Based on stakeholder feedback obtained over the last year, the Centers for Medicare and Medicaid Services (CMS) has made improvements to the Provider Enrollment, Chain, and Ownership System (PECOS), which allows most providers and suppliers to enroll in the Medicare program or make changes to their Medicare enrollment information via the Internet rather than through the paper form. The following upgrades aim to make PECOS more user-friendly:
APTA members can find more information about the program on the association's PECOS webpage.
Functional-based exercise, such as such as ironing while standing on 1 leg, should be a focus for interventions to protect older, high-risk people from falling and to improve and maintain functional capacity, say authors of an article published August 7 in BMJ.
Researchers in Australia conducted a 3-arm randomized trial in which 317 residents of Sydney older than 70 years who had 2 or more falls or 1 injurious fall within the previous year were recruited and randomly assigned to 1 of the following interventions—a novel activity-integrated exercise program called Lifestyle integrated Functional Exercise (LiFE), a structured exercise program, or a gentle exercise control program.
"In the LiFE approach, movements specifically prescribed to improve balance or increase strength are embedded within everyday activities, so that the movements can be done multiple times during the day… whenever the opportunity arises," write the authors. For example, a prescribed activity incorporating the balance strategy of "reducing base of support" might involve a tandem stand while working at a countertop, and over time could be upgraded to working while standing on 1 leg. A prescribed activity incorporating the strategy to increase strength by bending knees might involve squatting instead of bending at the waist to close a drawer, and could be upgraded to picking things up from the floor.
The researchers performed follow-up at 6 months and 12 months after study participants started their programs. After 12 months of follow-up, the authors recorded 172 falls in the LiFE group, 193 in the structured exercise group, and 224 falls in the control group. The LiFE, structure exercise, and control groups had 21, 24, and 26 people who fell once, and 39, 41, and 45 who fell at least twice, respectively.
"The LiFE program provides an alternative to traditional exercise to consider for fall prevention," say the authors.
Don't forget to sign up for the National Council on Aging's (NOCA) free webinar on August 28 and learn how you can participate in Falls Prevention Awareness Day, recognized September 22. Find patient care, consumer education, and NOCA resources, in addition to continuing education courses on balance and falls at www.apta.org/BalanceFalls/.
More than 2,000 hospitals, including some nationally recognized ones, will be penalized starting in October under the Affordable Care Act's Hospital Readmissions Reduction Program, says a Kaiser Health News article. Together, these hospitals will forfeit about $280 million in Medicare payments over the next year for excess readmissions for heart attack, heart failure, and pneumonia.
The penalties will be the most severe in hospitals in New Jersey, New York, the District of Columbia, Arkansas, Kentucky, Mississippi, Illinois, and Massachusetts. Hospitals that treat the most low-income patients will be hit particularly hard.
A total of 278 hospitals nationally will lose the maximum amount allowed under the health care law—1% of their base Medicare payments. Several of those are top-ranked institutions, including Hackensack University Medical Center in New Jersey; North Shore University Hospital in Manhasset, New York; and Beth Israel Deaconess Medical Center in Boston, the article says.
The total number of hospitals receiving penalties is 2,211. According to Medicare records, 1,933 hospitals will receive penalties less than 1% percent. Massachusetts General Hospital in Boston, which has been rated as the best hospital in the country, will lose 0.5% of its Medicare payments because of its readmission rates.
Nearly 1 in 5 Medicare beneficiaries are readmitted within 30 days of discharge each year, costing Medicare 17.4 billion in additional hospital bills, according to a 2009 study on Medicare claims data from 2003-2004. The national average readmission rate has remained steady at slightly above 19%, even as many hospitals have worked to lower theirs, says Kaiser Health News.
Physical therapists can help serve an important role in patient care transitions and care coordination and can help reduce readmissions by providing recommendations for the most appropriate level of care to the health care team prior to and during care transitions. For more information and to find clinical practice and patient education resources to reduce readmissions, visit APTA's Hospital Readmissions webpage.
APTA member Danielle Haggerty, PT, explains how her practice has successfully provided direct access to Medicare beneficiaries in a new APTA podcast. Haggerty shares her office's protocol for obtaining a signed plan of care to ensure that patients have access to physical therapy services and payment is received, and discusses the importance of educating therapists and office staff on Medicare requirements. In addition, Haggerty explains why she opts to have physicians recertify the plan of care every 30 days and how this has turned into an "excellent marketing tool" that strengthens the practice's relationship with the physician community.
For more information about direct access and Medicare, go to www.apta.org/DirectAccess/Medicare/.
Physical therapists are encouraged to apply to become review panelists for the Center for Medicare and Medicaid Innovation's (CMMI) Bundled Payments for Care Improvement Initiative. This initiative has 4 broadly defined models of care, 3 of which would involve a retrospective bundled payment arrangement, with a target price (target payment amount) for a defined episode of care and 1 of which would be paid prospectively. CMMI is ready to bring together expert panel members for the review of applications for models 2, 3, and 4.
Review panels will be held in Baltimore, Maryland, for 2 full days of meetings the week of September 19. Prior time commitment and travel to Baltimore will be required. Reimbursement of travel expenses and an honorarium will be offered.
If you are interested in participating, e-mail Diane Graham by August 17. CMMI will evaluate the panel list, finalize the list of panel reviewers, and contact applicants by August 27.