Alpha Lillstrom Cheng

Keep up the good work! Your efforts continue to enhance your relationship with your legislator and their understanding of the value of physical therapy provided in a private practice setting. 

 

Speaking Up on Behalf of Private Practice Physical Therapists 

Modernizing the Physician Self-Referral Policy 

With a goal of accelerating the transition to a value-based system, the Department of Health and Human Services (HHS) and the Center for Medicare and Medicaid Services (CMS) are seeking to implement regulations to remove what they see as unnecessary government obstacles to team-based care. For example, they see the self-referral prohibitions of the Stark Law to be a hindrance to coordinated care. CMS posted a Request for Information (RFI) seeking public input for how to modernize the physician self-referral law (also known as the “Stark law”). 

PPS responded to the RFI arguing three primary points. The first is that PT should be removed from the In-Office Ancillary Services Exception (IOASE) and that because a physician is allowed to self-refer physical therapy patients to providers with which he/she has a financial relationship, he/she has no real incentive to refer patients to independent rehabilitation professionals who have clinical expertise specific to the outcome desired for their patients, may be more cost-effective, and achieve higher functional outcomes for their patient populations. Secondly, PPS argued that value-based care and bundled-payment arrangements are also relevant to other Medicare enrolled providers and suppliers, including physical therapists and therefore encouraged CMS to allow physical therapists to participate in alternative payment models (APMs) on a risk-sharing basis. Finally, PPS urged CMS to consider how modernizations explored would impact the care Medicare beneficiaries receive from non-physician health care providers and suppliers. PPS pointed out that the goal of balancing the physician self-referral law’s restrictions while modernizing the regulations to support value-based reimbursement can be met while also protecting a Medicare beneficiary’s right to receive quality care from the provider of their choice—in many cases that will be from independent, private practice physical therapy practitioners. 

Medicare Physician Fee Schedule Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) has issued its proposed rule for calendar year 2019. Within the fee schedule portion, CMS proposes to eliminate functional limitation reporting and establish two new therapy modifiers to identify outpatient therapy services furnished in whole or in part by PTAs and OTAs. In the Quality Payment Program portion of the proposal, physical therapists were added to the list of Medicare-eligible providers who could be required to participate in the Merit-Based Incentive Payment System (MIPS). The agency also proposes to exempt providers who are below the low-volume threshold from participation in MIPS, but at the same time allow them to opt-in to the program so that more providers are able to participate. To promote participation in APMs, CMS is increasing flexibility for the All-Payer Combination Option and Other Payer Advanced APMs for non-Medicare payers to participate in QPP. APTA and PPS will both submit comments.

ADVOCACY OPPORTUNITY #1

You too can submit comments to CMS about how the 2019 Medicare Physician Fee Schedule proposed rule will impact you and your patients. APTA has prepared a template letter that you can modify to reflect your perspective. The deadline for comments is Monday, September 10, 2018. 

Engage with Candidates for Elected Office 

Being an active advocate in an election season is easy to do and is more important than ever. Candidates are crisscrossing their districts eager to talk to potential voters and community leaders. Fundamental to effective advocacy and representative democracy is the act of educating the policymaker. Whether or not you engage could impact the laws passed by those in Congress—in order to serve you and the needs of your patients they need to know and understand the legislative and advocacy priorities of the Section. All seats in the House of Representatives and one-third of the Senate seats will be contested this fall. This is a prime time for you meet to talk about the impact of healthcare policy and also reinforce the message of the important role you play in the local economy. With each engagement you enhance a candidate’s understanding of the unique value of physical therapy provided in a private practice setting. 

ADVOCACY OPPORTUNITY #2

See the July Legislative Update for templates, talking points, and scripts to use when engaging with candidates. 

 

Thank you for your continued advocacy and engagement! For one-pagers, talking points, and information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org