A patient injures herself during a physical therapy session. What happens next?
The patient faces a longer recovery time, of course. And depending on the physical therapist's (PT's) approach to risk management, the PT could be facing a potentially costly and career-damaging malpractice claim that might have been avoided.
The latest case study (.pdf) now available from Healthcare Providers Service Organization (HPSO) recounts the story of a self-employed contract PT working at a rehabilitation facility. His patient, a 49-year-old woman, is recovering from a hit-and-run accident that resulted in a vertebrae fracture, a wrist fracture, and a crushed spine. She's morbidly obese, a heavy smoker, and takes prednisone.
Five months into treatment, the patient is injured during a physical therapy session. She files a malpractice claim against the PT.
Could the injury have been avoided? Was the exercise she was performing at the time of the injury set up and monitored correctly? Was the exercise itself evidence-based? And what other elements of the PT's practice are likely to be exposed in mediation or a court hearing? The HPSO case study lays out the facts.
"Case studies like these are a reminder for PTs that risk management is not just a part of practice, but a professional responsibility," said Nancy White, PT, DPT, OCS, APTA executive vice president of professional affairs. "Things can and do go wrong, but a PT who fully understands risk is better able to protect the patient, which in turn protects the PT."
The latest case study joins a series of case studies available at the HPSO website. HPSO is the official provider of professional liability insurance for APTA members. For further information visit www.hpso.com/APTA.
The recently released proposed rules for inpatient prospective payment systems (IPPS) continues the US Centers for Medicare and Medicaid's (CMS) push for more data from facilities, with some payment increases being contingent on quality reporting participation and meaningful use of electronic health records (EHRs).
The rule sets out a 1.1% increase in operating payment rates for acute care hospitals that successfully participate in the hospital inpatient quality reporting program (IQR) and that are "meaningful" users of EHRs. Hospitals that don't meet the IQR requirements could see a one-fourth reduction in payment rates, and hospitals that fail to achieve meaningful EHR use by 2016 would face a cut of one-half of any update issued.
Other features of the proposed rule:
The proposed rule also seeks feedback on a CMS bundled payment initiative that links payments for multiple services during 1 episode of care into a combined payment. The initiative is testing 4 models of bundling, and CMS is asking for comments on future expansion of the plan.
APTA has produced a summary of the proposed rule (.pdf), and will provide comments to CMS on behalf of its membership.
In a health care environment in which health insurance copays are becoming an increasingly powerful driver in care decisions made by consumers, it's valuable to understand the lay of the land when it comes to the ways states regulate insurance companies and what they can demand. That's where APTA's new interactive copay map comes in.
The new resource provides a summary of each state's copay laws, including whether the law imposes limitations based on provider type, diagnosis, and patient variables, and how the law goes about establishing these limitations. Each state summary is captured in an easy-to-download pdf file.
The copay map is housed in APTA's Fair Physical Therapy Copays webpage, which also includes model legislation, examples of individual state efforts to establish fair copay regulations, and talking points on the issue.
Proposed US Centers for Medicare and Medicaid Services (CMS) rules for skilled nursing facilities (SNFs) would increase payments by $500 million in 2016 and set the stage for quality improvement and reporting requirements that, if not met, could result in loss of Medicare and Medicaid funding. The additional $500 million in aggregate funding represents a 1.4% increase.
The majority of the rule focuses on how CMS plans to implement elements of the IMPACT Act. Passed into law last year and supported by APTA, the IMPACT Act is intended to standardize how data is collected and used across postacute care settings.
Other parts of the proposal outline how a value-based purchasing program will be implemented beginning in 2019, and set up requirements for the submission of staffing information beginning in 2016.
To meet provisions of the IMPACT Act, the proposed rule would require SNFs to report on several quality measures, including skin integrity, percentage of residents with new or worsened skin ulcers, incidence of major falls, and changes to their functional and cognitive status. Facilities that don't meet the reporting requirements by 2018 would be subject to a 2 percentage point payment reduction in annual updates.
The proposed rule also sets out mandatory reporting on staffing at SNFs, including data on hours worked, resident case-mix and census, employee turnover and tenure, and hours of care provided per-resident per-day. The data would be collected on direct employees, agency employees, and contract staff; noncompliance could trigger penalties or exclusion from Medicare and Medicaid.
In addition, CMS is seeking comments on an SNF value-based purchasing program, mandated by Congress, that would provide incentive payments to facilities based on performance beginning in 2019. The proposed rule would adopt a measure that evaluates 30-day hospital readmission rates for SNF patients, and CMS is accepting comments on policies related to that measure, mostly having to do with how performance would be measured, scored, and reported.
The proposed SNF rule would also apply to noncritical access hospital "swing beds"—beds that are used for acute care or skilled care as needed.
The relatively small number of Medicare claims that were processed during the brief time between the implementation of the sustainable growth rate (SGR) payment reduction and its repeal—including claims subject to the Medicare outpatient therapy cap—will be automatically reprocessed to reflect the rates in place before the various fixes expired on March 31, according to a recent announcement from the US Centers for Medicare and Medicaid Services (CMS).
The announcement follows news that Congress passed legislation ending the SGR and extending the therapy cap exceptions process through December 31, 2017. The president is expected to sign the legislation into law soon. Beginning July 1, 2015, there will be a .5% update in the payment rates.
The reprocessing was announced to accommodate claims that may have been processed between the time when the previous fixes to SGR and therapy cap expired on March 31 and the establishment of the new law. CMS held claims for 10 business days beginning on April 1 in anticipation of a resolution.
CMS writes that "no action is necessary from providers who have already submitted claims for the impacted dates of service."
Outpatient physical therapists (PTs) who provide services in patient rooms at assisted living facilities, independent living facilities, skilled nursing facilities, or nursing facilities don't have to meet the requirements of an "extension location," according to a recently released clarification and update (.pdf) from the US Centers for Medicare and Medicaid Services (CMS). The technical-sounding tweak is actually a significant resolution of a question about whether PTs and facilities in those circumstances have to meet additional approvals and follow special rules about how many people need to be present during treatment.
What did CMS clarify? When an outpatient PT affiliated with an approved facility provides services in a patient's room that is "off premises"—for example, in an assisted living facility—the room itself is not considered an "extension location," which means that those services don't have to meet extension location requirements.
Why does this matter to PTs? If the "extension location" requirement were applied, the location of the service would have to be certified and approved, and PTs would be made to follow a requirement that mandates at least 2 persons be "on duty" any time rehabilitation treatment is being provided to a patient.
The exceptions only apply to services provided on an "intermittent basis" with no "ongoing or permanent presence" of an outpatient PT. CMS considers presence to be "ongoing and permanent" when there's a dedicated therapy gym; when equipment and records are stored at the location; or when PT staff is "regularly assigned to work at that facility directing a coordinated and ongoing rehabilitation program at that facility."
In addition to the clarifications around extension location definitions, the CMS guidance document also provides details on how facilities may qualify for approval of extension locations outside a 30-mile radius of an approved facility. Extension locations may now be approved beyond 30 miles provided outpatient PTs can demonstrate they have adequate supervision of these locations.
Physical therapists (PTs) and physical therapist assistants have long understood the value of the PT-PTA relationship and how that relationship can be put to best use in patient and client care. Now there's a 1-stop source for explaining that value to others.
Recently, APTA unveiled The Physical Therapist–Physical Therapist Assistant Team: A Toolkit (.pdf), a 54-page e-publication that touches on some of the most important elements of the PT-PTA relationship, from educational requirements to work with third-party payers.
Designed to serve as a resource "to share with payers, employers, patients and clients, and any other interested party," the toolkit is part primer, part compendium, with appendices that include sample appeal letters to payers, a list of minimum required skills of the PTA, and a problem-solving algorithm for the PTA.
The toolkit is available free to APTA members, and joins a suite of APTA resources on PTA Patient Care and Supervision.
As the Department of Health and Human Services (HHS) continues its evolution away from fee-for-service payments and toward "value based" models, a new opportunity to shape that evolution is being offered to providers, payers, the public, and other stakeholders.
It’s called the Health Care Payment Learning and Action Network (Network), and APTA will be there from the start.
On March 25, HHS debuted the Network, which it describes as "a forum for public-private partnerships to help the US health care payment system (both private and public) meet or exceed … Medicare goals for value-based payments and alternative payment models." Those goals call for 90% of Medicare payments to be tied to quality or value within 3 years.
Plans are for a series of (mostly) online meetings—1 or 2 per year for all participants and more for various work groups. APTA representatives are participating in the program, beginning with the March 25 kickoff meeting, which featured remarks from President Barack Obama and HHS Secretary Sylvia Burwell. Both stressed the importance of gaining input from providers and payers.
According to HHS, the participants in the Network will identify areas of agreement around how health care will move toward new payment models; collaborate to "generate evidence, share approaches, and remove barriers”; and develop approaches and implementation guides for payers, providers, and consumers. Participants will also be expected to help create definitions for various alternative payment models.
"The transition to alternative and value-based models is already happening and is only going to accelerate over the next 2 to 3 years," said Gayle Lee, JD, APTA senior director of health finance and quality. "The Network that CMS is offering is a good way for PTs to stay connected with the conversation about that transition and to contribute a provider's perspective."
The association will share information and other learning opportunities as the Network continues its work.
New ways of providing and paying for care are at the heart of APTA's transformative vision. Check out the association's Innovations in Practice webpage for the latest resources.
From TV to tablets, children have all sorts of ways to be sedentary during playtime. And as Sheree Chapman York, PT, DPT, PCS, explained in a recent episode of Move Forward Radio, those sedentary behaviors sometimes begin even before a child is old enough to walk.
“The parents are so proud that their babies will pay attention to a screen for an hour," York said in the episode. And even though physical therapists (PTs) might be keenly aware that the American Academy of Pediatrics recommends no screen time for children under 2, she said, “Parents don’t know these things.”
But screen time is only part of the problem, and awareness is only part of the solution, according to York. Sometimes, even when families understand the need to avoid sedentary behaviors, they face some very real obstacles to being more active. “There are safety issues with [some] neighborhoods, or sometimes it’s a busy work life,” York said. “Some parents don’t have things like bikes or safe parks to take their children to, the way we grew up.”
In the interview, York provides several easy-to-implement ways to get children active—some of which can help adults avoid their own sedentary behaviors.
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 a podcast via iTunes.
APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be e-mailed to firstname.lastname@example.org.
Work in postacute care? The US Centers for Medicare and Medicaid Services (CMS) wants you to know that it's changing the way it collects data used in quality measures of PAC settings, and will be providing a recording and transcriptions of a forum it held on February 25.
The special Open Door Forum sponsored by CMS provided information on the standardized data and assessment domains now required under the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). The new standardized submission requirements affect long-term care hospitals, skilled nursing facilities, home health agencies, and inpatient rehabilitation facilities.
The requirements are part of the IMPACT Act's standardization measures that will allow the US Department of Health and Human Services to compare quality across PAC settings, improve hospital and PAC discharge planning, and use this standardized data to reform PAC payments in the future. APTA was a supporter of the legislation that created the act.
To access the recording and transcript, or sign up for email notifications of future forums, visit the Open Door Forum webpage. Visit the CMS webpage on postacute care quality improvements, including the IMPACT Act, for more details on the changes.
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