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    posted: January 02, 2018

    As 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

    posted: December 28, 2017

    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.

    posted: December 11, 2017

    Hello Aquatic Membership,
     
    I am looking forward to seeing many of you at CSM 2018 in New Orleans!  This membership meeting will be monumental in that the membership will vote on the section name change and bylaw revisions.  I hope you'll join us on February 22 at the Hilton Riverside at 6:30 pm to cast your vote.  After the meeting, we'll celebrate our new identity: The Academy of Aquatic Physical Therapy and hopefully (pending the bylaw adoption) a full vote for PTAs, a new board position - Communications Director, and much more!
     
    To review the clean version of the proposed bylaws, click here.
    To review the tracked changes version of the proposed bylaws, click here
     
    Splashingly,
     
    Charlotte Norton
    President

    posted: December 05, 2017

    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 what should PTs do in the wake of the new PFS? 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/

    posted: November 29, 2017

    Many thanks to those who cast their vote in the 2017 elections and to those who ran for office.  We are pleased to present to you the election results

    posted: October 31, 2017

    At Combined Section Meeting 2017 APTA officially unveiled the only national Physical Therapy Outcomes Registry (registry). As savvy clinicians, daily we use evidence to direct our practice.  Aquatic therapy evidence while limited is rapidly growing.  Could the registry be another means to collect best aquatic practice data? Registries across disciplines alter healthcare practice by utilizing combined data to determine best practice, cost implications, and staffing patterns.

    Aside from the importance of understanding our practice better why should we be interested in data registries? Beginning in 2017 this registry is a Centers for Medicaid and Medicare Services (CMS) qualified clinical data registry (QCDR), the PT Outcomes Registry for practices participating in Merit-based Incentive Payment System (MIPS) or who will participate in the future. The current technology integrates with your electronic healthcare record (HER) eliminating additional staff data entry burden.

    Michelle Vanderhoff presents more information regarding the registry in the November issue of PT in Motion magazine.  To understand more registry specifics such as: what is the cost to facilities/practices, what if a given standard intervention does not appear to positively impact patient outcomes, how are disparate patient populations (inner city with multi factorial health issues vs. suburban more affluent clients) addressed, what does each practice/facility gain from registry participation, what data is available to demonstrate registry effectiveness to improve patient outcomes and practice profit, please review Michelle’s article.

     

    http://www.ptoutcomes.com/home.aspx

    http://www.ptoutcomes.com/HowItWorks/

    https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/index.html

    posted: May 21, 2017

    You asked for it, and we delivered!  The Aquatic Section is proud to offer membership the ability to post Aquatic-specific job openings, clinic equipment for sale, or Practices for sale on our new Classified System.

    Please visit here for introductory pricing and placement! http://www.aquaticpt.org/classifieds/

     

     

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The Journal of Aquatic Physical Therapy is the primary peer-reviewed, indexed resource for dissemination of research and scholarly work related to the field of aquatic therapy. With an emphasis on implications and applications for therapy practice, the journal promotes the integration of evidence into theory, education, research, and practice related to the field of aquatic therapy. The journal is dedicated to the development advancement of aquatic therapy through publication of research and scholarly work related, but not limited to, scientific bases, integration of theory into education, translation of clinically relevant knowledge, clinical application, and education of clinicians.

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Jeffrey Royce Royter, PT, MPT   |   Jacob Francis Brewer, PT, DPT, Ph.D., NCS   |   Robert E Donaldson, PT, DC   |   Trupti Bakshi, PT   |   Jaclyn M. Metro, PT, DPT, GCS   |   Diane Elizabeth Madras, PT, PhD   |   James D Schill, PT   |   Heather Renee-Gleason Jennings, PT, DPT, NCS   |   Ilana Nicole Kellogg Waasdorp, PT   |   Rachel Torlak, PT   |   Maria Penksa, PT   |   Shanelle Lynn Middleton, SPT   |   Megan Jones, PT   |   Andrea Trinidad Walker, PT   |   J.K. Nelms, PTA   |   Jonathan Bellizio, PT, DPT   |   Robert L Arledge, PT   |   Anne Frances Dziuba, PT   |   Emily Colleen Tarlini, PTA   |   Cynthia Dawn Golembiewski, PTA   |   Sharif Magdi Nafeh, PTA   |   Megan Zann, SPT   |   Marilyn D. Phillips, PT, MS, CAE   |   Brian Paul Van Valkenburg, SPTA   |   Andrea Christine Pettit, Andrea Pettit, PTA

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