April 2017 Newsletter

PRESIDENTS COLUMN
CONTENT
Presidents Column
Education Committee
Update
Insurance Updates
Communications
Committee Update
Treasurer Update
Federal Affairs Update
Student Update: CSM
2017
CARRIE ABRAHAM PT, DPT, MPH
PRESIDENT, WVPTA
On a dreary, rainy Friday morning in March, I had the pleasure of
speaking with the graduating class of Physical Therapist Assistants at
Pierpont Community Technical College alongside WV PTA Caucus
Representative Bryanna Ordiway. When getting to know the class a bit,
we determined that everyone in the room was from WV and planned on
staying in WV to practice except for my new friend from Illinois!
Bryanna did a wonderful job talking about the role of our professional
association both at a national and state level. She outlined the areas
within the association for PTAs to be involved and have a voice. We
talked together on the importance of the continuation of the PT/PTA team
and the need to advocate for its sustainability both with payers and in the
legislative arena. We described the importance of having a passion for
what you do, believing that it matters and has value, and being willing to
fight when an injustice hits it - taking that fire that you get deep in your
stomach and turning it into something that impacts change. We stressed
that in a professional organization it takes all members working
together to affect that change for the long term good. I hope that they
heard the message and are willing to join the movement!

Now, I sit here today on an absolutely beautiful, fresh spring day thinking
again about those same students. How they have successfully completed
another one of lifes challenges graduating from college and are preparing to rise up to an amazing
journey within the Physical Therapy profession. It is my favorite time in the continuum of education for
students in PT and PTA programs - a new start, a fresh start one with so many opportunities lying
ahead.

Such is spring for all of us. It is a time for renewal, rebirth, rejuvenation and opportunity. Personally, this
time of year brings to me a sense of cleansing. It is a time to stop, take a deep breath and let go of the
things that may be holding me back from new opportunities. Professionally, I get that same renewal from
taking some time away to gather with colleagues and break from the hustle and bustle of life in the work
place. Together, we can allow our minds to open, challenge our old notions and expand our minds to
accept new ideas. What a great opportunity that we have in WV every April to do just that. See you at
Annual Conference.

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

We are one week away from our Annual Conference (April 21 through the 23rd) and we could not be
st

more excited! Our keynote speaker (Chad Cook, PhD, PT, MBA, FAAOMPT) is nationally renowned and
excited to bring his contemporary approach to practice to the members of our state. Cervical spine
dysfunction affects all of our patients, regardless of age and setting. It is not too late to register so please
visit our website for further details (www.wvpta.org).

Annual conference attendees: we have added a question and answer session with the WVATA President,
Drew Mason, Saturday morning. In light of this, we will need to cancel the group hike planned for
Saturday morning. We apologize in advance for any inconvenience.

We are also excited to announce that we will soon be offering an online continuing education to our
members. Please stay tuned for further details this summer!

Hope to see you at Stonewall Resort next weekend!

INSURANCE UPDATES
SALLY OXLEY, PT, OCS, CHT, CMDT
WVPTA Payer Relations Committee Chair

Workers Compensation Case management for workers compensation patients is continuing to be

less and less. There are long waits with some carriers for patients to get imaging and rehabilitation
approved. Most carriers are accepting the new evaluation codes.

Highmark Highmark reported they did not enter the new evaluation codes in their system in January,
so it has taken until April to get paid for some January claims. Payments for those codes have been slow
and inconsistent. Since Highmark has eliminated their provider representative program, the only
recourse we have is to call and leave a message or access online through Navinet. We are told we should
get a response within 30 days. As we expected the West Virginia plan is more closely aligned with the
Pennsylvania plan with poor provider customer service. Highmark used to be one of the easiest to deal
with and it now the most difficult.

Medicaid The problem that providers are seeing is participants can change plans every month if they
choose, and it is hard to keep up with who to bill, Molina, Aetna Better Health, WV Family Health, the
Health Plan, WV CHIPS or Unicare. Participants change because different plans cover different services.
Our payments for the new evaluation codes are being paid fairly consistently by all but, Aetna Better
Health and WV Family Health. Pay close attention to the authorization requirements. Some require that
the authorization for treatment must be submitted within 24 hours of the initial evaluation. If that
window is missed they will not pay for the evaluation.
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Medicare If a patient is being treated for an injury that occurred as a result of an accident and there
may be another payer responsible, providers must submit an MSP (Medicare Secondary Payer ) Form to
let Medicare know. They will then contact the patient and the attorney, if there is one, and subrogate
their fees. If this is not done and Medicare discovers this after they have paid the provider for treatment,
they will recoup their payments and it will be incumbent on the provider to try to get paid from the
patient.

Aetna Aetna has informed Medicare providers that an ABN, Advanced Beneficiary Notice, is not valid
for Medicare Advantage Plans.

COMMUNICATIONS COMMITTEE UPDATE

BRANDON BEACOM DPT
Communications Committee Chair

Dont forget about the WVPTA 4th

ANNUAL GOLF SCRAMBLE ON APRIL
21st, 2017 @ THE PALMER COURSE
STONEWALL RESORT!
THAT MEANS THE SCRAMBLE IS ONE
WEEK AWAY!!
Its the perfect time to hit the green,
especially if you are already planning on
attending the WVPTA Annual Conference
@ Stonewall Resort that same weekend.
Refer to the image to the right for more
information. Visit
http://wvpta.org/events.html#golf-
scramble-registration to register you
and/or your team!
For more information, please contact
Johnna Gaunch at info.wvpta.org OR
Brandon Beacom at
beacom2012@gmail.com.

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 The WVPTA is supporting the APTA in their national awareness campaign emphasizing the option of choosing physical
therapy services to help a person manage pain. The APTA website has many resources to assist with this campaign. Go
to http://www.moveforwardpt.com/ChoosePT for more information. The WVPTA Board is working within the state to
promote the APTA #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.

TREASURER UPDATE
MATTHEW MADRID, MSPT
WVPTA Treasurer

Current Issues or Concerns Raised from executive committee meetings and/or chapter members.
a. (Executive committee conference call (2/28/17 )

What are APTA recommendations for chapter checking account balances?

What is the % return on investments in WVPTA Morgan Stanley account?

Response to questions from executive committee meetings and/or chapter members.

APTA recommends investments held for reserve is 40%-55% of the revenue budget of any given year.
2017 revenue budget = $92,700 x (40% -50%) = $37,080 to $50,985

Year Year End Checking Balance

2012 21,048
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 2013 31,146
2014 35,306
2015 54,171
2016 61,911

Regarding Morgan Stanley investment account:

Initial contribution in March of 2005 = $50,000

6 deposits made totaling $700
1 Withdrawal in 2011 for $10,000
Balance as of 2/28/17 = $64,649.72

Recent Treasurer Activities Organize and oversee peer review audit for 2016. Prepare and file 2016
tax return before 5/15/17

Financial Position (12/31/16) Current Assets

Cash & Cash Equivalents 61,911
Marketable Securities 62,090
Total Current Assets 124,001
Total Liabilities ----- 0 -------

Unrestricted Net Assets 124,001

Total Net Assets 124,001

2016 Total Liabilities & Net Assets $124,001

2015 Total Liabilities & Net Assets $114,478

Final Comments Feel free to contact me at Madrid.AffiliatedPT@gmail.com

Current net revenue over expenses as of 4/06/2017 = $5,197.03

FEDERAL AFFAIRS UPDATE

ERIC TARR PT, DPT, MBA, OCS
Federal Affairs Committee Chair

I was able to attend the Federal Affairs Forum on behalf of the WVPTA the week of March 27th. Physical
therapists and physical therapist students from across the nation attended the meeting. The following is
a brief, ticker tape style summary of the information shared to the students, Federal Affairs Liaisons, and
Section Liaisons during the meeting. Following the meeting, as your Federal Affairs Liaison, I met with US
Senator Shelly Moore Capito and US Congressman Evan Jenkins to discuss the issues near the end of the
summary.
Representatives of the National Journal Network Science Initiative presented flow diagrams of the Trump
leadership teams relationships to help predict policy initiative. The charts consider money flow, former
relationships, and current relationships from person to person and person to entities. For example,
Mariana McMahon is tied closely to Kelly Ann Conway and involved in opioids addiction / pain
management publications. Vice President Pence is driving the bus on CMS and Medicaid as evidenced by
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his influence on appointments. The appointments are highly focused on Medicaid and have very little
Medicare experience. The implication is that Medicare could see Medicaid-like policy initiatives. For
more info go to https://www.nationaljournal.com/bp/642867/network-science-
initiative?mref=recommended-6 .
Advanced Alternative Payment Models (APM's) are being sought from providers that can be implemented
nationwide. Advanced APMs give the practitioner a 5% bonus for taking risk on payment for quality vs
quantity. To be involved with an APM the practitioner must be using a certified EHR that uses quality
measures comparable to MIPS, that either is a medical home model or requires participant to bear more
than a nominal financial risk. Qualifying APM participants are called QP's. In 2021, all payers will be
considered for sufficient volume to qualify as an APM. Payment is made as a lump sum payment.
Examples of current Advanced APM's are on www.qpp.cms.gov.
Physician-Focused Payment Model Technical Advisory Committee (PTAC) advises CMS secretary as to
what models should be considered for APM. The APM must be small scale first but can be scaled
largely. The primary test is "Does it reduce cost and improve quality if expanded nationally?" PTAC is
leaning toward paying for populations of patients rather than paying for episodes, especially with
medical home models.
APTA also acknowledges that Federal Affairs Liaison (FAL) communication between chapter and APTA
can be improved. APTA recommends that if FAL communications to chapter at large is a problem,
consider how FAL is structured into the chapter. They ask, should the committee be Government Affairs
rather than State Affairs and the FAL sit on the Government Affairs committee? The group had several
ideas but no consensus. APTA shared that they have a monthly FAL call, and FAL needs to be connected
to component leadership. This FAL call occurs monthly at the same time and place. Additionally, APTA
has a government action app: APTA Action by Beekeeper Group that can be found at
https://appsto.re/us/CuuvR.i The app is more quickly updated than APTA website. There were
complaints from FAL's that website info is old relative to the info in the app. Individual states can
populate the state data.
APTA suggests chapters to have a key contact from each congressional district funded to attend the
Federal Affairs forum in the state chapter budget. APTA only pays for the FAL. Student retention as
members once licensed is dramatically improved for students who attend the Federal Affairs Forum.
Some chapters are also having success with National Advocacy Dinners and inviting students. There is
good student involvement with the advocacy dinners when students' dinners are free. Having legislators
attend is a must.

Regulatory Affairs:
Drive is toward collaborative models that take in patient populations rather than fee for
service. Payment will be moving toward alternative payment models, tied to quality, with data used to
drive quality care. Payment for episode of care data showing improved outcomes at less expense. More
information is available at www.ptoutcomes.com.
Mark Shields, https://en.m.wikipedia.org/wiki/Mark_Shields , a long time journalist that worked with
multiple Presidents spoke to the future of USA leadership. He said most always, you can divide the
electorate into two camps, the ideologue and the pragmatist. "The ideologue says, 'What is right is what
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works.' The pragmatist says, 'What works is what's right.' He acknowledged the need for the skills of
physical therapists in the very near future to be part of the solution for opioid addiction. Mark said, "The
USA is 5% of the world's population but consumes 85% of the world's opioids. Physical therapists must
be involved.
A major judicial victory was achieved for Medicare physical therapy recipients on February 2, 2017. The
court ordered Medicare to stop denying claims based on plateaus, including among 10 requirements the
following: CMS disavowal of the improvement standard, a dedicated CMS webpage to the ruling, CMS to
post one set of FAQs, CMS to post a corrective action statement, CMS to clarify summary of national call
for contractors and adjudicators (Dec. 16, 2013), CMS to direct Medicare Administrative Contractors to
conduct additional training on manual clarifications.
Therapy Cap repeal might happen this year. Sponsors are saying, "An arbitrary cap should not determine
if a person needs physical therapy." HR 807 and S253 have 85 house sponsors and 19 senate sponsors
respectively.
HR 1639 S619: authorizes PT's to be added to the National Health Services Corps Loan Repayment
Program to address the shortage of physical therapists in healthcare delivery system. Last profession
was added in 1989. They acknowledge that the required education for a physical therapist has increased
from 4 to 7 years. We have no problem competing with others in the program. The program incentivizes
meeting needs of underserved areas based on services most needed. The cost of adding PT is neutral.
HR 302 has passed house. It allows malpractice liability insurance to cross state lines when PT's and
other professionals travel with sports teams.
The Safe Play Act of the 114th congress amends The Elementary and Secondary Education Act to require
a state to develop guidelines that address the prevention, identification, treatment, and management of
concussions in school aged children and include physical therapists in return to participate in decision
making. Talk to members of congress and ask if they would be willing to work on a path forward with
this legislation. It has not been introduced as a bill yet.
Regarding APTA's position on ACA, there is an emphasis on maintaining access to rehabilitation. We have
great concern with removing essential health benefits. With regards to Medicaid, APTA has concerns
regarding access. Further, the APTA is concerned about insurers pulling out of exchanges and premiums
skyrocketing. However, APTA has made no formal position statement due to the topic being so politically
charged at the moment.
#choosePT is a national PR campaign to help combat the national prescription opioid epidemic. There
are PT provisions in S524/HR953-- the Comprehensive Addiction and Recovery Act.
HR1421 and S568 address Medicare access and observation policy and are supported by the APTA.
If you have any questions or would like to follow up on a certain issue come to the Spring Conference
Round Table sessions. Ill be there for discussion on federal affairs.

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STUDENT UPDATE: COMBINED SECTIONS MEETING 2017

Student #1: Kari Sims, SPT (WVU)

I am so thankful to the WVPTA for helping me finance my trip

to the Combined Sections Meeting in San Antonio! It was such
a fun and educational experience. I did my best to go to a
variety educational sessions. I went to a couple of womens
health classes, a couple of neurologic courses, an orthopedic
class, and a couple of those put on by the geriatric section! I
even met the head of the womens health section in the
airport on the way to CSM! It was so awesome to be part of
the biggest combined sections meeting yet! To be around
thousands of people interested in the same things Im
interested in was exciting! It seemed like everywhere I turned, even outside of meeting times, there was a
PT! A vast majority of students in my class attended CSM this year, so West Virginia was well represented
in San Antonio. When we returned to class the following week, we each told the class something that we
had learned while we were at the conference. It was nice to learn something from each other and see the
diversity of interests that exist amongst the class. I could not be more thankful for the opportunity to
attend this conference. I cant wait until next year!

Student #2: Kristen Whorter SPT (WVU)

Thanks to a scholarship provided by the WVPTA, I was able to

travel to the 2017 Combined Sections Meeting in San Antonio, TX.
As a 3rd year WVU DPT student, traveling to this conference was an
opportunity to explore the newest evidenced based practices,
network with other students and professionals from across the
nation, and explore a new city along with its culture. San Antonio
was a very welcoming city to the 14,000 PT/PTAs in attendance.
During the day, I attended various educational sessions and had the
opportunity to listen to distinct leaders of our profession. I made
an effort to attend a variety of sessions to expose myself to topics
that I had not covered within my curriculum at WVU. I found this
approach to be very enjoyable as it made the conference feel
diverse and allowed an opportunity for me to meet other young
professionals like myself. During the evenings, my classmates and I were able to enjoy the highlights of
San Antonio such as The Alamo, the River Walk, and the numerous local restaurants serving authentic
Tex-Mex and home-style barbeque. I would like to thank the WVPTA for this wonderful opportunity and
their continued support of our profession.
5 takeaways from CSM 2017:

1. Challenge yourself and your colleagues 4. Continue to support the APTA and #ptfam
2. Share patient victories 5. Proper dosage matters
3. Manage expectations/beliefs