Committees

Chair

Heather Byrne, PT, DPT
Email

Communications

The Virginian E-Newsletter and other communication tools (VPTA.org, Facebook and Twitter) are often the most visible member benefit of the Virginia Physical Therapy Association. Access to information and networking opportunities are the two major reasons why people become members.

The VPTA's communication tools are the most important contributor to membership retention and recruitment at the state level. Our membership chair and communications committee work closely together to provide the best member service through different communication platforms.

News

 

The Communications team is actively seeking 1 more member to join our amazing team! The position is "Social Media Advertising Management". Volunteer responsibilities include:

  1. Create posts unique to each social media source (currently Facebook and Twitter) for paid advertisements of courses and jobs. Posts will include: Text, hyperlinks, graphics, images
  2. Boost paid advertisement posts
  3. Interaction with followers on Social Media related to the events

Those interested in this position should write to vpta@apta.org.

Thanks for your interest,
Heather Byrne for the Communications Team 

 

VPTA has active Facebook and Twitter feeds reaching PTs and PTAs across Virginia.  Want to advertise your upcoming event or product? Find out more here.

 

 

 

 

 

Courtney Souter, PT, DPT, CSCS
Jessica To-Alemanji, PT, MSPT,DPT,PhD (c), PMP
Chelsea Laurens, SPT, ACSM EP-C

 
 
Communications Committee Members
  • Courtney Souter, PT, DPT, CSCS
  • Jessica To-Alemanji, PT, MSPT,DPT,PhD (c), PMP
  • Chelsea Laurens, SPT, ACSM EP-C
The Virginian

Our e-newsletter is distributed to members on the 1st Thursday of each month. To contribute to The Virginian, please write a short article and/or include 1-2 pictures, if applicable, formatted as jpeg files. Send submissions to Kimberly Hood by the 3rd Friday of each month.

Social Media

All PT/PTA professionals, students, and educators in Virginia are encouraged to share information, post photos, and engage in dialogue with others using Twitter and Facebook . To reach a larger audience on Facebook, please contact the Communications Chair and we will post for you or tweet us at @VPTA_Tweets. We want to hear from you!

Co-Chair

Anne Chan, PT, DPT, NCS, MBA
Email

Co-Chair

Ashley Kane, PT
Email

Education

The Education Committee serves to elevate the standard of physical therapy care delivery in the Commonwealth of Virginia through provision of evidence-based, high-quality, and cost-effective continuing education. The work of this committee has a significant impact on the financial health of the component. The committee is responsible for developing and executing—in partnership with the Executive Director and the VPTA Executive Committee—the Annual Conference, Mini-Conference at Annual Retreat, and other state-wide educational opportunities as directed.

Responsibilities:

  • General oversight of Education Committee activities such as Annual Conference, Mini-Conference, etc. (henceforth referred to as "Education")
  • Review and Select Educationconference topics and speakers in areas of importance to the profession of physical therapy and in accordance with member needs.
  • Schedule, coordinate, and execute the Education program in a way that meets members’ needs.
  • Evaluate each Education program, and implement changes as appropriate.
  • Participate in VPTA strategic planning activities related to Education
  • Act as a good steward of VPTA’s resources

Qualifications of individuals who serve on this committee:

  • Clinical expertise in one or more areas of practice
  • Excellent communication, coordination, and collaboration skills
  • Interest in elevating the standard of physical therapy care delivery in Virginia through education

News

Fractures and Beyond with Bill Boissonnault

Wednesday, April 25

8:30 am – 12:30 pm ET

1055 N Fairfax St, Alexandria, VA 22314

CEU Credits: 0.4 CEUs (4 Contact Hours)

Live Seminar Cost: $100 with all proceeds going to the NACR

 

 

Please join Bill Boissonnault, PT, DPT, DHSc, FAPTA, as he discusses the different types of fractures, the clinical manifestations associated with each, patient risk factors, symptom investigation, and physical examination special tests.

 

Upon completion of this seminar you will be able to:

  1. Compare and contrast traumatic, pathologic, and bony stress-reaction injuries including patient risk factors, symptom characteristics, and findings from physical examination and diagnostic imaging.
  2. Recognize patterns of patient examination red flag findings associated with fracture risk that lead to a patient referral.
  3. Initiate a patient referral for diagnostic imaging.
  4. Describe the strengths and limitations of commonly used imaging modalities such as plain films, CT scan, MRI, and bone scan.
  5. Describe the guidelines for appropriate use of plain films for patients post trauma to the knee, ankle or foot, and cervical spine regions, and for patients with low back pain.
  6. Use history and physical examination findings to screen for post fracture complications including DVT, PE, infection, neurovascular compromise, and mal-union, delayed union, and nonunion.
  7. Pursue additional information associated with differential diagnosis by the physical therapist.
 

The VPTA is happy to introduce our members to a great new benefit called CEU Locker.

CEU Locker provides an easy and convenient method for tracking your CEU requirements in our state, searching for approved courses that meet state requirements, and being assured that the courses you are taking provide quality content for our specialty.

VPTA will be providing the easy-to-recognize official seal for all approved courses. As a CEU Holder, you only need to look for this seal when searching for your courses to be assured that they have been vetted and approved and that they meet state requirements. After you have completed an approved course, simply type the CEU Locker number into your online dashboard; the course information instantly will be archived for safekeeping. 

As an additional benefit to your practice, our website will begin featuring a robust, searchable listing of approved courses that meet state requirements.

Find all this here.

Usage of the CEU Locker service is an exclusive benefit of your VPTA membership. Thank you for being a member, and please let us know how much you like using CEU Locker!

 
 

Chair

Tony Grillo, PT, DPT, OCS, FAAOMPT
Email

Ethics

Maintaining and promoting ethical principles and standards of conduct for members is a function of APTA. APTA is a voluntary organization without the legal power of licensing agencies to enforce standards of behavior; however, the Association's disciplinary process does represent a commitment of a public nature to hold its members to the ethical principles and standards of the profession.

The chapter ethics committee's function is vital to maintaining the ethical standards of an organization with which individuals want to be associated. The committee's obligation is to be fair to both the respondent and the complainant. The fact that every respondent is a member of the Association underscores the importance of the committee being fair and courteous in all its activities. The ethics committee faces the difficult task of balancing the need to be careful and thorough which tends to prolong the process against the typical respondent's desire to complete the process reasonable quickly.

The VPTA ethics committee works closely with the APTA and Ethics & Judicial Committee to ensure all cases or complaints are addressed promptly and directed to the proper channels.  While some cases may be handled through state or local committees, others are sent on directly to the APTA and their EJC.

Additional Information and Resources

APTA Ethics & Judicial Committee: http://www.apta.org/VolunteerGroups/EJC/
Contact: ejc@apta.org
APTA Ethics & Professionalism: http://www.apta.org/EthicsProfessionalism/
Continuing Education Resources: https://www.ptcourses.com/course.php?id=168
Health Regulatory Boards: http://www.dhp.virginia.gov/
Board of PT - Guidance Documents: http://townhall.virginia.gov/L/GDocs.cfm
Virginia Regulatory Town Hall Meetings: http://townhall.virginia.gov/index.cfm
Health Professions- Filing a complaint: http://www.dhp.virginia.gov/Enforcement/complaints.htm
APTA Ethics-Resolving Disputes or Complaints: http://www.apta.org/Ethics/Disputes/

News

Note: Currently, no news to display.

Chair

Wil Kolb, PT, DPT, FAAOMPT, OCS
Email

Finance

The component treasurer and finance committee is where the "rubber meets the road" so to speak. This committee ensures the fiscal well-being of the component as it is responsible developing and implementing the fiscal plan as directed by the yearly goals set from the VPTA BOD and EC. They are responsible for ensuring that the component fulfills its financial obligations and completes the necessary financial statements in a timely and accurate manner. Overall the finance committee members are responsible for the following:

  • Communicating with the VPTA BOD and EC
  • Assisting committee chairs develop yearly budgets
  • Develop and implementing the fiscal plan for the component

News

Note: Currently, no news to display.

Chair

Tom Bohanon, Jr, PT, DPT, OCS
Email

Legislative

The Legislative Committees is responsible for developing grassroots campaigns and for working with APTA Government and Payment Advocacy Department staff to further the legislative goals of the VPTA and APTA.

News

The Post-Therapy Cap System: 5 Basics You Need to Know

 

When Congress adopted a federal spending package that included the elimination of the hard cap on Medicare therapy services, it didn't just remove a rule—lawmakers also adopted a new system of payment thresholds and triggers, and a differential payment rate for physical therapist assistants (PTAs) and occupational therapy assistants (OTAs), among other things.

 

APTA supported an end to the hard cap, which is a significant win for the most vulnerable Medicare patients, but other parts of the system that replaced it are problematic.

The elimination of the hard cap is retroactive to January 1, 2018, but not all details of the post-cap system have been worked out, and it's possible that some may change before their implementation dates. In the meantime, here are the basic elements of the new system.

1. It boils down to a threshold for using KX modifiers and a trigger for possible medical review.
The basic idea is this: outpatient therapy under Medicare now has a $2,010 threshold; services delivered beyond that require a KX modifier indicating that the service meets the criteria for a payment exception. When therapy reaches $3,000, it's subject to possible targeted medical review—although CMS didn't receive any additional funding to conduct these reviews.

2. Physical therapy and speech-language pathology still are lumped together in the thresholds.
Just as in the previous payment system that included a hard cap and exceptions process, the new system doesn't separate physical therapy from speech-language pathology in establishing thresholds. Those $2,010 and $3,000 limits are for physical therapy and speech-language pathology therapy combined—another element opposed by APTA.

3. The thresholds apply to all part B outpatient therapy services—including services provided by hospital outpatient departments.
For the brief time beginning in January when the therapy cap was in place, hospital outpatient facilities were not subject to the cap. That changed with the adoption of the budget package, and now these departments or clinics are subject to the thresholds: $2,010 for use of the KX modifier and $3,000 for potential targeted medical review.

4. The PTA payment differential will start in 2022—along with a special claims designation.
In the post-cap payment system, outpatient therapy services performed by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) will be reimbursed at 85% of the Medicare physician fee schedule—a change opposed by APTA. However, that's not set to happen until 2022.

For now, claims do not include a way to designate whether a service was delivered by a PTA, but that too will change by 2022, when CMS will develop a modifier to make that distinction. Between now and then, look for opportunities to comment on proposed rules around this process, along with guidance and more details as they develop.

5. Home health also will be subject to the PTA payment differential, absent a plan of care.
The 85% payment differential for services provided by a PTA or OTA will apply to home health care provided to Medicare part B beneficiaries—but only when a home health plan of care is not in effect. The budget deal that resulted in the end to the hard cap also established other new rules for home health. PT in Motion News recently reported on these additional changes.

 

From: Justin Elliott
Subject: Therapy Cap: webinar recording

Dear APTA Component Leaders,

Yesterday APTA hosted a special edition of Insider Intel for our members that focused on additional details and frequently asked questions related to the Bipartisan Budget Act of 2018 signed into law on February 9. The budget deal included a permanent fix to Medicare’s hard cap on outpatient therapy services, PTA/OTA payment differential, changes to the home health payment system, funding for CHIP, and more.

A recording of yesterday’s Insider Intel webinar on the Therapy Cap has been posted to the APTA website at:

www.apta.org/insiderintel

(click on the February 15 recording posted under the ‘Archives’ section)

Please feel free to share this link with members or colleagues who have questions on this issue.

Best,

Justin Elliott

Vice President, Government Affairs

APTA

 

Dear APTA Component Leaders,

Below is the text of a recent announcement from CMS regarding outpatient therapy claims that are impacted by the Therapy Cap. The link to the CMS website with this announcement can be found HERE. Also attached please find APTA’s FAQ document on the Therapy Cap.

APTA along with our partners in the Repeal the Therapy Cap Coalition continue to aggressively push Congress to include the bipartisan proposal to permanently repeal the hard therapy cap in the next congressional spending deal. Congress must pass a spending deal by the February 8 deadline or risk another government shut-down. Our ongoing grassroots, public relations, and social media campaign (#StopTheCap) will continue to ramp up over the next 12 days. In addition, our coalition partner AARP launched their national grassroots push this week on repealing the therapy cap, which you can read more about HERE.

Please stayed tuned for additional updates. Thank you for your continued advocacy and support. Let me know if you have any questions.

Best,

Justin Elliott

Vice President, Government Affairs

 

Expired Medicare Legislative Provisions and Therapy Claims with the KX Modifier Rolling Hold

CMS is committed to implementing the Medicare program in accordance with all applicable laws and regulations, including timely claims processing. Several Medicare legislative provisions affecting health care providers and beneficiaries recently expired, including exceptions to the outpatient therapy caps, the Medicare physician work geographic adjustment floor, add-on payments for ambulance services and home health rural services, payments for low volume hospitals, and payments for Medicare dependent hospitals. CMS is implementing these payment policies as required under current law.

For a short period of time beginning on January 1, 2018, CMS took steps to limit the impact on Medicare beneficiaries by holding claims affected by the therapy caps exceptions process expiration. Only therapy claims containing the KX modifier were held; claims submitted with the KX modifier indicate that the cap has been met but the service meets the exception criteria for payment consideration. During this short period of time, claims that were submitted without the KX modifier were paid if the beneficiary had not exceeded the cap but were denied if the beneficiary exceeded the cap.

Starting January 25, 2018, CMS will immediately release for processing held therapy claims with the KX modifier with dates of receipt beginning from January 1-10, 2018. Then, starting January 31, 2018, CMS will release for processing the held claims one day at a time based on the date the claim was received, i.e., on a first-in, first-out basis. At the same time, CMS will hold all newly received therapy claims with the KX modifier and implement a “rolling hold” of 20 days of claims to help minimize the number of claims requiring reprocessing and minimize the impact on beneficiaries if legislation regarding therapy caps is enacted. For example, on January 31, 2018, CMS will hold all therapy claims with the KX modifier received that day and release for processing the held claims received on January 11. Similarly, on February 1, CMS will hold all therapy claims with the KX modifier received that day and release for processing the held claims received on January 12, and so on.

Under current law, CMS may not pay electronic claims sooner than 14 calendar days (29 days for paper claims) after the date of receipt, but generally pays clean claims within 30 days of receipt.

Attachments:
FAQ_TherapyCap_2018 Updated.pdf (80.8 KB)

 

Open http://www.apta.org/PTinMotion/News/2018/01/22/GovernmentShutdownTherapyCap/?utm_source=Informz&utm_medium=email&utm_campaign=Informz%20email%20link in a new window

 
 

Chair

Chelsea Lasky, PT, DPT
Email

Membership

The component membership committee has an important job -- membership development remains one of the highest priorities of APTA. The component membership committee is responsible for planning, implementing, and evaluating membership campaigns, including all recruitment and retention efforts.

News

The Post-Therapy Cap System: 5 Basics You Need to Know

 

When Congress adopted a federal spending package that included the elimination of the hard cap on Medicare therapy services, it didn't just remove a rule—lawmakers also adopted a new system of payment thresholds and triggers, and a differential payment rate for physical therapist assistants (PTAs) and occupational therapy assistants (OTAs), among other things.

 

APTA supported an end to the hard cap, which is a significant win for the most vulnerable Medicare patients, but other parts of the system that replaced it are problematic.

The elimination of the hard cap is retroactive to January 1, 2018, but not all details of the post-cap system have been worked out, and it's possible that some may change before their implementation dates. In the meantime, here are the basic elements of the new system.

1. It boils down to a threshold for using KX modifiers and a trigger for possible medical review.
The basic idea is this: outpatient therapy under Medicare now has a $2,010 threshold; services delivered beyond that require a KX modifier indicating that the service meets the criteria for a payment exception. When therapy reaches $3,000, it's subject to possible targeted medical review—although CMS didn't receive any additional funding to conduct these reviews.

2. Physical therapy and speech-language pathology still are lumped together in the thresholds.
Just as in the previous payment system that included a hard cap and exceptions process, the new system doesn't separate physical therapy from speech-language pathology in establishing thresholds. Those $2,010 and $3,000 limits are for physical therapy and speech-language pathology therapy combined—another element opposed by APTA.

3. The thresholds apply to all part B outpatient therapy services—including services provided by hospital outpatient departments.
For the brief time beginning in January when the therapy cap was in place, hospital outpatient facilities were not subject to the cap. That changed with the adoption of the budget package, and now these departments or clinics are subject to the thresholds: $2,010 for use of the KX modifier and $3,000 for potential targeted medical review.

4. The PTA payment differential will start in 2022—along with a special claims designation.
In the post-cap payment system, outpatient therapy services performed by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) will be reimbursed at 85% of the Medicare physician fee schedule—a change opposed by APTA. However, that's not set to happen until 2022.

For now, claims do not include a way to designate whether a service was delivered by a PTA, but that too will change by 2022, when CMS will develop a modifier to make that distinction. Between now and then, look for opportunities to comment on proposed rules around this process, along with guidance and more details as they develop.

5. Home health also will be subject to the PTA payment differential, absent a plan of care.
The 85% payment differential for services provided by a PTA or OTA will apply to home health care provided to Medicare part B beneficiaries—but only when a home health plan of care is not in effect. The budget deal that resulted in the end to the hard cap also established other new rules for home health. PT in Motion News recently reported on these additional changes.

 

From: Justin Elliott
Subject: Therapy Cap: webinar recording

Dear APTA Component Leaders,

Yesterday APTA hosted a special edition of Insider Intel for our members that focused on additional details and frequently asked questions related to the Bipartisan Budget Act of 2018 signed into law on February 9. The budget deal included a permanent fix to Medicare’s hard cap on outpatient therapy services, PTA/OTA payment differential, changes to the home health payment system, funding for CHIP, and more.

A recording of yesterday’s Insider Intel webinar on the Therapy Cap has been posted to the APTA website at:

www.apta.org/insiderintel

(click on the February 15 recording posted under the ‘Archives’ section)

Please feel free to share this link with members or colleagues who have questions on this issue.

Best,

Justin Elliott

Vice President, Government Affairs

APTA

 
 

Chair

Joseph Spagnolo, PT, DPT, MTC, OCS
Email

Nominating

Serves a two (2) year term.

Duties and Responsibilities

  • Study the qualifications of eligible candidates and prepare a list of the names and qualifications of nominees consenting to serve
  • Prepare a slate of nominees for vacant VPTA offices and Nominating Committee to be presented at the Annual Chapter Business Meeting.
  • Nominate one (1) or more candidates for upcoming vacancies in the American Physical Therapy association Board of Directors and Nominating Committee.
  • Discuss with Board of Directors Annual retreat possible nominees for National APTA awards such as Lucy Blair, Mary McMillan, etc.
  • Solicit nominees and supportive narratives for all VPTA awards.

News

2018 Year Nominating Committee Calendar - VPTA
DESCRIPTION  
When
May
Call for Chapter and District Nominations (eblast, website, social media, etc) 3
June
Call for District & State nominations closes 17
Deadline for Candidate Pictures, Bios, Consent to Serves & Statements 25
August
Tentative Chapter & District Slate Posted  3
September
Slated by Petition Deadline 2
Bios, Pictures, Statements & Consent to Serves from Petioned Nominations Due 10
Final Slate with All Bios, Pictures, Statements Posted 19
Chapter Elections Open 19
October
Chapter Elections Close 3
Chapter Election Results Posted 5
District Elections Open 15
District Elections Close 29
District Election Results Posted to Website 31
November
Election Results Announced at Annual Meeting & Noted in Minutes 3
Chapter Elections:
Even Year Chapter: Vice President, Treasurer, PTA Caucus Rep; Delegates
Odd Year Chapter: President-Elect, Chief Delegate, Secretary, Delegtes, PTA Caucus Rep.
District Elections
Even Year Districts: Secretary: Blue Ridge, Mountain Valley Treasurer: Central, Northern, Tidewater District Directors: even year directors Nominating Committee Member: Northern, Central, Tidewater
Odd Year Districts: Secretary: Central, Northern, Tidewater Treasurer: Blue Ridge, Mountain, Valley District Directors: even year directors Nominating Committee Member: Blue Ridge, Mountain, & Valley, 
 

Looking for an opportunity to recognize outstanding colleagues in the VPTA? Apply to serve on the inaugural VPTA Awards Committee. It’s a two year term from 2018-2020

 

The American Physical Therapy Association (APTA) has announced the 2018 Honors and Awards Program recipients. Congratulations to the following members of the Virginia Chapter have been selected by APTA’s Board of Directors to receive the following awards:

 

Catherine Worthingham Fellow of the APTA

Dianne Jewell, PT, DPT, PhD, FAPTA


Lucy Blair Service Award

Secili DeStefano, PT, DPT
Board Certified Clinical Specialist in Orthopaedic Physical Therapy


Humanitarian Award

Diana Venskus, PT, PhD


Societal Impact Award

Richard Jackson, PT
Board Certified Clinical Specialist in Orthopaedic Physical Therapy


Minority Scholarship Award for Student Physical Therapist Assistants

Jessika McNeil, SPTA

 

Award recipients will be recognized during the Honors & Awards Ceremony, tentatively scheduled for Thursday, June 28, 5:30–6:30 pm, at the NEXT 2018 Conference and Exposition in Orlando, Florida. A reception will immediately follow the ceremony, and we encourage you and your members to attend this celebration.

 

 

The Communications team is actively seeking 1 more member to join our amazing team! The position is "Social Media Advertising Management". Volunteer responsibilities include:

  1. Create posts unique to each social media source (currently Facebook and Twitter) for paid advertisements of courses and jobs. Posts will include: Text, hyperlinks, graphics, images
  2. Boost paid advertisement posts
  3. Interaction with followers on Social Media related to the events

Those interested in this position should write to vpta@apta.org.

Thanks for your interest,
Heather Byrne for the Communications Team 

 

By now, most physical therapists (PTs) have heard the news: the final 2018 Medicare Physician Fee Schedule (PFS) released in early November by the US Centers for Medicare and Medicaid Services (CMS) included some significant variations from the PFS proposed in July. Instead of finalizing CPT code values that were the same as—and occasionally larger than—current values, CMS opted to offer up a more complicated combination of cuts and increases that could affect PTs in different ways, depending on their case-mix and billing patterns.

So Here are APTA's top 4 suggestions.

  1. Know the design process for the fee schedule. It's important to understand what led to the changes to provide context, a slight sense of relief, and a reminder of why payment needs to move toward value-based models and away from fee-for-service.

The PFS now set to debut January 1, 2018, is the CMS response to an American Medical Association (AMA) committee's recommendation on potentially "misvalued" codes associated with a wide range of professions, not just physical therapy. When the process began in early 2016, many predicted that the final outcome would be deep cuts to nearly all valuations—as much as 10% or more overall. APTA and its members fought hard to substantiate the validity of the current valuations, and even the need for increases in some areas. The end result was a significant improvement from where things were headed at the start of the process.

That's not to say it's been an entirely satisfying process from start to finish. This recent PT in Motion News story goes into more detail about the sometimes-frustrating journey from points A to B.

            2. Understand what's being changed. Just about everything that happens at CMS is complicated, and the process that led to the new CPT code valuations is no exception. Still, a working knowledge of how CPT codes are valued is helpful in understanding why the PFS contains such a mix of positives and negatives.

One important thing to understand is that code valuation is actually a stew of 3 separate elements, known as relative value units (RVUs). These are estimations of the labor, expense, and possible professional liability involved in performing any given treatment or evaluation task associated with a CPT code. The 3 types of RVUs are known as "work," "practice expense" (PE), and "professional liability." The coding valuation differences between the proposed and final PFS were due to changes to the PE RVUs only.

This wasn't part of the proposed rule. While the AMA Relative Value Scale Update Committee Health Care Professions Advisory Committee did recommend changes to PE RVUs, CMS initially opted to not adopt those suggestions. When the final rule was released 3 months later, CMS—without seeking input from APTA or any other stakeholders—did an about-face and adopted the changes to PE RVUs.

So what? The answer is twofold: first, the tweaks to PE RVUs mean it's difficult to make many sweeping generalizations about how the new PFS will affect individual practices and clinics; second, it's worth noting that individual work RVUs either remained unchanged or increased.

A more detailed explanation of how the codes were affected is available in an APTA fact sheet on the 2018 PFS (listed under "APTA Summaries and Fact Sheets"). For a more complete explanation of RVUs and the differences between the 3 types, check out this APTA podcast on the CPT valuation process.

            3. Get a sense of how you might be affected. A sense of history and understanding of detail are all well and good, but the  bottom line is your bottom line.

Here's the complication with the 2018 PFS: because of the wide variation in upward and downward adjustments, it's hard to make statements about how PTs in general will be affected. CMS estimates the overall impact at a 1%-2% reduction, but a lot depends on the types of patients a PT or clinic typically sees and what interventions are commonly used. Some providers could see increases.

In an effort to clear up some of the uncertainty, APTA offers a calculator than can help you see how your typical case-mix would fare in the new PFS. The calculator, offered in Microsoft Excel, allows you to enter different codes to see what changes to expect, given your Medicare service area.

            4. Keep learning. There's much more to understand about the PFS—not just in terms of the details of how the new rule will work, but in terms of APTA's work to safeguard CPT codes throughout the misvalued codes review process.

One great way to learn more about what to expect is coming up in December, when the association hosts a free webinar on Medicare changes for 2018 on December 6 from 1:00 pm to 2:00 pm ET. The webinar will be presented in a "flipped" format, meaning that when you register, you'll be provided with a prerecorded presentation to listen to in advance. That way, more of the actual session can be devoted to live interaction with the presenters. Be sure to sign up—and listen up—soon.

Another opportunity is available December 13, when APTA hosts an "Insider Intel" phone-in session that will cover many of the same topics, albeit in a pared-down 30-minute session, from 2:00 pm to 2:30 pm ET. Instructions for signing up for this session are on APTA's Insider Intel webpage.

To view the news story, please see: http://www.apta.org/PTinMotion/News/2017/11/21/PFSTipsNovember2017/

 
 

Chair

Ron Masri, PT, ATC, FAAOMPT, OCS
Email

Payer & Practice Relations

The Payer and Practice Relations Committee addresses the primary elements involved in the practice of physical therapy: scope of practice, administration of practice, standards and ethics of practice, and the Guide to Physical Therapist Practice. The committee also recognizes that reimbursement/payment is likely the most confusing and frustrating part of clinical practice, so we are here to help you navigate any questions you might have.

News

The Post-Therapy Cap System: 5 Basics You Need to Know

 

When Congress adopted a federal spending package that included the elimination of the hard cap on Medicare therapy services, it didn't just remove a rule—lawmakers also adopted a new system of payment thresholds and triggers, and a differential payment rate for physical therapist assistants (PTAs) and occupational therapy assistants (OTAs), among other things.

 

APTA supported an end to the hard cap, which is a significant win for the most vulnerable Medicare patients, but other parts of the system that replaced it are problematic.

The elimination of the hard cap is retroactive to January 1, 2018, but not all details of the post-cap system have been worked out, and it's possible that some may change before their implementation dates. In the meantime, here are the basic elements of the new system.

1. It boils down to a threshold for using KX modifiers and a trigger for possible medical review.
The basic idea is this: outpatient therapy under Medicare now has a $2,010 threshold; services delivered beyond that require a KX modifier indicating that the service meets the criteria for a payment exception. When therapy reaches $3,000, it's subject to possible targeted medical review—although CMS didn't receive any additional funding to conduct these reviews.

2. Physical therapy and speech-language pathology still are lumped together in the thresholds.
Just as in the previous payment system that included a hard cap and exceptions process, the new system doesn't separate physical therapy from speech-language pathology in establishing thresholds. Those $2,010 and $3,000 limits are for physical therapy and speech-language pathology therapy combined—another element opposed by APTA.

3. The thresholds apply to all part B outpatient therapy services—including services provided by hospital outpatient departments.
For the brief time beginning in January when the therapy cap was in place, hospital outpatient facilities were not subject to the cap. That changed with the adoption of the budget package, and now these departments or clinics are subject to the thresholds: $2,010 for use of the KX modifier and $3,000 for potential targeted medical review.

4. The PTA payment differential will start in 2022—along with a special claims designation.
In the post-cap payment system, outpatient therapy services performed by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) will be reimbursed at 85% of the Medicare physician fee schedule—a change opposed by APTA. However, that's not set to happen until 2022.

For now, claims do not include a way to designate whether a service was delivered by a PTA, but that too will change by 2022, when CMS will develop a modifier to make that distinction. Between now and then, look for opportunities to comment on proposed rules around this process, along with guidance and more details as they develop.

5. Home health also will be subject to the PTA payment differential, absent a plan of care.
The 85% payment differential for services provided by a PTA or OTA will apply to home health care provided to Medicare part B beneficiaries—but only when a home health plan of care is not in effect. The budget deal that resulted in the end to the hard cap also established other new rules for home health. PT in Motion News recently reported on these additional changes.

 

From: Justin Elliott
Subject: Therapy Cap: webinar recording

Dear APTA Component Leaders,

Yesterday APTA hosted a special edition of Insider Intel for our members that focused on additional details and frequently asked questions related to the Bipartisan Budget Act of 2018 signed into law on February 9. The budget deal included a permanent fix to Medicare’s hard cap on outpatient therapy services, PTA/OTA payment differential, changes to the home health payment system, funding for CHIP, and more.

A recording of yesterday’s Insider Intel webinar on the Therapy Cap has been posted to the APTA website at:

www.apta.org/insiderintel

(click on the February 15 recording posted under the ‘Archives’ section)

Please feel free to share this link with members or colleagues who have questions on this issue.

Best,

Justin Elliott

Vice President, Government Affairs

APTA

 

By now, most physical therapists (PTs) have heard the news: the final 2018 Medicare Physician Fee Schedule (PFS) released in early November by the US Centers for Medicare and Medicaid Services (CMS) included some significant variations from the PFS proposed in July. Instead of finalizing CPT code values that were the same as—and occasionally larger than—current values, CMS opted to offer up a more complicated combination of cuts and increases that could affect PTs in different ways, depending on their case-mix and billing patterns.

So Here are APTA's top 4 suggestions.

  1. Know the design process for the fee schedule. It's important to understand what led to the changes to provide context, a slight sense of relief, and a reminder of why payment needs to move toward value-based models and away from fee-for-service.

The PFS now set to debut January 1, 2018, is the CMS response to an American Medical Association (AMA) committee's recommendation on potentially "misvalued" codes associated with a wide range of professions, not just physical therapy. When the process began in early 2016, many predicted that the final outcome would be deep cuts to nearly all valuations—as much as 10% or more overall. APTA and its members fought hard to substantiate the validity of the current valuations, and even the need for increases in some areas. The end result was a significant improvement from where things were headed at the start of the process.

That's not to say it's been an entirely satisfying process from start to finish. This recent PT in Motion News story goes into more detail about the sometimes-frustrating journey from points A to B.

            2. Understand what's being changed. Just about everything that happens at CMS is complicated, and the process that led to the new CPT code valuations is no exception. Still, a working knowledge of how CPT codes are valued is helpful in understanding why the PFS contains such a mix of positives and negatives.

One important thing to understand is that code valuation is actually a stew of 3 separate elements, known as relative value units (RVUs). These are estimations of the labor, expense, and possible professional liability involved in performing any given treatment or evaluation task associated with a CPT code. The 3 types of RVUs are known as "work," "practice expense" (PE), and "professional liability." The coding valuation differences between the proposed and final PFS were due to changes to the PE RVUs only.

This wasn't part of the proposed rule. While the AMA Relative Value Scale Update Committee Health Care Professions Advisory Committee did recommend changes to PE RVUs, CMS initially opted to not adopt those suggestions. When the final rule was released 3 months later, CMS—without seeking input from APTA or any other stakeholders—did an about-face and adopted the changes to PE RVUs.

So what? The answer is twofold: first, the tweaks to PE RVUs mean it's difficult to make many sweeping generalizations about how the new PFS will affect individual practices and clinics; second, it's worth noting that individual work RVUs either remained unchanged or increased.

A more detailed explanation of how the codes were affected is available in an APTA fact sheet on the 2018 PFS (listed under "APTA Summaries and Fact Sheets"). For a more complete explanation of RVUs and the differences between the 3 types, check out this APTA podcast on the CPT valuation process.

            3. Get a sense of how you might be affected. A sense of history and understanding of detail are all well and good, but the  bottom line is your bottom line.

Here's the complication with the 2018 PFS: because of the wide variation in upward and downward adjustments, it's hard to make statements about how PTs in general will be affected. CMS estimates the overall impact at a 1%-2% reduction, but a lot depends on the types of patients a PT or clinic typically sees and what interventions are commonly used. Some providers could see increases.

In an effort to clear up some of the uncertainty, APTA offers a calculator than can help you see how your typical case-mix would fare in the new PFS. The calculator, offered in Microsoft Excel, allows you to enter different codes to see what changes to expect, given your Medicare service area.

            4. Keep learning. There's much more to understand about the PFS—not just in terms of the details of how the new rule will work, but in terms of APTA's work to safeguard CPT codes throughout the misvalued codes review process.

One great way to learn more about what to expect is coming up in December, when the association hosts a free webinar on Medicare changes for 2018 on December 6 from 1:00 pm to 2:00 pm ET. The webinar will be presented in a "flipped" format, meaning that when you register, you'll be provided with a prerecorded presentation to listen to in advance. That way, more of the actual session can be devoted to live interaction with the presenters. Be sure to sign up—and listen up—soon.

Another opportunity is available December 13, when APTA hosts an "Insider Intel" phone-in session that will cover many of the same topics, albeit in a pared-down 30-minute session, from 2:00 pm to 2:30 pm ET. Instructions for signing up for this session are on APTA's Insider Intel webpage.

To view the news story, please see: http://www.apta.org/PTinMotion/News/2017/11/21/PFSTipsNovember2017/

 
 

Chair

Amanda Miller Avila, PT, DPT, WCS
Email

Research

The primary purpose of this section of the website is to provide a source of information for consumers of research as well as for clinical researchers.  A secondary purpose is to provide a forum for clinicians, academicians, and students to share ideas and to develop collaborative research projects.  Please let us know if you have an interesting link you would like to share.

Validating clinical practice by documenting outcomes and the efficacy of physical therapy are vital to our future as a profession.  Clinicians and academicians can combine efforts to answer questions of interest to our profession and the scientific community.  If you are interested in clinical research, or have an idea for a clinical research project contact any of the educational institutions in your area.  Many PT programs require a research project and you may be able to find students and faculty that are interested in assisting you.  If further assistance is needed in finding collaborators for clinical research please contact the Research Committee Chair.

News

Co-Chair

Brandon Smith
Email

Co-Chair

Megan McIntyre, PT, DPT
Email

Student Relations

The VPTA Student Relations Committee (SRC) serves to facilitate the engagement of student-related activities as they pertain to the VPTA, Student Special Interest Group (SSIG), and associated gatherings throughout the calendar year. The SRC plays a key role in mentoring and preparing student for future chapter leadership and encouraging involvement in current national and chapter student opportunities in leadership. These activities include:

Sponsorship to attend these programs and others

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