October 2017 Newsletter

PRESIDENTS COLUMN
CARRIE ABRAHAM PT, DPT, MPH
CONTENT PRESIDENT, WVPTA

Presidents Column Happy Physical Therapy Month! It is a very busy Fall for many people
out there! Thank you all for what you do to provide the citizens of WV
From the Desk of Dr. with quality physical therapy care. I want to give a special shout out to
Eric Tarr our volunteer warriors who have been so willing to generously serve the
profession of physical therapy in WV by their presence on our board of
Education Committee directors and their work in our committees. I wont share anyones age,
Update but some have been in this for the long haul! And, in the process of
serving, they have provided much needed guidance, wisdom and insight
Insurance Updates to many young professionals and emerging leaders. Thank you!

Treasurer Update We are in a great position right now in WV to continue to progress

forward with improving access to PT services, tearing down the
consumer barriers, advocating for transparency and equity in
reimbursement practices and impacting the delivery of preventative
health care services in WV and beyond. The proposed CMS Physician Fee Schedule shows the valuation
of our codes to be the same or even increased in some cases. CMS has recently withdrawn the proposed
requirement that practitioners furnishing custom orthotics and prosthetics have additional certification
and/or licensure to do so. APTA has spent many hours providing CMS with data, public comments and
the information necessary to see the benefit of the services that we provide and our value to the US
health care system.
We continue to respond to what we consider to be unfair, unethical reimbursement practices which limit
patient choice and may decrease the quality of care received by patients in the name of cost containment.
See Sally Oxleys Payer Relations article below for more details on this work. We need to continue to be
at the table to discuss the value of our services and the importance of fair and equitable reimbursement
for them. This is where I personally want to see some fire in our young professionals both PT and PTA
alike. These issues, and others, are directly affecting the ability of health care consumers to access your
services. As well as your ability to receive reasonable and appropriate compensation for your services.
The sustainability of the PT profession is at stake. This should fire you up! So lets rally, we can use your
moxie!
We are gearing up for the 2018 WV Legislative Session and our State Affairs Committee has provided us
with some plans for where our attention should be. We are considering legislation on the interstate
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licensure compact, we continue to look at legislation affecting fair and equitable reimbursement practices
and we will oppose legislation which seeks to do away with regulatory health care boards that are
charged with protecting the public health. We will also keep our eyes on any other issues that may
impact the provision of quality physical therapy, and health care in general within the state.
If you do not see the issues that you are dealing with in your daily practice in this newsletter, it may be
that we are not aware of the issue(s). Please communicate with our board or executive staff so that we
can put your concerns on our radar.
It takes commitment and engagement from ALL of our members to get this work done. The commitment
may be smallfor example, it may be simply sitting on a committee for one hour per month (or less) to
provide ideas on the challenges being addressed by the committee. You may have a desire to take the
lead on an issue in an ad hoc committee or task force for a short period of time, or you may feel led to
step up to a board seat to provide more vision and direction to the work of the association and actively
shape the profession of physical therapy in our state. Your input is vital. Please dont be tentative about
it, jump in we are all busy professionals, but with numbers, the work is lighter! Lets do this together
give me a call.

FROM THE DESK OF DR. ERIC TARR

Dear fellow PTs and PTAs,

I am running for West Virginia Senate! Thank you for the endorsement of the WVPTA! Im going to need
your help throughout the campaign. It was not long ago, that physical therapists struggled for influence in
the legislature. Your support of physical therapist running for office is changing that! Many of you know
that a focus of my work as a WVPTA Board member was to obtain and grow relationships between the
WVPTA and West Virginia Legislature by personally volunteering time, money, and leadership. Those
efforts have led to me taking a larger role within the legislature over the past three years as an advisor in
the Senate. In that capacity as an advisor, I have realized that I have a lot to offer WV as a Senator.

As therapists, we devote our lives to the service of others. We actively listen, consider evidence, diagnose
problems, set out an action plan and follow through on that plan. We gain the confidence of our patients
and their families. We constantly have to consider the fiscal impact of our decisions on our patients and
on our practices. We are professional in behavior and collegial but purposeful in difficult conversations.
These skills are incredibly valuable as a legislator. In addition to these skills I have the experience of
building successful businesses and jobs in physical therapy, fitness, practice management, real estate,
commercial leasing, mini-storage facilities, retail, building material sales, marketing, event management,
heating/cooling, plumbing, and handyman services. This variety of professional and business experience
allows me perspective that is unique within the Senate.

So, I am now in a campaign to win a West Virginia Senate seat in District 4. This seat was vacated by
former Senate Finance Chairman, Mike Hall. I am very grateful for the recent endorsement of the WVPTA
and APTA. I also need each of our members to support the campaign with donations. Both the primary
and general races will be very expensive. In the previous election for the other District 4 seat just two
years ago, over one million dollars were spent to try to unseat the Senate President. While I may not
personally be as big a target as the Senate President, the seat is a very big target and I will have a strong
contest for it. With each of you participating in this campaign with me we will win this. But I absolutely
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need you. Im asking you to go to www.ericjtarrwvsenate.com. Make a donation between $100 and
$1,000, if an individual account, or $2,000 if a joint account. Ask your colleagues to do the same. Then
post on my Facebook page https://www.facebook.com/ericjtarr4wvsenate/ that you support Dr. Tarr for
Senate! You can also follow me on twitter @EricJTarr4WV. If you want to share a short video on why
you support me for Senate and tag your colleagues, that helps too!

Also, we will be having a fund raiser in New Orleans at CSM in the PT-PAC suite on the evening of
Thursday February 22nd. If you are going to CSM, please let me know. My campaign committee needs
members that can help with the event that night in New Orleans. Once we win this race, West Virginia
will be the first State in the United States to have three PTs in the State House! Thank you again for your
endorsement! Dont forget to donate at www.ericjtarrwvsenate.com!

Yours truly,

EDUCATION COMMITTEE UPDATE

KRISSY GRUBLER, PT, DPT
WVPTA Education Committee Chair

WVPTA 2018 Annual Conference
April 20th 22nd, 2018, Stonewall Resort, Roanoke, WV

Concussion and Mild Traumatic Brain Injury

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

12.5 Hour CE Course

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
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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 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 Bachelors and Advanced Masters 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
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

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

Workers Compensation Call with the Insurance Commission, October 24th. Carrie Abraham , Cindy
Skiles, Jeff Stevens, Johnna Gaunch and I had a conversation with Tonya Gillespie, CPA, Assistant
Commissioner of the OIC and Andrew Pauley, CPCU, Deputy Commissioner and General Counsel of the WV
OIC. The conversation resulted from a complaint that was filed with the Insurance Commission against One
Call Medical and its subsidiary Align Networks, a Workers Compensation network. It was very educational,
but the information was not what we had hoped to hear. The Insurance Commission only has jurisdiction over
licensed insurance plans, not networks.
When a Workers Compensation carriers get a managed care plan accepted by the Insurance Commission
networks get involved. The companies are exempt from the state fee schedule and the employees lose the

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right to choose their providers except in the instance of a second opinion or if they are willing to share in the
cost of care.
The OIC does not have jurisdiction over self-insured (ERISA) plans. The Department of Labor does. They do
not have jurisdiction over federal (Medicare) or state programs such as Medicaid and PEIA. They do not
regulate networks/silent PPOs.
If providers have a complaint to file with the OIC the person to send it to is Dena Wildman, Director of
Consumer Services. If they do not have jurisdiction they will try to assist by sending it on to the proper agency
or department. The take home message is be very careful signing a contract with an insurance company and
especially the discount networks. Be sure it pays enough to cover your expenses and if you do not understand it
get an attorney to read it over and explain it to you. Watch your EOBs carefully to be sure you are getting the
reimbursement that you signed up for. Signing a deeply discounted contract undervalues the physical
therapy profession.
Highmark It is necessary that all practices update their practice information with Highmark, such as:
the provider name is correct
the practice name is correct
the providers specialties are accurately listed
there are not providers listed at practice locations where they dont actually practice
the providers address and phone number are accurate
the provider is accepting new patients.
If this is not done the providers may be removed from the directory and their status within
Highmarks networks may be impacted. Detailed instructions are available in the Provider File
Management Navinet Guide, which is available on the Provider Resource Center under
Education/Manuals.

Medicare CMS will be releasing the Physician Fee Schedule on November1, 2017. A 2% increase is
projected.
Medicare will not be adding any new Bundle Total Joint Programs. Current plans are to reduce the
number of mandatory areas from 67 to 34.
Medicare plans to introduce MIPS (Merit Based Incentive Payment System) for Physical Therapists.
PTs will be told in May if they will be implementing it in 2019. 2019 will report on 2017 data. It is
possible to get increases or reductions of 3%, 5%, 7%, or 9% based on data submitted.

Humana Update on Humana audits. Humana is continuing to do audits all over the country. Be sure to
send in all the information they ask for within their timeline to avoid funds being recouped. We have not heard
of many recoupments so far in those providers that send in requested information.
Humana is starting a Total Joint Replacement Episode-based Bundled Payment Initiative nationwide. It is not
clear when it will begin and there is no information on the website regarding how it will affect physical therapy
providers.

Medicaid Providers were notified in August by Aetna Better Health of WV that due to an incorrect fee
schedule being received and loaded, claims related to RVRBS were incorrectly priced and there will be

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upcoming adjustments on future remits. The corrected fee schedule has been loaded and claims are now pricing
accurately. This appeared on their website. Providers received a reduction in the fee schedule and money has
been taken back, in some cases thousands of dollars on claims from January, 2017 through August. Taking
back money on subsequent remits causes an accounting nightmare trying to keep up with the accuracy of the
process. We asked if we could refund the money instead which would help our bookkeeping and were told,
NO.

State Policy and Payer Forum I attended the forum in Detroit September 16th and 17th. There were
several take home messages:

APTA membership has grown to 103,471 members as of July 2017.

The Choose PT campaign has increased traffic to the APTA website. Australia has adopted a Choose
Physio campaign.
Helene Fearon retired from the AMA CPT Board in September. She had been APTAs advocate for CPT
coding since 1992.
PTs need to look at the data in their practices and determine how to provide great care that is less
costly to the payers. Establish protocols that rehabilitate patients in fewer visits providing greater
VALUE.
APTA is talking to the Department of Defense about including language in a bill that will accept
treatment by PTAs with Tricare. PTA treatment is not presently a billable service to Tricare.
APTA did a study and found there was no correlation between Functional Limitation Reporting and
outcomes. Some commercial payers are considering implementing FLR. PTs need to communicate this
to the payers.

TREASURER UPDATE
MATTHEW MADRID, MSPT
WVPTA Treasurer

No Current Issues or Concerns Raised from executive committee meetings and/or chapter members.

Recent Treasurer Activities

Peer Review Audit - 2016 WVPTA peer review audit completed by President, Executive Director, and
Treasurer. Review forwarded to Margo Westenhoff, staff accountant at APTA.

Morgan Stanley Investment Account Transition to Vanguard Based upon email and phone
communication between Mike Bostler, APTA independent investment advisor and WVPTA executive
board members. Completing Vanguard Brokerage Account application for organizations. Once
completed and application accepted, treasurer will contact Morgan Stanley to terminate account and
liquidate assets.

Financial Position (10/16/17) Current Assets

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 Cash & Cash Equivalents 69,268

Marketable Securities 70,337

Total Current Assets 139,605

Total Liabilities ----- 0 -------

Final Comments Current net revenue over expenses as of 10/16/2017 = $10,939.28

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

THANKS TO OUR 2017 SPONSOR!