Top Regulatory Changes of 2014

Ch-ch-ch-changes: We’ve seen a plethora of regulatory changes this year in the PT space—from the ICD-10 delay to the therapy cap increase. Although some of these legislative twists and turns have caused headaches for therapists, others have been hugely positive. For instance, some form of direct access is now available in all 50 states as well as Washington, DC, and the US Virgin Islands. Read on to learn this year’s top regulatory changes.

Regulatory Heavy-Hitters of 2014

• Four PQRS measure changes affected PTs this year:

1. Measure 131 (Pain Assessment) is now available for reporting on PT initial evaluations and re-valuations. In 2013, this measure was only available at the initial evaluation.
2. Measure 246 (Chronic Wound Care: Use of Wet to Dry Dressings in Patients) was eliminated.
3. Measure 155 (Falls Plan of Care) must include documented consideration—or referral to a physician—for vitamin D supplementation.
4. Measure 182 (Functional Outcome Assessment) is available for both PTs and OTs.

• Thanks to newly passed direct access legislation in both Michigan and Oklahoma, therapists in those states can evaluate patients without physician referrals. Oklahoma’s law went into effect November 1, 2014, and PTs in Michigan can take advantage of their state’s new direct access regulation starting on January 1, 2015.
• ICD-10 was delayed when the Senate passed HR 4302—thus keeping the terribly outdated ICD-9 code system alive. In addition to losing both time and money preparing for a change that never occurred, clinics now must shoulder the burden of outdated codes until at least October 2015—the new ICD-10 go-live date. And with talks of another delay in 2015 circulating among those in the healthcare industry, the future of the ICD-10 transition is still in limbo. Keep an eye on our blog—we’ll provide updated ICD-10 information as it’s released.
• The therapy cap increased to $1,920—up from $1,900 in 2013—for PT and SLP combined. (And for 2015, the cap will increase to $1,940.)
• For two years, CMS has used a policy known as Multiple Procedure Payment Reduction (MPPR) to reduce payments for therapy services when therapists perform multiple services in one visit. In 2014, the payment reduction (of the practice expense portion) increased to 50% of all services after the first unit is paid in full.

An Attack on the Scope of PT Practice

• As many PTs are aware, some members of the acupuncture community have advocated against the practice of dry needling in physical therapy. A campaign to remove the modality from the scope of PT practice casts dry needling as “illegal” acupuncture that puts the public at risk for injury. These erroneous claims have already spurred legal action in Washington state, where a county court ruling barred a PT clinic and an educational group from teaching or performing acupuncture as part of physical therapy care. Now, traditional Chinese medicine acupuncturists are attempting to push this issue through further legislation. My two cents: Outside organizations should neither be allowed to withhold the benefits of dry needling from patients, nor define PT qualifications and scope of practice. And a lot of PTs agree with me. If you do, too, you can sign a petition here to keep this effective treatment in the hands of PTs.

I don’t know about you, but for the remaining days of 2014, I’m happy to reflect on all the changes that happened this year—regulatory or not—and kick back with some dairy-free nog. Cheers to a happy new year. Oh, and if I missed any other noteworthy legislative developments for 2014, please share them in the comments.