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  • MedPAC June Report Subject of Congressional Subcomittee Hearing

    Though it contains no formal recommendations, the Medicare Payment Advisory Commission's (MedPAC) June report describes the commission's exploration into the possibility of future changes in several areas, including the idea of paying the same rates to inpatient rehabilitation facilities (IRFs) as are paid to skilled nursing facilities (SNFs) for some types of postacute care. The report was the subject of a June 18 hearing of the House Ways and Means Committee's Health Subcommittee.

    The MedPAC report (.pdf), released June 13, is focused on 7 areas: bringing payments in line across fee-for-service, Medicare Advantage, and accountable care organizations (ACOs); measuring quality of care in Medicare; improving risk adjustments; financial assistance for low-income beneficiaries; per-beneficiary payment for primary care; measuring the effects of medication adherence for the Medicare population; and payment differences across postacute settings.

    In the postacute settings portion of the report, MedPAC looks specifically at outcomes for major joint replacement, other hip and knee procedures, and stroke, assessing differences between IRFs and SNFs. Although the report notes more analysis must be done to account for variability in stroke treatment, MedPAC's initial findings are that joint replacement and other hip and knee procedures may have similar outcomes, and are "a good starting point for a site-neutral policy," which would aim to bring payments to IRFs more in line with SNF payments.

    APTA staff attended the subcommittee hearing, in which Chairman Kevin Brady (R-TX), described MedPAC as a "key nonpartisan advisor with a lot of analytical firepower." MedPAC Executive Director Mark Miller was on hand to testify, and his testimony was posted (.pdf) on the Ways and Means Committee's website.

    Burwell Pressed to Expand Payment for Telehealth

    The newly confirmed Secretary of Health and Human Services can put another item on her "to do" list—changing Medicare payment policy to allow for accountable care organizations (ACOs) to receive payment for telehealth and remote patient monitoring, including when used as part of physical therapy. At least that's what a coalition of health care-related organizations and a tech corporation would like to see, anyway.

    According to a June 11 article in Medscape (free one-time registration required), organizations including the Alliance for Connected Care, the American Telemedicine Association, and the National Association of ACOs have requested that Secretary Sylvia Matthews Burwell look at expanding Medicare's coverage of telehealth beyond beneficiaries in rural areas who must travel to "originating sites." This could be done, the letters argue, if Burwell were to waive restrictions in the Medicare Shared Savings Program.

    The letter from the American Telemedicine Association, the Health Information and Management Systems Society, and 10 other nonprofit organizations and for-profit corporations argues that current Medicare regulations "place arduous restrictions on telehealth services which limit patient access to new technologies, effectively discouraging providers from utilizing advanced … solutions in their practices." The letter lists physical therapy as one of the services that could benefit from a new approach that would lower costs and improve outcomes.

    The letter estimates that current Medicare restrictions disqualify 80% of Medicare beneficiaries who don't happen to live in a setting defined as "rural," and that coverage is denied for service that originates from a patient's home or other nonmedical location, such as hospice.

    BioMed Journal Focuses on Physical Therapy

    A recent issue of BioMed Research International is entirely devoted to role of physical therapy in the treatment of chronic wounds, cancer-related lymphedema, and urinary incontinence, with an accompanying editorial stating that "well-documented, promising, and inexpensive methods for physical therapy are necessary" in order to respond to these "common and costly" problems.

    The issue is available for free and covers topics including new promising methods in wound healing, physical therapy of urinary incontinence, electromyography and biofeedback in rehabilitation of pelvic floor muscles, and kinesiology taping in lymphedema.

    In the issue's editorial, Luther C. Kloth, PT, MS, CSW, FAPTA, joins other editors in writing that the diseases covered in the issue are among "the major health disorders" affecting frail young and older people, and that establishing effective treatment methods is "a pressing issue."