From 1997 to 2011, the average cost of a hospital stay rose to $10,000, with the costs for stays for osteoarthritis and back problems increasing at more than 2 times the overall rate. In terms of the reason for stays, musculoskeletal conditions represented the second largest single area of costs, at 14%.
The statistical brief (.pdf) released this month by the federal Agency for Healthcare Research and Quality's (AHRQ) Healthcare Cost and Utilization Project (HCUP) is based on data from community hospitals and reflects 95% of all discharges in the United States. Among the findings from the study:
Established in 1988, HCUP contains the largest all-payer longitudinal database in the United States and uses state government data, hospital associations, private entities, and the federal government to create its studies.
APTA offers information to physical therapists (PTs) and physical therapist assistants (PTAs) on how to reduce hospital stays and costs through minimizing risk of readmission, as well as how to keep up with current reporting requirements for inpatient care. Additionally, former APTA Board of Directors member Dianne Jewell, PT, DPT, PhD, CCS, serves on the National Quality Forum's (NQF) Ad-hoc Planned Readmissions Committee. Better still: minimize the risk of any hospital stay for hip fracture by learning about falls prevention.
The California Physical Therapy Association (CPTA), in collaboration with the California PT Fund (CAL-PT-Fund), has pledged $100,000 toward a Foundation for Physical Therapy project that would create the nation's first Center of Excellence for Health Services and Health Policy Research dedicated to training physical therapist researchers.
The Foundation already has received more than $2 million of the $3 million needed to establish the center, which will be devoted to training the next generation of physical therapist (PT) investigators equipped with the skills to examine and analyze physical therapy delivery, organization, financing, and outcomes. The Center of Excellence will build on the Foundation's efforts to support scientifically based and clinically relevant research in physical therapy.
The Foundation issued a press release on the pledge, and is encouraging other states to join California in making a commitment to development of the center. Individual tax-deductible contributions are also accepted and can be made online or by postal mail at 1111 North Fairfax Street, Alexandria, VA 22314. For more information, contact Barbara Malm or call 800/875-1378.
Physical therapists (PTs) who contract with Humana have been finding out about the managed care company's shift to the multiple procedure payment reduction (MPPR) policy the hard way—by being notified that they have to reimburse the company for payments they've already received. Humana has informed APTA that it plans on moving away from its practice of retroactive "overpayment recovery" and is working to fix errors in how the policy has been applied and calculated, but the insurer warns that it may be some time before all changes are in place.
Earlier this year, Humana began applying the MPPR policy on Medicare Advantage and commercial insurance plan payments for physical therapy, a change that resulted in reductions in payments to PTs. APTA wrote a letter (.pdf) to the company in early October outlining concerns over both the flawed MPPR policy and Humana's implementation of it. Among the concerns APTA voiced were issues around lack of provider notification, the burden placed on PTs through overpayment recovery, the inappropriate ways Humana applies MPPR on a per-visit basis, and inaccuracies in Humana's overpayment recovery calculations.
In its response letter (.pdf) to APTA, Humana acknowledged that it intended for the policy to be applied only to fee-for-service arrangements and identified 5 per-visit claims that it had incorrectly processed. The company also admitted that errors were made in MPPR calculations for some claims, and reported that it is reviewing all calculations and completing any corrections by the end of the year.
Humana described its overpayment recovery system as "not ideal" and wrote that "it takes time to make the necessary changes to apply this payment policy on initial claims processing." However, the company provided no timeline for when it would make the shift away from retroactive reductions.
APTA remains concerned about the administrative burden on providers subjected to MPPR through overpayment recovery instead of on initial payment and will continue to discuss this issue with Humana representatives in the coming weeks. Your direct experiences and documentation can support this discussion: send an e-mail to email@example.com with your name, member ID, and contact information for staff follow-up.
Older adults are at significant risk of developing vision differences between their eyes that, if undetected, could increase the likelihood of falls.
A new longitudinal study (abstract) in Optometry and Vision Science found that nearly 1 in 3 adults develop significant vision differences in each eye (called anisometropia) by their late 70s, an incidence rate that "needs to be clearly emphasized to clinicians" to ensure appropriate correction, according to the study's authors. If left uncorrected, the condition can interfere with depth perception and other visual skills necessary to prevent falls.
APTA identifies visual impairments as a significant contributor to falls and recommends interventions that address multiple risk factors.
Need more information on falls prevention? Get evidence-based practice information through PTNow and Open Door, and download APTA's education on exercise prescriptions for balance and falls prevention and pocket guide on falls risk reduction (.pdf). Share falls prevention information and experiences with APTA's online community dedicated to the issue.
A full repeal of the Medicare therapy cap could become part of congressional discussions on the sustainable growth rate (SGR)—but your voice is needed now to ensure that the repeal remains a priority on Capitol Hill.
APTA has been meeting with the Senate Finance and House Ways and Means Committees to urge members to include a full repeal of the Medicare therapy cap in the SGR reform package currently under discussion. With less than 30 days until the expiration of the therapy cap exceptions process, grassroots involvement is more important than ever.
There are several easy ways to take action right away:
Legislators only have until December 31 to permanently repeal the cap or extend the exceptions process.
Stanley Paris, PT, PhD, FAPTA, FAAOMPT, would tell you that physical therapists (PTs) are a diverse, multitalented group of professionals, but you'd have to catch him first—or at least wait until he returns from his attempt to become the oldest and fastest person to sail around the world solo.
Paris, 76, began his attempt on December 2, and will attempt to complete the circumnavigation in 120 days. If successful, he will beat the current speed record by 1 month and the current age record by 22 years. Paris is also leveraging his attempt as a way to raise funds for the Foundation for Physical Therapy, where he serves on the Board of Trustees.
The trip is being made on Paris's 63-foot yacht, the Kiwi Spirit, a craft that runs solely on wind and solar energy. Paris will document his journey and post videos and other information on his website, www.stanleyparis.com.
Paris is a widely known PT who founded the University of St. Augustine (Florida) for Health Sciences. He has written more than 40 research articles and 1 textbook, The Spinal Lesion.
Help Stanley Paris bring more attention to the need for research in physical therapy: find out how to donate in honor of the sail and how your name can be added to the hull of the Kiwi Spirit upon her return. Visit www.foundation4pt.org for details.
The final 2014 Medicare physician fee schedule rule (.pdf) released by the Centers for Medicare and Medicaid Services (CMS) sets the therapy cap amount on outpatient services at $1,920. In addition, the rule announces a 20.1% reduction in Medicare payment rates for physical therapists (PTs), physicians, and other health care professionals—a cut linked to the flawed sustainable growth rate (SGR) formula being discussed in Congress.
The new rule also updates payment amounts for physical therapists, physicians, and other health care professionals, makes changes to the Physician Quality Reporting System (PQRS), and revises other payment policies.
The final rule’s 20.1% reduction is to the conversion factor used to determine Medicare payment rates, a reduction generated by the flawed SGR formula. Since 2003, Congress had enacted legislation preventing the reduction every year. The president’s budget calls for averting these cuts and finding a permanent solution to this problem, and Congress is currently working to address an alternative payment method that would include permanent repeal of the SGR. If Congress does stop the 20.1% payment cut, the aggregate payment for outpatient physical therapy services due to changes in practice expense, work, and malpractice relative value units would remain unchanged from 2013.
Aside from setting the therapy cap at $1,920 for 2014, the rule makes changes to payments to critical access hospitals (CAHs) beginning January 1, 2014. Despite strong objections from APTA and other stakeholders, the rule subjects CAHs to the therapy caps, as well as any potential extension of the therapy cap exceptions processes, in the same manner as other providers of outpatient therapy services. The therapy cap automatic exceptions process and the manual medical review process, applicable to outpatient therapy expenditures exceeding $3,700 per beneficiary, will expire on December 31, 2013, unless Congress acts to extend them. APTA is working aggressively to have Congress address the therapy cap through repeal or extension of the exceptions processes.
CMS has finalized its proposal, supported by APTA, to require that individuals performing “incident-to” services in the physician’s office must meet any applicable state requirements, including licensure. This would enable the federal government to recover funds paid if services are not furnished in accordance with state law.
PQRS will see major changes for 2014. Physical therapists, physicians, and other eligible professionals will be able to avoid the 2016 2.0% PQRS penalty by reporting at least 3 individual measures via claims or registry for 50% or more of eligible Medicare patients in the 2014 reporting period. Though opposed by APTA and other stakeholders, CMS will increase the number of PQRS quality measures that providers must report either via claims or registry from 3 to 9 to qualify for the 0.5% bonus payment in 2014. CMS will maintain the current 12-month calendar year reporting period for the PQRS program but will eliminate the option to report on measures groups via claims.
APTA submitted extensive comments in response to the proposed rule that was issued in July 2013. The final rule with comment period will appear in the December 10 Federal Register. APTA will post a detailed summary of the final rule shortly.
Congressional discussions on SGR and therapy cap repeal will be taking place soon. Join APTA's grassroots efforts to call for an end to both flawed policies on December 2. Find out how to make your voice heard.
The Centers for Medicare and Medicaid Services (CMS) has issued a new rule for the Outpatient Prospective Payment System (OPPS) that will create 29 comprehensive Ambulatory Payment Classifications (APCs) to handle payment for the most costly device-dependent services, require direct supervision for a range of outpatient services in critical access hospitals (CAHs), and increase the payment rates under the OPPS by 1.7 %. The new rule will be effective January 1, 2014; however, CMS will delay implementation and final configuration of the new 29 comprehensive APCs until 2015.
The comprehensive APCs would treat all individually reported codes as components of a comprehensive service, resulting in a single prospective payment based on the cost of all individually reported codes. CMS will make a single payment for the comprehensive service based on all charges on the claim, and charges for services that cannot be covered separately by Medicare Part B or that are not payable under the OPPS will not be reimbursed. Although physical therapy services are typically paid separately under Medicare Part B, some therapy services would be considered part of the comprehensive service based on several factors. In general, physical therapy services that occur in the perioperative period would be paid under the comprehensive APC payment.
The new rule also establishes a direct supervision requirement for outpatient therapeutic services in CAHs, a change that CMS believes will ensure quality and safety. Additionally, the rule reiterates the requirement in the physician fee schedule that the therapy cap must be applied to CAHs.
APTA submitted comments regarding the proposed rule and will continue to monitor the effect that these provisions will have on physical therapy. APTA will post a detailed summary of the final rule shortly.
Physical therapists (PTs) have long understood that mobility plays a key role in a patient's recovery from the Intensive Care Unit (ICU), but now national-profile articles are bringing this fact to a much wider audience. In recent articles in The Wall Street Journal and The Atlantic, physical therapy is being identified as 1 of several post-ICU treatments that can reduce the risk of long-term cognitive and physical impairment after stays in the ICU.
WSJ reported on November 25 on the prevalence of post-intensive care syndrome, a condition that includes brain dysfunction, post-traumatic stress symptoms, depression, fatigue, and muscle weakness.
Researchers quoted for the story pointed to the importance of "hard-core physical and mental rehabilitation" in successful recovery and asserted that "post-ICU patients need the same kinds of occupational and physical therapy as heart attack and stroke survivors."
A related essay in the November 21 Atlantic by Daniela J. Lamas, MD, touches on the long-term challenges faced by patients treated in ICUs and advocates for treatment approaches that acknowledge that release from the ICU "is not a victory narrative now, but one person's unfinished story."
The articles echo earlier pieces of reporting that appeared on National Public Radio and other outlets, most of which were sparked by a Vanderbilt University report on post-ICU conditions.
PTs play a key role in successful treatment of patients in ICUs, recently released from the units, and throughout the post-acute care continuum. APTA offers multiple resources on ICU-related practice, including a video on collaborative care models in the ICU and continuing education on promoting early mobility. The latest evidence-based research, including an article titled "Innovative Mobility Strategies for the Patient With Intensive Care Unit-Acquired Weakness: A Case Report," are available through PTNow, APTA's research access tool.
When Time magazine asked Sen Mark Kirk (R-Ill) to share what he was thankful for, he came right to the point. "I am thankful for the more than 300,000 physical and occupational therapists in the U.S.," he wrote, adding that without these professionals "there is no way I could have returned to the U.S. Senate … after I suffered a massive stroke in January 2012."
The statement from Kirk appeared in the November 25 issue of the magazine, which asked several public figures "to share what they're grateful for." Kirk described how he recovered from the ischemic stroke he suffered less than a year ago thanks to the work of his rehabilitation team, and how his experiences inspired him to introduce a "Stroke Agenda" that seeks legislative changes to enhance stroke research and rehabilitation access. APTA has worked with Sen Kirk to advance these efforts, and supported his introduction of the Rehabilitation Improvement Act (S 1027) targeted at advancing rehabilitation research within the National Institutes of Health (NIH). Sen Tim Johnson (D-NM) introduced the bill with Kirk.
"Having a stroke shouldn't mean the end of a productive life," Kirk wrote. "Physical and occupational therapists make a major difference in countless Americans' lives, including the life of this U.S. senator."
Sen Kirk's return to the U.S. Senate was documented in an NBC video, and photos of Kirk in rehabilitation are available at the Huffington Post.
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