The final 2015 Medicare physician fee schedule rule released by the Centers for Medicare and Medicaid Services (CMS) includes an aggregate increase in payment for physical therapy services of 1%--provided Congress stops implementation of a payment cut due to the flawed SGR formula by March 31. In addition, despite objections from APTA and other organizations, the new rule increases the number of Physician Quality Reporting System (PQRS) measures required for reporting of physical therapists (PTs) in private practice and other health care professionals to as many as 9.
The PQRS change will increase the number of individual measures PTs are required to report in order to avoid the 2016 2.0% PQRS penalty, from 3 to between 6 and 9, depending on whether the PT is using claims (9 required, or as many as apply to the provider), or registry (6 required, or as many as apply to the provider). As in 2014, the reports must be made on at least 50% of eligible Medicare patients. APTA opposed these changes.
While the new reporting requirements are moving forward as proposed, CMS delayed bringing nonphysician eligible professionals (including physical therapists) into the value-based modifier (VM) program until 2018. The delay from the proposed 2017 implementation date is intended to allow the nonphysician professionals to familiarize themselves with PQRS and VM systems.
APTA submitted extensive comments on the rule after it was proposed by CMS earlier this year. Some of the association's recommendations—including the delay of VM rules—were adopted by CMS.
Other changes include:
In other rules announcements, CMS issued final rules on the methodology for adjusting the DMEPOS feel schedule payment amounts, and the establishment of alternative payment rules for a phase-in of a competitive bidding program.
APTA will post detailed summaries of the new rules in the coming weeks.
PT in Motion News
for more information on recently-released rules from CMS, including the 2015 outpatient prospective payment system and home health prospective payment system.
The final rule for the outpatient prospective payment system (OPPS), released by the Centers for Medicare and Medicaid Services (CMS) on October 31, includes a 2.2% increase in payment rates to hospital outpatient departments beginning January 1, 2015.
The rule includes the packaging of payment for certain ancillary services provided in the hospital as well as comprehensive payments for a list of 25 primary services. The comprehensive payments include adjunctive services and supplies that support delivery of the primary service, which may include some physical therapist services that occur in the perioperative period. Further, the rule requires physician certification for hospital inpatient admissions only for long-stay cases and outlier cases, not short stays.
Except for a small subset of ‘‘sometimes therapy’’ services delivered without a certified therapy plan of care, most physical therapist services provided in the outpatient hospital department are paid under the Medicare physician fee schedule (PFS), not the OPPS. CMS provides an annual update of these “sometimes therapy” services that are paid under the OPPS and subject to direct supervision requirements.
A detailed summary of the rule will be available for APTA members in the coming weeks.
Visit PT in Motion News for more information on recently released rules from CMS, including the 2015 physician fee schedule and home health prospective payment system.
Never mind the latest iPhone 6—how about an insole than can gather and transmit motion data, or a monitoring system that can provide detailed assessments of wounds to help thwart the development of wounds?
Recently, Medscape published a list of 15 "game changing" wireless health technology devices selected by cardiac electrophysiologist David Lee Scher, MD, clinical associate professor of medicine at Penn State University, director of a digital health consulting firm, and chairman of the Healthcare Information and Management Systems Society (HIMSS) Mobile Health Roadmap Task Force. While cardiac, records, and medications monitors made up much of the list, Scher also included 2 devices that could be of special interest to physical therapists and physical therapist assistants—"WoundRounds" and "Moticon."
WoundRounds combines a special app with a dedicated device that allows providers to record the state of a wound over time, and share that information with other providers. Though intended for use in facilities, the device and app can also be used in home care settings.
Moticon is a removable device that its developers describe as the world's "first integrated sensor insole." Once slipped into a wearer's shoe, Moticon wirelessly transmits data on gait to a special smartphone app and, according to Scher, could even help providers track when a patient is experiencing a growing risk for falls.
A new study of individuals who undergo anterior cruciate ligament reconstruction (ACLR) shows that patients who participate in both pre- and postoperative rehabilitation not only get a head start on recovery, but experience markedly better outcomes than patients receiving usual care even 2 years after surgery. The study was e-published ahead of print in the October 28 British Journal of Sports Medicine (abstract only available for free).
Researchers compared Knee Injury and Osteoarthritis Outcome Scores (KOOS) of 84 patients who participated in progressive pre- and postoperative rehabilitation between 2007 and 2011 with 2,690 patients who received usual care between 2006 and 2010. The usual-care patient data were taken from the Norwegian National Knee Ligament Registry (NKLR); patients receiving the progressive pre- and postoperative care were from the US and Norway.
Patients completed the KOOS—a knee-specific self-assessment instrument of injuries linked to posttraumatic arthritis—preoperatively and again 2 years after reconstruction surgery. Researchers found that patients who underwent a 5-week preoperative rehabilitation program, followed by a yearlong progressive rehabilitation program after surgery, reported what authors describe as "significantly better" scores than their usual-care counterparts at both measurement points.
Patients in the rehabilitation cohort were recommended to achieve 90% quadriceps strength, hamstring strength, and hopping performance prior to surgery. The postoperative rehabilitation varied by surgical circumstances and patient functional status, and was divided into 3 phases that began with quadriceps contractions and range-of-motion exercises and progressed to heavy resistance strength training, plyometric exercises, and sport-specific drills. Authors did not include a description of usual-care.
Researchers found that the rehabilitation program not only set the stage for better short-term outcomes, but showed positive results long afterwards. "Compared to usual care, [the rehabilitation cohort] had superior preoperative patient-reported knee function, and still exhibited superior … function 2 years after the surgery, with 86–94% of patients scoring within the normative range in the different KOOS subscales," authors write.
Authors recommend that treatment strategies that include progressive pre- and postoperative rehabilitation for ACLR patients "be considered in the standard treatment protocol," but acknowledge that more research needs to be conducted to identify which parts of the rehabilitation programs are most responsible for the improvements.
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.
Beginning in 2015, the Centers for Medicare and Medicaid Services (CMS) will adopt a change suggested by APTA and others, and replace a requirement that home health therapy reassessments be performed at the 13th and 19th visits with one that requires a reassessment every 30 calendar days by each therapy discipline. The new requirement is part of a set of finalized changes to the Home Health Prospective Payment System rule announced by CMS on October 30.
Under the final rule, set to be implemented January 1, 2015, physical therapists (PTs) must "perform the needed therapy services, assess the patient, measure progress, and document objectives and goals at least once every 30 calendar days during the home health episode of care." The reassessment policy applies to physical therapy, occupational therapy, and speech-language pathology, and must be conducted by a qualified therapist from each discipline. In the case of physical therapy, "qualified therapists" would be limited to PTs.
CMS had originally proposed that the reassessment be performed every 14 calendar days, but increased the requirement to 30 days after receiving comments from the public, including APTA.
CMS also announced that it will eliminate the mandate for a "narrative" to be supplied by a physician in order to comply with a physician "face to face" requirement. APTA supported this change, expressing concerns that the current rule creates an undue burden on the home health community. The physician (or nonphysician practitioner) will still be required to certify that a face-to-face patient encounter occurred in order to meet the requirements for the home health stay. That encounter must take place no more than 90 days before the start of home health care or within 30 days after it begins.
The final rule also includes 0.3% ($60 million) reduction for Medicare home health payments in 2015. This decrease is caused by a 2.1% increase to the home health market basket, which was then reduced by 2.4% for the second phase of home health rebasing. In addition, there are new provisions for the home health quality reporting program.
The rule has been posted on the federal register. APTA will draft a complete summary of the final rule in the coming days, and will offer educational programs on this and other CMS rule changes for 2015.
CMS will also be issuing rules for 2015 on the physician fee schedule and the outpatient prospective payment system. Visit APTA's
PT in Motion News
page to get the latest reports.
Exercise therapy can improve some symptoms of fibromyalgia, but conclusive evidence favoring aquatic or land-based programs as the best way to achieve those improvements is still lacking, according to a new Cochrane review of randomized controlled trials (article available through the Cochrane Database of Systematic Reviews in PTNow ArticleSearch). The study is part of a larger update of a Cochrane review on exercise for treating fibromyalgia syndrome.
In an effort to determine how aquatic exercise training stacked up both to no exercise and land-based programs, researchers analyzed 16 aquatic training studies that included 866 women and 15 men. Aquatic exercise was compared with a non-exercise control group in 9 studies, and compared with land-based programs in 5 studies. In 2 studies, different types of aquatic exercise were compared with each other.
When it comes to the benefits of aquatic exercise compared with no exercise, researchers found that individuals with fibromyalgia who participated in the aquatic programs reported improvements in physical function, pain, and stiffness. The studies also noted improvements in muscle strength and cardiovascular fitness. Although improvements were characterized as statistically significant across all measures, only stiffness and muscle strength met researchers' 15% threshold for clinical relevance. In general, authors described the evidence as "low to moderate quality" in favor of aquatic training.
Comparisons of aquatic programs with land-based exercise yielded no clinically relevant differences between the 2, according to the study's authors, with evidence characterized as "very low to low quality."
The final analysis is that there can't really be a final analysis when it comes to an assessment of aquatic vs land-based exercise for improvement of fibromyalgia symptoms, according to the review. "As so few studies have been done so far, we are very uncertain about the results," authors write.
Those who heard the 45th Mary McMillan Lecture at the 2014 NEXT Conference and Exposition have been talking about it ever since. Now's your chance to see why.
"If Greatness Is a Goal," by James Gordon, PT, EdD, FAPTA, is now available to watch on APTA’s website.
In his lecture, Gordon called for fewer physical therapy programs. These programs, he said, should consist of faculties committed to a 3-part academic mission of research, education, and clinical practice.
Members can also read Gordon’s lecture in the October issue of PTJ, as well as view a NEXT dispatch interview. A PTJ podcast discussion with Gordon, Editor-in-Chief Rebecca Craik, PT, PhD, FAPTA, and other participants will be available in December at PTJ’s Podcast Central.
The McMillan Lecture is part of the APTA Honors and Awards program now seeking nominees for recognition in 2015. Visit the Honors and Awards webpage to learn more. Nominations close December 1.
What did you do for National Physical Therapy Month (NPTM) this year? Time to share it with the world!
Whether you participated in the "7 Myths" campaign or created your own ways to honor the profession, APTA would like to know. Share your NPTM 2014 celebration images and descriptions by using the #PTmonth hashtag on Twitter, Facebook, and Instagram, or by e-mailing us at firstname.lastname@example.org.
The US Centers for Disease Control and Prevention (CDC) is still trying to identify the cause of an illness that has now resulted in various degrees of paralysis among 51 children in 23 states as of October 23. The agency began asking states to track the condition after a cluster of cases were reported in Colorado in August and September.
The New York Times reports that CDC officials continue to describe the cases as "extremely rare," and they are not supporting a connection between the polio-like condition and respiratory virus enterovirus 68, although some doctors "suspect a link." The NYT article quotes Mark Pallansch, director of the division of viral diseases at CDC, as saying, "We don't have a single clear hypothesis that's the leading one at this point."
Early reports cited the condition as appearing in 40 states. Since those initial reports, CDC ruled out several cases that do not meet its definitions for inclusion, which require the presence of spinal lesions largely in the gray matter, among other factors.
The condition seems to strike younger children and advances rapidly, becoming most acute within 1-3 days of initial symptoms of weakness. The paralysis varies in severity, and most recovery is made within the first 2 months, with a slowdown in gains as time progresses. A pediatric neurologist quoted in the NYT story describes recovery as "highly variable," saying that "some patients recover very well, others not."
CDC updates case tallies every Thursday, and continues to ask state and local health departments to report cases that meet its criteria for inclusion: sudden-onset acute limb weakness experienced in August or after in a patient 21 or younger, and the presence of a spinal cord lesion largely restricted to gray matter. The agency has also posted a report on its investigation into the cluster of cases in Colorado in August and September.
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