February 2018 Newsletter

PRESIDENT’S COLUMN
CARRIE ABRAHAM PT, DPT, MPH
CONTENT PRESIDENT, WVPTA

• President’s Column On November 29, 2017 we lost a very
special human being. Nancy Tonkin
• WVPTA 2018 Annual passed away after a hard-fought battle
Conference Report with cancer. She was the executive
director of the West Virginia Physical
• WVPTA 5 Annual
th Therapy Association for many years
and a friend of physical therapy for life.
Golf Scramble Update
When I sit and reflect on what made
Nancy…well, Nancy – a long list of
• Insurance Updates
admirable traits come to my mind.
Nancy could be described as driven,
• Nancy Tonkin
fierce, loyal, compassionate, kind, persistent, virtuous, determined, loving,
Distinguished Service a visionary…the list could go on. These characteristics put together made
Award Nancy a one of a kind friend, executive, mentor, co-worker, advocate and
leader.
• WVPTA PAC “Spring
into Action Under her guidance, the WVPTA saw great successes and forged into a
new, modern era of association management. She guided the team
Run/Walk” Report through the turbulent waters of the legislative process of updating the
professional practice act. And in doing so, was able to assist in
overcoming challenges from those who were seeking to limit the scope of
physical therapy practice in West Virginia.

Nancy provided skilled guidance to our payer relations committee in their attempt to strengthen the
relationship between the physical therapy profession and insurance providers. The vision to see the
value in these relationships continues to benefit the physical therapy practitioners of our state today. She
facilitated the opening of doors that were previously closed, allowing us a path to continued dialogue in
the ever-changing world of health care reimbursement.

As a lobbyist, Nancy mentored young professionals in the skill of legislative advocacy by providing
educational sessions, visiting legislators alongside physical therapy clinicians and providing resources to
new advocates to develop the knowledge to be successful in creating change in health care policy.
Allowing the team to recognize that individual voices when heard with a common theme, can be
impactful! And they were!
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Under Nancy’s leadership, the WVPTA received the Best Small Chapter award by the APTA for the work
related to the successful passage of a modern and relevant physical therapy practice act, work to
establish and strengthen relationships with insurance providers in the state and creating a strong
organizational structure within the association that would allow the achievement of the organizational
vision and goals.

Nancy continued to provide consultative services to our association even after she was no longer our
executive director. Nancy did all that she did because she truly believed in the value that physical
therapists provide to patients and consumers of health care services in WV. She did it because she truly
believed in the capacity of the volunteer leadership team driving the WVPTA. She did it because she was
a winner. She did it all because she was a fierce warrior who never let a challenge get the best of her.
Nancy was a warrior until the very end. She will be remembered, she will be missed and we, the WVPTA,
will honor her by continuing to believe that our work has value, that the fight is always worth it and that
together, we can make a difference. Thank you for everything Nancy – God speed.

WVPTA 2018 ANNUAL CONFERENCE UPDATE

KRISSY GRUBLER, PT, DPT
WVPTA Education Committee Chair

WVPTA 2018 Annual Conference

April 21-22, 2018
Stonewall Resort, Roanoke, WV
12 CEU

Concussion and Mild Traumatic Brain Injury

Implications for the Physical Therapist

Anne Mucha, PT, DPT, MS, NCS
Coordinator of Vestibular Rehabilitation
Sports Concussion Clinic &
Centers for Rehab Services
University of Pittsburgh Medical Center

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Course Description

The CDC has determined that concussion is a high priority public health initiative, due to high prevalence
and potentially serious long-term consequences that may arise from incomplete recovery and improper
management. Most physical therapists, regardless of specialty (sports, orthopedic, neurologic, geriatric,
pediatric, federal, acute care, etc.), are likely to encounter patients with concussion in their clinical
practice. Despite its designation as a mild traumatic brain injury, approximately 20% of patients with
concussion may not experience a quick recovery, resulting in significant disruption to the performance of
work, school and life roles. The role of the physical therapist as a member of the team managing
concussion is integral, due to the frequency of cervical, vestibular, oculomotor and return to activity
needs encountered by these patients. This course will review the current information with respect to
pathophysiology, epidemiology and biomechanics of concussion, along with pertinent evidence regarding
diagnosis and negative outcome following this injury. A proposed framework for classification following
concussion will be discussed, along with screening, evaluation and management strategies to influence
the course of recovery following concussion.

Speaker Biography

Anne Mucha, PT, DPT, MS, NCS is the Coordinator of Vestibular Rehabilitation for the UPMC Sports
Concussion Clinic and Centers for Rehab Services. She is a board
certified clinical specialist in Neurologic Physical Therapy and has advanced certification in vestibular
rehabilitation. With over 20 years in treating individuals with neurologic conditions, she is also actively
involved in clinical research related to the evaluation and management of patients following concussion.
Dr. Mucha serves as a member of the CDC panel of experts to develop clinical guidelines for diagnosis and
management of mild traumatic brain injury among children and adolescents. She received her Bachelor’s
and Advanced Master’s degrees in Physical Therapy from the University of Pittsburgh; and her Doctor of
Physical Therapy degree from Temple University. Dr. Mucha is a national and international lecturer on
topics related to concussion and is an adjunct faculty member in the School of Health and Rehabilitation
Sciences at the University of Pittsburgh.

Conference Learning Objectives

• Describe the pathophysiology and epidemiology of concussion
• Discuss the latest research and guidelines related to concussion
• Describe factors that contribute to prognosis and outcome following concussion
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 • Identify common abnormal findings following concussion and potential interventions
• Identify methods for screening vestibular and ocular motor function
• Describe considerations for recovery following concussion
• Discuss the importance of a team approach in the effective management of individuals with
concussion and the role of physical therapists on the treatment team

CONFERENCE ACTIVITIES:

Friday, April 20th WVPTA Annual Golf Scramble

Please visit the WVPTA website (http://wvpta.org/events/#golf-scramble) for more information.

Friday, April 20th 8- 10 pm Welcome Reception and Wine Tasting

Saturday, April 21st 6:30 -8:00 pm PAC- First Annual “Spring into ACTION 5K run/walk”
The Political Action Committee is hosting its first annual “Spring into ACTION 5K run/walk” to raise
money for funding needed for political action(s) that occur during the year. The entry fee is $20.00 per
person. Appalachian Timing Group will be providing official time for the event. Everyone is welcome to
participate, however the deadline to pre-register and receive a tee shirt is March 23rd, 2018. Please visit
the WVPTA website (http://wvpta.org/events/#5K) for details. You can sign up the day of the event.
Donations accepted without entry in run/walk. To pre-register, volunteer, or help sponsor the event
please contact: Brad Profitt, PAC chair, at profitt2@marshall.edu or call 304-696-5619.
For more information and to view the conference flyer and register for the WVPTA 2018 Annual
Conference, please visit: https://www.wvpta.org/events.html

WVPTA 5TH ANNUAL GOLF SCRAMBLE

UPDATE
BRANDON BEACOM DPT
Communications Committee Chair

Don’t forget about the WVPTA 5th ANNUAL GOLF

SCRAMBLE ON APRIL 20th, 2018 @ THE PALMER
COURSE STONEWALL RESORT!
It’s 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. Sign
up your team HERE!
For more information, please contact Johnna Gaunch at
info.wvpta.org OR Brandon Beacom at
beacom2012@gmail.com.
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INSURANCE UPDATES
SALLY OXLEY, PT, OCS, CHT, CMDT
WVPTA Payer Relations Committee Chair

Highmark - Healthways is giving 12 visits with an authorization request for 2018, rather than the 8 they
gave in 2017.

Be sure all practice information has been reviewed and updated with Highmark for 2018. Provider
payments can be withheld if information is not updated.


Medicare – Congress failed to pass the repeal of the therapy CAP before they adjourned for the holiday
recess. The CAP will be $2,010.00 for 2018 with no exceptions process, so it is a hard CAP and the KX
modifier does not apply. The allowed amounts are applied toward the CAP, not the amount paid by
Medicare. The allowed amount includes the 80% paid by CMS and 20% paid by the secondary or the
patient. They will be back in session Jan 19th, so may act then. Keep your fingers crossed.


Humana – As of January 1, 2018 timely filing has been updated to 180 days, from the date of services.

Humana Medicare Advantage Plans and Commercial plans no longer require authorization. They will be
following Medicare guidelines where care “must require medical necessity”. Documentation will be
scrutinized so make sure all treatment is related to improvement of life skills/ function. Providers must
pay close attention to policy plan limits, referral requirements and dollar limit maximum.


Tricare – As of January 1, 2018 Tricare North and Tricare South are merging into Tricare East. Providers
must complete new EDI (electronic data interchange) and ERA (electronic remittance advice)
enrollments for Tricare East to submit claims electronically and receive ERAs for dates of service after
January 1st.

Also effective January 1st, 2018 Tricare claims are going to a new payer, Humana Military. Claims filed
prior to January 1st will still go to Health Net Federal. Be sure to check with your clearinghouse to see if
enrollment is required to file Humana Military.

The bill has been signed by President Trump to allow PTAs to treat (and bill) for patient care. However,
PTAs still cannot treat Tricare patients until the Department of Defense makes appropriate changes to
their policies and regulations.

Aetna - Carole Galletta, the payment chair from Pennsylvania, has reported that Aetna has significantly
decreased their payment rates in Pennsylvania, effective for dates of service 10/15/17 ongoing. In some
cases CPT code reimbursement has decreased by 60%. Watch your EOB’s and contact Sally Oxley
(soxley@hptservices.com) of the Payer Relations Committee if you see reductions in your Aetna
payments.

Kentucky’s Orange Envelope Law – In Kentucky if an insurer makes changes to their plan that produces
a decrease in reimbursement to providers, providers must be notified by mail in an orange envelope.
West Virginia is considering similar legislation.
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http://www.klsreports.com/ShowDocument.aspx?BTextID=195054
This is the link to Kentucky’s newly passed orange envelope law.


Jimmo v. Sebelius Settlement Agreement - On January 24, 2013, the U. S. District Court for the District
of Vermont approved a settlement agreement in the case of Jimmo v. Sebelius, in which the plaintiffs
alleged that Medicare contractors were inappropriately applying an “Improvement Standard” in making
claims determinations for Medicare coverage involving skilled care (e.g., the skilled nursing facility (SNF),
home health (HH), and outpatient therapy (OPT) benefits). The settlement agreement sets forth a series
of specific steps for the Centers for Medicare & Medicaid Services (CMS) to undertake, including issuing
clarifications to existing program guidance and new educational material on this subject. The goal of this
settlement agreement is to ensure that claims are correctly adjudicated in accordance with existing
Medicare policy, so that Medicare beneficiaries receive the full coverage to which they are entitled.

Thus, such coverage depends not on the beneficiary’s restoration potential, but on whether skilled care is
required, along with the underlying reasonableness and necessity of the services themselves. Any
Medicare coverage or appeals decisions concerning skilled care coverage must reflect this basic principle.
In this context, it is also essential and has always been required that claims for skilled care coverage
include sufficient documentation to substantiate clearly that skilled care is required, that it is in fact
provided, and that the services themselves are reasonable and necessary, thereby facilitating accurate
and appropriate claims adjudication.

The settlement agreement is intended to clarify that when skilled services are required in order to
provide care that is reasonable and necessary to prevent or slow further deterioration, coverage cannot
be denied based on the absence of potential for improvement or restoration. As such, any actions
undertaken in connection with this settlement do not represent an expansion of coverage, but rather,
serve to clarify existing policy so that Medicare claims will be adjudicated consistently and appropriately.

CMS will be updating their manuals and making clarifications.

THANKS TO OUR SPONSOR!

New Award Developed to Recognize Outstanding Service by a WVPTA

Member and Honor the Service Provided by Nancy Tonkin
By Scott Davis, Vice President

On January 9th the WVPTA Board approved a new award titled the Nancy
Tonkin Distinguished Service Award. The new award was developed to
acknowledge and honor an outstanding West Virginia Physical Therapy
Association member whose contribution to the profession of physical therapy
is of exceptional and enduring value and representative of the dedication and
service provided by the late Nancy Tonkin. The new award will be presented
for the first time in April 2019 at the WVPTA Annual Conference.
Nominations will be accepted starting in the fall of 2018 with a deadline of
December 1, 2018. To be eligible for the award, a nominee must be a PT or
PTA member of the Chapter for a minimum of 10 years and have made a
significant contribution to the physical therapy profession. The nominee must
have made a significant professional contribution in one or more of the
following ways: 1) through prominent professional leadership; 2) have
obtained state or national recognition and respect for professional activities;
3) helped advance the profession through education, practice, research or
advocacy; 4) served as a professional role model or mentor.
All nominations will be reviewed by a committee of three Chapter members,
and the awardee will be notified by February 1, 2019. The awardee will
receive a complimentary registration to the 2019 WVPTA Annual Conference
and receive an engraved plaque honoring their service at the annual meeting
luncheon. Please look for a call for nominations starting in the late spring or
early summer 2018. The call for nominations will outline the submission
process and all requirements for the nomination.

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STUDENT PERSPECTIVE: NATIONAL STUDENT CONCLAVE
HANK HAVLIN SPT
Wheeling Jesuit University

This year I was blessed with the opportunity to attend the National Student Conclave in
Portland, Oregon on behalf of the West Virginia Physical Therapy Association. Having never
attended a nation conference, I did not realize I was heading towards one of the most refreshing
and enlightening weekends of my career. Registration on the first evening was quick, allowing
for a bit of relaxation and exploration before the action-packed weekend ahead of me. The
following morning, however, was an eye-opening and busy beginning. Rising early on Friday
morning, I made my way towards the event. Having attended by myself, I was eager to meet
others who shared my same passion. I chanced upon a table of students running for Student
Assembly, a yearly position filled with some of the brightest most ambitious students in the field.
Each of these individuals had visions of advancing the profession and fulfilling the vision of the
APTA.

The conference started off with a wonderful keynote speech by the distinguished track
star and U.S. Olympian, Alysia Montano. Ms. Montano highlighted her tenacity for her craft, and
praising the benefits of physical therapy and how it helped her accomplish her dreams.
After thunderous applause, the conference was in full swing, with the exhibit hall opening to the
masses.

With every booth and sector of the APTA beaming with pride and passion, the energy in
the event hall was infectious. There were dozens of booths housing licensure preparation
companies, corporate and private practice clinics, and universities promoting their residency
programs.

My personal favorite was a booth highlighting a new intervention targeting the rotator
cuff musculature. Named the Shouldersphere, this tool was composed of two balls attached by
a base to your forearm. The outer shell was clear plastic allowing view of the smaller rubber ball
within. With small rotary movement, one would create rotation of the smaller ball around the
perimeter of the larger casing. Maintaining the rotation was enough to break a sweat, but why
stop there? One would then complete active motion of the shoulder, forward flexing, completing
PNF patterns, completing pitching or tennis serving motions, all while maintaining the rotation of
the smaller ball within the large. This was not only immensely enjoyable, but extremely effective
in targeting this muscle group providing a complete workout. Having personally suffered
shoulder injuries, resulting in my pursuit of this field, I could not resist the draw of unique
treatments.

It was hard to tear myself away from the exhibit hall, but I was hoping the seminars
would contain just as much exciting and innovative information. These seminars covered a
variety of topics, building a successful career in travel therapy, creating excitement to work in
geriatrics, and discussing the many unique pursuits of therapists. The scheduled events
concluded with a speech by the APTA’s Board of Directors President Sharon Dunn. Ms. Dunn
fielded questions from the crowd, as well as offering her sage advice to the next generation of
therapists.

Saturday was a day of inspiration. With talks discussing therapist roles as leaders and
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the wisdom of previous Student Assembly presidents, I found myself inspired to better myself as
a therapist both inside and out of the clinic. I ended Saturday with a clearer career path, inspired
to pursue further advancement of physical therapy and to get involved in anything and
everything that this profession has to offer.

The conclusion to the conference was the swearing in of the newly elected Student
Assembly Board of Directors. Having spent time with several of these individuals throughout the
weekend, I was elated to hear their names called and watch them take a leap forward in their
careers. They are bright, passionate individuals, and I am excited for what they will accomplish
during their time serving on the board.

I took a lot away from this weekend. I was able to network directly with residency
Programs. I met a great group of new people that I hope will stay in touch and become fast
friends. Most importantly, I revitalized my love for physical therapy. I have not felt this
enthusiastic about my chosen profession since I wrote the words “ I will be a physical therapist:
on a post-it note seven years ago. I highly recommend both national conferences and the
national student conclave. While the conferences are educational and great for networking, the
conclave may provide an even bigger benefit. I would urge all first year students to consider
attending. It is an excellent way to get involved and to be proactive about your profession.

I would like to extend an enormous thank you to the state of West Virginia, and all the
therapists a part of WVPTA, for allowing me this unique opportunity. This national conference
was a weekend that I will not soon forget, and I hope to attend again in the future. Between the
seminars, the exhibit hall, and the new friendships, I walked away with a new outlook on
physical therapy. It was an enlightening and invigorating experience that I will continue to replay
in my head for weeks to come.

WVPTA PAC “SPRING INTO ACTION 5K RUN/WALK” REPORT

BRAD PROFITT PT, DPT, DC, CSCS, CFCE, ITPT
WVPTA PAC Chair

A call for ACTION from the PAC,

The West Virginia Physical Therapy Association’s (WVPTA) Political Action Committee (PAC) is hosting
the first annual “Spring into ACTION 5K Run/Walk.” This race is set to occur at 6:30pm on April 21st,
2018 during the WVPTA Annual Conference at the Stonewall Resort in Roanoke, WV.

This event is a fundraising event for the PAC.

We are looking for runners and sponsors for this event. By running in the 5K during the conference you
will be promoting advocacy for the PT profession. By participating as a sponsor, your organization will
benefit from exposure through any electronic campaigns and promotional efforts directed toward the
participants/supporters of our race. You will also receive recognition during the weekend conference
course to all those attending, ensuring your exposure to those that are not participating in the 5K.

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We have four levels of sponsorship packages and thus you can select the level of participation that best
meets your needs, and be secure in the knowledge that your sponsorship fee will be used to help with
springing folks into ACTION for the PAC.

Thank you in advance for your willingness to support the efforts of the first annual “Spring into ACTION
5K Run/Walk” and make a difference in the PT community across the state of WV. Please contact the PAC
chair below for sponsorship opportunities or visit WWW.WVPTA.ORG/CONFERENCE2018 for more
information regarding signing up to run this race.

THANKS TO OUR SPONSOR!

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