News from APTA:

We're pleased to share that Aetna has updated its physical therapy policy to provide unrestricted direct access to physical therapist services in response to ongoing advocacy efforts by APTA. Effective June 17, Aetna will no longer require a referral or signed plan of care for physical therapy.

The change in policy is the result of sustained and strategic effort from APTA staff and the engagement of members spanning almost a decade and marks a significant victory for patients and for the profession.

The previous policy indicated "Aetna considers physical therapy (PT) medically necessary when this care is prescribed by a chiropractor, DO, MD, nurse practitioner, podiatrist or other health care professional qualified to prescribe physical therapy according to State law. . ."

Great work APTA!

• Check your home for fall risks: Use this falls prevention checklist from the CDC to find ways to make your home safer as you age.
• Stay physically active and focus on overall wellness: Do these simple falls prevention exercises at home or find a fitness class at your local area agency on aging. Staying hydrated, eating a healthy diet, and getting quality sleep can all improve your overall wellness and decrease your risk of falling.
• Get an annual fall screening: The CDC recommends that all adults over the age of 65 get an annual fall screening. If you have additional symptoms, such as dizziness or light-headedness, you may need a fall screening earlier.
• Get regular medical checks: Changes in vision, hearing, and foot stability may cause you to fall. Ask your medical provider how often you should have your vision and hearing checked. If you receive new eyewear or hearing aids, take time to get used to them. If you are noticing changes in your foot strength or the way you walk, talk to your medical provider about these changes.
• Tell your medical provider if you have fallen: A fall can alert your medical provider to a possible problem and help them provide you with steps to prevent future accidents. These steps may include things like changing medication, seeing a physical therapist, or seeing an occupational therapist.

Direct Access in MO Now in Effect!

Today, August 28th, 2023, is the day patients can finally being accessing care from PTs without first being mandated to see a physician for a referral!  Please contact us if you have questions, or if you would like to share your experiences with direct access. ckemna@bardgett.net

APTA MO member Ann Fick was recently selected to give the Linda Crane Lecture at CSM in San Diego.  She was joined by the supportive faculty and students of the Maryville University PT Department. 

Congratulations Ann!

Washington University's PT Program has been leading the charge in making Diversity, Equity, and Inclusion (DEI) a priority for their program and for the university as a whole.  At the same time, many Washington University faculty members and students are extending the work of their program and sharing their time and resources to help build APTA Missouri's DEI Committee!  

We sincerely thank and congratulate everyone with the Washington University PT Program for your leadership and hard work to ensure that every voice is heard and valued.

Congratulations to Dr. Ann Fick, the Director of Clinical Education for PT Program at Maryville University.

Dr. Fick is the recipient of the 2022 APTA Lucy Blair award. This award is given to physical therapists who have volunteered their time and service across various chapters, sections, committees of APTA and their partners to moving the profession forward.

Dr. Fick has been involved with the Academy of CVP, Academy of Education, Academy of Acute Care and APTA Missouri plus volunteered for the Federation of State Board Examiners in the National PT Exam Development and the Academy of Academy PT in advancing clinical education.

Dr. Shirley Sahrmann served as the keynote speaker for APTA MO's 2022 Spring Conference on Saturday, April 23.  Sahrmann emphasized the important role of PTs as experts in movement.

PAULA BURNETT, PT, honored at 2021 SLU Program in Physical Therapy
Class of 2024 White Coat Ceremony

Paula Burnett with Florence Kendall

(Lee’s Summit, MO – September 2021) Summit Strength Physical Therapy is celebrating 20 years of treating patients in Lee’s Summit and Blue Springs.  In 2001, Scott Knoche opened Summit Strength in Lee’s Summit with a primary focus to always provide One-on-One Therapy for every patient.  In 2010, Summit Strength was named the Business of the Year by the Lee’s Summit Chamber of Commerce. 

Over the past 20 years, Summit Strength has grown to 30 plus employees, including 16 clinicians providing therapy tailored to meet all patients’ needs.  Both locations treat patients of all ages and offer extended hours for ease of scheduling, as well as telehealth.  Summit Strength is certified in Blood Flow Restriction (BFR) and six therapists have advanced certification in Mechanical Diagnosis and Therapy.

Former patient of Summit Strength said, “I interviewed a few rehab therapy businesses before my first total knee replacement.  I chose this one for the breadth of treatments, variety of equipment for reconditioning muscle groups and skilled and experienced therapists.  In my opinion, they were genuinely interested and involved with getting me back on my feet. I was completely satisfied with my rehab.”

Summit Strength therapy includes:  pain management, sports injury recovery, stroke recovery, post-surgery rehabilitation, developmental issues and workers compensation.

Luckily, the Zoom was recorded, so you can still enjoy the talk and learn from one of the most recognized PTs in the profession.  Just click the title below:

Dr. Shirley Sahrmann: 100 Years of Physical Therapy: Where have we been and where are we going?

 APTA Missouri is extremely proud to introduce the winners of the 2020 Outstanding Service Awards:

Gerti Motavalli, PT - Outstanding Service in the Area of Patient Care

Nominated by: Dana Martin, PT, DSc

Letters of support state: “…she is innately driven to provide the best practice for her patients and their families on a daily basis, demonstrating excellence in all that she does.”

“Gerti continues to go above and beyond for her patients using innovation and her clinical expertise to improve patient outcomes.”

“Gerti worked with the father of a child with Spina Bifida to develop a crawling device called The Frog. To date, 170 Frogs have been shipped, most free of cost, to families in 7 countries around the world.”  (An organization called Patient Innovation chose The Frog as one of the world’s three best new innovations designed by caregivers in 2019.)

Teresa Briedwell, PT, DPT - Outstanding Service in the Area of Education

Nominated by: Dana Martin, PT, DSc

Letters of support state: “Never one to shy away from service to others, Teresa serves as an excellent role model for those around her.”
“She is able to translate knowledge to the next generation of practitioners as well as current clinicians.
“She documents evidence of interest in and efforts toward continual improvement in her teaching efforts.”

“She exemplifies the best in what a university teacher should be.”

Cheryl Caldwell, PT DPT - Outstanding Service in the Area of Education

Nominated by Tammy Burlis, PT, DPT, MHS; and Suzy Cornbleet, PT, DPT

Letters of support state: She has been involved in service for 40 plus years, making valuable contributions locally, nationally, and internationally.”

“Cheryl has been and continues to be a servant leader.  She does so by being articulate, unafraid to voice an unpopular or alternative opinion, focused on the
big picture issues and willing to listen…”

“She is highly regarded by the students as an asset to our Program and her mentorship is often sought.”

Please pass along the information below to family, friends, and patients, asking them to contact their Missouri State Senator about HCS HB 410!

Friends, Family, and Patients, 

The direct access bill passed a final vote of the House on March 14th, which means the bill now moves to the Senate. This is a milestone as we have never had a direct access bill advance this far! However, the work is far from over. Medical groups are working harder than ever to defeat this bill in the Senate and will continue their efforts to overturn the ban on referral for profit. If you want to have the option of receiving PT services without having to first get a referral, it is critical that you write or call your Senator and ask them to please support HCS HB 410.

·        Find your Missouri State Senator contact info here: Senator Lookup

·        Copy the email text below, personalize, and send to your Senator.

 Email text for Senators

Dear Sen. ____

I am writing as your constituent to ask you to support HCS HB 410.  This bill will allow patients to more easily access physical therapy (PT) services for a limited time (10 visits or 21 days) without a physician referral.   The bill will save patients time and money, and allow them to receive the care they want more efficiently.  This bill will not eliminate physician referrals, nor does it allow therapists to make medical diagnosis.  It simply allows patients initial access to physical therapy, without a referral, and actually facilitates greater physician-therapist communication than currently required. 

HCS HB 410 received overwhelming support in the House; however certain physician groups attempted to use the bill as a vehicle to overturn a Missouri law that has been in place for almost 30 years prohibiting physician kick-backs for their own referrals.  Some physicians want to own physical therapy clinics and then profit from their own referrals.  Studies have shown that referral for profit can negatively impact patient care and result in over-utilization and healthcare costs.

I believe that physical therapists and physicians should work in cooperation for the good of the patient; however, patient care should not be tied to physician profit.  I ask that you please be aware of these attempts by physician groups to use HCS HB 410 to allow them to own/profit from PT referrals, rather than allowing HCS HB 410 to simply improve patient access to PT, as it is intended.

I look forward to discussing this legislation with you and answering any questions you might have. 

Sincerely,

YOUR NAME

YOUR ADDRESS

This session brought in one of the largest groups of freshman legislators the Capitol has seen in years.  Educating all legislators, particularly those new to the General Assembly, about PT is critical and an ongoing process.  MPTA's lobbyists are the voice of PT in the Capitol; however, legislators represent YOU - their constituents.  It is important that you know your legislators and they hear from you about your profession.

Do your legislators know who you are?  Do  they know about your education and what you do as a PT professional?  How PT changes and enhances the lives of your patients?  They represent you as lawmakers.  As you get to know your legislators, you can help them by making sure THEY know YOU.

MPTA Director Wendy Nall meets with Sen. Caleb Rowden (R - Columbia) on January 9th.  Thank you to Senator Rowden for taking time on the first day of session to meet with his constituent!

We are excited to announce that Teresa Briedwell, PT, DPT, OCS, will be honored by the Federation of State Boards of Physical Therapy (FSBPT) on October 27 at their Annual Meeting awards luncheon in Reston, Virginia.

Teresa submitted questions that were selected for the national board test.  Questions are submitted by PT professionals across the country who work in a variety of practice settings.  All submissions undergo a rigorous review and selection process. Having questions selected for the exam is is quite the accomplishment!

Teresa is the Associate Department Chair, an Associate Teaching Professor, and the Director of Admissions and Academic Affairs with the Physical Therapy Department at the University of Missouri.  She has served in numerous leadership roles on the MPTA Board and currently serves on the MPTA Finance Committee.  Teresa also serves as the Chief

Financial Officer of the PT Fund.

Several PTs, a PTA, an OT, and students from Missouri State University and Southwest Baptist University volunteered this past weekend to screen athletes for the Special Olympics 50th State Summer Games.  They screened 114 athletes in 4.5 hrs.  Check out photos of them in action below.

Update from Paula Burnett, MPTA Payment Chair:

Patients who have Medicare or Managed Medicare will be issued new Medicare Beneficiary Numbers and new cards starting in June.  The patient will no longer use their SSN as the Medicare number.  Please take time to review the link from Medicare explaining the process. 

New Medicare Beneficiary Identifier: Get It, Use It MLN Matters Article — New

A new MLN Matters Article on New Medicare Beneficiary Identifier (MBI) Get It, Use It is available. Learn about three ways you and your office staff can get MBIs.

APTA Component Leaders,

As you all know, Congress recessed on December 22 without acting on the bipartisan, bicameral agreement for a permanent fix to Medicare therapy cap. They also did not enact a temporary patch or extension of the current exceptions process.  Thus, a hard cap of $2,010 on outpatient therapy services (PT/SLP combined) will be applied beginning on January 1, 2018.   A separate hard cap of $2,010 will be applied to outpatient OT services.  It should be noted that the hard cap will not apply to hospital outpatient clinics (OPs).  Hospital OPs were not originally included under the therapy cap when it was first enacted as part of the Balanced Budget Act (BBA) in 1997.  Hospital OPs were subsequently added to the cap exceptions process in 2012. However with the expiration of the exceptions process on December 31, 2017, the requirement for hospital OP to participate in the therapy cap exceptions process also expires.

Our congressional champions expected Congress to introduce and pass an omnibus Medicare extenders bill in early December. This bill would have addressed a number of Medicare provisions set to expire the end of 2017, including the therapy cap permanent fix.  Unfortunately, the debate over the tax reform legislation pushed nearly all other issues to 2018. On its way out of town, Congress passed another short term funding bill to keep open the Federal Government through January 19, 2018.  We lobbied our champions to add the therapy cap fix to this spending bill, but congressional leadership made it clear in the waning days of the session that only a select few items would allowed to be added, the most notably being the temporary funding for the Children’s Health Insurance Program.

Congress returns to Washington on January 3^rd and must adopt another spending bill by January 19^th.  APTA, AOTA, ASHA and our allies in the Therapy Cap Coalition will continue to keep the pressure on Congress during their recess urging them to take quick action on the therapy cap in early January.  In addition, APTA reached out to CMS requesting guidance for how providers should handle therapy claims during this time of uncertainty under the hard cap.  In years past when Congress failed to act and a hard cap went into effect temporarily, CMS asked providers to hold all claims until Congress enacted a fix.  The fix was then retroactively applied to January 1 of that year.  However we have not been able to secure an assurance that will be the case this time. We continue to seek clarification from the agency.

Our efforts over the next several weeks will include:

1) Lobbying & Grassroots Advocacy – APTA will continue our ongoing grassroots advocacy efforts aimed at members of Congress through a variety of mediums including action alerts, phone calls, paid media, and social media.  APTA engaged Revolution Media this fall in targeted online advertisements aimed at social media advocacy with a good deal of success, and we intend to continue this engagement in January.  Our grassroots efforts this fall resulted in over 20,000 emails aimed at members of Congress and we intend to keep this level of engagement as we move into January.

2) Member education and guidance – APTA will be providing ongoing communication to component leaders, payment chairs, practice chairs, FALs, and general membership on how to manage claims and billing during this uncertain time.  We will be rolling out addition information in the coming days to assist providers and provide further details.  In addition, we will continue to pressure CMS to issue a transmittal that provides guidance to providers on managing therapy claims under the anticipated temporary application of the hard cap.

3) Therapy Cap Coalition – we will continue coordinating lobbing outreach, grassroots, and media with our partners in the Therapy Cap Coalition, including ASHA, AOTA, NASL, AHCA, , and patient advocacy groups.

4) Public Relations/Media – APTA and our partners will continue to press this story with media outlets and the Capitol Hill press.

While we are hopeful that Congress will quickly address the therapy cap when they return in January, nothing is certain given the current environment on Capitol Hill.  However resolution of this issue remains a top priority for us in January. 

Please stay tuned for further developments.  In the interim please let me know if you have any questions.

Best,

Justin Elliott

Vice President, Government Affairs

APTA

On Friday, December 8th the University of Missouri - Columbia hosted MPTA for a panel to discuss hot topics in the Missouri PT industry.  The importance of membership, advocacy, ethics, and payment are just a few of the topics that were discussed during the two hour panel.  MPTA would like to thank all who participated in the panel and MU for hosting us!

20 CSR 2150-3.040 - Licensing by Reciprocity-Physical Therapists (Click Here)PDF Document

During the October 27, 2017 Board meeting the Board approved an amendment that will enable more physical therapists who have passed an examination and are actively licensed in another state to come to Missouri and work without having to retake examinations.

Currently, under section 334.540, RSMo, the Board can issue a physical therapy license to an applicant who possesses an active license in another jurisdiction, provided that, such person has not been disciplined by another board and is licensed in a jurisdiction whose requirements are substantially equal to, or greater than, the requirements for licensure of physical therapists in Missouri. While examination and academic requirements are substantially uniform across physical therapist (PT) licensing authorities in the United States, approximately fifteen (15) states do not currently require applicants to present evidence of their good moral character. The proposed amendment would incorporate good moral character into the threshold criteria for a PT license in Missouri, thereby ensuring the Board is afforded the opportunity to grant a license to otherwise qualified applicants actively licensed in those jurisdictions without asking them to pass another examination.

Furthermore, under the current rule, applicants who "received examination scores equivalent to those set forth in 20 CSR 2150-3.030" are candidates for PT licenses by reciprocity, exclusively. As 20 CSR 2150-3.030 only describes the Federation of State Boards of Physical Therapy (FSBPT) examination's scaled scores, applicants who passed a state board examination prior to their state's adoption of the FSBPT examination are not eligible for a license by reciprocity. The proposed amendment would also address this issue and ensure that the Board is able to license as many qualified as possible without imposing an additional burden on Missouri citizens and professionals intending to relocate to Missouri.

The rule must be approved by the Governor's office and upon approval will be filed by the Board in accordance with chapter 536, RSMo.

We are proud to announce that MPTA Past President, Paula Burnett, received the Helen May Bradley Achievement Award this weekend at Maryville University in St. Louis, Missouri.  The award honors a PT who exemplifies the best of the therapy profession.  

Paula Burnett serves as the MPTA Reimbursement Chairperson and previously served as MPTA President for 6 years.

Congratulations on this well-deserved recognition!

She is pictured here with APTA President Sharon Dunn. Congratulations, Paula!

By now, most physical therapists (PTs) have heard the news: the final 2018 Medicare Physician Fee Schedule (PFS) released in early November by the US Centers for Medicare and Medicaid Services (CMS) included some significant variations from the PFS proposed in July. Instead of finalizing CPT code values that were the same as—and occasionally larger than—current values, CMS opted to offer up a more complicated combination of cuts and increases that could affect PTs in different ways, depending on their case-mix and billing patterns.

So what should PTs do in the wake of the new PFS? Here are APTA's top 4 suggestions.

1. Know the design process for the fee schedule.
It's important to understand what led to the changes to provide context, a slight sense of relief, and a reminder of why payment needs to move toward value-based models and away from fee-for-service.

The PFS now set to debut January 1, 2018, is the CMS response to an American Medical Association (AMA) committee's recommendation on potentially "misvalued" codes associated with a wide range of professions, not just physical therapy. When the process began in early 2016, many predicted that the final outcome would be deep cuts to nearly all valuations—as much as 10% or more overall. APTA and its members fought hard to substantiate the validity of the current valuations, and even the need for increases in some areas. The end result was a significant improvement from where things were headed at the start of the process.

That's not to say it's been an entirely satisfying process from start to finish. This recent PT in Motion News story goes into more detail about the sometimes-frustrating journey from points A to B.

2. Understand what's being changed.
Just about everything that happens at CMS is complicated, and the process that led to the new CPT code valuations is no exception. Still, a working knowledge of how CPT codes are valued is helpful in understanding why the PFS contains such a mix of positives and negatives.

One important thing to understand is that code valuation is actually a stew of 3 separate elements, known as relative value units (RVUs). These are estimations of the labor, expense, and possible professional liability involved in performing any given treatment or evaluation task associated with a CPT code. The 3 types of RVUs are known as "work," "practice expense" (PE), and "professional liability." The coding valuation differences between the proposed and final PFS were due to changes to the PE RVUs only.

This wasn't part of the proposed rule. While the AMA Relative Value Scale Update Committee Health Care Professions Advisory Committee did recommend changes to PE RVUs, CMS initially opted to not adopt those suggestions. When the final rule was released 3 months later, CMS—without seeking input from APTA or any other stakeholders—did an about-face and adopted the changes to PE RVUs.

So what? The answer is twofold: first, the tweaks to PE RVUs mean it's difficult to make many sweeping generalizations about how the new PFS will affect individual practices and clinics; second, it's worth noting that individual work RVUs either remained unchanged or increased.

A more detailed explanation of how the codes were affected is available in an APTA fact sheet on the 2018 PFS (listed under "APTA Summaries and Fact Sheets"). For a more complete explanation of RVUs and the differences between the 3 types, check out this APTA podcast on the CPT valuation process.

3. Get a sense of how you might be affected.
A sense of history and understanding of detail are all well and good, but the bottom line is your bottom line.

Here's the complication with the 2018 PFS: because of the wide variation in upward and downward adjustments, it's hard to make statements about how PTs in general will be affected. CMS estimates the overall impact at a 1%-2% reduction, but a lot depends on the types of patients a PT or clinic typically sees and what interventions are commonly used. Some providers could see increases.

In an effort to clear up some of the uncertainty, APTA offers a calculator than can help you see how your typical case-mix would fare in the new PFS. The calculator, offered in Microsoft Excel, allows you to enter different codes to see what changes to expect, given your Medicare service area.

4. Keep learning.
There's much more to understand about the PFS—not just in terms of the details of how the new rule will work, but in terms of APTA's work to safeguard CPT codes throughout the misvalued codes review process.

One great way to learn more about what to expect is coming up in December, when the association hosts a free webinar on Medicare changes for 2018 on December 6 from 1:00 pm to 2:00 pm ET. The webinar will be presented in a "flipped" format, meaning that when you register, you'll be provided with a prerecorded presentation to listen to in advance. That way, more of the actual session can be devoted to live interaction with the presenters. Be sure to sign up—and listen up—soon.

Another opportunity is available December 13, when APTA hosts an "Insider Intel" phone-in session that will cover many of the same topics, albeit in a pared-down 30-minute session, from 2:00 pm to 2:30 pm ET. Instructions for signing up for this session are on APTA's Insider Intel webpage.

To view the PT in Motion News article, please see: http://www.apta.org/PTinMotion/News/2017/11/21/PFSTipsNovember2017/  

We expect the House and Senate to pass the legislation shortly after the Thanksgiving holiday, and the President to sign the bill in December. This will kick in the process by which the DOD will make the change on the regulatory front. APTA will continue to work with Congress and the DOD as this process moves forward, but we are thrilled that this language will finally be resolved.

To see the exact language, you can click here and go to page 379 (page numbers are located at the top center of each page). 

From: Dena Kilgore, CAE
Subject: Alert on Essential Health Benefits

On Friday, October 27^th, the Centers for Medicare and Medicaid Services (CMS) released the Notice of Benefit and Payment Parameters for 2019 proposed rule. Within the rule, CMS proposes standards for issuers and Exchanges, generally for plan years beginning on or after January 1, 2019. This proposed rule is intended to increase flexibility in the individual market, improve program integrity, and reduce regulatory burdens associated with the Patient Protection and Affordable Care Act in the individual and small group markets. APTA will be providing comments to the CMS, as well as preparing a template letter for members to submit to CMS as well. The template letter will be made available to members in approximately the next 7-10 days. A summary of the Notice of Benefit and Payment Parameters for CY 2019 proposed rule is attached.

Comments can be submitted electronically via regulations.gov.  In the Search box, type in the name of the rule (HHS Notice of Benefit and Payment Parameters for 2019) and then follow the “Comment Now” instructions.

Comments on the rule are due by November 27, 2017.