KPTA Town Meeting
Kansas Physical Therapy Association
Topeka, Kansas 66603
785-233-5400 Fax: 785-290-0476
Email: kpta@kpta.com
www.kpta.com
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2012 TOWN MEETING
SCHEDULE
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K.C. at Shawnee Mission Medical Center – 11/6
Topeka at Rebound Physical Therapy – 11/6
K.C. at Olathe Medical Center – 11/8
Colby at Colby Community College – 11/15 (7-9pm)
Great Bend at Advance Therapy & Sports Med. – 11/8
(6:15-8:15 pm)
Manhattan at Mercy Regional Health Center – 11/13
(6:30-8:30 pm)
Salina at Southwind PT – 11/14 (6:30-8:30 pm)
Wichita at Via Christi - St. Francis Campus – 11/8
Pittsburg at Via Christi Hospital – 11/5

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Define the current status of developing and implementing regulatory and payer policies.
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Identify barriers and opportunities.
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Increase your involvement in and knowledge of issues that have an impact on the practice of physical therapy.
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Improve your advocacy efforts.

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The audience members will identify and discuss the varied regulatory and payment policies related to physical therapy services.
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The audience members will outline strategies for barriers and opportunities.
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The audience will discuss and develop strategies for advocacy efforts.

AMA Challenges
 The Scope of Practice Partnership (SOPP) formed and officially rolled out in January, 2006.
 Comprised of various physician organizations that engage in tracking scope of practice legislative and regulatory efforts.
 Targeted professions: Nurses, Psychologists, Podiatrists,
Naturopaths, Optometrists, Pharmacists, Audiologists, Oral
Surgeons, and Physical Therapists.
 In 2006 the Coalition for Patients Rights (CPR) was formed to counteract the SOPP and consists of more than 35 organizations representing a variety of licensed healthcare professionals. APTA is a member.

AMA Challenges
 AMA published a white paper entitled “AMA
Scope of Practice Data Series
.
 APTA responds http://www.apta.org/uploadedFiles/APTAorg/
Advocacy/State/News/CPR/Statement_12220
9.pdf
 January, 2011, the APTA publishes “ Today
s
Physical Therapist: A Comprehensive
Review of a 21 st Century Health Care
Profession
.

AMA Challenges
 2011 AMA House of Delegates publishes a statement:
“ Physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health.
 “Whereas, Based on education and training, this is beyond the appropriate scope of practice of physical therapy; and
 “Whereas, Instead, this would constitute the practice of medicine .”

AMA Challenges
 AMA Document, “ Creation of State-based
Scope-of-Practice Review Committees
Legislative Template ” .
 Idea is to review scope practice changes before they are allowed to be brought to legislation.
 Many physician practice acts are broad and would probably preclude physicians from this type of process.

AMA Challenges
 Dry needling is also referred to as Intramuscular needling (IMS) and/or trigger point dry needling.
 APTA does not currently have any HOD or BOD policies or positions on this technique.
 AMA fights this based on “ invasive ” = practice medicine.

Infringement issues
 Athletic trainers’ legislative agenda has shifted from securing professional regulation to:
 Expanding scope of practice beyond treatment of athletic injuries in athletes.

Changing language on population from “ athlete ” to
“ individual,” “ person,” or “ patient.”
 Mandating payment for services provided by athletic trainers.
 Others looking at expanding scope: massage therapists, exercise physiologists, and personal trainers.

 Language included in the FSBPT Model Practice Act.
 18 states have explicit language protecting “ physical therapy.
”
 14 states have explicit language protecting
“ physiotherapy.
”
 A number of state PT Acts contain vague language.
 Key to enforcement is strength of term protection language + exemption language found in PT Act.

 Chiropractic Practice Acts
 17 states + DC use the term
“ physiotherapy ”
 2 states contain the term “ physical therapy ”
 2 states explicitly restrict use of term
“ physical therapy ” (AR + OH)

Practice Act Revisions
 State practice acts should reflect current state of the profession, including scope of practice and education requirements.
 May need to be updated to include emerging areas of PT practice.
 Fifth Edition of the FSBPT Model
Practice Act: Released in August, 2011.

MEDICARE
 Physical Therapists in Private Practice
(PTPPs) placed in moderate risk category.
 PTPPs must have a site visit prior to enrollment as of March 25, 2011.

DES MOINES UNIVERSITY
Jane Pendergast,
Stephanie A. Kliethermes,
Janet K. Freburger,
Pamela A. Duffy
© Health Research and Education Trust
DOI: 10.1111/j.1475-6773.2011.01324.x
Health Services Research

DES MOINES UNIVERSITY
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Collaboration: Agreement between
University of Iowa and Wellmark, Inc.
 Compare patient profiles and health care use for physician-referred and self-referred episodes of PT on large, non-Medicare population.

DES MOINES UNIVERSITY
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Results: Comparison
Average Age
Average visits / episode
Allowable amount / episode
Physician Referred
45.9
7.0
$420
Self-Referred
43.5
5.9
$347

DES MOINES UNIVERSITY
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Results similar to previous studies, and differences may be due to controlling for case-mix.
 Role of physician as gatekeeper may be overstated.
 Health care use in self-referred groups 86% of physician-referred groups.

DES MOINES UNIVERSITY
 Allowable amount for self-referred PT episode 87% of physician-referred episode of care
 Health care use before and after PT episode similar in both groups.
 Both PT and related non-PT claims/episode were less in self-referred vs. physician-referred group.

State Regulation of
Premium Hikes
 Beginning to see states develop more regulations related to premium hikes.
 U.S. Department of Health and Human
Services awarded 45 states and DC $1M each to help them improve their oversight of health insurance premium increases.

Prompt Payment Laws
 Prompt payment laws have been enacted in
50 states and the District of Columbia.
 Prompt payment laws require “ clean claims ” to be submitted.
 Payers may still delay and/or deny claims as a result of what the payer considers to be an improper, incomplete, or inaccurate. claim.

 Retrospective recovery of previously paid claims.
 Review state law regarding prompt payment and payment recovery.
 Review individual payer contracts.
 Inform patients of collections policy and financial responsibility.

 Estimates by government and law enforcement agencies place the loss due to health care fraud as high as 10% of U.S. annual health care expenditure —or $226 billion / year.
 Blue Cross And Blue Shield Companies'
Anti-Fraud Efforts Collect More Than Half A
Billion Dollars In 2009
 Physical therapist assistants may provide services under the direction and supervision of a physical therapist.

MEDICARE
 For fiscal year 2010, HHS reported almost $48 billion in Medicare improper payments, (38 percent of the total $125.4 billion estimate for the federal government).
 Medicare Fee for Service error rate in 2010 was around 10.5% ($34.3 billion).
 Government’s goal is to reduce the Medicare
FFS improper payment rate to: 8.5% by Nov.,
2011, and 6.2% by Nov., 2012.

MEDICARE
 Post Payment Review
 Reviews are being conducted by Office of
Inspector General, ZPICs, MACs, Recovery
Audit Contractors
 RACs identify Medicare underpayments & overpayments & recover overpayments.
(Part A & B-so any provider can be subject to RAC review)
 KANSAS = Region D –HealthDataInsights, Inc. of
Las Vegas, NV

MEDICARE
 RACs
 Can reopen claims up to three years from the date the claim was paid.
 RACs cannot review claims prior to October 1, 2007.
 The RAC Program is required to follow all applicable Medicare regulations such as payment policies, reopening timeframes, and appeal rights for providers.
 RACs required to have a medical director on staff, and to use nurses, therapists, and certified coders.
 Cannot collect contingency fee if claim is being appealed at any level of appeal.

MEDICARE
 RACs
 RACs choose issues to review based on data mining techniques, OIG and GAO reports and experience of staff.
 Two types of review
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Automated (no medical record)
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Complex (medical records)
 New issues for review will be posted on
RAC’s website.

MEDICARE
 RACs
 RACs will send request for medical records.
 If provider does not submit requested record in 45 days, the service will be denied.
 Records may be submitted via mailed paper copy, fax, or mailed CD/DVD
 CMS has established medical record limits.

MEDICARE
 RACs
 Medical Record Request Limits
 inpatient hospital, IRF, SNF, hospice =10% of avg monthly Medicare claims (max of
45 days) per NPI
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Other Part A Billers (outpatient hospital, home health)=1% of avg monthly Medicare services (max of 200) per 45 days per NPI
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Physicians, Physical therapists in private practice
 Solo practitioner = 10 medical records per 45 days per NPI
 Partnership of 2-5 individuals: 20 medical records per 45 days per
NPI
 Group of 6-15 individuals=30 medical records per 45 days per NPI
 Large Group (16+ individuals)=50 medical records per 45 days per
NPI.

 BCBS of KC: eff. 3/15/11, reimburse at 100% of the first unit of each service and 20% reduction to the PE.
 Wellmark: eff. 7/1/11, the highest priced procedure (PE) will be paid at 100% and subsequent procedures are subject to
20% reduction of PE.
 Aetna: eff. 11/14/11, the procedure with the highest practice expense RVU will be allowed at 100%. Each additional therapy service performed by the same provider group on the same date of service will be allowed at 80%.
 More to come???

 Costs for deductibles, copayments, and other cost sharing rise significantly.
 Employers are shifting more responsibility for health-care decisions to employees.
 The Kentucky Law went into effect on June 8, 2011.
This means that a patient that renews his or her plan or gets a new plan on or after June 8th will have the benefit of these reduced co-pays.

 United Health Care / Optum Health
 UHC certificates of coverage all read that PM&R services must be performed by a physician, licensed therapy provider, or provider duly licensed to provide said services.
 Anthem BCBS – Indiana
 Providers of PT Services …”Physical therapy assistants may provide services under the direction and supervision of a physical therapist. Benefits for services provided by these practitioners are dependent upon the member's contract language .”
 http://www.anthem.com/medicalpolicies/guidelines/gl_pw_a051172.htm

 TRICARE
 Does not cover services provided by PTAs goes back to the regulations (32 CFR
199.6).
 Missouri HealthNet
 Therapy treatment services that may be billed to MO HealthNet are treatment services provided directly to the patient by the therapist.

SUPER COMMITTEE
 Joint Congressional Committee Created to Identify
$1.2-$1.5 trillion in spending cuts
 12 Members of Congress
– 3 Republicans & 3 Democrats from each chamber.
 Must produce savings package by November 23 rd.
 House and Senate must approve package by December 23 rd
 Without action, process known as sequestration goes into effect.
 January 15th with impact on 2013 budget.

SUPER COMMITTEE
 Scenario #1
 Super Committee and Congress approve debt reduction package
 Cuts could affect Medicare, Medicaid and provider specific accounts
 Cuts could be greater than $1.5 trillion

SUPER COMMITTEE
 Scenario #2
 Super Committee and Congress fail to produce a package
 Sequestration goes into affect
 Medicaid is sheltered from cuts
 Medicare receives 2% across the board cut which cannot not touch benefits

SUPER COMMITTEE
 Scenario #3
 Super Committee produces partial package.
 Cuts could affect Medicare, Medicaid and provider specific accounts.
 Sequestration still goes into affect- across the board cuts occur.

SUPER COMMITTEE
 Opportunities
 May be the only vehicle for SGR / Therapy
Cap exceptions extension before end of year deadline.
 APTA will propose long-term fix for Therapy
Cap.

SNF PPS FY 2012 Final Rule
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DIAGNOSIS CODING:
TRANSITION TO
‐
 Identify all facility / practice stakeholders and provide education materials and develop training plans for all levels of staff (admin. and clinical).
 Develop plan for discussing with information technology vendors and billing clearinghouses to determine their readiness and plans for updating systems.
 Access private sector/or professional resources to provide for smooth and informed transitions.
 CPT will continue to be used on claims when ICD-10 is implemented.
 When appropriate; test, re-test and test some more!

REFORMING PAYMENT FOR
OUTPATIENT PHYSICAL THERAPY
 Alternative to the Therapy Cap
 Regulatory Activism
 MPPR
 Shrinking of “ Skilled ” Therapy
 Trends in Payment
 Increasing Consumer Responsibility
 Consistent with Policy Changes

REFORMING PAYMENT FOR
OUTPATIENT PHYSICAL THERAPY
 Based on Clinical Judgment of the PT rather than selection of intervention and time
 Clinical Reasoning Value over sole selection of procedures
 Consolidation of the Code Set
 Re-valuing services at a visit level vs. procedural level
 More Consistent with Future Models
(Bundling/Integrated Models)

REFORMING PAYMENT FOR
OUTPATIENT PHYSICAL THERAPY
 2-level “ Severity and Intensity ” system
 Evaluation
 Severity: Patient Need Over Episode of Care
 Intensity: Tiered Evaluation
 Examination and Intervention System: Visit
Base
 Severity: Patient Presentation at Visit
 Intensity: Intervention Needed to Address
Visit ’ s Contribution to Treatment Plan

REFORMING PAYMENT FOR
OUTPATIENT PHYSICAL THERAPY
 Potential Coding System – 18 new codes?
 Time Line
Stage Timeline
Concept
Comment /
Support
Refinement
Refinement
Member Action
March ’ 11 Board Appointed
Experts to CPT/RUC
June ’ 11
Member Survey
Member Comments on Concept Paper
Education / Information
Education July ’ 11
–
October
‘ 11
Fall ’ 11 Education
Proposal /
Implementation
2012 Education
Board Action
Presentation
Recommendation
Education / Information
Endorsement /
Recommendation
Potential Budget
Implications
Education /
Information
Stakeholders
AMA Meeting
CPT / RUC Meetings
AMA Meeting
CPT / RUC Meetings
AMA Workgroup
Consultant
AMA
CMS
Congress
Private Payers
Workers Comp

 Presentation on Reimbursement news
 Summary:
 $3700 counts for outpatient part B services
(not inpatient/not swing bed) 1850 for SLP+PT and 1850 for OT
 $3700 is for the reimbursed total
 The cap is per calendar year based on start of
Medicare (usually around the birthdate)
 Need a physician signature or NPP on all
Plans of Care (90 days) per Medicare and by law/practice act every 30 days
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Join a KPTA committee today
&
Recruit at least 1 member!

2012 KPTA
LEGISLATIVE PLAN
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HB 2159
Direct Patient Access to PT Services
KPTA will ask that HB 2159 be worked this legislative session

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 PTs do not have enough education to practice without doctor referral
 There are significant differences between physician and PT education
 Without physician evaluation, underlying medical diagnoses will missed (i.e. PTs will miss cancer diagnoses)

KPTA RESPONSE
“ ONE VOICE”
Nebraska has had unrestricted DA since 1957, Arizona since 1983, and Colorado since 1988
 If PTs are not educated well enough, if PTs are missing cancer diagnoses because we are not trained well enough, if the public was indeed being harmed…..
THEN THE LAWS IN THE ABOVE NOTED STATES
WOULD HAVE BEEN REVOKED BY NOW

KPTA RESPONSE
“ ONE VOICE”
 In addition, if the public was being harmed because of direct patient access to PT services, then PTs would have higher malpractice rates in states with DA
BUT VERIFICATION FROM HPSO (leading carrier of malpractice insurance for PTs) SHOWS THIS NOT
TO BE TRUE

PLEASE CONTACT THE KPTA IF YOU
WOULD LIKE TO BE A LEGISLATOR P0INT
OF CONTACT
WE ARE LOOKING FOR PEOPLE TO SHARE
OUR
“ONE VOICE”
MESSAGE TO LEGISLATORS

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 June 2012
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RC 2-12 PHYSICAL THERAPIST RESPONSIBILITY AND
ACCOUNTABILITY FOR THE DELIVERY OF CARE
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Position statement that physical therapy is provided by or under the direction of the physical therapist. Evaluation remains the complete responsibility of the physical therapist.
Proviso that the position becomes effective when all necessary changes are in place, including approval of new policies by the
House.
Annual reports beginning in 2013
PASSED as Amended
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RC 2-12 PHYSICAL THERAPIST RESPONSIBILITY AND
ACCOUNTABILITY FOR THE DELIVERY OF CARE (Continued)
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Charge to explore practice models responsive to society’s needs by
Identifying changes needed
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Amending any APTA documents as necessary
Approval of the model by the House
 Interim report in 2013, final report in 2014
PASSED as Amended
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RC 13-12
AMEND DIAGNOSIS BY PHYSICAL THERAPISTS
 Physical therapists may order imaging and other studies
 Physical therapists may perform or interpret selected imaging and other studies
PASSED as Amended
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RC 1412 PHYSICAL THERAPIST’S ROLE IN MANAGEMENT OF
THE PERSON WITH CONCUSSION
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Physical therapists participate with a multidisciplinary team in education, prevention and management of concussion
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Individuals with concussion should not return to organized activity without written clearance of a health care professional trained in concussion management
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 should not return to selected activities until a health care professional trained in concussion management has determined they should return to the activity
PASSED as Amended
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RC 18-12 AMEND: EDUCATIONAL DEGREE QUALIFICATION
FOR PHYSICAL THERAPISTS
 Amend policy to show that, effective 2018, the Doctor of Physical Therapy Degree is the minimal educational qualification for graduation
 PASSED (Consent)
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RC 20-12 EXPLORE FEASIBILITY OF TRANSITIONING TO AN
ENTRY-LEVEL BACCALAUREATE PTA DEGREE
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Conduct a feasibility study including
Content of a potential 4 yr. curriculum
Models for baccalaureate education
Mechanisms for 2 yr institutions to grant baccalaureate degree
Models for PTAs with AA degrees to earn the baccalaureate degree
Any necessary practice act changes
Interim report in 2013, final report in 2014
 PASSED as Amended
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RC 22-12 RESOURCE MATERIALS FOR PHYSICAL THERAPISTS
AS EXPERT OR FACTUAL WITNESSES
 Make available resources for use by physical therapists (PT), physical therapist assistants
(PTA), and PT and PTA students to serve as expert or factual witnesses.
 PASSED as Amended
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RC 23-12 STANDARDS OF CONDUCT IN THE USE OF SOCIAL
MEDIA
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Adoption of a position that, in using social media, PTs and PTAs should
Consider whether and how to interact with patients through social media
Be clear when speaking as an individual as opposed to a representative of an organization
Identify and correct mistakes
Apply the Code of Ethics for PTs and
Standards of Ethical Conduct for PTAs to their engagement in social media
PASSED as Amended
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RC 26-12 RESOURCE MATERIALS FOR PHYSICAL THERAPISTS
PRACTICING IN THE EMERGENCY DEPARTMENT
 That APTA develop additional resources supporting the role of the physical therapist in the Emergency Department
 PASSED
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RC 27-12 PHYSICAL THERAPISTS AS EXPERT PROVIDERS OF
EXERCISE AND PHYSICAL ACTIVITY PRESCRIPTION
 Position that
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APTA promotes as providers of choice for exercise and physical activity prescription for persons with noncommunicable diseases
(NCD) (eg, heart disease, stroke, chronic respiratory diseases, diabetes, certain cancers)
APTA seeks participation in development of exercise and activity guidelines for these
NCDs
 PASSED (Content)
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The Kansas Physical Therapy Association is the member organization of physical therapists and physical therapist assistants that represents, promotes, and advocates for the profession of physical therapy, promotes evidence-based practice, and assists members in addressing the health and wellness needs of individuals in Kansas.

Consumers have unrestricted access to physical therapists as the practitioner of choice for diagnosis, evidence-based interventions, prevention of functional limitations and disabilities related to body function and structure, and promotion of physical activity and life participation. Physical therapists and physical therapist assistants, under the direction of physical therapists, are recognized and valued as the only providers of physical therapy.

1. Statutory, regulatory, and policy barriers to patient/client access to physical therapy services provided by the PT and PTA, under the direction and supervision of the PT, are reduced and, where possible,
 Objective #1: eliminated.
and Senate PHW Committees and 50% of all other legislative districts.
 Objective #2: Conduct one (1) KPTA Legislative Day prior to February 28, 2012, with a minimum of 125 participants.
 Objective #3: Collect PAC funds to $30,000 by May 31, 2012, and $35,000 by
May 31, 2014.
 Objective #4 : Conduct five (5) activities every year to promote policymaker awareness of barriers to patient/client access to physical therapy services.

2. Physical therapists are recognized as the practitioners of choice in maximizing movement and function.
 Objective #1: Educate members on how to brand themselves and their work settings with follow-up surveys to track implementation over two years.
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Objective #2: Utilize the KPTA website more effectively by adding a consumer component and track user hits to the website quarterly for two years.
Objective #3: Facilitate 2 interdisciplinary speaking opportunities to other professional organizations or referral sources in two years.

3. Payment accurately reflects the resources and professional competency of PTs and PTAs required for achieving efficient and effective patient/client outcomes.
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Objective #1: Educate PTs and PTAs about the APTA elements of defensible documentation through educational sessions at all KPTA conferences for the year 2011-2012.
Objective #2: Develop and disseminate virtual and real time educational programming tools reflecting the physical therapy brand to educate stakeholders (members, consumers, payers, legislators, regulators, employers) about the scope of physical therapy practice and clinical outcomes with the goal of utilization by 5% of the membership by July 2013 measured through electronic tracking and /or submission of brief reports.

3. Payment accurately reflects the resources and professional competency of PTs and PTAs required for achieving efficient and effective patient/client outcomes.
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Objective #3: Develop collaborative relationships with referral and payment sources through proactive involvement of designated KPTA representatives as liaisons to identified payers through quarterly contact with payers and annual reports to the reimbursement committee.
Objective #4: Establish a KPTA survey tool to gather data related to outcomes for dissemination to our stakeholders(members, consumers, payers, legislators, regulators, employers).

4. Best practice principles of physical therapy are identified, applied, and integrated by PTs and PTAs.
 Objective # 1:
Create a user-friendly, technology-savvy website that allows for easy navigation, access to resources, and ecommerce as needed to promote best practice by June 2012.
 Objective # 2:
Programming committee will make online resources
(including webinars) accessible as part of the updated website to KPTA members by 2012.

5. Current and future members embrace membership and active participation in the organization.
 Objective # 1:
Coordinate Regional Membership Representatives to present to clinics by April, 2012.
 Objective # 2:
Incentivize membership to increase overall membership to 40% of total PT/PTA representation in Kansas within two
(2) years.

 PTs - 613
 PTAs - 119
 Students - 353
 Overall 1085
 Never cracked 1000 until this year!
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for attending the KPTA Town Meeting.
If you have any questions regarding membership or any of the issues discussed tonight please contact the KPTA office at
785.233.5400 or kpta@kpta.com
.
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