"Transformative" changes mandated by the Affordable Care Act (ACA) and a slowly recovering economy have contributed to a Medicaid system in which most states are expanding eligibility, adopting delivery system reforms, and increasing community and home-based services, according to a new study from Kaiser Commission on Medicaid and the Uninsured.
The Kaiser report surveyed Medicaid directors in all 50 states and the District of Columbia to gather information on program changes implemented in the 2014 fiscal year or planned for the next year. Authors of the study write that these years "will stand out as a time of significant change and transformation." Among the findings:
While the Kaiser report shows more variation in how states are adjusting provider rates, authors note that generally "more states implemented provider rate increases across most major provider types … inpatient hospital rates being the exception."
"States are expanding their reliance on managed care but also implementing new innovative delivery systems and care coordination arrangements, some of which are new options made available by the ACA," according to the authors. In turn, this expansion could be putting some programs to the test, with most directors "report[ing] staffing and resource constraints in the face of the magnitude of the changes occurring in the program today."
Keep up with Medicaid as it continues to evolve: check out APTA's Medicaid webpage for resources, including a members-only guide titled "Making Sense of Health Care Reform: Medicaid Expansion."
The American Medical Association's (AMA) latest ratings of health insurance competitiveness across the United States finds that in 17 states, a single health insurer commands 50% or more of the market in each state, and that in 45 states 2 insurers have captured over half or more of each state’s share.
The AMA's Competition in Health Insurance: A Comprehensive Study of US Markets (summary available for free) uses commercial enrollment data from 2012 to create lists of the country's most and least competitive states for insurance companies, and to assess competitiveness in 388 metropolitan areas.
The 10 least-competitive states are, in order, Alabama, Hawaii, Michigan, Delaware, Louisiana, South Carolina, Alaska, Illinois, Nebraska, and North Dakota. States that have the most competitive markets are, in order, Oregon, Wisconsin, Pennsylvania, New York, Colorado, Missouri, Washington, Ohio, California, and Florida.
The AMA analysis of metropolitan areas found a "significant absence" of competition in 72% of the areas studied, and identified a single insurer as capturing 50% or more of the market share in 41% of the areas.
Overall, Wellpoint Inc was found to be the largest insurer in most markets, with a "commanding position" in more than 20% of metropolitan areas—more than double the number of the next 2 largest insurers, Health Care Services Corporation and UnitedHealth Group.
Carmen Elliott, senior director of payment and practice management at APTA, thinks the shrinking competitiveness contributes to a larger picture of insurers looking to reduce costs and control utilization.
"The lack of competition is a reality," she said. "At the same time, insurers are trying to keep costs down by doing things like narrowing the network of providers covered by the system, increasing copays and deductibles, and implementing utilization management programs. The insurers argue that some of these efforts, like the shift of a greater payment burden to patients, will make consumers more accountable around health care costs and lifestyle choices, but the real challenge is to reduce costs while ensuring high-quality care. That can be a difficult balance."
Keep up with the insurance industry as it continues to evolve. Check out the APTA Private Insurance webpage to find resources including toolkits, videos, podcasts and FAQs on topics ranging from payment methodologies to patient and client advocacy.
A planned change to Medicare coverage of pneumatic compression devices (PCDs) that would have severely restricted patient access to the devices at home has been put on indefinite hold, thanks in part to the efforts of an alliance that includes APTA.
Had it been implemented, the final local coverage determination (LCD) would have imposed restrictions for PCDs that would only allow their use after a 6-month period of "chronic and severe" lymphedema, and would have attached other requirements including the presence of lymphedema into the trunk or chest, the use of manual lymphatic drainage prior to PCDs, and the use of medications. Additionally, the new policy would have denied PCDs to patients who experience any kind of improvement through conservative therapy. The requirements were set to become effective on November 1.
In an October 13 statement to the Medicare Durable Equipment Medicare Administrative Contractors (DME MACs) responsible for the change, the Alliance of Wound Care Stakeholders wrote that "many of the new requirements have no basis in either published medical literature or professional standards of practice," and that the proposed LCD "virtually eliminates access to medically necessary equipment for a significant portion of Medicare beneficiaries" who need the devices for treatment of lymphedema and venous ulcers. APTA is a member of the alliance.
The alliance also asserted that the final policy released in October was "significantly different" from the draft policy released in 2011, and that no additional public comment period was provided.
On October 16, the DME MACs announced that the change would be placed on indefinite hold. The brief announcement stated only that "Additional clinical information published since the release of the draft policy is being reviewed."
a significant victory for beneficiaries who need PCDs and the physical
therapists who are providing treatment," said Gillian Leene, JD, senior
regulatory affairs specialist at APTA. "In the end, the alliance was able to
halt a policy that not only lacked support in medical literature, but also
would have been damaging to patients and severely restricted access to an
effective home treatment option for this progressive and chronic condition.”
Help promote National Physical Therapy Month, spruce up your social media posts with snazzy graphics, and bust a few myths while you're at it—all with a few clicks.
As part of its "7 Myths About Physical Therapy" campaign, APTA is offering free online ad graphics that you can copy and share on social media channels. It's a fun and cool way to get the word out that physical therapy can change lives in ways that might surprise some people.
Get your graphics today, and let the mythbusting begin.
A recent APTA Google+ Roundtable now available on YouTube makes one point very clear: while there's plenty of media attention on which party will control the US Senate after the coming midterm elections, that's just 1 of several moving parts in Congress that could impact how the physical therapy profession's legislative priorities are addressed on Capitol Hill.
In a 35-minute video session that covered everything from Senate races to the politics of lame duck sessions, APTA Director of Grassroots and Political Affairs Michael Matlack answered questions about the current political landscape in Washington, and how APTA and its members can continue to influence legislation on issues such as the therapy cap, locum tenens, and direct access.
In addition to insight on politics and the legislative process, the session also provides viewers with an overview of how APTA relies on its members to identify important issues in the profession, and how those issues take root as advocacy through grassroots efforts and the work of PT-PAC, the profession's political action committee.
Want to keep up with where your members of Congress stand on the issues important to the physical therapy profession? Download the free APTA Action App for the latest information and easy ways to make your voice heard. Search "APTA Action" in your Apple or Google Play app store to download the app.
Time marches on—and so do the preparations for the 2015 World Confederation for Physical Therapy (WCPT) Congress. The world's largest international physical therapy gathering is set for May 1-4 in Singapore, and the following activities and resources are already available:
Registration for the event is now open for the Congress, to be held at the Suntec Singapore Convention and Exhibition Centre. APTA is a member of WCPT. For more information, contact Rene Malone.
The US Food and Drug Administration (FDA) has approved a replaceable urinary prosthesis that could free women with impaired detrusor contractility (IDC) from the mobility problems associated with catheters.
The inFlow Intraurethral Valve-Pump is a replaceable device consisting of a sterilized single-use urethral insert, an introducer, an activator, and a sizing shaft. According to a news release from the FDA, the device "draws urine out to empty the bladder and blocks urine flow when continence is desired."
Patients with IDC are unable to spontaneously urinate, a condition that can result from stroke, spinal cord injury, diabetic neuropathy, or other neurologic disease or injury. Typically patients with IDC must use some type of catheter, and are unable to experience continence.
The FDA reported that in testing, more than half of the 273 women who used the new device stopped using it because of leakage or discomfort. Or those who continued to use the device, 98% had post-void urine volume similar to those recorded with clean intermittent catheterization (CIC). The FDA reported that though urinary tract infection was the most significant adverse event associated with the new device, rates of infection were lower than those associated with CIC.
After initial sizing and training by a physician, insertion and removal of the device can be performed by the patient or caregiver. Inserted components must be replaced every 29 days.
"The inFlow device allows women with IDC to urinate, without the need to catheterize daily or be attached to a urine drainage bag," said William Maisel, deputy director for science and chief scientist in the FDA's Center for Devices and Radiological Health. "This may allow for increased mobility and the ability to be more self-sufficient."
APTA has provided guidance to the federal Agency for Healthcare Research and Quality (.pdf) in its research efforts around urinary incontinence, and the association offers several resources to members and the public, including the APTA Section on Women's Health and the PT's Guide to Incontinence. PTs looking for evidence-based research on UI treatment can find resources at PTNow.
Tailored hand exercise used as an adjunct to drug regimens can make a significant, cost-effective difference in function and quality of life for individuals with rheumatoid arthritis (RA) of the hand, according to a new randomized controlled trial from the United Kingdom (UK).
In the Strengthening and Stretching for Rheumatoid Arthritis of the Hand study (SARAH), 438 participants representing "the population of people with rheumatoid arthritis in the UK in terms of age and sex" were divided into 2 groups, 1 receiving usual care and the other receiving usual care plus special strengthening and stretching exercises overseen by a physiotherapist or occupational therapist. More than 90% of participants in both groups had been placed on a stable regimen of disease modifying drugs (DMARDs) for at least 3 months before the study, and all continued to take the drugs.
Results of the study were e-published ahead of print in the October 10 issue of The Lancet. Currently only the study's abstract is available for free; however, APTA members will have access to the full article in 2 months via PTNow ArticleSearch. More detailed data on the trial have been posted online.
Researchers administered the Michigan Hand Outcome Questionnaire (MHQ) at 4 and 12 months after a 20-day baseline to both groups, and found that the exercise group's reported level of improvement was "more than double" the usual care group's ratings. The usual-care group's ratings on the 1-100 MHQ scale averaged 3.56 after 12 months, compared with the exercise group's 7.93 average.
Other indicators were equally significant. "Changes in secondary outcomes mirrored these trends," authors write, "with significant differences in … activities of daily living, work, and satisfaction subscales, MHQ summed score, and self-efficacy." Global ratings of change in the exercise group improved for 45% of the participants, compared with 21% reporting improved ratings in the usual-care group.
The 12-week exercise program included 7 mobility exercises and 4 strength training or endurance exercises using bands, balls, or putty, and was tailored to the individual after assessment for baseline strength, pain, and flexibility. Physiotherapists or occupational therapists conducted 6 sessions with each participant, and participants were instructed to perform the exercises daily.
The mean cost per participant for the exercise therapy was approximately $165 higher than usual care; however, authors noted that "the costs of the intervention were small compared with the annual cost of providing drug regimens." Authors speculate that they may have actually underestimated cost-effectiveness "because the analysis was limited to a time horizon of 1 year."
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.
The PTNow blog's recommendation for learning more about putting evidence into practice: spend some time in a club.
A journal club, that is. The most recent PTNow blog post features "9 Hot Tips for Running a Successful Journal Club" that can help you get started creating a lively, engaging forum for discussion of the latest in physical therapy research.
Tips range from the practical to the aspirational, and include insight from physical therapists who have created successful clubs. Check out the tips and join the conversation by sharing your own experiences.
Then go clubbing.
APTA, the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASL) have come together to deliver the message that inappropriate administrative mandates, quotas, and productivity standards should never stand in the way of professional clinical judgment and knowledge of billing and reporting requirements.
The 3 organizations have released a "Consensus Statement on Clinical Judgment in Health Care Settings (.pdf)" as part of a combined effort to highlight the central role of the clinician in a health care landscape that increasingly looks to patient-centered outcomes as the true measure of quality.
"Respect for the therapist's clinical judgment and expertise is critical to achieving optimum patient/client care," according to the statement. "Overriding or ignoring clinical judgment through administrative mandates, employer pressure to meet quotas, or inappropriate productivity standards may be a violation of payer rules, may be in conflict with state licensure laws, and may even constitute fraud."
The statement provides examples of unacceptable practices and reminders on the importance of knowing all rules and regulations, following proper evaluation and treatment protocols, and completing all documentation. Clinicians are encouraged to take action if they encounter a billing process that may be suspect and are provided with possible steps to take in response to employer policies or practices that conflict with clinical judgment.
The partnership between APTA, AOTA, and ASHA is not new. The 3 organizations have worked together to produce guidelines on cotreatment and engage in advocacy around ending the therapy cap.
“This is an important step both for APTA, its partner organizations, and the patients we serve,” said APTA President Paul A. Rockar Jr, PT, DPT, MS. “It provides further clarity and framework to help ensure appropriate treatment and it is just one of many steps APTA has taken to ensure patients are receiving the highest quality, most efficient care; care that is skillfully thought out and planned with the patient’s wants and needs at the forefront. This has long been a driving principle for our organization.”
The statement on clinical judgment follows a charge made earlier this year by APTA’s House of Delegates (RC-16-14) for the association to identify and develop resources that equip physical therapists and physical therapist assistants in negotiations for conceptual frameworks of productivity and performance that ensure the provision of quality physical therapy care.
This and other resources on clinical judgment contribute to APTA's Integrity in Practice Campaign, and can be found at the APTA Center for Integrity in Practice website. In addition to the consensus statement, the website's resources include information on the Choosing Wisely® list of "5 Things Physical Therapists and Patients Should Question;” a primer on preventing fraud, abuse, and waste; a free course on compliance; and other information on regulation and payment systems, evidence-based practice, ethics, professionalism, and fraud prevention.
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