SGR Repeal Signals Accelerated Move to Value-Based Payment

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By Jerome Connolly, PT, CAE
June 6, 2015

On April 14, the Senate passed The Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2) by a vote of 92 to 8 thus repealing and replacing the flawed sustainable growth rate (SGR) formula and averting the 21 percent reduction in provider payments that was scheduled to take effect in April. The legislation, which originated in the House and passed that chamber with an astounding 392 “yea” votes, was signed by the president and is now law. The measure extends the therapy cap exceptions process through December 31, 2017. An amendment in the Senate to fully repeal the cap fell two votes shy of the necessary 60-vote threshold. However, the underlying legislation does contain provisions for more targeted (and palatable) manual medical review vis-à-vis the therapy cap.

Obviously, much work remains for the Private Practice Section (PPS) in the advocacy arena and despite these favorable SGR and therapy cap developments we will continue to aggressively pursue our legislative priorities that include locum tenens and opt-out. But more activity on the therapy cap may still be possible this Congress. One senator (Dean Heller, R-NV) who opposed the therapy cap repeal amendment offered by Senators Ben Cardin (D-MD) and David Vitter (R-LA), indicated he did so only after receiving assurance from his leadership Majority Leader Mitch McConnell (KY) and Finance Committee Chairman Orrin Hatch (UT) that there would be another opportunity this year to advance and work on full repeal of the cap.

Since the spring congressional recess occurred between the House and Senate consideration of the Medicare bill, the PPS advocacy team took advantage of the two-week hiatus and worked diligently with the American Physical Therapy Association (APTA), the Therapy Cap Coalition, and our locum tenens allies to urge the Senate to delay, amend, and then pass H.R. 2. Numerous grassroots alerts—both broad and targeted—were issued and PPS members responded diligently. However, with the senators not being in Washington, decisions could not be made on how the bill would be handled procedurally, and whether or not any given senator would be willing to push for consideration of amendments. In addition, a decision had to be reached as to whether any given amendment, if offered, would require budgetary offsets.

Ultimately, the leadership allowed six amendments, and the Cardin/Vitter amendment to fully repeal the therapy cap was one of them. All six amendments were defeated but therapy cap repeal was the one that came closest to passage. The “postmortem” analysis determined that this was a purely political vote and not necessarily one that accurately reflects any given senator’s position on the policy. Nevertheless, reaching 58 affirmative votes in such a political climate is no insignificant feat. A close look at the yeas and nays reveals no member of the Republican leadership voted for the amendment. Likewise, no Republican chairman of a major committee voted “aye” and only one Republican member of the Senate Finance Committee (Sen. Richard Burr-NC) voted for the amendment. All Democrats with the exception of Sen. Joe Manchin (WV) voted in favor of the amendment. (See Senate Roll Call Vote Tally, p.25.)

The repeal of the SGR formula is also an enormous accomplishment as it was responsible for the frequent (nearly annual) threats of double-digit cuts in our Medicare payment rates. The new law replaces the SGR with an approach focused on rewarding high-performing providers while supporting alternative payment models such as accountable care organizations and patient-centered medical homes.1 As such, it represents a dramatic shift in Medicare reimbursement philosophy and pragmatics as it places an emphasis on value through the establishment of a merit-based incentive payment system (MIPS).

The regular threatened cuts to fees under the SGR will be replaced by modest annual updates allowing fees to increase by 0.5 percent this month (June) and each year from 2016 through 2019, after which they will remain at the 2019 level through 2025. But “high-performing providers and providers participating in alternative payment models” will have the opportunity for additional payments.2

Beginning in 2019, the MIPS will replace three previous incentive programs (physician quality reporting system [PQRS], meaningful use of electronic medical records, and the value-based modifier) with a combined value-based payment program that assesses the performance of each eligible provider based on quality, resource use, clinical practice improvement activities, and meaningful use of certified electronic health record technology.2

This is an open, clear statement of Congress’s intent to accelerate the move of the basis of Medicare reimbursement from volume to value. The legislation calls for a new payment plan that eventually bases physician payments on their participation in value or incentive-based payment models. The SGR replacement reinforces the need for health care organizations to have a strategy in place to address the shift away from the fee-for-service payment model.3

The Secretary of Health and Human Services (HHS) will have substantial flexibility—within guidelines—to specify the quality measures to be used in determining the MIPS payment adjustment and to update the measures list as appropriate. The Secretary also will be responsible for developing the methodology for assessing the performance of each provider and the formula for calculating payment adjustments, as well as setting the threshold for bonus payments for exceptional performance. While physical therapy was not specifically mentioned in the statute, there is direction that all non physician providers will be included through the regulatory process through the provision that empowers the Secretary to decide whether and which other categories of health care professionals would be eligible for the MIPS after the first two years.

Providers who participate in alternative payment models can receive extra payments, such as shared savings for accountable care organizations or patient-centered medical homes. In addition, a 5 percent bonus would be available each year from 2019 through 2024 for those physicians who receive a substantial portion (at least 25 percent) of their revenues through those models. Providers who choose to participate in the MIPS would be subject to positive or negative payment adjustments based on their performance, with $500 million in funding each year from 2019 through 2024 to provide an additional adjustment for providers with exceptional performance.1

Beginning in 2026, fees would increase by 0.75 percent each year for providers who participate in an alternative payment model and 0.25 percent per year for those who do not. All providers not participating in alternative payment models will be subject to the MIPS beginning that year.1

All this obviously means that much critical work lies ahead in the regulatory arena that will impact our Medicare reimbursement rates as private practitioners.

Given CMS and congressional history, it is clear that the MIPS will be predicated on quality and outcomes. Physical therapy is well positioned for this new era as functional outcomes measures abound in our profession. Conversely, the care of medical doctors generally is not as conducive to measuring the effects of care, which is why physicians are currently emphasizing process measures; that is, whether or not something was done, rather than the ultimate result (outcome) of their care on the patient.

Consequently, there is a level of angst within the physician community about the new payment method, even though the American Medical Association strongly endorsed H.R. 2. Some specialty societies are clearly concerned and some believe this is a dramatic step into the unknown. “American Society of Plastic Surgeons is greatly concerned about the impact H.R. 2 will have on patient care and maintains its conviction that the Act is not in the best interest of patients, access to care, nor the quality of patient care delivered by all medical specialties.”4

Under the new reimbursement schema, Medicare will pay doctors based on how well they do their jobs, but it is hazy on how the government will accomplish this. “I am very skeptical of this,” Urban Institute Fellow Robert Berenson, M.D., was quoted as saying. “It is really absurd that we do not have any measures for most doctors that can place a value on their performance.”5

Blair Childs, senior vice president of Premier Inc., a large provider alliance, was unequivocal about what the repeal means for their industry. “It’s a new era,” he said. Though his organization has been deeply involved in pursing alternative payment models such as accountable care organizations (ACOs), “I do think a lot of the physician organizations have not been as engaged in this area,” he added. “This is a wake-up call and it is going to have big implications for health care in this country.”6

The plan represents one of the biggest steps yet from the government to actively accelerate the transition from the traditional fee-for-service model to value-based care. Some experts such as Paul Keckley, managing director at the Navigant Center for Healthcare Research and Policy Analysis, believe this will significantly “raise the stakes for clinically integrated networks of physicians, allied health professionals and their business partners to take on payer-sponsored risk.”7

To refine and implement a value-based system, health care leaders and the government must take several steps, including standardizing the definition of value, developing payment models geared toward positive outcomes, and aligning stakeholder interest.8

Meanwhile, and separate from the SGR legislation, HHS has embarked on a fundamental reform of how it pays providers for treating Medicare patients in the coming years. The intent, according to HHS officials, is to cut down on the volume of unnecessary procedures while improving patient outcomes.

“Those models will depend on how well providers care for their patients, instead of how much care they provide,” HHS Secretary Sylvia Mathews Burwell said at a January press conference in Washington.9

For the first time, her agency is “setting clear goals—and establishing a clear timeline—for moving from volume to value in Medicare payments.” In doing so, CMS will tie 30 percent of all fee-for-service (FFS) payments to providers to quality initiatives through alternative payment models—particularly ACOs and bundled payments—by 2016. It will rise to 50 percent by 2018. According to HHS, about 20 percent of Medicare FFS payments are through new payment models.10

PPS members can be relieved that we no longer have to worry about Medicare cuts that caused the frequent legislative SGR “fire drills.” However, we cannot understate the importance of the shift to value-based payments, a method that is sure to gather momentum now that it is recognized by the major federal payer.11

References

1. H.R. 2: The Medicare Access and CHIP Reauthorization Act of 2015.

2. Guterman S, With SGR Repeal, Now We Can Proceed with Medicare Payment Reform, The Commonwealth Fund Blog, April 15, 2015.

3. Ellison A, SGR replacement reinforces move toward value-based care, Becker’s Hospital CFO, April 16, 2015.

4. www.plasticsurgery.org, accessed April 23, 2015.

5. Budryk Z, Is the proposed SGR fix too vague to work?, Deficit hawks question savings while healthcare experts call for better-defined quality measures, Vox. April 7, 2015.

6. Small L, What the SGR repeal means for value-based payment models, Providers, payers weigh in about “doc fix” replacement’s ‘wake-up call’ to industry, Fierce Healthcare, April 15, 2015.

7. Keckley P, The SGR fix: what does it mean for hospitals and health systems?, April 6, 2015, Hospital and Health Networks Daily, AHA Publications.

8. Szczerba R, The Medicare ‘Doc Fix’ Bill: How Do We Pay For Value-Based Care?, Forbes, April 7, 2015.

9. Millman J, The Obama administration wants to dramatically change how doctors are paid, Washington Post, January 26, 2015.

10. Burwell Statement, Progress Towards Achieving Better Care, Smarter Spending, Healthier People, HHS.gov, January 26, 2015.

11. Japsen B, Anthem Blue Cross’ $38 Billion Move From Fee-For-Service Medicine, Forbes, January 29, 2015.

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Jerome Connolly, PT, CAE, is a registered federal lobbyist whose firm, Connolly Strategies & Initiatives, has been retained by PPS. A physical therapist by training, he is a former private practitioner who throughout his career has served in leadership roles of PPS and APTA. Connolly also served as APTA’s Senior Vice President for Health Policy from 1995–2001.

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Medicare, the Budget, and Our Exec

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By Jerome Connolly, PT, CAE
May 5, 2015

I was hoping to dedicate this column to a summary of the successful passage of Medicare legislation that would have fully repealed and reformed both the Medicare therapy cap and the sustainable growth rate (SGR) formula used to calculate our payments—but alas, as of this writing, Congress has not quite finished the job.

The House of Representatives did pass H.R. 2 on March 26 and the bill does include a repeal and replacement for the dysfunctional SGR formula. After transmitting the bill to the Senate, the House recessed for a two-week spring break. Meanwhile, the Senate was engaged in a marathon debate on a budget resolution (the first in years, but more on that later), and could not act on the SGR bill before it also recessed. Actually, there was time for a voice vote, but with three Republican senators objecting, the unanimous consent required for such a maneuver was not present.

So, the Senate left Washington despite the March 31 expiration date of the current SGR waiver and Medicare reimbursement level. Of course, the therapy caps exception process, which always travels with the SGR, also expired at the end of March, so our patients as well as our payments were jeopardized by this action (or lack thereof).

But the House did not include full repeal of the therapy cap in H.R. 2, opting instead to extend the exceptions process through 2017. The decision to separate these two policies that have traveled in tandem since their inception in the same law in 1997 was disappointing to say the least. It also was somewhat mystifying that the House would take care of a physician payment problem but neglect to ensure that patients most in need of rehabilitation therapy were not protected.

When Congress left the job unfinished, we worked aggressively during the recess to urge the Senate to fix the House mistake and include full repeal of the therapy cap in the SGR bill. Our message: Repealing the cap is a full solution that was vetted by and agreed to in the Senate last year. As stakeholders, we have also improved the exceptions process with manual medical review, agreed to report functional limitations, and by doing so lowered the budgetary cost of full repeal. We have acted in good faith, doing everything Congress asked of us. But the House turned its back on beneficiaries this year when they developed the package without Senate input and without including the therapy cap repeal.

Currently, we are activating grassroots and forging a comprehensive stakeholder assault on the Senate emphasizing the importance of therapy cap full repeal to our nation’s seniors. And to underscore the therapy cap as a beneficiary issue, we have been delighted to enlist the support of American Association of Retired Persons (AARP) and its 33 million member grassroots organization. Together we are calling on the Senate to amend H.R. 2 by repealing the beneficiary therapy cap along with the physician payment formula (SGR). It may turn out to be a futile attempt as the Senate may eschew amendments as it will have only about 36 hours to act after reconvening. Otherwise, Medicare claims processing and reimbursements will be severely disrupted. Nevertheless, we intend to make our position known and to advocate on behalf of our Medicare patients. And even if this is not the time the cap is fully repealed, we will not rest until it is.

Federal Budget
As mentioned above, the 114th Congress has decided to consider a nonbinding budget resolution, and separate bills were passed by each chamber before the spring recess. This is the first time in six years such a budget bill has been adopted by Congress and was made possible by the Republican takeover of the Senate in the November 2014 elections. Even though the measure does not carry the force of law nor require the president’s signature, it is an important statement for the Republican-controlled Congress and will be held up by the GOP as evidence they are capable of governing, an important demonstration in advance of the 2016 elections, which they hope will award them control of both the executive and legislative branches of government. The GOP’s first months in control of both chambers of Congress were marked by high-profile stumbles and a near-shutdown of the Homeland Security Department.

But translating a budget resolution into an actual budget is a much more difficult endeavor that requires the adoption of spending bills that do have the force of law, if and when they are signed by the president. Congress has until October 1 to accomplish this task, as that date marks the beginning of the 2016 fiscal year.

This budget resolution is merely a blueprint, but it can be enormously valuable in the Republican-controlled Senate where it can be used as framework for Budget Reconciliation, a process by which adoption of an actual budget that reduces the deficit can be approved with a simple majority, not the 60 votes required for most legislation.

This, of course, means the Republicans could avoid the leverage of the filibuster and push through the budget on a party-line vote without Democratic help. Readers may recall that this is the same parliamentary maneuver used by the Democrats in 2010 to push the Affordable Care Act (ACA) over the finish line. It could be considered ironic but fitting that the Republicans would use the same procedure to put repeal of Obamacare on the president’s desk, embedded in an overall deficit-reducing budget. It is difficult to envision any circumstance under which President Obama would sign such a bill into law, but it would doubtless put him in a difficult position, which, of course, is the object of the exercise for Republicans.

Farewell to PPS Executive Director
It has been a positive, productive process working with Laurie Kendall-Ellis over the past five years and I want to add my best wishes to the voices of many as she moves on to lead a larger health care organization in Washington.

In my view, Laurie’s unique background and skillset as a physical therapist, a private practice owner, a Private Practice Section (PPS) and American Physical Therapy Association (APTA) member, and a professional association executive, served the Section well at its stage of organizational development. Among her many notable achievements belong the three PPS Washington Advocacy Conferences—a new endeavor for the Section and a Laurie Kendall-Ellis brainchild—each more successful than the last.

Laurie’s presence, participation, and professionalism were of significant assistance to me as the PPS lobbyist and I know to the entire Section as well. To Laurie, I extend my gratitude and congratulations.

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Jerome Connolly, PT, CAE, is a registered federal lobbyist whose firm, Connolly Strategies & Initiatives, has been retained by PPS. A physical therapist by training, he is a former private practitioner who throughout his career has served in leadership roles of PPS and APTA. Connolly also served as APTA’s Senior Vice President for Health Policy from 1995–2001.

Right Time, Right Place

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Physical therapy on Capitol Hill.

By Jerome Connolly, PT, CAE
April 4, 2015

The Private Practice Section (PPS) conducted its third successful Capitol Hill Lobby Day this past February. This year, our forces were fortified thanks to collaboration with the American Physical Therapy Association (APTA), which brought 25 additional physical therapists to Washington, D.C. Members of the APTA’s board of directors and the Payment Policy Advisory Committee joined the 72 PPS Key Contacts in walking the halls of Congress, conducting 185 meetings discussing the Medicare beneficiary therapy cap, payment rate, and locum tenens. Forty states and 105 unique House districts were covered by the total 97 attendees, many of whom met with their actual representative or senator.

The timing for this meeting, which was optimal, was established by the PPS board of directors and was heavily influenced by the looming March 31 deadline when the therapy cap would be fully implemented and Medicare reimbursement for outpatient services would be cut by more than 20 percent. The payment reduction is due to the expiration of the waiver of the sustainable growth rate (SGR) used to calculate the conversion factor for the Medicare physician fee schedule under which outpatient physical therapy services are paid.

Half of Medicare Payments to Be Based on Quality by 2018

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PPS to Lobby Congress in February.

By Jerome Connolly, PT, CAE
March 3, 2015

This month Medicare providers are facing another familiar deadline, as once again, Congress must act to avoid delivering a 20.4 percent cut in payments to therapists, physicians, and others who choose to treat Medicare patients. If you have not yet contacted your representative and your senators—or even if you have—please do so and encourage them to pass legislation that reforms the dysfunctional formula mislabeled as the sustainable growth rate (SGR). While you are at it, tell them how important it is for Medicare beneficiaries that Congress repeals and replaces the arbitrary and discriminatory per-beneficiary Medicare therapy caps. If the above action is not taken by March 31, our nation’s seniors in need of physical therapy will be significantly disadvantaged and even harmed.

Starting Anew

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PPS to Lobby Congress in February.

By Jerome Connolly, PT, CAE
February 2, 2015

As we learned in January, due largely to members engaging in advocacy efforts, the Private Practice Section (PPS) reported substantial progress on its federal legislative and advocacy priorities in the 113th Congress. Significant steps were taken with respect to the Sustainable Growth Rate (SGR), the formula used to determine Medicare reimbursement rates. We also prevented the Medicare therapy caps from being fully imposed on our patients. We introduced bills in both chambers that would add physical therapists to the Medicare Locum Tenens statutory provision that allows physicians and other health professionals to retain qualified licensed professionals in their practices when the owner needs to be absent for a short time due to illness, pregnancy, professional development, or jury duty. Physical therapists were included in the Medicare Patient Empowerment Act (HR 1700), which represented an important step in identifying the physical therapy profession with the opt-out issue when such legislation is revisited in the next Congress. Even on the polarizing issue of physician self-referral, steps forward were made with the new bill (HR 2914) that would close the in-office ancillary services exception loophole.

But with the opening of the 114th Congress, all legislation must begin anew and steps are underway to line up sponsors and supporters for legislation consistent with PPS advocacy goals.

The new Congress was seated in early January but little legislation is typically accomplished in the first 90 days. New members need to receive committee assignments, orientation, and an opportunity to familiarize themselves with their colleagues, hire staff, and organize their offices. In addition, two weeks is spent back home in their district connecting with constituents. Congress also returns to their constituents in February during a weeklong break recognizing the birthdays of presidents George Washington and Abraham Lincoln.

All this suggests a compressed timetable for the first 60 to 90 days, one not so compatible with accomplishing substantive policy work on Medicare payment. This timing is unfortunate as the current Medicare payment rate and the extension of the exceptions process for the Medicare beneficiary therapy caps expire March 31.

In the last Congress, substantial progress was made in creating legislative policy that would repeal and replace the SGR formula and repeal and replace the therapy caps. However, since such legislation was developed under different leadership in the Senate and in different leadership of key committees in both the Senate and the House, it is unlikely that policy will be advanced under the new regime.

A Republican majority now rules the Senate and Senator Orrin Hatch (R-UT) holds the gavel for the quite influential Senate Finance Committee. Chairman Hatch believes the future of Medicare is at risk, calling it the single greatest contributor to our nation’s debt. Says Hatch, “If we are to tackle our runaway debt, then Medicare must be on the table.” He strongly supports efforts to modernize and reform the Medicare program using more, not less, patient empowerment and greater choice for seniors. Hatch is also a strong supporter of the Medicare Advantage (MA) program, which he says represents a strong foundation for addressing Medicare’s long-term fiscal challenges.1

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Over in the House, Representative Paul Ryan (R-WI) assumes chairmanship of the powerful Ways and Means Committee. Ryan, the 2012 GOP vice presidential nominee, has proposed Medicare reform on at least two occasions by employing what he referred to as premium support. Under this policy, Medicare beneficiaries would receive insurance vouchers that could be used as payment toward Medicare coverage, which would be a choice between traditional fee-for-service Medicare or a list of private health plans.2

Ryan emphasizes that his proposal still gives seniors the choice of remaining in regular Medicare.3 However, a Congressional Budget Office (CBO) analysis of Medicare premium support systems found that plans such as Ryan’s would increase traditional Medicare premiums by a staggering 50 percent.4

Ryan’s proposal would establish an exchange for private Medicare insurance plans. Health plans that chose to participate in the Medicare Exchange would agree to offer insurance to all Medicare beneficiaries, to avoid cherry-picking, and to ensure that Medicare’s sickest and highest-cost beneficiaries receive coverage.

A third House committee, Energy and Commerce, with jurisdiction over some Medicare policy will retain its current chairman in the person of Representative Fred Upton (R-MI). Upton is in concert with the proposals espoused by Hatch and Ryan as is evidenced by a policy document recently released by the committee calling for combined Medicare Part A and Part B fee-for-service deductibles, means testing, and the strengthening of Medicare advantage.5

As chairs of these committees with jurisdiction over Medicare, and a track record of proposing bold policy changes to the program, chairmen Hatch, Ryan, and Upton will be eager to craft Medicare reform (including payment reform) to their likeness.

Reform of the SGR and the therapy caps has been considered by Congress since 2001, and both issues have enjoyed bipartisan support. But the parties have disagreed over how to pay for such revisions to the Medicare law. Now that Republicans control both the Senate and the House, methods of funding the Medicare legislation should be easier to identify. The only obstacles will be skirting the filibuster in the Senate and making the policy sufficiently palatable to President Obama as his signature will be required. While it is possible to avoid the filibuster by employing a parliamentary tactic known as “Budget Reconciliation,” getting Obama to sign a bill that guts or seriously threatens the Affordable Care Act, his signature legislation, will be much more difficult.6

It is highly unlikely that these two new chairmen can successfully undertake the scale of Medicare reform they both envision by the above-mentioned March 31 deadline. Failure to accomplish such reform would hopefully compel the Congress to entertain yet another short-term patch to the Medicare payment formula. Failing to do so will result in a 20.4 percent reduction in Medicare reimbursement rates to therapists and physicians on April 1 (and that’s no April Fool’s joke).

Likewise, the therapy caps exceptions process also expires March 31, and would require an extension to avoid the full provisions of the cap being applied to all Medicare patients. Therapy cap legislation traditionally is included in Medicare SGR bills, but this is no given. In fact, we would be foolish to believe that even the avoidance of the steep Medicare payment rate cut is assured at this time. The new Congress, with new committee chairs and a vastly more complex political climate in Washington, creates a much more volatile legislative environment in which nothing should be taken for granted.

For this reason, PPS will convene its third “Lobby Day” in as many years this month. The Section will bring its Congressional Key Contacts to Washington to lobby our legislators and policymakers on these important Medicare issues. This fly-in, to be conducted February 22-24, presents an important opportunity for PPS to make an impression and create a presence with the members of the 114th Congress.

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We hope nearly 100 PPS members answer this call to come to Washington to learn about the issues from members of Congress and their staff, become adept at presenting our “asks,” and persuading our legislators to take the appropriate action with respect to Medicare policy affecting our patients and our practices.

In addition to the critical issues of SGR and therapy caps, we will be advancing our other advocacy priorities developed by the PPS Government Affairs Committee and adopted by the Board of Directors, including locum tenens, opt-out, and physician self-referral. (See sidebar on page 26.)

The PPS advocacy program could not have made the progress recorded last year without the willing and eager participation of its grassroots members. The PPS Key Contact program is growing as we identify more members willing to serve the Section in this capacity. Creating relationships with your federal legislators, both at home and in Washington, is of critical assistance in advancing the PPS advocacy goals. If you have not yet registered and made plans to attend the February PPS Lobby Day, I would encourage you to promptly do so. Your patients and your profession are counting on you.

PPS Legislative and Advocacy Priorities for 2015

Permanently replacing the Medicare Sustainable Growth Rate formula with a reimbursement method that pays physical therapists fairly and predictably, and repealing the arbitrary per beneficiary Therapy Caps on outpatient rehabilitation covered by Medicare are the highest priorities for PPS.

Other Medicare Priorities

  • Achieve legislation that allows physical therapists in private practice to opt out of Medicare or privately contract with Medicare patients
  • Achieve legislation that allows physical therapists in private practice to utilize locum tenens
  • Pursue elimination of arbitrary limits and denials for services provided by physical therapists in private practice in accordance with evidence of value
  • Address and mitigate the negative effects associated with physician self-referral
  • Encourage and achieve a streamlined, responsive and transparent process for manual medical review of Medicare records by Medicare administrative contractors
  • Promote the adoption by the Accountable Care Organizations (ACO) of quality measures that include functional health status
  • Remove the barriers to patient access to physical therapists in private practice under Medicare and the Federal Employee Health Benefit Plans
  • Achieve consistent Medicare standards for supervision of support personnel across physical therapy practice settings
  • Promote policy that embraces the use of physical therapists in private practice as timely evaluators and managers of quality of life for patients with chronic conditions
  • Monitor and respond to ICD-10 implementation in a timely fashion with minimum disruption
  • Achieve legislation that allows reimbursement through Medicare and federal health plans for physical therapy care through telehealth
  • Continue to fight for fair and equitable Medicare reimbursement for physical therapists in private practice in part by eliminating or mitigating the effects of unsupported multiple procedure payment reduction (MPPR)
  • Pursue improvements in the Physician Quality Reporting System (PQRS) that would result in appropriate participation and recognition of the value of physical therapy

Insurance Issues

  • Support opportunities for physical therapists in private practice to purchase health insurance across state lines
  • Address and mitigate the negative effects of market control by insurance plans and related entities on physical therapists in private practice and their patients

Small Business Issues

  • Pursue federal student loan repayment programs in underserved areas that enhance recruitment efforts of physical therapy private practices in these areas
  • Monitor, respond to, and participate in tax reform efforts to benefit physical therapists in private practice

Other Federal Issues

  • Promote policy that increases opportunities for veterans to receive outpatient services provided by physical therapists in private practice
  • Mandate that physical therapists in private practice are included in the medical team providing concussion management

NOTES

References

1. Hatch website (accessed 12/29/14): www.hatch.senate.gov/public/index.cfm/releases?ID=88a3acbc-7608-4bde-aaf3-2d568e9ba3a5.

2. Paul Ryan’s budget makes big Medicare changes, Politico, April 1, 2014.

3. http://thinkprogress.org/health/2014/04/01/3421546/paul-ryans-latest-attempt-to-gut-medicare.

4. A Premium Support System for Medicare: Analysis of Illustrative Options, Congressional Budget Office, September 2013, http://www.cbo.gov/sites/default/files/cbofiles/attachments/09-18-PremiumSupport.pdf.

5. GOP Solutions: A Compilation of Policy Proposals from the House Committee on Energy and Commerce, Dec. 29, 2014. http://energycommerce.house.gov/sites/republicans.energycommerce.house.gov/files/files/The%20Policy%20Paper%20Series%20—%20V3I3%20Compilation.pdf.

6. Policy Basics: Introduction to the Federal Budget Process, Center on Budget and Policy Priorities, 9/10/14, www.cbpp.org/cms/?fa=view&id=155.

 

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Jerome Connolly, PT, CAE, is a registered federal lobbyist whose firm, Connolly Strategies & Initiatives, has been retained by PPS. A physical therapist by training, he is a former private practitioner who throughout his career has served in leadership roles of PPS and APTA. Connolly also served as APTA’s Senior Vice President for Health Policy from 1995–2001.

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