For the fourth year in a row, the federal budget plan announced by President Barack Obama proposes that the so-called Stark law be tightened up to eliminate exceptions that allow physicians to self-refer for certain services, including physical therapy. And should Congress need an additional reminder of the importance of this change, it need look no further than APTA, which recently supplied Senate and House committees with comments outlining exactly why the loopholes should be closed.
The $4.1 trillion FY 2017 budget plan is unlikely to be enacted by Congress, where Republican leaders have stated that they would break with tradition and not hold a hearing on the budget with the administration’s budget chief. Still, Obama’s budget has helped to emphasize issues that the administration believes are worth attention—and action.
As the prominence of stem cell clinics has increased, so has attention from the US Food and Drug Administration (FDA)—along with more public debate on whether the techniques are useful interventions or a new form of “quackery.”
In a recent article in STAT, an online health care and science magazine, reporter Usha Lee McFarling looks at the arguments for and against therapies that involve injecting stem cells processed from the patient into an injured area. Proponents say it speeds healing and can help patients avoid surgery, while detractors question its effectiveness and legality.
According to the STAT article, “federal regulators are preparing to crack down on scores of clinics” that perform the therapies, based in part on new FDA guidelines that define the stem cells used in most clinics as drugs that require “a rigorous approval process.”
APTA’s efforts to support improvements in rehabilitation research just received a major boost by way of a US Senate Committee, which has completed the “markup” phase of a bill that would bolster research efforts at the National Institutes of Health (NIH).
Next stop: the Senate floor.
Titled the “Enhancing the Stature and Visibility of Medical Rehabilitation Research at NIH Act,” (S. 800), the bill passed through markup by the Senate Committee on Health, Education, Labor, and Pensions (HELP) with only minor changes. The Disability Rehabilitation and Research Coalition (DRRC) worked with NIH and the office of Sen Mark Kirk (R-IL), the bill’s sponsor, to develop the necessary compromises. APTA is on the steering committee of DRRC, which is composed of over 40 organizations committed to promoting rehabilitation research.
When the Jimmo v Sebelius settlement was announced in 2013, patient advocates applauded what they saw as a landmark change for individuals who need care to maintain their medical conditions or slow their declining health. However, 3 years later, many providers and payment adjudicators are still making coverage decisions as if they’re living in a pre-Jimmo world—mostly because the US Centers for Medicare and Medicaid Services (CMS) hasn’t done enough to bring them up to speed, according to an advocacy group supported by APTA.
Recently, APTA provided a supporting declaration to the Center for Medicare Advocacy’s (CMA) efforts to get CMS to do a better job of making it clear that the “Improvement Standard”—the idea that Medicare coverage can only be extended if that care will actually improve the patient’s condition—is a fallacy, and that skilled maintenance care can qualify for payment.
“There are still many providers and contractors who do not know about, understand, or trust the change in the improvement policy,” CMA wrote in a December 2015 letter to APTA and other stakeholders. “We believe this is largely due to the fact that CMS’ Education Campaign was insufficient to make up for the rigor with which Medicare enforced the Improvement Standard—for decades.” According to CMA, CMS conducted only 1 briefing for providers and adjudicators, in early December of 2013. Since that time, CMS “has refused to do more,” CMA writes.
Six years after gaining FDA approval for the treatment of upper limb spasticity, onabotulinumtoxinA—commonly known as Botox—has now been OK’ed for the same use in lower limbs.
According to Medscape (free sign-in required) the FDA approval was based on a clinical trial of more than 400 individuals who were experiencing lower limb spasticity poststroke. Participants treated with Botox showed statistically significant improvements at weeks 4 and 6 in muscle tone and clinical patient benefit.
The trials were focused on the ankle and toes, and didn’t confirm use in other areas of the lower extremities.
The Zika outbreak has been elevated to a “public health emergency of international concern” by the World Health Organization (WHO) while health officials scramble to understand the disease, including its possible relationship to Guillain-Barré Syndrome (GBS) and other disorders that affect the nervous system.
As of January 30, 26 countries had reported locally transmitted Zika infections across Central America, South America, the Caribbean, and the Pacific Islands. The list of countries treating these infections continues to grow. Travel-related cases have been identified in the continental United States. Puerto Rico, American Samoa, and the US Virgin Islands already are experiencing ongoing transmission of the virus.
The new status from WHO may help affected countries better respond to the virus through stepped up research, surveillance, care, and follow-up.
In a proposal aimed in part at building on an initiative that includes APTA, President Barack Obama has designated $1.1 billion in new funding over 2 years to intensify the fight against the country’s opioid use and heroin abuse epidemic.
According to a White House fact sheet, Obama’s proposal takes a “2-pronged approach” to address the drug problem: $1 billion in new mandatory funding for expanding treatment for individuals with an opioid use disorder, and $500 million to increase prescription drug overdose prevention strategies, including more funding for medication-assisted treatment. Some of the funds will be directed specifically to rural areas of the country, which have seen disproportionately high levels of abuse and overdose.
The proposal, which requires congressional approval, further intensifies the administration’s focus on the opioid abuse epidemic. That focus received national attention in October 2015, when Obama announced the creation of a public- private partnership to combat opioid abuse and heroin use. APTA is participating in the initiative along with 39 other health care provider groups that include the American Medical Association, the American Academy of Family Physicians, and the American Nurses Association.
The challenges of providing care to individuals with chronic health conditions are now the focus of a bipartisan working group in the US Senate, and APTA is helping to shape the group’s policy proposals.
In December 2015, the Senate Finance Committee’s Bipartisan Chronic Care Working Group issued a 30-page “policy options document,” the product of a 6-month investigation of possible ways to improve care delivered to Medicare beneficiaries with chronic health conditions. The information-gathering process included over 80 stakeholder meetings and 530 recommendations, with the final document including 24 policy proposals ranging from the changes to the Medicare Advantage (MA) program to expanded education and research initiatives.
According to the work group, the policy changes listed in the document are aimed at increasing care coordination, streamlining Medicare payment systems “to incentivize the appropriate level of care,” and establishing a chronic care system that “facilitates the delivery of high quality care, improves care transitions, produces stronger patient outcomes, increases program efficiency, and contributes to an overall effort that will reduce the growth in Medicare spending.”
It’s established fact that minorities and other vulnerable populations face a higher risk of hospital readmissions for conditions such as chronic heart failure or procedures such as total knee or hip arthroplasty. But that could change if hospitals and other health care providers started to comprehensively address the matrix of cultural, economic, and comorbidity issues faced by racially and ethnically diverse patients, according to a new publication from the US Centers for Medicare and Medicaid Services (CMS).
“While not all readmissions are entirely preventable, it is widely understood that a portion of unplanned readmissions could be avoided by addressing a series of barriers patients face prior to, during, and after admission and discharge,” write authors of a recently release CMS guideline. The publication, titled “Guide to Preventing Readmissions Among Racially and Ethnically Diverse Medicare Beneficiaries,” lays out key issues related to the higher readmission rates, and accompanies those issues with a set of ambitious strategies for reducing those rates.
A review of recent research on the role of physical therapy in hospice and palliative care supports the idea that physical therapy can go a long way toward improving patients’ physical, social, and emotional well-being. The problem, according to authors, is that the research itself has a long way to go.
In a systematic review published in the American Journal of Hospice & Palliative Medicine, authors reviewed 13 articles—mainly qualitative—that looked at the use of physical therapy among patients diagnosed with a critical or terminal illness. Authors focused on 5 major components addressed in the various studies—age of participants, types of physical therapy interventions used, assessment tools used, efficacy of treatment, and patient-reported satisfaction and quality of life. Authors of the study include Ahmed Radwan, PT, DPT, PhD.