Keeping up with Health Care Reform(s)!
Wherever I go whether it is to a hospital- large or small, a private Practice or a Birth-3 provider’s office- I hear the same questions: How do I keep up with what’s going on in the healthcare scene? And how will this all effect me? What is APTA?WPTA doing on my behalf?
HealthCare Reform:
Fortunately, the APTA has a up-to-date resource page that not only provides current written information but timely podcasts on reform as it pertains to PT & links to government websites that provide greater detail & a broader perspective. It can be found @ www.APTA.org/healthcarereform. Any news shared now will be trumped by September updates!
Medicare Reform:
WI is scheduled to have its Medicare claims management consolidated under a single Medicare Administrative Contractor- Noridian The implementation period of Noridian Administrative Service's J6 Medicare Administrative Contractor A/B contract began January 7, the day the Centers for Medicare & Medicaid Services made the award announcement. The transition date is expected to be set for no later than March, 2010. On the transition date, Noridian Administrative Services will begin processing Part A and Part B Medicare claims home health and hospice claims for Wisconsin.
This change is pending a decision on a formal protest filed. Please watch the WPTA website for updates. When the change occurs- their will be new Local Coverage Determinations (LCDs) for consideration.
New 2010 Proposed Fee Schedule:
On July 1, 2009, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2010 Medicare physician fee schedule rule that updates 2010 payment amounts and revises other payment policies. The public will have until August 31 to submit comments in response to this rule. On behalf of its members, APTA will submit comments in response to this rule. After reviewing public comments, CMS will publish a final rule by November 1, which will become effective for services furnished during calendar year 2010. APTA has a link for ongoing updates for members: www.apta.org/medicareupdates.
PTs may anticipate:
- A net decrease in Medicare Reimbursement of approximately 10% in 2010. Continuing access to Medicare PQRI payments for Pts
- The exceptions process to the Medicare CAP is being revisited.
- Both Cardiac & Pulmonary Rehabilitation coverage for Medicare Part B after January 1, 2010.
RAC Audits:
In addition, WI Physical Therapists serving Medicare recipients across settings may anticipate visits from Medicare Recovery Audit Contractors- RACS- See more detailed information in the July 2009 PT Connections Edition for Members.
New IRF Guidelines :
CMS released new Guidelines for CMS released the Inpatient Rehabilitation Facility (IRF) fiscal year 2010 final rule in the Federal Register on August 7, 2009.
APTA has posted comprehensive summaries of the inpatient rehab facilities (IRF) and skilled nursing facilities (SNF) final rules that were published by the Centers for Medicare and Medicaid Services on its website for Members. Both rules will have major implications on the manner in which physical therapists practice in these settings. Of note for SNFs are significant provisions related to changes in the documentation and provision of concurrent therapy, elimination and modification of therapy sections of the MDS, expansion of case-mix indices, and transition to the new MDS 3.0 and RUG-IV models. As for IRFs, there are significant changes to pre- and post-admission screening requirements, team conference meetings, and physician involvement and oversight.
Wisconsin Medicaid:
Medicaid Rate Reform Project – The Department of Health Services has been conducting discussion groups of stakeholders, including WPTA, regarding ways to reduce costs within the Medicaid program. WPTA has been at the table for these discussions and solicited WPTA membership input during the earlier meetings. After synthesis of ideas from all stakeholders, DHS is proposing a number of initiatives to reduce expenditures and balance the budget. Of those initiatives, plans may include reduction in payments to Critical Access Hospitals, realigning the Medicaid fee schedule to be no higher than current Medicare rates or below and the addition of audit positions to generate an additional $5million in savings.
Another important initiative involves a move to paperless Medicaid, including Electronic Funds Transfers for providers along with other paperless options.
A message from State Medicaid Director, Jason Helgerson, regarding this project can be found at this link.
Prior Authorization – A group of stakeholders has met with DHS to begin assessing the effectiveness and possible redesign of the prior authorization (PA) process. Stakeholder groups, including WPTA, will be continuing discussions and work on this project in fall 2009.
Spell of Illness Prior Authorization (SOI/PA) – WPTA is working with the Department of Health Care Access and Accountability (DHCAA) on revising the diagnosis codes eligible for using the SOI/PA. WPTA membership was influential in identifying additional codes that meet the criteria for inclusion in this shortened PA document. We hope to have a final decision some time this fall 2009.
Throughout the year, keep up to date on what’s happening with the Wisconsin Medicaid program by accessing information on the WPTA website Reimbursement page or on the ForwardHealth web page located at http://dhs.wisconsin.gov/ForwardHealth/
As a member, you also have access to WPTA MA Committee members for answers to your questions. Contact the WPTA office for more information. Our committee members include Lori Dominiczak (Chair), Ange Baeten, Bill Born, Jeb Husmann, Julie Kerk and Lynn Steffes.
Wisconsin Worker’s Compensation: Did you know that Wisconsin consistently out performs other states in its return-to-work Worker’s Compensation Management? Physical Therapy is a big part of keeping our workforce active & working despite injury risks. In the past 3 years, Work Comp rehabilitation has been under increasing scrutiny in Wisconsin for increasing costs for medical/rehabilitative services. The WPTA has “been at the table” providing input to the Work Comp Advisory Committee & participating through one of our Members: Laurie Pollack, PT Aurora. We have provided input on the new Medical Management Guidelines (See PT Connections January 2008 Edition available to Members on the Website for detailed information.) & on potential changes in the fee schedules which are the most current issue.
Facts about WI Work Comp:
- Avg total cost per claim grew rapidly for four of the five years in the study period in 2006/2007, medical costs per claim increased by 11 percent, driven by growth in costs per claim to both non-hospital and hospital providers.
- Growth was driven primarily by the increase in the medical payments per claim. Medical costs per claim with more than seven days of lost time grew throughout the study period, with double-digit growth in four of the five years in the study period, including 14 percent in 2005/2006.
- Avg total cost per claim in Wisconsin was among the lowest of 14 states - 36 percent lower than the median of the study states for 2003/2006 claims.
- Wisconsin had the highest average prices paid among the study states, but this was offset by lower utilization of medical services.
- Factors playing a significant role in the lower cost per claim including: faster return to work; much lower permanent partial disability (PPD)/lump-sum payments per claim; and among the lowest expenses per claim for delivering indemnity and medical benefits to injured workers.
Workers Compensation Research Institute (WCRI) 2008
As a result of escalating medical claims charges, Management & Labor are currently considering proposals to set upper limits on the fee schedules that will slow the growth of charges. At a June 5, 2009 meeting of the Medical Advisory Committee- healthcare liaisons passed out proposal to "freeze" current prices and then grow them based on the Medical Cost Price Index would continue to guarantee Wisconsin both access to injured workers and the finest medical care for WC in the country while addressing cost issues.
Apparently, at this point the "drop dead" date for arriving at some type of agreement to present to the legislature is September 30th. WPTA will keep you posted via the website on further developments.
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