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
60% Favorable: 46% 50% 40% Unfavorable: 46% 30% 20% Favorable Unfavorable 10% 0% '10 '11 '12 '13 '14 '15 '16 '17
7 Years Post ACA • 21.3 M insured through ACA • Uninsured Rate Historically Low (8.6%) Uninsured Drops • 155 M employer based, 77M Medicaid, 57M Medicare, 12M Exchanges Healthcare • 561 Hospital mergers since 2010 Consolidates • 33% of physicians employed by hospitals in 2013 • Healthcare costs expected to grew by 5.8% in 2015, expected to grow 6.5% in 2017 Costs Varied • Family of Four Out of Pocket Costs Exceed 25K, per capita cost $9,990 Changes • Replacement bill introduced and died in 19 days Proposed • Much can change administratively
7 Things to Watch in Physical Therapy in 2017 • CHIP re-authorization, including of other health care and Medicare 1 provisions (Therapy Caps) • 2 nd Generation of Quality / Payment Reform (MIPS, IMPACT, Bundling) 2 3 • Regulatory Reforms / Administrative Simplification 4 • More Narrow Regulation of Essential Benefits 5 • Medicaid Expansion / Retraction, including 1115 waivers • Individual Market Stabilization (7 States have one carrier on exchange) 6 7 • Changes to Individual Mandate (hardship waiver / penalties)
BUILDING MOMENTUM FOR NEXT CENTURY
• Choose PT / Opioid Epidemic Building Identity • MoveForward PT • Movement Summit • Physical Therapy Classification and Payment System Creating • Payment Reform (Bundling, IMPACT, ACOs) Relevance • Quality / Pay for Performance Models • Professional Integrity Campaign Value through • Physical Therapy Outcomes Registry Data • 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) 2012 2013 2014 2015 2016 2017 2011 First Application of MPPR Phase II (6- .5% increase (more Neutral Payment Neutral Payment 1% increase .5% increase MPPR (6-7%) 7%) for evaluations) 2-Tier Cap Exceptions Continuation of 2-Tier Cap Exceptions (last / Inclusion of Hospital Exceptions (Manual Caps Exceptions Caps Exceptions Cap Exceptions year) OP Department Medical Review) Functional Measures FLR Continues FLR Continues FLR Continues FLR continues Requirement MIPS benchmarking PQRS Penalty Phase PQRS Penalty Phase PQRS Penalty Phase PQRS Penalty Phase (no penalty / no Continues Continues Continues reward Sequestration (-2%)
Coding Driving Change • New Evaluations Codes PTCPS / APS • Interventions Delayed • 31 codes on list – 3 Groups went forward Misvalued Code • Congressional Mandated -2% reduction Initiative • Implementation – Jan 1, 2018 • Quality Programs (Transition to MIPS) Regulatory Requirements • Functional Limit Reporting
DEMONSTRATING VALUE TO POLICYMAKERS, PUBLIC, HEALTH CARE PROFESSIONAS & PAYERS
Integrity Registry / Quality in HSR Initiatives Practice Initiatives
Integrity in Practice Campaign Take Action Now PREVENT REGULATION ENHANCE REPUTATION 21
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 • Determine clinical • Guide payment policy practice patterns • Inform payment contract • Assess adherence to negotiations PAYMENT PRACTICE CPGs RESEARCH QUALITY • Demonstrate the value • Fulfill quality reporting of PT services requirements • Promote health services • Support quality research improvement initiatives
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 Fellowships Pilot Studies Conferences Scientists
5 FOR THE FUTURE
Increasing Competition Transparency Growing (pricing and Markets outcomes) Use of Data (intra / inter Partnership / Future professional / Collaborations provider)
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 over 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
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