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  • Coronavirus Update: May 15, 2020

    A possible blueprint for telehealth exercise programs, pediatric COVID-related illness, CDC guidance on reopening, and more.

    From PTJ

    May 5: "COVID-19 Pandemic and Beyond: Considerations and Costs of Telehealth Exercise Programs for Older Adults With Functional Impairments Living at Home—Lessons Learned from a Pilot Case Study"
    Authors of a recent open-access PTJ article published ahead of print developed what they hope is a “blueprint” for developing and implementing new telehealth exercise programs for older adults with functional impairments — or for transitioning traditional in-person visits to telehealth during a pandemic such as COVID-19. The case study findings include a list of steps taken, participant and provider considerations, resources used, and cost analyses.

    May 8: "Musculoskeletal Physical Therapy During the COVID-19 Pandemic: Is Telerehabilitation the Answer?"
    In a PTJ Point of View published ahead of print, authors examine the clinical evidence on telerehabilitation for musculoskeletal conditions, discuss the evidence for telerehabilitation's feasibility and acceptability, and address potential benefits and challenges for physical therapists.

    From PT in Motion News

    May 11: FSBPT to Host May 18 Webinar on National Physical Therapy Exam
    On Monday, May 18, the Federation of State Boards of Physical Therapy is hosting a free webinar for students and others, COVID-19 and the Impact on the Physical Therapy Community, to answer common questions about the national health emergency’s impact on the National Physical Therapy Examination.

    May 11: TRICARE Allows Audio-Only Services, Waives Copays for Telehealth
    As of May 12, TRICARE, the health insurance used throughout the military, temporarily allows for the use of audio-only remote services for office visits when audiovisual communication is not possible — with documentation for that clinical decision. The rule, which will remain in effect until the COVID-19 public health emergency ends, also eliminates copays and copayments for telehealth services and relaxes provisions around licensing requirements for providers.

    In the Media

    May 8: Worldwide Increase in Reports of COVID-19-related Pediatric Multi-System Inflammatory Syndrome
    From MedPage Today [free account required]: "In the NYC health department report, the 15 cases in children ages 2 to 15 years were hospitalized with typical or incomplete Kawasaki disease, some with shock. All had fever and more than half had rash, abdominal pain, vomiting, or diarrhea. However, less than half have had respiratory symptoms."

    May 8: Health Care Sector "Hemorrhages" 1.4 Million Jobs in April
    From HealthLeaders: "With the COVID-19 pandemic steamrolling much of the nation during April, new federal data show the healthcare sector shed 1.4 million jobs for the month, as hospitals and outpatient care venues shuttered money-making elective services and slashed payrolls to stem the red ink."

    May 13: As States Begin to Reopen, 19 States Are Seeing Rise in COVID-19 Infections
    From Reuters: "Nationally, new cases of COVID-19, caused by the new coronavirus SARS-CoV-2, are down 11% in the last week, according to the Reuters analysis. However, hot spots are emerging in some southern and western states, while the Northeast has seen new infections plunge."

    May 14: CDC Issues Guidance on Reopening Schools, Workplaces
    From NPR: "The Centers for Disease Control and Prevention released a set of documents on Thursday designed to provide guidance on how child care centers, schools, restaurants and bars, and other establishments could begin the process of reopening in the face of the coronavirus. The direction comes after calls from lawmakers and state officials mounted for the CDC to weigh in on how regions should reopen their economies."

    Evidence Reports

    May 7: People of Color and Low-Income Patients in General Are at Higher Risk of Serious Illness if Infected With COVID-19
    According to a new report from Kaiser Family Foundation, national and state-level data "suggest that serious illness resulting from coronavirus disproportionately affects people in communities of color, due to the underlying health and economic challenges that they face. Similarly, adults with low incomes are more likely to have higher rates of chronic conditions compared to adults with high incomes, which could increase their risk of serious illness if infected with coronavirus."

    May 13: Infrared Temp Assessment Ineffective, Research Indicates
    According to Clinical Evidence Assessment by ECRI, infrared temperature screening programs to detect people infected with coronavirus are ineffective. Simulation studies, authors write, "suggest such screening will miss more than half of infected individuals," because many infected individuals do not have fever at the time of screening and because screeners may be inconsistent in their technique.

    From U.S. Department of Labor

    May 9: U.S. CARES Act Authorizes Additional $600 Per Week for Individuals Receiving Unemployment Compensation
    The U.S. Department of Labor published a series of responses to specific inquiries and questions raised by states regarding the Federal Pandemic Unemployment Compensation program. The CARES Act authorizes the FPUC program, and provides an additional $600 weekly payment boost to certain eligible individuals who are receiving other qualifying benefits.

    May 14: OSHA Issues Safety Guidance for Nursing Home and Long-Term Care Facility Workers
    The U.S. Department of Labor’s Occupational Safety and Health Administration has issued an alert listing safety measures employers can follow to help protect nursing home and long-term care facility workers from exposure to the coronavirus. The agency also has issued more general workplace guidance for keeping employees safe from infection.

    From the U.S. Department of the Treasury

    May 13: Small Business Administration, Treasury Department Publish FAQ on Paycheck Protection Program
    The Small Business Administration, in consultation with the Department of the Treasury, issued additional guidance to address borrower and lender questions concerning the implementation of the Paycheck Protection Program established by the CARES Act.

    From the Centers for Medicare & Medicaid Services

    May: CMS Issues Toolkit to Help Nursing Homes Mitigate COVID-19 Prevalence
    CMS released a compilation of actions employed by organizations, including state governments and outlying U.S. territories, to help nursing homes meet the needs of their residents since the onset of the COVID-19 pandemic. CMS notes that the document is not intended as guidance and does not replace or serve as a substitute for CMS requirements and policy. The agency has not evaluated the actions outlined in this document for effectiveness.

    Visit APTA's Coronavirus webpage for more information and updates.

    First Major Insurer Adopts a Permanent Telehealth Benefit

    BCBS of Tennessee will now include telehealth services — including telehealth provided by PTs — among benefits in place even after the COVID-19 health emergency ends.

    An isolated change or a glimpse into the post-COVID health care environment? BlueCross BlueShield of Tennessee announced that is making coverage of in-network telehealth service a permanent part of its benefit packages, including telehealth delivered by PTs. The change is the first time a major insurer has extended telehealth coverage beyond the length of the current public health emergency.

    According to a press release from BCBS Tennessee, the expansion began in March, when it began covering telephone and video visits with in-network primary care providers, specialists, and behavioral health providers. That coverage was later extended to PTs, occupational therapists, and speech-language pathologists.

    The now-permanent benefit includes member-to-provider and provider-to-provider consultations.

    BCBS Tennessee is the latest development in a trend among many commercial insurers to cover telehealth services delivered by PTs. Aetna, UnitedHealthcare, and Cigna are among the payers that have adopted telehealth — but until now, all insurers limited the benefit to the duration of the COVID-19 public health emergency.

    "Providers and patients have indicated that they believe telehealth provided for therapy and many other services is not only efficient but effective — and not just during a public health crisis," said Carmen Elliott, APTA's vice president of payment and practice management. "This innovative step by BlueCross BlueShield of Tennessee is encouraging, and hopefully other payers will see the same promise in telehealth as a permanent offering."

    As for Medicare, CMS has adopted waivers that allow for telehealth by PTs and PTAs that are set to expire when the public health emergency ends (the current federal emergency declaration doesn't include a set end date). APTA urges its members to advocate that CMS make those changes permanent.

    Visit APTA's Telehealth webpage for regularly updated information on payment, information on coding, and general guidance on what to consider when evaluating whether telehealth is right for you.

    APTA, AOTA, ASHA Alert Patients, Physicians to Misuse of SNF and HHA Payment Systems

    In addition to providing CMS with reports of inappropriate practices by HHAs and SNFs, the organizations are now taking concerns about PDPM and PDGM misapplication directly to physician and consumer groups.

    From the moment new payment rules governing skilled nursing facilities and home health agencies were rolled out, APTA, and the professional associations representing occupational therapists and OTAs and speech-language pathologists have been battling some employers' willful misapplication of the rules. Now the organizations are taking that mythbusting effort directly to physicians and consumers.

    This week, APTA, the American Occupational Therapy Association, and the American Speech-Language-Hearing Association released two joint letters and a consumer "fact sheet" that exposes how some SNFs and HHAs inappropriately use the new systems — known as PDPM for SNFs and PDGM for HHAs — to reduce patient care, cut therapist hours, and sometimes eliminate entire jobs. "PDPM" stands for "Patient-Driven Payment Model"; "PDGM" stands for "Patient-Driven Groupings Model."

    In a joint statement announcing release of the letters, the organizations write that "Preserving access to therapy services is critical, particularly as postacute care organizations prepare for the expected surge in patients recovering from COVID-19."

    The consumer-focused letter, sent to numerous patient and consumer advocacy groups, cites examples of HHAs and SNFs reducing therapist hours, requiring therapists to perform services outside their scopes of practice, ignoring or modifying physician orders and plans of care, misinforming therapists about which treatments are allowed under the payment systems, and failing to provide maintenance therapy, among other practices.

    "Our associations stand committed to ensuring all patients retain access to medically necessary therapy services and ensuring all stakeholders understand the impact these business-driven decisions can have on patient outcomes," the organizations write, adding that "Medicare beneficiaries and their caregivers deserve to know the facts about Medicare coverage in SNFs and HHAs to address the inappropriate practices."

    To that end, APTA, AOTA, and ASHA created an accompanying fact sheet that explains, in easy-to-understand language, the most common mistruths patients and caregivers are being told. Among the messages that the organizations point out as false:

    • Medicare limits the amount of therapy that can be received.
    • Medicare dictates what forms of therapy a therapist can deliver.
    • A portion of SNF therapy treatment must be provided in a group setting.
    • Medicare only pays for therapy services that improve a patient's condition.
    • Medicare does not pay for certain diagnoses.
    • Medicare does not cover home health services unless the patient is discharged from the hospital or institutional setting.
    • Medicare won't reimburse for any home health care services that exceed a total of 30 days of service.

    "Many SNFs and HHAs are using these payment systems in ways that support patient access to necessary care, but some are purposefully providing misinformation," said Kara Gainer, APTA's director of regulatory affairs. "We believe the facilities and agencies misusing the systems are outliers, but it's still important that all patients are aware of their rights."

    The fact sheet includes steps patients can take if they believe a SNF or HHA has inappropriately restricted access to therapy services, including links to consumer advocacy groups that can help pursue the issue.

    The letter directed at physician groups is aimed primarily at home health and warns that "some HHAs are making care choices for patients based on the perceived financial incentives … rather than the actual needs of patients of patients or the plan of care."

    "We recognize that CMS only implemented PDGM on January 1, 2020," the letter continues. "However, we anticipate that as patients raise concerns with their physicians and outcomes data becomes available, the failure of some HHAs to provide the care that has been ordered as medically necessary for the patient will require your attention."

    APTA, AOTA, and ASHA have been supplying CMS with a steady stream of examples of inappropriate practices by SNFs and HHAs since the new payment plans were introduced. For its part, CMS says it has been tracking SNF and HHA utilization and outcomes data, but has yet to release any findings, describing any release as "premature" at this stage.

    APTA's webpage devoted to PDPM and PDGM includes resources to better understand the rules, as well as links to materials that can help PTs and PTAs advocate for proper application of the systems.

    APTA MIPS Reporting Update, Registry Enrollment Deadline May 31

    Practices thinking about or planning to report 2020 MIPS data to CMS via APTA’s Registry need to enroll by the end of this month.

    Physical therapists who are participating in the Merit-based Incentive Reporting System for 2020 should be aware of important changes in reporting requirements and some key deadlines.

    MIPS Changes for 2020

    • Clinicians and groups must now earn a minimum of 45 points in order to avoid a negative payment adjustment. This is up from 30 points in 2019.
    • Data must be collected on at least 70% of all patients, rather than last year's 60%.
    • Groups must now complete and document Improvement Activities for at least 50% of clinicians on staff.
    • Two Improvement Activities have been removed from the Centers for Medicare & Medicaid Services’ approved list.
    • A COVID-19 Improvement Activity has been added for 2020. Learn more at the CMS Quality Payment Program Measures and Activities webpage.

    If you don’t hit all three thresholds for reporting, you could be eligible to opt-in for potential payment adjustments or voluntarily report to receive feedback directly from CMS.

    2020 Deadlines

    • The deadline for collecting data for the MIPS 2020 reporting year is December 31, 2020.
    • If you are considering participating in MIPS via the APTA Physical Therapy Outcomes Registry for the 2020 reporting year, you must enroll by May 31. Contact registry@apta.org for more information or to enroll.

    With more than 20 MIPS measures, including 11 qualified clinical data registry (QCDR) measures and two electronic clinical quality measures (eCQMS), APTA's Registry makes it easy for PTs to participate in MIPS and maximize payment. The Registry is an ONC-Certified Electronic Health Records Technology Registry and contains more than 1 million unique patient visits for benchmarking outcomes.