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

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.

 

 

 

 

 

Download Spring Conference Brochure.pdf

 

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

Download Spring Conference Brochure.pdf

 

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

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

 

  1. you all know, Congress recessed on December 22 without acting on the bipartisan, bicameral agreement for a permanent fix to Medicare therapy cap. They also did not enact a temporary patch or extension of the current exceptions process. Thus, a hard cap of $2,010 on outpatient therapy services (PT/SLP combined) will be applied beginning on January 1, 2018. A separate hard cap of $2,010 will be applied to outpatient OT services. It should be noted that the hard cap will not apply to hospital outpatient clinics (OPs). Hospital OPs were not originally included under the therapy cap when it was first enacted as part of the Balanced Budget Act (BBA) in 1997. Hospital OPs were subsequently added to the cap exceptions process in 2012. However with the expiration of the exceptions process on December 31, 2017, the requirement for hospital OP to participate in the therapy cap exceptions process also expires.

 

Our congressional champions expected Congress to introduce and pass an omnibus Medicare extenders bill in early December. This bill would have addressed a number of Medicare provisions set to expire the end of 2017, including the therapy cap permanent fix. Unfortunately, the debate over the tax reform legislation pushed nearly all other issues to 2018. On its way out of town, Congress passed another short term funding bill to keep open the Federal Government through January 19, 2018. We lobbied our champions to add the therapy cap fix to this spending bill, but congressional leadership made it clear in the waning days of the session that only a select few items would allowed to be added, the most notably being the temporary funding for the Children’s Health Insurance Program.

 

Congress returns to Washington on January 3rd and must adopt another spending bill by January 19th. APTA, AOTA, ASHA and our allies in the Therapy Cap Coalition will continue to keep the pressure on Congress during their recess urging them to take quick action on the therapy cap in early January. In addition, APTA reached out to CMS requesting guidance for how providers should handle therapy claims during this time of uncertainty under the hard cap. In years past when Congress failed to act and a hard cap went into effect temporarily, CMS asked providers to hold all claims until Congress enacted a fix. The fix was then retroactively applied to January 1 of that year. However we have not been able to secure an assurance that will be the case this time. We continue to seek clarification from the agency.

 

Our efforts over the next several weeks will include:

 

1) Lobbying & Grassroots Advocacy – APTA will continue our ongoing grassroots advocacy efforts aimed at members of Congress through a variety of mediums including action alerts, phone calls, paid media, and social media. APTA engaged Revolution Media this fall in targeted online advertisements aimed at social media advocacy with a good deal of success, and we intend to continue this engagement in January. Our grassroots efforts this fall resulted in over 20,000 emails aimed at members of Congress and we intend to keep this level of engagement as we move into January.

 

2) Member education and guidance – APTA will be providing ongoing communication to component leaders, payment chairs, practice chairs, FALs, and general membership on how to manage claims and billing during this uncertain time. We will be rolling out addition information in the coming days to assist providers and provide further details. In addition, we will continue to pressure CMS to issue a transmittal that provides guidance to providers on managing therapy claims under the anticipated temporary application of the hard cap.

 

3) Therapy Cap Coalition – we will continue coordinating lobbing outreach, grassroots, and media with our partners in the Therapy Cap Coalition, including ASHA, AOTA, NASL, AHCA, , and patient advocacy groups.

 

4) Public Relations/Media – APTA and our partners will continue to press this story with media outlets and the Capitol Hill press.

 

While we are hopeful that Congress will quickly address the therapy cap when they return in January, nothing is certain given the current environment on Capitol Hill. However resolution of this issue remains a top priority for us in January.

 

Please stay tuned for further developments. In the interim please let me know if you have any questions.

 

Best,

 

Justin Elliott

Vice President, Government Affairs

APTA

 

In a development that leaves patients and providers in the lurch, Congress has recessed without addressing the Medicare therapy cap in any meaningful way. The inaction is particularly disappointing for APTA and other stakeholders given that a bipartisan agreement had been reached to permanently end the hard cap.

The bottom line: beginning on January 1, 2018, the $2,010 hard cap on physical therapy and speech-language pathology services combined will be instituted, and the exceptions process that currently permits medically necessary services above the cap through use of the KX modifier will no longer apply.

In late October, Congress seemed poised to enact a permanent repeal of the hard cap and included that change in a package of Medicare "extenders." Had those extenders been approved, it would have ended Congress' continual tradition of late-year scrambling to come up with a short-term exceptions process. Instead, Congress recessed without approving the extenders or enacting a temporary exceptions process.

Over the past several months, thousands of APTA members called and tweeted their members of Congress, and generated over 20,790 emails to Capitol Hill urging Congress to pass the permanent fix for the therapy cap

"Congress’ inaction creates the worst-case scenario for patients and providers," said APTA President Sharon Dunn, PT, PhD. "Medicare patients will start the new year unsure if they will receive medically necessary care. This inaction by Congress means arbitrary barriers, stress for patients and their families, and disruptions for providers."

The therapy cap is just 1 of several issues left unresolved by Congress. A number of other critical Medicare extender policies that needed action, but also will now expire on December 31, include everything from special payments for ground ambulances, to reauthorization of special needs plans, to an extension of the State Health Insurance Health Programs.

There is a chance the cap could be short-lived. Congress returns from its recess on January 19, and APTA’s congressional advocates and other patient and provider groups that are part of the Repeal the Therapy Cap Coalition will work to get the bipartisan agreement included in the next "must-do" bill to be taken up.

"Congress is well aware of the negative ramifications of the therapy cap, which is why there is bipartisan support to repeal it," said Justin Elliott, APTA's vice president of government affairs. "It is imperative that Congress take action as soon as possible in January, and we will keep up the fight."

APTA also will provide additional information and resources to help practitioners prepare for the application of the hard cap on January 1.

 

Lobby Day for 2018, will be grassroots/district effort since the General Assembly building is under major construction.

More details to come.

 
 

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

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

The Central District is currently seeking a secretary to serve on their Board.  Primarly responsiblities include attending the periodic Board meetings and taking the minutes (notes) at the meetings.  No prior experience needed!  This is a great opportunity to enhance your resume and give back to the association!  If you are interested in this position, please email vpta@apta.org.

 

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

  1. you all know, Congress recessed on December 22 without acting on the bipartisan, bicameral agreement for a permanent fix to Medicare therapy cap. They also did not enact a temporary patch or extension of the current exceptions process. Thus, a hard cap of $2,010 on outpatient therapy services (PT/SLP combined) will be applied beginning on January 1, 2018. A separate hard cap of $2,010 will be applied to outpatient OT services. It should be noted that the hard cap will not apply to hospital outpatient clinics (OPs). Hospital OPs were not originally included under the therapy cap when it was first enacted as part of the Balanced Budget Act (BBA) in 1997. Hospital OPs were subsequently added to the cap exceptions process in 2012. However with the expiration of the exceptions process on December 31, 2017, the requirement for hospital OP to participate in the therapy cap exceptions process also expires.

 

Our congressional champions expected Congress to introduce and pass an omnibus Medicare extenders bill in early December. This bill would have addressed a number of Medicare provisions set to expire the end of 2017, including the therapy cap permanent fix. Unfortunately, the debate over the tax reform legislation pushed nearly all other issues to 2018. On its way out of town, Congress passed another short term funding bill to keep open the Federal Government through January 19, 2018. We lobbied our champions to add the therapy cap fix to this spending bill, but congressional leadership made it clear in the waning days of the session that only a select few items would allowed to be added, the most notably being the temporary funding for the Children’s Health Insurance Program.

 

Congress returns to Washington on January 3rd and must adopt another spending bill by January 19th. APTA, AOTA, ASHA and our allies in the Therapy Cap Coalition will continue to keep the pressure on Congress during their recess urging them to take quick action on the therapy cap in early January. In addition, APTA reached out to CMS requesting guidance for how providers should handle therapy claims during this time of uncertainty under the hard cap. In years past when Congress failed to act and a hard cap went into effect temporarily, CMS asked providers to hold all claims until Congress enacted a fix. The fix was then retroactively applied to January 1 of that year. However we have not been able to secure an assurance that will be the case this time. We continue to seek clarification from the agency.

 

Our efforts over the next several weeks will include:

 

1) Lobbying & Grassroots Advocacy – APTA will continue our ongoing grassroots advocacy efforts aimed at members of Congress through a variety of mediums including action alerts, phone calls, paid media, and social media. APTA engaged Revolution Media this fall in targeted online advertisements aimed at social media advocacy with a good deal of success, and we intend to continue this engagement in January. Our grassroots efforts this fall resulted in over 20,000 emails aimed at members of Congress and we intend to keep this level of engagement as we move into January.

 

2) Member education and guidance – APTA will be providing ongoing communication to component leaders, payment chairs, practice chairs, FALs, and general membership on how to manage claims and billing during this uncertain time. We will be rolling out addition information in the coming days to assist providers and provide further details. In addition, we will continue to pressure CMS to issue a transmittal that provides guidance to providers on managing therapy claims under the anticipated temporary application of the hard cap.

 

3) Therapy Cap Coalition – we will continue coordinating lobbing outreach, grassroots, and media with our partners in the Therapy Cap Coalition, including ASHA, AOTA, NASL, AHCA, , and patient advocacy groups.

 

4) Public Relations/Media – APTA and our partners will continue to press this story with media outlets and the Capitol Hill press.

 

While we are hopeful that Congress will quickly address the therapy cap when they return in January, nothing is certain given the current environment on Capitol Hill. However resolution of this issue remains a top priority for us in January.

 

Please stay tuned for further developments. In the interim please let me know if you have any questions.

 

Best,

 

Justin Elliott

Vice President, Government Affairs

APTA

 

We have great news! Effective December 18, 2017, Humana no longer require preauthorization for outpatient physical, speech and occupational therapy services for patients with commercial and Medicare Advantage (MA) coverage. For additional details, visit Humana.com.

 

In a development that leaves patients and providers in the lurch, Congress has recessed without addressing the Medicare therapy cap in any meaningful way. The inaction is particularly disappointing for APTA and other stakeholders given that a bipartisan agreement had been reached to permanently end the hard cap.

The bottom line: beginning on January 1, 2018, the $2,010 hard cap on physical therapy and speech-language pathology services combined will be instituted, and the exceptions process that currently permits medically necessary services above the cap through use of the KX modifier will no longer apply.

In late October, Congress seemed poised to enact a permanent repeal of the hard cap and included that change in a package of Medicare "extenders." Had those extenders been approved, it would have ended Congress' continual tradition of late-year scrambling to come up with a short-term exceptions process. Instead, Congress recessed without approving the extenders or enacting a temporary exceptions process.

Over the past several months, thousands of APTA members called and tweeted their members of Congress, and generated over 20,790 emails to Capitol Hill urging Congress to pass the permanent fix for the therapy cap

"Congress’ inaction creates the worst-case scenario for patients and providers," said APTA President Sharon Dunn, PT, PhD. "Medicare patients will start the new year unsure if they will receive medically necessary care. This inaction by Congress means arbitrary barriers, stress for patients and their families, and disruptions for providers."

The therapy cap is just 1 of several issues left unresolved by Congress. A number of other critical Medicare extender policies that needed action, but also will now expire on December 31, include everything from special payments for ground ambulances, to reauthorization of special needs plans, to an extension of the State Health Insurance Health Programs.

There is a chance the cap could be short-lived. Congress returns from its recess on January 19, and APTA’s congressional advocates and other patient and provider groups that are part of the Repeal the Therapy Cap Coalition will work to get the bipartisan agreement included in the next "must-do" bill to be taken up.

"Congress is well aware of the negative ramifications of the therapy cap, which is why there is bipartisan support to repeal it," said Justin Elliott, APTA's vice president of government affairs. "It is imperative that Congress take action as soon as possible in January, and we will keep up the fight."

APTA also will provide additional information and resources to help practitioners prepare for the application of the hard cap on January 1.

 

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

News

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