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  • Final Rule Aims to Reduce Burdensome Regulations, Encourage Efficiency

    The Centers for Medicare and Medicaid Services (CMS) issued updates today to the Medicare Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs) that include provisions that reduce regulatory burdens and help providers to operate more efficiently. CMS estimates that annual savings to hospitals from the final rule on CoPs could exceed $900 million in its first year.

    CoPs are federal health and safety requirements ensuring high-quality care for all patients. Hospitals and CAHs must meet these conditions to participate in Medicare and Medicaid. The final rule includes the following provisions that provide more flexibility and recognize the key role of nonphysician practitioners, such as physical therapists, in providing care:

    • Broadens the concept of "medical staff" to allow hospitals the flexibility to include other practitioners as eligible candidates for the medical staff with hospital privileges to practice in the hospital in accordance with state law. All practitioners will function under the rules of the medical staff.
    • Allows hospitals the flexibility to use standing orders and requires that protocols must be based on nationally recognized and evidence-based guidelines and recommendations.
    • Eliminates the requirement for authentication of verbal orders within 48-hours and defers to state law to establish authentication time frames.
    • Makes permanent the previous temporary requirement that all orders, including verbal orders, must be dated, timed, and authenticated by either the ordering practitioner or another practitioner who is responsible for the care of the patient and who is authorized to write orders by hospital policy in accordance with state law.

    A copy of the rule is available at this link.

    CMS Clarifies Medicaid Definition of 'Qualified' Physical Therapist: Aligns With Medicare Definition

    In a final rule released today, the Centers for Medicare and Medicaid Services (CMS) has removed the outdated personnel qualifications language in the current Medicaid regulations and cross referenced them to the updated Medicare personnel qualifications for physical therapists and occupational therapists. (Personnel qualifications can be found under 42 CFR §484.4.)

    The final rule has the potential to ensure that certain physical therapists are not excluded from providing services under Medicaid. In addition, it strengthens the consistency of standards across Medicare and Medicaid. APTA has worked since 2010 to eliminate the outdated qualifications.

    Specifically, APTA is hopeful that today's rule is a major victory for many foreign-trained physical therapists, in states such as New York, who were previously considered qualified to treat Medicaid patients but were told around 2010-2011 that they were no longer considered qualified to provide services under Medicaid. 

    In response to comments received regarding certain states that have excluded PTs from treating Medicaid patients due to being trained in foreign countries, CMS states in the final rule, “If practices at the State level are prohibiting individuals from meeting Medicaid qualifications, we suggest addressing those concerns with the State Medicaid Agency."

    CMS' comments also stated that, although the Medicaid regulations are silent on the use of physical therapist assistants for Medicaid services, "States utilizing PT or OT assistants would be well served to follow the Medicare definition found at 42 CFR §484.4, to ensure consistency across programs."

    Under Medicare, physical therapists are licensed providers in all states and physical therapist assistants are licensed providers in the majority of states. As licensed providers, the state practice act governs supervision requirements. Some state practice acts mandate more stringent supervision standards than Medicare laws and regulations. In those cases, the physical therapist and physical therapist assistants must comply with their state practice act.  More information can be found on APTA's Use of Physical Therapist Assistants (PTAs) Under Medicare webpage.  

    ACR Guidelines Call for Individualized Exercise Programs for Knee, Hip OA

    The American College of Rheumatology (ACR) recently updated its 2000 recommendations for hip and knee osteoarthritis (OA) and developed new recommendations for hand OA. The guidelines include nonpharmacologic therapies, such as exercise supervised by a physical therapist for knee and hip OA.  

    The guidelines, which use clinical scenarios representing patients with symptomatic hand, hip, and knee OA are based on the "best available evidence of benefit and safety/tolerability" of both nonpharmacologic and pharmacologic interventions, in addition to the consensus judgment of clinical experts from a wide range of disciplines. They are published in the April 2012 issue of Arthritis Care & Research.  

    According to the Technical Expert Panel, patients with symptomatic knee and hip OA should be enrolled in an individualized exercise program commensurate with their ability to perform these activities. The panel also calls for the use of thermal agents and manual therapy in combination with exercise supervised by a physical therapist.

    Because there were few high-quality randomized controlled trials of interventions for hand OA published in the peer-reviewed literature, the panel made no strong recommendations for this indication. However, the panel recommends that all patients with hand OA be evaluated by a health professional, either their primary care provider or a physical therapist or occupational therapist for their ability to perform activities of daily living. Based on the evaluation, patients could receive assistive devices as necessary, instruction in joint protection techniques and in the use of thermal agents for relief of pain and stiffness. 

    APTA members G. Kelley Fitzgerald, PT, PhD, and Carol A. Oatis, PT, PhD, served on the panel. 

    Free, full text of the guidelines is available from ACR.

    APTA Initiative Encourages Women to 'Overshare' Health Concerns

    During Women's Health Week, which is celebrated May 13-19, APTA is partnering with its Section on Women's Health to build awareness of women's health issues that can be prevented and treated by a physical therapist with its #overshare initiative. APTA will host a 1-hour program on Move Forward Radio and a Twitter party, both on May 15 at 7 pm ET. Women across the country can listen online and call the show to ask questions or submit them in advance via Twitter by tweeting @MoveForwardPT and using the hashtag #overshare. APTA members Pamela Downey, PT, DPT, WCS, of Miami and Rebecca Stephenson, PT, DPT, WCS, of Medfield, Massachusetts, and Los Angeles gynecologist Judith Reichman, MD, author of Slow Your Clock Down: The Complete Guide to a Younger, Healthier You, will discuss women's health issues, covering everything from incontinence and pregnancy to fitness and bone health. APTA also has published a free, downloadable e-book, Women’s Health Across the Lifespan, to support the initiative, which will be available the day of the show at www.moveforwardpt.com/womenshealth. Read more about the initiative in the press release. 

    APTA Sets the Record Straight: 'Physical Therapy' Is Not a Generic Term

    APTA responded to FoxNews.com regarding a May 2 article, "How can chiropractors benefit your health?" in which Keith Overland, president of the American Chiropractic Association, said that chiropractic treatment may include "combinations of chiropractic manipulation, physical therapy, and rehabilitative procedures for many musculoskeletal problems." APTA tells Fox News, "'Physical therapy' is not a generic term. It describes only those services provided by a licensed physical therapist. Chiropractors may provide some of the same treatment modalities as physical therapists, but they should portray their services as chiropractic and not as 'physical therapy.'"