APTA's public policy priorities for 2013-2014 were posted this week on APTA's website for members and public audiences, representing issues to which APTA will direct its efforts in the 113th Congress and federal agencies. Initially adopted by the Board of Directors in November 2012, the priority list has been adjusted to reflect implications of the fiscal cliff legislation and sequestration, such as the multiple procedural payment reduction (MPPR) and a Blue-Ribbon Commission report on the future of rehabilitation research at the National Institutes of Health.

Every 2 years, APTA, through its Public Policy and Advocacy Committee, develops public policy priorities by gathering extensive member feedback on the issues that matter to your practice and patients. The committee will continue to update and revise the priorities as challenges and opportunities emerge over the next 2 years.

This list does not include all issues for which the association is advocating to advance physical therapy practice, education, and research; however, these issues were identified as priorities by members, confirmed by APTA leaders, and implemented by APTA staff. As these issues become active in Congress or federal agencies, APTA will communicate with and activate its membership to ensure physical therapy is best represented. To stay informed, join APTA's grassroots network, PTeam.

Also consider coming to Washington, DC, to educate and lobby your member of Congress on these priorities, including the immediate challenges facing physical therapist payment under Medicare, such as the therapy caps, MPPR, and impact of the sequester cuts. Join your engaged colleagues at the annual Federal Advocacy Forum, April 14-16. Learn more and register.

For the second time in 6 months, Medicare has erred in calculating hospital readmission penalties for more than 1,000 of the nation's hospitals, says a Kaiser Health News article.

As a result, Medicare has slightly lessened its readmissions penalties for 1,246 hospitals as part of its Hospital Readmissions Reduction Program. The penalty imposed on St Claire Regional Medical Center in Morehead, Kentucky, will drop the most, from 0.93% to 0.72% of every payment Medicare makes for a patient during the fiscal year that ends in September.

Medicare also modestly increased the penalties for 226 hospitals. LaSalle General Hospital in Jena, Louisiana, will see its penalty grow by the greatest percentage. LaSalle will lose 0.84% of each Medicare payment per patient, instead of the 0.65% reduction Medicare previously announced.

The payment changes for most hospitals were small, averaging .03% of each reimbursement. Overall, hospitals will pay $10 million less in penalties than previously calculated, for a total of $280 million this year. The changes are retroactive to October 2012, when the program began.

The readmission program, created by the Afforadable Care Act, is looking at the number of patients with heart attack, heart failure, and pneumonia who return to the hospital within 30 days of discharge. Hospitals with more readmissions than Medicare expected given their mix of patients are penalized by losing up to 1% of their regular payments. The maximum penalty ramps up to 2% starting this October and grows to 3% in 2014.

Medicare originally released the penalties last August, but then revised them at the end of September after determining that it had left some patients out of its calculations. That change increased penalties for 1,422 hospitals and decreased them for 55 others.

This second correction brings many hospitals closer to where they originally were, says Kaiser. More than 320 hospitals that had their penalties altered in September now will have their initial penalties restored.

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.

There were no significant differences in functional improvement after 6 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone, say authors of an article published in the New England Journal of Medicine.

The multicenter, randomized, controlled trial involved 351 symptomatic patients aged 45 years or older with a meniscal tear and evidence of mild-to-moderate osteoarthritis. Subjects randomly were assigned either to surgery and postoperative physical therapy or to a standardized physical therapy regimen (with the option to cross over to surgery at the discretion of the patient and surgeon). Patients were evaluated at 6 and 12 months, primarily using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical-function score (ranging from 0 to 100, with higher scores indicating more severe symptoms) 6 months after randomization.

In the intention-to-treat analysis, the mean improvement in the WOMAC score after 6 months was 20.9 points (95% confidence interval [CI], 17.9 to 23.9) in the surgical group and 18.5% (95% CI, 15.6 to 21.5) in the physical therapy group (mean difference 2.4 points, 95% CI, -1.8 to 6.5). At 6 months, 51 active participants in the physical therapy alone group (30%) had crossed over to undergo surgery, and 9 patients in the surgery group (6%) had not undergone surgery. The results at 12 months were similar to those at 6 months, say the authors, and the frequency of adverse events did not differ significantly between the groups.

The authors say their findings suggest that both options are "likely to result in considerable improvement … over a 6-12 month period." However, they continue that "these data provide considerable reassurance regarding an initial nonoperative strategy."

As states work to implement the Affordable Care Act (ACA) and improve Medicaid and CHIP for current beneficiaries, the Medicaid and CHIP Payment and Access Commission (MACPAC) made 2 recommendations Friday to Congress on eligibility policy.

MACPAC's March 2013 Report to the Congress on Medicaid and CHIP reflects the key priorities facing program administrators: implementing Medicaid eligibility provisions; managing the policy and operational interactions among Medicaid, CHIP, and coverage through new health insurance exchanges; and pursuing delivery system and payment innovations for individuals dually enrolled in Medicare and Medicaid, who are among the highest need and highest cost enrollees in both programs.

In its report, the commission recommends that Congress create a statutory option for states to implement 12-month continuous eligibility for children enrolled in CHIP and adults enrolled in Medicaid, as is now the case for children in Medicaid. This recommendation is designed to reduce frequent enrolling and disenrolling from different health plans in a short period and decrease the administrative burden of the eligibility determination process. It would enable states to enroll eligible individuals for a full year, regardless of changes in income. The commission is making the recommendation to ensure that the option, which would otherwise be removed under new income-counting eligibility standards, remains available to states.

The second recommendation calls for Congress to permanently fund transitional medical assistance (TMA), which provides additional months of Medicaid coverage to millions of families who might otherwise become ineligible and uninsured due to an increase in earnings. MACPAC's recommendation would allow states that expand Medicaid to the new adult group to opt out of TMA. If the recommendation were implemented, it would provide certainty that funding will be available for states that choose not to expand eligibility, and it would reduce administrative burden for states that do expand.

The report also continues the commission's work on people who are dually eligible for Medicare and Medicaid. This group is of great interest to Congress because of the complexity and cost of the health care needs of "dual eligibles."

An executive summary of the report is available at this link.

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