In response to a troublesome provision included in the fiscal cliff package
passed by Congress on Tuesday, APTA is advising members to monitor APTA's website and the Legislative Action Center specifically for upcoming
action alerts regarding efforts to avert the increased multiple procedure
payment reduction (MPPR) included in the American Taxpayer Relief Act of 2012
Set to be implemented on April 1, the provision applies the MPPR to therapy
services at 50%, up from 20% for office settings and 25% for facility settings.
APTA estimates the application of a 50% MPPR policy will reduce payments by
approximately 6%-7%. This reduction will be partially offset by a 4% increase
that resulted from the Centers for Medicare and Medicaid Services' (CMS) use of
new survey data of practice expenses conducted by APTA. Coupled together, APTA
expects the net overall decrease for outpatient therapy services to be between
2%-3%, a lower cut than expected. Nevertheless, APTA will advocate to fix
this flawed policy. The association soon will call on APTA members to make
their voices heard on Capitol Hill.
The increase to a 50% MPPR was recently endorsed by the Medicare Payment
Advisory Commission (MedPAC). Despite months of aggressive lobbying
efforts to reject the provision, Congress ultimately included this and a number
of other spending cuts in the fiscal cliff package to offset other health care
related provisions, including the prevention of the 26.5% fee schedule cut and
the extension of the therapy cap exceptions process.
Once policy options are assessed,
APTA will issue additional alerts to PTeam. If you're not a member of PTeam, sign up today to receive the alerts. In the
members are encouraged to learn more about this and other important provisions
included in the legislation through the resources provided on APTA's 2013 Medicare Changes: January 2013 webpage
at www.apta.org/Payment/Medicare/2013/Changes/. These resources include a statement by
APTA's president on HR8, a congressional summary, a 2013 Medicare therapy cap
FAQ, and a 2013 Physician Fee Schedule and MPPR FAQ.
Additionally, APTA has updated the MPPR calculator to help association members determine their reimbursement for services based on the MPPR only.
Safe patient handling (SPH) programs do not appear to
inhibit patient recovery, say authors of a retrospective cohort study conducted
in a rehabilitation unit in a hospital system. Fears among therapists that the
use of equipment may lead to dependence may be unfounded, they add.
For this investigation, the authors enrolled consecutive
patients (N=1,291) over a 1-year period without an SPH program in place (n=507)
and consecutive patients over a 1-year period with an SPH program in place
(n=784). The SPH program consisted of administrative policies and patient
handling technologies. The policies limited manual patient handling by staff.
Equipment included ceiling- and floor-based dependent lifts, sit-to-stand
assists, ambulation aides, friction-reducing devices, motorized hospital beds
and shower chairs, and multihandled gait belts. The main outcome measure was
the mobility subscale of the FIM.
Patients who were rehabilitated in the group with SPH
achieved similar outcomes to patients rehabilitated in the group without SPH. A
significant difference between groups was noted for patients with initial
mobility FIM scores of 15.1 and higher after controlling for initial mobility
FIM score, age, length of stay, and diagnosis. Those patients performed better
APTA member Marc
Campo, PT, PhD, OCS, is the article's lead author. APTA member Heather Margulis, PT, is coauthor. The article
is available in this month's Archives
of Physical Medicine and Rehabilitation.
Two themes emerge in this month's PTJ, says Editor in Chief Rebecca Craik, PT, PhD, FAPTA, in her January Craikcast. The first theme, which reflects back on PTJ's December 2011 Special Issue on Advances in Disability
Research, calls for physical therapists to go beyond measurements of
impairments and consider other variables when evaluating outcomes following
interventions. Craik notes that 4 papers in the current issue "certainly
have gone beyond the impairment level in looking at outcome measures." The
second theme, motor control and motor learning, can be found in articles on
intermanual transfer in patients with upper-limb amputation, body-scaling, and
mastering motivation in toddlers.
Responding to a charge from the 2012 House of Delegates to
revise Vision 2020 to "reflect the
vision of the profession of physical therapy and its commitment to society
beyond 2020," the Vision Task Force sent a revised vision to the APTA
Board of Directors for consideration at its November 2012 meeting. The Board
will forward the proposed vision to the 2013 House of Delegates for
consideration. Information about the proposed vision has been posted and is available
for members and delegates to review. Please direct your comments about the
vision to your chapter or section delegates or directly to the members of the
Vision Task Force.
The Foundation for Physical Therapy recently launched a new
effort that enables students, faculty, and members of the community to
collectively raise funds for physical therapy research. Built around the
concept of training for a triathlon, physical therapy programs will form teams,
and team members will log the number of miles they each swim, bike, and run on
the Log 'N Blog website. Register today!
The relationship between health care spending and quality of
care is "totally unclear," say researchers in a Reuters Health article
about their meta-analysis of 61 studies that compared health care spending with
outcomes on both small hospital-wide scales and broader state-wide levels.
Some of the studies looked at whether hospitals that spent more money per patient had fewer in-hospital deaths,
or if their physicians and nurses better followed guidelines. Others compared
states' Medicare spending with how well their older residents were treated for
a range of conditions.
"The bottom line was that no matter how you drill down into the
results, at every level the results are just all over the map," Peter S. Hussey, PhD, the study's lead investigator, told
Twenty-one of the 61 studies showed higher spending was tied to better
outcomes for patients, such as fewer deaths. However, 18 studies found a link
between more spending and worse outcomes, and 22 showed no difference or an
unclear association based on spending.
Many of the studies compared certain types of spending with potentially
unrelated outcomes. Others didn't take into account how sick patients were
initially when looking at how they fared in different situations, the article
Hussey and colleagues
conclude that future studies should focus on what types of spending are
most effective in improving quality and what types of spending represent waste.
The findings are published in the January 1 issue of Annals of Internal Medicine.
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