Spring 2013

Taking It To The Street

July 1, 2013 Functional Measures non-payment for Non-compliance begins.

January 1, 2013 Functional Measures reporting begins. Therapy Cap exceptions process renewed.

December 31, 2013 Therapy Cap exceptions process expires.

May 1, 2013 GAO report to Congress on MMR.

2013 -PQRS Reporting Deadline Year to Avoid Penalties

March 1, 2013 Sequestration triggered.

March 27, 2013 Continuing Resolution expires.

April 1, 2013 MPPR & Sequestration reduction for Medicare providers implemented. New MMR process begins.

June 15, 2013 MedPAC report due to Congress.

June 2013 SGR reform consideration possible & fee schedule released.

October 10-11, 2013 Target date for formal submission of CPT proposal.

• Therapy Cap Repeal

• APTA Priorities for SGR

• Physical Therapist Workforce and Patient Access Act

The Medicare Therapy Cap •  Revised Two Step Exceptions Process

•   KX Modifier at $1,900 •   Manual Medical Review- April 1, 2013 – care exceeding

$3,700 will be reviewed (Pre-payment or Post payment Review)

•  MedPAC report on reforming outpatient therapy expected June 2013

•  Data Collection- Functional Measures Reporting began January 1, 2013. Non reporting = non payment starting July 1, 2013

What’s New Since Last Year •   Medicare Access to Rehabilitation Services Act

•   H.R. 713 was introduced by Representatives Xavier Becerra (D-CA) and Jim Gerlach (R-PA)

•   S. 367 was introduced by Senators Ben Cardin (D-MD) and Susan Collins (R-ME).

•   Current exceptions process extended until December 31, 2013

•   Congressional consideration of SGR reform likely

Hill Strategy Moving Forward: •   Generate Congressional support for inclusion of

therapy cap repeal & MPPR delay in SGR legislation •   Work closely with policy makers to develop an

alternative payment methodology for outpatient therapy

•   Bipartisan support for permanent repeal strong

What we asked for on the Hill: •  Cosponsor H.R. 713 and S. 367 •   Include repeal in any SGR Reform package •   Extend exceptions process before the end of 2013

What’s New Since Last Year •  SGR is on sale

•  CBO’s cost estimate is $138 Billion

•  SGR reform as a vehicle •  A large reform bill could see many other health fixes

•  Movement towards alternative forms of payment •  Committees of jurisdiction are moving forward this summer

Hill Strategy Moving Forward:

SGR is a vehicle to: •  Repeal Therapy Cap •  Move to new payment system •  Delay MPPR

SGR Reform Priorities: Alternative Payment

•  CMS’ charge in 1997 Balanced Budget Act •  In 2011, after 15 years of inaction, APTA is leading the reform effort •  APTA proposal: Per-session payment system that takes in to account severity of a patient’s condition and intensity of services required

•  This better reflects the professional clinical reasoning and judgment of physical therapists

•  Ensures the integrity of medically necessary services

SGR Priorities: Delay MPPR

•  On average, the 50% increase in the MPPR that started on April 1st amounts to a 6 – 7 % cut

•  Delay 50% MPPR until Jan 1, 2015 •  Aligns with scheduled start of APTA’s new payment system

•  Score of delay is much less than repeal

•  New payment system moves away from multiple procedures

SGR Reform: Other issues to consider

Self – Referral •  Contentious issue, but also likely a cost-saver •  Obama Budget 2014 (In Ancillary Services) Opt – Out

•  Ability to privately contract with Medicare beneficiaries •  Legislation introduced by Rep. Price to include PTs •  House is more supportive than Senate

Locum Tenens •  Private practice PTs do not have this ability, which is not

consistent with physician use of provision.

SGR Reform Message

•  Note the importance of inclusion of therapy cap repeal in any reform bill •  SGR fix happens virtually every year; without this as a vehicle, extenders are more difficult to pass •  Emphasize the patient impact of therapy cap •  Overall push for payment reform •  SGR is not only physician payment

SGR: What we asked for on the Hill •  Repeal the SGR

•  Include Therapy Cap repeal in any SGR Reform Bill •  Move to a new payment system for therapy services

•  Delay MPPR until start of new payment system

Physical Therapist Workforce and Patient Access Act

•  National Health Service Corps •  Rural/Urban Underserved areas •  $60K/2yr… $170K/5yr •  Legislation to add physical therapists to the primary health

services section of the National Health Services Corp (NHSC) for student loan repayment programs.

•  NHSC serves 10 million Americans •  NJ has 23 Health Professional Shortage Areas •  Budget Neutral

What’s New Since Last Year:

•  The Physical Therapist Workforce and Patient Access Act •  H.R. 1252 was introduced by Rep. John Shimkus (R-IL) and

Rep. Diana DeGette (D-CO) •  S. 602 was introduced by Sen. Jon Tester (D-MT) and Sen.

Roger Wicker (R-MS)

What’s New Since Last Year

•   Boosting Grassroots for Increased Co-sponsorship •   Student Assembly Flash Action Strategy •   Focus on Senate

•  Outreach to Committees of Jurisdiction •  Engaging Health Resources and Services Administration (HRSA) •  Reintroduction and Rebranding

Hill Strategy Moving Forward: •   Rebranding to focus on PT workforce and patient access

•  Better strategy for political environment

•   Goal of Committee hearing

•   Greater focus on increased Senate cosponsors

PTW Act Messaging •  Greater patient access to rehabilitation

•   No rehab represented in program •  Role of PT in health care team

•   Alleviate demands on primary care providers •  NHSC is successful pipeline for providers

•   82% retention rate •  Meeting the workforce needs of underserved areas

•   Demand for PT continues to grow •  Legislation is budget neutral

What we asked for on the Hill: •   Cosponsor H.R. 1252 and S. 602

Legislative Topics of Interest

•   In-Office Ancillary Services Exception (IOASE) allows for physician ownership of PTs, and thus allows for self-referral.

•   APTA supports excluding PTs from this exception •   Undercuts the purpose of original law •   Unnecessary utilization

•   Alliance for Integrity in Medicare (AIM) Coalition •   A number of studies and reports support excluding PT and other

services from exception •  MedPAC; Georgetown Mitchell Study; GAO

•   NEW: Politically hot issue, but saves $$$ •   Included in President’s FY14 Budget Proposal •   Savings estimated at $6.1 billion

•   Senate is currently more supportive

•   The Affordable Care Act (ACA) created Independent Payment Advisory Board (IPAB), a 15 member independent board tasked to find savings in the Medicare program •  Authority with limited Congressional Oversight

•   Protecting Seniors' Access to Medicare Act (H.R. 351/S. 351) •  Repeals the IPAB •  Bipartisan Legislation led by Representatives Roe(R-TN) &

Schwartz (D-PA) and Senator Cornyn (R-TX) •   APTA supports the repeal of the IPAB

•   Medicare Patient Empowerment Act of 2013 (H.R. 1310), which would provide physical therapists and other healthcare providers with the ability to privately contract with Medicare beneficiaries. •  Representative Tom Price (R-GA)

•   Concern for patient access & affordability •  H.R. 1310 allows beneficiaries to submit claims for

reimbursement •   APTA supports Medicare private contracting for physical

therapists

•   Direct Access Under Medicare – Policy Victories •   FEHBP Overview

•  Advantages of FEHBP •  Avalere Cost Study

•   Next Steps •  Laying groundwork in the 113th Congress •  Building materials to support APTA position and nullify opposition •  Generating Congressional Support in key committees •  Seeking Technical Legislative Fix and/or bill introduction in 1st

Session of 113th Congress

•   Join the PTeam – www.apta.org/PTeam •   Write your legislators using APTA’s Legislative Action Center or

the Patient Action Center – www.apta.org/TakeAction •   Attend a Town Hall •   Set-up a meeting with your member(s) of Congress at home •   Invite your legislators to your practice to see physical therapy

first hand

•   Advocacy website – www.apta.org/Advocacy •   PTeam Resources – www.apat.org/PTeam •   Legislative Action Center & Patient Action Center

•   Form Letters •   Town Hall Schedule

•   Grassroots Toolkit •   How to Host a Practice Visit •   Podcasts •   PT-PAC Website •   APTA’s Government Affairs Staff