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  • New Podcast: Reporting Under the Group Practice Reporting Option for 2013

    In 2013, physical therapists (PTs) will be eligible to participate in the Physician Quality Reporting System (PQRS) under the Group Practice Reporting Option (GPRO) for the first time, as a result of changes in the group practice definition and changes to the reporting methods for data submission under GPRO. A new APTA podcast explains the some of the important differences that PTs should consider before deciding whether to report as an individual physical therapist or as a part of a physical therapy practice under the GPRO option. The accompanying transcript also includes charts illustrating how these 2 reporting options work from a data analysis standpoint.

    For more information and resources on PQRS, go to www.apta.org/PQRS/

    APTA podcasts are prerecorded discussions and interviews, not live events. Members can listen to podcasts at their convenience by clicking on the links provided in News Now articles, visiting www.apta.org/podcasts/, or subscribing to APTA podcasts on iTunes.

    Patients With RA Have More Complications After TJA

    Patients with rheumatoid arthritis (RA) have more complications after total joint arthroplasty (TJA) than patients with osteoarthritis (OA) and are at notably higher risk for dislocation of replaced hip joints, according to a Medscape Medical News article based on a systematic review published online November 28 in Arthritis & Rheumatism.

    The analysis included 40 reports published between 1990 and 2011 that describe primary TJA of the hip or knee in patients with RA (n = 2,842) or OA (n = 61,861). Outcomes included revision, hip dislocation, infection, 90-day mortality, and venous thromboembolic events.

    The researchers found that patients with RA had double the risk for hip dislocation after total hip arthroplasty compared with patients with OA. Adjustments were made for age, sex, surgical approach, and surgeon's volume.

    Infection risk was up to a 10-fold increase in patients with RA after total knee arthroplasty, particularly in patients with prior infection in the replaced joint, prior infection in any joint, or longer duration of operating. There was no association between infection risk and perioperative systemic corticosteroid use or withdrawal of biologic treatment before surgery. However, meta-analysis was not completed due to variable definitions of infection and preoperative antibiotic protocols, the article says.  

    Johannes Cornelis Schrama, MD, who was not involved in the study, told Medscape Medical News that that the researchers do not appear to have overlooked any major factors in their analysis, but he was cautious about possible clinical application. "It is difficult to define clinical implications other than possible preventive measures [against infection] in patients undergoing [total knee arthroplasty]," he said. 

    Individual Insurance Market Passes on MLR Savings to Consumers in 2011

    Consumers saw nearly $1.5 billion in insurer rebates and overhead cost savings in 2011 due to the Affordable Care Act's (ACA) medical loss ratio (MLR) provision requiring health insurers to spend at least 80% of premium dollars on health care or quality improvement activities or pay a rebate to their customers, according to a new Commonwealth Fund report. Consumers with individual policies saw substantially reduced premiums when insurers reduced both administrative costs and profits to meet the new standards. While insurers in the small- and large-group markets achieved lower administrative costs, not all of these savings were passed on to employers and consumers, as many insurers increased profits in these markets.

    The report, Insurers' Responses to Regulation of Medical Loss Ratios, looks at how insurers selling policies for individuals, small-employer groups (up to 100 workers), and large-employer groups (more than 50 or 100 workers, depending on the state) in every state reacted to ACA's MLR requirement between 2010, the year just before the new rule took effect, and 2011, the first year the rule was in place.

    The authors find that in the individual insurance market, improvements were widespread: 39 states saw administrative costs drop, 37 states saw MLRs improve, and 34 states saw reductions in operating profits. Some states stood out for significant improvements. In New Mexico, Missouri, West Virginia, Texas, and South Carolina, MLRs improved 10 percentage points or more, while administrative costs dropped $99 or more per member in Delaware, Ohio, Louisiana, South Carolina, and New York.

    However, the report finds that in small- and large-group markets, MLRs were largely unchanged, and while spending on administrative costs dropped, profits increased. For example, in the small-group market, administrative costs were reduced by $190 million, profits increased by $226 million, and the medical loss ratio remained at 83%, unchanged from 2010. In the large-group market, insurers reduced administrative costs by $785 million, increased profits by $959 million, and kept their medical loss ratio at 89%, also unchanged from 2010.

    The authors note that while insurers in the individual market have a less stringent medical loss ratio requirement—80%, as opposed to 85% in the large-group market—their traditionally higher overhead costs and lower MLRs mean they have to work harder to reach the new standard. As a result, these insurers lowered both administrative costs and profit margins, therefore reducing growth in premiums.  

    Conversely, insurers in the small- and large-group markets generally already have MLRs in the range of the required 85%, so while they reduced administrative costs, they had the option of turning those cost savings into profits instead of passing them along to consumers. In light of rising profits and falling administrative costs, the authors suggest it is possible insurers took profit increases in the small- and large-group markets to offset the reduced profits in the individual market. And because many insurers sell policies in all three markets, any reduction in administrative costs could have been spread across all of a given insurer’s lines of business.  

    The authors conclude that stronger measures—such as rate regulation, tighter loss-ratio rules, or enhanced competitive pressures—may be needed to ensure that administrative costs are reduced in all markets and savings are passed along to consumers.