2014component award application (1)

Component Award Category: Innovative Component: Kentucky Physical Therapy Association Address: 15847 Teal Road Verona, KY 41092 E-mail: katyloousa@aol.com Web site: www.kpta.org Phone: 859-485-2812 Fax: 859-485-2812 Submitting Nomination: Lisa Volz, Executive Director, katyloousa@aol.com The Kentucky Physical Therapy Association (KPTA) respectfully requests your consideration of our achievements for the “Innovative Component Award.” KPTA has spent the last year building bridges to other healthcare providers. As a result of our collaboration, we have celebrated monumental successes in payment policy, advocacy and inter-professional networking, which we feel qualify us for this prestigious recognition.

Collaboration Results in Positive Payment Policy Changes For many years, KPTA has been lobbying the Kentucky Department of Medicaid Services to allow freestanding/outpatient/private practice physical therapy clinics to bill Medicaid. When Kentucky developed its’ Office of the Health Benefit Exchange, which expanded Medicaid coverage to an additional 300,000 citizens within the Commonwealth, we knew the potential for success was within our grasp. KPTA organized a meeting with the Kentucky Occupational Therapy Association (KOTA) and the Kentucky Speech Hearing Association (KSHA) to discuss how the three groups might position themselves to bill Medicaid outside of hospital-based settings.

Representatives of the three associations (pictured here) met on July 16, 2013 and drafted the “Recommendation to the Cabinet and the Medicaid Advisory Committee,” (exhibit 1). The recommendation was sent to Kentucky’s Cabinet for Health & Family Services, the Medicaid Advisory Committee, Governor Steve Beshear, Lawrence Kissner (Kentucky Medicaid Commissioner) and Audrey Haynes (Secretary for the Cabinet for Health & Family Services).

In October, we were notified by the Office of the Health Benefit Exchange that outpatient physical, occupational and speech therapies would be covered under Medicaid.

From left: Tom Pennington, PT (KPTA Board Member); Linda Gregory, MA, CCC-SLP (KSHA Member), Leslie Sizemore, OTR/L (KOTA Board Member), Michael Muscarella, PT, DPT (KPTA President), Elizabeth Ennis, PT, EdD, PCS, ATP (KPTA Member), Lisa Volz (KPTA Executive Director), Dale Lynn, OTR/L (KOTA President)

In congratulatory correspondence, the presidents of the three associations commit to continue collaboration on items of mutual interest. The Tri-Alliance is born.

Collaboration Effects Legislative Activity & Advocacy At the start of the 2014 Kentucky Legislative session our lobbyist notified us of a bill being drafted by the Kentucky Athletic Trainer’s Society (KATS) which would allow athletic trainers to bill insurance for services provided to an athlete. KPTA had multiple concerns since the administrative regulations for athletic trainers lacked the specificity to ensure public protection. Their regulations were missing: standards of practice (to include supervision, definition of patient population, as well as documentation guidelines), disciplinary standards, code of ethics standards, and objectives of athletic training. KOTA shared our concerns.

On January 10, 2014 representatives from KPTA, KOTA and KATS met for an open dialogue on the proposed legislation. Following the meeting, a letter was sent to KATS, jointly drafted by KPTA and KOTA presidents (exhibit 2). In addition, KPTA and KOTA lobbyists joined forces to inform potential bill sponsors of the unintended consequences the bill may have if the administrative regulation issues were not first addressed.

As a result of the teamwork displayed by KPTA and KOTA, the bill was never filed. KATS representatives have communicated they will spend the next year drafting language for their practice act that will ensure accurate, patient-specific billing and public protection.

On February 19, 2014 KPTA, KOTA and KSHA convened the first annual “Tri-Alliance Day” at Kentucky’s Capital. Over 450 physical, occupational and speech therapists participated in the event.

Attendees were treated to a brief welcoming program and then disbursed to meet and network with state legislators. Participants discussed the reimbursement rate for Medicaid and the cost efficacy of therapy services compared to other interventions. Legislators were given the Value of Physical Therapy (exhibit 3) and APTA’s Term Protection Ad (exhibit 4). As part of the day’s events, legislators were invited to a lunch sponsored by the Tri-Alliance. Members and legislators enjoyed conversation over the daily special. The “2nd Annual Tri-Alliance Day” is planned for February 18, 2015. Pictures from the 2014 Tri-Alliance Day are below.

From left: KPTA President, Michael Muscarella, PT, DPT (addressing the Tri-Alliance Day attendees), Representative Ben Waide, PT, CHT and KPTA Lobbyist, Leigh Ann Thacker look on.

The guest speaker at Tri-Alliance Day was Colman Eldridge, Assistant to Governor Steve Beshear. Colman inspired the group with the story of his wife, Victoria. Diagnosed with severe epilepsy, Victoria received therapy throughout her childhood. Against all odds and motivated by her therapists who wouldn’t give up on her, Victoria graduated college and earned a Master’s Degree in Occupational Therapy.

Above: Leadership from the associations celebrate a job well done.

Left: KPTA Vice President, Ed Dobrzykowski, PT, DPT, ATC, MHS pictured with State Representative Addia Wuchner. Representative Wuchner shared how physical therapy restored her mobility after a debilitating car accident.

Below: Attendees at the 2014 Tri-Alliance Day gathered on the steps of the Kentucky Capitol Building for a group photo.

The Tri-Alliance Thrives As a result of KPTA’s initiative to develop a multi-disciplinary approach to issues, the Tri-Alliance is thriving. The associations are working together to offer a continuing education course for members this summer. Plans are underway for a “Tri-Alliance Conference” in 2015 to bring members education on common interests such as stroke, traumatic brain injuries, challenging geriatric behaviors, policy matters, etc.

While there are areas of overlap in physical, occupational and speech therapies, we ensure each profession is distinctly represented so there is no confusion as to the autonomy, authority and areas of expertise within the respective disciplines.

Most recently, it was brought to our attention by the KOTA lobbyist that St. Catharine College in Kentucky was marketing their developing athletic trainer program as “close relative to physical therapy,” (click here to be directed to the St. Catharine web page with this language). In a show of solidarity, KOTA supports KPTA’s efforts to have this language removed (exhibit 5). We are awaiting the results of our letter.

Because our multi-disciplinary approach to addressing rehabilitative issues has strengthened our position and visibility as outlined above, we hope you will consider the Kentucky Physical Therapy Association as this year’s Innovative Component Award.

EXHIBIT 1 Recommendation to the Cabinet and the Medicaid Advisory Committee Evidence indicates that access to therapy services is a measurably effective way to reduce the overall cost of healthcare. These services can often prevent the need for more costly procedures, such as surgeries; while enhancing post-surgical recovery, and increasing participation in home, work and community. Yet, Physical Therapists in Kentucky are only able to become a Medicaid provider in a hospital based outpatient clinic, home health agency or school system. Within this structure, other than serving children in the schools, they are only able to provide services to clients who have both Medicare and Medicaid, and bill Medicaid as the secondary policy. Speech Language Pathologists and Occupational Therapists are even more limited in their ability to become providers.

While the administration has encouraged enrollment of children into the Medicaid pediatric program, access to care has not improved. A survey conducted within the last two years across the commonwealth looked at rates of referral and service provision across disciplines for Medicaid clients. Children in the school system were the only subgroup that was reported to be consistently served, and this group is having difficulty accessing services needed outside of school. However, it should be noted that services provided in the school setting are limited to those that are educationally relevant, and these children often need services that are medically necessary. The survey reflected that these services are being denied due to services provided in the school setting. Also, providers for other age groups (birth -3 and adult), and children being served through waiver programs, reported extensive waiting lists, or having to refer patients to other agencies who are running waiting lists as well. Lack of transportation and having to travel long distances to reach providers has also impaired the ability of clients on Medicaid to be compliant with services.

Studies have documented the efficacy of therapy services in decreasing disability, improving function and assisting with return to work (see attachments), and many other states cover these services as part of their Medicaid package. As of 2010, Kentucky is lagging behind the thirty-nine states that have Physical therapy as a covered benefit, with 13 charging small co-pays. Forty states cover services for speech, language and hearing disorders, with 13 requiring a co-pay, and thirty-five cover occupational therapy services with 13 requiring a copay.

Currently, none of these services in Kentucky are allowed outside of dual-covered or waiver funded programs, with those limited to very specific types of facilities (hospital based, home health agency) with extensive, exhaustive and costly application processes, and individual providers or practices are not allowed to become providers. While Medicare currently caps therapy services, all three disciplines are covered services under Medicare, and a rehabilitative services benefit is currently included in the majority of third-party coverage, as a recognized component of health, wellness, and return to function.

With the expansion in Medicaid coverage, we anticipate that the need for therapy services will grow further, especially since the expansion covers the working poor, who would also benefit from services to aid in improved function and return to work. Access to therapy services for these laborers increases the likelihood they remain employed, thus improving the overall economy. While there is a cost related to these services, it is expected that there will be decreased cost due to improved function, decreased need for surgical and other expensive medical procedures, and earlier return to work.

The Therapy Services Technical Advisory Committee is recommending that the Cabinet and the Medicaid Advisory Committee expand the provider definition for these three services, to allow clients with Medicaid who are currently on long waiting lists to be served, as well as for these services to have a role in the health and wellness of these clients. Our recommendation is that Physical Therapists, Occupational Therapists, and Speech Therapists become recognized as providers for Medicaid, that private practices be allowed to enroll, that the limitation on dual coverage be removed, and that the provider enrollment process be simplified, possibly through MCO enrollment, as many of these practices are familiar with contracting with third party payors. There is precedent for this as several

rural and urban providers have contracted with the MCOs to provide services to their customers, and there is no indication of increased cost.

We would like to close by reiterating the fact that these services can often prevent the need for more costly procedures, such as surgeries, enhance post-surgical recovery, and increase participation in home, work and community, which would offset the cost of therapy provision.

The Therapy TAC thanks you for your consideration and we are available for dialogue as needed in the future.

Beth Ennis, PT, EdD, PCS, ATP, Chair, Therapy TAC David Boyce, PT, EdD, OCS, ECS, TAC Member Linda Sizemore, OTR/L, TQAC Member Teresa Justice, OTR/L, TAC Member Linda Gregory, MA, CCC-SLP, TAC Member Sherry Hoza, MA, CCC-SLP, TAC Member Dale E. Lynn, OTR/L, President, KOTA Tim Ball, MA, CCC-SLP, President, KSHA Mike Muscarella, PT, DPT, President KPTA Tom Pennington, PT, Western District Chair, KPTA

EXHIBIT 2

January 15, 2014 Keith Webster Kentucky Athletic Trainers Society 316 Weil Lane Nicholasville, KY 40356 Dear Keith: It was a pleasure meeting with you and other KATS representatives last Friday. We enjoyed the open dialogue shared between the three groups in attendance.

Our leadership met briefly to review your practice act and discuss your proposed changes. We also took a few moments to consider our practice acts, and the differences between them.

Although our leadership agreed that we would consider endorsing your endeavor to seek a change to KRS 311.903 which would allow athletic trainers to bill for services provided to an athlete, it is our consensus that your current Administrative Regulations lack the specificity to ensure public protection.

We suggest first developing and enacting the following regulatory changes prior to introduction of such legislation. The suggested regulation would define: • • • •

Standards of practice to include supervision, definition of patient population, as well as documentation guidelines Disciplinary standards Code of ethics standards Objectives of athletic training

Similar statutes and regulations are clearly defined in the Physical Therapy and Occupational Therapy practice acts and ensure accurate, patient-specific physical therapy billing and public protection. It is our opinion that in order for athletic trainers to bill, KRS 311 should also include similar standards and defining regulations.

We are committed to promote our open dialogue, transparency and multidisciplinary teamwork which began on January 10th. As such, we are willing to assist you in the development of these suggested amendments. We propose development of the wording this year, along with marketing of the upcoming revisions to legislators during this session. The official bill will then be introduced during the 2015 legislative session as a collaborative and mutually supported effort among our associations.

I look forward to hearing from you and working with you in the future.

Sincerely,

Michael Muscarella, PT, DPT President, KPTA

Dale E. Lynn, OTR/L President, KOTA

EXHIBIT 3 Physical therapists are health care professionals who restore and improve movement and enable individuals of all ages to have optimal functioning and quality of life. Physical therapists promote health, wellness, and fitness through risk factor identification and implementation of services to reduce risk and slow the progression of or prevent disability.1 Thank you: Thank you Kentucky Legislators for the passage of a co-pay bill in 2010 which made access to physical therapy more affordable for Kentuckians with private insurance.

Physical Therapists Provide High Value Services for Patients There is strong evidence to indicate that physical therapists are a cost effective alternative to medication and surgery for many conditions.

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Low Back Pain: Recent studies indicate that physical therapists who combine manual mobilization techniques with appropriate therapeutic exercises can effectively alleviate low back pain with long-lasting effects.2,5

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Knee Arthritis: There is scientific evidence that physical therapy, combined with comprehensive medical management, is just as effective as surgery for relieving pain and stiffness of moderate to severe osteoarthritis of the knee.3 -4

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Tendonitis, Bursitis, and Arthritis: Research shows that individuals who receive active physical therapy experience greater improvement in function and decreased pain intensity. 5 In fact, for patients at risk of heart disease, the American Heart Association encourages individuals to see a physical therapist for initial treatment of musculoskeletal pain rather than taking pain prescription medication. 6

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Vertigo: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo due to a peripheral vestibular disorder. Research indicates that most patients improve rapidly when treated by physical therapists.7-9

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Breast Cancer-Related Lymphedema: Secondary prevention of lymphedema through prospective physical therapy surveillance aids in early identification and treatment of breast cancer-related lymphedema. Recent studies indicate that early intervention may reduce the need for intensive rehabilitation and may be cost saving. 10

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Wound and Ulcer Management: Physical therapists effectively provide treatment for skin repair and protection and educate the patient and caregiver on the prevention of pressure ulcers associated with certain conditions such as spinal cord injury and diabetes. 11-12

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Incontinence and Pelvic Floor Disorders: Research on the conservative management of pelvic floor disorders supports physical therapist practice for these conditions, even over medical and surgical options for some patients.13-15

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Type II Diabetes: Exercise, along with dietary intervention, represents first-line therapy for diabetes mellitus. Physical therapists play an important role in reducing disease risk indicators for these individuals.16-18

The Right Care for the Right Patient at the Right Time • In a 2011 study of 63,000 episodes of physical therapy care, researchers found that self-referred patients had fewer PT visits and lower physical therapy costs and lower use of related health care services such as diagnostic testing and injections.19 •

Recent studies demonstrate that physical therapists have higher levels of knowledge about managing musculoskeletal conditions than most physician specialists except for orthopedists. 2

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Early treatment of musculoskeletal injuries results in improved outcomes and reduced costs.TBA

References

Today’s Physical Therapist: A Comprehensive Review of a 21st Century Health Care Profession. Alexandria, VA: American Physical Therapy Association; 2011.

2Childs JD, Whitman JM, Sizer PS, Pugia ML, Flynn TW, Delitto A. A description of physical therapists' knowledge in managing musculoskeletal conditions. BMC Musculoskeletal Disorders 2005, 6:32 doi:10.1186/1471-2474-6-3. Accessed at http://www.biomedcentral.com/1471-2474/6/32.

3Kirkley A, Birmingham, TB, Litchfield RB, et al. A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. The New England Journal of Medicine. 2008;359:1097-1107 4Deyle GD, Henderson NE, Matekel Rl, Ryder MG, Garber MB. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. Annals of Internal Medicine 2000; 132:3. 173-181.

5Fritz JM, Cleland JA, Speckman M, Brennan G, Hunter SJ. Physical Therapy for Acute Low Back Pain: Associations With Subsequent Healthcare Costs. Spine. 2008;33(16):1800-1805.

6Elliott MA, Bennett JS, Daugherty A, Furberg C, Roberts H, Taubert KA. Use of Nonsteroidal Antiinflammatory Drug. Circulation.

2007:115:1634-1642 7Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol. 1980;106:484-485.

8Bhattacharyya N, Baugh RF, Orvidas L, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2008;139:S47-S81.

9Helminski HO, Zee DS, Janssen I, Hain T. Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review. Phys Ther. 2010;90:663-678.

10Stout NL, Pfalzer LA, Springer B, Levy E, et al. Breast cancer-related Lymphedema: comparing direct costs of a prospective surveillance model and a traditional model of care. Phys Ther. 2012;92:152-163; published ahead of print.

11Guihan M, Hastings J, Garber SL.Therapists’ role in pressure ulcer management in persons with spinal cord injury. J Spinal Cord Med.2009;32(5):560-7.

12 Lemaster JW, Mueller MJ, Reiber GE, et al. Effect of weight-bearing activity on foot ulcer incidence in people with diabetic peripheral neuropathy: feet first randomized controlled trial. Phys Ther. 2008;88:1385–1398 13Burgio KL, Locher JL, Goode PS. Combined behavioral and drug therapy for urge incontinence in older women. J Am GeriatricsSociety.2000;48:370-374.

14Balmforth JR, Mantle J, Bidmead J, Cardozo L. A prospective observational trial of pelvic floor muscle training for female stress urinary incontinence. BJU International.2006;98,811-817.

15Williams KS, Assassa RP, Gillies CL, Abrams KR, Turner DA, et al. A randomized controlled trial fo the effectiveness of pelvic floor therapies for urodynamic stress and mixed incontinence. . BJU International.2006;98,1043-1050.

16Chen CN, Chuang LM, Wu YT. Clinical measures of physical fitness predictinsulin resistance in people at risk for diabetes. Phys Ther. 2008;88:1355–1364.

17Turcotte LP, Fisher JS. Skeletal muscle insulin resistance: roles of fatty acid metabolism and exercise. Phys Ther. 2008;88:1279– 1296 18Gulve EA. Exercise and glycemic control in diabetes: benefits, challenges,and adjustments to pharmacotherapy. Phys Ther.

2008;88:1297–1321 19Pendergast J, Kliethermes Sa, Freburger JK, Duffy PA. A comparison of health care use for physician referred and self-referred episodes of outpatient physical therapy. Health Serv Research. Published ahead of print September 23, 2011. DOI: 10.1111/j.14756773.2011.01324x.

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