Health Policy, Advocacy & Association Management

Health Policy and Advocacy

Times could not be more tenuous and chaotic for healthcare, specifically for the rehabilitation industry. Changes in Medicare coverage and payment methodologies, stepped-up fraud and abuse enforcement combined with less than clear regulations, create a perilous course for the rehabilitation and health providers whose primary mission is to deliver a high quality health care experience to their patients.

Mere awareness of these public policy perils is not always enough to safely and effectively navigate the difficult channels. It is necessary at times to collaborate with a knowledgeable, experienced partner in the policy arena who can provide the necessary guidance, assistance and advocacy.

Jerome B. Connolly is that partner for health and rehabilitation providers. For nearly 30 years, Connolly has been active in the physical therapy profession, developing programs, treating patients, contracting services, achieving and maintaining Medicare certification in hospitals, skilled nursing facilities, home health agencies, school systems and outpatient clinics. But Connolly has been active in other ways as well, influencing state, federal and private insurance policy as it affects the delivery of care to patients. For over twelve years, Connolly has been an effective voice for advancing physical therapy policy in Washington. For six of those years, Connolly served as Senior Vice President for Health Policy at the American Physical Therapy Association, directing all of APTA's state and federal legislative and regulatory and private insurance reimbursement advocacy efforts.

From 1995 to 2001, Connolly designed and directed APTA staff and volunteers in multiple activities that:

* Expanded the physical therapy market by approximately $2 billion;

* Overturned federal law which placed a $1500 Medicare therapy cap on all therapists;

* Eliminated the 30-year Medicare cap on private practitioners;

* Won a lawsuit against Medicare over elimination of coverage for electrical stimulation in treatment of chronic wounds;

* Attained successful Medicare coverage decisions in wound care and urinary incontinence;

* Developed recognized reimbursement codes for physical therapy evaluation and reevaluation procedures;

* Successfully defended legislative and regulatory assaults in 19 states on the right of physical therapists to practice manipulation;

* Protected and preserved legislative ban on physician self-referral;

* Influenced substantial content of Medicare Carrier Medical Directors' Model Policy for payment of physical therapy services;

* Designed and conducted first-ever physical therapy practice expense survey, which will raise the Resource-Based Relative Value Scale (RBRVS) reimbursement rate for physical therapy by 11 percent;

* Developed and implemented a nationwide 17,000 member grassroots advocacy network.

In response to market demands, Connolly founded Connolly Strategies & Initiatives, a health policy and advocacy firm that puts Connolly's record of achievement, his professional practice background, his business and policy experience to work for you; to fight for the laws and regulations that will enable you to provide the best care you know how with the least amount of government interference.

Below are a number of issues currently facing the health and rehabilitation professions and industries. Each poses an ominous threat to the solvency, survival and success of your health and rehabilitation business.

If you, or anyone you know, is concerned enough about one or more of these issues and is interested in changing the way health care is governed and regulated, contact Connolly today for a complimentary initial consultation to discuss advocacy services that may help you weather this tumultuous storm and calm the health care system waters for smoother sailing in the days ahead.

*Pay-for-Performance – With an escalating interest in value-based purchasing on the part of Congress, Medicare and other payers, health care practices must begin to position themselves to align with this new payment paradigm. CSI is familiar with the measure development process and the numerous demonstration projects currently underway. Connolly is prepared to assist health care entities in making a successful transition to this new reimbursement scheme.

*Regulation Interpretation, Guidance, Advocacy -- Those clients interested in successfully navigating the health care regulatory channels should feel free to call upon the experience, strategic expertise, policy analysis and contacts of Connolly Strategies in an effort to gain adequate coverage and proper payment for services provided to patients.

*Medicare Therapy Caps – The arbitrary Medicare cap on therapy has been suspended through June 2008 and replaced with an exceptions process. Documentation and quality measurement guidelines were outlined in CMS Transmittal 63. Congress must act to prevent the therapy caps from taking full effect on July 1. CSI can provide an effective voice for your organization in advocating for repeal or replacement of the arbitrary therapy caps. Continued grassroots pressure on Congress is critical at this time. Likewise, it is important to engage in meaningful work that will lead to the identification of possible alternatives to the cap such as including outliers and outcomes measurement. It will be from such proposals and from the numerous studies currently underway that the likely successor to the $1810 cap will emerge.

*Provider Reimbursement – Congress enacted a 0.5% increase in the Medicare Physician Fee Schedule effective for the first six months of 2008. Continued grassroots pressure on Congress is critical to avert a fee schedule cut of more than 10% on July 1. Since 2001, Connolly has been strategically involved in the broad coalition fighting for revision of the Sustainable Growth Rate (SGR), the arcane formula used to determine reimbursements under the Medicare Physician Fee Schedule. The coalition has been successful in postponing draconian cuts in Medicare reimbursement and will continue to work with CMS, Congress and a large cross-section of stakeholders in an attempt to develop a more reasonable formula.

*Fraud and Abuse, OIG Inspections, Audits, Corporate Compliance Plans -- From supervision of personnel to documentation and coding of treatment, every aspect of health care intervention is scrutinized in today’s environment. Connolly Strategies can provide assistance and guidance to practices and providers developing compliance plans which will protect the client against fraud and abuse errors. Important guidance with respect to the False Claims Act (FCA) and the Health Insurance Portability and Accountability Act (HIPAA) can also be made available.

*Physician Self-Referral – Stark II – Physician self-referral has been outlawed, yet the regulations weaken a key definition that enables the practice to continue. Recent evidence indicates escalation of this phenomenon. The recently published Stark II regs are lengthy, complicated and in some cases apparently contradictory. Proper interpretation, application and response to the regulation is essential.

*Coding Issues – Numerous coding issues surface annually as a result of the yearly revision of the Resource-Based Relative Value Scale (RBRVS). Moreover, the fee schedule is being applied to nearly every practice setting, making proper interpretation and application critical, particularly in this era of stepped-up fraud and abuse detection initiatives. Likewise, every provider group has an interest in the established and rigorous regulatory requirements employed by CMS to calculate practice expense values. Connolly’s direct experience in conducting one of the first ever practice expense surveys under new (then HCFA) requirements can provide necessary and valuable guidance to a profession desiring to develop accurate practice expense data which can account for 10 to 15 percent of Medicare reimbursement.

*Rural Health Issues -- As a former clinician and practice owner who provided health care in rural Montana, Connolly understands the issues and obstacles associated with the delivery of health services to patients in rural America. Assistance with Congress or a regulatory agency in overcoming these obstacles and making the voices of rural patients and practitioners heard is a service in which Connolly Strategies excels.

• Scrapbook
  CSI Photos and News