Proposed US Centers for Medicare and Medicaid Services (CMS) rules for skilled nursing facilities (SNFs) would increase payments by $500 million in 2016 and set the stage for quality improvement and reporting requirements that, if not met, could result in loss of Medicare and Medicaid funding. The additional $500 million in aggregate funding represents a 1.4% increase.
The majority of the rule focuses on how CMS plans to implement elements of the IMPACT Act. Passed into law last year and supported by APTA, the IMPACT Act is intended to standardize how data is collected and used across postacute care settings.
Other parts of the proposal outline how a value-based purchasing program will be implemented beginning in 2019, and set up requirements for the submission of staffing information beginning in 2016.
To meet provisions of the IMPACT Act, the proposed rule would require SNFs to report on several quality measures, including skin integrity, percentage of residents with new or worsened skin ulcers, incidence of major falls, and changes to their functional and cognitive status. Facilities that don't meet the reporting requirements by 2018 would be subject to a 2 percentage point payment reduction in annual updates.
The proposed rule also sets out mandatory reporting on staffing at SNFs, including data on hours worked, resident case-mix and census, employee turnover and tenure, and hours of care provided per-resident per-day. The data would be collected on direct employees, agency employees, and contract staff; noncompliance could trigger penalties or exclusion from Medicare and Medicaid.
In addition, CMS is seeking comments on an SNF value-based purchasing program, mandated by Congress, that would provide incentive payments to facilities based on performance beginning in 2019. The proposed rule would adopt a measure that evaluates 30-day hospital readmission rates for SNF patients, and CMS is accepting comments on policies related to that measure, mostly having to do with how performance would be measured, scored, and reported.
The proposed SNF rule would also apply to noncritical access hospital "swing beds"—beds that are used for acute care or skilled care as needed.
APTA has produced a summary of the proposed rule (.pdf), and will provide comments to CMS on behalf of its membership.
Although APTA, its members, and supporters were left with a mixed bag when Congress passed legislation that ended the sustainable growth rate (SGR) but did not permanently repeal the Medicare outpatient therapy cap, the effort to make the cap repeal a reality resulted in one decidedly great outcome: a reminder of the energy, commitment, and solidarity of the physical therapy profession.
When it came to pure impact, the grassroots campaign to contact senators about allowing and voting for an amendment to add therapy cap repeal to the SGR bill seems to have hit its mark, according to Monica Massaro, APTA manager of congressional affairs.
Although it's hard to estimate the actual number of contacts made by members and supporters, "when we met with Senate offices during the week leading up to the vote, every single office told us they had received calls and emails from physical therapists," Massaro said. "Our voice was being heard, and our comments were being remembered."
While physical therapists (PTs) and physical therapist assistants (PTAs) did their advocating best, they also stayed tuned in to the progress of the Senate debate over the bill. And when, in the end, the final bill was approved that did not end the cap but extended the exceptions process until the end of 2017, members voiced their reactions via—where else?—social media. Anyone doubting the passion of the profession can set those doubts aside by reading through the Facebook comments posted during the Senate debate and after the bill was passed.
And you know what else? Turns out APTA members are pretty darn photogenic when they're on the phone with their senators.
"This was a fantastic team effort and our members sought out every avenue to make it work," said Mandy Frohlich, APTA vice president of government affairs. "We will reassess in the coming weeks and work on the path forward."
And yet, Frohlich added, there's more to be reflected on than next steps.
"It's also important to appreciate not just the effort that was made, but why that effort was made," Frohlich said. "Our members affect people's lives in very real ways every day, and our members' advocacy efforts are aimed at doing the same thing. It was truly impressive to see how our members never lost sight of the real reason for taking action—to transform the lives of their patients."
Did the therapy cap effort spark a fire for advocacy? Then don't miss out on PT Day on Capitol Hill, coming June 3-4. Join hundreds of PTs and PTAs in Washington, DC, to make your professional voice heard. Free to participate, but you need to register by May 14.
The relatively small number of Medicare claims that were processed during the brief time between the implementation of the sustainable growth rate (SGR) payment reduction and its repeal—including claims subject to the Medicare outpatient therapy cap—will be automatically reprocessed to reflect the rates in place before the various fixes expired on March 31, according to a recent announcement from the US Centers for Medicare and Medicaid Services (CMS).
The announcement follows news that Congress passed legislation ending the SGR and extending the therapy cap exceptions process through December 31, 2017. The president is expected to sign the legislation into law soon. Beginning July 1, 2015, there will be a .5% update in the payment rates.
The reprocessing was announced to accommodate claims that may have been processed between the time when the previous fixes to SGR and therapy cap expired on March 31 and the establishment of the new law. CMS held claims for 10 business days beginning on April 1 in anticipation of a resolution.
CMS writes that "no action is necessary from providers who have already submitted claims for the impacted dates of service."
A new study from Australia has found that when physical therapists (PTs) serve as a primary patient contact in emergency departments (EDs), use of imaging and patient length of stay drop—all without an increase in adverse events.
The 12-month research project analyzed outcomes of 9,037 patients who presented to an ED in 2012, at a time when Australia was investigating "expanded roles for non-medical practitioners," according to the study's authors. After being assigned ICD 9 codes, and evaluated as to whether those codes were "appropriate" for treatment by a PT, patients were divided into 2 groups: 1,249 patients received treatment managed by a PT, and 7,788 were treated by "usual medical staff."
Conditions deemed appropriate for PTs to manage in the ED included closed limb fractures, nontraumatic spinal pain, and soft tissue conditions including strains and sprains. The study found that 12.9% of all people presenting to the ED "had ICD-9 codes suitable to be managed by a physiotherapist." Results were published in the Journal of Physiotherapy (.pdf).
Researchers looked at "adverse events" that may have surfaced through re-presentations to the ED within 28 days, consumer complaints, and reports to a local safety reporting system, and found no evidence of adverse events from the PT group. Although there were 33 re-presentations in the 28-day window, authors write that none "were due to incorrect diagnosis or missed fracture."
When the researchers turned to length of stay and use of imaging (a data point that authors believe contributes to longer stays), they found some significant differences between the PT and non-PT groups.
On average, the patients whose primary contact was the PT remained in the ED 83 fewer minutes than the patients seen by usual medical staff—an average of 103 minutes compared with 185 minutes. When it came to imaging, PTs ordered fewer x-rays, CT scans, and ultrasounds than the other providers.
Researchers also analyzed the imaging statistics in terms of "number needed to treat," and found that for every 8 patients managed by the PT, 1 x-ray was avoided. That rate was 1 CT scan avoided for every 40 patients under the care of the PT, and 1 ultrasound avoided for every 69 patients seen by the PT.
Authors acknowledge limitations to their study, including the fact that the PT option was only available during daytime hours, and that the research lacked data on whether the patients presenting to the ED had diagnostic imaging from somewhere else. Still, they write, "the physiotherapy service was able to identify appropriate patients and provide safe management without any identified adverse events or misdiagnoses."
"These outcomes have potentially important implications, particularly in the context of increasing pressures on [EDs] across Australia," authors write.
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 US Senate voted Tuesday to approve a bill that repeals the flawed sustainable growth rate (SGR) and moves toward payment systems based on quality, but, despite a concerted, historic grassroots advocacy effort, does not end the Medicare outpatient therapy cap. The therapy cap repeal amendment was defeated by a 58-42 vote, coming up just short of the 60 votes needed for passage.
Instead of a full repeal, the therapy cap exceptions process will extend until December 31, 2017.
The vote on the SGR ends a flawed system for payment that would have resulted in 21% reductions in Medicare payments to providers. The bill approved by the Senate passed with an overwhelming 92-8 vote, and President Barack Obama has stated that he will sign it into law. The bill was approved by the House in late March.
Among the most significant features of the bill are the ways it sets the stage for a transition to value-based health care services, and away from the fee-for-service model—a shift strongly supported by APTA.
The effort to include an amendment to end the therapy cap was championed by Sen Ben Cardin (D-MD) along with Sen David Vitter (R-LA), and was the focus of an intensive effort by APTA, its members, supporters, and other organizations to urge senators to vote in favor. In the end, the amendment was 1 of only 6 allowed to be considered, and among those 6, garnered 1 of the highest number of votes in favor.
"Ending the SGR is good news not just because it ends a flawed policy, but because it's helping to transform payment models," said Justin Moore, PT, DPT, APTA executive vice president of public affairs. "We are of course disappointed that the therapy cap repeal effort was not successful, but thanks to the hard work of APTA members and supporters, we were able to seize an historic moment and move this issue closer to the goal line than at any time in the 18-year history of the cap. We will capitalize on this energy, unity, and momentum, and will never stop working for the best interests of patients."
APTA will provide further information and resources on the provisions passed in the SGR bill over the coming weeks and will continue to influence its implementation with the Centers for Medicare and Medicaid Services.
Could a back awareness education program and a few simple daily exercises reduce the risk of low back pain (LBP) in children? Researchers in New Zealand think so.
In a study published in the April edition of Physical Therapy (PTJ), 710 children aged 8 to 11 were divided into 2 groups: 1 group of 469 received education on "spine awareness" and were taught 4 spinal movements to be practiced daily, and 1 group of 239 received the education only. The programs were conducted in 4 schools, and monitored for 270 days. According to an APTA news release, the study is one of a "small number" of trials involving young children and LBP.
Researchers found that while both groups reported a reduction in LBP episodes, the reduction was greater among the children who received exercise instruction—down from 23% at day 7 of the study to 13% at the study's conclusion, compared with a concluding rate of 24% of the children who received education only. Children in the exercise group were also less likely to report a lifetime first episode of LBP and experience a longer time to onset of a first episode when one did occur.
The exercises themselves involved 4 simple movements that encouraged flexion, extension, and lateral flexion of the lumbar spine. Authors write that the exercises were designed so that "they could be completed quickly without supervision, were easy to remember, were enjoyable, and could be combined with existing routines to maximize adherence." Still, adherence did drop off over time.
The back awareness education program, called "MySpine," teaches strategies believed to keep the spine healthy and encourages healthy behaviors.
Authors write that "it is unlikely (although not impossible) that the 4 exercises in this study were sufficient to have a physiological effect," but they speculate that "it is possible that monitoring participants and talking about the spine … and introducing the concept of back care, movement, and spinal awareness confers some therapeutic effect."
"Perhaps vigilance creates opportunities for control," authors write. "By participating in the MySpine program, children may have been empowered to identify and adjust behaviors to reduce the risk of LBP."
Articles in PTJ are available for free to APTA members.
For more research and evidence-based practice information, visit the association's PTNow website.
Outpatient physical therapists (PTs) who provide services in patient rooms at assisted living facilities, independent living facilities, skilled nursing facilities, or nursing facilities don't have to meet the requirements of an "extension location," according to a recently released clarification and update (.pdf) from the US Centers for Medicare and Medicaid Services (CMS). The technical-sounding tweak is actually a significant resolution of a question about whether PTs and facilities in those circumstances have to meet additional approvals and follow special rules about how many people need to be present during treatment.
What did CMS clarify? When an outpatient PT affiliated with an approved facility provides services in a patient's room that is "off premises"—for example, in an assisted living facility—the room itself is not considered an "extension location," which means that those services don't have to meet extension location requirements.
Why does this matter to PTs? If the "extension location" requirement were applied, the location of the service would have to be certified and approved, and PTs would be made to follow a requirement that mandates at least 2 persons be "on duty" any time rehabilitation treatment is being provided to a patient.
The exceptions only apply to services provided on an "intermittent basis" with no "ongoing or permanent presence" of an outpatient PT. CMS considers presence to be "ongoing and permanent" when there's a dedicated therapy gym; when equipment and records are stored at the location; or when PT staff is "regularly assigned to work at that facility directing a coordinated and ongoing rehabilitation program at that facility."
In addition to the clarifications around extension location definitions, the CMS guidance document also provides details on how facilities may qualify for approval of extension locations outside a 30-mile radius of an approved facility. Extension locations may now be approved beyond 30 miles provided outpatient PTs can demonstrate they have adequate supervision of these locations.
Editorial staff members at PT in Motion are hoping you're no slouch at picking covers.
It's time once again for members to help PT in Motion magazine decide the design to be used on the cover of the upcoming issue. For June, editorial staff is proposing 3 designs and asking members to vote on their favorite cover to illustrate physical therapists and workplace ergonomics.
Vote by April 17. Just pick the design you think is likely to get you to open up the magazine, and then check out the May issue to see which cover was most popular.
An article in Modern Healthcare reports that despite federal emphasis on interoperability of health records, a new survey of health care executives has found that only 11% of respondents were able to actually achieve record exchanges with other providers in the US. The survey results come on the heels of a draft "interoperability roadmap" released by the federal government—a draft that has already received comments from APTA.
According to Modern Healthcare, the survey results show that interoperability of health records remains "a bridge too far for many providers, despite more than a decade of federal emphasis on information exchange and $29.1 billion spent on federal [electronic health record] incentive payments." The survey targeted health care executives, including members of the Association of Medical Directors of Information Systems and the College of Healthcare Information Management Executives.
Among the findings from the survey:
On a more positive note, Modern Healthcare reports that 71% of respondents were optimistic that they'd be able to exchange a "core data set" of patient information across the country in time to make the 2017 goal set by the federal Office of the National Coordinator for Health IT's (ONC's) interoperability roadmap (.pdf).
In January, the roadmap was released in draft form, and APTA provided extensive comments to the plan. In those comments, APTA states that "too often, discussions about [health information technology and electronic health records] expansion are centered on physicians and hospitals only," and the association urges the ONC to expand any plan's scope to include "the full continuum of care."
A new study says that when it comes to leisure time physical activity, the more the better—but that doesn't mean that cranking out 10 times the minimum activity recommendations makes you 10 times more likely to live longer than someone who just meets the recommendations (or exceeds them by a bit).
Researchers compared mortality rates with activity levels among 661,137 men and women over 14.2 years in an effort to gauge the dose-response relationship between leisure time physical activity (LTPA) and mortality generally, with a focus on finding out if an "upper limit" of activity exists in which the longevity benefits level off—or actually decrease.
Some of what they found is already widely accepted: namely, that adhering to the 2008 Physical Activity Guidelines for Americans of 75 vigorous-intensity or 150 moderate-intensity activity minutes a week significantly reduces mortality. Other findings were new, particularly when it came to how much activity produces the biggest longevity payoff. Results were published in the April 6, 2015, online version of JAMA Internal Medicine (abstract only available for free).
By using self-reported activity data from 6 large-scale studies and then converting those data to metabolic equivalent of task (MET) numbers, researchers were able to compare results even when the studies asked slightly different questions about physical activity. The study sample consisted of 291,485 men and 369,652 women, although with a rate of 95% Caucasian participants it was not representative of the US population.
The analysis found that individuals who met or engaged in twice the guideline recommendations (7.5 to 14.9 METs per week) lowered their risk of mortality by 31%, and those who exceeded recommendations by 2 to 3 times (15 METs to 22.4 METs per week) saw a 37% drop. However, that benefit tapered off and finally plateaued at 3 to 5 times the minimum. From that point on, no additional activity—even activity that exceeded the guidelines by 10 times or more—seemed to make a dent in longevity rates.
Authors described the additional benefit of increased activity as "modest," writing that "meeting the recommended guidelines by either moderate- or vigorous-intensity physical activities was associated with nearly the maximum longevity benefit." Another study from Australia, published the same day in the same journal, looked more closely at the effects of vigorous vs moderate activity and found a positive relationship between increasing proportions of vigorous activity and further declines in mortality rates.
While spending large amounts of time engaging in physical activity didn't necessarily translate to a commensurate increase in longevity, researchers also found no support for the opposite hypothesis—that there's an upper limit to physical activity, beyond which increased activity actually negatively impacts mortality. "Thus, current trends in increasing marathon or triathlon participation should not cause alarm, at least with regard to mortality," authors write.
In an invited commentary accompanying the article, author Todd M. Manini, PhD, points to the study results as more evidence that primary care providers need to engage patients in conversations that encourage simply following the minimum requirements, where the most significant longevity benefits occur.
Unfortunately, according to Manini, those conversations aren't happening enough.
"The fact that only approximately one-third of adults received counseling [in physical activity] from a physician or other health professional is disappointing, although this rate has improved by 40% from 2000 to 2010," Manini writes.
APTA is a strong and vocal advocate for the ability of physical activity to transform society through its effects on public health. The association offers a prevention and wellness webpage with resources on how physical therapists and physical therapist assistants can help individuals become more physically active. Additionally, the association's MoveForwardPT.com website stresses the importance of physical activity in ways designed to be easily understood by the general public. The association is also on the board of the National Physical Activity Plan alliance, a high-profile effort to create a comprehensive set of policies, programs, and initiatives to increase physical activity in all segments of the American population.
The study's authors write that their findings do a kind of double duty.
"These findings are informative for individuals at both ends of the physical activity spectrum," they write. "They provide important evidence to inactive individuals by showing that modest amounts of activity provide benefit for postponing mortality while reassuring very active individuals of no exercise-associated increase in mortality risk."
American Physical Therapy Association | 1111 North Fairfax Street, Alexandria, VA 22314-1488 703/684-APTA (2782) | 800/999-2782 | 703/683-6748 (TDD) | 703/684-7343 (fax)
Contact Us | For Advertisers & Exhibitors | For Media | Follow APTA
All contents © 2014 American Physical Therapy Association. All Rights Reserved.