• News New Blog Banner

  • Expanded Health Reimbursement Arrangement Rule May Widen Use of the Employer Offering

    A final rule from the US Department of Health and Human Services (HHS) will expand small employers' ability to offer Health Reimbursement Arrangements (HRAs), a change that may make it easier for more Americans to purchase health insurance that they don't receive from their jobs. While it's still too early to tell if the change will significantly impact patients seen by physical therapists (PTs), APTA's advice is to keep an eye open, and be aware of the nuances of HRA payment.

    The new rule, set to go into effect January 1, 2020, will allow qualified small employers to offer what's being called an "Individual Coverage HRA" as an alternative to traditional group coverage plans. The idea behind HRAs is that employers provide a monthly tax-free allowance to employees, who can be reimbursed for health care-related expenses up to the allowance limit. The changes set to go into effect next year would permit HRAs to be used to pay for health insurance purchased on the individual market, and allow employers to offer "excepted benefit" HRAs to supplement employer-sponsored insurance—even if the employee isn't enrolled in the group plan.

    HHS believes that the change will open up coverage options for more than 11 million employees and family members and increase insurance portability, according to an HHS press release. APTA submitted comments to the proposed rule that largely supported the changes, but recommended that any individual health insurance paid via an HRA must be a policy deemed compliant with the Affordable Care Act. The final rule supports APTA's position.

    Those numbers are just estimates, however, and there's no way of knowing just how the use of HRAs will shake out next year, said Kate Gilliard, APTA regulatory affairs senior specialist.

    "PTs need to understand that these HRAs will be out there, and that whether the patient can use the HRA for copays depends on how it's set up with the employer," Gilliard said. "Some HRAs are only good for premium payments, so we're advising our members to verify the details of a patient's HRA. If it's found appropriate for use, the HRA can be processed just like a health savings account or flexible spending account."

    APTA regulatory affairs staff will monitor rollout of the rule and share new information in PT in Motion News and elsewhere.

    Older-Adult Deaths From Falls Have Increased; Intervention May Help Decrease Falls in the Future

    Researchers analyzing health statistics have uncovered some disturbing news: in 2016, adults 75 and older were dying from falls-related injuries at more than double the rate they were in 2000. And while authors of a recent JAMA editorial on the numbers say the reason for the dramatic increase "is not fully understood," a separate study in the same issue of the journal points to a physical therapist (PT)-led falls prevention program as a potentially effective way to counteract the trend.

    Using data from the National Vital Statistics System, authors of "Mortality from falls among US adults aged 75 years or older, 2000-2016" found that, in adults over age 75, the number of deaths from falls increased from 8,613 in the year 2000 to a staggering 25,189 in 2016. The age-adjusted mortality rates in 2016 was 42.1 per 100,000 people for those aged 75–79 and 590.7 for individuals aged 95 or older.

    Mortality rates increased for both men and women. The age-adjusted mortality rate for men rose from 60.7 deaths per 100,000 people in 2000 to 116.4 in 2016. Likewise, among women, rate of death from falls went from 46.3 per 100,000 people to 105.9 in 2016.

    Authors of the editorial say the reason for the increase in deaths resulting from falls "is not fully understood." Still, they write, while older adults clearly have the highest risk for falls, they also have the highest potential for cost-effective interventions that make a difference.

    One such promising intervention for secondary fall prevention in community-dwelling older adults is the Otago home-based exercise program. In a study (abstract only available for free) published in the same issue of JAMA that includes the falls editorial, researchers including APTA member Teresa Liu-Ambrose, PT, PhD, write that the program "may have been effective because it reduced the number of falls among individuals who fell repeatedly."

    Researchers for the recently published JAMA study designed a randomized controlled trial to specifically examine whether the Otago exercise program could do so for adults over age 70 who previously had experienced a fall. Upon seeing a physician after a fall, patients were randomly assigned to receive 12 months of "usual care" or usual care plus the home-based strength and balance retraining program. Usual care included fall risk and medical assessment; treatment by a geriatrician, including lifestyle recommendations; and referral to other providers as necessary.

    In the Otago program, a PT delivers balance, strength, and walking exercises that increase in difficulty over time. Participants in the JAMA study were instructed to repeat the exercises 3 times a week and walk for 30 minutes each week. The PT returned every other week to adjust the exercises, and individuals were evaluated by a physician at 6 and 12 months.

    Authors found that falls were significantly reduced among those who completed the Otago program (236 falls) compared with those who only received usual care (366 falls). While a majority of participants experienced additional falls, the rate was 1.4 per person-year for the Otago group compared with 2.1 for the usual care group.

    However, consistent with previous research, there were no significant differences between groups in fall risk, general balance, and mobility. "It is possible to observe a significant reduction in falls without significant improvements in physical performance," authors conclude. APTA provides extensive resources on falls prevention at its Balance and Falls webpage. Offerings include consumer-focused information, online courses, and links to other sources of information, including the CDC and the National Council on Aging. In addition, APTA's PTNow evidence-based practice resource offers a unilateral vestibular hypofunction clinical summary, a summary on falls risk in community-dwelling elders, an osteoporosis clinical summary, and tests and measures such as a fracture risk assessment, a clinical test of sensory interaction and balance, and a self-paced walk test. The association's scientific journal, PTJ (Physical Therapy) has published a clinical guidance statement from the APTA Academy of Geriatric Physical Therapy on management of falls in community-dwelling older adults.

    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.