Published by IPTA—Idaho Physical Therapy Association, Inc.
 
The Idaho Insight

FALL 2014 :: 4220 Bodenheimer St, Boise, Idaho 83703 Phone: 208/342-6647 www.ptidaho.org E-mail: office@ptidaho.org

Inside this edition:

 

Message from the President Cory Lewis, PT, DPT, CMPT, OCS

By Cory I. Lewis, PT, DPT, OCS, CMPT - President, Idaho Physical Therapy Association

Our annual fall conference and business meeting will be held October 11th and 12th in Boise, Idaho.  The continuing education offering is a course from The Gary Gray Institute.  Jay Inman, PT will be presenting The Functional Lower Extremity. Cost is $325 for APTA members.  Participants will receive 14 contact hours toward their continuing education.

Please consider joining us for our annual social event at 5:30 on Sat. Oct. 11 at The BarrelHouse, 5181 Glenwood, Garden City. Appetizers will be available and the first drink is free.

We will also be hosting a fun run/walk/ride with proceeds benefiting Idaho State University Student Physical Therapy Association.  We will begin a short, 5k course on the Boise Greenbelt, beginning outside the Shilo Inn – Riverside.   The run will begin at 7:15 am, with a $25 onsite registration.  Our continuing education schedule has been organized to allow class attendees to participate.  Registration for the course and fun run are also available through our website at www.ptidaho.org.

 Our fall business meeting will include our awards ceremony and elections. The IPTA would like to recognize Stephanie Liddle as the 2014 PT of the Year for her contributions both professionally and personally within her community.  Congratulations to Steen Edward, this year’s PT/PTA Student of the Year winner.  Also, we will be recognizing Nick Munning, with the J. Perry Silver Award, our association’s career achievement award.  Nick will be presented with the award for his long-term dedication and service to our profession.  The IPTA Board of Director positions available include president, secretary, delegate, and nominating committee.  Please refer to the IPTA website for details on these positions, and consider advancing your professional development through volunteering in our professional organization.  

The American Physical Therapy Association has partnlistered with the American Board of Internal Medicine Foundation in providing recommendation for the Choosing Wisely® Campaign.  The initiative aims to inform consumers by “providing lists of procedures that tend to be done frequently, yet whose usefulness is called into question by evidence.”  APTA members submitted >180 concepts which were then distilled down to nine by a panel of experts.  The final list was then set to vote by APTA’s  ~88, 000 members who chose the final five recommendations (which are listed below).  The APTA is the first non-physician group to participate in the initiative among a growing number of more than 50 provider organizations.  For a full list of references, please refer to the APTA website.

  • Don’t employ passive physical agents except when necessary to facilitate participation in an active treatment program.
  • Don’t prescribe under-dosed strength training programs for older adults.
  • Instead, match the frequency, intensity and duration of exercise to the individual’s abilities and goals.
  • Don’t recommend bed rest following diagnosis of acute deep vein thrombosis (DVT) after the initiation of anti-coagulation therapy unless significant medical concerns are present. 
  • Don’t use continuous passive motion machines for the postoperative management of patients following uncomplicated total knee replacement. 
  • Don’t use whirlpool for wound management.

New Career Center

Check out the New Career Center at: http://careercenter.ptidaho.org/home/index.cfm?site_id=19438

Besides looking at jobs available, you can now post your resume on IPTA's Career Center.  Information such as your location and current employment are blocked to avoid your present employer recognizing that you are job seeking.

Members posting to the Career Center are charged less than non-members.  Another membership benefit for you.

Whether you are an employer seeking to fill a position, or a PT or PTA looking for a new opportunity, check out the Career Center at www.ptidaho.org, hit Career Center across the top banner, or the icon halfway down the home page.

Payment Specialist Update

Payment Issues What you need to know…What you need to do….

By Tom Howell - IPTA Payment Specialist
 
Hi everyone, 
This newsletter article will just provide a quick overview of some major changes coming in payment policy that therapists need to know.  I STRONGLY recommend that you attend the IPTA Chapter Business Meeting on Sat. October 11, 12- 1 at St. Al’s main campus- McCleary Auditorium for a more in depth presentation and an open forum for questions. 

Payment Issues

The two biggest changes are coming in the progress of the APTA’s alternative payment system (known as PTCPS) and in the way private practices will be paid via Medicare.

PTCPS

The AMA has continued to allow the Physical Therapy Classification and Payment System (PTCPS) to move forwards.  It is now in a pilot study in clinics around the country.

What you need to know:

  • The system is supported by 11 stakeholder groups (OT, SLP, chiros, etc)If approved, it would eliminate most of the 49 physical medicine CPT codes we now use and replace them
  • 14 specialty procedure codes would remain including aquatic therapy, lymphedema massage, wound care etc
  • The new codes would encompass 3 levels of evaluation, some type of reassessment and 5 treatment codes
  • The treatment codes would be based on the episode of care, not on how many procedures you do
  • The 5 treatment codes would also be based on the severity of the patient and the intensity of the service
  • This new coding system MAY have two tiers of valuation – one for PT’s and one for PTA’s
  • AMA will meet in FEB 2015 to approve, deny or delay the implementation
  • The codes may be approved but they also need to be valuedIf approved, the new system could go into effect as of JAN 2016!
What you need to do:
  • ARE YOU GOING TO BE READY?  This will change coding and payment for all settings and require significant procedural changes in many areas including EMR, productivity and HR
  • Start saving money to change over your systems
  • Stay informed with the IPTA and APTA

PQRS System Changes (Affects only PT’s in Private Practice – PTPP)

We are anxiously awaiting the release of the CMS Medicare Final Rule on NOV 1. 2014 which will include a major restructuring of the PQRS system
What you need to know:

  • CMS is going to start using the PQRS data, not just collecting it to switch to what is called a Value-Based Modifier (VBM)System
  • PTPP clinics will be required to fill out ALL available PQRS measures (APTA estimates that there will be 6 measures) and do it correctly on at least 50% of Medicare patients
  • 2015 data will be used to calculate the VBM for 2017.
  • If you do not meet the required reporting in 2015 you will lose 2% from the PQRS system AND an additional 4% from the VBM system for a total of 6% loss of payment in 2017.
  • You will have no recourse and will lose it for an entire year for each year you don’t report correctly

What you need to do:

  • Audit your practice and make sure you are filling out the PQRS modifiers

  • Get your FEEDBACK REPORTS on PQRS (77% of PTPP have NEVER looked at this report) and see if you are doing PQRS correctly

  • EDUCATE your staff on how to do PQRS correctly now

  • Most importantly, keep watching for the APTA’s summary of the NOV 1 release of the final rule for the actual details. Based on the Final Rule, the IPTA will most likely do courses on PQRS in early 2015.

Functional Limitation Reporting (FLR)

What you need to know:

  • Problems continue but have decreased since May 6 edits

  • Any rejected claims prior to May 6, 2014 should be resubmitted

  • New edits were due September 15, 2014 so watch for the APTA Summary of those edits

What you need to do:

  • It helps to put the G-codes and Modifiers RIGHT AFTER the CPT code for them to help reduce them getting split off the claim

  • Continue to use $0.01 cents in the amount NOT $0.00 as originally recommended

  • Remember that G-codes are tracked per beneficiary and clinic NPI NOT by individual provider so large group practices may still be having some problems.

  • KEEP SENDING COMPLAINTS AND PROBLEMS TO THE APTA

Recovery Audit Contractors (RAC) Review

What you need to know:

  • CMS tried to fire poor performing RAC’s and rebid but a number of RAC’s took it to court

  • Because of that there have been no RAC reviews since 2-28-14 including on Manual Medical Review patients (No ADR requests over $3700)

  • New RAC’s are awaiting CMS approval

  • NOTE: claims dating back to 2-28-14 WILL STILL BE REVIEWED RETROACTIVELY

  • There will be NO 10 day turnaround 

What you need to do:

  • Make sure any Medicare OP claims over $3700 are in good shape- all the paper work, chart notes etc are there and ready.

  • Be ready financially for return of payments upon audits of almost a year of charts

Therapy Cap

What you need to know:

  • The Therapy Cap exceptions process EXPIRES on March 31, 2015

  • It is now tied to the Sustainable Growth Rate (SGR) fix

  • Congress plans a complete overhaul by the expiration – will be one of the top goals for the new Congress in 2015. November’s elections will give the APTA some idea on the direction of the SGR fix

  • APTA is still pursuing a bill to eliminate the cap

What you need to do:

  • Continue to lobby Congress for repeal of the Therapy Caps

  • Stay informed of the SGR fix in the first quarter of 2015 

Mis-valued Physical Medicine CPT Codes

What you need to know:

  • CMS has targeted our most commonly used CPT codes for review and re-valuation due to the high costs associated with those codes. This is a normal process that they do

  • APTA is hopeful that this will go away with the adoption of the PTCPS

  • Target date for revaluation is Jan 2016 

What you need to do:

  • Stay tuned on this one

Physical Therapy Outcomes Registry (PTOR)

What you need to know:

  • The APTA has created its own FOR PAY registry of PT outcomes data

  • This data will go live in 2015

  • It will be open to both members and non-members and compete with FOTO and Care Connections and other similar databases

  • It is important to have this as it will provide the data needed to fight issues like Care Core using data we just don’t have (and the insurances do)

Return of Utilization Management (UM)
What you need to know:

  • Please see my companion update of the Care Core issue.

  • It was clear at the Forum that Insurances are moving back to an antiquated system of pre-authorization and UM because the Affordable Care Act (ACA) allowed insurers to budget UM in their medical costs not their administrative costs.

  • This is huge because the insurers now get penalties for spending too much on administration.

  • Care Core is probably not the last we will see of this.

  • The APTA is looking at legislative fixes and developing a tool kit

What you need to do:

  • Get on the IPTA listserve and keep looking for updates 

Return of Limited Networks
What you need to know:

  • The Healthcare Exchange has opened the door for limited provider networks.

What you need to do:

  • PLEASE CONTACT ME if you are having trouble getting into networks and , more importantly, if you are having patients having to drive long distance for care due to limited networks 

Improving Medicare Post Acute Care Transformation (IMPACT) Act of 2014 AND CMS Final Rule (HEAD’S UP SNF, IRF, LTACH and HH PROVIDERS)

What you need to know:

  • Congress is looking at new ways to reimburse SNF, HH and IRF and a bill has been proposed

  • Bill would standardize the collection of data and the payment for SNF,HH, LTACH and IRF facilities and providers

  • Have sent out a bid to a third party to come up with new methods

  • HH and IRF – new Rules due out NOV 1, 2014 – some changes in the definition of a group, recording minutes, changing the 14 day HH calendar

What you need to do:

Look for the IPTA and APTA summary of the new Final Rules after Nov 1, 2014

Stay up to date on the long term changes

Legislative Issues

HighCo-pays

What you need to know:

  • Mixed legislative successes and failures

  • Very difficult to overcome Insurance Lobby

  • PA had their effort be sent to the State Insurance Department to decide “what was fair”

  • Caution is being advised BUT Co-pays keep increasing especially with the Exchanges

What you need to do:

  • Look for an IPTA survey of the issue

Dry Needling

What you need to know:

  • Legislatively states efforts to get this into the practice act has been mixed

  • In WA state, the acupuncturists sued PT’s who attended a dry needling course – important case as it will be a test to see if legal remedies work

  • Arizona did a great job – very organized. They are a model of how it should be done

  • APTA supports this in policy

What should you do:

  • Please consider how you talk about Dry Needling. Acupuncturist say that PT’s are not allowed to use the needles, nor do acupuncture. Counter their arguments by that the needle is only a tool and when that tool is used by a PT, just like US, they are doing PT. No-one has the rights to the tool

  • Those OP PT’s who would like to practice in Idaho – we need to hear from you as you are the ones who would need to organize an effort in Idaho.

  • Any process in Idaho will be difficult because our PT Licensure Board has ruled that we cannot do it in Idaho

TeleHealth

What you need to know:

  • The APTA is working with the Federation of State Boards of PT (FSBPT) to come up with model legislation on “Compacts” which would greatly reduce the time and paperwork now needed to get licensed in another state.

  • Compacts, like drivers licenses, are recognized rules across states’ lines

  • This would be needed as one of the steps in allowing PT’s to do telehealth

  • Model language for changing our practice act to allow telehealth is available from the FSBPT

  • We are waiting for the state Telehealth Council to issue a report and recommendations to act on this in Idaho

What you need to do:

  • Look for more about this in 2016 including a survey on the issue of WHO we should allow to practice PT telehealth (i.e. Do you think the PT should live in Idaho? Be limited in the type of compact license?) There are questions we need to address.

 

NOTE: look for additional surveys on IPTA legislative issues in 2016. We need and value your input.

IPTA Serving You Well

Payment Specialist Corner – Part II – Care Core Update

Thomas M Howell, PT, MPT

IPTA Payment Specialist

 

Hi everyone,

I had the honor of being asked to present a summary of the Care Core issue, along with my counterparts from WA, UT and OR, to the attendees at the APTA Policy and Payment Forum. Through that process we were able to assess where to go from here. 

What you need to know:

  • With our combined efforts, the APTA has sent three letters recommending changes

  • The online and phone processes have improved

  • The APTA is investigating a long term solution

 

What you need to do:

  • Contact your IPTA Payment Specialist with any continued problems

  • Contact Vicki Federico, Vicki.Federico@regence.com directly with continued problems

PTA NEWS

Lou Levy, PTA, IPTA Caucus Representative

At last year's House of Delegates the APTA board was charged with increasing membership value for the PTA.  The following by law changes are currently being discussed :

1. Provide eligibility for PTAs to serve in non officer positions;
2. Allow state chapters the option of giving PTAs a full vote at the chapter level; 
3. Allow eligibility for PTAs to serve as chapter delegates with the approval of each state chapter;
4. Creation of a "section like"  component for PTAs.

These suggested motions will be presented and better explained at the fall meeting.

Thanks to the membership for their valued input and support!

 

 

Credentialed Clinical Instructor Program

New Trainers Ready to Advance Clinical Instruction

The physical therapy profession now has 28 more reasons to feel good about the future of clinical training.

On July 1, 28 physical therapists (PTs) and physical therapist assistants (PTAs) were awarded the Clinical Trainer credential, including Tyler Jepson of Boise, ID.

The credential allows them to deliver APTA's Credentialed Clinical Instructor Program (CCIP), a training offering that refines clinical instructor skills and provides them with the tools to promote APTA's professionalism core values. The 28 new Credentialed Clinical Trainers will be responsible for conducting and administering APTA's CCIP courses, teaching selected content of the CCIP using active training strategies, and managing the assessment center that awards the APTA Clinical Instructor credential.

To become a Credentialed Clinical Trainer you must attend APTA's 3-day CCIP Trainer course in Alexandria, Virginia, where you will be instructed on how to provide high-quality, active learning clinical instructor education, how to deliver a competency assessment program, and how to effectively manage, coordinate, and administer the CCIP.

The program continues to receive positive reviews from participants, who have described the course as "fantastic," "superb," and one that provides teaching techniques that are "applicable immediately in the classroom."  Read below for further information on becoming a Credentialed Clinical Trainer or Credentialed Clinical Instructor.

Credentialed Clinical Instructor Program (CCIP)

The Credentialed Clinical Instructor Program (CCIP) is intended for health care providers who work primarily in a clinical setting and are interested in developing their teaching abilities. Participants will explore different aspects of the clinical learning environment and will learn skills and techniques necessary to provide a structured and effective learning environment for students. The goal is not to improve individual clinical skills, but to develop and each refine participant's ability to teach, instruct, and guide the development of his or her students.

CCIP courses are taught throughout the year in both Canada and the United States, and enrollment is open to physical therapists and physical therapist assistants. Clinicians from other health care professions are also welcome to participate - courses regularly include speech therapists, occupational therapists, nurses, and more.

Successful completion of the course provides physical therapists and physical therapist assistants with 1.5 CEU's and the Clinical Instructor (CI) Credential. Health care providers from other professions are eligible to receive 1.2 CEU's, but may not be awarded the CI Credential.

District NEWS

North District

Adam M. Borg, PT, DPT, OCS, CSCS
North District Chair

The North District will be having its first Pub Night social/networking meeting on Tuesday October 21st from 6:30pm - 8:00pm. 

The event will be held at Mad Bomber Brewing (madbomberbrewing.com) in Hayden, ID.  This is a great opportunity to drink quality craft beer and hang out with your local colleagues/friends while supporting a newer local business.  We will also have a quick update from our IPTA president Cory Lewis concerning the fall annual meeting/elections from October 11th-12th, and a preview of the spring state meeting/courses that will be hosted in Coeur d'Alene in April 2015.

We look forward to seeing you there!

Idaho PTA Program Accepts 2014 Challenge to Raise Funds for Research

By: Allison Czaplewski, SPT and Caroline Miller, SPT

A total of 109 schools participated in the 2013-2014 Miami-Marquette Challenge to raise $219,716 in support of the Foundation for Physical Therapy. The Foundation wishes to thank the students of Idaho State University for their strong support of the Challenge. Since its inception in 1989, 192 different schools have participated in the Challenge, and PT and PTA students have raised a grand total of $2,757,216!

The annual Marquette Challenge is a grassroots fundraising effort coordinated and carried out by physical therapist and physical therapist assistant students across the country to support the Foundation for Physical Therapy’s mission of providing funding opportunities to outstanding physical therapist researchers. Ryan Mizner, PT, MPT, PhD, an assistant professor at the University of Montana, is the recipient of the 2013 Miami-Marquette Challenge Research Grant.  His 2-year project, “A Novel Unweighting Technology to Address Psychological Impairments Limiting Outcomes after ACL Reconstruction,” will look at the effects of a bodyweight reduction instrument to deliver graded exercise (BRIDGE) on the outcomes of anterior cruciate ligament reconstruction. Mizner received both his master’s in physical therapy and PhD in biomechanics and movement science from the University of Delaware.  The Challenge also funded a PODS I Scholarship in 2014, which went to Allyn Susko, PT, DPT of the University of Pittsburgh.

For the second year in a row, the first place winner of the Challenge was the University of Miami, whose students raised $31,625. We welcome the University of Miami as co-host again this year for the upcoming 2014-2015 Miami-Marquette Challenge. The University of Pittsburgh won second place, raising $21,119. Sacred Heart University students raised $16,860 and earned the third place title this year.

The Foundation for Physical Therapy was established in 1979 as a national, independent nonprofit organization dedicated to improving the quality and delivery of physical therapy care by providing support for scientifically-based and clinically-relevant physical therapy research and doctoral scholarships and fellowships.

Students of all PT and PTA programs in the State of Idaho are encouraged to support the Foundation for Physical Therapy and physical therapy research. To learn how you can support the Challenge, please visit the Foundation’s Web site at www.Foundation4PT.org/get-involved/Challenge/, call the Foundation at 800/875-1378, or email Marquette student coordinators at Challenge4PT@gmail.com. Contributions for the 2014-2015 Miami-Marquette Challenge should be submitted by April 16, 2015.