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  • CMS Releases Proposed 2013 Physician Fee Schedule Rule

    Today, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2013 Medicare physician fee schedule rule that updates 2013 payment amounts and revises other payment policies. Excluding the 31% projected sustainable growth rate payment cut, the aggregate impact on payment of changes in the rule is a positive 3% for outpatient physical therapy services. Additional proposed policies that will impact physical therapists include implementation of new functional status codes for reporting therapy services, updates to the Physician Quality Reporting System (PQRS) program, and initiatives to promote care coordination.

    As required by the Middle Class Tax Relief Jobs Creation Act of 2012, CMS proposes to implement a claims-based data collection process to gather data about patient function for patients receiving outpatient physical, occupational, and speech therapy services. Therapists would be required to report new codes and modifiers on the claim form that reflect a patient's functional limitations and goals at initial evaluation, periodically throughout care, and at discharge. This data is for informational purposes and is not proposed to be linked to reimbursement. This reporting system is proposed to be implemented on January 1, 2013. Claims will be processed during the first 6 months until July 1, 2013, regardless of the inclusion of the functional limitation codes. Beginning July 1, 2013, all claims must include functional limitation codes to be paid by Medicare.

    CMS proposes to retain the 12-month calendar year reporting period for the PQRS program in 2013 and beyond. The incentive payment for 2013 will remain 0.5%. The 2013 reporting period data will be used to inform both the 2013 incentive payment (0.5%) and the 2015 payment adjustment (-1.5%). Successful reporting requirements for the program are proposed to remain as they were in 2012 requiring that participants report a minimum of 3 individual measures or 1 group measure via claims based reporting on 50% or more of all eligible Medicare patients, or report a minimum of 3 individual measures or 1 group measure via registry reporting on 80% or more of all eligible Medicare patients. 

    CMS proposes to establish new procedure codes that would allow reporting and payment for additional resources required for a physician and nonphysician practitioner to coordinate a patient's care outside a face-to-face patient encounter in the 30 days following discharge to the community from an inpatient hospital stay and skilled nursing facility stay.

    The public will have until September 4 to submit comments in response to this rule. On behalf of its members, APTA will submit comments in response to the rule. After reviewing public comments, CMS will publish a final rule on or about November 1, which will become effective for services furnished during calendar year 2013. APTA will provide a more detailed summary of the rule in the upcoming week.

    CMS Proposes Revisions Regarding Documentation and Reassessment in Home Health Rule

    In a home health proposed rule issued today, the Centers for Medicare and Medicaid Services (CMS) proposes additional regulatory flexibility regarding therapy documentation and reassessment as well as face-to-face encounter requirements. In addition, the rule would reduce Medicare payments to home health agencies in calendar year (CY) 2013 by 0.1%, or $20 million.

    Proposed revisions regarding documentation and reassessment include:

    • Revising the regulations to state that if a qualified therapist missed a reassessment visit, therapy coverage would resume with the visit during which the qualified therapist completed the late reassessment. This would be a change from the current policy that does not allow payment for the late reassessment visit.
    • Amending the regulations to state that in cases where multiple therapy disciplines are involved, if the required reassessment visit was missed by any 1 of the therapy disciplines, therapy coverage would cease only for that particular therapy discipline. Under current policy therapy coverage would cease for all disciplines until reassessments are completed by all therapy disciplines involved in care.
    • Modifying the regulations to clarify that in cases where the patient is receiving more than 1 type of therapy, qualified therapists could complete their reassessment visits during the 11th, 12th, or 13th visit for the required 13th visit reassessment and the 17th, 18th, or 19th visit for the required 19th visit reassessment.

    CMS proposed to change the regulations to allow a nonphysician practitioner in an acute or post-acute facility to perform the face-to-face encounter in collaboration with or under supervision of the physician who has privileges and cared for the patient in the acute or post-acute facility. This will inform the decision regarding the patient’s homebound status and need for skilled services.

    In addition, this proposed rule includes provisions regarding quality reporting for hospice and provides updates to the home health quality reporting program. This rule also would establish requirements for unannounced, standard, and extended surveys of home health agencies (HHAs) and provide alternative sanctions if HHAs are out of compliance with federal regulations.

    APTA will provide members with a thorough analysis of the proposed rule shortly. The association will submit comments to CMS by the September 4deadline. A final rule will be issued on or around November 1 and provisions will become effective in 2013.

    CMS Issues Outpatient Hospital Prospective Payment System Rule

    The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule today that would update payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) beginning January 1, 2013. CMS projects that total payments to hospitals under the Outpatient Prospective Payment System (OPPS) in calendar year 2013 will be approximately $48.1 billion.

    The OPPS proposed rule includes several proposals that would affect the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program. Specifically, the proposed rule would allow updates to the IRF quality reporting program measures based on changes that occur during recognized measure endorsement processes. All IRF quality measures will remain in effect until the measure is actively removed, suspended, or replaced.

    APTA will submit comments in response to the proposed rule by the September 4 public comment deadline. CMS will respond to all comments in a final rule to be issued by November 1. 

    July Craikcast Now Available

    Enjoy a "diversity of topics" in this month's PTJ as Editor  in Chief Rebecca Craik, PT, PhD, FAPTA, summarizes articles that range from treadmill training for people with Parkinson disease, and transcutaneous electrical nerve stimulation for the management of pain, to parameter selection for hypoalgesia using interferential therapy, and postural and movement experiences on head control in infants.

    International Groups Issue Statement on Diabetes in Older Adults

    A new position paper by 3 international groups addresses 8 domains of interest for older adults with diabetes: hypoglycemia, therapy, diabetes in the nursing home, influence of comorbidities, glucose targets, family/caretaker perspectives, diabetes education, and patient safety. The groups wrote the position paper because "most international clinical diabetes guidelines fail to address issues that are common in the elderly, including frailty, functional limitation, mental health changes, and increasing dependency," says an article by Medscape Medical News.

    The authors, from the International Association of Gerontology and Geriatrics, European Diabetes Working Party for Older People, and International Task Force of Experts in Diabetes, identified major research areas that need to be explored, including:

    • the use of exercise, nutrition, and glucose-lowering therapies in the effective management of type 2 diabetes in older people;
    • practical community-based interventions to reduce hospitalization;
    • methods to decrease hypoglycemia rates in various clinical settings;
    • health economic evaluations of metabolic treatment;
    • interventions to delay/prevent diabetes-related complications that are important in older age, such as cognitive impairment and functional dependence; and
    • development of technical devices that help to maintain autonomy and safety for older people with diabetes.

    The authors note that although functional status and well-being are a major focus of experts in geriatric diabetes, the issue of glucose targets is a fundamental one that needs to be addressed.

    The position paper is published in the July issue of Journal of the American Medical Directors Association.

    Study Shows Promise for Personalized Medicine for Parkinson Disease

    A National Institutes of Health-funded study shows that cells from patients with different types of Parkinson disease have unique drug responses, a finding that suggests that personalized medicine for the disease is possible.

    For this study, researchers collected skin cells from patients with genetically inherited forms of Parkinson disease and reprogrammed those cells into neurons. They found that neurons derived from people with distinct types of the disease showed common signs of distress and vulnerability—in particular, abnormalities in the cellular energy factories known as mitochondria. At the same time, the cells' responses to different treatments depended on the type of Parkinson disease that each patient had.

    Most cases of Parkinson disease are sporadic, meaning that the cause is unknown. However, genetics plays a strong role. There are 17 regions of the genome with common variations that affect the risk of developing Parkinson disease. Researchers also have identified 9 genes that, when mutated, can cause the disease.

    These results hint that induced pluripotent stem (iPS) cell technology could help define subgroups of patients for clinical trials. To date, interventional trials for Parkinson disease have not focused on specific groups of patients or forms of the disease, because there have been few clues to point investigators toward individualized treatments. Although the current study focused on genetic forms of the disease, iPS cell technology also could be used to define disease mechanisms and the most promising treatments for sporadic Parkinson disease.