From PT in Motion: Physical Therapy With Patients Who Are Transgender

The patient or client who is transgender faces a host of issues, both physical and cultural, that can have a very real impact on how a physical therapist (PT) or physical therapist assistant (PTA) provides treatment. This month’s issue of PT in Motion magazine explores some of those issues, and offers a few tips on how PTs and PTAs can uphold a core ethical principle of a profession that charges its members to respect the inherent dignity and rights of all individuals.

In “Managing Patients Who Are Transgender,” author Chris Hayhurst describes the current gaps that can occur in a PT’s or PTA’s understanding of the unique needs of patients who are transgender. The PTs he interviews have advice on how to narrow those gaps through the entire treatment process—from intake, to provision of services, to referral if needed.

The article includes perspectives on how to create a practice that patients who are transgender will see as welcoming, from providing easy-to-do “clues” in the waiting area to seeing to it that intake forms are sensitively worded in ways that allow patients to express (or choose not to express) their gender identity. Hayhurst also interviews PTs who provide perspectives on how the patient who is transgender may require different approaches in the treatment room, and underscore how important it is that the PT be aware of the ways gender reassignment surgeries undertaken by a subgroup of patients can sometimes affect mobility and cause pain. Finally, the article looks at the PT’s responsibility to see to it that, should a referral be required for any reason, the referred provider is also attuned to the needs of the transgender population.

Full story of PT with transgender patients at APTA

First-Ever Tests of Deep Brain Stimulation on Humans Poststroke Ready to Begin

Researchers at the Cleveland Clinic are ready to begin human testing on the use of deep brain stimulation (DBS) for individuals poststroke, in hopes that the technology will help to “jump start” damaged areas of the brain and aid in physical rehabilitation.

According to an article in TIME magazine, the clinic has been federally approved to begin a human trial of a DBS technique that previously has been tested only on rats. The procedure involves sending electrical pulses from a power source implanted in the subject’s chest to electrodes implanted in the brain, a technology that has been successfully used for some time on individuals with Parkinson disease (PD).

But the intent of using DBS poststroke is not the same as its use for PD, according to Andre Machado, who heads up the project.

Full story of deep brain stimulation testing poststroke at APTA

Proposed Home Health Rule Includes Planned $180 Million Reduction, Shift to Cost-per-Unit System for Outlier Payments

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule for the 2017 Medicare home health prospective payment system (HH PPS) that would continue a planned series of cuts that began in 2014, with an estimated overall 1% reduction, or about $180 million, scheduled for next year. The proposal, released on June 27, also includes a move away from cost-per-visit in favor of a cost-per-unit system for outlier payments, a plan to make separate payments for negative pressure wound therapy (NPWT) devices, and refinements to a value-based purchasing model used in 9 states.

APTA regulatory affairs staff is reviewing the proposed rule and will submit comments on the proposal to CMS. PT in Motion News will publish a report summarizing those comments; in the meantime, here are some key features of the changes that may be happening next year.

Full story of proposed HH PPS to reduce costs at APTA

Study: Primary Prevention Key to Decreasing Disparity in Black-White Stroke Mortality Rate

Reducing the stark disparity in stroke mortality between black and white Americans requires a focus on risk prevention in primary care and public health, say authors of a new study. But, they add, those efforts need to “go further upstream” by examining the reasons for the higher prevalence of stroke risk factors among black Americans, including consideration of what authors call “nontraditional risk factors.”

While overall stroke mortality and risk factors such as hypertension have declined over the years for both groups, black Americans at age 45 are more than 3 times as likely as their white peers to die of the disease. Although this difference has existed for decades, it wasn’t clear, based on evidence, where and how to target interventions accordingly.

The big question, according to authors, has to do with whether black Americans are having more strokes than white Americans, or whether strokes are more often fatal for black Americans. The answer could help health care providers, including physical therapists, understand the best way to approach this public health issue.

Full story of disparity in black-white stroke mortality rate at APTA

New Reports Underscore the Severity of the Opioid Epidemic

In what’s becoming a grim and all-too-familiar pattern, new reports and studies continue to point to alarming trends in the use and abuse of opioids across the US. Combined, they create a picture of a country in the throes of an epidemic that reaches all societal levels, with laws that do little to curb the rise in abuse, and a federal drug regulatory agency that has “opened the gate wide” for the overproduction of prescription opioids.

Here’s a rundown of a few of the studies and reports that surfaced recently:

Nearly 1 in 3 Medicare beneficiaries received an opioid prescription in 2015.
A report from the US Department of Health and Human Services (HHS) estimates that 12 million Medicare beneficiaries—about 30%—received a prescription for a commonly abused opioid in 2015, at a cost of over $4 billion in Medicare part D spending. The 4% increase over 2014 rates represents a very modest slowdown from 2013, but the long-range trend shows a 165% increase from 2006. Each Medicare beneficiary who was prescribed a commonly abused opioid received an average of 5 prescriptions a year. The opioids with the highest part D spending were OxyContin, hydrocodone-acetaminophin, oxycodone-acetaminophin, and fentanyl.

Full story of the use and abuse of opioids across the US at APTA

Medicare Fraud Dragnet Identifies a Record $900 Million in Illegal Billing

The federal government has announced the largest-ever Medicare fraud sweep, a takedown that involves 301 individuals connected to alleged fraudulent billing totaling $900 million.

The defendants were announced by the US Justice Department on June 22 on charges including conspiracy to commit health care fraud, violations of antikickback laws, money laundering, and aggravated identity theft. In addition to violations connected to home health care, fraud charges were also associated with psychotherapy, durable medical equipment, drug prescribing, occupational therapy, and physical therapy. Home health-related fraud represents about 50% of the cases, with pharmacy fraud accounting for 25%.

The sweep was led by the Medicare Fraud Strike Force in 36 federal districts, but also included 23 state Medicare fraud control units and cases brought by 26 US Attorney’s offices. In terms of payments based on fraudulent claims, a CNN report shows that Florida led the list with $237 million, followed by Texas at $193 million, California with an alleged $162 million, and Michigan at $114 million. Other states associated with larger payment amounts were Illinois ($12 million) and New York ($86 million). The remaining $96 million was spread out over other states.

Full story of Medicare fraud billing at APTA

Second Innovation 2.0 Learning Lab Coming July 12: Clinical Care Pathways, From Acute to Postacute Care

APTA members will have another opportunity to hear firsthand from physical therapy innovators pursuing new, creative models of care when the association hosts the second of 4 online “Learning Lab” events July 12, 1:00 pm-4:00 pm ET.

The July 12 event will focus on clinical care pathways and transitions of care from acute care hospitals to skilled nursing facilities (SNFs) and other postacute care settings. The project was developed as part of the APTA Innovation 2.0 program.

Conducted through the University of Utah in Salt Lake City and led by Robin Marcus, PT, PhD, the project examines a partnership between a contract provider of physical therapist services to local SNFs and the University of Utah physical therapy program .The project has developed evidence-based care pathways for patients with hip fracture, total hip arthroplasty, and total knee arthroplasty. In this model, physical therapists are working collaboratively within the health care system to improve value-driven outcomes.

Full story of clinical pathways learning lab at APTA

Interdisciplinary Rehab Improves Function, Quality of Life for Individuals With Chronic Pain

Amid a national conversation about how to safely treat chronic pain comes a new study that reinforces the idea that interdisciplinary rehabilitation can improve function and quality of life for individuals with chronic pain, even in instances when significant pain reduction itself is not possible.

In an article published in Pain Research and Treatment, researchers from the Mayo Clinic Department of Pain Medicine in Jacksonville, Florida, tracked functional outcomes among 132 patients enrolled in a 3-week interdisciplinary rehabilitation program for individuals with chronic pain. Authors relied on the 6-minute walk test (6mWT) as a primary outcome, accompanied by results from the Canadian Occupational Performance Measure (COPM), a semi-structured interview process designed to capture limitations in and attitudes about activities of daily living.

The clinic’s pain rehabilitation center program involves physical therapists (PTs), occupational therapists (OTs), and pain psychologists who oversee a 5-day-a-week program that lasts 3 weeks. To qualify for the program, patients must have expressed an interest in improving daily function, and a willingness to taper and cease all pain medications and behaviors.

Full story of interdisciplinary rehabilitation for individuals with chronic pain at APTA

Humana Expands TKA, THA Bundling Program in OH, TN

The transition toward value-based payment systems marches on with the recent announcement from insurer Humana that it will expand its bundling programs for total knee arthroplasty (TKA) and total hip arthroplasty (THA) in 2 states.

Partly funded by a Centers for Medicare and Medicaid (CMS) State Innovation Grant, the expanded Medicare Advantage program now includes 7 orthopedic groups in Ohio and 4 in Tennessee. The bundling model “closely mimics both states’ existing [CCMS] State Innovation Models,” according to an article inHealthLeaders Media.

“The care model is designed to improve quality, outcomes, and cost across a person’s entire joint replacement episode of care, and it financially rewards orthopaedic surgeons for better outcomes,” states Humana in a press release. “For the patient, this is expected to deliver a more coordinated care experience and reductions in readmission and complication rates.”

Full story of Humana expanding TKA and THA programs at APTA

New Rules for ACOs Aim to Encourage Participation

Accountable care organizations (ACOs) participating the Medicare Shared Savings Program (MSSP) will begin operating under some new rules designed to incentivize participation in the program while continuing the Centers for Medicare and Medicaid’s (CMS) evolution toward value-based payment.

Under the new rule, ACOs that sign up for a second or subsequent contract period will be subject to a benchmarking process based on regional rather than national spending data—a move aimed at acknowledging the fact that health care costs aren’t the same across the country. Also, so-called Track 1 ACOs (which share in savings but are not responsible for losses) that are approved for renewal will be allowed more time to transition to a risk-based Track 2 or 3 model by way of a 1-year deferment.

The rule also sets up a 4-year window for appeals and reopenings of reviews of savings or losses—the first time CMS has offered specifics on the process.

Full story on Accountable care organizations new rules at APTA