• Thursday, July 02, 2015RSS Feed

    Updated APTA Calculator Reflects 0.5% Increase in Payment Under Medicare

    Did you know that Medicare payments will be increased by 0.5% effective July 1? Stay on top of the new rates with APTA's MPPR calculator—an outpatient therapy claim pricer that can help you determine your payment for services.

    Tip: Be sure to click on the calculator that corresponds to the date service was provided.

    Thursday, July 02, 2015RSS Feed

    From PT in Motion Magazine: Value vs Volume

    Yes, physical therapists (PTs) should be judged by the value of their work; and no, that value should not be solely tied to cold statistics having to do with how many billable hours and services they can deliver. But applying that seemingly simple idea to real-world PT practice is, well … complicated.

    This month's issue of PT in Motion magazine takes on the issue of how PT performance is measured, with a particular emphasis on some employers' reliance on "productivity" metrics. APTA and other organizations believe this can ignore the importance of the PT's clinical judgment and challenge the PTs’ integrity in providing appropriate care.

    The article presents the debate as complex and multifaceted, with perspectives from PTs who (sometimes anonymously) recount their own experiences and fears about how productivity pressures impact ethical practice, as well as from PTs who understand that business realities force health care employers to scrutinize every cent of cash flow and adopt policies that allow them to survive in a world of shrinking profit margins.

    Further complicating the issue: health care's evolution away from fee-for-service models, a transformation that is already challenging the profession and its employers to rethink how to get at, document, and measure the "value equation" in care. The article looks at this issue in part through the eyes of Jim Dunleavy, PT, DPT, MS, who participates in an APTA work group focused on the topic and along with Lynn Steffes, PT, DPT, recorded a webinar on how PTs can help facilitate a transition from volume to value.

    The need to counterbalance volume-based metrics with a value-based model is clear and immediate, according to Dunleavy.

    "Because in an environment in which we're not generating dollars every time we touch someone, which is the way most of health care is headed, if we can't show why we're here and how we're helping, we're in trouble," Dunleavy says in the article.

    "Measuring by Value, Not Volume," is featured in the July issue of PT in Motion and is open to all viewers—pass it along to nonmember colleagues to show them one of the benefits of belonging to APTA. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.

    Wednesday, July 01, 2015RSS Feed

    What's Up at CMS? Here's a Quick Rundown of 5 Rules That May Affect You

    Spring is gone, summer's here, and the US Centers for Medicare and Medicaid (CMS) just keeps on churning out more proposed and final rules that can have a big impact on physical therapists (PTs) and physical therapist assistants (PTAs). Sometimes the changes will be felt directly by PTs and PTAs; sometimes the changes affect how employers will operate; sometimes the changes have to do with the ways beneficiaries interact with the systems.

    The regulatory affairs staff at APTA keeps a close eye on all of the rulemaking and creates detailed resources that can keep you up to speed. It's all part of an effort to untangle rules that can seem dizzingly complex—but should not be ignored.

    Here are 5 rules you should know about—4 proposed and 1 final—and what APTA offers for a more detailed take.

    Acute care hospitals and long-term care hospitals (proposed rule)
    Quick take:
    The IMPACT Act signed into law last year is sparking some significant changes around the kind of data long-term care facilities gather and report, with emphasis on standardized quality reporting across the different types of postacute care facilities—long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies. CMS estimates that Medicare spending on inpatient hospital services will increase by about $120 million in FY 2016.
    Available from APTA: summary and highlights, comments to CMS

    Skilled nursing facility (SNF) prospective payment system (proposed rule)
    Quick take:
    CMS is proposing an increase in payments to SNFs, and also implementing a SNF quality reporting program by 2018. Again, the IMPACT Act plays a big role in the proposal, with requirements for new quality measures for the SNF quality reporting program. Also worth noting—new rules on mandatory reporting about staffing, including hours worked and employee turnover.
    Available from APTA: summary and highlights, comments to CMS

    Inpatient rehabilitation facility (IRF) prospective payment system (proposed rule)
    Quick take:
    IRFs will receive an average overall estimated increase of 1.7% in 2016. Like other postacute care settings, IRFs would be subject to increased quality reporting requirements for quality domains identified in the IMPACT Act. CMS also proposes 4 additional functional status measures for IRFs.
    Available from APTA: summary and highlights, comments to CMS

    Medicaid Managed Care Organizations (proposed rule)
    Quick take:
    The first major change proposed to Medicaid in a dozen years, the rule is described by Health Affairs as "a defining moment" for the program. The rule takes aim at how Medicaid managed care plans can market to consumers, and how the plans can be integrated with the health care exchanges developed through the Patient Protection and Affordable Care Act (ACA). The proposal, which also affects the Children's Health Insurance Plan (CHiP), would increase program integrity and quality improvement requirements.
    Available from APTA: summary and highlights (comments under development)

    Medicare Accountable Care Organizations (ACO) (final rule)
    Quick take:
    The final CMS rule on Medicare ACOs includes more flexibility for the care networks, which now number nearly 400 and serve an estimated 7 million beneficiaries. Among other changes, the rule opens up a "third option" for ACOs that involves taking on more risk in exchange for the potential to keep more money linked to savings. The new rule also opens up the possibility for ACOs to avoid penalties beyond the 3-year timeframe previously established by CMS,
    Available from APTA: summary and highlights of final rule

    Plus: Stay tuned for one of the year's most-anticipated rules—the CMS proposal for next year's physician fee schedule, likely to be released on or around July 1. Also due to drop soon: proposed rules on home health and outpatient hospitals. APTA will review all proposed rules and create a highlights resource, as well provide comments to CMS.

    Tuesday, June 30, 2015RSS Feed

    Girls' High School Sports Post Highest Incidence of Overuse Injuries

    Larger numbers of girls participating in high school sports and the growing range of sports offerings available to them are very good things, with a not-so-good side-effect—an increase in overuse injuries.

    According to a recent study of 2,834 overuse injuries (.pdf) between 2006 and 2012, girls' track and field and field hockey have come to top the list of high school sports linked to higher rates of overuse injuries in a set of 20 boys' and girls' sports. While the all-sports average injury rate was 1.50 per 10,000 athletic "exposures," girls' track and field registered a 3.82 rate, while girls' field hockey reported a 2.93 rate. The highest overuse injury among boys' sports was in track and field, at 2.24 injuries per 10,000 exposures.

    Overall, overuse injuries represented 7.7% of all injuries, but rates among girls and boys differed significantly, with overuse representing 13.3% of all injuries for girls, and only 5.5% among boys.

    The study, which appeared this spring in the journal Pediatrics, was based on data submitted by school athletic trainers through the National High School Sports-Related Injury Surveillance System, which randomly selected 100 high schools from an even distribution of geographic regions and school sizes. The injury statistics were drawn from 18,889,141 "athletic exposures," defined as 1 athlete participating in 1 practice or competition.

    Among other findings in the study:

    • Of the 20 sports studied, overuse injuries were more likely to occur in practice than in competition in all sports except boys' baseball, boys' ice hockey, and cheerleading. Girls' lacrosse and girls' field hockey reported the greatest increased risk of injury at practice vs competition.
    • Of 2,832 overuse injuries, 79.9% were reported as new.
    • Among sex-comparable sports, girls had an overall injury rate of 2.08; the injury rate for boys was 1.44.
    • Although overall injury rates were fairly evenly distributed across athletes' year in school, girls' rates decreased as they advanced, while boys' rates increased.
    • The lower leg was the most frequently injured body site (21.8%), followed by knee (15.9%), shoulder (11.5%), and foot (11.3%).
    • Boys' volleyball (.18), boys' ice hockey (.32), cheerleading (.35), and boys' wrestling (.57) reported the lowest overuse injury rates.
    • Sports with the highest percentage of injuries related to overuse were boys' swimming (55.7%), girls' swimming (47.7%), girls' track and field (36.8%) and boys' track and field (28.5%).

    In a video produced by Ohio State University, where lead author Thomas Best, MD, teaches and practices, Best links the intensity of practice and focus on a single sport as potential areas to be watched.

    "Many of these youngsters are playing a single sport, and that may in fact be a major risk factor for these overuse injuries because their bodies are seeing the same repetitive blows with one sport," Best said.

    In the study, authors write that their work could inform the development of sport-specific preventive measures to avoid a potentially worsening problem.

    "As the popularity of high school sports continues to increase, the number of high school athletes sustaining overuse injuries may also increase unless effective prevention programs are developed," authors write. "The body sites affected with overuse injuries were sport specific. Identifying high school athletes at risk of overuse injuries is the first step in working to prevent these injuries."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Also available from APTA:  a recorded webinar on repetitive stress injury in youth sports, presented by Jeff Taylor-Hass, PT, DPT, OCS, CSCS, and Chad Cherny, PT, DPT, MS, SCS, CSCS.

    Tuesday, June 30, 2015RSS Feed

    Survey: Many Providers Lag Behind in ICD-10 Testing

    With startup of the ICD-10 coding system just over 3 months away, a new survey finds that, for the most part, providers are trying to get up to speed. But that doesn't mean everyone's ready to roll—particularly when it comes to testing just how the codes work with internal and external systems.

    The eHealth Initiative (eHI) survey, conducted in partnership with the American Health Information Management Association (AHIMA), found that of 271 providers responding, only 17% had completed all external testing, and 66% have not yet completed internal testing. A total of 19% stated that they have no plans to conduct end-to-end testing, and between 50% and 60% of respondents reported that they had not conducted ICD-10 testing with Medicaid (56%), private payers (54%), or other providers (59%).

    Most respondents represented hospitals and other health systems (60%); while clinics and physician practices made up the next biggest share, at 18%. The remaining respondents represented integrated delivery networks (9%), postacute care settings (3%), and "other work setting" (10%).

    In terms of other preparation steps, most respondents reported taking actions that varied from providing educational materials to staff (78%) to evaluating workflows and systems (64%).

    APTA has been helping its members understand the new system through ongoing education and online resources, including a webpage devoted to ICD-10 and physical therapy. On July 9, the association will present a special webinar on final steps for implementation of ICD 10. The session is free to APTA members.

    Tuesday, June 30, 2015RSS Feed

    PTA a Featured Career in Chicago Tribune Article

    A recent article in the Chicago Tribune not only makes the case for the physical therapist assistant (PTA) as a career that's growing fast, it describes those who pursue the profession as dedicated, knowledgeable, and tuned in to people.

    The June 21 article highlights the work of Lee Hatfield, PTA, who works in Los Angeles, California, describing him as spending his days "traveling to patients' homes and working with them to perform various exercises and help them with gait and balance training, mobility, and more."

    Overall, the article presents an accurate snapshot of the PTA's responsibilities, the education required to assume those responsibilities, and the relationship under the direction of a physical therapist. Despite a few minor oversights—for example, occasionally calling the PTA a "physical therapy assistant" (it's "physical therapist assistant"), and stating that licensure or certification is required in "most" states (it's required in all 50), the article captures the basics of the profession in a short amount of space.

    The article also provides Hatfield with an opportunity to explain why he chose the profession.

    "I enjoy working with people, helping them recover from injuries and illness," he says in the article. "I also enjoy exercise and educating patients on how to live a healthier and happier life."

    Monday, June 29, 2015RSS Feed

    Study: Location Differences, Disproportionate Burdens Among PT Copay Problems

    The amount of out-of-pocket (OOP) expenses a patient may be expected to pay for an episode of physical therapy is likely to vary not only depending on where the patient lives, but on a number of demographic factors, according to a new study. In addition to these variations, the study says, the payment burden is not equally distributed, with 25% of patients who incurred OOP expenses accounting for 75% of all expenditures.

    The analysis, e-published ahead of print in APTA's journal PTJ (.pdf), looked at datasets from the Medical Expenditures Panel Survey (MEPs) in 2-year increments beginning in 2008 and ending in 2012. Researchers drew from expenditure records of 2,189 patients who received physical therapy treatment (identified in the article as "PT").

    Among the findings of the study:

    • The average episode of care for physical therapy was 9.9 visits, with a mean total expenditure of $1,708. OOP expenditures were required in 54% of episodes, a lower rate than in general medical care.
    • The average OOP expenditure for physical therapy was $351.
    • OOP expenditures averaged 19.5% of the total expenditure for care, or about $44.73 in OOP costs per visit.
    • Being female, non-Hispanic, and of a higher income correlated with higher odds of incurring OOP expenses; being in worse general health, 65 or older, having public funding, and being nonwhite were factors associated with lower odds of having an OOP expenditure.
    • Among geographic regions, the Northeast fared the best in terms of lowest average OOP costs. Rates for the South were 44% greater than for the Northeast; rates for the West about 29% higher than for the Northeast, results that authors write " are consistent with current APTA lobbying efforts at limiting patient expenditures through the fair copays model legislation, which are focused in these same geographic regions."
    • Urban areas registered OOP expenditures that were, on average, 72% higher than rural areas.
    • The top 1% of those with an OOP expenditure accounted for 14.6% of all OOP payments; the top 5% accounted for 38.2%. Overall, about one-quarter of patients with any OOP expense account for three-quarters of all expenditures.

    Authors point to this lopsided distribution of OOP expenditures as an area for further policy work, writing that "we believe that if there is a desire to reduce the level of OOP expenditures, attention to the small proportion of higher expenditure episodes could result in the largest reduction of OOP expenditures for PT."

    They also cite overall average cost as a matter of concern, writing that while the average $351 OOP expenditure for physical therapy "may not appear excessive," when this amount is compared with another study that estimated an average annual OOP expenditures rate of $703 for health care in general, the average for physical therapy expenditures takes a disproportionate bite.

    "We believe that for some individuals the OOP expenditure could be a barrier to obtaining PT care and that the policy implications could include advocacy for a limit on OOP expenditures for physical therapy services as a small proportion of annual OOP health spending," authors write. "In the least our findings indicate that the profession should continue to monitor the proportion of those who have OOP expenditures and the amount incurred."

    Fair physical therapy copay policies are a major focus of APTA advocacy efforts, particularly at the state legislative level. Visit the APTA webpage on copays for resources, background, and model legislation, as well as a new interactive copay map that lets you find out how your state is handling the issue.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Monday, June 29, 2015RSS Feed

    Endowed Chair Established in Honor of Marilyn Moffat

    Physical therapy leader Marilyn Moffat, PT, PhD, DPT, FAPTA, can now add another honor to her list: namesake of the first-ever endowed chair position in New York University's Department of Physical Therapy, a position created through $2 million in gifts.

    "We have always been fortunate to have Marilyn as part of our faculty, given her dedication to the field of physical therapy and to improving the lives of her students and patients, so we are exceedingly pleased to establish this position in her name," said Mitchell Batavia, PT, chair of the physical therapy department, in an NYU press release.

    The Marilyn Moffat Endowed Chair in Physical Therapy will be held by a new hire. The department aims to name a candidate to fill this position in the coming year.

    Moffat is a past president of APTA and the World Confederation for Physical Therapy, as well as a Catherine Worthingham Fellow of APTA. She delivered the 35th Mary McMillan Lecture and also was given APTA’s Lucy Blair Service Award. She directs both the professional doctoral program (DPT) and the postprofessional graduate master's degree program in pathokinesiology at NYU, and is a well-known author of several influential physical therapy texts.

    Thursday, June 25, 2015RSS Feed

    Health Care Worker Injuries Due to Patient Handling Continue to Rise

    According to a new report from the US Centers for Disease Control and Prevention (CDC), health care workers are still number 1 when it comes to on-the-job injuries, accounting for 20% of all nonfatal occupational injuries across the country.

    And the most prevalent source of health care worker injury? Patient handling.

    In a report that reviews Occupational Health Safety Network (OHSN) data from 112 health care facilities with a total of 162,535 full-time employees, the CDC found that patient handling injuries occurred at an average rate of 11.3 per 10,000 worker-months; with slips, trips, and falls occurring at a 9.6 rate, and workplace violence from patients at 4.9 per 10,000 worker-months. All 3 categories have been on the rise over the past 2 years.

    The report cited nurses and nurse assistants as the most frequently injured health care staff, with nurse assistants recording a patient handling injury rate of just over 35 per 10,000 worker-days, and nurses reporting a rate of 16. According the report, upping the risk factors for nurses are a growing number of obese/overweight patients, high patient-to-nurse ratios, long shifts, and increased efforts to mobilize patients as soon as possible after a medical procedure.

    Although the report did not include physical therapists (PTs) or physical therapist assistants (PTAs) as a separate category, research that appeared in a 2014 issue of PTJ estimated the 1-year work-related injury rate for PTs at 20.7%.

    "Similar to findings from other studies, OHSN data indicate that [the use of lifting equipment and other interventions] could potentially reduce patient-handling injuries, particularly for activities involving positioning, transferring, or lifting a patient," the CDC writes. "Additionally, to prevent patient-handling injuries, health care institutions might establish a safety culture emphasizing continuous improvement and … provide resources such as training in safe patient handling."

    APTA provides multiple resources on safe patient handing for physical therapists and physical therapist assistants through an association webpage devoted to the topic. In 2012, APTA joined a broad-based effort by the American Nurses Association to establish national standards on safe patient handling.

    Thursday, June 25, 2015RSS Feed

    SCOTUS Upholds ACA Subsidies

    The question of whether qualified individuals who buy health insurance through the federal exchange set up through the Patient Protection and Affordable Care Act (ACA) can receive premium subsidies has been laid to rest, now that the US Supreme Court issued its ruling in favor of the federal government.

    The 6-3 opinion against the petitioners in King v Burwell rejected the King argument that the federal government could not offer subsidies in the (currently) 34 states that have federally facilitated health care insurance exchanges.

    In writing the majority opinion favoring Burwell, Chief Justice John Roberts stated that "the tax credits are one of the Act's key reforms and whether they are available on federal exchanges is a question of deep economic and political significance; had Congress wished to assign that question to an agency, it surely would have done so expressly. And it is especially unlikely that Congress would have delegated this decision to the IRS, which has no expertise in crafting health insurance policy of this sort." The complete opinion (.pdf) is available at the Supreme Court website.

    Had the court ruled in favor of King, an estimated 6.5 million Americans may have lost tax credits linked to health insurance plans purchased through the federal marketplace.

    For details on health care reform, the ACA, and its impact on physical therapy, visit APTA's webpage on health care reform.