APTA has earned another national award—this time for collaborative efforts to push for an end to the Medicare outpatient therapy cap.
The American Society of Association Executives (ASAE) announced that APTA, the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASHA) were the joint winners of a 2018 Power of A Gold Award for their combined “Stop the Cap” efforts. The work of the 3 associations was instrumental in a congressional decision to permanently end the flawed cap process.
ASAE’s Power of A (the A stands for “association”) Awards, are the industry’s highest honor, recognizing the association community’s valuable contributions on local, national, and global levels. The award will be presented to APTA, AOTA, and ASHA at an ASAE awards dinner on October 3. As a Gold Award winner, the Stop the Cap program is 1 of 6 campaigns under consideration for ASAE’s Summit Award, which will be announced later this summer.
When I graduated with a DPT in 2013, I never considered that I might someday end up going back to school, in any capacity.
I spent the first four years of my career in the outpatient orthopedic setting full time, and also worked a per diem weekend gig in the hospital in order to pay off my hefty student loan bill as quickly as possible (which I can proudly say I have now accomplished!).
By the end of that I was definitely starting to feel a bit of burnout. However, during that time, I had taken the APTA Credentialed Clinical Instructor course, and had the opportunity to take on the role of Clinical Instructor, in which I found a great deal of joy. This prompted me to consider a more significant role in physical therapy education which, though I knew it was something I enjoyed, at first seemed outside the realm of my abilities and qualifications.
For some patients, physical therapy can both decrease overall health care utilization and save money down the road—especially if delivered sooner rather than later. These were the takeaways from 2 articles in a May 2018 special issue on nonpharmacological management of pain published by PTJ (Physical Therapy), APTA’s scientific journal. PTJ Editor-in-Chief Alan Jette, PT, PhD, FAPTA, interviewed authors of each of the studies via podcast.
One study, coauthored by Xinliang “Albert” Liu, PhD, examined the effect of timing of physical therapy on downstream health care use and costs for patients with acute low back pain (LBP) in New York state. The patients were categorized by whether and how soon they received physical therapy after seeing a physician for LBP: at 3 days, 4–14 days, 15–28 days, 29–90 days, and no physical therapy. Patients who received physical therapy within 3 days (30%) incurred the lowest costs and utilization rates, while those who didn’t see a PT at all saw the greatest of both.
With nearly a third of the total Medicare population enrolled in a Medicare Advantage (MA) plan and growth expected to continue, it’s time for the public-private hybrid system to evolve and move away from excessive use of prior authorization—that’s the message being delivered to the Centers for Medicare and Medicaid Services (CMS) from a coalition of health care and consumer organizations including APTA.
In an April 10 letter to CMS Administrator Seema Verma, the Coalition to Preserve Rehabilitation (CPR) writes that MA’s uses of prior authorization “may be sources of increasing barriers to accessing needed care, particularly inpatient and outpatient rehabilitation services and devices, for beneficiaries nationwide.” The coalition argues that in many cases, prior authorization “often serves as an unnecessary delay for beneficiaries seeking medically necessary care, and often results in no cost savings to the plan.”
APTA’s #ChoosePT opioid awareness campaign makes the case that opioids simply “mask” pain—but a new study in JAMA has concluded that the drugs probably don’t even do that much, at least not any more effectively than nonopioid medications. The research, which focused on individuals with chronic back pain or hip or knee osteoarthritis (OA) pain, led authors to an unequivocal conclusion: there’s no support for opioid therapy for moderate-to-severe cases of those types of pain.
The published findings are based on a study of 240 randomized patients in the Minneapolis, Minnesota, Veterans Affairs (VA) health care system who reported chronic back pain or knee or hip OA pain, defined as daily moderate-to-severe pain for 6 months or more with no relief provided by analgesic use. Participants were divided into 2 groups: 1 that received an opioid regimen, and a second group that received nonopioid drugs.
To more closely resemble real-world treatment, researchers used a “treat-to-target” approach that stepped up the drugs as needed for participants to reach identified goals. The opioid regimen began with immediate-release morphine, hydrocodone/acetaminophen, and oxycodone, but the regimen could advance to sustained-action morphine and oxycodone, and on to transdermal fentanyl. The nonopioid approach began with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDS), but it could move on to topical analgesics and finally to drugs requiring prior authorization (such as pregabalin and duloxetine), including tramadol. All participants also were permitted to pursue nondrug treatment during the study, but researchers did not evaluate data related to those treatments.
Physical therapists (PTs) and patients may face plenty of challenges when it comes to dealing with private insurers, but for those who participate in the Humana system, preauthorization for physical therapy is no longer one of them. In a move strongly supported by APTA, the insurer lifted the prior authorization requirement for outpatient physical therapy, occupational therapy, and speech-language pathology.
Humana made the announcement earlier this month, stating that the change was effective December 18, and applies to both commercial and Medicare Advantage policies. Other elements of the Humana benefit package remain unchanged, including visit limits, referral requirements for some plans, and medical necessity requirements. Prior to the change, PTs, occupational therapists, and speech-language pathologists were required to obtain preapproval from a utilization management/review vendor.
Efforts by the US Centers for Medicare and Medicaid Services (CMS) to make Medicare Advantage (MA) plans more accessible to more vulnerable beneficiaries are laudable, and provisions that would steer patients away from overuse of drugs are understandable, but CMS needs to be mindful of the unintended consequences of these and other changes, says APTA in its comments on proposed MA rules changes for 2019.
At the center of APTA’s comments are proposed changes to so-called “uniformity requirements,” out-of-pocket limits, and frequently abused drugs. Essentially CMS would like to make it easier for more vulnerable individuals to participate in MA plans by reducing cost-sharing requirements, and harder for providers and patients to overutilize certain drugs, including opioids. Both efforts are worth pursuing, APTA says in its comments to CMS.
As a 19-year player in the National Basketball Association (NBA), Grant Hill was no stranger to injury, both major and minor. Experiencing “aches and pains, bumps and bruises is kind of par for the course,” he says.
Now available from APTA’s Move Forward Radio: a conversation with Hill, who describes his experience with injury, managing pain, and what he would do differently today. “We all have pain in some fashion. The most important thing is to educate yourself…about pain—how do you handle postsurgery? What are your rights as a patient?” With regard to opioids, he explains, “You have options.”
The 7-time all-star retired in 2013 after numerous ankle injuries and surgeries—and painful recoveries—over the course of his career. Hill is a strong proponent of nonopioid alternatives to pain management and is a spokesperson for Plan Against Pain, a national campaign that educates the public on the availability of nondrug approaches to pain treatment postsurgery. As a player, he was prescribed opioids after surgery and for very painful injuries but says, “I didn’t like the way I felt.” Hill tried to find alternative ways to treat his pain, including physical therapy. “Physical therapy has been an integral part of my career and my longevity” as a player, he says.
Getting individuals with knee osteoarthritis (OA) to walk regularly is a crucial component in reducing knee pain, improving physical function, and staving off comorbidities such as cardiovascular disease. But how can a clinician know if a patient is capable of meeting minimum walking recommendations? Authors of a recent study believe it may come down to performance on 3 simple tests.
In a study of 1,925 participants with or at risk for knee OA, researchers sought to link performance on the 5 times sit-to-stand test, the 20-meter walk test, and the 400-meter walk test to walking patterns outside the clinic. Participants ranged in age from 56 to 74 years, with an average age of 65. The study was e-published ahead of print in Arthritis Care and Research.
After receiving significant opposition from APTA, the APTA Home Health Section, and other professional and consumer advocacy organizations, the US Centers for Medicare and Medicaid Services (CMS) has backed off on a proposed rule that would have dramatically altered the home health care payment landscape in ways that would have reduced care.
Issued on November 1, the home health prospective payment system final rule for 2018 does not finalize the proposed Home Health Groupings Model (HHGM), a payment system that, among other changes, would have removed therapy service-use thresholds from the payment mix. The proposed HHGM prompted immediate outcry from a wide range of stakeholders, with APTA characterizing the rule as one that would create “perverse financial incentives” for reductions in care in home health.