A recent story from National Public Radio (NPR) tackles the concept of bundled payment by looking at how a Texas health system is handling hip and knee replacements—including how they are transitioning away from postoperative nursing home-based physical therapy and toward approaches conducted in the patient's home.
The April 30 report focuses on San Antonio-based Baptist Health System (BHS), whose 5 hospitals "joined forces to cut costs for hip and knee replacements, getting patients on their feet sooner and saving taxpayers money."
According to NPR, the hospital group is participating in a bundled payment program with Medicare that let BHS take charge of "the whole process of replacing knees and hips, from admission to surgery to rehab and anything else that happened within a month." Medicare lowered its average payment amounts by 3% and gave BHS a lump sum for each payment, allowing the health system to keep any unspent money.
The report claims that BHS was able to save money, partly because it reduced patient stays and decreased the use of nursing facilities for rehabilitation.
"Baptist keeps part of the savings and shares part with the orthopedic surgeons — a bonus of up to half their surgery fee if they maintain the highest quality measures and their patients do well," NPR reports. "The loss to the nursing homes and other post-discharge providers was their gain."
APTA has been helping its members prepare for the evolution of health care payment and organization, and offers multiple resources on bundled payment systems, accountable care organizations, and other collaborative care models.
"Standardizing procedures, avoiding overpriced hardware, and coordinating care always did make sense for hip and knee replacements," reports NPR. "Now, 4 decades after such surgery became routine, some hospitals and doctors seem to agree."
Want to go to where physical therapists (PTs) earn the most money? Go west, young PT—or at least as far west as New Jersey.
A new report from GoBankingRates claims to list the "best- and worst-paying states for the top 20 jobs," physical therapy being among those in-demand careers. The interactive map can be filtered by occupation, pay differentials, median income, and other factors, and is based on US Bureau of Labor Statistics data. The data do not include physical therapist assistants (PTAs).
Overall, the site pegs the median national income for PTs at $81,853. The highest-paying state, according to GoBankingRates, is California, with a median PT income of $91,160, followed by Nevada ($88,580), New Jersey ($88,530), Texas ($87,515), and New Mexico ($86,580). Technically Alaska reports the highest median PT income at $91,515, but the relatively small number of PTs in the state may make the calculation less reliable.
The lowest-paying states, according to the report? Vermont was fifth from the bottom with a median income of $72,540, followed by South Dakota ($72,145), Nebraska ($71,970), and North Dakota ($71,730). Montana paid the least, with a median PT income of $69,560.
When it comes to specific cities, Las Vegas and Dallas top the list, with median PT incomes of $111,250 and $93,840, respectively. Among the cities included in the list, 2 New York locations were at the bottom: Syracuse was lowest, with a median of $66,740, followed by Albany, with a $69,020 median.
There's more to understanding PT pay than median salary data: check out the extensive resources at APTA's Physical Therapy Workforce Data webpage to get a more detailed picture of how—and how well—PTs and PTAs are paid. And see PT in Motion magazine’s annual “The Best States in Which to Practice” feature for other benchmarks on what makes a location friendly for physical therapists.
When it comes to participation in the Physician Quality Reporting System (PQRS), physical therapists are fast adopters and strong participants—so much so that the profession's participation rates in 2013 beat the national average by more than 10 points.
Last week, the US Centers for Medicare and Medicaid Services (CMS) released a report on use of the PQRS among all eligible health care providers. Findings revealed that PTs and occupational therapists (OTs) jumped from a 25.7% participation rate in 2012 to a 62.6% rate in 2013, a dramatic increase well above the average overall participation rate of 51.2% of eligible professionals.
PQRS is the quality reporting program under Medicare Part B. PTs who bill Medicare for outpatient physical therapist services in private practice settings are included under this program and face penalties for nonparticipation—this year, PTs who fail to satisfactorily report data will be subject to a 2.0% adjustment in their fee schedule amounts beginning in 2017.
For PTs and OTs, data submitted by way of individual claims remained the most popular way of participating in PQRS, accounting for about 75% of all submissions. The number of submissions made through registries has increased steadily, however, and now makes up about 16% of the total.
"PTs have an understanding of how the transformation of health care and the physical therapy profession will be driven in part by data collection," said Heather Smith, PT, MPH, APTA director of quality. "The impressive level of PQRS participation among PTs will only enhance a broader appreciation of the value of physical therapy, and help make the case that the profession is well situated to play a major role as health care continues to evolve."
APTA engaged in an extensive initiative to educate its members on PQRS when it was created and as it developed. The association continues to offer a PQRS webpage with multiple resources on the program and how to participate.
Get all you need to know about PQRS in 2015: check out APTA's pre-recorded session on how to report successfully.
After several years of evaluating the possibilities, the US Centers for Medicare and Medicaid Services (CMS) is now ready to create a standalone payment system for inpatient rehabilitation facilities (IRFs) that will increase data reporting requirements and boost IRF payments by $130 million in 2016.
The rule recently proposed by CMS would extract IRFs from the "market basket" that combined those facilities with psychiatric and long-term care facilities. The new IRF-only market basket would be based on cost report data from both freestanding and hospital-based IRFs and, at least initially, would be anchored in how the price of the same mix of goods and services has increased over time—in this case, the increase since 2012. Factors such as the quantity of goods and services, or changes in the mix, are not measured.
After various additional adjustments, CMS established an average overall estimated increase for IRFs of 1.7% for 2016.
The creation of a standalone IRF market basket will also allow CMS to more effectively apply data-reporting requirements created under the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), a law that seeks to standardize reporting across postacute care facilities. APTA supported the legislation.
The proposed IRF rule would add 3 new reporting domains to help satisfy IMPACT Act requirements: percentage of residents with new or worsened pressure ulcers, incidence of falls, and changes in patient function and cognitive function. CMS announced that it intends to add more quality-reporting measures to future rules, mostly around changes to self-care and mobility scores in-facility and at discharge.
According to the proposed rule, CMS would begin publically sharing IRF quality-reporting data beginning in fall of 2016.
APTA has drafted a summary of the proposed rule, and will provide comments to CMS on behalf of its members.
Researchers in Spain would like to introduce you to the "social therapist" of the future (some assembly required; batteries not included).
Fully human physical therapists (PTs) obviously can’t pack it in just yet, but a multi-university project centered at the University of Carlos III (UCIII) in Madrid has unveiled NAO, a 9-pound 22-inch fully articulated robot designed to lead and evaluate a child's rehabilitation exercises.
According to a press release from UCIII, NAO is able to interact with children by asking questions, demonstrating correct form for particular rehab exercises, evaluating whether the child carries out the exercises correctly, and then instructing the child on what he or she needs to do differently. The robot is also capable of providing words of encouragement and can acknowledge when a set of exercises may have left a child feeling exhausted.
And NAO's kind of cute too, as robots go. UCIII has created a video of the robot in action.
NAO has worked with "more than 100 children," according to the release, which states that "both the children and their parents, as well as the medical staff who work with them, have noted that this makes the activity more fun and attractive for the patients."
Researchers acknowledge that much more work lies ahead before an army of mechanical exercise evaluators can be unleashed, but they say that advances continue, including the development of algorithms that will "allow the robot to recognize the child's gestures using camera" and the ability "to recognize when the child is smiling, getting angry, or having difficulty with an exercise."
Rather than a replacement for human PTs, the researchers see the robot as a way to "enliven rehabilitation processes." Even at that level, they say, there is much work to be done, right down to the robot's "contribution to the evaluation and monitoring of the therapies"—something yet to be determined.
On Capitol Hill, votes around a repeal of the Medicare outpatient therapy cap may seem to be about politics and pay-fors, but the result—an extension of an exceptions process that leaves some patients vulnerable—is about real people who may not get the treatment they need, according to a recent article in the Bend, Oregon, Bulletin.
In the April 24 edition of the Bulletin, reporter Mac McLean interviews local physical therapists (PTs) who put the therapy cap debate into real-world terms. Both Chuck Brockman, PT, MPT, CSCS, OCS, and Tannus Quatre, PT, outline just what the cap—and the exceptions process—means for people who need PT services that exceed the $1,940 cap.
In the article, Quatre explains how a patient who qualifies for the cap exception also has to agree to pay for the sessions if a medical review later deems the treatments as unnecessary.
In those cases, Quatre says, "the cost will kick back to the beneficiary." Some patients find that risk too great. "Sometimes the patient will say, 'Screw that, I'm out,'" he added.
The Bulletin article also provides background and context for the latest therapy cap debate on Capitol Hill from Mandy Frohlich, APTA vice president of government affairs.
Frohlich describes the debate over the therapy cap repeal amendment as an indication that Congress understands the problems with the current cap exceptions patch, and may actually move toward a repeal in the future.
"We were very pleased this issue was raised," Frohlich says in the article. "We're in assessment mode right now, but we're hopeful we'll be able to bring this up again soon."
A prominent specialist at the University of Virginia is voicing support for physical therapy by using physical therapy to support the voice.
Wait, we can explain.
An April 22 report from Virginia public radio station WVTF describes the efforts of Jim Daneiro, MD, of the UVA Voice and Swallowing Clinic, to "change the way people think about their voices to see talking as something closer to exercise."
Danerio, a head and neck surgeon, is quoted as saying that people who rely on their voices in their jobs—such as teachers, singers, and lawyers—are "akin to anyone who's throwing a baseball and … using their shoulder a lot. It's going to wear out at some point."
In cases like that, Daneiro refers patients for physical therapy. According to Danerio, the "number one" issue associated with a voice problem is "strain and stress on the neck and shoulder." In those cases, he says, "We get them into physical therapy or speech therapy and they usually get better."
Think of it as TripAdvisor for hospitals: last week, the US Centers for Medicare and Medicaid Services (CMS) unveiled a 5-star rating system for hospitals based on patient satisfaction.
Better yet, think of it as a really, really selective TripAdvisor for hospitals, because only 7% of the 3,553 hospitals reviewed earned a full 5-star rating.
Last week, CMS added the rating system to its "Medicare Hospital Compare" resource, an online lookup that allows the public to compare hospitals according to a wide range of information, from the facility's ability to receive lab results electronically to its Medicare reimbursement totals. The new patient satisfaction rating system is similar to Medicare's 5-star system for nursing homes.
The star system is based on patient responses to questions about doctor and nurse communication, room and bathroom cleanliness, noise, staff responsiveness, pain management, and clarity of postdischarge recovery instructions.
User ratings of hospitals were also the subject of a recent research article that correlated hospitals' Facebook ratings with readmission rates.
Of the 3,553 hospitals that had sufficient patient survey data to review, only 251 received all 5 stars. Just over a third of hospitals (1,205) received a 4-star rating, while 3-star ratings were earned by 40% of the facilities (1,414), and 2 stars were given to 16% (582). Approximately 3% of reviewed hospitals (101) received a 1-star rating.
According to a report from National Public Radio, "Many [of the 5-star hospitals] are small specialty hospitals that focus on lucrative elective operations such as spine, heart, or knee surgeries." The report states that these smaller hospitals tend to fare better in patient reviews than general hospitals, "where a diversity of sicknesses and chaotic emergency rooms make it more likely patients will have a bad experience."
Taking on what it calls "an opportunity to address challenges that exist in current practice," the Joint Commission (Commission) is developing a new optional certification program for organizations that perform total hip and total knee replacements--and it needs input on the program standards from health care providers, including physical therapists (PTs) and physical therapist assistants (PTAs).
According to an email notice from the Commission, the new advanced certification program will build on a core certification already in place by supporting "quality, consistency, and safety throughout the pre-operative, intra-operative, and post-operative phases of care." The new program will pay special attention to how transitions between these phases are managed.
APTA member Jerry Cain, PT, MPT, served on the Commission's technical advisory panel during the development of the new certification standards.
Providers who'd like to comment on the proposed requirements are asked to review the proposal and then participate in an online survey. Deadline for comments is May 19.
An article in Modern Healthcare reports that despite federal emphasis on interoperability of health records, a new survey of health care executives has found that only 11% of respondents were able to actually achieve record exchanges with other providers in the US. The survey results come on the heels of a draft "interoperability roadmap" released by the federal government—a draft that has already received comments from APTA.
According to Modern Healthcare, the survey results show that interoperability of health records remains "a bridge too far for many providers, despite more than a decade of federal emphasis on information exchange and $29.1 billion spent on federal [electronic health record] incentive payments." The survey targeted health care executives, including members of the Association of Medical Directors of Information Systems and the College of Healthcare Information Management Executives.
Among the findings from the survey:
On a more positive note, Modern Healthcare reports that 71% of respondents were optimistic that they'd be able to exchange a "core data set" of patient information across the country in time to make the 2017 goal set by the federal Office of the National Coordinator for Health IT's (ONC's) interoperability roadmap (.pdf).
In January, the roadmap was released in draft form, and APTA provided extensive comments to the plan. In those comments, APTA states that "too often, discussions about [health information technology and electronic health records] expansion are centered on physicians and hospitals only," and the association urges the ONC to expand any plan's scope to include "the full continuum of care."
American Physical Therapy Association | 1111 North Fairfax Street, Alexandria, VA 22314-1488 703/684-APTA (2782) | 800/999-2782 | 703/683-6748 (TDD) | 703/684-7343 (fax)
Contact Us | For Advertisers & Exhibitors | For Media | Follow APTA
All contents © 2014 American Physical Therapy Association. All Rights Reserved.