WELCOME! 2009 KPTA Town Meeting

1. WELCOME!2009 KPTA Town Meeting Kansas Physical Therapy Association Topeka, Kansas 66603 785-233-5400 Fax: 785-290-0476 Email: kpta@kpta.com www.kpta.com

2. AGENDA • APTA Branding Campaign • Payment/Reimbursement Update: Local & National Issues • APTA Code of Ethics Update • 2010 KPTA Legislative Plan Update • KPTA Website Update 2

3. 2009 TOWN HALL MEETINGS • Pittsburg at Mt. Carmel Medical Center - Oct. 13 • K.C. at Shawnee Mission Medical Center - Oct. 19 • Manhattan at Mercy Regional Health Center - Oct. 22 • Wichita at Via Christi - St. Francis Campus - Oct. 29 • Topeka at Washburn University - Nov. 2 • K.C. at Olathe Medical Center - Nov. 3 • Great Bend at Advance Therapy & Sports Med. - Nov. 3 • Salina at Comcare - Nov. 5 • Colby at Colby Community College - Nov. 5 • SW Kansas via Webconference - Nov. 5 3

4. American Physical Therapy Association The Physical Therapy Brand Learn It. Live It. Share it. Wear it.

5. Brand Fundamentals Brands define expectation Brands live everywhere Brands are hard to create Brands are easy to destroy Brands can be influenced Brands are not fully controlled

6. A good brand evokes emotion. Good brands connect on a subconscious level.

7. A good brand is relevant. It makes a connection. It stimulates opinions. A good brand is consistent. A good brand is strategic.

8. So, how are we doing?

9. Evaluation of the Physical Therapist Brand • Existing Strength • Esteem: Is it held in high regard? • Knowledge: What is the level of understanding? • Potential • Differentiation: How distinctive is the brand? • Relevance: Is it meaningful to those who use us?

10. APTA conducted primary qualitative and quantitative research to assess the existing strength and potential of the physical therapist. We talked to: Consumers: Physical therapy Users and Non-Users MDs and Nurse Practitioners Insurers APTA Leaders and Members Legislators We evaluated: Macrotrends impacting consumer behavior Research Scope

11. Esteem: High Nearly 90% of all consumers have a positive impression of physical therapists 80% of physical therapy users likely to consider using a physical therapist in the future 68% of non-users likely to consider a physical therapist in the future 84% of physical therapy users would refer a friend or family member to their physical therapist 88% of physical therapy users say care was very or somewhat beneficial “I’m such a believer…I went for two months… I’m fixed, I’m cured. Without any surgery.” “I usually look forward to physical therapy because it helps, and I don’t have the will power to do it on my own.” “There was some genuine caring about how I was doing and progressing.”

12. Esteem: High “They are highly educated, highly knowledgeable people. I’m very, very satisfied.” “Extremely capable. Extremely knowledgeable. There’s one that’s one of my favorites as far as someone to direct patients to.” Physical Therapist is provider of choice for loss/limitation of movement, injury or experiencing pain – above Orthopedists and Chiropractors. MDs and Nurse Practitioners express satisfaction with physical therapists

13. Consumers are confused… Who do I go to? And for what condition? Differentiation: Blurred

14. Differentiation: Blurred • On the whole, physicians did not believe the DPT would improve clinical abilities and were concerned that it would drive the cost of physical therapy even higher • Physicians did not support direct access because they do not trust physical therapists to diagnose possible underlying medical conditions • While consumers do not view physical therapists as doctors, they do see the DPT designation as valuable. In fact, 73% were more likely to consider a physical therapist if they knew that they had completed requirements for a DPT. “… the physician should be making the diagnosis… It’s expensive treatment. So there would be a lot of abuse.”

15. 94% of consumers have gone to their PCP for pain relief and improvement in movement or performance of daily activities While many consumers still want their PCP to “diagnose”, more than half say they are more likely to use physical therapists if they could “treat” patients without a doctor’s referral Relevance: Growing

16. Consumers are looking for prevention and wellness options Consumers would be more likely to use a physical therapist if they knew she/he could: Significantly improve mobility to perform daily activities Provide an alternative to surgery, in many cases Manage or eliminate pain without medication, in many cases Relevance: Growing

17. Physical Therapist Brand Opportunity: Earlier Mindshare “What about the physical therapist option?” Physical Therapist ProblemPain Orthopedists PCP/NP PILL/RUB Chiropractor

18. Physical Therapist Current Mindshare

19. Expand Mindshare of Physical Therapy

20. Ownership of a Broader Mindshare

21. The Sage Helps people act smarter and feel more confident. Known as: Coach/Teacher Delivers: Knowledge Offers: Independence Focus: Understanding Traits: Experts, advisors

22. The Hero Helps people perform at their upper limits. Known as: Rescuer/Warrior Delivers: Courage Offers: Mastery Focus: Proving Traits: Motivates

23. Our Brand Promise What we do Physical therapists help you restore and improve motion to achieve long-term quality of life.

24. Our Key Words and Phrases • What we say • Physical therapists can help you improve mobility, in many cases, without surgery or pain medication • Physical therapists have extensive education and expertise • Physical therapists can help you prevent or manage a health condition

25. Our Tag Line

26. It matters because our brand can… Influence Protect Differentiate Command a Premium

27. We need to act now because… Our future is uncertain.

28. Our brand needs us… Because we care. Because we have influence. Because we are the brand.

29. How do I start? Step 1: Learn the brand.

30. Step 1: Learn the brand. www.APTA.org Brandbeat Resources www.MoveForwardPT.com

31. Step 2: Live the brand.

32. Step 2: Live the brand. Be professional. Be entrepreneurial. Be knowledgeable. Be consistent.

33. Tools You Can Use to Live and Breathe the Brand • BrandBeat at www.apta.org/brandbeat • Consumer Web site – www.moveforwardpt.com • Brand Video onwww.youtube.com

34. KPTA Plans for the Brand • Links on KPTA website • Promote at KPTA and community events • Informational handouts, media advertising • Encouraging you to use APTA resources to promote and “live the brand” in your region

35. THANK YOU Questions?Christina Wisdom, PT, DPT, OCS c.wisdom@earthlink.net

36. Payment/ Reimbursement Update: Local & National Issues Maximizing and Protecting It

37. CONCERNS SHARED BY BLUE CROSS BLUE SHIELD KANSAS • Documentation • Computerized documentation appears “canned” with little to no originality from provider • Abbreviations are not standard – should avoid • No documented time frames • What was provided for codes billed is not clearly documented

38. CONCERNS SHARED BY BLUE CROSS BLUE SHIELD KANSAS • Documentation • Skill (why service of PT / PTA needed) • BCBSKS released a letter to all Kansas PT providers contracted with BCBSKS on September 21, 2009 that outlines what medical necessity is and standards for documentation

39. CONCERNS SHARED BY BLUE CROSS BLUE SHIELD KANSAS • Modalities (lack of documented rationale or rationale “canned”) • No tapering • Ultrasound and HP to the same body part same day repeatedly • Massage and Man Therapy for the same body part same day repeatedly • Ultrasound and E-stim to the same body part same day repeatedly

40. CONCERNS SHARED BY BLUE CROSS BLUE SHIELD KANSAS • Length of episode of care • Medically necessary versus maintenance • Co-morbidities and confounding factors not clearly documented • Referral source sends patient back despite PT recommendation to D/C

41. CONCERNS SHARED BY BLUE CROSS BLUE SHIELD KANSAS • “Decompression Therapy” versus “Decompression Traction” • Length of episode of care • Multiple modalities included as well as braces and foot orthotics • All patients get the same type of treatment (package deal)

42. CONCERNS SHARED BY BLUE CROSS BLUE SHIELD KANSAS • PT signs note however handwriting in body of note is different • Qualified provider of services • Utilization of available documentation resources

43. CONCERNS SHARED BY BLUE CROSS BLUE SHIELD KANSAS • Patient signing a waiver for non-covered services • This excludes modalities considered “content of service” • When is good enough – “good enough” • Trying to achieve function higher than pre morbid function

44. Educate yourself on all codes and proper utilization • Educate yourself on all available resources for documentation • “Say what you see” and “what your skill is” • Documentation “Quality” versus “Quantity” • Ask yourself “if I had to pay for this would I pay based on what is in my documentation?” • READ and become familiar with BCBSKS – Business Procedure Manual ( Appendix F: Occupational and Physical Therapy Guidelines ( pages F 1 – F 33) http://www.bcbsks.com/CustomerService/Providers/Publications/professional/manuals/pdf/BPMappF_OccPT.pdf

45. RED FLAG RULE http://www.apta.org/AM/Template.cfm?Section=Fraud_and_Abuse&Template=/MembersOnly.cfm&ContentID=57432 • CMS releases Final Rules regarding Payment Polices for Inpatient Rehabilitation Facilities and Skilled Nursing Facilities http://www.apta.org/AM/Template.cfm?Section=SNFs1&Template=/MembersOnly.cfm&ContentID=62651

46. Health Care Reform http://www.apta.org/AM/Template.cfm?Section=Therapy_Cap&CONTENTID=64052&TEMPLATE=/CM/ContentDisplay.cfm Medicare Therapy Cap and Extension Rule http://www.apta.org/AM/Template.cfm?Section=Coding&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=22191 Group Therapy http://www.apta.org/AM/Template.cfm?Section=Coding&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=22191

47. 2010 Physician Fee Schedule Proposed Rule Released http://www.apta.org/AM/Template.cfm?Section=Medicare_Updates1&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=342&ContentID=48513 Referral for Profit (POPTS) Resource Center http://www.apta.org/AM/Template.cfm?Section=State_Gov_t_Affairs&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=311&ContentID=37286

48. WPS JMAC 5 LOCAL COVERAGE DETERMINATIONS (LCDs) • CURRENT 2009 PART A LCD (L 26555) - Outpatient: http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=26555&lcd_version=7&basket=lcd%3A26555%3A7%3APhysical+Therapy+%2D+Outpatient%3AMAC+%2D+Part+A%3AWisconsin+Physicians+Service+Insurance+Corporation+%2805101%29%3A • DRAFT 2009 PART A LCD (DL28531) – OUTPATIENT: http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=28530&lcd_version=3&basket=lcd%3A28530%3A3%3APhysical+Medicine+and+Rehabilitation%3AMAC+%2D+Part+A%3AWisconsin+Physicians+Service+Insurance+Corporation+%2805201%29%3A28531 • CURRENT 2009 PART B LCD (L 2688)- PHYSMED-509 Physical Medicine and Rehabilitation) : http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=26688&lcd_version=28&basket=lcd%3A26688%3A28%3APhysical+Medicine+and+Rehabilitation%3AMAC+%2D+Part+B%3AWisconsin+Physicians+Service+Insurance+Corporation+%2805202%29%3A • DRAFT 2009 PART B LCD ( DL 28531): http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=28530&lcd_version=3&basket=lcd%3A28530%3A3%3APhysical+Medicine+and+Rehabilitation%3AMAC+%2D+Part+B%3AWisconsin+Physicians+Service+Insurance+Corporation+%2805202%29%3A28531

49. Recovery Audit Contractors (RACs) and Medicare(materials accessed from www. cms.hhs.gov/RAC September 13, 2009) KPTA TOWN HALL MEETINGS

50. What is a RAC? The RACs detect and correct past improper payments so that CMS and Carriers, FIs, and MACs can implement actions that will prevent future improper payments Providers can avoid submitting claims that do not comply with Medicare rules CMS can lower its error rate Taxpayers and future Medicare beneficiaries are protected