A recently released list of practices nurses and patients should question will likely get nods of agreement from physical therapists (PTs) and physical therapist assistants (PTAs) for the ways the recommendations promote early mobility in hospital settings.
The American Academy of Nursing (AAN) became the most recent nonphysician profession to add to the American Board of Internal Medicine (ABIM) Foundation's Choosing Wisely® campaign aimed at educating consumers and health care professionals on health care-related tests, procedures, and practices that may not be necessary or appropriate under certain circumstances. In September, APTA became the first nonphysician group to join the campaign when it unveiled its list of "5 Things Physical Therapists and Patients Should Question."
Of particular interest to PTs and PTAs in the AAN list of "5 Things Nurses and Patients Should Question" (.pdf) are recommendations that nurses should not let older adults lie in bed or only get up to a chair during their hospital stay, that physical restraints should not be used with patients who are older and in the hospital, and that urinary catheters should not be placed or maintained in a patient "unless there is a specific indication to do so."
"PTs know that an important contributor to hospital-associated disability is immobility during hospitalization, which leads to decreased function, increased fall risk, and increased length of stay—especially in older adults," said Anita Bemis-Dougherty, PT, DPT, MAS, clinical practice director at APTA. "The AAN Choosing Wisely list is an excellent addition to the support for greater mobility in hospitalized patients."
Bemis-Dougherty noted that the AAN recommendations around restraints are consistent with The Joint Commission (TJC) restraint standards. In addition, she said, the AAN list correlates strongly with APTA's Choosing Wisely recommendations against using continuous passive motion machines after uncomplicated total knee replacement, and against bed rest following diagnosis of acute deep vein thrombosis after anti-coagulation therapy, unless significant medical concerns are present.
"Improved strength in older adults is associated with improved health, quality of life and functional capacity, and with a reduced risk of falls," noted Bemis-Dougherty.
"If the patient is restrained, the immobility could lead to poor outcomes."
APTA Senior Director of Practice and Research Nancy White, PT, DPT, OCS, was involved in the development of the APTA Choosing Wisely list, and thinks that the AAN recommendations add to the reach of a campaign that's making a difference.
"Choosing Wisely is recognized as a great way to improve outcomes of care and reduce the use of treatment approaches that are either not effective or that may even be harmful," White said. "AAN has identified several practices that are common in many hospital settings that result in prolonged and unnecessary bed rest—something that PTs know leads to poorer outcomes and prolonged hospital stays."
Bemis-Dougherty believes that the AAN list can help APTA in its efforts "to change the culture of immobility in the hospital to one of mobility."
"Creating that kind of change is a daunting task and can't be accomplished by PTs alone," Bemis-Dougherty said. "To have nursing recognize the problem caused by immobility is huge and hopefully can contribute to a more widespread culture of mobility that involves all health care professionals within hospital settings."
APTA's Choosing Wisely list is offered in several forms, including consumer-focused versions in English and Spanish, and an expanded version containing citations on the association's Center for Integrity in Practice website. Resources on that site also include a ProfessionWatch paper from Physical Therapy that details the process of the list's development and provides professional context for APTA's decision to partner with the ABIM Foundation.
After a 9-month delay, the Humana health insurance corporation has restarted a multiple procedure payment reduction (MPPR) policy that applies to Medicare Advantage and commercial insurance plans.
On October 29 Humana reinstated the MPPR policy on the initial claims adjudication for non-facility providers. The policy will be applied to facility settings in late January.
The 50% reduction applies to the practice expense (PE) portion of the relative value unit (RVU). Humana will pay 100% of the first code with the highest PE RVU, and all codes billed after that will be reduced by multiplying the PE portion of the code by 50%. For Medicare advantage plans, Humana will apply the reduction regardless of whether the therapy services were provided in 1 therapy discipline or multiple therapy disciplines.
Humana originally implemented this policy in the fall of 2013 and applied the program retroactively, requiring physical therapists (PTs) to pay back portions of reimbursement that Humana claimed exceeded MPPR standards. APTA raised questions about the accuracy of the overpayment calculations and concerns about the administrative burden of the overpayment recovery process on PT practices, among other issues. As a result of those efforts, Humana temporarily ceased application of the MPPR policy in January 2014 to focus on correcting its payment logic and refunding inappropriate overpayment recoveries.
Members who have questions about the reimbursement policy and suspect a calculation error should contact APTA at email@example.com.
Need more information on MPPR? Visit APTA’s MPPR webpage. Resources include FAQs, strategies for managing contracts, approaches to verify payment accuracy, and more.
The US Department of Veteran's Affairs (VA) has issued an interim final rule amending regulations in the Veterans Choice Program, which allows eligible veterans to receive care from non‐VA entities and providers in certain circumstances. APTA is helping members understand how the changes could affect physical therapists (PTs).
APTA posted a summary (.pdf) of the interim rule (under the "summaries" header) from VA. Many of the changes focus on definitions in Veterans Choice and clarifications around the non-VA providers who can provide hospital and medical services through the program. The APTA summary provides highlights of provisions that may impact PTs, including copayment regulations, program scope, key terms, eligibility requirements, payment rates, and other issues.
The interim final rule took effect on November 5.
The best way to ensure a healthy future for physical therapy is to ensure that physical therapists (PTs) and physical therapist assistants (PTAs) get involved in APTA early in their careers.
Now's your chance to help.
APTA is calling for volunteers to serve on the Recruitment and Retention of Early-Career Members Task Force, the group charged with analyzing and evaluating existing membership trends and current outreach practices for early career PTs and PTAs, and identifying innovative strategies to increase membership value. Deadline for application is December 1. Complete details on the task force can be found on APTA's Volunteer Groups webpage.
APTA relies heavily on its volunteers, who gain valuable leadership and growth opportunities while working with some of the most outstanding physical therapists in the country.
Interested? Complete a volunteer interest profile, then click on the "Apply for Current Vacancies" button and select the task force you're interested in joining.
Legislation that will enhance government-sponsored research and data collection on traumatic brain injury (TBI) will move to the president's desk for signature, now that the TBI Reauthorization Act (S. 2539) has been passed by the House of Representatives. Individual House and Senate versions of the legislation were passed in the summer and fall, but last week the House decided to adopt the Senate version instead of reconciling the 2 bills.
APTA was among the organizations advocating for the legislation as part of the association's broad push to bring attention to TBI and rehabilitation in general.
If signed by the president, the finalized, bipartisan legislation will:
The Senate version of the bill was sponsored by Sen Orrin Hatch (R-UT) and cosponsored by Sen Bob Casey (D-PA).
Besides its efforts in support of TBI reauthorization legislation, APTA has participated in the Joining Forces initiative, promoted the Protecting Student Athletes From Concussions Act (H.R. 3532) (.pdf), and participated in a congressional Brain Injury Awareness Day in March. Concussion management awareness was also the focus of this year's student-led Flash Action Strategy, which resulted in the largest concussion-related grassroots effort in APTA history.
APTA provides extensive resources to its members on the role of physical therapy in brain injury treatment and recovery, and offers a TBI webpage that includes continuing education courses and links to other interest groups.
Physical therapist and physical therapist assistant education program directors interested in developing their leadership skills have an opportunity to participate in a yearlong fellowship program designed to do just that.
APTA's American Board of Physical Therapy Residency and Fellowship Education’s accredited Education Leadership Institute (ELI) Fellowship, a collaborative with the American Council of Academic Physical Therapy, Education Section, Physical Therapist Assistant Educators Special Interest Group, and APTA, now is accepting applications for 2015. Submission deadline is December 1, 2014, 5:00 pm ET.
This yearlong, invitational, blended learning (online and onsite components) fellowship program includes experienced mentorship, and is designed to develop emerging and novice (0-7 years) physical therapist and physical therapist assistant education academic program and residency and fellowship directors with leadership skills to facilitate change, think strategically, and engage in public discourse to advance the physical therapy profession.
Applicants are selected based on the strength of their application and meeting all eligibility criteria. To learn more about the Education Leadership Institute Fellowship, go to the ELI webpage.
Considering the fellowship experience? Check out the video testimonials of ELI graduates.
The November 15 startup of the second open enrollment period for insurance under the Affordable Care Act's (ACA) insurance exchange system is marked by some increases in premiums, and cost-sharing amounts for physical therapy and other services that will generally hold steady—with exceptions that will result in significant increases and decreases in a few cases.
As reported in Bloomberg.com, the Washington Post, and elsewhere, the average premium for a "silver" plan will rise by 2% in 2015, while the average "bronze" plan increase will be closer to 4%.
At a more granular level, different parts of the country are seeing more significant increases—and a few reductions. For example, Alaska residents will experience a 28% increase to marketplace premium rates that are already among the highest in the country, while Mississippi residents well see a 19% drop in premium rates for a bronze plan.
The approved rates released by CMS also contain information on deductibles and cost-sharing increases or decreases, depending on the plan. While there are variations, in general, physical therapists (PTs) can expect to see a continued trend toward higher cost-sharing and more limited participation in narrow networks, said Gillian Leene, senior regulatory affairs specialist at APTA.
"In 2014, we saw high deductibles and high cost sharing, such as copays and coinsurance, for patients with coverage through the health insurance exchange plans, which in many cases limited access to physical therapist services," she said. "Additionally, many plans sold on the health insurance exchanges are narrowing their provider networks to contain costs and have very limited out-of-network coverage."
Leene suggested that the startup of the open enrollment period is a good time for PTs to reacquaint themselves with the ACA through APTA's Health Care Reform page, and in particular via the association's series of resource documents titled Making Sense of Health Reform. Topics covered in the series include narrowed networks, cost-sharing, and the grace period. "It's a great way for PTs to understand practical implications and get a few tips on how to mitigate some of these issues," she said.
Sharing information and experiences is another way to stay on top of health care reform. Members are urged to contact APTA with any issues they're experiencing through the association's feedback form.
The American Diabetes Association (ADA) has expanded its free "Living With Type 2 Diabetes" program to offer text messaging, web, and app support through a program called Care4life. The expanded offering joins other resources targeted at patients who recently have been diagnosed with the disease.
Care4life allows participants to set reminders for appointments, medications, and glucose testing; as well as set and track weight and exercise goals. The features are available through text message, on the app, and by logging on to www.care4life.com.
ADA continues to offer "Where Do I Begin," a hardcopy guide for patients with a recent type 2 diabetes diagnosis. The 16-page guide helps patients understand the fundamentals of type 2 diabetes and the steps that can be taken to live with the disease, including exercise and proper diet. Multiple copies of the booklets are available at no charge to PTs and PTAs to give to their patients.
A study that evaluates on how job demands affect compliance with professional standards chose hand hygiene in hospitals as its focus—and the results aren't especially good.
In an analysis of 4,157 hospital-based health care providers in 35 hospitals, researchers monitored compliance with 13.7 million hand-washing opportunities, and found that over the course of a single 12-hour shift, hand-washing compliance rates dropped by just over 20%, from rates that weren't all that high to begin with. Authors of the study, published in the November issue of the Journal of Applied Psychology (abstract only available for free), believe that this is the first research to show that the negative effects of job demands on workplace compliance accumulate much more quickly than previously believed.
Researchers looked at data from hospitals that use radio frequency identification technology in the form of badges worn by providers that track behavior. The badges are capable of registering when and where providers use hospital room sanitizer dispensers. Authors of the study correlated hand-washing opportunities to specific shifts, and examined compliance through the course of a shift as well as the ways compliance changed after the provider took a break or had more than 3 days off.
The study sample comprised nurses (65%), patient care technicians (12%), physicians (4%), and unspecified "therapists" (7%), with behaviors reviewed over a 3-year period.
First, the bad news: compliance with hand-washing standards (washing upon entering and leaving a patient's room) started at 42%, and dropped by more than 8 percentage points over the course of a single 12-hour shift, to 34.8%. Authors write that "for every additional hour worked, the fitted odds of compliance are estimated to decrease by … 4%." Making matters worse, compliance drops even more dramatically "when caregivers have had more frequent interactions with patients during a shift and when caregivers have spent a larger proportion of their time in patient rooms," they write.
Not only were the compliance effects cumulative over the course of a single shift, the problem was compounded as a caregiver worked through consecutive shifts. "The more total hours a caregiver had worked in the past week, the faster his or her compliance decreased during a given shift," authors write.
The relatively good news is that researchers discovered a strong relationship between time off and subsequent compliance. Specifically, authors found that taking as little as an additional half-day off was associated with a 1.3% increase in the probability that a caregiver will comply with hand-washing on his or her next shift.
While authors acknowledge that the improvement rate may seem small, they maintain that the real-world effects could be significant, citing a Swiss study that correlated a 1% improvement in hand hygiene with a reduction in hospital-acquired infections of 3.9 per 1,000 patients. When evaluated against another study that estimated a per-patient cost of $20,549 for every hospital-acquired infection, authors concluded that across the US, the rates of noncompliance they observed could produce an additional 600,000 infections per year at an estimated annual cost of $12.5 billion.
"The findings reported here suggest that demanding work environments can produce negative consequences far more rapidly than prior [research] … has recognized," authors write. "In other words, a day in the saddle can indeed take its toll."
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.
New resources from APTA are aimed at helping physical therapists (PTs) understand Centers for Medicare and Medicaid Services 2015 changes to the physician fee schedule, outpatient prospective payment system (OPPS), home health prospective payment system (HHPPS), and provisions around durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). In addition, the association will offer a webinar next week focusing on the new requirements for PTs under the Physician Quality Reporting System.
APTA members can now access summaries of final rules for the following areas:
To access each document, scroll down to the "APTA Summaries" headline and select the link for 2015 rules.
The association will also hold a webinar on November 20 for PTs who bill Medicare for outpatient physical therapy services in private practice settings (using the 1500 claim form or 837-P) and face new requirements under PQRS. The 90-minute session, which will begin at 2:00 pm ET, will help PTs understand how to comply with the new rules in 2015 in order to avoid a 2% pay cut in 2017. APTA Director of Quality Heather Smith, PT, MPH, will lead the discussion. Registration includes on-demand access to a recording of the webinar for later listening.
APTA also offers an overview of the PQRS changes through a podcast, free to members.
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