WVPTA PT After Hours 2011

1. WVPTAPT After Hours 2011 WVPTA update WV PT Practice Changes APTA Advancing Your Profession Technology in Physical Therapy

2. WVPTA Update Current membership Mission Strategic Goals Activities

3. WVPTA Purpose • The West Virginia Physical Therapy Association exists to advance excellence and quality of the physical therapy profession through advocacy, education and services for its members and the public. • www.wvpta.org

4. WVPTA Committees • Practice • Payer Relations • Legislative • Education • Research • Membership • Ethics • Media/Newsletter • Finance • Nominating

5. WVPTA Practice Goal • Payment policies and reimbursement will exist to support clinical and practice management services and financial stability for the profession, including development of new practice models, use of evidence-based principles, and quality initiatives within the scope of health care reform.

6. Payment Issues • Health Care Reform • PT Co-Pay Legislation • Assignment of Benefits • Silent PPO • Accountable Care Organizations (ACO) • PT/PTA Pay Differential • ICD-10 • Medicare Updates

7. Payment Issues/PT Areas of Risk in Medicare • Aberrant billing practices • Failing to comply with the 8 minute rule • Billing for excessive duration and frequency of services • Billing for maintenance therapy • Home health patients that are not homebound just “transportationally challenged” • Missing certifications on POCs or illegible physician signature

8. Payment Issues/PT Areas of Risk in Medicare • Documentation does not support medical necessity • Billing for services furnished by Aides/Techs/Students or not furnished • Billing for one on one codes instead of group codes • Failing to comply with CCI edits • Upcoding (e-stim), or unbundling • Billing for “not medically necessary services” without an ABN

9. WVPTA Advocacy • WVPTA will continue to exercise a strong advocacy voice and presence to protect the practice of physical therapy and ensure physical therapists are the practitioners of choice.

10. Advocacy Activities • WV grassroots network/Legislature redistricting • http://www.legis.state.wv.us/ • WVPT-PAC • Lobby Day • Scope of Practice Protection • Legislative Action Center • http://www.apta.org/TakeAction/ enter member information and click on Legislative Action Center

11. WVPTA Public Awareness • WVPTA will increase education and awareness among the general public to recognize physical therapists as the practitioner of choice through a broad range of current and emerging media venues

12. PR Activities • Public Relations Committee • Social Media • Lobby Day • Letters to Editors

13. WVPTA Education • WVPTA will continue to provide cost effective and relevant professional development opportunities for members on topics such as best practices, ethical practice standards, and growing technology

14. WVPTA Meetings • Basic Lymphedema Education and Bandaging November 4, 2011 in Clarksburg • Annual Spring Conference April 27-29, 2012 Stonewall Resort • Research Posters for Annual Conference

15. WVPTA Organization • WVPTA will maintain a strong organizational structure through leadership development and continuity, a viable membership base, and financial growth and sustainability.

16. Organization • Membership • Financial Sustainability • Leadership

17. What you can do for WVPTA • Be a member  • Serve on a committee • Help on task force or focused effort • Donate to WVPT-PAC • Participate with Grassroots networking and advocacy • Stay informed and be proactive • http://www.wvpta.org/

18. WV PT Practice Changes Supervision PTA Continuing Education

19. West Virginia Board Of Physical Therapy Links • Website http://www.wvbopt.com/index.cfm • Continuing Education Guidelines http://www.wvbopt.com/index.cfm • PT and PTA Rules effective 6/16/2011 http://www.wvbopt.com/documents/Title%2016%20Series%201%20General%20Provisions%20for%20PT-PTA%20-%20Effective%20June%2016%2020111.pdf

20. WVBOPT Informal Presentations Regarding New Rules • Webster Continuous Care Center 10/27/11 @ 5:30pm • Wheeling Jesuit University 11/18/11 @ 5:30pm • Mountain State University - Carter Hall 11/10/11 @ 6:00 PM

21. Supervision of PTA • 1 PT may now supervise no more than 4 support staff in any setting, this includes: PTA’s, PTA’s with a temporary permit, physical therapy aide or any combination thereof. • Students are NOT included in the ratio. • Physical Therapy Aides must be directly supervised by the PT. Direct supervision is the actual physical presence of the PT in the immediate treatment area where the treatment is being rendered. Immediate treatment area is the area within the PT’s direct line of sight or within audible distance of the PT and the ability of the PT to immediately respond to calls for assistance from the patient or PT aide.

22. Supervision of PTA • 8.1.a. The initial visit shall be made by the PT for evaluation of the patient and establishment of plan of care. (PTA does not have to be present for any PT’s visits including initial visits). Therefore, communication between the PT and PTA is essential. • 8.1.b. The PT shall make the final visit to terminate the plan of care unless the patient or physician terminates the plan of care.

23. Supervision of PTA • 8.2.a. A PTA can work in hospital or other acute care center, free standing, outpatient, or independent practice setting, with general supervision 40% of their work week. Each PTA must receive on-site supervision the remaining 60% of the week.

24. Supervision of PTA • 1000 hours of experience is required and the supervising PT shall document when the general supervision is utilized. Where the documentation is done and kept is up to the facility but must be producible upon board request.

25. Supervision of PTA • 8.2.b. When care is delivered in a skilled/unskilled nursing facility, distinct part skilled/unskilled nursing unit or swing-bed unit in an acute care hospital, home health or school system setting, general supervision may be utilized. • The physical therapist must visit the patient at least once every 10 PTA visits or within 30 calendar days, whichever comes first. Again communication between the PT and PTA is crucial.

26. Supervision of PTA • If the supervising PT changes, the new supervising PT must discuss the patients diagnosis and plan of care with the previous supervising PT before the next PTA visit is made and either PT must document such communication.

27. Emergency Situation • Such as serious illness or injury of the therapist or therapists family member or death of a family member. It is an unanticipated absence. • This allows a PTA to continue to practice under the supervision of another PT for 3 consecutive days not to exceed 12 days per year. The PTA can only treat those patients for which the licensed PTA has previously participated in the intervention for established plans of care.

28. Emergency Situation • In this instance, the second PT may exceed the ratio limit for these days. • The PT must document the dates and emergency situation. You will be asked to provide a form with this information upon license renewal. The form is available on the website.

29. Temporary Situation • The temporary situation allows the PTA to practice under general supervision up to 1 day in a work week and no more than 80 hours in a year. Also only includes patients in which the PTA has previously participated in their care. • This rule is in addition to the 40% that the PTA is allowed to work under general supervision. • The PT must document the hours, dates, and temporary situation to the board. You will have to provide a form upon license renewal, which is available on the website.

30. Continuing Education • Changed from 10 per year to 24 over license period of 2 years. • CEU requirements for licenses expiring in December 2011 remain the same at 10 units per year. • CEU requirements for licenses expiring in 2012 may follow either the old or the new rule and have either 10 units in each year or 24 units total for the two years. • Any licensee renewing after December of 2012 must have 24 CEU credits for the license period.

31. Continuing Education • Continuing education courses must be board approved. If they are not listed within the rule you must go through the approval process. There is a $50 fee and Form A (located on the website) must be completed and turned in, along with the required documents. A listing of all board approved courses that aren’t automatically approved are listed on the website. • Some examples of automatic approval includes: courses sponsored by APTA, WVPTA, course given by a CAPTE approved PT or PTA school, completing a specialty certification and being a clinical instructor.

32. Continuing Education • If a licensee experiences a disability, illness, or hardship a waiver form (located on the website) can be filled out and submitted with the appropriate documentation from physician or another qualified practitioner and the board will review for approval. Must be turned in by October first of the year of renewal. Can only be granted for one renewal cycle. If illness, etc continues a new waiver request is required.

33. Continuing Education Audit • Currently in March, the board runs a random audit of a percentage of active PT and PTA licensees every year. Now since the CE requirement is for license period the board will only audit people who renewed the previous year. • A certified letter will be sent to the licensee requesting a copy of their board approved CE units for the previous licensing period. The board will accept original or notarized copy of certificate. A form is available on the website to take to a notary. It can be found under CE Info

34. Continuing Education Audit • The licensee has 21 days from receipt to respond. If you don’t correspond by letter to the board within 21 days, you are found noncompliant and your license will be placed in delinquent status. • You then have to go through the process for delinquent status to reactivate. A letter will be sent to the licensee and their employer notifying them of the delinquent status. • Once the requirements are fulfilled a letter will be sent informing the licensee that they are in compliance. • Do not submit CE’s to the board unless you are audited.

35. Revisions we haven’t discussed: • Definition changes • Application and renewal changes • Temporary and volunteer permits • Inactive vs Delinquent status • Ethics Section • Scope of Practice changes

36. American Physical Therapy Association: Advancing your Profession

37. What is APTA? APTA is the only national organization dedicated to advancing and protecting the interests of the physical therapy profession and its practitioners. APTA’s goal is to foster advancements in physical therapy practice, research, and education

38. APTA Is a Member-Driven Organization More than 77,000 members elect More than 400 representatives to the House of Delegates, who then elect 15 individuals to the Board of Directors.

39. Advocates Patient access Payment policy PT Provisions in Healthcare Reform Physical Therapy Education

40. Payment • APTA Board voted unanimously in March 2011 to develop payment reform for outpatient physical therapy services • Lobbied vigorously against CMS’s MPPR proposal, cutting in half a 50% practice expensive value reduction. Worked with providers to analyze millions of claims. • APTA has strongly urged CMS to reconsiderits rejection of the Health Care Professionals Advisory Committee's (HCPAC) recommended work value for wound care codes and find an alternative to MPPR.    • Provided policy options to remove PT as designated health service for inclusion in the in-office ancillary services exceptionto MEDPAC, with positive outcome in recent MEDPAC report • Advancing quality initiatives, including registry reporting, for PTs through federal policies and agencies

41. Government Affairs • Lobbied for PT-friendly provisions in health care reform law. Rehabilitation, habilitation now required minimum health benefits, and CMS demo project proposed to study service delivery models including direct access under Medicare. • Organizing comprehensive strategy on health care reform, including member education initiatives, regulatory implementation plan, identification of policy areas needing modification • Helped avert scheduled 24.9% SGR Medicare payment cut, extend the 1.0 work floor of the GPCI until December 31, 2011, and repeal delay of Skilled Nursing Facility Prospective Payment System Resource Utilization Group - Version 4 (RUG-IV). 

42. Government Affairs • Secured a one-year extension of the therapy cap exception process until December 31, 2011, while continuing to work on long-term alternatives • Securing permanent solutions to fee schedule cuts and therapy caps remain top priorities • Protecting integrity of PT practice against threats to erode current state legislation that curbs referral for profit by physicians • Seeking policy changes to advance the use of health information technologies for physical therapists • Advocating for rehabilitation research funding and recognition through report language in appropriations process

43. APTA 2011 Legislative Agenda • Student Loan Repayment Eligibility Act (HR1426/S975) • Medicare Access to Rehabilitation Services Act (HR1546/S829) • Protecting Student Athletes from Concussions (HR469) • Medicare Patient Access to Physical Therapists Act • http://www.apta.org/FederalAdvocacy/ • http://thomas.loc.gov/home/thomas.php

44. Educates Physical Therapy Community Consumers

45. PT Practice • Revision in process for Guide to Physical Therapist Practice • Continuing to further develop and analyze the APTA National Outcomes Database • Processes underway to develop clinically useful evidence based documents in collaboration with Sections • Developing resources to support the use of direct access in various practice settings

46. Education • Record number of credentials awarded for clinical instructors, clinical residency and fellowships, and board certified clinical specialists • APTA’s new Learning Center continues to grow with 24/7 access to content, on-demand CEU certificates, and more than 14 hours of free content to members • Physical Therapist Centralized Application Service (PTCAS) – 9,297 applicants applied to 107 participating programs during 2009-2010. As of March 2011, 11,502 applicants have applied to 128 participating programs during 2010-11. The 2011-12 cycle opened on July 5 with 140+ programs.

47. Education • PTCAS now offers centralized criminal background check for PT programs -- available for PTA programs in 2011 • Clinical Education Principles, a new voluntary resource for PT academic and clinical educators, now available • Promoting professionalism through expanded online offerings – Professionalism Series and newly revised Code of Ethics • Continuing competence resources now centralized on APTA Web site • Developing new resources for PTAs and PTA educators

48. Connects and Strengthens Communication Research Professional Development

49. Communications • Rolling out next phases of “Move Forward” brand to consumers, other health care professionals • Developing and launching consumer and clinician portals in 2011 • Established national Media Corps of APTA spokespersons professionally trained to generate positive media coverage for the profession • Securing national media coverage: CNN.com, Forbes.com, USA Today, Business Week, New York Times, Wall Street Journal, Los Angeles Times, Chicago Tribune, and Good Morning America … to name just a few

50. Communications • Launched a redesigned APTA Web site with improved functionality and enhanced user experience