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  • New York Chapter Relief Fund Information Now Online

    As reported Friday in News Now, the New York and New Jersey chapters have set up relief funds for the physical therapy community affected by Hurricane Sandy, with APTA matching contributions up to $5,000. The New York Chapter's donation page now is live on the chapter's website. The New Jersey Chapter's donation page can be found at the chapter's website. 

    New Resources Available to Help PTs Adopt Cash-based Models

    Physical therapists (PTs) sometimes find that the restrictions placed on their services by third-party payers interfere with their ability to help patients reach their goals. Additionally, the cost of collecting payment from third-party payers and the difficulties in negotiating rates with insurance companies may undermine the financial viability of a PT practice. For these reasons, some physical therapists are choosing an out-of-network, or cash-based, model for their practices. New resources at www.apta.org/Payment/Billing/CashPractice/ can help PTs understand the various types of cash-based practice models, the importance of complying with laws and regulations, and pros and cons of practicing as an out-of-network provider.

    AHA and Hospitals Sue CMS for 'Arbitrary and Capricious' Payment Policy

    Related to the solicitation of public comments regarding Medicare's policy to rebill for subsequently denied inpatient Part A stays under the Medicare Part B outpatient hospital benefit (see News Now article), the American Hospital Association along with a number of hospitals across the country filed a lawsuit in US District Court (The American Hospital Association, et al. v. Kathleen Sebelius, Case No. 1:12-cv-1770) on November 1. In the lawsuit, the plaintiffs contend that the Medicare payment denial policy is "arbitrary and capricious" as it unfairly denies payment to hospitals for medically necessary services that are not statutorily excluded under Medicare Part B. Therefore, the plaintiffs request that the court grant a declaratory judgment affirming that the Centers for Medicare and Medicaid Services' (CMS) payment denial policy is invalid and that CMS has failed to promulgate a regulatory rationale for the application of this arbitrary policy. In addition, the plaintiffs request that the court direct CMS to pay the plaintiffs accordingly for the denied services under the Medicare Part B benefit.

    In its comments to CMS submitted September 4, APTA urged the agency to consider the effect that payment for inpatient hospital services under Medicare Part B might have on the therapy cap for outpatient therapy services. Due to risk of denials when classifying patients for an inpatient stay, APTA explains, there are instances in which a patient's entire stay in the hospitals, sometimes spanning as much 16 days, is classified as an outpatient hospital stay. Therefore, all physical therapy services received during this period as of October 1, 2012, will count toward the therapy cap. "We believe that this is unfair to these patients as it may limit their access to physical therapy in the outpatient setting, when in fact these services should have been billed as inpatient services," says APTA. 

    Review Examines Quality Improvement Measurement of Outcomes for People With Disabilities

    Care coordination literature for people with disabilities is relatively new and focuses on initial implementation of interventions rather than assessing the quality of the implementation, says a new review commissioned by the Agency for Healthcare Research and Quality (AHRQ). The review is part of a series that provides a critical analysis of existing literature on quality improvement strategies and issues for topics identified by the 2003 Institute of Medicine report Priority Areas for National Action: Transforming Health Care Quality. As part of its charge to continuously assess progress toward quality and to update the list of priority areas, AHRQ identified people with disabilities as a priority population.

    For this review, the authors included all forms of disability except severe and persistent mental illness for all age groups in outpatient and community settings. They focused on outcomes, patient experience, and care coordination process measures. They searched for generic outcome measures rather than disability/condition-specific measures. They also looked for examples of outcomes used in the context of disability as a complicating condition for a set of basic service needs relevant to the general population, and secondary conditions common to disability populations.

    Of 15,513 articles screened, 15 articles were included for general outcome measures and 44 studies for care coordination.

    Overall, the reviewfound very few direct examples of work conducted from the perspective of disability as a complicating condition. "Capturing the disability perspective will require collaboration and coordination of measurement efforts across medical interventions, rehabilitation, and social support provision," the authors write.

    The Cost of Chronic Conditions

    A new interactive map from the Robert Wood Johnson Foundation (RWJF) illustrates the prevalence of diabetes, cardiovascular disease, and asthma in adults from 2001 to 2010. Users can breakdown the statistics by educational attainment and race/ethnicity. The map is part of  RWJF's Prevention Saves Lives and Money webpage, which includes studies that highlight prevention initiatives that are effective in improving health and reducing health care costs, in addition to case studies that examine innovative public health initiatives that enhance workplace wellness.