On Capitol Hill, votes around a repeal of the Medicare outpatient therapy cap may seem to be about politics and pay-fors, but the result—an extension of an exceptions process that leaves some patients vulnerable—is about real people who may not get the treatment they need, according to a recent article in the Bend, Oregon, Bulletin.
In the April 24 edition of the Bulletin, reporter Mac McLean interviews local physical therapists (PTs) who put the therapy cap debate into real-world terms. Both Chuck Brockman, PT, MPT, CSCS, OCS, and Tannus Quatre, PT, outline just what the cap—and the exceptions process—means for people who need PT services that exceed the $1,940 cap.
In the article, Quatre explains how a patient who qualifies for the cap exception also has to agree to pay for the sessions if a medical review later deems the treatments as unnecessary.
In those cases, Quatre says, "the cost will kick back to the beneficiary." Some patients find that risk too great. "Sometimes the patient will say, 'Screw that, I'm out,'" he added.
The Bulletin article also provides background and context for the latest therapy cap debate on Capitol Hill from Mandy Frohlich, APTA vice president of government affairs.
Frohlich describes the debate over the therapy cap repeal amendment as an indication that Congress understands the problems with the current cap exceptions patch, and may actually move toward a repeal in the future.
"We were very pleased this issue was raised," Frohlich says in the article. "We're in assessment mode right now, but we're hopeful we'll be able to bring this up again soon."
A patient injures herself during a physical therapy session. What happens next?
The patient faces a longer recovery time, of course. And depending on the physical therapist's (PT's) approach to risk management, the PT could be facing a potentially costly and career-damaging malpractice claim that might have been avoided.
The latest case study (.pdf) now available from Healthcare Providers Service Organization (HPSO) recounts the story of a self-employed contract PT working at a rehabilitation facility. His patient, a 49-year-old woman, is recovering from a hit-and-run accident that resulted in a vertebrae fracture, a wrist fracture, and a crushed spine. She's morbidly obese, a heavy smoker, and takes prednisone.
Five months into treatment, the patient is injured during a physical therapy session. She files a malpractice claim against the PT.
Could the injury have been avoided? Was the exercise she was performing at the time of the injury set up and monitored correctly? Was the exercise itself evidence-based? And what other elements of the PT's practice are likely to be exposed in mediation or a court hearing? The HPSO case study lays out the facts.
"Case studies like these are a reminder for PTs that risk management is not just a part of practice, but a professional responsibility," said Nancy White, PT, DPT, OCS, APTA executive vice president of professional affairs. "Things can and do go wrong, but a PT who fully understands risk is better able to protect the patient, which in turn protects the PT."
The latest case study joins a series of case studies available at the HPSO website. HPSO is the official provider of professional liability insurance for APTA members. For further information visit www.hpso.com/APTA.
A prominent specialist at the University of Virginia is voicing support for physical therapy by using physical therapy to support the voice.
Wait, we can explain.
An April 22 report from Virginia public radio station WVTF describes the efforts of Jim Daneiro, MD, of the UVA Voice and Swallowing Clinic, to "change the way people think about their voices to see talking as something closer to exercise."
Danerio, a head and neck surgeon, is quoted as saying that people who rely on their voices in their jobs—such as teachers, singers, and lawyers—are "akin to anyone who's throwing a baseball and … using their shoulder a lot. It's going to wear out at some point."
In cases like that, Daneiro refers patients for physical therapy. According to Danerio, the "number one" issue associated with a voice problem is "strain and stress on the neck and shoulder." In those cases, he says, "We get them into physical therapy or speech therapy and they usually get better."
The recently released proposed rules for inpatient prospective payment systems (IPPS) continues the US Centers for Medicare and Medicaid's (CMS) push for more data from facilities, with some payment increases being contingent on quality reporting participation and meaningful use of electronic health records (EHRs).
The rule sets out a 1.1% increase in operating payment rates for acute care hospitals that successfully participate in the hospital inpatient quality reporting program (IQR) and that are "meaningful" users of EHRs. Hospitals that don't meet the IQR requirements could see a one-fourth reduction in payment rates, and hospitals that fail to achieve meaningful EHR use by 2016 would face a cut of one-half of any update issued.
Other features of the proposed rule:
The proposed rule also seeks feedback on a CMS bundled payment initiative that links payments for multiple services during 1 episode of care into a combined payment. The initiative is testing 4 models of bundling, and CMS is asking for comments on future expansion of the plan.
APTA has produced a summary of the proposed rule (.pdf), and will provide comments to CMS on behalf of its membership.
Think of it as TripAdvisor for hospitals: last week, the US Centers for Medicare and Medicaid Services (CMS) unveiled a 5-star rating system for hospitals based on patient satisfaction.
Better yet, think of it as a really, really selective TripAdvisor for hospitals, because only 7% of the 3,553 hospitals reviewed earned a full 5-star rating.
Last week, CMS added the rating system to its "Medicare Hospital Compare" resource, an online lookup that allows the public to compare hospitals according to a wide range of information, from the facility's ability to receive lab results electronically to its Medicare reimbursement totals. The new patient satisfaction rating system is similar to Medicare's 5-star system for nursing homes.
The star system is based on patient responses to questions about doctor and nurse communication, room and bathroom cleanliness, noise, staff responsiveness, pain management, and clarity of postdischarge recovery instructions.
User ratings of hospitals were also the subject of a recent research article that correlated hospitals' Facebook ratings with readmission rates.
Of the 3,553 hospitals that had sufficient patient survey data to review, only 251 received all 5 stars. Just over a third of hospitals (1,205) received a 4-star rating, while 3-star ratings were earned by 40% of the facilities (1,414), and 2 stars were given to 16% (582). Approximately 3% of reviewed hospitals (101) received a 1-star rating.
According to a report from National Public Radio, "Many [of the 5-star hospitals] are small specialty hospitals that focus on lucrative elective operations such as spine, heart, or knee surgeries." The report states that these smaller hospitals tend to fare better in patient reviews than general hospitals, "where a diversity of sicknesses and chaotic emergency rooms make it more likely patients will have a bad experience."
In what may be a prime example of absence making the heart grow fonder, recently published research claims that the lower a hospital's readmission rate, the better-liked it is—at least on Facebook.
The study, published in the March 7 edition of the Journal of General Internal Medicine (abstract only available for free), links Facebook user-supplied ratings to a commonly accepted objective measure associated with hospital quality—the facility's rate of readmissions of patients within 30 days of discharge. Using data from the Medicare Hospital Compare website, researchers identified 315 hospitals performing better than the national average for hospital-wide all-cause unplanned readmission rates (HWR), and 364 hospitals with a worse-than-average HWR. Then they tracked down each facility's Facebook page (if it had one) and looked at how user ratings compared with HWRs.
What they found was that for every 1-star increase in a hospital's star rating on Facebook, the probability that the facility has a lower-than-average 30-day readmission rate increases by 5 times. Another finding: an in-group comparison revealed that hospitals with a Facebook page tended to have lower HWRs than those without.
"These findings add to the small but growing body of literature suggesting that unsolicited feedback on social media and hospital ratings sites corresponds to patient satisfaction and objective measures of hospital quality," authors write.
The study was published just 1 month before the US Centers for Medicare and Medicaid Services added a 5-star rating system based on patient satisfaction to the Hospital Compare site. In that system, only 7% of reviewed hospitals earned all 5 stars.
Study authors cite limitations that include the fact that the HWR statistics were from 2011-2012, before Facebook started its rating system, and that "user-generated feedback … may be biased and not reflective of patient experiences, and it could also be subject to fraud."
Still, they argue, user-generated ratings could become increasingly important "as consumers become more aware of rating services and as high-deductible plans drive patients to seek care beyond their local hospital."
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.
Significant improvements to research on rehabilitation—a longstanding policy priority for APTA, and an important element in accomplishing the association's transformative vision—are at the center of proposed bipartisan legislation on Capitol Hill that aims to foster and better coordinate this type of research at the National Institutes of Health (NIH).
Titled the Enhancing the Stature and Visibility of Medical Rehabilitation Research at the NIH Act (S. 800; H.R. 1469), the companion bills were introduced in the Senate by Sens Mark Kirk (R-IL) and Michael Bennett (D-CO), and in the House by Reps Jim Langevin (D-RI) and Gregg Harper (R-MS) on March 19. The legislation would reform practices at NIH around how rehabilitation research is integrated across the Institute's research centers, and how often research plans are reviewed and updated.
Among the proposals in the legislation:
The proposed changes build on recommendations from an NIH blue ribbon panel that was co-chaired by Rebecca Craik, PT, PhD, with members that included Anthony Delitto, PT, PhD, and Alan M. Jette, PT, PhD. The panel's recommendations, issued in 2013, were supported by APTA, with APTA President Paul A. Rockar Jr, PT, DPT, MS, characterizing the findings as ones that reflect APTA's "core principles," and are "critical to meeting the NIH's mission and impacting society in a positive manner."
Improvements to rehabilitation research and support of NIH work in this area are among APTA's public policy priorities. In addition to its individual advocacy efforts, the association is a member of the Disability and Rehabilitation Research Coalition, a group of more than 40 organizations working together to promote this type of research.
"Along with our fellow members in the coalition, we are extremely happy about the introduction of these bills," said Justin Moore, PT, DPT, APTA executive vice president of public affairs. "We fully supported the NIH blue ribbon panel's recommendations, which are clearly reflected in this legislation. If passed into law, these changes would represent a real move forward for rehabilitation research and its ability to transform lives."
APTA will continue to monitor and report on the progress of these bills.
In a health care environment in which health insurance copays are becoming an increasingly powerful driver in care decisions made by consumers, it's valuable to understand the lay of the land when it comes to the ways states regulate insurance companies and what they can demand. That's where APTA's new interactive copay map comes in.
The new resource provides a summary of each state's copay laws, including whether the law imposes limitations based on provider type, diagnosis, and patient variables, and how the law goes about establishing these limitations. Each state summary is captured in an easy-to-download pdf file.
The copay map is housed in APTA's Fair Physical Therapy Copays webpage, which also includes model legislation, examples of individual state efforts to establish fair copay regulations, and talking points on the issue.
Taking on what it calls "an opportunity to address challenges that exist in current practice," the Joint Commission (Commission) is developing a new optional certification program for organizations that perform total hip and total knee replacements--and it needs input on the program standards from health care providers, including physical therapists (PTs) and physical therapist assistants (PTAs).
According to an email notice from the Commission, the new advanced certification program will build on a core certification already in place by supporting "quality, consistency, and safety throughout the pre-operative, intra-operative, and post-operative phases of care." The new program will pay special attention to how transitions between these phases are managed.
APTA member Jerry Cain, PT, MPT, served on the Commission's technical advisory panel during the development of the new certification standards.
Providers who'd like to comment on the proposed requirements are asked to review the proposal and then participate in an online survey. Deadline for comments is May 19.
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.
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