It’s Monday, April 2nd, and here are some headlines impacting PT this week. First off, the Health Policy and Administration section of the APTA is looking for nominations to their board of directors. ATI Physical Therapy was victim to a data breach putting patient info at risk, the Office of the Inspector General warns of hundreds of millions in potentially improper reimbursements by CMS for Physical Therapy, Cigna, and Blue Cross Blue Shield work to reduce the number of opioid prescriptions, and we have state updates from Illinois and West Virginia.
Finally, Rachel Jermann sits down with Joe Farrell, first president of the American Academy of Orthopedic Manual Physical Therapists. Let’s get down to it.
HPA The Catalyst is Looking for Board Members
Are you even half as interested in health policy as Talus correspondent Ian MacMurdie? Well, you are in luck because the Health Policy and Administration Section of the APTA is looking for nominations for board membership. Applications are due April 13th, so if you or anyone you know is interested, be sure to fill out their form here.
ATI Physical Therapy Hit with Major Data Breach
ATI Physical Therapy was the victim of a phishing incident that may have exposed intimate information of up to 35,000 of their patients nationwide. The company, one of the largest PT providers in the nation with over 600 clinics in 24 states, noticed that several employee email accounts had been improperly accessed. This breach, which potentially exposed drivers license and social security numbers, as well as protected health data, has been reported to the Department of Health and Human Services. If you’re an ATI patient or know of anyone that has been one, you can find out if you’ve been impacted by calling 855-828-5850.
OIG Warns of Potentially Improper Reimbursements by CMS
The Office of the Inspector General has recently filed a report that CMS overpaid Physical Therapy claims by 367 million dollars in a 6 month period of 2013. The report stipulates that many claims that were paid did not adhere to stringent documentation and coding standards put forth by CMS, and were improperly reimbursed. The OIG has made several recommendations including informing providers about the discrepancies, and about further educating providers on proper coding. It is worth noting, however, that CMS has disagreed with these recommendations, and claims further investigation is required before concluding that these claims were improperly paid.
The American Physical Therapy Association was asked for a comment on this story and have responded with a statement. The “APTA is committed to ensuring that outpatient physical therapy services meet Medicare coverage and payment requirements. As noted by the Centers for Medicare & Medicaid Services (CMS), several of the findings in the OIG report do not align with CMS payment policy and further analysis of the sampled claims is warranted. APTA is also concerned that the OIG interpretation of CMS’s coverage policy for outpatient therapy services relative to “significant improvement” is contrary to CMS policy and the court-approved settlement in Jimmo. Given the potential for misinterpretation of Medicare policy on outpatient therapy services and the role of physical therapists, it is important to include a physical therapist as part of the team conducting such reviews.”
Insurance Companies Work to Reduce Opioid Prescriptions
Two major insurance companies are making strides to reduce opioid prescriptions they reimburse for. The Blue Cross Blue Shield Association, who insures over 100 million Americans, launched an education platform for physicians in their network that recommends opioid pain medication not be the first or second-line treatments for pain management. Cigna, another major national insurer, announced earlier this week that similar education measures have reduced opioid prescription reimbursements by 25%. Both insurers cited adherence to recent CDC guidelines recommending non-pharmacologic therapies for pain management – including physical therapy.
State Legislative Updates
The opioid crisis has hit no state harder than West Virginia. Their state legislators are fighting back, however. Governor Jim Justice signed the Opioid Reduction Act into law last week after the bill had been passed nearly unanimously by both houses of the legislature. Featuring limits on opioid prescription duration and mandatory referral to non-pharmacologic treatments, as well as insurance coverage mandates for said treatments, the law intends to dramatically cut down on the rate of addiction from prescribed opioids. The law is set to go into effect in June.
In Illinois, a bill providing Direct Access has a hearing on April 10th. If you’re a PT or patient in Illinois and want to advocate for the bill, be sure to check out the IPTA talking points here.
Talus Media News is a subsidiary of Talus Media: PT Views & PT News. You can find all interviews mentioned in this newscast on our sister channel, Talus Media Talks. Check us out on Twitter & Facebook @TalusMedia.