist assistants (PTAs) face every day can be expansive, and staying on top of the latest effective treatment approaches can seem like an impossible task. PTNow is helping to change all that by bringing members the evidence they need in just a few clicks.
Best of all, the association’s flagship site for evidence-based practice resources continues to expand in ways that help PTs and PTAs easily find an even wider array of information. If you haven’t visited the site lately, check it out soon. Here’s a quick take on the latest additions.
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.
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.
A new “mini grant” project aimed supporting implementation of a self-directed and group intervention program for adults living with arthritis is now accepting applications. The grants of at least $2,000 each are available to individual physical therapists (PTs) as well as APTA state chapters. APTA is a cosponsor of the program.
The grants will be awarded to successful applicants who propose ways to implement the “Walk With Ease” (WWE) program either directly or in partnership with an external agency. Developed by the Arthritis Foundation, WWE is a community-based walking program based on group walking sessions and pre-walk discussions held multiple times per week. The initiative is a US Centers of Disease Control and Prevention (CDC)-recommended physical activity program.
Grantees are expected to recruit at least 200 participants and work to ensure all participants complete 100% of the intervention by September 29, 2018, the end of the 3-month project period. Selected applicants can anticipate an average award of $2,000, although the number of awards is contingent on the availability of federal funds.
The people of Michigan are better off—and the physical therapy profession has reached an important milestone—now that legislation has been signed into law allowing allow patients in Michigan to go directly to a physical therapist (PT) for evaluation and treatment without a physician’s referral. The legislative victory now means that all 50 states and the District of Columbia allow for some form of direct access to PTs for evaluation and treatment.
SB 690, signed into law by Gov Rick Snyder, was sponsored by Sen John Moolenaar and promoted by the Michigan Chapter of APTA (MPTA). The new law creates the option for patients to see a PT without a referral or prescription from a physician for up to 21 days or 10 treatment visits, and will also allow patients to see a PT directly for injury prevention and fitness promotion, with no time or visit limit. SB 690 also strengthens the profession by specifying that only licensed PTs may use the term “doctor of physical therapy” in connection with their services. A similar bill was sponsored in the Michigan House of Representatives by Rep Margaret O’Brien.
Recently announced changes to the American Medical Association’s (AMA’s) Current Procedural Terminology (CPT) editorial process emphasize greater transparency and collaboration, and could bolster opportunities for physical therapists (PTs) to work with APTA to ensure the codes accurately reflect practice.
The changes put in place are the result of input received by AMA from stakeholder organizations. According to an AMA press release, the new approaches are designed to “increase transparency and fairness” in the process through more in-person meetings beyond the CPT editorial and advisory committee, more wide and proactive communication about requested code changes, and the establishment of a “medical advisor” to facilitate the process with staff and applicants new to the CPT process.