A partnership created by the National Institutes of Health (NIH) and the National Football League (NFL) will be awarding over $14 million in grants for research focused on the long-term effects of traumatic brain injury (TBI) and the development of better ways to diagnose and measure concussions.
The Sports and Health Research Program issued a press release on December 16 announcing that 8 projects have been selected for the funding. Two major research efforts will receive $6 million each, and over $2 million in additional funding will be spread out over 6 pilot projects mostly focused on ways to better detect concussion presence and severity.
The $6 million grants will be used to pursue research around chronic traumatic encephalopathy (CTE). One project will seek to define a range of specific features of the disorder, and to distinguish these features from other conditions such as Alzheimer disease and amyotrophic lateral sclerosis. The second project will investigate the relationship between the effects of TBI and various features of CTE, with the aim of identifying markers to help diagnose the degenerative effects of TBI.
The pilot grants are intended to support initial research into concussion. Grants were awarded to the following projects:
The Sports Health Program is a partnership between NIH, the NFL, and the Foundation for the National Institutes of Health. In 2012, the NFL donated over $30 million to the NIH Foundation for research into injuries that affect athletes.
The $1.014 trillion federal budget compromise passed by Congress includes a 3-month "fix" that will prevent implementation of Medicare payment cuts associated with the sustainable growth rate (SGR). The temporary patch is intended to allow the House and Senate time to finalize legislation that would permanently repeal the flawed SGR formula.
The patch prevents a 20.1% cut to the conversion factor in the physician fee schedule and extends the current therapy cap exceptions process. In past years, the so-called "doc fix" was approved for an entire year—this time, legislators hope to use the first 3 months of 2014 to hammer out details of a plan that would not only end the SGR but could include a repeal of the therapy cap. APTA has created a webpage that explains the SGR reform proposals on the table.
Under the 3-month extension of the therapy cap exceptions process, physical therapists will continue using the KX modifier at the 2014 cap level of $1,920 and will be subject to the manual medical review process when a patient reaches $3,700 in annual spending.
The Senate is expected to return on January 6 and the House on January 7. Congress will resume negotiations on the proposals and begin discussing how to pay for the cost of the SGR reform legislation.
APTA will continue to work the members of Congress to ensure the final reform package includes policies that reflect the interests of physical therapists and the patients we serve. Members interested in joining APTA's advocacy efforts to reform SGR and repeal the therapy cap can sign up for PTeam.
The US Department of Veterans Affairs (VA) will be making it possible for veterans with traumatic brain injury (TBI) to receive additional disability payments for 5 conditions that have been connected with brain trauma.
The new regulation will go into effect January 16, 2014, and will provide a way for veterans with Parkinsonism, seizures, certain dementia, depression, or hormone deficiency diseases to receive the additional payments if the conditions appeared after moderate-to-severe TBI. In a press release announcing the decision, the VA pointed to a National Academy of Sciences Institute of Medicine study that supported a strong link between the TBI and the 5 conditions.
According to an article in Stars and Stripes, VA does not characterize the change as a new entitlement, but as a more direct path to payment. The current system allows for the additional benefits, but only after veterans submit medical documentation verifying a link between their TBI and the second condition. The new system will not require the documentation, but will base benefit eligibility on the severity of the TBI and the length of time between the brain injury and the onset of the second condition.
Nearly 300,000 veterans have been found to have brain injuries since 2000, according to the Department of Defense.
APTA has been a strong advocate for the important role physical therapy can play in treatment and management of TBI. Access more resources at the association's TBI webpage.
House and Senate proposals now on the table would end the sustainable growth rate (SGR) formula that has confounded adequate payment to Medicare providers since its inception. The Senate version also suggests a permanent repeal of the Medicare therapy cap. The proposals are scheduled for discussion this week.
Both proposals—created by the Senate Finance and House Ways and Means committees—repeal the current SGR formula and freeze payment rates for 10 years. During this 10-year period providers are eligible to earn payment above the base level through value-based performance programs and alternative payment models.
The Senate Finance Committee proposal also includes a full and immediate repeal of the Medicare therapy cap. However, manual medical review would remain in place at the $3,700 level through 2014, followed by the development of a modified medical review process beginning in 2015.
The Senate proposal also calls for the creation of a new data collection system to replace the current functional limitation reporting system and includes language directing the Secretary of Health and Human Services to explore new payment models for outpatient therapy. The bill also requires that beginning in 2015, claims for outpatient therapy include data on whether a physical therapist assistant provided the service.
The House Ways and Means proposal focuses solely on repeal of the SGR formula and does not include a repeal of the therapy cap or any Medicare extenders. The House committee is expected to discuss its proposal sometime this week before adjourning on Friday, December 13.
APTA continues to work with legislators and staff on the Senate Finance and House Ways and Means committees as these proposals make their way through the legislative process. APTA will provide additional resources for members and an analysis of the impacts on the physical therapy profession after this week's discussions.
The influential Workgroup for Electronic Data Interchange (WEDI) has released what it calls a new "roadmap" for the future of health care, and a high level of consumer control is one of the primary destinations.
The newest WEDI report (.pdf) comes 20 years after its initial examination of the use of technology in health care. The 1993 report played an influential role in the development of the Health Insurance Portability and Accountability Act (HIPAA) as well as the transition to standardized transaction formats in payment.
The newest report focuses on 4 major areas: patient engagement, payment models, data harmonization and exchange, and "innovative encounter models." Although approaches and priorities differ in each area, the WEDI report emphasizes the need for greater coordination of technologies, both to make information-sharing more efficient and to provide consumers with a high degree of control over their own care and information.
"Health IT is not the cure in and of itself but, when adequately deployed, can serve as a powerful change agent," the report states. "The rise of mobile and other technologies creates many opportunities for the healthcare industry to move forward together to solve many of the challenges that have plagued the American healthcare system."
APTA members now have access to detailed information on how the 2014 Medicare physician fee schedule and the hospital outpatient prospective payment system (OPPS) will affect physical therapist practice. APTA staff has prepared analyses of the final rules that the Centers for Medicare and Medicaid Services (CMS) announced on November 27.
APTA's fee schedule summary (.pdf) covers the new schedule's impact on payment, including the impact of the sustainable growth rate (SGR) and therapy cap. The summary also includes an analysis of the proposed changes to the physician quality reporting system (PQRS).
The OPPS highlights (.pdf) document also addresses payment changes and provides analyses of the final Ambulatory Payment Classifications (APCs) as well as new rules around supervision of outpatient therapeutic services in critical access hospitals (CAHs).
Both resources are free to APTA members, and have been added to the physician fee schedule and Medicare in hospital settings information on the APTA website.
When is it safe to drive after an extremity injury? According to a recent article in the New York Times, even when the question is limited to a specific injury such as a broken wrist or sprained ankle, the considered answer from research boils down to a firm "it depends."
NYT reporter Jan Hoffman looked at recent studies of postoperative driving and interviewed several orthopedic surgeons to find out what firm guidelines existed relative to getting back on the road after an injury or surgery. While there were some constants—no driving with a brace on the right leg, no driving if the wrist or elbow is immobilized, for example—there were few hard-and-fast rules, and many complicating factors.
Some of these complicating factors include the kind of car being driven, individual driving habits, and lack of sleep due to pain. Additionally, Hoffman reported that surgeons are sensitive to the potential variations in recovery and often hesitate to make a specific recommendation for fear of legal repercussions should the patient get into an auto accident or aggravate the original injury by driving.
Editor's note: be sure to check out the comments on the article posted by readers, many of whom describe their own experiences with recovery after injury/surgery.
The latest episode of APTA's Move Forward Radio looks at chronic pain through 3 people who were part of a new Discovery Channel documentary on the subject and a physical therapist (PT) who treats chronic pain in his practice. APTA has also issued a press release on the episode.
The Move Forward Radio episode includes Iraq war veteran Derek McGinnis, as well as Melanie Rosenblatt, MD, and American Chronic Pain Association CEO Penney Cowan. Also featured is John Garzione, PT, DPT, president of the Orthopaedic Section’s Pain Management Special Interest Group, who discusses the role of physical therapy for chronic pain.
McGinnis, Rosenblatt, and Cowan were featured in Pain Matters, a documentary that features the stories of 6 individuals living with chronic pain, as well as the perspectives of several experts in pain management. The film can be viewed online and will be rerun on December 7 and 14 on the Discovery Channel.
Designed to be of interest to consumers, Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as podcasts via iTunes.
Feedback on a past episode? Great idea for a future episode? E-mail email@example.com.
From 1997 to 2011, the average cost of a hospital stay rose to $10,000, with the costs for stays for osteoarthritis and back problems increasing at more than 2 times the overall rate. In terms of the reason for stays, musculoskeletal conditions represented the second largest single area of costs, at 14%.
The statistical brief (.pdf) released this month by the federal Agency for Healthcare Research and Quality's (AHRQ) Healthcare Cost and Utilization Project (HCUP) is based on data from community hospitals and reflects 95% of all discharges in the United States. Among the findings from the study:
Established in 1988, HCUP contains the largest all-payer longitudinal database in the United States and uses state government data, hospital associations, private entities, and the federal government to create its studies.
APTA offers information to physical therapists (PTs) and physical therapist assistants (PTAs) on how to reduce hospital stays and costs through minimizing risk of readmission, as well as how to keep up with current reporting requirements for inpatient care. Additionally, former APTA Board of Directors member Dianne Jewell, PT, DPT, PhD, CCS, serves on the National Quality Forum's (NQF) Ad-hoc Planned Readmissions Committee. Better still: minimize the risk of any hospital stay for hip fracture by learning about falls prevention.
The final 2014 Medicare physician fee schedule rule (.pdf) released by the Centers for Medicare and Medicaid Services (CMS) sets the therapy cap amount on outpatient services at $1,920. In addition, the rule announces a 20.1% reduction in Medicare payment rates for physical therapists (PTs), physicians, and other health care professionals—a cut linked to the flawed sustainable growth rate (SGR) formula being discussed in Congress.
The new rule also updates payment amounts for physical therapists, physicians, and other health care professionals, makes changes to the Physician Quality Reporting System (PQRS), and revises other payment policies.
The final rule’s 20.1% reduction is to the conversion factor used to determine Medicare payment rates, a reduction generated by the flawed SGR formula. Since 2003, Congress had enacted legislation preventing the reduction every year. The president’s budget calls for averting these cuts and finding a permanent solution to this problem, and Congress is currently working to address an alternative payment method that would include permanent repeal of the SGR. If Congress does stop the 20.1% payment cut, the aggregate payment for outpatient physical therapy services due to changes in practice expense, work, and malpractice relative value units would remain unchanged from 2013.
Aside from setting the therapy cap at $1,920 for 2014, the rule makes changes to payments to critical access hospitals (CAHs) beginning January 1, 2014. Despite strong objections from APTA and other stakeholders, the rule subjects CAHs to the therapy caps, as well as any potential extension of the therapy cap exceptions processes, in the same manner as other providers of outpatient therapy services. The therapy cap automatic exceptions process and the manual medical review process, applicable to outpatient therapy expenditures exceeding $3,700 per beneficiary, will expire on December 31, 2013, unless Congress acts to extend them. APTA is working aggressively to have Congress address the therapy cap through repeal or extension of the exceptions processes.
CMS has finalized its proposal, supported by APTA, to require that individuals performing “incident-to” services in the physician’s office must meet any applicable state requirements, including licensure. This would enable the federal government to recover funds paid if services are not furnished in accordance with state law.
PQRS will see major changes for 2014. Physical therapists, physicians, and other eligible professionals will be able to avoid the 2016 2.0% PQRS penalty by reporting at least 3 individual measures via claims or registry for 50% or more of eligible Medicare patients in the 2014 reporting period. Though opposed by APTA and other stakeholders, CMS will increase the number of PQRS quality measures that providers must report either via claims or registry from 3 to 9 to qualify for the 0.5% bonus payment in 2014. CMS will maintain the current 12-month calendar year reporting period for the PQRS program but will eliminate the option to report on measures groups via claims.
APTA submitted extensive comments in response to the proposed rule that was issued in July 2013. The final rule with comment period will appear in the December 10 Federal Register. APTA will post a detailed summary of the final rule shortly.
Congressional discussions on SGR and therapy cap repeal will be taking place soon. Join APTA's grassroots efforts to call for an end to both flawed policies on December 2. Find out how to make your voice heard.
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