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  • Proposed Rule Includes Quality Measures for Hip, Knee Replacement Readmissions

    A proposed rule that would update Medicare payment policies and rates for inpatient stays in  general acute care hospitals and long-term care hospitals (LTCH) aims to strengthen the inpatient quality reporting program by including measures for readmissions relating to hip and knee replacement procedures. 

    The proposal, issued Tuesday by the Centers for Medicare and Medicaid Services (CMS), would strengthen the Hospital Value-Based Purchasing Program (VBP Program) to further Medicare’s transformation to a system that rewards efficient, high-quality care. This program, which was required by the Affordable Care Act, will adjust hospital payments beginning in Fiscal Year (FY) 2013 and annually thereafter based on how well they perform or improve their performance on a set of quality measures.

    Specifically, CMS proposes to:

    • Add the Medicare spending per beneficiary measure to the Hospital VBP Program, which would affect payments beginning in FY 2015. 
    • Reduce payments beginning in FY 2013 (for discharges on or after October 1, 2012) to certain hospitals that have excessive readmissions for 3 selected conditions—heart attack, heart failure, and pneumonia. 
    • Build on quality reporting initiatives by recommending measures that will be used for LTCHs for FY 2015 and FY 2016 payment determinations. 

    In the proposal, CMS projects that payment rates to general acute care hospitals will increase by 2.3% in FY 2013. The agency projects that total Medicare spending on inpatient hospital services will increase by about $175 million in FY 2013.

    For LTCHs, CMS proposes a 2.1% update to payment rates and projects that LTCHs payments will increase by approximately $100 million in FY 2013.  

    CMS will accept comments on the proposed rule until June 25 and will respond to all comments in a final rule to be issued by August 1. APTA will submit comments on behalf of its membership.

    A detailed summary of the proposed rule is available on APTA's Medicare Payment and Policies for Hospital Settings webpage.

    New in the Literature: Manual Therapy for Low Back Pain (Man Ther. 2012 March 21. [Epub ahead of print])

    According to the authors of an article published online in Manual Therapy, their study is the first to show an association of within/between-session changes with disability scores at discharge in patients who were treated with manual therapy for low back pain, and the first to define the extent of change necessary for prognosis of an outcome. A within/between-session change should be considered as a complimentary artifact along with other examination findings during clinical decision making, they add.  

    This randomized controlled trial involved 100 participants who demonstrated a positive response to manual therapy during an initial assessment. Within- and between-session findings (within/between session) were defined as a change in pain report from baseline to after the second physical therapy visit. Within/between-session changes were analyzed for associations between pain change scores at discharge, rate of recovery, and a 50% reduction of the Oswestry disability index (ODI) by discharge. The results suggest there is a significant association between a within/between-session change after the second physical therapy visit and discharge outcomes for pain and ODI in this sample of patients who received a manual therapy intervention. A 2-point change or greater on an 11-point scale is associated with functional recovery at discharge and accurately described the outcome in 67% of the cases, say the authors.

    APTA member Chad E. Cook, PT, PhD, MBA, FAAOMPT, is lead author of the article. APTA members Christopher Showalter, PT, OCS, FAAOMPT, Vincent Kabbaz, PT, and Bryan O'Halloran, PT, OCS, SCS, are coauthors. 

    Fewer Workers Offered, Accept Employer-based Coverage

    Since 2002 the percentage of workers with health care coverage has been declining, mostly because fewer workers have access to coverage, says a new issue brief by the Employee Benefit Research Institute.

    Both the offer rate (the percentage of workers offered health benefits) and the coverage rate for employment-based health benefits declined between 1997 and 2010. Between 1997 and 2010, the percentage of workers offered health benefits from their employers decreased from 70.1% to 67.5%, and the percentage of workers covered by those plans decreased from 60.3% to 56.5%.

    In addition, the percentage of workers taking coverage when offered by their employers (take-up rate) declined from 86% in 1997 to 83.6% in 2010. Among the reasons given by respondents who chose not to participate in their employer’s health plan, 67.9% stated that they were covered by other health insurance in 2010, 29.1% reported that their employer’s plan was too costly, and another 2.2% reported either that they did not need insurance or that they did not want insurance.

    According to the brief, offer rates increase with firm size. In 2010, 39.4% of workers in firms with fewer than 25 employees were offered health benefits, compared with 76.5% in firms with 100 or more employees. Take-up rates, while they vary with firm size, do so much less than offer rates. In 2010, 77.8% of workers in firms with fewer than 25 employees took coverage when it was offered, compared with 84.9% of workers in firms with 100 or more employees. Both offer and take-up rates are higher for full-time employees.

    As for demographics, men, non-Hispanic workers, and workers with college degrees are more likely to be offered health care benefits.