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  • Now Available: Your 2015 PQRS Data – and Possible Payment Reductions for 2017

    Participating in the Physician Quality Reporting System (PQRS)? You can now check on your 2015 reporting results, and find out if those results mean you're subject to any payment adjustments for 2017.

    The Centers for Medicare and Medicaid Services (CMS) announced that the reporting results—known as the Annual Quality and Resource Use Reports (QRURs)—as well as the feedback reports are now available for online viewing. The 2015 PQRS feedback report contains all detailed information used to determine your 2015 reporting results and indicates if you are subject to the 2017 PQRS negative payment adjustment. CMS is advising PQRS participants to review all information for accuracy.

    You can access the reports through the CMS "enterprise portal," but to do that you'll need an enterprise identity management (EIDM) account (CMS provides instructions for creating an EIDM). Also available: a user guide to the reports.

     In addition to the reports, CMS has also announced that will soon send out individual notices to providers who did not met PQRS requirements in 2015. Those providers are subject to a 2.0% Medicare Part B payment reduction beginning in 2017.

    If you have been identified for a 2017 payment reduction based on the report, and you think that decision was made in error, you'll need to ask for an informal review. CMS offers instructions on that process on the PQRS Analysis and Payment webpage.

    For additional assistance regarding EIDM or the content or data contained in the PQRS feedback reports, contact the QualityNet Help Desk at 866/288-8912 (TTY 877/715- 6222) 7:00 am–7:00 pm CT, Monday through Friday, or by email at qnetsupport@hcqis.org. If you are having trouble accessing the PQRS feedback reports, contact the Physician Value Help Desk at pvhelpdesk@cms.hhs.gov or 888/734-6433 (select option 3).

    Changes to ICD-10 Take Effect Oct 1

    With ICD-10 reaching its 1-year anniversary in the United States, the Centers for Medicare and Medicaid Services (CMS) has announced that the "grace period" for coding will end October 1. After that, CMS will become much less flexible about the codes it will accept. In response, APTA has created an opportunity for members to receive discounts on an online portal that helps physical therapists find the most specific ICD-10 codes.

    During the ICD-10 grace period, CMS accepted codes that were technically inaccurate, so long as they were from "the right family." According to CMS, adoption of the new codes has been a relatively smooth process, paving the way for the agency to require that providers accurately code to the highest level of specificity beginning in October—a requirement that will not be phased in. More information about the change can be found in a CMS questions-and-answers document available online (look for questions 23 through 33).

    Just in time for the changeover, APTA has announced the addition of an offer that could help members meet the new ICD-10 specificity requirements. Members are now eligible for discounts on Cypher, a cloud-based tool that can help PTs identify the most specific ICD-10 codes—including the additional 1,900 codes CMS added recently, and the more than 3,600 codes added in March. More information on the program is available at the Cypher Member Value Program webpage.

    Another important ICD-10 issue: Beginning October 1, providers must use the 2017 ICD-10 codes, which include new codes, as well as some revised and reorganized codes. The 2017 codes should be used for discharges occurring from October 1, 2016, through September 30, 2017, and for patient encounters occurring from October 1, 2016, through September 30, 2017. CMS offers a webpage with links to the 2017 codes.

    Latest News Reports Touch on Cost, Politics of Opioid Epidemic

    As National Physical Therapy Month approaches in October, APTA continues to share its #ChoosePT message to help the public better understand how physical therapy can play a role in addressing pain and reducing opioid use. It's a message that remains relevant, set against a news cycle that seems to add a new, often harrowing perspective on the opioid epidemic nearly every day.

    Here's a brief roundup of some recent notable reports and stories.

    The prescription opioid epidemic has cost the US $78.5 billion.
    Science Daily reports on a recent study that estimates the cost of the prescription epidemic at $78.5 billion, with about one-third of those costs related to health care, and one-fourth borne by the public sector.

    Private insurers have witnessed a 1,300% increase in costs related to opioid treatment between 2011 and 2015.
    A report in Kaiser Health summarizes research that found insurers' annual payments to providers, hospitals, laboratories, and treatment centers related to treatment for opioid abuse grew from $32 million in 2011 to $446 million in 2015.

    The rate of opioid-dependent babies born in the US has doubled.
    According to a report in Live Science, researchers have found that the rate of newborns diagnosed with neonatal abstinence syndrome—essentially, withdrawal symptoms experienced after being exposed to opioids while in the womb—has increased from 2.8 cases per 1,000 births in 2008 to 7.3 per 1,000 in 2015.

    Drug companies have adopted "a 50-state strategy" to "kill or weaken" anti-opioid legislation.
    The Associated Press has released a lengthy investigative piece that chronicles the efforts of prescription drug makers to use their already-formidable lobbying arm to fight restrictions on opioids, including "funding advocacy groups that use the veneer of independence." The tactics are being used at both the federal and state levels, according to the report.

    Both Trump and Clinton have weighed in.
    From Business Insider: a look at how both presidential candidates have talked about the opioid epidemic—with 1 candidate pressing for the wider adoption of pain treatment guidelines that "identify treatments other than opioids."

    Housed at MoveForwardPT.com/ChoosePT, the #ChoosePT campaign now includes a video public service announcement, as well as other targeted advertising and media outreach. APTA is also a member of the White House’s working group addressing the opioid epidemic.

    JAMA: Better Health Care Workplace Violence Prevention Plans Needed

    With half of all workplace assaults involving health care workers already, and the number of violent crime episodes in hospitals on the rise, it's time for health care facilities to address workplace violence "aggressively and comprehensively," say authors of an editorial recently published in JAMA.

    The "Viewpoint," (first-page sample only available for free) written by 2 employees of the Joint Commission and a representative from a Veterans Health Administration workplace violence prevention program, cites data from the Joint Commission, Occupational Safety and Health Administration (OSHA), and Bureau of Labor Statistics (BLS) to outline what they assert is a growing problem. Among the data:

    • Within health care settings, approximately 24,000 workplace assaults occurred between 2010 and 2013, with most threats and assaults occurring between noon and midnight.
    • Between 2012 and 2015, the incidence of violent crime events in hospitals rose from 2.0 to 2.8 per 100 beds.
    • According to BLS, 50% of all workplace assaults involve health care workers, while workers in this labor segment only account for 20% of all workplace injuries.
    • An OSHA study of 100 health care worker or patient fatalities in health care settings found that nearly a third (27%) were attributable to assaults and violence.
    • A Joint Commission study of 33 homicides, 38 assaults, and 74 rapes in health care workplaces between 2013 and 2015 concluded that "root causes of these events were failures in communication, inadequate patient observation, lack of or noncompliance with policies addressing workplace violence prevention, and lack of or inadequate behavioral health assessment to identify aggressive tendencies in patients," authors write.

    Authors of the JAMA article assert that increasing workplace safety will require health care employers to step up the creation of violence prevention programs. These programs, they write, must be rooted in a recognition that "personnel underreport violent events because they believe these experiences are part of the job, reporting is either cumbersome or unlikely to result in action from leadership, or they fear retaliation for reporting." To counter that tendency authors urge the development of reporting systems that are "simple, trusted, secure, and with optional anonymity," result in "transparent outcomes and delivery of a report confirmation," and are "fully supported by leadership, labor unions, and management."

    "Safety in health care workplaces relies on leadership enacting appropriate polices; trained employees intervening and reporting; multidisciplinary teams using evidence-based threat assessments and management practices, communicating safety plans, and analyzing environmental context; and ongoing evaluation of program effectiveness," authors write. "A workplace violence prevention program should be a required component of the patient safety system of all health care organizations."

    Landmark NIH Plan Delivers 5-Year Roadmap for Rehabilitation Research

    Rehabilitation research, one of APTA's longstanding areas of advocacy, has just received a major boost with the publication of a revised National Institutes of Health (NIH) Rehabilitation Research Plan, a 5-year roadmap intended to address a broad swath of research science. Nearly 2 years in development, the revision is the first change to the plan made in over 2 decades, and was guided by a blue ribbon panel that included prominent APTA members and physical therapy researchers.

    The plan, which will guide NIH support for rehabilitation medicine, addresses 6 priority areas: the need for rehabilitation research, NIH's investment in rehabilitation research, current rehab research activities at NIH, coordination with other federal agencies, and opportunities, needs, and priorities. According to NIH, each area has witnessed significant change since the 1993 edition of the plan, attributable to everything from an increase in rehabilitation researchers and growth in evidence to advances in brain-computer interfaces and other technologies that have altered the rehabilitation landscape.

    Among the topics covered within the priority areas: investigation of new approaches to assistive technology in the home; increasing resources to recruit more researchers; ramped-up efforts to analyze biological, chemical, and genetic components of recovery; and intensified research on rehabilitation and disability across the lifespan.

    A call for a revision to the plan, and the establishment of a 5-year update cycle, were among the recommendations from an NIH blue ribbon panel that was co-chaired by former Physical Therapy (PTJ) Editor-in-Chief Rebecca Craik, PT, PhD, with members that included Anthony Delitto, PT, PhD, and current PTJ Editor-in-Chief Alan M. Jette, PT, PhD.

    Improvements to rehabilitation research and support of NIH work in this area are among APTA's public policy priorities. In addition to its individual advocacy efforts, the association is a member of the Disability and Rehabilitation Research Coalition, a group of more than 40 organizations working together to promote this type of research.

    "The rehabilitation research plan now published will be a major resource, both for researchers and the agencies that provide funding," said Justin Moore, PT, DPT, chief executive officer of APTA. "Rehabilitation science can help providers truly transform lives, and this new plan marks a long-awaited and significant step forward."

    Development of the plan was led by the National Center for Medical Rehabilitation Research (NCMRR), under the leadership of Director Alison Cernich, PhD. NCMRR is part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

    FDA Clears First Device Specifically Designed to Assess Function After Concussion

    The US Food and Drug Administration (FDA) has given its first-ever clearance for marketing of devices designed to help clinicians assess cognitive function immediately after a suspected brain injury or concussion.

    Called Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and ImPACT Pediatric, the tool was approved under a new FDA category titled "Computerized Cognitive Assessment Aid for Concussion." The test battery is already used by more than 7,400 high schools, 1,000 colleges and universities, and 900 clinical centers as a way to test cognitive skills such as word memory, reaction time, and word recognition. ImPACT is designed for use on individuals aged 12 to 59, and operates on a desktop or laptop computer; ImPACT Pediatric is intended for children aged 5 to 11, and is run on an iPad.

    While not intended as the sole tool for making a diagnosis or return-to-play decision, the ImPACT device can provide additional evaluative information though comparisons with age-matched databases or patient baseline scores, according to an FDA news release. Pittsburgh, Pennsylvania-based ImPACT Applications submitted more than 250 peer-reviewed articles—half of which were independent clinical research studies—supporting the safety and reliability of the devices.

    Prior to the ImPACT approval, the FDA had cleared only devices that help determine the need for imaging after a head injury.

    $20 Million NIH Health Disparities Program Includes Project Focused on Increasing Physical Activity in Communities

    The National Institutes of Health (NIH) is starting a new community-based research program to address health disparities related to chronic disease. One the program's first targets: a project that will focus on improving physical activity and healthy eating for a community in Flint, Michigan.

    The program, operating under NIH's National Institute on Minority Health Disparities (NIMHD), will establish so-called "transdisciplinary collaborate centers" (TCCs) to address "the need for more robust, ecological approaches to address chronic diseases among racial and ethnic minority groups, underserved rural populations, people of less privileged socioeconomic status," and other groups subject to discrimination, according to an NIH news release. The TCCs will involve coalitions of research institutions, community organizations, providers, health care systems, and state and local public health agencies to develop interventions "that can be implemented in real-world settings."

    NIMHD plans to spend about $20 million over 5 years to support 2 projects—one will apply "community-engaged health disparities research" around interventions aimed at increasing physical activity and healthy diet; the other aims to control hypertension among American Indians, Alaskan natives, native Hawaiians, and other Pacific islanders.

    The first program, known as the Flint Center for Health Equity Solutions, will evaluate the effectiveness of interventions that approach physical activity and diet issues from multiple levels, including programs that involve local churches, peer coaching, family reunification, and support for individuals in recovery from substance abuse.

    "Multilevel interventions that take into account complex interactions between individuals and their environments can better address the determinants of health and enhance chronic disease prevention and health promotion for local communities," said NIMHD Director Eliseo Perez-Stable in the news release. "Studies in these centers will add to our knowledge of what works in health disparities populations, thus advancing knowledge towards our nation's health."

    How do health disparities affect physical therapist practice, and what are some of the driving forces behind them? Check out APTA's health disparities webpage for more insight.

    Emphasizing Mobility in Elderly Hospital Patients: One Facility's Journey

    A hospital in Alabama had what seemed to be a fairly straightforward idea: it wanted to get its elderly patients up and moving as soon and as often as possible. Accomplishing that goal, however, has required the restructuring of an entire unit, and a "culture change" in how staff prioritize mobility in patients.

    A recent article in Kaiser Health News (KHN) recounts the efforts of the University of Alabama-Birmingham (UAB) Hospital Highlands to rethink care of the elderly through the creation of a special unit, called Acute Care for Elders (ACE). The focus of the 26-bed unit's efforts: to do everything possible to promote mobility. According to KHN, the ACE unit is among only "a few hundred" facilities in the US attempting to provide "better and more tailored care to geriatric patients."

    The unit, which opened in 2008, employs a multidisciplinary team approach, with every team member receiving training on the importance of movement while a patient is in the hospital. The ACE rooms are also designed to facilitate mobility, with plenty of space to move, handrails on the walls, low-glare lighting, and floors that aren't slick. In addition, the program includes "geriatric scholars" who advocate for the cognitive and physical needs of geriatric patients, as well as volunteers who regularly walk with patients.

    Adres Viles, a nurse coordinator at the hospital, told KHN that the new approach requires a "culture change" for staff. In the KHN story, he describes a typical hospital staff so busy "administering medications and tending to wounds" that they don't have the time to walk with patients.

    In addition to time constraints, the KHN article also points out another possible reason mobility isn't emphasized: fear of patient falls.

    "We are doing an awful lot to prevent falls, but there is a cost," Heidi Walk, associate professor at the University of Colorado School of Medicine, told KHN. "The cost is decreased mobility."

    KHN asserts that part of the reason for hospitals' reluctance to emphasize movement may have to do with reporting requirements mandated in the Affordable Care Act (ACA). Hospitals must monitor injury from falls—regarded as a preventable adverse event—and face penalties if those rates are too high.

    Those fears are not stopping the UAB program from emphasizing movement. According to KHN, it's because the hospital understands that "making sure hospitalized patients spend sufficient time out of their beds can save money, keep them mobile after they return home, and improve overall health."

    ACE Program Coordinator Terri Middlebrooks frames the issue more succinctly when she speaks with her patients, KHN reports. "Don't quit walking," Middlebrooks tells a patient. "It's the most important thing you can do … This bed is not your friend."

    Advance your knowledge and skills related to mobility and falls in older adults through APTA Learning Center courses, including: Create a Culture of Mobility in Acute Care, Musculoskeletal Changes With Aging, and Geriatrics Focus for the Physical Therapist – 2016. Also, check out the association's Balance and Falls webpage for resources, and find a clinical practice guideline on falls and fall injuries in the older adult and a clinical summary on falls risk in community-dwelling elderly people in PTNow.

    Zika Virus Effects Go Beyond Microcephaly, Guillain-Barré, Say Researchers

    Medical experts have long known of the link between microcephaly and Zika virus infections in expectant mothers. But new research is shedding light on the extent of virus' effects—both on fetal and adult brains.

    A cranial imaging study in the journal Radiologyhas found other severe brain abnormalities in Brazilian babies with congenital Zika virus infection, even in those with typical head circumference at birth.

    Radiologists identified ventriculomegaly in 43 out of 45 infants with confirmed or presumed Zika infections. Authors hypothesize that these larger-than-normal fluid-filled structures in the brain, as well as cerebral atrophy, are responsible for the often unusual skull shape in these infants; essentially, the baby’s soft skull collapses as the brain shrinks.

    Researchers also observed calcium deposits in most cases. In 38 of the infants, the corpus callosum, which connects the 2 sides of the brain, was thin, malformed, underdeveloped, or completely absent. Several of the infants had incomplete or atrophied brainstems, and in all but 1 case had abnormal migration of neurons in the cerebral cortex.

    Co-author Deborah Levine, MD, told the Washington Post, “The likelihood the babies in our series are going to have normal development because of so many abnormalities — the prognosis is not good.”

    Public health officials continue to focus on warning pregnant women to avoid exposure to the virus. However, a new study in Cell Stem Cell indicates the potential for the virus to affect adult brain cells as well. Study authors examined the 2 areas of the adult brain that still contain neural stem cells. Adult mice injected with Zika virus experienced nerve cell death and generated fewer new nerve cells compared with the control group.

    While researchers don’t know the exact ramifications yet, it's already understood that cognitive decline, Alzheimer’s disease, and other neurological conditions are associated with deficits in new nerve cells. Co-author Sujan Shresta also suggests that “infection of adult neural progenitor cells could be the mechanism behind” the development of Guillain-Barré syndrome in adults who have previously been infected with Zika virus.

    The Centers for Disease Control and Prevention (CDC) have issued an advisory for people living in or traveling to South Florida, as Miami-Dade County has experienced 29 locally acquired cases. Officials worry that Zika will spread to Texas and Louisiana, due to the standing water from massive storms and flooding. The CDC awarded $6.8 million to a number of national public health organizations to help with mosquito surveillance and public awareness efforts.

    For the most up-to-date Zika research, see the World Health Organization open access studies, and the Pan American Health Organization list of published research, and the BMJ free access content.

    Surgeon General Letter Urges Action on Opioids, Recommends CDC Treatment Guideline That Includes Physical Therapy

    Physicians across the United States can expect something in their mailboxes soon—a letter from the Office of the US Surgeon General urging them to take part in the battle against the opioid epidemic, accompanied by a card that specifically mentions physical therapy as one of the preferred first-line approaches for treatment of chronic pain.

    "Everywhere I travel, I see communities devastated by opioid overdoses," writes Surgeon General Vivek Murthy, MD. "I meet families too ashamed to seek treatment for addiction. And I will never forget my own patient whose opioid use disorder began with a course of morphine after a routine procedure."

    In the letter, Murthy asks physicians to sign a pledge at www.TurnTheTideRx.org, the surgeon general's initiative to stem the opioid abuse epidemic.

    Murthy also asks doctors to review an enclosed pocket card that contains the basics of the US Centers for Disease Control and Prevention (CDC) opioid prescription guideline. That guideline lists physical therapy as among the preferred options for the treatment of chronic pain without the use of opioids. Murthy calls the CDC guideline a "good place to start" toward better physician education on how to treat pain "safely and effectively."

    A CNN report on the letter includes Murthy's remarks during a speaking engagement, in which he described how many physicians were taught that opioids are not addictive. Some continue to believe that false information, Murthy told the audience, including 1 of his own physician friends—until Murthy informed him otherwise. He was taught that opioids aren't addictive so long as a patient is "truly in pain," Murthy said.

    "Years from now, I want us to look back and know that, in the face of a crises that threatened our nation, it was our profession that stepped up and led the way," Murthy writes in the letter.

    APTA has added its voice to the effort to curb opioid abuse through its national #ChoosePT campaign, an initiative to promote physical therapy as a safe and effective alternative to the use of opioids in the treatment of pain. Housed at MoveForwardPT.com/ChoosePT, the #ChoosePT campaign will unfold throughout 2016 and include national online advertising, TV and radio public service announcements, and other targeted advertising and media outreach. APTA is also a member of the White House’s working group addressing the opioid epidemic.