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  • Humana Coverage Limitations: More of the Same

    Humana’s latest list of physical therapy services it won't cover may not have changed much, but that doesn't mean the limitations should continue, according to APTA. The association recently voiced its concerns over the ways the health insurer characterizes physical therapy, its imprecise terminology, and its continued noncoverage of aquatic physical therapy and group physical therapy.

    The APTA letter was sparked by the release of the latest updates to Humana's medical coverage policy, which has drawn attention in the physical therapy community because of a list of services it says it may not cover. That list includes aquatic therapy, group therapy sessions, sensory integration, community/work reintegration, and work hardening/conditioning.

    While disappointing for physical therapists (PTs) and their patients, the coverage limitations themselves aren't new, according to Alice Bell, PT, DPT, senior payment specialist at APTA. Bell was part of a payment and practice management staff team that reviewed the policy.

    "The latest update from Humana changed very little from the policy in place in 2017 and earlier," Bell said. "Noncoverage of aquatic therapy, group therapy, and work hardening dates back to at least 2014."

    Still, that doesn't mean the policy is acceptable, in APTA's view. Earlier this month, APTA sent a letter to Humana that specifically cites aquatic therapy and group therapy as services that should be covered.

    "Evidence demonstrates that for some patients the progression to land-based exercise and functional movement is effectively facilitated through the use of aquatic therapy," the letter states. When it comes to group therapy, APTA asserts that for certain conditions and patient populations, "the psychosocial benefits of peer support and group interaction can serve to enhance the therapeutic experience and impact," adding that it's distinct from group exercise in its integration into an overall skilled plan of care aimed at optimizing the effectiveness of therapy.

    The APTA letter also points out other areas in which Humana uses sloppy language or just plain gets it wrong. One example: Humana's description of exercise as a modality. "Modalities are passive interventions," the association reminds Humana. "Therapeutic exercise is an active aspect of therapy."

    APTA also describes Humana's statement that "[physical therapy] procedures in general include therapeutic exercises and joint mobilization" as an "extremely narrow" characterization of the profession.

    "Representing the interventions in such a limited way in the description of the practice fails to acknowledge the breadth and depth of the profession, the therapeutic benefit to the patient, and the services covered under the current policy," the letter states. "APTA would like to highlight that the core of skilled physical therapist practice lies in the evaluation, reevaluation, and implementation of therapeutic procedures."

    "Humana has taken some positive steps, particularly when it lifted prior authorization requirements for physical therapy earlier in the year," Bell said. "The latest coverage policy updates do not move any issues forward—or backward for that matter. That's why APTA will continue to advocate for changes that better serve patients."

    CMS to Study Administrative Burden of MIPS; PTs Can Participate

    The US Centers for Medicare and Medicaid Services (CMS) wants to engage in a study to gain a better understanding of the administrative burdens associated with its Merit-based Incentive Payment System (MIPS), and physical therapists (PTs) are invited to participate in the research even if they aren't currently involved in the program.

    According to an announcement from CMS, in addition to MIPS-eligible clinicians, the study is open to a limited number of clinicians who aren’t eligible for mandatory participation—such as PTs—even if they haven’t volunteered to participate. Currently, participation in MIPS is optional for PTs, though the system could be mandatory as early as 2019.

    During the April 2018–March 2019 study period, CMS will evaluate workflows and data collection methods and explore the challenges faced by clinicians in collecting and reporting data to MIPS. Applications for being included in the survey are being accepted through March 23, 2018. For more information, contact MIPS_Study@abtassoc.com.

    Want to learn more about MIPS, its relationship to the CMS Quality Payment Program, and the future of health care? Check out APTA's new value-based care podcast series.

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    #PTTransforms Blog: Keeping the Patient at the Center of Pain Management

    Although APTA’s recent “Beyond Opioids” panelists were diverse in experience and profession—including patient advocacy, health care provision, government, and business—several common themes arose around pain management. A new #PTTransforms blog post goes beyond the opioid statistics to highlight patient-centered strategies suggested by the guests.

    Several participants urged improved provider-patient communication, including patient advocate Joan Maxwell, who was prescribed opioids after each of 9 surgeries, without a single discussion about the risks and alternatives. In a Washington Post/Kaiser Family Foundation survey, only 65% of respondents said their doctor talked with them about the possibility of addiction when prescribing the drugs, and only 62% received education from their physician about other ways to manage pain.

    Read the full blog post here, and keep an eye out for upcoming posts on a variety of topics.

    APTA’s award-winning #ChoosePT awareness campaign focuses on physical therapy as a safe alternative to opioids for pain management. To learn more, visit the association’s consumer website, www.MoveForwardPT.com/ChoosePT/.