APTA Private Practice News
Report on Bipartisan Therapy Bill “SMART Act” Paves the Way for Congressional Action
New Report Identifies Potential Medicare Cost Savings by Changing Supervision Requirement; Underscores Critical Role of Therapy Assistants in Rural and Underserved Areas
Alexandria, VA – The results of a new independent, nonpartisan study, commissioned by a coalition of health care provider groups, show Medicare could save between $168 million and $242 million over 10 years by reducing administrative burdens on physical therapists and occupational therapists. These savings could help offset urgently needed changes necessary to improve access to therapy services for Medicare beneficiaries and to provide relief to rural and medically underserved areas of the country experiencing therapy workforce shortages. The win-win findings underscore the urgent need for Congress to pass pending legislation that would make those improvements possible.
The study, conducted by Dobson DaVanzo & Associates, looked at the potential financial impact of the Stabilizing Medicare Access to Rehabilitation and Therapy Act, or SMART Act (H.R. 5536), introduced in the U.S. House of Representatives by Rep. Bobby Rush, D-Ill., and Rep. Jason Smith, R-Mo. The bill aims to exempt rural or underserved areas from a 15% Medicare payment cut implemented earlier this year when services are provided by an occupational therapy assistant or physical therapist assistant. That cut was implemented on Jan. 1, 2022, and applies to OTA and PTA services under Medicare Part B.
“Many seniors and Medicare recipients rely on physical and occupational therapy services to maintain their independence and stay healthy and mobile after illness or injury,” said Rep. Bobby Rush, D-Ill. “These misguided pay cuts will cause severe harm to older Americans in underserved communities and to physical and occupational therapy assistants — many of whom are people of color.”
“Through the SMART Act we can improve access to physical and occupational therapy services while cutting red tape in Washington,” said Rep. Jason Smith, R-Mo. “I’m proud to co-lead this legislation with Representative Rush that will not only expand seniors’ access to treatment, especially in rural and underserved areas, but will also preserve the functional therapy community for future generations of Medicare patients.”
In addition, the legislation would bring supervision requirements of OTAs and PTAs under Medicare Part B in private therapist practices in line with state licensure laws, as well as all other settings where Medicare beneficiaries receive therapy services.
The study projects costs and savings associated with both provisions of the SMART Act. Results show that the cost savings generated through the change in supervision for OTAs and PTAs in the outpatient setting could help pay for the elimination of the 15% assistant payment cut in rural or underserved areas, which is estimated to cost CMS from $741 million to $1.58 billion over 10 years.
These provisions of the SMART Act would make therapy services more accessible to millions of Americans experiencing challenges accessing these services in rural or underserved areas, where beneficiaries are 50% more likely to receive therapy from an OTA or PTA. The standardization of general supervision requirements for private practices is cost-effective and would reduce administrative burden while implementing common-sense consistency with state laws and across all other Medicare settings.
The research was commissioned by the American Physical Therapy Association, American Health Care Association, American Occupational Therapy Association, Alliance for Physical Therapy Quality and Innovation, National Association of Rehabilitation Providers and Agencies, National Association for the Support of Long-Term Care, and APTA Private Practice, a section of the American Physical Therapy Association. The report can be accessed online at: Dobson | DaVanzo & Associates, LLC - Health Care Consulting - Publications (dobsondavanzo.com)
Presented by APTA Private Practice Industry Partner Hands-On Diagnostics You can claim up to 0.1 CEUs for your participation (keep scrolling for details)!
EMG & MSK Ultrasound in the PT Private Practice: Challenges & Opportunities
Tuesday, August 30 | 7:00 PM ET
Bart McDonald, PT, MPT, ECS, FMSK
Dr. Dimitrios Kostopoulos, DPT, MD, PhD, DSc, ECS
Dr. Joe McGilvrey, DPT, ECS, FMSK
Empower your PT Private Practice with EMG & MSK Ultrasound: The diagnostic tools that will take your practice into the upper echelon of your industry.
Discover how EMG & MSK Ultrasound are improving the quality of care, helping therapists create more comprehensive treatment plans, changing the future of healthcare, and taking private practices to the next level. Learn how diagnostic testing can become a major revenue generator for your private practice and weigh the risks and benefits of implementation in your own practice.
Outline the clinical and financial benefits of EMG & MSK Ultrasound Testing in the PT private practice setting
Outline the steps needed to implement a new diagnostic tool in the practice setting, and predict the risks and benefits associated with it
Discuss state practice acts, CMS and other insurance regulations regarding EMG & MSK Ultrasound Testing in PT practice
Outline insurance billing codes for EMG & MSK Ultrasound and reimbursement patterns.
By the end of the session, participants will be able to evaluate the risks and benefits of EMG & MSK Ultrasound testing, decide if these services are appropriate for their own practice and further develop an implementation plan.
CEU Approval and Certification
APTA Private Practice, designates this educational webinar for up to 0.1 CEUs. Upon completion of watching the webinar and achieving a score of 70% or higher on the post-test, the participant will be eligible to claim the credit. Credit can be claimed until August 30, 2023.
To claim this free CEU credit, the learner will need to enter their name and email address to take the CEU exam. By doing so, the learner agrees to share their contact information with the sponsor.
APTA Private Practice online CEUs are accepted by the following physical therapy licensure boards, as allowed by the type of course requirements in state regulations: AL, AZ, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, MI, MN, MS, MO, MT, NE, NH, NY, NC, ND, OR, PR, RI, SC, SD, TN, UT, VT, VA, WA, WV, WI, WY. Those in Oklahoma may apply individually for credit.
APTA Private Practice is accredited by the California Physical Therapy Association (Provider #CPTAAP-12) and the Texas Physical Therapy Association (Provider # 2008027TX). Consequently, all courses are accepted by California and Texas.
APTA Private Practice online courses are not automatically approved in AK, AR, LA, MD, NV, NM, NJ, OH, OK and PA, though individuals may be able to seek credit depending upon your state regulations.
APTA Private Practice issues CEUs/CCUs based on the following definitions: 1 CEU = 10 contact hours/10 CCUs. .1 CEU = 1 contact hour/1 CCU. 1 contact hour/1 CCU = 60 minutes of structured educational activity.
UPDATED July 18, 2022
The PPS COVID State of Affairs document is updated as needed, with the newest information highlighted in red to help you keep abreast of the most recent legislative and regulatory updates.
On July 15, 2022, the PHE was extended for another 90 days (until October 13, 2022).
Today’s renewal of the PHE means that the 151-day extension of coverage for telehealth provided in the Consolidated Appropriations Act of 2022 will result in the ability of physical therapists and PTAs to keep providing physical therapy via telehealth until at least mid-March 2023. The actual expiration date of the PHE-linked flexibility of rehabilitation therapists to independently provide care via telehealth will not be known until the PHE expires and triggers the 151-day extension countdown. The ability to achieve direct supervision via audio/visual communications will expire at the end of the year in which the PHE ends (at this point, that would be December 31, 2022).
UPDATED March 14, 2022
The PPS COVID-19 State of Affairs document is updated weekly, with the newest information highlighted in red, to help you keep abreast of the most recent legislative and regulatory updates. Here are some important notes this week:
The Public Health Emergency (PHE) has been extended again and will be in place through mid-January 2022. PTs and PTAs are able to provide care to Medicare beneficiaries via telehealth only for the duration of the PHE. Whereas, PTs will be able to use virtual audio/visual technologies to achieve direct supervision until the end of the calendar year in which the PHE ends—through at least the end of 2022.
Medicare Coverage of Telehealth:
- Physical therapists are eligible to provide and bill for Medicare services, as of 4/30/20 with a retroactive coverage date for claims beginning March 1, 2020. The Omnibus Federal Spending bill signed into law on March 11, 2022 includes a 151 day (~5 month) extension of Medicare coverage for real-time, face-to-face services provided by physical therapists and physical therapist assistants via telehealth after the Public Health Emergency (PHE) expires.
- The current expiration date of the PHE is April 16, 2022. However, the administration has promised a 60 days "heads up" that they don't plan to renew the PHE; no such warning has been provided. Therefore it is anticipated that the PHE will be renewed in April and expire mid-July 2022.
- Some waivers linked to the PHE expire when the PHE expires, some like the use of telehealth have been singled out for an extension, while others expire at the end of the year in which the PHE ends.
What We Don’t Know:
- When/If/How MACs will audit
- Whether Congress will pursue another extension of current waivers or provide a permanent path to telehealth coverage for services provided by PTs and PTAs.
What You Can Do Now:
- Advocacy Opportunity: Contact your Member of Congress and ask them to pass legislation to permanently enable physical therapists to provide physical therapy services to Medicare beneficiaries via telehealth.
- Request that they cosponsor the Expanded Telehealth Access Act (S.3193/H.R.2168) which would permanently add physical therapists, physical therapist assistants, and other rehabilitation therapists to the statutory list of distant site providers that Medicare pays for telehealth.
- Further ask that the text of the Expanded Telehealth Access Act be included in any long-term telehealth policy package that will be voted on by Congress.
Presented by PPS Industry Partner OnusOne You can claim up to 0.1 CEUs for your participation (keep scrolling for details)!
Designing Effective Employee Compensation Models
Tuesday, March 22 | 7:00 PM ET
Speaker: Jason Wambold, Co-Founder & Partner at OnusOne
Today's workforce carries an unprecedented debt load, demands higher salaries, and cites "work-life" balance as a top priority. Most employees expect pay to be commensurate with experience vs. production. Given the COVID pandemic and declining reimbursement, now is an ideal time to permanently alter the method by which we compensate rehab professionals. This session will present new/innovative concepts in compensation modeling.
Topics will include: shared risk/reward compensation models vs traditional bonus models, revenue-based vs volume based models, multiple plan tiers, best practice rollout strategy, compliance, and ethics.
CEU Approval and Certification
The Private Practice Section, APTA, designates this educational webinar for up to 0.1 CEUs. Upon completion of watching the webinar and achieving a score of 70% or higher on the post-test, the participant will be eligible to claim the credit. Credit can be claimed until March 22, 2023.
To claim this free CEU credit, the learner will need to enter their name and email address to take the CEU exam. By doing so, the learner agrees to share their contact information with the sponsor.
Private Practice Section online CEUs are accepted by the following physical therapy licensure boards, as allowed by the type of course requirements in state regulations: AL, AZ, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, MI, MN, MS, MO, MT, NE, NH, NY, NC, ND, OR, PR, RI, SC, SD, TN, UT, VT, VA, WA, WV, WI, WY. Those in Oklahoma may apply individually for credit.
The Private Practice Section is accredited by the California Physical Therapy Association (Provider #CPTAAP-12) and the Texas Physical Therapy Association (Provider # 2008027TX). Consequently, all courses are accepted by California and Texas.
PPS online courses are not automatically approved in AK, AR, LA, MD, NV, NM, NJ, OH, OK and PA, though individuals may be able to seek credit depending upon your state regulations.
PPS issues CEUs/CCUs based on the following definitions: 1 CEU = 10 contact hours/10 CCUs. .1 CEU = 1 contact hour/1 CCU. 1 contact hour/1 CCU = 60 minutes of structured educational activity.
UPDATED February 4, 2022
The No Surprises Act (part of Public Law 116-260) requires certain disclosures related to surprise billing. In the implementation of the Act, CMS has promulgated regulations requiring that many providers including private practice PTs need to disclose a good faith estimate of costs of care to certain patients. Making this new requirement work in private practices has proven difficult, and PTs have raised many questions about how to comply. PPS has developed a new State of Affairs document available to keep you updated about the latest requirements as well as the work that PPS is doing to advocate on your behalf to decrease the administrative burden this new requirement imposes.
As I am sure you have heard on the news, on Friday 12/14, a federal judge in a lower court in TX filed a decision that declared the Affordable Care Act to be unconstitutional. His decision hinged on the fact that last December's tax bill the fine for not obtaining health insurance was reduced to zero. The decision held that since that fine has bee reduced to zero, that "tax" has been functionally removed from the law.
The reason this argument matters is that when the Supreme Court evaluated the constitutionality of the ACA previously, it determined that in fact the government did have the authority to compel Americans to have health insurance coverage, citing the Constitution granting Congress the authority to tax and spend. In yesterday's decision, the judge determined that since the "tax" has been reduced to zero, that authority has been relinquished and therefore the whole law must be struck (because of the argument that the taxing authority granted to Congress was the sole reason that it was able to compel Americans to have health insurance--and that the existence of the entire law hinged upon the taxing authority).
The ruling will not impact the 2019 health insurance plans sold through the exchange/marketplace of healthcare.gov or the state equivalents. It also won't immediately affect Americans' health coverage. The most immediate impact could be upon whether or not states will continue to consider expanding Medicaid at a time when the effort might be for naught.
An appeal is inevitable and already being discussed by a group of states led by California. They are likely to argue that the amount of the fine is immaterial, and that the $0 amount is not the equivalent of repealing the tax/fine and that the law still contains (and has the authority to impose) a fine. Because of the high stakes, and the political aspect of the law, the appeal process is likely to make its way to the US Supreme Court. This will take time.
If the US Supreme Court upholds the argument that the entire Congressional authority hinges on whether or not there is a tax/fine of more than $0 imposed upon those who do not have health insurance coverage, then the entire law will be invalidated. If that is the case, Americans will lose pre-existing condition protections, the ability of folks to stay on their parents' health insurance up to age 26 and other provisions of the ACA that have recently become popular on both sides of the aisle and the preservation of which has been a PPS legislative priority.
In a closely watched case, Judge Reed O’Connor of the Federal District Court in Fort Worth, Texas ruled that the Affordable Care Act's individual mandate, which Republicans zeroed out with their tax bill, “can no longer be sustained as an exercise of Congress’s tax power.” And the rest of the law cannot be separated from that provision and is therefore invalid, he wrote.
The New York Times: Texas Judge Strikes Down Obama’s Affordable Care Act As Unconstitutional
A federal judge in Texas struck down the entire Affordable Care Act on Friday on the grounds that its mandate requiring people to buy health insurance is unconstitutional and the rest of the law cannot stand without it. The ruling was over a lawsuit filed this year by a group of Republican governors and state attorneys general. A group of intervening states led by Democrats promised to appeal the decision, which will most likely not have any immediate effect. (Goodnough and Pear, 12/14)
The Associated Press: Federal Judge Rules Health Care Overhaul Unconstitutional
In a 55-page opinion, U.S. District Judge Reed O’Connor ruled that last year’s tax cut bill knocked the constitutional foundation from under “Obamacare” by eliminating a penalty for not having coverage. The rest of the law cannot be separated from that provision and is therefore invalid, he wrote. Supporters of the law immediately said they would appeal. “Today’s misguided ruling will not deter us: our coalition will continue to fight in court for the health and wellbeing of all Americans,” said California Attorney General Xavier Becerra, who is leading a coalition of states defending the ACA. (Alonso-Zaldivar, 12/14)
Politico: Judge Rules Obamacare Unconstitutional, Endangering Coverage For 20 Million
“In some ways, the question before the Court involves the intent of both the 2010 and 2017 Congresses,” O’Connor wrote. “The former enacted the ACA. The latter sawed off the last leg it stood on.” (Demko and Cancryn, 12/14)
Texas Tribune: Federal Judge Rules Obamacare Unconstitutional, Handing Texas An Early Win
In a ruling that could throw the nation’s health care system into chaos, Fort Worth-based U.S. District Judge Reed O’Connor on Friday ruled that a major provision of the Affordable Care Act is unconstitutional — and that the rest of the landmark law must fall as well. In February, a Texas-led coalition of 20 states sued the federal government to end the health care law in its entirety, arguing that after Congress in December 2017 gutted one of its major provisions, the rest of the law was unconstitutional. (Platoff, 12/14)
Kaiser Health News: Judge Strikes Down ACA Putting Law In Legal Peril — Again
It is all but certain the case will become the third time the Supreme Court decides a constitutional question related to the ACA. In addition to upholding the law in 2012, the court rejected another challenge to the law in 2015. (Rovner, 12/14)
PPS’ legislative priorities call for us to address and mitigate the negative effects associated with physician self-referral. In August, PPS filed formal comments in response to CMS’ RFI on physician self-referral. On October 26th, PPS filed formal comments with the Department of Health and Human Services’ Office of Inspector General urging both limits to the use of beneficiary incentives as well as transparency if providers are offering incentives to retain or induce patients to choose a particular provider. In both comments, PSS urged the prompt removal of PT from the IOASE and requesting increased accountability and transparency for referrals made utilizing the IOASE.
PPS has developed multiple educational video series to ensure that every PPS member has fundamental business management knowledge in Marketing, Finance, and Operations. The courses below can be accessed at anytime in the PPS Learning Center and are free to PPS members
In this 5-module, video series, learn how to define your target audience and develop a brand promise that engages customers. Discover marketing best practices, and tools to develop your marketing plan and accompanying budget. Finally, take a deep dive into three marketing strategies proven effective in marketing a physical therapy practice.
- Module 1: Defining your target audience & developing a brand promise
- Module 2: Developing a marketing plan and budget
- Module 3: Referral source marketing
- Module 4: Internal marketing
- Module 5: Consumer/community outreach & marketing
Operations 101 provides an introduction to Key Performance Indicators and outlines the standardized definitions of recommended KPI's used to manage physical therapy practices. In modules two and three of this 3-part series, participants will learn how to use data and metrics to successfully manage practice operations, and will develop a strategy to create successful KPI performance.
- Module 1: Introduction to Key Performance Indicators (KPI's)
- Module 2: Using KPI's in your Physical Therapy Practice
- Module 3: Management and Impact of KPI's on Your Practice
Finance 101 is a free, multi-module, video series that provides a solid foundation for those managing the finances of a physical therapy practice. The series was designed for non-financial people to gain improved understanding of bookkeeping methods, financial statements, and key terms requisite to successfully managing the finances of a physical therapy practice.
- Module 1: Setting the Stage: Introducing key financial terms and concepts
- Module 2: Finance for Non-Financial People
- Module 3: Financial Statements
- Module 4: Using Finance in Your Practice
- Module 5: Bringing it All Together
- Module 6: Real Life Questions
- Module 7: How To and Tools
Three years after being elected President of the American Physical Therapy Association, Sharon L. Dunn, PT, PhD, stood before the House of Delegates and delivered an invigorating address to the body of electorates who first voted her into leadership back in 2015. At the heart of her message was a repeated and compelling charge to act as she emphasized that it is not enough to call out inadequacies in the system, or to idly tweet about embracing change or promoting inclusion. No, she reiterated that as a profession we must band together and work collaboratively to secure the future of our profession.
“The members of the American Physical Therapy Association were bold enough to dream of transforming society,” she reminded, “Now we must deliver on that promise by following the most universal piece of advice we provide to our patients and clients: we must move!”
Memorable Quotes from President Dunn’s speech are highlighted below:
SETTING A NEW TONE FOR THE FUTURE
“Most of us in this room wear those battle scars—and quite proudly. But where our past was shaped with sharp elbows, our future must be shaped with open arms. Where our origins situated our profession in recovery and the treatment of disorder, our future will be characterized by an increased role in sustaining health and proactively preventing disability and disease. And where previously we have demanded respect in part by staking out turf and occasionally pointing to the shortcomings of others, in our future we will demonstrate our value based on the irrefutable data of our own outcomes and in partnership with our colleagues across disciplines. The health care system and our patients will demand nothing less."
QUESTING OVER RESTING
“We should approach our future with enthusiasm, not dread, because our profession has never been satisfied with our position within the status quo. Our existence has been one of almost constant self-challenging evolution. Our progress has never been inevitable; it has always been hard-earned. So if we truly desire to not only see society transformed but to shape that transformation, we must not only weather the storm of health care disruption. Instead, as Dr Alan Jette urged in his 2012 Mary McMillan Lecture, we must face into the storm and choose questing over resting.
WE MUST BE AGENTS, NOT CRITICS
"We cannot transform society through judgment. Our vision charges us not to stand at a distance and point our fingers at our nation's ills but instead to accept a personal responsibility to try to make a difference.
"At our core, we are healers, and as much as ever our country and our society need healing. It is not enough that we tweet about it in judgment. It is not enough that we adopt policies that articulate our principles. It is not enough that we sit idly by, in the comforts that were afforded by those who forged the path before us.
LET NO ONE FEEL LIKE AN OUTSIDER
"To fulfill our mission, our community must vastly improve our diversity by being intentional about inclusion. We must prioritize listening and learning. We must enable the next generation of physical therapists and physical therapist assistants to transform our association, just as our association must transform society. Most of all we must get involved—with open arms and open minds—not only as a community, but as individuals."
OUR MOST VALUABLE ASSET: AN ENGAGED MEMBER
"When we formally charge APTA to act, or simply daydream about "what APTA should do...," we sometimes behave as if we're writing a check for someone else to cash. But as an individual membership association, we are charging ourselves-we are writing our own to-do list. APTA is not a distant factory that churns out ready-to-order physical therapy progress on a conveyor belt. It's a community of physical therapists, physical therapist assistants, and students. It's our community. We are APTA, and APTA is us. Our association's growth, commitment, and determination cannot outpace our own personal development."
FOLLOW OUR DREAMS WITH OUR OWN FOOTSTEPS
"If, like I do, you anticipate a day when physical therapists, like dentists, are part of our society's regular health routines, don't just point the way—raise a hand and accept a portion of responsibility to take us there.
APTA President Sharon L. Dunn, PT, PhD, Board-Certified Orthopaedic Clinical Specialist, was reelected to a second 3-year term, June 25, 2018. To read the full transcript of her 2018 address, or to watch the video, visit the APTA website.