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  • APTA Adds Physical Therapy Perspective to Senate Work Group Report on Chronic Health Conditions

    The challenges of providing care to individuals with chronic health conditions are now the focus of a bipartisan working group in the US Senate, and APTA is helping to shape the group's policy proposals.

    In December 2015, the Senate Finance Committee's Bipartisan Chronic Care Working Group issued a 30-page "policy options document," the product of a 6-month investigation of possible ways to improve care delivered to Medicare beneficiaries with chronic health conditions. The information-gathering process included over 80 stakeholder meetings and 530 recommendations, with the final document including 24 policy proposals ranging from the changes to the Medicare Advantage (MA) program to expanded education and research initiatives.

    According to the work group, the policy changes listed in the document are aimed at increasing care coordination, streamlining Medicare payment systems "to incentivize the appropriate level of care," and establishing a chronic care system that "facilitates the delivery of high quality care, improves care transitions, produces stronger patient outcomes, increases program efficiency, and contributes to an overall effort that will reduce the growth in Medicare spending."

    On the whole, APTA's comments to the proposals were supportive, with the association focusing on 12 proposals that would most directly affect physical therapy. Among them:

    Expansion of the Independence at Home demonstration project into a "permanent, nationwide program." APTA supported the idea, but advocated for a careful approach.

    Continued access to MA special needs plans. APTA asserted that "all plans have access to physical therapy services."

    Provisions that would allow MA plans to vary benefit structures to meet the needs of chronically ill enrollees. APTA supported this idea, but called for care in the definition of "non clinical" professionals.

    Telehealth provisions that would expand opportunities for use in MA, accountable care organizations (ACOs), and for beneficiaries poststroke (3 separate policy proposals). APTA supported all 3 proposals, particularly in relation to physical therapy, writing that "telehealth will not replace traditional client care, but it will give [physical therapists] and [physical therapist assistants] the flexibility to provide services in a greater capacity."

    Ensuring accurate payment for individuals who are chronically ill. APTA wrote that it was "generally supportive" of the proposal, but suggested that to truly achieve a more effective payment system, additional regulatory changes need to happen—including a full repeal of the Medicare therapy cap.

    The association also commented on proposals to increase care coordination among ACOs, the development of quality measures for chronic conditions, and a suggestion to increase transparency at the CMS Center for Medicare and Medicaid Innovation (CMMI), a center that should create more grant funding opportunities "aimed at providers such as physical therapists," according to APTA.

    APTA highlights the role of the physical therapist and physical therapist assistant in the treatment of chronic conditions through its prevention, wellness, and disease management webpage. In addition, the 2015 House of Delegates adopted the position Health Priorities for Populations and Individuals (RC 11-15) "to guide [APTA's] work in the areas of prevention, wellness, fitness, health promotion, and management of disease and disability." The priorities include active living, injury prevention, and secondary prevention in chronic disease and disability management. The topic was also the subject of a popular presentation at the 2015 NEXT Conference and Exposition.

    Also available from the APTA Learning Center: "Disease Management Models for Physical Therapists: Focus on Diabetes and Cardiovascular Disease."

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