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  • Alert: Suspect 'Checks' Are Making the Rounds

    It isn't really payment for services — it's a tactic that makes it easy for you to unwittingly agree to join a provider network.

    Did you recently receive what appears to be a check for payment of services from a national proprietary provider network? Be careful: It may not be what you think.

    APTA has been made aware that some PTs are receiving what looks like a check but is in fact an agreement to participate in a provider network. The fine print that accompanies the check makes it clear: Endorsing and cashing or depositing this check constitutes acceptance of network participation, and acceptance and agreement of all terms and conditions of the agreement. APTA is sharing this information with you as a reminder of the importance of thoroughly reading all information from a payer or third-party administrator, or TPA.

    Before cashing or depositing checks from payers or third-party administrators make sure you are aware of any conditions associated with its processing. If you have office staff that manages checks received by your clinic, it is strongly recommended that you inform them of this practice and the need for you to be alerted to this type of communication from a payer or TPA.

    If you have questions or concerns contact advocacy@apta.org. Additionally, if you have been solicited by a network such as the one described above please let us know. For more information regarding managed care contracting, visit the APTA Commercial Insurance webpage.

    Please share this information with your colleagues.

    CMS Issues COVID-19 Guidance on Infection Control, Protective Equipment

    The ever-growing list of resources from CMS includes guidance related to particular settings including hospice, SNFs, and home health.

    Note: This article was posted on March 11, 2020 and includes the latest information available at that time. For regularly updated resources, visit APTA’s webpage on physical therapist management of patients with diagnosed or suspected COVID-19 

    The Centers for Medicare and Medicaid Services has issued several statements recently with regard to infection control, patient care, and provider safety precautions in a variety of settings. To prevent further spread of the virus, "all health care providers must immediately review their procedures to ensure compliance with CMS’ infection control requirements," said CMS Administrator Seema Verma in a press release. Following is a summary CMS guidance.

    Guidance for Infection Control and Prevention Concerning Coronavirus Disease 2019 (COVID-19) in Home Health Agencies
    These guidelines address how to screen home health patients for COVID-19, when staff should avoid home visits, if and when patients with confirmed COVID-19 should be transferred to a hospital, and special consideration for patients requiring therapeutic interventions, among others.

    Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes (REVISED)
    CMS has provided recommendations for limiting transmission of the virus in skilled nursing facilities, including screening and/or restricting visitors. It also offers information on accepting residents from or transferring residents to hospitals.

    Guidance for Infection Control and Prevention Concerning Coronavirus Disease 2019 (COVID-19) by Hospice Agencies
    The document provides guidelines for screening and treating patients, visitors, and hospice staff for COVID-19, as well as infection control and use of personal protective equipment. CMS recommends coordinating these actions with local health departments.

    Emergency Medical Treatment and Labor Act Requirements and Implications Related to Coronavirus Disease 2019 (COVID-19)
    CMS has published guidance to hospitals with emergency departments on patient screening, treatment, and transfer requirements to prevent the spread of infectious disease and illness, including COVID-19. Any hospital that participates in Medicare or Medicaid should follow both CDC guidance for infection control and Emergency Medical Treatment and Labor Act requirements.

    Medicare Advantage Organizations, Part D Sponsors, and Medicare-Medicaid Plans: Information Related to Coronavirus Disease 2019 – COVID-19
    This memo explains special requirements, permissive actions, relaxation of "refill-too-soon" edits in Medicare Part D, and business continuity plans in Medicare Advantage, among other topics.

    Interim Infection Prevention and Control Recommendations for Patients With Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings
    The CDC recommendations include standard precautions, patient placement for those with known or suspected COVID-19, infection control, monitoring and managing personnel who are ill or have been exposed to the virus, and protocol for reporting between and within health care facilities.

    The document updates CMS guidance on personal protective equipment, stating that facemasks, which protect the wearer from splashes and sprays, are an acceptable temporary alternative to respirators, which filter the air, for most medical services until demand for respirators lessens.

    Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel With Potential Exposure in a Healthcare Setting to Patients With Coronavirus Disease (COVID-19)
    The CDC document describes how to assess a provider's level of exposure, risk factors, recommended monitoring, and type of work restrictions.

    Study: Even in After-Hours Settings, Seeing a PT First for MSK Conditions in the Emergency Department Saves Time, Reduces Opioid Prescriptions

    An Australian study found that when patients' primary ED contact was with a PT, treatment times, orthopedic referrals, and analgesic prescriptions decreased — all in an after-hours setting, and with most PTs having no prior ED experience.

    In this review: Emergency department after-hours primary contact physiotherapy services reduce analgesia and orthopedic referrals while improving treatment time.
    (Australian Health Review, February 2020)

    The Message
    The beneficial role PTs can play in emergency departments is fairly well-established in research, but now a study from Australia takes that support even further, with authors finding that even in after-hour settings, patients with musculoskeletal issues whose primary contact was with a PT tended to leave the ED with fewer orthopedic referrals and opioid prescriptions than did those for which the PT was a secondary contact, all in less time than for patients who were seen by another professional first. And those improvements were accomplished with a cohort of PTs who, with one exception, had no prior ED experience.

    The Study
    Researchers analyzed data from an Australian ED that treated patients between 4:30 and 8:30 p.m. from a Saturday through a Tuesday, focusing on patients who presented with a musculoskeletal or orthopedic diagnosis. Those patients, just over 1,000 included in the study, were divided into two treatment groups — one group that saw a PT as primary contact, and a control group of patients whose first contact was with an ED medical officer and only later with a PT. Authors of the study then compared rates of referral for orthpedic consultation, prescriptions for analgesics (defined as "any restricted medication requiring a script from a medical officer, primarily opioid-based medication"), and overall treatment times. A total of 12 physiotherapists provided ED services. Overall professional experience among the PTs ranged from three to 16 years, but only one had prior ED experience.


    Orthopedic referrals. Among patients in the primary PT group, 36.7% were referred for orthopedic consultation in the ED; the rate was 57.1% among the secondary PT group. Just over 48% of patients in the primary PT group were referred to an orthopedic clinic after discharges from the ED, compared with 69.4% among the control.

    Analgesic prescriptions. In all, 16.2% of the primary PT patients received prescriptions for analgesia on discharge. That rate rose to 24.7% among patients in the secondary PT group.

    Treatment times. The percentage of patients discharged from the ED or admitted to the hospital within four hours — a goal in the Australian health care system — was 89.6% for the primary PT group. Fewer patients in the secondary PT group, 64.4%, were treated within that four-hour window.

    Why It Matters
    Authors of the study characterize the findings as not just consistent with previous research but also ones that "build on" earlier studies by demonstrating "similar outcomes … using an ED PCP [primary care physiotherapist] workforce consisting of less-experienced physiotherapists than in previous studies, and in an after-hour setting."

    More From the Study
    Researchers believe the findings reflect well on the diagnostic abilities of PTs in the ED, writing that the study "supports the notion that [PTs] may be more confident than ED medical officers with diagnostic accuracy for musculoskeletal and simple orthopaedic presentations, as well as in establishing an effective treatment regimen that may not require orthopaedic consultation." They add that the reduced analgesia rates suggest that "either patients managed by ED PCPs require less analgesia in general or that ED PCPs seek non-pharmacological forms of analgesia to manage soft tissue injuries."

    Authors also pointed out that the results were achieved by PTs without previous ED experience, a detail that "suggests that even physiotherapists without prior ED experience can provide a safe effective service."

    Keep in Mind …
    The researchers acknowledge a few limitations to their study, primary among them that the control group was composed of patients with secondary contact with a PT, a factor that could necessitate longer overall treatment times or point to more complex presentations. Still, they argue, the study was limited to patients with an ICD-10-AM diagnosis code, which mitigated some of those potential confounders, making them "highly unlikely" to explain the magnitude of differences noted in outcomes. Authors also acknowledge that the particular study setting — a hospital ED with after-hours radiology and orthpedic services on-site — may make generalizing findings more difficult, and they advise that "confirmation of findings of this study across a range of ED settings and times would be beneficial."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.