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Posts Tagged ‘advocacy’

 

Giving Voices to Our Women’s Health Patients: Highlights from the APTA Federal Advocacy Forum  

Posted on: April 7th, 2017 by Aika Barzhaxynova No Comments

 

Federal Affairs Forum 2017By April Ritz, DPT

First, I want to give a huge shout-out to the Section on Women’s Health for sponsoring me to attend my first American Physical Therapy Association Federal Advocacy Forum in Washington, D.C., March 26-28, 2017.

Second, I’m giving special thanks to Gail Zitterkopf, SOWH federal affairs liaison, for taking me under your wing, showing me the city, and sharing your knowledge.

This was a memorable experience for me. We covered so many issues before heading to Capitol Hill to voice our opinions and to educate our elected officials on the following legislation:

  • The Medicare Access to Rehabilitation Services Act (a.k.a., Therapy Cap Repeal, H.R. 807/ S. 253). The Therapy Cap currently limits Medicare patients to a total of $1,980 for speech and physical therapy services. While extensions can be added, this can delay care. The bill has failed to be implemented 16 times since 1997, and extensions have just been added, but the current extension ends December 31.
  • Physical Therapist Workforce and Patient Access Act (H.R. 1639/ S. 619). My Representative, John Shimkus is a co-sponsor of this important bill, which would add PTs to the pool of health professionals able to serve in shortage areas (National Health Service Corps). In my district of central Illinois alone, there are 43 health professional shortage areas. Being part of the NHSC also would qualify PTs to be part of the loan repayment program.
  • The Sports Medicine Licensure Clarity Act of 2017 (H.R. 302/ S. sister bill). This bill lets physicians, PTs, and athletic trainers travel with their professional or collegiate team across state borders and still practice. Passed by the House of Representatives, it is awaiting Senate approval.
  • SAFE Play Act. APTA is trying to standardize protocol for concussion management and return-to-play guidelines for youth athletes. Currently, without standards, most states have a wide variety of rules.
  • Lymphedema Treatment Act (H.R. 930). Lymphedema compression garments are not considered Durable Medical Equipment under Medicare, which limits patients’ recoveries and boosts medical costs due to complications from lymphedema.

I know it’s a lot of information, but it would be great if you would contact your state representatives or senators this week. Those of us on Capitol Hill met with or gave an APTA folder to every senator, representative, and/or legislative assistant. Please follow up with them and let them know that you care! They need to hear from their constituents.

Here’s a true story: A representative stopped supporting a PT bill solely because he had not heard from any of his PT constituents that year on the issue. You can use the templates online through the APTA website (http://www.apta.org/TakeAction) or download the PTaction app on your phone. Try to customize it, though, to reflect that you are their constituent and that you support what the APTA stopped in their office to discuss March 28.

I highly recommend attending the FAF or at least your state PT Day on the Hill! We need to realize that if we do not stand up for our profession, we will be in trouble down the road. If not for APTA and PT-PAC, our profession would not have locum tenens, the ability to practice dry needling and many PT-friendly laws and policies. We would be a lot worse off than we are now!

I know our profession is facing a lot of issues, but we need to remember the Section on Women’s Health, APTA, and PT-PAC are fighting for us. To have the greatest leverage, though, we need to donate to the political action committee. As an APTA member, our annual dues are not allowed to go to the PAC, so we need to make an additional contribution to them. I urge you to do so yearly.

If every APTA member gave $20 a year, we would have the largest health professional PAC. This would help us tremendously! Here is a link for you to donate and support our profession for the future: http://www.ptpac.org/support_ptpac. As a side note, you must be an APTA member to donate to the PAC (it’s the law).

Remember the words of Thomas Jefferson: “We in America do not have government by the majority. We have government by the majority who participate.”

AUTHOR: April Ritz, DPT, works in outpatient orthopedics and women’s health in Mattoon and Champaign, Ill., for Carle Foundation Hospital. She also works as needed in the acute inpatient setting for HSHS St. John’s in Springfield, Ill.

 

 

 


 

 

 

Speak Out on Proposed Orthotics and Prosthetics Rule: Here’s How

Posted on: March 2nd, 2017 by Aika Barzhaxynova No Comments

By Gail Zitterkopf, PT, DPT

A proposed rule from the Centers for Medicare and Medicaid Services (CMS) is drawing criticism from physical therapists (PTs) over additional requirements that PTs would need to meet to qualify as providers of custom orthoses and prostheses—and the Section on Women’s Health is making it easy for members to let CMS know what they think!

Please use the attached template to notify CMS of your concern, since CMS is accepting comments until March 13. This would impact members’ ability to determine the need and fitting for pessaries.

CMS’s proposal is to eliminate the Medical Improvements for Patients and Providers Act exemption and require physical therapists to become qualified practitioners subject to the licensure and accreditation requirements of § 424.57(d)(3).

These additional proposed licensure and accreditation requirements are unnecessary, because licensed physical therapists already receive extensive education in orthotics and prosthetics, and orthotics and prosthetics are part of the recognized practice of physical therapy.

For these reasons, the Section on Women’s Health is asking members and others to send this letter to CMS as soon as possible. We thank you in advance for your much-needed advocacy for the profession and will keep you posted on this important issue.

AUTHOR: Gail Zitterkopf, PT, DPT, is chair of the SOWH Federal Affairs Subcommittee.

YOUR ADDRESS:
DATE
Patrick Conway, MD, MSc,
Acting Administrator
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Room 445-G, Hubert H. Humphrey Building
200 Independence Avenue SW
Washington DC, 20201

Re: CMS-6012-P; Proposed Rule: Medicare Program; Establishment of Special Payment Provisions and Requirements for Qualified Practitioners and Qualified Suppliers of Prosthetics and Custom-Fabricated Orthotics

Dear Acting Administrator:

I would like to submit the following comments in response to the Establishment of Special Payment Provisions and Requirements for Qualified Practitioners and Qualified Suppliers of Prosthetics and Custom-Fabricated Orthotics proposed rule. The standards that CMS is putting forth in the proposed rule are so restrictive that the effect will be to limit Medicare beneficiaries’ access to my services that are safe and effective.

  • Include a paragraph about yourself, the O&P services you provide, your practice setting, the patients you serve, and how the proposed rule would negatively impact you and your patients, etc.

CMS’s proposal to eliminate the MIPPA exemption and require physical therapists to become qualified practitioners subject to the licensure and accreditation requirements of § 424.57(d)(3). These additional proposed licensure and accreditation requirements are unnecessary as licensed physical therapists already receive extensive education in orthotics and prosthetics, and orthotics and prosthetics are part of the recognized practice of physical therapy.  In addition, pelvic floor physical therapist must obtain additional training beyond that which is required for licensure to treat in this practice pattern.

The use of orthotic devices, such as a pessary is an integral part of the practice of physical therapy.  Physical therapists use specific tests and measures to determine the need for a pessary, in patients not currently using them and to evaluate the appropriateness and fit of pessaries presently in use. Physical therapists have extensive training and education in the fabrication of pessaries which makes additional regulations and certifications are needless, anti-competitive, and serve no practical purpose.

It is not uncommon for a woman to need a pessary after the birth of a child or before having pelvic surgery. It is most often used for prolapse of the uterus which is caused by the weakening or sagging of the muscles and/or ligaments. Pessaries are often used in conjunction with pelvic floor therapy to assist the patient in successfully achieving their health goals.

A vaginal pessary is a plastic, or rubber device inserted through the vagina to help support the uterus, vagina, bladder or rectum. This device is also helpful if you have stress urinary incontinence (the leaking of urine when you cough, strain or exercise), or experience incontinence while pregnant.

Prohibiting physical therapists from performing interventions with orthotics including pessaries would place an undue burden on patients by forcing them to see alternative providers.  This would increase the cost to the patient and the amount of time spent using health care practitioners. Currently no U.S. jurisdictions prohibit physical therapists’ ability to use orthotics and prosthetics as a component of physical therapist practice.

The proposed rule specifies that a qualified practitioner needs to be certified either by the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) or the Board of Certification/Accreditation (BOC). The proposed rule also states that certification may be granted by “A Secretary-approved organization that has standards equivalent to the ABC or BOC.”  At the current time, there are no Secretary-approved organizations with standards equivalent to ABC or BOC that are granting certification.  The fact that there are currently only two organizations granting certification will make it difficult for any provider seeking to become a qualified practitioner to meet the certification requirements of the proposed rule. In addition, neither of these two organizations provide regulation nor training for pessaries, thus eliminating orthotic fitting of pessaries from daily practice.

HOW TO SUBMIT YOUR LETTER:

In commenting, please refer to file code CMS-6012-P. You may submit comments in one of four ways (please choose only one of the ways listed):

  1. Electronically.You may submit electronic comments on this regulation to http://www.regulations.gov. Follow the “Submit a comment” instructions.
  2. By regular mail.You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-6012-P, P.O. Box 8013, Baltimore, MD 21244-8013.

Please allow sufficient time for mailed comments to be received before the close of the comment period.

  1. By express or overnight mail.You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-6012-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.

 

 

 


 

 

 

Ready or Not Here They Come! Prepping the Women’s Health Physical Therapist for the New Evaluation Codes

Posted on: January 7th, 2017 by Aika Barzhaxynova No Comments

By Kelly Huestis, MPT; Nakisha Jackson, DPT; and Katie Pring, MPT

As women’s health physical therapists, changes in health care policy always evoke the question, “But how does this apply to MY patients?” We often march to our own drum in terms of treatments and types of patients seen. This is no different for the new evaluation codes that started January 1, 2017.

Codes 97001, PT Evaluation, will no longer be used and will be replaced by three new codes of varying patient complexity:

97161 (PT evaluation low complexity)

97162 (PT evaluation moderate complexity)

97163 (PT evaluation high complexity)

To determine the correct code, the four components of History, Examination, Clinical Decision Making, and Development of Plan of Care must be documented clearly. See the APTA’s page as an excellent resource on the basics of the new codes:  http://www.apta.org/PaymentReform/NewEvalReevalCPTCodes/.

The following are three case examples for classic women’s health patients and our suggested evaluation code for each, based on the four elements.

Case #1

A 65-year-old female presents with stress urinary incontinence (UI) for the past 10 years, 1 pantiliner per day. New onset of urge UI with 3 episodes of complete loss of control over the last 6 months and frequent dribbling on the way to the restroom. Voiding eight to 10 times per day, 1 time per night. PMH: HTN, 2 C-sections. Medication: Lisinopril. Examination finds normal lumbar, SIJ and lower quadrants, pelvic floor weakness.

History Examination Presentation Decision-Making
None to affect current POC Pelvic Floor Weakness Stable, uncomplicated Low Complexity

We would consider this a Low Complexity Evaluation, Coded 97161.  

Case #2

A 76-year-old female is referred for cystocele, unimproved with pessary. History of frequent urinary tract infections. Presents with urinary retention, urge UI, frequency, nocturia. Functional limitations: bathroom mapping, sleep disruption, inability to travel, and pain with sitting. Patient is retired but volunteers regularly in a hospital. PMH: IBS, HTN, arthritis. Outcome Tools: UDI-6 25/100, PFIQ 86/300. Objective findings: Pelvic floor weakness and tension, low endurance, pelvic floor and core incoordination, poor bladder habits.

History Examination Presentation Decision-Making
Frequent UTIs

IBS

Pelvic Floor Weakness & Dysfunction

Nocturia and urgency/frequency

Pain in sitting

Unstable due to frequent UTIs Moderate. Use of outcome tools shows QOL impact.  Behavioral modifications impact success. Combination of weakness, retention, and incontinence.

We would consider this a Moderate Complexity Evaluation, Coded 97162.

Case #3

A 48-year-old female referred for pelvic pain. She presents with complaints of mild UI and pelvic pain that increases throughout the day. Worse with prolonged seated and stance activities. Recently underwent bladder suspension surgery with continued pain and UI. She reports having a lumbar fusion five years ago, with chronic LBP that requires pain management intervention. Pelvic girdle pain is located at the right SI joint. PMH includes MS, DM, smoking, depression, two C-sections, gall bladder removal. Exam Findings: decreased PFM extensibility and inability to relax, 4/5 Positive SI Joint Provocation Tests, decreased hip strength for hip extension and abduction, decreased core stability and coordination, poor posture and body mechanics, difficulty with gait, trouble with transfers, no current attempt at self-management or exercise. Outcome Tools: Oswestry LBP Questionnaire 72%, PFIQ 201/300.

History Examination Presentation Decision-Making
MS, DM, recent bladder suspension, smoking, depression, lumbar fusion Pelvic Floor Tension, SI Dysfunction, Gait dysfunction and trouble with transfers,

Hip and core weakness, sitting intolerance

Unstable, Progressive.  S/p recent surgery High. Use of outcome tools shows QOL impact.  Complicating co-morbidities will impact success of interventions, many inter-related active impairments.

We would consider this a High Complexity Evaluation, Coded 97163.

Keep an eye on the SOWH Payment, Policy, and Advocacy Page for more examples and helpful links on the topic: http://www.womenshealthapta.org/practice-payment-policy-and-advocacy. For more information about outcome measures, please refer to the Practice section of the SOWH website under Functional Outcome Measures:  http://www.womenshealthapta.org/fom/. Send your questions to [email protected].

AUTHORS: Kelly Huestis, MPT; Nakisha Jackson, DPT; and Katie Pring, MPT, serve on the SOWH Reimbursement Committee.

 

 


 

 

 

Goodbye, 97001 & 97002

Posted on: July 26th, 2016 by Aika Barzhaxynova No Comments
Monica White

Monica White

By Monica White, DPT, PRCP

As you may have heard, Centers for Medicaid & Medicare Services (CMS) is changing how we code for physical therapy evaluations in 2017. There will be three new evaluation codes– 97X61, 97X62, and 97X63–that will replace 97001, and one new re-evaluation code, 97X64, that will replace 97002.

How will this change the reimbursement rate?

At this point we’re not sure. CMS will publish the final ruling on payment rates in late October or early November. CMS has proposed to keep the same reimbursement rate whether you are evaluating a relatively simple or a complex patient or whether you spend 20 minutes or 45 minutes evaluating a patient. Check out what the new codes will look like below:

New Physical Therapy CPT Codes

CodeCPT Long Form Descriptors for Physical Medicine and Rehabilitation
97X61Physical therapy evaluation: low complexity, requiring these components:
A history with no personal factors and/or comorbidities that impact the plan of care;
An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions;
A clinical presentation with stable and/or uncomplicated characteristics; and
Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome.
Typically, 20 minutes are spent face-to-face with the patient and/or family
97X62Physical therapy evaluation: moderate complexity, requiring these components:
A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care;
An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following body structures and functions, activity limitations, and/or participation restrictions;
An evolving clinical presentation with changing characteristics; and
Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome.
Typically, 30 minutes are spent face-to-face with the patient and/or family.
97X63Physical therapy evaluation: high complexity, requiring these components:
A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care;
An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions;
A clinical presentation with unstable and unpredictable characteristics; and
Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome.
Typically, 45 minutes are spent face-to-face with the patient and/or family
97X64Reevaluation of physical therapy established plan of care, requiring these components:
An examination including a review of history and use of standardized tests and measures is required;
and
Revised plan of care using a standardized patient assessment instrument and/or measurable assessment
of functional outcome
Typically, 20 minutes are spent face-to-face with the patient and/or family.
97X65 Occupational therapy evaluation, low complexity, requiring these components...

https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-16097.pdf

 Change is just around the corner! Keep an eye on the SOWH Blog and the SOWH Payment, Policy, and Advocacy web page for more updates:  http://www.womenshealthapta.org/practice/payment-policy-and-advocacy/

AUTHOR: Monica White, DPT, PRCP, is a CAPP-Pelvic certified member of the SOWH Reimbursement Committee.

 

 

 


 

 

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