With the official startup date looming and the last dry run complete, the Centers for Medicare and Medicaid Services (CMS) says that at least from its end of things, all systems are go.
In its latest summary (pdf) of end-to-end testing of ICD-10 codes in its reporting systems, CMS reported that the July 20-24 tests did not uncover any new issues with the fee-for-service claims processing systems, and that there were no claims rejections made "due to front-end CMS systems issues."
"Overall, participants … were able to successfully submit ICD-10 test claims and have them processed through Medicare billing systems," CMS states in its report. "The acceptance rate for July was similar to rates in January and April, but with an increase in the number of testers and claims submitted."
During the testing period, CMS received 29,286 claims, with an 87% acceptance rate. Of the claims rejected only 1.8% were rejected because of an invalid submission of an ICD-10 diagnosis or procedure code. Just over half the claims received—52.7%--were from professionals. Institutions supplied 40.9% of the claims, with suppliers submitted 6.4%.
The official start date for ICD-10 use remains October 1. APTA offers a recorded webinar, free to members, and an ICD-10 webpage that is being updated with resources to help physical therapists prepare for the changeover.
An alarming rise in opioid abuse is sparking an important related conversation about the effectiveness of physical therapy and other nondrug approaches to treat pain.
Recent coverage has been driven by a US Centers for Disease Control and Prevention (CDC) report that documents a resurgence in heroin use, with rates more than doubling for individuals aged 18-25, and females in particular. The CDC report coincided with an announcement from the White House of a new $13.4 million program to battle heroin trafficking.
The CDC report links the rise in heroin use to increased rates of addiction to opioid painkillers, an addiction that often begins with legitimate prescriptions to treat pain. That link, in turn, has prompted discussion about the importance of nondrug approaches to pain treatment.
Increasingly, coverage of the opioid abuse epidemic includes at least a mention of alternatives to drug therapies for chronic pain. The popular Everyday Health website, for example, recommends that physical therapy and other nondrug approaches be seriously considered as a first-line pain treatment, writing that, at the very least "a team that includes pain specialists, physical therapists, mental health professionals, and primary care providers, tends to be best for patients with chronic non-cancer pain, who often also have mental health concerns such as anxiety or depression." Similarly, a recent edition ofNeurology Now calls for health professionals to "rethink chronic pain" through multidisciplinary approaches that include exercise prescriptions.
The role of physical therapy as a bulwark against painkiller abuse was also noted by the White House Office of National Drug Control Policy, which recently met with APTA President Sharon L. Dunn, PT, PhD, OCS, and Mandy Frohlich, APTA vice president of strategic communications and alliances, who at that time was the association's vice president of government affairs.
APTA has long advocated for the role of the physical therapist (PT) in pain management, using its MoveForwardPT.com website to educate the public on about it, and featuring new approaches to pain treatment being used by PTs in a 2014 feature story in PT in Motion magazine. More recently, the August issue of Physical Therapy (PTJ), APTA’s peer-reviewed journal, includes a discussion of how to interpret the burgeoning effectiveness evidence from recent clinical trials and systematic reviews on pain treatment.
Consumer Reports and The Washington Post are helping to spread the word: physical therapy, not surgery, can be the best first-option treatment when it comes to meniscus tears and spinal stenosis.
The July 24 online edition of the Post includes a feature from Consumer Reports titled "If your doctor says you need surgery, you may want to explore other options." The article lists 4 common surgeries—arthroscopic surgery for a torn meniscus, carotid artery surgery, laminectomy and fusion for stenosis, and hysterectomy—that it describes as "procedures to question if your doctor pushes for them."
The article states that "research shows that [arthroscopic surgery is] often no better than physical therapy at easing symptoms" of a torn meniscus and points to a study, reported in PT in Motion News in early 2014, that found no differences in outcomes for patients who underwent actual vs sham arthroscopic surgery.
Similarly, the report says there's "no evidence" that fusion should be added to a laminectomy procedure to treat spinal stenosis, and that "there's a good chance, in fact, that you don't need any surgery," citing a study authored by Anthony Delitto, PT, PhD, FAPTA, Sara R. Pilva, PT, PhD, FAAOMP, OCS, Julie M. Fritz, PT, PhD, FAPTA, and Deborah A. Josbeno, PT, PhD, NCS. That study, outlined in PT in Motion News in April, found physical therapy's effects similar to surgery for patients with spinal stenosis.
Instead of surgery, the article recommends 6 to 8 weeks of physical therapy.
Welcome to "The Good Stuff," an occasional series that highlights (mostly) recent (mostly) local media coverage of physical therapy and APTA members, with an emphasis on good news and stories of how individual PTs and PTAs are transforming health care and society every day. Enjoy!
Here's why you should see a PT every year. (from St. Louis magazine)
"The smiling faces of occupational therapists and physical therapists are very special when you’re down and out. He was on his back and the OT’s and PT’s come in and say, 'We’re here to help you, we’re here to get you back to life as best as we possibly can.'' - Scott Michael Love, PT, professor at the University of St Augustine for Health Sciences, speaking about a program for wounded veterans. (Jacksonville, Florida, channel 4 news)
"Given these results, I think it’s worth giving physical therapy a try before surgery." (Racine, Wisconsin Journal-Times advice column)
Edison Au, PT, heads to the Pan Am Games to serve as lead medical practitioner for boxing. (myCentralJersey.com)
"My physical therapist saved my life." (Orange Rhino challenge blog)
Cora T. Huitt, PT, DPT, BCB-PMD, was interviewed for a story on how physical therapy can help women postpartum. (Richmond, Virginia Times-Dispatch)
"Too bad Humpty Dumpty didn't have physical therapists." (opinion from the Kansas CityStar)
UM-Flint DPT students travel to the Honduras to help people in need. (UM-Flint press release)
An inside look at PTs and PTAs helping to staff the FUNfitness screening program at Special Olympics. (ESPN.com)
A story on the University of Delaware stroke rehabilitation program features Susanne Morton, PT, PhD, and Darcy Reisman, PT, PhD. (Delaware Online)
"The opening bars of Whitney Houston’s 'How Will I Know' echo through a bustling therapy gym as 13-year-old Courtney Turner practices her physical therapy for the day: lip syncing." (profile of Rankin Jordan Pediatric Bridge Hospital from St Louis National Public Radio)
Rocky Mountain University DPT students headed to Malawi to build a new primary school for about 250 students. (from Provo, Utah, Herald)
Got some good stuff? Let us know. Send a link to firstname.lastname@example.org.
The volume vs value debate, long-familiar to physical therapists (PTs) and physical therapist assistants (PTAs), is now getting wider exposure by way of a recent Wall Street Journal (WSJ), article on the "copious" use of ultrahigh therapy hours billed to Medicare by skilled nursing facilities (SNFs).
In a story published on August 16, WSJ describes results of an analysis it conducted on SNF billing patterns between 2001 and 2013, which found that the use of the ultrahigh category of rehabilitative therapy reimbursement—720 minutes or more a week per patient—has increased from 7% of patient days in 2002 to 54% of patient days in 2013.
While the story acknowledges the benefits of rehabilitative therapy, describing physical therapy, occupational therapy, and speech therapy as often "crucial to recovery," it also cites interviews with "more than two dozen current and former therapists, rehabilitation directors, and others" who told WSJ reporters that "managers often pressure caregivers to reach the 720-minute threshold."
These therapists and directors related instances of therapy "sometimes delivered even when patients are unresponsive, aren't likely to benefit, or have declined such services, at times distressing vulnerable patients," according to reporters.
The article, which includes personal accounts of seemingly questionable care, points to an issue that APTA and its members have emphasized for some time: the obligation of the PT and PTA to bring their clinical judgment to bear in circumstances that open the gap between productivity demands and the actual value of those services for patients and clients.
"Unfortunately, it's not uncommon for PTs and PTAs to find themselves in situations where they feel pressured to meet goals that are less about the patient and more about the volume of services provided," said APTA President Sharon L. Dunn, PT, PhD, OCS. "But we need to understand that every time we allow our education and clinical judgment to take a backseat to this pressure, we're potentially putting patients at risk—and our licenses on the line."
This idea is at the heart of a collaborative effort by APTA, the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASHA) that produced a "Consensus Statement on Clinical Judgment in Health Care Settings (.pdf)," which highlights the important role of the clinician in patient-centered outcomes.
"Respect for the therapist's clinical judgment and expertise is critical to achieving optimum patient/client care," according to the statement. "Overriding or ignoring clinical judgment through administrative mandates, employer pressure to meet quotas, or inappropriate productivity standards may be a violation of payer rules, may be in conflict with state licensure laws, and may even constitute fraud."
The theme is also central to the APTA Center for Integrity in Practice website, which houses information on how PTs, PTAs, and students can continue to uphold the profession's high standards. Resources include information on the recently released Choosing Wisely® list of "5 Things Physical Therapists and Patients Should Question;” a primer on preventing fraud, abuse, and waste; a free course on compliance; and other information on regulation and payment systems, evidence-based practice, ethics, professionalism, and fraud prevention.
More on productivity: check out "Measuring by Value, Not Volume," a recent feature article in PT in Motion magazine that takes a closer look at how some PTs are responding to the challenge.
Nearly 1 in 3 reproductive-aged women may be experiencing chronic or cyclic pelvic pain, with many cases going unreported and untreated, according to a new report from the National Institutes of Health (NIH).
In a study designed to assess the connection between pelvic pain and endometriosis, researchers from NIH and the University of Utah School of Medicine surveyed 473 18- to 44-year-old women scheduled to undergo surgery or imaging. The reasons for the surgery or imaging included infertility, menstrual irregularities, tubal sterilization, masses or lumps in the pelvic region, or pelvic pain.
Prior to surgery, the women answered questions about the location and severity of any pain they had experienced in the past 6 months. The survey included questions about 17 specific types of pain related to sexual intercourse, menstrual period, urination or bowel elimination, or other pain, such as muscle or joint pain or migraine headaches.
Researchers found that more than 30% of the women had experienced chronic or cyclic pelvic pain that lasted 6 months or more—a percentage that included women without any pelvic disorder.
While women with endometriosis experienced the highest incidence of chronic pain (44%), 30% of women without any pelvic condition reported significant chronic or cyclic pain. The results were published online in Human Reproduction (abstract only available for free).
"Our study suggests that many reproductive-age women are experiencing but not reporting some form of pelvic pain," lead author Karen Schliep, PhD, MSPH, said in an NIH news release. "If they aren’t doing so already, gynecologists may want to ask their patients if they’re experiencing pain, as well as the type and precise location of the pain, and offer treatment as appropriate."
APTA has recognized the important role physical therapists (PTs) can play in pelvic health and pain management for women, and has created consumer-focused resources on pelvic pain at MoveForwardPT.com. In addition, the work of PTs to improve pelvic health, as well as the overall impact of the association's Section on Women's Health, were featured in a May 2014 article in PT in Motion magazine.
Want to find out how PTs can apply the latest in pain science to the treatment of persistent pelvic pain? Check out this recorded session from the 2014 NEXT Conference and Exposition.
An estimated 11.2% of American adults have experienced daily pain for the past 3 months, and more than half of the country's adults have experienced some type of pain during the same time period, according to a new report from the National Institutes of Health (NIH).
The estimates were arrived at through an analysis of the 2012 National Health Interview Survey (NHIS), which included questions about the frequency and intensity of pain experienced by respondents. Results are based on a subsection of responses of 8,781 American adults, with the full analysis published in the August issue of The Journal of Pain (abstract only available for free).
Among the estimates developed from the survey:
The analysis also found that adults in the 2 most severe pain categories tended to have worse overall health status, use more health care, and suffer more disability; however, about half of those individuals still rated their overall health as good or better.
APTA, through its MoveForwardPT.com website, has been helping to educate the public on the role of the physical therapist (PT) in pain management. That role was also examined in a 2014 feature story in PT in Motion magazine. Called "Treating Pain Head On," the article looks at how PTs are using brain science to help address pain in patients and clients.
NIH analysis lead author L. Nahin, PhD, MPH, believes that the report highlights the need for more data on the extent of what already appears to be a prevalent problem.
"The experience of pain is subjective," said Nahin in an NIH news release. "It's not surprising then that the data show varied responses to pain even in those with similar levels of pain. Continuing analyses of these data may help identify subpopulations that would benefit from additional pain treatment options."
More on pain and the PT: check out the August issue of PTJ, APTA’s peer-reviewed journal, for a discussion of how to interpret the burgeoning effectiveness evidence from recent clinical trials and systematic reviews on pain treatment. The PTJ website also allows you to search for the most recent articles on pain in the journal.
Prehabilitation for patients with cancer can be effective, but that doesn't necessarily mean insurance companies or even some health care professionals are on board with the concept, according to a recent article inThe Washington Post.
The Post article—essentially a more concise version of the same article published earlier in Kaiser Health News—describes "growing interest in … using prehab in cancer care to prepare for treatment and minimize some of its potential long-term physical impairments, such as heart and balance problems."
The article cites a study on prehabilitation, previously reported in PT in Motion News, that shows promise for prehabilitation in the treatment of patients with colorectal cancer. The Post report characterizes the research as in its "beginning stages."
The state of prehabilitation research is part of the reason for insurance coverage that the article describes as "spotty," a situation that's unsurprising given insurers' inconsistent coverage for more traditional rehabilitation, where "patients can face coverage problems such as preauthorization and limits on visits."
Making matters somewhat more challenging for prehabilitation the Post says, is the way it's regarded by some health care providers.
Catherine Alfano, vice president of survivorship at the American Cancer Society, is quoted in the article as saying that "there are some physiatrists who don't believe in prehab," adding that these individuals "feel like the science isn't there yet."
As part of a change aimed at improving what one state official described as a "really stupid" health care policy, Medicaid recipients in Oregon will be able to access physical therapy and other nonsurgical and nondrug approaches to back pain as the priority treatment beginning in 2016.
The Bend, Oregon, Bulletin reports that the Oregon Health Plan (OHP)—the state's Medicaid program—will apply the change to all types of back conditions, and will restrict surgery to cases of spinal stenosis and "certain types of radiating pain."
According to the Bulletin report, the impetus for the change was based in part on evidence that points to the efficacy of nonsurgical, nondrug approaches, and in part on troubling statistics that showed that of the 8% of OHP recipients who sought treatment for back pain, over half received prescriptions for narcotics.
“We were hearing really loud and clear … our current state of affairs is really stupid,” said Ariel Smits, medical director for the Health Evidence Review Commission, in the Bulletin story. Backers of the new plan hope that a reduction in narcotic use will partly offset what they expect to be increased costs associated with the change.
OHP members will be allowed to see 1 or more providers, in any combination, up to 30 times a year for back pain. Physical therapy, acupuncture, chiropractic, cognitive behavioral therapy, osteopathic manipulation, and occupational therapy are included in the list of priority treatments.
In research that builds on previous breakthroughs in electrical stimulation of the spinal cord, researchers report that 5 additional individuals with complete lower extremity motor paralysis are now able to voluntarily generate movements by way of electrical stimulation—this time, through a noninvasive technique.
The new approach, developed through research partially funded by the National Institutes of Health (NIH), uses the same concept of electrical stimulation to the spine, but does so through electrodes on the surface of the individual's skin, rather than through a surgically implanted device. The earlier study used surgically implanted devices to restore a degree of voluntary movement to 4 people with paralysis.
The 5 men who participated in the most recent study had experienced total lower extremity paralysis for at least 2 years. Each individual participated in a series of 45-minute sessions once a week for 18 weeks. Those sessions also involved physical conditioning and the administration of buspirone during the final 4 weeks.
By the end of the sessions, the men were able to "voluntarily generate step-like patterns" while their legs were suspended in braces that hung from the ceiling, according to a news release from NIH. "Movement in this environment is not comparable to walking," NIH states. "Nevertheless, the results signal significant progress towards the eventual goal of developing a therapy for a wide range of individuals with spinal cord injury."
Researchers believe the new approach may be useful for individuals with paralysis who have already undergone extensive surgeries and may not be ready for or capable of more.
Another significant factor: cost. If the technology can be refined, the noninvasive approach could be one tenth as expensive as the surgically implanted device.
Lead researcher V. Reggie Edgerton, PhD, who participated in the earlier study with implants, believes that both the invasive and noninvasive approaches need to be pursued, according to NIH. Edgerton is hoping to expand research to find out whether the noninvasive stimulation can also help individuals with paralysis regain autonomic functions they may have lost, according to NIH.
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