Category: Physical Therapy

Navigating Home Modifications Billing for Medicare-Covered Clients

As the population ages, and the majority of older adults express a desire to age in place, the need for home modification evaluations and interventions is expanding. While home modification services are clearly within the scope of occupational therapy, what is not so clear are the options for reimbursement. Many questions arise regarding proper billing.

Medicare-covered clients are entitled, under law, to medically necessary services. Occupational therapy practitioners do NOT have the right, under current statutes, to “opt out” of Medicare. Any occupational therapy practitioner, even those who are not Medicare providers, must directly bill Medicare for any medically necessary skilled therapy services provided to Medicare-covered clients. Whether or not to bill Medicare for home modification OT services must be based on the occupational therapy practitioner’s clinical determination of whether the services are medically necessary.   

This guide first provides a brief overview of the occupational therapy practitioner’s role in home modification and the current Medicare program. Second, case scenarios are provided on some of the factors used in determining whether the services are medically necessary. It should be noted that the scenarios are only examples, and each case requires a unique determination. The occupational therapy practitioner is ultimately responsible for determining Medicare medical necessity for each client.

Full article at AOTA

Virtual PT after knee replacement provides good outcomes with lower costs

A virtual system for in-home physical therapy (PT) provides good outcomes for patients undergoing rehabilitation following total knee arthroplasty (TKA) – with lower costs than traditional in-person PT, reports a study in the January 15, 2020 issue of The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.

“Relative to traditional home or clinic PT, virtual PT with telerehabilitation for skilled clinical oversight significantly lowered three-month health-care costs after TKA while providing similar effectiveness,” according to the clinical trial report by Janet Prvu Bettger, ScD, of Duke University, Durham, N.C., and colleagues.

Ready full article at News-Medical.net

Study finds dopamine, biological clock link to snacking, overeating and obesity

Coinciding with this increase in weight are ever-rising rates of heart disease, diabetes, cancer and health complications caused by obesity, such as hypertension. Even Alzheimer’s disease may be partly attributable to obesity and physical inactivity.

“The diet in the U.S. and other nations has changed dramatically in the last 50 years or so, with highly processed foods readily and cheaply available at any time of the day or night,” Ali Güler, a professor of biology at the University of Virginia, said. “Many of these foods are high in sugars, carbohydrates and calories, which makes for an unhealthy diet when consumed regularly over many years.”

In a study published Thursday in the journal Current Biology, Güler and his colleagues demonstrate that the pleasure center of the brain that produces the chemical dopamine, and the brain’s separate biological clock that regulates daily physiological rhythms, are linked, and that high-calorie foods — which bring pleasure — disrupt normal feeding schedules, resulting in overconsumption. Using mice as study models, the researchers mimicked the 24/7 availability of a high-fat diet, and showed that anytime snacking eventually results in obesity and related health problems.

Read full article at Science Daily

Earlier falls predict subsequent fractures in postmenopausal women

The risk of fracture in postmenopausal women can be predicted by history of falls, according to new findings from the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) at the University of Eastern Finland. Published in Osteoporosis International, the study is the first to follow up on the association between history of falls and subsequent fractures.

Falls in the elderly are common, resulting in fractures and other serious health consequences. In people aged 65 years or over, falls are the leading cause of injury-related death and hospitalisation. Fall-induced injuries cause a substantial economic burden worldwide.

Conducted at the University of Eastern Finland and Kuopio University Hospital, the study comprised 8,744 women whose mean age at the beginning of the study was approximately 62 years. The study started in 1999 with an enquiry asking the study participants about their history of falls in the preceding 12 months. The researchers wanted to know how many times the study participants had fallen, what had caused the falls and how severe the falls had been; i.e., did they lead to injuries that required treatment. A follow-up enquiry was conducted in 2004, asking the study participants about any fractures they had suffered during the five-year follow-up. The self-reported fractures were confirmed from medical records.

Read full article at Eureka Alert

A key-hole procedure to treat foot and ankle disorder decreases pain, improves patient outcomes

A minimally invasive procedure to treat a common foot and ankle disorder can reduce pain, recovery time, and postsurgery complications while improving functional outcomes, according to a report published in the journal Foot and Ankle Surgery.

The procedure treats insertional Achilles tendinopathy, a common and chronic orthopedic disorder in which patients experience pain at the Achilles tendon. The chronic degenerative condition can be particularly painful for athletes who perform push-off activities, such as basketball and soccer players.

The key-hole procedure, known as percutaneous Zadek osteotomy (ZO), can significantly decrease pain and provide a patient with relief in as little as six weeks after this technique compared to 23 weeks for recovery after the traditional open surgery.

Full article at News-Medical.net

5 Reasons Why I Love Working in a Military Health System

I’m a physical therapist (PT) at Walter Reed National Military Medical Center (WRNMMC), and I love my job.

I didn’t start my career in the military health system (MHS). I worked in a civilian outpatient physical therapy clinic like a lot of physical therapists do, and then began working at WRNMMC 2 years ago. I have to say that it has been an eye-opening experience for me. What I want to do in this post is to break down the 5 reasons why I love working in the MHS. They revolve around 2 things: our patients, and the autonomy PTs have in taking care of them.

  1. The patient population: As a PT working at WRNMMC, I see a diverse group of patients. We see active duty service members, beneficiaries of service members, and retirees. The variety of patients, in turn, allows me to see a wide variety of diagnoses from poly traumas to neck and low back pain. This keeps me excited to come to work every day, because I know I’m likely to see something different. Most important, it’s incredibly rewarding to know that I can help return active duty service members to full health and duty.
  2. Working with my military counterparts: WRNMMC is my first clinical experience in the MHS, and the facility is considered the “flagship of military medicine.” I work alongside my active duty PT counterparts and military and civilian physical therapist assistants and physical therapy technicians, many with deployment and overseas experience. The level of care and compassion that the WRNMMC PT staff show daily is what makes this service run as well as it does, and it is one of my favorite things about working at WRNMMC.

Full article at APTA

Using gene therapy to treat CTE

A new study shows the feasibility of using gene therapy to treat the progressive neurodegenerative disorder chronic traumatic encephalopathy (CTE). The study, which demonstrated the effectiveness of direct delivery of gene therapy into the brain of a mouse model of CTE, is published in Human Gene Therapy.

Ronald Crystal and colleagues from Weill Cornell Medical College, New York, NY, coauthored the article entitled “Anti-Phospho-Tau Gene Therapy for Chronic Traumatic Encephalopathy.”

There is currently no treatment for CTE, which is caused by repeated trauma to the central nervous system (CNS), such as that suffered by soldiers, athletes in contact sports, and in accident-related trauma. Inflammation results in the accumulation of hyperphosphorylated forms of Tau protein (pTau). Crystal et al. developed an adeno-associated virus (AAV) vector to deliver an anti-pTau antibody to the (CNS). They showed that direct delivery of the AAVrh.10anti-pTau directly into the hippocampus of brain-injured mice was associated with a significant reduction in pTau levels across the CNS. They propose that doses could be scaled up and this strategy could be effective in humans as well.

Full article at Nuero Science News

Judo holds promise for reducing sedentary behavior among children with autism

Judo may be just the right sport to increase the physical activity level among children with autism spectrum disorder (ASD) and holds promise for reducing sedentary behavior, which is linked to obesity and diabetes, according to a new study from the University of Central Florida.

The pilot study found increases in moderate to vigorous physical activity among participants during and beyond the study period and a reduction of sedentary time, although researchers say the amount was not statistically significant. However, the children in the study were eager to continue judo lessons beyond the scope of the study and the few who did not continue failed to do so because of scheduling or transportation problems, rather than lack of interest. More research is needed to see if the reduction in sedentary time will last.

Full article at News-Medical.net

Separate Studies, Similar Conclusions: Bundling for Knee, Hip Replacement Seems to be Working

Has all the bundling been worth it? Two new studies of bundled care models used by the Centers for Medicare and Medicaid Services (CMS) conclude that, at least for lower extremity joint replacement (LEJR), the answer is yes. Taken as a whole, the studies make the case that while the savings achieved through some bundled care models may not be dramatic, they do exist — and aren’t associated with a drop in quality.

The studies, published in Health Affairs, take different approaches to answering questions about the effectiveness of bundling programs mostly associated with CMS’ voluntary Bundled Payments for Care Improvement (BPCI) initiative: one was a systematic review that analyzed existing research on the programs, while the other focused on data from hospitals that did and did not participate in BCPI over a three-year period. Their conclusions, however, had much in common.

Full article at APTA

New APTA-Supported CPG Looks at Best Ways to Improve Walking Speed, Distance for Individuals After Stroke, Brain Injury, and Incomplete SCI

The message
A new clinical practice guideline (CPG) supported by APTA and developed by the APTA Academy of Neurologic Physical Therapy concludes that when it comes to working with individuals who experienced an acute-onset central nervous system (CNS) injury 6 months ago or more, aerobic walking training and virtual reality (VR) treadmill training are the interventions most strongly tied to improvements in walking distance and speed. Other interventions such as strength training, circuit training, and cycling training also may be considered, authors write, but providers should avoid robotic-assisted walking training, body-weight supported treadmill training, and sitting/standing balance that doesn’t employ augmented visual inputs.

The study
The final recommendations in the CPG are the result of an extensive process that began with a scan of nearly 4,000 research abstracts and subsequent full-text review of 234 articles, further narrowed to 111 randomized controlled trials (RCTs), all focused on interventions related to CNS injuries, with outcome data that included measures of walking distance and speed. CPG panelists evaluated the data and developed recommendations, which were informed by data on patient preferences and submitted for expert and stakeholder review.

Full article at APTA