APTA has updated its Medicare Physician Fee Schedule FAQ to
clarify the impact of the multiple procedure payment reduction (MPPR) on
payment for therapy services.
Set to be implemented on April 1, the provision applies the
MPPR to therapy services at 50%, up from 20% for office settings and 25% for
facility settings. APTA estimates
the application of a 50% MPPR policy will reduce payments by approximately 6-7%
in aggregate for outpatient therapy services. This reduction will be partially
offset by a 4% increase in practice expense that resulted from the Centers for
Medicare and Medicaid Services' use of new survey data of practice expenses
conducted by APTA. The impact of the MPPR reduction on individual practices and
facilities will vary depending on the CPT codes billed and the typical duration
of the therapy sessions. To determine the impact on your practice, refer to APTA’s MPPR calculator, which can be used to determine payment rates for 2012 and
APTA will advocate to fix this flawed policy. The
association soon will call on APTA members to help in this effort.
The Centers for Medicare and Medicaid Services (CMS) has
further clarified the regulations on the new functional limitation reporting
requirements that were included in transmittal R2622CP and a new Medicare Learning Network resource. CMS was mandated to collect information on claim
forms regarding beneficiaries' function and condition, therapy services furnished,
and outcomes achieved on patient function by the Middle Class Tax Relief Act of
2012. All practice settings that provide outpatient therapy services must
include this information on the claim form. These new functional limitation
reporting requirements were implemented on January 1. To ensure a smooth
transition, CMS sets forth a testing period January 1-July 1. After July 1,
claims submitted without the appropriate G-codes and modifiers will be returned
The major points of clarification include:
Additionally, CMS has released revisions to the Medicare Benefit Policy Manual that include the functional
limitation reporting requirements (see related article titled "CMS
Releases Updates to the Medicare Benefit Policy Manual").
APTA has posted links to these documents on its functional limitation reporting webpage. The association also has updated the FAQ
posted on the webpage, which provides resources to help members meet this new
The Centers for Medicare and Medicaid Services (CMS) has
revised the Medicare Benefit Policy Manual to include a change to the progress note requirement,
which now is required at either a date chosen by the clinician or the 10th
treatment day, whichever is shorter. Additionally, there is a new section
dedicated the functional limitation reporting requirements that were implemented on
January 1. Therapists are required to include functional limitation reporting
information in their documentation. The functional impairments identified and
expressed in the long-term treatment goals must be consistent with those used
in the claims-based functional reporting using nonpayable G-codes and severity
modifiers for services furnished on or after January 1. For more information,
visit APTA's functional limitation reporting webpage.
On Thursday, Sen Mark Kirk (R-IL) returned to Capitol Hill
for the first time since having a stroke in January 2012 that paralyzed the
left side of his body. Kirk climbed the steps to the Capitol using a 4-prong
cane and assisted by Vice President Joe Biden and Sen Joe Manchin (D-WV) while
his colleagues in the 113th Congress cheered.
Kirk was scheduled to hold a press conference Thursday with physicians and
researchers from the Rehabilitation Institute of Chicago and Northwestern
Memorial Hospital to discuss the treatment he underwent.
APTA member Michael Klonowski, PT, DPT, PCS, who
was Kirk's primary physical therapist in Chicago, told USA
that he was "more emotional" than he thought he would be as he watched
his former patient make the climb.
"Seeing what he's done
is absolutely inspiring," Klonowski said. "I've seen him go up tons
of stairs. ... It was really something to see him do what he did today."
In an interview published Wednesday in the Chicago Sun-Times Kirk said that his experience with the
health care system has given him a new perspective. He said that he plans to
take a look at the Illinois Medicaid program, which he noted allows 11 rehab
visits for patients with stroke.
"Had I been limited to that, I would have
had no chance to recover like I did," Kirk said. "So unlike before
suffering the stroke, I’m much more focused on Medicaid and what my fellow
Watch this NBC video of Kirk's "45
monumental steps." To view photos of Kirk in rehabilitation, visit the Huffington Post.
Adults diagnosed with diabetes are at significantly increased risk for
fracture-related hospitalization, says a Medscape
Medical News article
based on the results from an analysis of data from a large, community-based
More than 15,100 patients between 45 and 64 years old participated in the
Atherosclerosis Risk in Communities (ARIC) study, a 4-community study that
began in 1987. There were a total of 1,078 fracture-related hospitalizations
during the 20-year follow-up period. (Only fractures that resulted in inpatient
hospitalization were captured in ARIC.)
At baseline, 1,195 participants had been diagnosed with diabetes based on
self-report, and 605 had undiagnosed diabetes according to their measured serum
Compared with the 13,340 study participants without diabetes, the incidence
of fracture-related hospitalization was significantly greater among the group
with diagnosed diabetes (6.6 vs 3.9 per 1,000 person-years of follow-up).
The incidence of fracture hospitalization was higher among those with
diagnosed diabetes compared with those without diabetes for all age groups.
However, the fracture risk was not increased among those with undiagnosed
diabetes compared with those without diabetes, the article says.
After adjustment for the covariates, diagnosed diabetes still was associated
with a significantly increased risk for fracture hospitalization, with a hazard
ratio (HR) of 1.74.
However, also in the fully adjusted analysis, the fracture risk among those
with undiagnosed diabetes was similar to that for those participants without
diabetes (HR 1.12).
There also was a significant relationship with glycemic control. After
adjustment, participants with diagnosed diabetes who had hemoglobin A1c values
of 8% or greater had a significantly greater risk for fracture hospitalization
than did those with A1c values less than 8% (HR 1.63). After further
adjustment for diabetes medication use that risk was reduced (HR 1.50).
The authors say further studies are needed to understand if exercise
interventions or strategies to improve glycemic control while minimizing
hypoglycemic episodes may prevent fractures among people with diabetes.
The study was published online December 17 in Diabetes Care.
In response to a troublesome provision included in the fiscal cliff package
passed by Congress on Tuesday, APTA is advising members to monitor APTA's website and the Legislative Action Center specifically for upcoming
action alerts regarding efforts to avert the increased multiple procedure
payment reduction (MPPR) included in the American Taxpayer Relief Act of 2012
Set to be implemented on April 1, the provision applies the MPPR to therapy
services at 50%, up from 20% for office settings and 25% for facility settings.
APTA estimates the application of a 50% MPPR policy will reduce payments by
approximately 6%-7%. This reduction will be partially offset by a 4% increase
that resulted from the Centers for Medicare and Medicaid Services' (CMS) use of
new survey data of practice expenses conducted by APTA. Coupled together, APTA
expects the net overall decrease for outpatient therapy services to be between
2%-3%, a lower cut than expected. Nevertheless, APTA will advocate to fix
this flawed policy. The association soon will call on APTA members to make
their voices heard on Capitol Hill.
The increase to a 50% MPPR was recently endorsed by the Medicare Payment
Advisory Commission (MedPAC). Despite months of aggressive lobbying
efforts to reject the provision, Congress ultimately included this and a number
of other spending cuts in the fiscal cliff package to offset other health care
related provisions, including the prevention of the 26.5% fee schedule cut and
the extension of the therapy cap exceptions process.
Once policy options are assessed,
APTA will issue additional alerts to PTeam. If you're not a member of PTeam, sign up today to receive the alerts. In the
members are encouraged to learn more about this and other important provisions
included in the legislation through the resources provided on APTA's 2013 Medicare Changes: January 2013 webpage
at www.apta.org/Payment/Medicare/2013/Changes/. These resources include a statement by
APTA's president on HR8, a congressional summary, a 2013 Medicare therapy cap
FAQ, and a 2013 Physician Fee Schedule and MPPR FAQ.
Additionally, APTA has updated the MPPR calculator to help association members determine their reimbursement for services based on the MPPR only.
Safe patient handling (SPH) programs do not appear to
inhibit patient recovery, say authors of a retrospective cohort study conducted
in a rehabilitation unit in a hospital system. Fears among therapists that the
use of equipment may lead to dependence may be unfounded, they add.
For this investigation, the authors enrolled consecutive
patients (N=1,291) over a 1-year period without an SPH program in place (n=507)
and consecutive patients over a 1-year period with an SPH program in place
(n=784). The SPH program consisted of administrative policies and patient
handling technologies. The policies limited manual patient handling by staff.
Equipment included ceiling- and floor-based dependent lifts, sit-to-stand
assists, ambulation aides, friction-reducing devices, motorized hospital beds
and shower chairs, and multihandled gait belts. The main outcome measure was
the mobility subscale of the FIM.
Patients who were rehabilitated in the group with SPH
achieved similar outcomes to patients rehabilitated in the group without SPH. A
significant difference between groups was noted for patients with initial
mobility FIM scores of 15.1 and higher after controlling for initial mobility
FIM score, age, length of stay, and diagnosis. Those patients performed better
APTA member Marc
Campo, PT, PhD, OCS, is the article's lead author. APTA member Heather Margulis, PT, is coauthor. The article
is available in this month's Archives
of Physical Medicine and Rehabilitation.
Two themes emerge in this month's PTJ, says Editor in Chief Rebecca Craik, PT, PhD, FAPTA, in her January Craikcast. The first theme, which reflects back on PTJ's December 2011 Special Issue on Advances in Disability
Research, calls for physical therapists to go beyond measurements of
impairments and consider other variables when evaluating outcomes following
interventions. Craik notes that 4 papers in the current issue "certainly
have gone beyond the impairment level in looking at outcome measures." The
second theme, motor control and motor learning, can be found in articles on
intermanual transfer in patients with upper-limb amputation, body-scaling, and
mastering motivation in toddlers.
Responding to a charge from the 2012 House of Delegates to
revise Vision 2020 to "reflect the
vision of the profession of physical therapy and its commitment to society
beyond 2020," the Vision Task Force sent a revised vision to the APTA
Board of Directors for consideration at its November 2012 meeting. The Board
will forward the proposed vision to the 2013 House of Delegates for
consideration. Information about the proposed vision has been posted and is available
for members and delegates to review. Please direct your comments about the
vision to your chapter or section delegates or directly to the members of the
Vision Task Force.
The Foundation for Physical Therapy recently launched a new
effort that enables students, faculty, and members of the community to
collectively raise funds for physical therapy research. Built around the
concept of training for a triathlon, physical therapy programs will form teams,
and team members will log the number of miles they each swim, bike, and run on
the Log 'N Blog website. Register today!
The relationship between health care spending and quality of
care is "totally unclear," say researchers in a Reuters Health article
about their meta-analysis of 61 studies that compared health care spending with
outcomes on both small hospital-wide scales and broader state-wide levels.
Some of the studies looked at whether hospitals that spent more money per patient had fewer in-hospital deaths,
or if their physicians and nurses better followed guidelines. Others compared
states' Medicare spending with how well their older residents were treated for
a range of conditions.
"The bottom line was that no matter how you drill down into the
results, at every level the results are just all over the map," Peter S. Hussey, PhD, the study's lead investigator, told
Twenty-one of the 61 studies showed higher spending was tied to better
outcomes for patients, such as fewer deaths. However, 18 studies found a link
between more spending and worse outcomes, and 22 showed no difference or an
unclear association based on spending.
Many of the studies compared certain types of spending with potentially
unrelated outcomes. Others didn't take into account how sick patients were
initially when looking at how they fared in different situations, the article
Hussey and colleagues
conclude that future studies should focus on what types of spending are
most effective in improving quality and what types of spending represent waste.
The findings are published in the January 1 issue of Annals of Internal Medicine.