Centers for Medicare & Medicaid Services seeks to implement merit-based incentive payment system.
By Alpha Lillstrom Cheng, JD, MA
The Private Practice Section’s (PPS) federal policy efforts focus on advocating for and supporting the passage of bills that impact private practice physical therapy. However, the passage of legislation is not the end of the road for policy development. After a bill is signed into law by the President, the intent and direction of the law needs to be determined and implemented by an agency in the executive branch. The Department of Health and Human Services (HHS) and its Centers for Medicare & Medicaid Services (CMS) are tasked with drafting, proposing, and finalizing regulations that put meat on the bones of health care laws. Through a process known as “notice of proposed rulemaking” (NPRM), CMS releases draft regulations to the public and requests feedback and comments from stakeholders. Based on the summary, analysis, and draft comments developed by your lobbying team, PPS routinely weighs in on these proposals on behalf of the membership.
Engage with candidates this campaign season.
By Alpha Lillstrom Cheng, JD, MA
It is August in an election year. While many things are uncertain in this incredible election cycle, one thing is for sure—candidates are pounding the pavement, knocking on doors, kissing babies, and eager to meet as many constituents as possible in order to earn as many votes as they can. This presents you with many opportunities to engage with those running for office while he or she is in campaign mode.
During campaign season, people running for office host events such as town hall meetings, rallies, and listening sessions. These public events are often well publicized and are the perfect opportunity to introduce yourself to the candidate and their staff. Often the local papers or news stations report on upcoming events, but the most efficient way to find out when and where an event will take place is to sign up for notices on his or her website. The process is similar for anyone running for office, but the mechanisms differ slightly because of differing levels of organization and resources a given candidate might have. Campaign websites vary widely in their sophistication and ease of use. The easiest way to find a campaign website is to search for the full name and the candidate and “campaign” in a search engine such as Google. For candidates challenging an incumbent legislator, it is often most efficient to call or stop by their campaign office and ask for the best way to get on their event mailing list. In the case of incumbent members of Congress running for reelection, there are two places to look—their campaign website and their official congressional website. Generally a sitting senator’s official website uses the following naming convention: www.senator’slastname.senate.gov; for an incumbent representative it will be www.representative’sname.house.gov. If your legislator has the same last name as another member of Congress, use their first name too; for example www.paulryan.house.gov is Speaker Paul Ryan’s official congressional website. Another way to make sure you learn of upcoming events in your area is to reach out to both the incumbent’s district and campaign offices and ask to be added to their event mailing list.
Beginning in 2017, health insurance plans will be classified as basic, standard, or broad network so that consumers can better understand their options.
By Alpha Lillstrom
Like any for-profit corporation, health insurance companies are in the business of providing a service—paying for care—but are also seeking to gain revenue while meeting their business obligations. With the passage of the Affordable Care Act (ACA) in 2010, the insurance companies’ previously utilized tactics for controlling cost—limiting the benefits they cover and the people they insure—were outlawed.
The ACA was also designed to educate and empower consumers and thereby required that health insurance marketplaces list insurance products side by side, using universal terminology, in order to provide consumers the opportunity to compare plans, coverage, and cost all in one forum. This transparency was intended to increase consumers’ ability to shop for an insurance plan that met their health coverage needs at a price point of their choosing. It also meant that if insurance companies increased premiums without providing enough value, they would run the risk of losing customers to lower-cost competitors. At the same time, many new exchange customers were previously uninsured; therefore, insurers had little or no information upon which to predict their use of health care. That meant that insurers could not be sure where to set premiums or how aggressively to try to control costs, including the use of limited networks of physicians and hospitals that enrollees could use.1
By Alpha Lillstrom
The staffing challenges of a small private practice are familiar to many: If you are unavoidably absent from your practice, it is likely that you have insufficient staff to cover all of the Medicare patients you have on the schedule. Unlike many private payers who will accept a substitute therapist or locum tenens provider, Medicare does not allow physical therapists to bring in a qualified substitute to provide care in the absence of a physical therapist enrolled at that clinic location. Instead, you must cancel appointments—interrupting their care and your cash flow. If you want to use a visiting physical therapist, that individual must already be credentialed by Medicare for your specific practice.
By Alpha Lillstrom
These days more providers, patients, and payers are evaluating the utility and benefits of using technology to support or provide health care services remotely. The use of telehealth is a significant and rapidly growing component of health care in the United States. Also known as telemedicine, the term encompasses everything from electronic visits, video technology, and remote monitoring to provide maintenance and preventive care for patients, to diagnosis and treatment when it is clinically appropriate. In some cases telehealth is used to provide access to care over distances that would otherwise present insurmountable obstacles to care. In other situations the technology improves convenience for both the provider and the patient. Over half of U.S. hospitals now use some form of telemedicine.1 In fiscal year 2013, more than 600,000 veterans accessed Veterans Affairs (VA) care using a telemedicine program—for a total of more than 1.7 million episodes of care.2 Even when effective mitigation of challenges is taken into account, reimbursement continues to present the most formidable obstacle.3 While your specific practice might not yet be delving into providing care using telemedicine, some are. Policy is evolving to make it more feasible and reimbursable.