Tuesday, January 08, 2019 Draft HHS Report Backs Nonpharmacological Pain Management, Calls for Better Payer Coverage of Physical Therapy Much like an APTA white paper on opioids and pain management published in the summer of 2018, a draft report from the US Department of Health and Human Services (HHS) says that it's time to address the gaps in the health care system that make it difficult to follow best practices in addressing pain—including improved access to and payment for physical therapy. APTA provided comments to the HHS task force that created the report. The draft "Report on Pain Management Best Practices" now available for public comment aims to identify "gaps, inconsistencies, updates, and recommendations for acute and chronic pain management best practices" across 5 major interdisciplinary treatment modalities: medication, restorative therapies including physical therapy, interventional procedures, behavioral health approaches, and complementary and integrative health. The entire report is predicated on a set of "key concepts" that emphasize an individualized biopsychosocial model of care that employs a multidisciplinary approach and stresses the need for innovation and research. The report devotes an entire section to what it calls "restorative therapies"—physical therapy, occupational therapy, therapeutic exercise, "and other movement modalities." "Restorative therapies play a significant role in acute and chronic pain management, and positive clinical outcomes are more likely if restorative therapy is part of a multidisciplinary treatment plan following a comprehensive assessment," the report states. Authors of the report point out that restorative therapies not only improve outcomes, but can "maintain functionality." The problem, they write, is that "use of restorative therapies is often challenged by incomplete or inconsistent reimbursement policies." The reimbursement issue is underscored later in the report, in an analysis of insurance coverage for complex pain management. "Although the HHS National Pain Strategy calls for greater access and coverage for pain management services, there is a lack of uniformity in insurance coverage and lack of coverage alignment with current practice guidelines for pain management," the report states. "This is particularly true for the coverage of nonpharmacologic and behavioral health interventions." And the problem isn't just about coverage, according to the report—there's also a disconnect when it comes to the hoops patients and providers have to go through to access the most effective pain-management approaches. "Consistently forcing providers to try a series of non-first-line treatments prior to authorizing treatment plans can be problematic, hindering appropriate patient care, creating tremendous inefficiency, and resulting in a loss of time and resources," authors write. The HHS report is consistent with a 2018 APTA white paper, "Beyond Opioids: How Physical Therapy Can Transform Pain Management to Improve Health." In that resource, APTA recommends the adoption of public and public health plan benefit models that support early access to physical therapy and other nonpharmacological interventions for pain, and a reduction or elimination of out-of-pocket costs for those approaches. Recommendations in the HHS report include stepped-up research on which restorative therapies are the best fit for specific pain syndromes, and minimizing barriers to patient access to them. On the insurance front, the report recommends that the US Centers for Medicare and Medicaid Services and other payers reimburse pain treatment using a chronic disease management model "in the manner they currently reimburse cardiac rehabilitation and diabetes chronic care management programs." The task force also recommends "innovative payment models that recognize and reimburse holistic, integrated, multimodal pain management, including complementary and integrative health approaches." APTA will be submitting comments on the draft report, and encourages members and other stakeholders to do the same by the April 1 deadline. The association has even developed a template comment letter that makes it easy to provide your insights—for more information and to download the template letter, visit APTA's regulatory "Take Action" webpage. APTA continues to build on its successful #ChoosePT campaign to educate the public on safe, effective alternatives to opioids for pain management. The most recent addition: a downloadable pain profile chart that makes it easy for patients to assess the severity and impact of the pain they're experiencing.