Knoxville, TN @APTATweets #ChoosePT @MoveForwardPT - - PowerPoint PPT Presentation

April 21, 2017 Knoxville, TN

@APTATweets #ChoosePT @MoveForwardPT #TransformPT @Policy4PT #PTAdvocacy @fotoinc #OC2017 American Physical Therapy Association

POSITIONING PHYSICAL THERAPY FOR THE NEXT CENTURY

LOOKING BACK BEFORE LOOKING FORWARD

Favorable: 46% Unfavorable: 46%

0% 10% 20% 30% 40% 50% 60% '10 '11 '12 '13 '14 '15 '16 '17 Favorable Unfavorable

7 Years Post ACA

Uninsured Drops

• 21.3 M insured through ACA
• Uninsured Rate Historically Low (8.6%)
• 155 M employer based, 77M Medicaid, 57M Medicare, 12M

Exchanges

Healthcare Consolidates

• 561 Hospital mergers since 2010
• 33% of physicians employed by hospitals in 2013

Costs Varied

• Healthcare costs expected to grew by 5.8% in 2015, expected to

grow 6.5% in 2017

• Family of Four Out of Pocket Costs Exceed 25K, per capita cost

$9,990

Changes Proposed

• Replacement bill introduced and died in 19 days
• Much can change administratively

7 Things to Watch in Physical Therapy in 2017

1

• CHIP re-authorization, including of other health care and Medicare

provisions (Therapy Caps) 2

• 2nd Generation of Quality / Payment Reform (MIPS, IMPACT, Bundling)

3

• Regulatory Reforms / Administrative Simplification

4

• More Narrow Regulation of Essential Benefits

5

• Medicaid Expansion / Retraction, including 1115 waivers

6

• Individual Market Stabilization (7 States have one carrier on exchange)

7

• Changes to Individual Mandate (hardship waiver / penalties)

BUILDING MOMENTUM FOR NEXT CENTURY

Building Identity

• Choose PT / Opioid Epidemic
• MoveForward PT
• Movement Summit

Creating Relevance

• Physical Therapy Classification and Payment System
• Payment Reform (Bundling, IMPACT, ACOs)
• Quality / Pay for Performance Models

Value through Data

• Professional Integrity Campaign
• Physical Therapy Outcomes Registry
• Health Services Research (CoHSTAR, PCORI)

GROWING OUR IDENTITY TO CONSUMERS

https://www.youtube.com/watch?v=RWpnMsAjX5k http://www.moveforwardpt.com/PatientResources/VideoLibrary/detail/physical-therapy-makes-it-possible

CREATING RELEVANCE TO PHYSICAL THERAPISTS

Payment Challenges (7 year window)

2011

First Application of MPPR (6-7%)

2012

Neutral Payment

2-Tier Cap Exceptions / Inclusion of Hospital OP Department

2013

MPPR Phase II (6- 7%)

Continuation of 2-Tier Exceptions (Manual Medical Review) Functional Measures Requirement PQRS Penalty Phase

2014

Neutral Payment

Caps Exceptions FLR Continues PQRS Penalty Phase Continues

2015

1% increase

Caps Exceptions FLR Continues PQRS Penalty Phase Continues

2016

.5% increase

Cap Exceptions FLR Continues PQRS Penalty Phase Continues

2017

.5% increase (more for evaluations)

Cap Exceptions (last year) FLR continues MIPS benchmarking (no penalty / no reward

Sequestration (-2%)

Coding Driving Change

PTCPS / APS

• New Evaluations Codes
• Interventions Delayed

Misvalued Code Initiative

• 31 codes on list – 3 Groups went forward
• Congressional Mandated -2% reduction
• Implementation – Jan 1, 2018

Regulatory Requirements

• Quality Programs (Transition to MIPS)
• Functional Limit Reporting

DEMONSTRATING VALUE TO POLICYMAKERS, PUBLIC, HEALTH CARE PROFESSIONAS & PAYERS

Registry / HSR Initiatives Quality Initiatives Integrity in Practice

Integrity in Practice Campaign

21 ENHANCE REPUTATION PREVENT REGULATION

Take Action Now

Don’t employ passive modalities exception when facilitating an active treatment plan. Don’t prescribe under-dosed strength training for older adults. Don’t recommend bed rest following acute DVT after anti- coagulation therapy, unless there are significant medical concerns. Don’t use CPM machines postoperative for uncomplicated TKA. Don’t use whirlpool for wound management.

Registry Project

• Fulfill quality reporting

requirements

• Support quality

improvement initiatives

• Demonstrate the value
• f PT services
• Promote health services

research

• Determine clinical

practice patterns

• Assess adherence to

CPGs

• Guide payment policy
• Inform payment contract

negotiations PAYMENT PRACTICE QUALITY RESEARCH

The Center on Health Services Training and Research (CoHSTAR) is a multi- institutional center dedicated to advancing health services and health policy research in physical therapy. CoHSTAR builds upon the well-established, interdisciplinary, intellectually rigorous and nationally renowned health services research and training infrastructure available at its trio of collaborating

• institutions. CoHSTAR offers fellowships, hosts visiting scientists, and provides

special summer training sessions. The center will also fund several pilot studies each year from investigators inside and outside the program.

Visiting Scientists Fellowships Pilot Studies Conferences

5 FOR THE FUTURE

Future

Use of Data (intra / inter professional / provider) Transparency (pricing and

• utcomes)

Increasing Competition Growing Markets Partnership / Collaborations

Tomorrow’s Practitioner

• Use of Data – To show outcomes of care, to improve practice, to demonstrate value to

payers, employers, public.

• Use of Evidence – Adherence to Known Standards of Practice, Contribution to Improving

Standards through Clinical Research

• Use of Enterprise Thinking Skills – How to be part of and contribute to systems: pit crews
• ver cowboys
• Interprofessional Experience – Collaboration, Communication, and Consultant Roles to

Augment Clinical

• Challenge Known through Innovation – Quest for Triple Aim of Lower cost, Better Care, and

Improved Health

#APTA100K

@APTATweets #ChoosePT @MoveForwardPT #TransformPT @Policy4PT #PTAdvocacy @fotoinc #OC2017 American Physical Therapy Association