Temperatures here in Indianapolis have finally broken the freezing mark, with today’s predicted high at a balmy 40 degrees. But that warming trend isn’t limited to the brisk Midwest air. Things also are heating up inside of the Indiana Convention Center, where thousands of physical therapy professionals and students have converged for the APTA’s 2015 Combined Sections Meeting (CSM). There’s no shortage of hot issues on the radar for the physical therapy industry this year—and CSM’s jam-packed schedule of informative course offerings is a major testament to physical therapists’ thirst for knowledge in the areas that will shape the future of their profession.
Here on the WebPT Blog, I’ll cover as many of those topics as I can by providing live updates throughout the conference. Yesterday, I recapped a couple of presentations on preventive care and direct access. (Missed that post? Check it out here.) Today, I’ll tackle two more major subjects: healthcare reform and women’s leadership in the PT space. These are some very meaty topics, and I could write pages and pages about both—seriously, I’ve already taken 40-plus pages of notes—but for the purposes of this post, I’ll stick to a few key takeaways.
On the Road to Reform: Medicare and Health Care at Large
Healthcare reform moves pretty fast; if you don't stop and look around once in a while, you could miss it. Yes, that’s a Ferris Bueller’s Day Off reference, and yes, I realize that it’s kind of—okay, extremely—corny. But when it comes to healthcare policy as a whole—and Medicare policy in particular—there’s actually a lot of truth in that statement.
Unless you’ve been living in an underground doomsday bunker for the last few years, you’re well aware that the healthcare landscape in this country is rapidly changing. In an effort to vastly increase the quality and accessibility of healthcare services—while simultaneously decreasing the cost of delivering those services—the federal government has introduced a flurry of new rules, regulations, and initiatives, many of which impact physical therapists in a big way. Here are some of the change-related concepts the presenters in two sessions—“Health Care Reform and the Affordable Care Act: One Year Later” and “Emerging Issues in Medicare and Health Care Reform”—hit the hardest:
1. There is an overutilization problem within the current continuum of care.
In this context, “continuum” refers to a patient’s path from an inpatient acute setting to an outpatient therapy setting. There is a defined progression from one end to the other—with stopping points at “in-between” settings like skilled nursing facilities and home health. But in the interest of controlling costs, some leaders in healthcare reform are challenging the efficiency of that process and proposing that providers at every “step” coordinate and collaborate with each other to determine whether a particular patient should actually skip some of the transitional environments along the way, so he or she can start receiving outpatient services—which are less costly—sooner rather than later, thus scoring major downstream savings.
Putting this into practice, however, means that physical therapists must assert themselves as care coordinators—and demonstrate confidence in their ability to, as presenter Edward Dobrzykowski, PT, DPT, ATC, MHS, put it, “do the right thing at the right time”—as their expertise is critical in determining appropriately timed setting transitions for individual patients. The good news is that hospitals are hungry for that exact type of leadership, as they are under immense pressure to reduce readmission rates. “Hospital administrators are realizing that we [PTs] can impact their 30-day readmission rate,” said Janice Kuperstein, PhD. Those administrators recognize that in order to increase efficiency, they have to change their processes—and that is exactly what some are doing. “I think this is a tremendous opportunity for physical therapists,” said Charles Workman, PT, MPT, MBA. And that opportunity doesn’t just exist in hospital settings; after all, as one speaker pointed out, many hospitals do not have their own rehabilitation departments, opting instead to contract with outside providers.
2. Prevention is becoming crucial as the number of people with health coverage—through Medicare, the government health exchanges, or private plans—explodes to unprecedented levels.
According to data Kuperstein cited during one of the sessions, 87% of people have at least one chronic condition by the time they turn 65. And with upwards of 10,000 people enrolling in Medicare every day, there are major concerns about the current system’s ability to handle such a massive influx. That’s why now, more than ever, it’s crucial that providers in all settings and disciplines turn their focus to preventive care. “If we don’t do prevention now, we’re not going to be able to control healthcare costs,” Kuperstein said.
The Affordable Care Act (ACA) also aligns with the push for more preventive care—by allowing for a billable CPT code for ongoing preventive care in patient-centered medical homes, for example. As Kuperstein pointed out, if PTs were able to step up and take advantage of that provision, “Think of what we could do in terms of wellness.” Furthermore, the ACA expanded coverage for essential health benefits—including physical therapy—which, in turn, increased demand for those services.
The major piece of the puzzle that is missing, of course, is a clear explanation of how PTs will receive reimbursement for the vast array of services that fall under the preventive care umbrella—something of urgent interest to many therapists, especially those who have suffered shrinking profit margins in the wake of the ACA. Fortunately, the wheels are already turning on the issue of payment, which brings me to my next point.
3. The government is pushing hard and fast for implementation of alternative payment models.
“Right now, cost is the driving factor in health care.” This comment from an audience member in one of today’s sessions forms a perfect summary of the reasoning behind the impending shift to value-based payment structures. Because at the end of the day, if these structures work the way they are supposed to, the overall cost of health care will fall. However, in line with the Institute for Healthcare Improvement’s “Triple Aim” philosophy, those structures also account for quality and patient experience. While function may indeed—as Kuperstein suggested—be PTs’ currency, Workman emphasized that it’s “not just about the end result, but the whole process.”
To ensure that PTs’ unique ability to deliver on all fronts—cost, quality, and results—leads to payment structures that reward their effectiveness and increase their clout among practitioners in other disciplines, therapists must, in Workman’s words, “universally be able to define our value.” Sound familiar? If you’re a regular WebPT Blog reader, it should, because we’ve devoted quite a bit of space to promoting the importance of meaningful outcomes tracking. Workman echoed our sentiments: “We need a standard across the continuum that other providers can rely on and interpret.”
4. Medicare is leading the charge to crack down on questionable billing practices and poor care quality.
Physical therapists who treat Medicare patients are all-too-familiar with the never-ending stream of new rules, regulations, and initiatives aimed at reducing unnecessary expenditures (e.g., the therapy cap, MPPR, and recovery audits) as well as enhancing the quality of care (e.g., PQRS and functional limitation reporting). Well, brace yourselves, because there are even more changes coming down the pike:
- Just last week, the US Department of Health and Human Services (HHS) announced its goal to base 30% of all Medicare fee-for-service (FFS) on alternative payment models by the end of 2016, with that proportion increasing to 50% by 2018. And if that weren’t aggressive enough, HHS also wants to link 85% of FFS payments to outcome measures by the end of 2016, with that percentage bumping up to 90% by the end of 2018. This is the first time we’ve seen such a short, defined timeline for a change of this scope, and it definitely signifies that the government is serious about getting the healthcare community on board with alternative payment.
- There is currently a Sustainable Growth Rate (SGR) repeal bill in Congress that would get rid of the flawed payment determination formula that has cost the government $169.5 billion since 2003. The bill, called the SGR Repeal & Medicare Provider Payment Modernization Act, would introduce annual payment increases of 0.5% through 2018, with additional bonuses for those who adopt alternative payment models. This legislation also would combine individual quality programs—including PQRS, Meaningful Use, and the Value-Based Modifier (VM) program—into a single merit-based incentive payment system. (As a side note, the VM program—which links actual quality and performance with cost measures and efficiency—is currently set to go into effect for physical therapists in 2016, with a nonparticipation penalty of 4%.)
- Just yesterday, legislation that would repeal the therapy cap was introduced in the House of Representatives. (That means now is the time to contact your congresspeople to get their support or cosponsorship!) The new bill would give CMS the power to review claims based not on dollar amount, but a variety of other indicators—among them, unusual billing practices. As Gayle Lee, JD, said during one of today’s sessions, this allows CMS to target their reviews “rather than reviewing every single provider arbitrarily.”
- CMS also has introduced new rules around recovery audits, with a goal of reducing the number of appeals—as there is currently a massive backlog of appeals waiting to be heard. For example, if you have a history of good compliance, your recovery audit contractor (RAC) won’t ask for as many claims from you. Also, your RAC will have only 30—rather than 60—days to complete the review and notify you of the outcome.
5. The changes happening in the post-acute care (PAC) realm will influence future developments in the outpatient space.
There’s a lot of movement on reform in the PAC space. One of the most visible efforts: Medicare’s Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, which involves the collection of standardized quality measures to inform the creation of a payment system prototype and a discharge-planning predictor tool. Sure, that prototype will probably only apply to PAC settings at first, but make no mistake about it—this data eventually will drive decisions that affect outpatient providers, as well. After all, as Roshunda Drummond-Dye, JD, noted in one of today’s presentations, “Therapy is therapy, no matter what setting you’re providing services in.” So pay attention to policy changes across the spectrum of physical therapy; staying shortsighted in the present could mean getting shortchanged in the future.
What’s Stopping Women PTs from Taking the Lead?
Numbers don’t lie, and the numbers that speak to the state of women’s leadership in the physical therapy industry suggest a pretty harsh truth: According to presenters in today's session, a recent survey of APTA members revealed that the median gross income of women respondents was $80,000 a year, whereas that of men respondents was $92,500. And while salary isn’t the only indicator of leadership, it’s certainly one of the most universally understood. But, consider this: Since 1921, 23 of the 31 APTA presidents have been women, and women make up two-thirds of the current APTA board. So clearly, women’s leadership is alive the PT space—it’s just that it’s occurring outside of a practice setting.
The obvious question, then, is: What’s the disconnect? In this interactive discussion forum, panelists and audience members alike shared their own perspectives and ideas about the lack of women’s leadership in private practice—particularly at the executive level. And through all of their insight, wisdom, and personal stories, there emerged a handful of common threads about the barriers—both real and perceived—that hold women back from climbing the corporate ladder. Here are a few of the most poignant takeaways from this very popular session:
1. Women define leadership and success differently than men.
Men and women are different. That’s just a fact of life. They think differently, react differently, communicate differently, and—yes—lead differently. As Sandy Hilton, PT, DPT, MS, put it, “When people say women are not leading in PT, that’s not accurate. We might just be leading a little more quietly.” Furthermore, a woman’s endgame for stepping into a leadership role often is not the same as a man’s. “For women, maybe leadership doesn’t look like owning 40 outpatient private practices,” said Ann Wendel, PT, ATC, CMTPT.
2. There aren’t enough women leaders serving as role models and mentors in the PT community.
To springboard off of the first item above, perhaps the reason women have a different perception of what leadership and success look like is because they—quite literally—don’t see it the same way men do. On that issue, WebPT’s own Heidi Jannenga—who, as a C-level executive of an Inc. 500 company, is living proof that women are more-than-capable business leaders—posed the following question to the rest of the audience: “Why don’t you want that top position? Is it because there’s no one there you identify with, no one to emulate? I think it’s maybe that we don’t have enough role models—someone who has been there, done it, and can show you that...you can have that same path.” That’s exactly why Bridgit Finley, an audience member who owns 18 clinics, feels such a responsibility to maintain visibility as a woman business leader in the physical therapy industry—not only to serve as a role model for up-and-coming women leaders, but also to provide aspiring women with the opportunities they need to advance their careers. “That’s the reason I do this—to promote other women,” she said, noting that men executives often aren’t thinking in those terms as they make personnel decisions. “If we wait for men to make the change, it’s going to take longer than if we’re actually willing to step up...We need to recognize this as a problem, and also realize that we’re the solution.”
3. Imposter syndrome is a pervasive issue among women professionals—PTs included.
As Karen Litzy so eloquently put it, “Leadership is not a position; it’s not how many clinics you own. It’s a mindset.” And too often, women approach leadership opportunities with the mindset that they just aren’t cut out for the job—that there’s someone better-suited to the task at hand. Men, on the other hand, tend to assume the opposite: that they are the best-suited people to take on any challenges or opportunities that arise. To combat that, women must start raising their hands when they do have chances to accept challenges—or even when they don’t. “We need to get past this concept that we need permission to do things,” said Wendel, who started her own cash-based physical therapy practice despite everyone around her telling her it would never work. “If I had waited for someone to tell me that it was possible, I wouldn’t have done it,” she said. Furthermore, people—both men and women—who are in positions to present women with opportunities to advance must start leveraging that power. “The most important thing we can do is invest in people,” said Justin Moore, PT, DPT, who has served as the lead APTA lobbyist in Washington, DC. “The minute you give them that hand, you will find wonderful things.”
4. Women have to stop worrying about “having it all.”
The elusive—and by all accounts, impossible—prospect of achieving a perfect work-life balance is so overwhelming that many women stop running before they’ve even gotten to the starting line. After all, “having it all” is a pretty lofty standard to live up to—which is exactly why women need to take a page from Elsa’s book and let it go. It’s a broad cliché open to endless interpretation, which is why, if you asked 100 women to define what it means to “have it all,” you’d come away with 100 definitions. Instead, women should focus on what they want—professionally and personally—and make choices that align with those desires. Otherwise, they’ll always be left wanting. “Personally, I don’t think anyone else in this world can define what that means to me,” one audience member said. “What having it all to me is, is going to be very different from someone else’s definition.” Also, women must keep in mind that they have their whole lives to realize their goals; they don’t have to “have it all” within the next five or ten years. “The long-term plan is really what you want to look at,” said one audience member. “Don’t just focus on the immediacy.”
Whew! We’ve certainly covered a lot of ground today—kind of like all the CSM attendees who are blowing up their FitBits as they navigate the seemingly endless hallways of the Indiana Convention Center. Be sure to check back Monday for the exciting conclusion to this marathon of on-the-spot blogging. Want to add to the conversation? Leave a comment below.