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  • CMS to Issue Rules On Outpatient and Home Health Payments, Physician Fees in Late November

    Although the federal Centers for Medicare and Medicaid Services (CMS) is still assessing the impact of the recent government shutdown on its work schedule, physical therapists (PTs) can count on seeing final rules for calendar year 2014 on at least 3 issues relevant to PTs by the end of November.

    A recent memo from CMS stated that the agency will issue final rules on regulations that include:

    • Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B Final Rule With Comment Period (CMS-1600-FC (.pdf)). Excluding the 24.4% projected sustainable growth rate payment cut, the rule’s aggregate impact on payment is a positive 1% for outpatient physical therapy services. Additional proposed policies that will impact physical therapists include updates to the Physician Quality Reporting System (PQRS), application of the therapy cap to critical access hospitals, and changes to the calculation of geographic practice cost indices. APTA issued comments on the proposal (.pdf) in September.
    • Changes to the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (CMS-1601-FC). APTA published a summary of the proposed rule when the rule was published (see "Outpatient Care" at the APTA "Medicare Payment and Policies for Hospital Settings" site), and issued comments on the proposal in September (.pdf).
    • Home Health Prospective Payment System Final Rule (CMS-1450-F). The rule affects services provided by home health agencies under Medicare Part A beginning January 1, 2014. The proposed national, standardized 60-day episode payment for 2014 is $2,860.20. CMS projects that as a result Medicare payments to home health agencies in 2014 will be reduced by 3.5%, based on the proposed policies. APTA issued comments on the proposal (.pdf) in August.

    Typically, rules are issued by November 1 of each year, but CMS says that this year they could be finalized as late as November 27. All rules generally will go into effect on January 1, 2014.

    NIH to Fund Research on Robotic Ankle Exoskeletons for Patients Recovering From Stroke

    The National Institutes of Health (NIH) National Institute of Biomedical Imaging and Bioengineering has announced a $2.4 million funding program focused on the development of robotic technologies, including a project to help researchers evaluate designs for ankle "exoskeletons" for patients recovering from stroke.

    Titled "Novel Platform for Rapid Exploration of Robotic Ankle Exoskeleton Control," the research will attempt to establish a way to consistently test controls and designs used in powered braces and other devices. The design research was 1 of 3 areas to be funded; NIH will also back research on the development of a "co-robotic cane" for people with visual impairments, and the creation of a robotic catheter that could adjust for heart movement and blood flow when patients are undergoing procedures to treat atrial fibrillation.

    The awards mark the second year of NIH's participation in the National Robotics Initiative (NRI), a commitment among multiple federal agencies to support the development of a new generation of robots that work cooperatively with people, known as co-robots. NRI has issued an announcement for research applications in 2014, and NIH says it is interested particularly in proposals that support the development of assistive robotic technology to achieve functional independence in humans, improve quality of life, assist with behavioral therapy and personalized care, and promote wellness/health.

    APTA offers information on the use of technology in patient care, and has produced podcasts on robotics in physical therapy.

    Rise in Observation Status Could Be Costly for Patients and PTs

    A recent article in the Wall Street Journal reports that hospitals, wary of regulatory penalties, are increasingly holding patients for observation rather than formal admission. The practice triggers outpatient therapy caps and requires physical therapists (PTs) to submit functional limitation reporting data to the Centers for Medicare and Medicaid Services (CMS) for physical therapy services provided while the patient is on “observation status.”

    The WSJ article draws data from the Medicare Payment Advisory Commission, which released a report showing a 34% rise in observation services related to Medicare beneficiaries between 2004 and 2011. During the same period, inpatient admissions declined by 7.8%. According to the report, the overall rise in beneficiaries over that same time period—13%—does not account for the increase in observation status.

    The use of observation status in hospitals can be problematic for PTs, whose services can be subject to therapy caps should a patient's hospital stay be classified as outpatient, according to an APTA advocacy letter (.pdf). Additionally, beginning this year, CMS requires that PTs must submit functional limitation data (G-codes) for observation patients in order to receive payment. PTs can also find themselves challenged to create discharge plans for patients whose observation status disqualifies them from the 3-night inpatient stay required to receive Medicare payments for skilled nursing facilities.

    APTA has taken positions that advocate for the elimination of functional limitation reporting for observation patients and is engaged in a grassroots effort to end the therapy cap. The association also provides a functional limitation reporting website that offers resources on the reporting requirement, including a podcast on G-codes and observation patients.