October 2016 Newsletter

PRESIDENTS COLUMN
CONTENT
President Carrie
Abrahams Column

CARRIE ABRAHAM PT, DPT, MPH

PRESIDENT, WVPTA
Happy National Physical Therapy Month to the hard working PTs in
WV! I hope that you and your colleagues are planning to celebrate our
profession in some way this month. If you do, remember, let us know
at info@wvpta.org so that we can share!

Your Board of Directors has been working very hard on your behalf on
a variety of issues related to PT practice in WV. As you will see in this
issue, Sally and the Payer Relations Committee have been on top of the
News from the
issues related to your reimbursement and have brought us up to speed
Education Committee
with what is happening nationally after attending the APTA State
Payment Forum in September. Brandon has been working with his
Treasurer Update
committee and APTA staff to bring the #ChoosePT initiative to the
forefront in WV. WV is one of 10 hot states in this initiative due to our
News from the
rates of addiction and overdose related to opioid use. We want people
Practice Committee
to know that there may be a better choice to help them deal with their
pain without having to rely on addictive pain medications. Try PT
First!! Krissy, Kimeran and your Education Committee have been on
the go planning for top of the line continuing education for you in 2017
since the day after Annual Conference 2016 actually even before that. And these are only a few
examples of the Behind the Scenes at WVPTA!
Insurance Updates

So, you can see, PT in WV Rocks! And we would love to have more of you be a part of moving us forward.
After our last board meeting, a few areas were identified that are a bit lighter than we would like. Your
association needs an active Political Action Committee (PAC), it needs to reinstate the Ethics Committee
with a new charge from the APTA and it is looking for someone to chair the Bylaws Committee as your
previous chair is now serving as Chief Delegate for WV to the APTA House of Delegates. During our
Strategic Planning meeting in August, a new priority area was created of fostering a culture that
encourages community outreach and service. A committee to discuss how this looks for us would be
great!
I was approached by a number of people at Annual Conference 2016 about wanting to be involved, but
not knowing how or where to start. Some were not sure how much time they could dedicate, etc. I
completely understand tight schedules! So, how about just giving me a call (304-243-7201 x108) and we
can discuss what you are thinking, where your interest areas are and how we can fit you in to meet your
needs and the needs of your association. Lets Get This Done!
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INSURANCE UPDATES
SALLY OXLEY, PT, OCS, CHT, CMDT
WVPTA Payer Relations Committee Chair
Workers Compensation We are continuing to see that many Workers Compensation carriers are not
authorizing appropriate care for injured workers in a timely manner. There have also been delays in
payment. It is recommended that if you do not get resolution of issues within 60-90 days that you file a
complaint with the Industrial Council of the Office of the Insurance Commission, since in West Virginia, it
is a complaint driven system. This is the link to complaint forms.
http://www.wvinsurance.gov/Portals/0/wc_complaint_form%5B1%5D.pdf
Highmark Beginning in 2016 we are seeing a return of the plans that pay 80/20 for 20 treatments
(units) then 50/50. Patients are coming for 5-6 visits then stopping care. Small companies have chosen
to stay with the old plan and this may be why we are seeing these. They may have stayed with their
grandfathered plans so they would not be subject to ACA regulations.
Medicaid Most states have free on-line licensure verification so insurance companies go on-line to
verify licensure. In West Virginia the Board of Physical Therapy charges for licensure verification.
Medicaid will not pay the fee, so providers are responsible for sending verifications in to Medicaid. If it is
not done timely, providers are dropped from the Medicaid program and claims are denied. Because
license verifications fees are in the fee schedule it can not be changed until it goes through legislature.
The licensing board is in the legislative process of decreasing that fee to $0 for online verifications. If you
utilize the in-office option there will still be a fee.
Coventry Medicaid has merged with Aetna Better Health effective 9/26/16.
Medicare The new Value Based Payment Model evaluation codes will go into effect January 1, 2017.
97161 Low Complexity Evaluation, 97162 Moderate Complexity Evaluation, 97163 High Complexity
Evaluation, and 97164 Re-evaluation. The payment will be the same for all of the initial evaluation
codes. All evaluations will require functional outcome measures. The 4 components that determine the
severity and complexity are: patient history (medical and functional, including co-morbidities);
examination and the use of standardized tests and measures; the clinical presentation of the patient; and
clinical decision making.
The Comprehensive Joint Replacement Program, CJR, began April 1, 2016. There are 67 designated
regions where hospitals will receive a bundled payment for lower extremity total joint replacements.
None of those regions are in West Virginia. The program is mandatory and has been implemented very
quickly from the final rule in November of 2015 to its beginning in April. The program was implemented
because LE Total Joint Replacement is one of the most common inpatient procedures with 400,000
procedures in 2014 at a cost of $7 B for the hospital portion. The hospitals are on the line for the bundled
payment, which will include services provided 3 days before surgery and 90 days after. In 2016 they will
be paid as always and in 2017, once the target price has been determined, the hospitals will be notified as
to where they stand. There will be 4 target prices. In 2017 hospitals will not have to pay if they exceed
the target price. In 2018 the payback is limited to 5%, 10% in 2018 and 20% in 2019 and 2020. Physical
therapists in private practice will still be able to see those patients and bill Medicare as they always have.
Medicare will not recoup payments from independent providers. Patients may be directed to a provider
by the hospital, but patients do have the choice of where they go. PTs can enter into a CJR Model
Collaborative Agreement with a hospital (28 pages) in order to share the risk with the hospital. With the
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agreement a provider will be subject to the downside paybacks and the upside gains. Those monies will
be received or paid out to the provider by the hospital. At this time hospitals can only collaborate with
individual therapists not therapy groups.
CMS also proposes to extend the CJR bundling provisions beyond total knees and total hips (TKR/THR) to
include patients undergoing surgical hip and femur fractures treatment (SHFFT) episodes, seeking to
complete the transition to episodic payment for the surgical treatment and recovery of the significant
clinical condition of hip fracture. The program is to launch July 1, 2017 and last 5 performance years
through December 31, 2021. This proposed rule also focuses on implementing mandatory retrospective
episodic payment models for care associated with bypass surgery and heart attacks.
Updates from 2016 State Policy and Payer Forum
Medicare Trust Report 2016
55.3 M people covered
$647.6 B spent yearly
$644.4 B income yearly
Estimated depletion by 2028
PT spending per MC fee schedule
97110
$1.3 B.
97140
$550 M
97112
$300 M
97530
$800 M
97001.
$200 M

9%
8%
5%
4%
8%

South Carolina anti-POPTS legislation. The SC Supreme Court reversed Board of PTs ability to sanction
PTs who worked for POPTs on procedural grounds, not constitutional.
Affordable Care Act Exchange Updates
CIGNA and Anthem have losses, if they don't get a rate increase they will discontinue
participation.
Humana is decreasing participation
UHC/Aetna are making major cut backs. UHC will only continue in 3states or less
Aetna is going from 15 to 4 states, VA, IO, NE, and DE.
Highmark is suing the Federal government.
Wanda Evans, Workers Compensation National Trends
Employers cost have increased by 19.8 % since 2010
65-85% of workers get Opioids, more appropriate treatment would be OTC meds and
PT
10-15% of LBP patients drive close to 75% of the cost of associated medical costs
and loss of productivity.
Money is wasted on poor care and unnecessary surgery and imaging

THANK YOU TO OUR 2016 SPONSORS

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NEWS FROM THE EDUCATION COMMITTEE

KRISSY GRUBLER PT, DPT and KIMERAN EVANS PT, DPT
WVPTA Education Committee Co-Chairs

The education committee has been planning for a fantastic Annual Conference 2017!
We will welcome Dr. Chad Cook who will be presenting Monday Morning Management of Neck Pain.
Chad Cook, PT, PhD, MBA, FAAOMPT is the program director and a professor in the Doctor of Physical
Therapy division at Duke University. Dr. Cooks passions include refining and improving the patient
examination process and validating tools used in day-to-day physical therapist practice. He has
published over 200 peer-reviewed papers and has two textbooks in their 2nd edition and a third
textbook in its 1st edition. His work has been cited over 4000 times and he has presented over 180
clinical workshops on six continents and 16 countries.
This course will break down the different types of neck pain, best examination and treatment choices,
and the role of management of the patient throughout the health system.
PLEASE register early and reserve your spot by December 2016. We will be opening up registration to
surrounding states January 2017.
We are looking forward to seeing all of you in April!

TREASURER UPDATE
MATTHEW MADRID, MSPT
WVPTA Treasurer
I look forward to serving as the new treasurer for the WVPTA. I would like to thank outgoing treasurer
Eric Shaw, PT for his time in making this a smooth transition.
The WVPTA Executive Committee approved a budget for 2016 that includes spending of $79,750.80, with
expected revenues totaling $86,000. As of 9/19/16 the Chapter has a total of $121,860.33 in its asset
accounts including cash and investments. Total revenue sits at 82% of 2016 projected goals.
It is important for members to have an understanding of how their dues are being used, and to know that
the Chapter takes very seriously its financial responsibility to spend those funds appropriately and
wisely. Dues income makes up 47% of the WVPTAs revenues. The rest comes from Chapter-sponsored
events like the Spring Conference and Fall CEU offerings, partnerships, and advertising. The Annual
Conference at Stonewall Resort was well attended and exceeded the projected goal.
The WVPTA pays its highly-skilled Executive Director and Lobbyist, both of whom are critical to the
success of our Chapter. Our executive director from West Virginia Lobbyist Group was able to negotiate a
$1,500 credit secondary to the A/V issues at the Spring Conference. This is an important example of how
the Chapter provides value to its members!
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In the upcoming month, The Executive Committee will be in the process of completing a budget for next
year. APTA bylaws require a yearly audit report done by a professional audit firm or peer review. A
compilation audit of the WVPTA for 2015 is currently being conducted by Tetrick & Bartlett, PLLC. If any
members would like copies of our financial reports they are available though the WVPTA offices. This
includes our tax return, statement of revenue and expenses, and balance sheet. I look forward to
continuing to serve you as WVPTA treasurer. Please feel free to email me with any direct questions you
may have at Madrid.AffiliatedPT@gmail.com.

NEWS FROM THE

PRACTICE COMMITTEE
RHONDA HALEY PT, DPT
Practice Committee Chair

#ChoosePT
The APTA is conducting a
national awareness campaign
emphasizing the option of
choosing physical therapy
services to help a person
manage pain. The Centers for
Disease Control and Prevention has been urging health care providers to use safe alternatives such as
physical therapy in the treatment of pain instead of prescribing opioids. In some situations, prescription
opioids are an appropriate part of medical treatment. However, the risks associated with opioid use can
include depression, overdose, addiction, and withdrawal symptoms when stopping usage. In addition,
people addicted to prescription opioids are 40 times more likely to become addicted to heroin.
The APTA website has many resources to assist with this campaign. Please visit the APTA home page to
find this topic or go to http://www.moveforwardpt.com/ChoosePT. Here are a few of the topics within
the campaign that you can utilize to educate others:
Opioids vs Physical Therapy - Learn when to #ChoosePT.
9 Things to Know About Pain - Pain intensity and injury severity don't always match.
7 Staggering Statistics - Explore stats about the opioid epidemic.
Assess Your Pain - Use this chart to help determine your care.
Find a Physical Therapist - Search our national database of physical therapists.
How Physical Therapists Manage Pain - Learn about safe and effective treatment.
Campaign Toolkit - Support the #ChoosePT campaign.

The WVPTA Board is working within the state to promote the #ChoosePT campaign. Please contact the
President, Carrie Abraham, or any other member of the Board in order to find out more about this topic
or to learn how you can assist with this campaign.