APTA's summary of Medicare's proposed rule for general acute care hospitals and long-term care hospitals, which includes quality measures for readmissions relating to hip and knee replacement procedures, now is available on the Medicare Payment and Policies for Hospital Settings webpage. (See related article posted April 26)
Yesterday, the Centers for Medicare and Medicaid Services (CMS) released the final rule on the Medicaid program’s Community First Choice (CFC) option as mandated under the Affordable Care Act (ACA) establishing a new option for states to provide home and community-based attendant services and supports for beneficiaries.
With the additional flexibility to finance home and community-based services and support, the provision is expected to increase state and local accessibility to services that augment the quality of life for beneficiaries through a person-centered plan of service and various quality assurances—at a potentially lower per capita cost relative to institutional care settings.
According to the rule, states that elect this option must make available home and community-based attendant services and supports to assist in accomplishing activities of daily living, instrumental activities of daily living, and health-related tasks through hands-on assistance, supervision, and/or cueing. Additionally, the following services may be provided at the state’s discretion—transition costs, such as rent and utility deposits; first month's rent and utilities; purchasing bedding, basic kitchen supplies, and other necessities required for transition from an institutional setting; and the provision of services that increase independence or substitute for human assistance to the extent that expenditures would have been made for the human assistance, such as nonmedical transportation services or purchasing a microwave.
The final rule sets forth the requirements for CFC, however, requirements pertaining to "setting," under §441.530, will be addressed in future rulemaking.
More than 250 physical therapists, physical therapist assistants, and students who participated in this year's Federal Advocacy Forum, held April 22-24 in Washington, DC, met with members of Congress from all 50 states to discuss the repeal of the therapy cap, the physical therapist's role in managing patients with traumatic brain injury, and student loan repayment.
On Monday, an interactive town hall session that featured APTA health quality and financing staff informed attendees about regulatory hot topics such as therapy cap implementation, payment, quality, and accountable care organizations. Forum participants also attended a session on direct access and received updates on APTA's legislative and regulatory activities.
APTA presented Sen Susan Collins (R-ME) with this year’s Public Service Award for her work on therapy cap repeal and access to physical therapy for military members and veterans. APTA member Eva Norman, PT, DPT, was awarded the 2012 Federal Government Affairs Leadership Award for her continued leadership and dedication to APTA's federal legislative issues.
This year's Federal Advocacy Forum was held in conjunction with APTA's Leadership Forum, which included APTA's Board of Directors meeting and Leadership Symposium.
An April 22 article by Kaiser Heath News highlights the growing number of insurers and employers who classify physical therapy visits as specialty care, resulting in higher copayments for patients that often are equal to a specialist visit. The article quotes Matthew Hyland, PT, PhD, MPA, CSCS, president of the New York Chapter, and Justin Elliott, APTA director of state government affairs.
APTA's Fair Physical Therapy Copays webpage offers a variety of legislative resources, such as APTA model legislation and a sample letter to legislators, to help chapters in their fight against excessive copays. Examples of state strategies used by the Kentucky, Missouri, New Jersey, and New York chapters also are available.
A proposed rule that would update Medicare payment policies and rates for inpatient stays in general acute care hospitals and long-term care hospitals (LTCH) aims to strengthen the inpatient quality reporting program by including measures for readmissions relating to hip and knee replacement procedures.
The proposal, issued Tuesday by the Centers for Medicare and Medicaid Services (CMS), would strengthen the Hospital Value-Based Purchasing Program (VBP Program) to further Medicare’s transformation to a system that rewards efficient, high-quality care. This program, which was required by the Affordable Care Act, will adjust hospital payments beginning in Fiscal Year (FY) 2013 and annually thereafter based on how well they perform or improve their performance on a set of quality measures.
Specifically, CMS proposes to:
In the proposal, CMS projects that payment rates to general acute care hospitals will increase by 2.3% in FY 2013. The agency projects that total Medicare spending on inpatient hospital services will increase by about $175 million in FY 2013.
For LTCHs, CMS proposes a 2.1% update to payment rates and projects that LTCHs payments will increase by approximately $100 million in FY 2013.
CMS will accept comments on the proposed rule until June 25 and will respond to all comments in a final rule to be issued by August 1. APTA will submit comments on behalf of its membership.
A detailed summary of the proposed rule is available on APTA's Medicare Payment and Policies for Hospital Settings webpage.
According to the authors of an article published online in Manual Therapy, their study is the first to show an association of within/between-session changes with disability scores at discharge in patients who were treated with manual therapy for low back pain, and the first to define the extent of change necessary for prognosis of an outcome. A within/between-session change should be considered as a complimentary artifact along with other examination findings during clinical decision making, they add.
This randomized controlled trial involved 100 participants who demonstrated a positive response to manual therapy during an initial assessment. Within- and between-session findings (within/between session) were defined as a change in pain report from baseline to after the second physical therapy visit. Within/between-session changes were analyzed for associations between pain change scores at discharge, rate of recovery, and a 50% reduction of the Oswestry disability index (ODI) by discharge. The results suggest there is a significant association between a within/between-session change after the second physical therapy visit and discharge outcomes for pain and ODI in this sample of patients who received a manual therapy intervention. A 2-point change or greater on an 11-point scale is associated with functional recovery at discharge and accurately described the outcome in 67% of the cases, say the authors.
APTA member Chad E. Cook, PT, PhD, MBA, FAAOMPT, is lead author of the article. APTA members Christopher Showalter, PT, OCS, FAAOMPT, Vincent Kabbaz, PT, and Bryan O'Halloran, PT, OCS, SCS, are coauthors.
Since 2002 the percentage of workers with health care coverage has been declining, mostly because fewer workers have access to coverage, says a new issue brief by the Employee Benefit Research Institute.
Both the offer rate (the percentage of workers offered health benefits) and the coverage rate for employment-based health benefits declined between 1997 and 2010. Between 1997 and 2010, the percentage of workers offered health benefits from their employers decreased from 70.1% to 67.5%, and the percentage of workers covered by those plans decreased from 60.3% to 56.5%.
In addition, the percentage of workers taking coverage when offered by their employers (take-up rate) declined from 86% in 1997 to 83.6% in 2010. Among the reasons given by respondents who chose not to participate in their employer’s health plan, 67.9% stated that they were covered by other health insurance in 2010, 29.1% reported that their employer’s plan was too costly, and another 2.2% reported either that they did not need insurance or that they did not want insurance.
According to the brief, offer rates increase with firm size. In 2010, 39.4% of workers in firms with fewer than 25 employees were offered health benefits, compared with 76.5% in firms with 100 or more employees. Take-up rates, while they vary with firm size, do so much less than offer rates. In 2010, 77.8% of workers in firms with fewer than 25 employees took coverage when it was offered, compared with 84.9% of workers in firms with 100 or more employees. Both offer and take-up rates are higher for full-time employees.
As for demographics, men, non-Hispanic workers, and workers with college degrees are more likely to be offered health care benefits.