Private Practice Section Recent Committee Accomplishments (June 2018 through July 2019)
EDUCATION (PPS Education Committee)
Designed around the “mastermind” principle, Peer2Peer NetWorks brings together private practice owners of similar, non-competitive practices to share best practices, discuss hot topics, establish key metric benchmarks, analyze operations, build life-long friendships, and work toward helping each other improve the bottom line. Now in its fourth year, the program has grown to 159 members. PPS is now taking sign-ups for the 2020 class. Apply here
KPI Benchmarking Study
Now in its fourth year, the PPS Key Performance Indicator (KPI) Benchmarking Study is open to all PPS members. The study results paint a clear picture of how participants’ KPI metrics stack up against similar practices in each region and nationwide. In 2019, the study had 178 practice owners participating. Register now to join the 2020 study.
The Education Committee has developed two new video series to add to the Private Practice Essentials, which are offered free to PPS Members. Two new series will complement the three popular series already available.
The new series will be available in January. To view the current Private Practice Essentials, visit the PPS Learning Center.
Paul J. Welk, PT, JD, and Albert Lee
Mike Osler, PT, DPT and Eric Sacia PT
Rock Valley Physical Therapy
The Business Education Leadership Task Force is working to develop a curriculum that PT schools can use as part of course work required for accreditation. The curriculum would help PT schools cover fundamental business principles, and could be used by schools and by Private Practice members serving as adjunct faculty.
The Education Committee continues to work to inform new PPS members on the resources available to them within the section, and to maximize members’ engagement in the Section.
LOBBYING (GOVERNMENT AFFAIRS COMMITTEE)
PPS continues to drive legislative change through proactive lobbying and grassroots efforts. Initiatives through FY 2019 and into FY 2020 include the following:
- Filed a comment letter with CMS in opposition to the proposed 8% cut to payment in 2021 which explained the negative impact its proposals would have on private practice physical therapists and Medicare beneficiaries; used the September 2019 PPS Fly-In to facilitate a bipartisan letter to CMS from 55 Representatives who strongly opposed the proposed 8% cut.
- Utilized member feedback to write a comment letter to CMS that challenged the application of the PTA differential onto physical therapist time; asked legislators sitting on healthcare committees to tell CMS that its proposed rule regarding the PTA differential was beyond their legislative intent.
- Continued to pursue the expansion of the locum tenens provision of Medicare to include physical therapists practicing all communities.
- PPS filed a response to CMS’ RFI re: Reducing Administrative Burden to Put Patients over Paperwork and pointed out that as small business owners, PPS members are keenly aware when an administrative task is burdensome and duplicative and that time spent on redundant paperwork is time they are not able to be caring for patients. PPS recommendations included revising the initial certification requirement for the therapy plan of care, suggesting that CMS include physical therapists within the list of practitioners for whom CMS has established an effective date of Medicare billing privileges, and reducing administrative burden through standardization where possible.
- Addressed physical therapy workforce issues including cost of education; pursue federal programs to reduce student loan burden and support legislation that promotes the use of physical therapist services as non-pharmacological treatment options in response to the opioid crisis. This included testimony by PPS President Sandy Norby before the House Small Business Committee in June 2019 about the negative impact of student loan burden upon physical therapists who seek to work or open clinics in health professional shortage areas, and how access to physical therapist services can provide non-pharmacological treatment options for pain management.
Impact (the Impact Editorial Board)
The Impact Editorial Board plans the annual editorial calendar and recruits new and returning authors to deliver the quality content readers have come to expect. The Board uses feedback from Impact readership surveys and input from member satisfaction surveys and other data collected by PPS.
During FY2019, PPS built upon the successes of FY2018 by continuing outreach and engagement efforts across social media, which in turn have played an important role in driving traffic to Impact online. Unique users of Impact online grew 23.7% compared to last year, and total page views grew 24.8%. The most popular magazine issues included “Why Physical Therapy Should Embrace TeleHealth” (May 2019), “4 Things You Need to Know About MIPS” (January 2019), “Patient Engagement” (March 2019), “How to Calculate and Increase Staff Productivity” (April 2019).
PPS Administrator’s Network (PPS Administrator’s Network Council)
The Administrators Network exists to improve the operational excellence of the PPS member clinics’ administrative functions. The Network also offers high-value education to administrators who are employed in PT private practice settings. In addition to the exclusive Administrators Certificate Program and webinar series, the volunteer Administrator’s Network Council appoints liaisons to four different PPS program areas and to the Impact Magazine Editorial Board, to ensure that administrators’ interests are reflected across the spectrum of PPS activities.
Advancing Payment Policy for Members (PPS Payment Policy Committee)
A suite of resources provides members guidance through the complicated payment environment via the PPS Website
- Level 1, designed to educate member therapists on the landmark 2018 Milliman study
- Level 1B, customizable slide deck on the value of PT, suitable for presentation to payers
- Level 2 Milliman slide deck with a deep dive of Milliman study details.
- Level 3 Milliman Powerpoint presented at 2019 Annual Conference: Analyze and Market Your Practice for Value-Based Care and APM’s
Additional online resources for members include the following:
- Model Contract Checklist for managed care provider agreements
- A just-completed FAQ, “Medicare Advantage Billing Rules,” regarding out of network and cash-based delivery of physical therapy,is a ready resource for PTs. The FAQ is being presented at the 2019 Annual Conference and will be available online soon .
- Also coming soon: the webinar, “Best Practices for PT Businesses to Prepare for Value Based Care”
- As part of an effort to monitor the development of dry needling CPT code available for use in 2020, members should look for an upcoming Impact article on the topic.
The Graham Sessions (Institute of Private Practice Physical Therapy)
The Institute of Private Practice Physical Therapy hosted the 13th Annual Graham Sessions in Austin, TX in February 2019. Close to 150 participants attended.
The 14th Annual Graham Sessions is set for January 23-25, 2020 in Nashville, TN. For more information, contact email@example.com
The Institute Board is considering hosting a regional version of the Graham Sessions called “Graham X.” The vision of Graham X consists of an “independently organized” Graham Sessions event, designed to keep all the elements that have made the Graham Sessions a success but on a localized basis.
PPS Contributions to the Annual APTA Components and Sections Meeting (CSM Program Working GROUP)
At 2019’s APTA CSM, PPS held a one-day pre-conference workshop, “Kickstarting Your Private Practice.” PPS also held 11 conference educational sessions, and co-sponsored 3 sessions with other sections. The PPS member reception hosted current and prospective members with close to 200 attendees.
For the 2020 CSM, PPS is offering 3 one-day pre-conference workshops, with topics on Starting a Private Practice, Social Media, and Billing and Coding. The Section is also holding 11 conference educational sessions, and co-sponsoring 4 more sessions with other sections. The ever-popular member reception will again be offered at the 2020 CSM.
After hearing from PPS members that their businesses were being adversely impacted by an unlevel playing field within the broader marketplace of onsite services, PPS sprang into action. After a few months of behind the scenes work, in early February PPS and APTA staff and physical therapist members met with the staff of the Occupational Safety and Health Administration (OSHA). That meeting was followed up with a formal request for the agency to clarify that there are a multitude of soft tissue massage techniques administered by health care professionals, including physical therapists, that are similar to Active Release Techniques (ART) and which OSHA considers first aid, as defined under 29 CFR §1904.7(b)(5)(ii). Utilizing the leverage of the parent organization, PPS worked with APTA to facilitate written guidance from OSHA stating that soft tissue management (massage) is first aid for recordkeeping purposes, regardless of whether such treatments are performed by individuals with ART certification or by physical therapists with comparable training. On May 23, 2019, OSHA issued this letter of interpretation to APTA. The letter clarifies that:
- Soft tissue massage is first aid for record-keeping purposes.
- First aid treatments listed in section 1904.7(b)(5)(ii) (including soft tissue massage) would be considered first aid regardless of the professional status or certifications of the person providing the treatment.
- Accordingly, soft tissue massage is first aid whether or not such treatment is performed by individuals with ART certification.
- A clear line has been drawn. A work-related soft tissue injury or illness would only be considered recordable if treatment involved medical treatment beyond first aid, days away from work, job transfer, or restricted work for the purposes of Part 1904 OSHA recordkeeping regulations. Massage provided by a physical therapist or other healthcare provider is considered first aid care, not medical treatment.
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.
Each fall, PPS members exercise their voting rights by electing new leadership to serve the Private Practice Section, APTA. This year, online voting began on October 5th and will close November 2nd. Those who are present at the PPS Annual Conference and Exhibition in Colorado Springs will be given the opportunity to vote onsite at the PPS booth November 8-9th. All PT and PTA members are eligible to vote.
CANDIDATE SLATE AND CANDIDATE STATEMENTS
The 2018 Slate of Candidates is shown below. Each candidate was unanimously approved by the PPS Nominating Committee and Board of Directors. PPS believes that each of these individuals will uphold the mission of the Section, and that they possess the background, talent, adn character required to acheive the goals established in the PPS strategic plan.
Click on each candidate's name to view their candidate statement. *Candidates are listed in reverse-alphabetical order
Treasurer (1 Position Open)
Secretary (1 Position Open)
Director (2 Positions Open)
Nominating Committee (1 Position Open)
The PPS Administrators' Network was formerly known as the PPS Administrators Council. All members of the PPS Administrators Council have retained their active membership status and login credentials with the Administrators' Network and need not reapply.
PPS is more than a network of PTs, PTAs, and students. Every physical therapy clinic is home to at least one administrator who serves as the first point-of-contact for patients, oversees marketing, ensures compliance and proper coding, and more. PPS has a built a home for these invaluable staff with the PPS Administrators’ Network. Give your administrators and office managers the resources, education, and networking opportunities they need to serve your practice best by giving them a membership to the PPS Administrators' Network. Give your administrators and office managers the resources, education, and networking opportunities they need to serve your practice best by giving them access to the PPS Administrators' Network.
What are the Benefits?
ACCESS TO THE CERTIFIED ADMINISTRATOR PROGRAM Administrators who complete and pass the Administrators' Certification coursework are proficient in Billing & Coding, Legal Compliance, Human Resources, Business Operations, Marketing, Customer Service, and Financial Management.
After successful completion of 12 hours of coursework covering the above topics, students are tested on their knowledge and, if they pass, will be recognized as a PPS Certified Administrator. The certification coursework is available at PPS Annual Conference.
FREE QUARTERLY WEBINARS Designed to keep administrators up-to-date on the latest billing and coding information, compliance issues, marketing trends, and other relevant topics.
PEER NETWORKING OPPORTUNITIES As a PPS member, you understand the value of peer networking, collaboration, and mentorship. Administrators' Network members enjoy the same benefits through in-person networking events, an exclusive online community, and membership directory.
LEADERSHIP DEVELOPMENT All Administrators are encouraged to participate in the development of the Network and its strategic initiatives through volunteer participation in committees and task forces.
FULL ACCESS TO PPS MEMBER RESOURCES Administrators' Network members receive the same discounts on educational conferences and materials as PPS members, they gain full-member access to the PPS website, and their own subscription to Impact Magazine where they can read articles written by their colleagues in Impact's Administrators Edge Column.
Who is Eligible?
The Administrators' Network welcomes all non-PT office managers and administrators employed by PPS members to be a part of the largest network of physical therapy clinic administrators in the country!
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.
The monthly toolkit is made up of free, ready-to-Share, professionally written, content for marketing your physical therapy practice to your community. We have monthly newsletters/blog posts, social media posts, and press release templates that can be copied and pasted, or customized to your practice with some simple edits. This month's theme, "Promoting the Annual PT Exam," encourages readers to schedule an annual PT exam with their family physical therapist. You are encouraged to take advantage of the newsletter, press release, and social media posts, in your own promotions of the annual PT exam.
If you have questions about how to incorporate a press release into your marketing plan, or how best to use the press release template provided each month by PPS, refer to this article by Michelle Collie, PT, DPT, MS: "Press Releases: Your Top Six Questions Answered."
PPS 2018 Annual Conference | November 7-10, 2018 | The Broadmoor, Colorado Springs, CO | Register Now
Registration for the 2018 Private Practice Section Annual Conference and Exhibition is now open. Physical Therapists from around the globe will join PPS members at The Broadmoor in Colorado Springs for the nation’s leading Physical Therapy Business Conference.
Attendees will have the opportunity to rub shoulders with industry leading experts, entrepreneurs, students, administrators, academics, vendors, and world-renowned speakers. Take the opportunity to network and learn with this high talent group of health care leaders by registering the 2018 PPS Annual Conference today. Early bird rates will expire on August 8th 2018.
In an effort to showcase our profession within the health care community and the impact PTs and PTAs have on the public at-large, APTA and the Private Practice Section of the American Physical Therapy Association (PPS) hosted a video contest in 2017. Physical Therapists were challenged to develop a piece of creative that challenged payors to acknowledge that physical therapy is the most cost-efficient, non-invasive, and speedy way to improve a patient's long-term condition. Contest participants were asked to highlight three key points in their videos:
- Physical Therapy Transforms Society
- Physical Therapy Reduces Health Care Costs
- Physical Therapy Improves Patient Outcomes
First Place: "Get PT 1st" by Sports Physical Therapy
Second Place: "Physical Therapy" by Sarton Physical Therapy
The Private Practice Section hosts online learning events each month geared toward the professional development of physical therapists, physical therapist assistants, and their practice administrators. These events are open to the public, and all are encouraged to attend to get a taste of the benefits the Private Practice Section has available to you. PPS live webinars cover a wide range of topics that, when collectively applied, will prepare all who are employed in physical therapy with the business skills required to ensure the success of your practice.
Those who take advantage of PPS Online Learning are looking to:
- Develop a library of marketing skills;
- Brush-up on legal/compliance knowledge;
- Learn about cutting-edge technology in the industry;
- Improve overall management techniques;
- Identify tools and resources to keep their niche practice alive;
- Monitor changes in payment policy and reimbursement;
- Increase employee engagement and foster a positive company culture;
- Learn about new and innovative ideas that are changing the profession; and
- Utilize data to set goals, track progress, and ultimately increase ROI.
Upcoming PPS webinars are posted on our Education Calendar and emailed to members each Wednesday. Following the live event, the recording of each webinar is stored publicly in the PPS learning center. PPS members can access these recordings by logging into their Learning Center accounts.
2018: Recent Webinar Recordings
Free To PPS Members: Select Recordings from the 2017 PPS Annual Conference
In the early morning hours of February 9th, the permanent repeal of the therapy cap was included in the spending bill passed by both the House and the Senate. President Trump then signed the bill into law. The legislation eliminates the cap on physical therapy (PT) and speech-language pathology (SLP) services, and the separate cap on occupational therapy (OT).
The new policy requires that the KX modifier indicating services are medically necessary must be included once therapy spending reaches the $2010 level. This amount will be adjusted annually. Bills can be denied if the KX modifier is not used on claims which exceed the $2010 threshold. At the $3000 threshold, there is the potential of a targeted medical review triggered by factors such as one is a new Medicare-enrolled provider, an aberrant billing as compared to their peers, or belongs to a practice whose partners have been flagged for aberrant billing. The $3000 amount will also be adjusted annually according to the Medicare Economic Index (MEI), beginning in the year 2028.
The fix will be retroactively applied to all therapy expenses incurred starting January 1, 2018.
The budget deal also includes a pay-for that PPS did not support and worked hard to change after it was announced at the last minute. The law allows for a reduction in Medicare Part B payment for services in which a physical therapist assistant (PTA) is involved. Beginning January 1, 2022, payment for services provided by a PTA, as well as services provided by an occupational therapy assistant (OTA), would be paid at 85% of the Medicare fee schedule. This policy was not part of any of the discussions or negotiations with Congress over the past year, nor was it included as part of the proposed package of pay-fors that were announced this past fall as part of the bipartisan, bicameral agreement. PPS worked with APTA and AOTA to provide alternative proposals to eliminate, reduce, or delay the PTA and OTA payment differential, but each of these legislative options was rejected. Going forward, PPS will work with together with APTA to convince CMS and our Congressional champions to reduce the impact of this unexpected pay-for.