A new study that links urologists' self-referral to increased use of tests to detect prostate cancer without better outcomes is being hailed by the Alliance for Integrity in Medicare (AIM) because it provides independent, peer-reviewed evidence that self-referral is a serious problem that drives up costs with no benefit to patients. AIM is a broad coalition that includes APTA and other medical specialty, laboratory, radiation oncology, and medical imaging groups.
The study, published this month in Health Affairs, found that urologists involved in self-referral arrangements bill Medicare for 72% more specimen evaluations for patients with suspected prostate cancer than urologists who send specimens to independent providers of pathology services. Despite the increased billing, the study found that self-referring urologists usually detect cancer at a much lower rate than do urologists who do not self-refer. The per-patient cancer detection rate for self-referring urologists in 2007, according to the study, was 12 percentage points lower than that for non-self-referring urologists.
AIM is urging Congress to revise the physician self-referral law's in-office ancillary services exception that allows urologists to self-refer patients to pathology labs they own directly or in which they have an ownership interest. "Other medical services, including advanced diagnostic imaging, physical therapy, and radiation oncology, are also prone to significant abuse through this exception," says AIM.
AIM's press release has been featured in The Wall St Journal and Politico.
The Prospective Surveillance Model, an innovative new model of breast cancer rehabilitation, is featured in a special supplement to the American Cancer Society's journal Cancer, released April 6. APTA members Nicole L. Stout, PT, MPT, CLT-LANA, and Jill Binkley, PT, MClSc, CLT, were among a panel of internationally known experts who developed the model over the past year.
The goal of the Prospective Surveillance Model for cancer rehabilitation is to identify impairment at the earliest onset, to alleviate impairment, or prevent it from progressing. Soon after diagnosis, a physical therapist will perform a preoperative examination to establish a baseline level of function. Follow-up examinations are then conducted postoperatively at 1 month and then 3-month intervals, for up to 1 year.
The panel of experts and national organizations involved in developing the model will continue to raise awareness about the model, with the goal of increasing the number of women who receive rehabilitation and exercise in order to maximize quality of life for the 1 in 8 women who will be diagnosed with breast cancer in their lifetime.
Read more about the model in APTA's press release or view the supplement online. The study, Breast Cancer-related Lymphedema: Comparing Direct Costs of a Prospective Surveillance Model and a Traditional Model of Care, led by Stout, was published in the January issue of PTJ. Hear Stout describe the model in this APTA video.
With numerous multiple procedural payment reduction (MPPR) policies in effect, it is important for physical therapists to understand the methodology each payer uses in determining payment. Aetna's methodology for the application of its MPPR policy varies slightly from the policy adopted by the Centers for Medicare and Medicaid Services (CMS). CMS has only 1 payment rate and payment structure in a given geographic area, while Aetna may have several different types of payment structures in the same area. Therefore, Aetna is unable to efficiently apply the exact CMS calculations to arrive at a final payment amount.
Aetna bases its reduction for the second and subsequent therapy services on the contribution of the practice expense relative value unit (RVU) to the total RVUs for a given procedure. Aetna, unlike CMS, does not use geographic practice cost indexes (GPCIs) in calculating its reduction. An example of Aetna's methodology can be found here.
A special edition in the Heard on the Hill podcast series provides an overview of the pending legal issues before the Supreme Court on the Affordable Care Act. Learn about the anti-injunction act and how it could cause the court to dismiss the case for the time being, the 3 constitutional provisions that the plaintiffs used in their argument against the constitutionality of the individual mandate, and how the concept of "severability" will come into play if the individual mandate is ruled unconstitutional. The podcast also covers the less known provision of the health care law related to Medicaid expansion.
A transcript accompanies the prerecorded podcast.
Hall of Fame quarterback and NFL analyst for FOX Terry Bradshaw will deliver the Keynote Address to thousands of physical therapy professionals who will gather for PT 2012, APTA's Annual Conference & Exposition in Tampa, Florida, on Wednesday, June 6.
In his dual roles as cohost and analyst on Fox NFL Sunday, Bradshaw has been a primary force in making the 4-time Emmy Award-winning show America's most-watched NFL pregame program.
The first pick in the 1970 NFL draft out of Louisiana Tech, Bradshaw was the Pittsburgh Steelers' dominating quarterback from 1970-1983, leading the team to 4 Super Bowl titles and 8 AFC Central championships. He was a 2-time Super Bowl MVP and 3-time Pro Bowl selection, and was inducted into the Pro Football Hall of Fame in 1989, his first eligible year.
Bradshaw also hosts "Today in America with Terry Bradshaw," an educational TV show that profiles organizations making a difference in how people live, play, and work. He has recently dedicated his time and efforts to shedding light on the subtle and chronic long-term problems associated with concussions.
Investigators have until April 20 to submit a Letter of Intent (LOI) for the Foundation's special issue Request for Applications titled The Influence of Physical Therapy Referral Characteristics and Practices on Quality, Cost Effectiveness, and Utilization Patterns.
Potential applicants should visit the Foundation's website to view guidelines and instructions and apply for this opportunity. E-mail Scientific Program Administrator Karen Chesbrough for more information.
Investigators with extensive experience and publication in health services research are invited to apply for this opportunity.
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