Much like an APTA white paper on opioids and pain management published in the summer of 2018, a draft report from the US Department of Health and Human Services (HHS) says that it’s time to address the gaps in the health care system that make it difficult to follow best practices in addressing pain—including improved access to and payment for physical therapy. APTA provided comments to the HHS task force that created the report.
The draft “Report on Pain Management Best Practices” now available for public comment aims to identify “gaps, inconsistencies, updates, and recommendations for acute and chronic pain management best practices” across 5 major interdisciplinary treatment modalities: medication, restorative therapies including physical therapy, interventional procedures, behavioral health approaches, and complementary and integrative health. The entire report is predicated on a set of “key concepts” that emphasize an individualized biopsychosocial model of care that employs a multidisciplinary approach and stresses the need for innovation and research.
You want blunt? The US Department of Health and Human Services can do blunt—at least when it comes to physical activity (PA) recommendations for Americans.
“Adults should move more and sit less throughout the day,” HHS says in its latest edition of nationwide guidelines for PA. “Some physical activity is better than none.”
That’s the bottom-line recommendation that HHS rolled out this week in its revised Physical Activity Guidelines for Americans. And there’s arguably little room for nuance: according to HHS, 80% of all Americans are not meeting current PA recommendations, a failure that is contributing the prevalence of a host of chronic health conditions.
The new guidelines, with their emphasis on the importance of movement to prevent disease and extend life no matter an individual’s age, echo many perspectives long-championed by APTA and its members.
President-elect Donald Trump has announced his hoped-for changes to leadership of the US Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS), with Georgia Rep Tom Price (R-6th) to be nominated for HHS secretary, and Seema Verma, CEO of the Strategic Health Policy Solutions (SVC) consulting group, tapped to serve as CMS director.
Price joined Congress in 2004, where he now serves as chairman of the House Budget Committee, and is a member of the Health Subcommittee of the House Ways and Means Committee. Trained as an orthopedic surgeon, Price worked in private practice for nearly 20 years.
Timing, as they say, is everything. That’s certainly the case for a recently released joint guidance document on compliance created by APTA and 3 other organizations, which arrives during a period of increased federal scrutiny of fraud associated with companies providing physical therapist services. That scrutiny resulted in settlements totaling more than $35 million.
A new resource created by APTA, the American Occupational Therapy Association, the American Speech-Language-Hearing Association, and the National Association for the Support of Long-Term Care helps health care providers understand compliance: what it is, the role of corporate compliance programs, and recommended steps for reporting. The 2-page guide also includes links to Department of Health and Human Services (HHS) Office of the Inspector General (OIG) compliance materials, and OIG national compliance hotline information.
Close to 1 in 3 Medicare beneficiaries in independently-run rehabilitation hospitals experience adverse or temporary harm events during their stay—and nearly half of those events are preventable, according to a new report from the Department of Health and Human Services (HHS) inspector general.
The report, part of a series that also analyzed adverse events in acute care hospitals (ACHs) and skilled nursing facilities (SNFs), involved reviews of a “representative sample” of 417 Medicare beneficiaries who were discharged from independently-run (as opposed to hospital-based) rehab hospitals in March 2012. Nurse screeners identified cases that indicated adverse events, and a panel of physicians evaluated the events to rate severity, as well as to assess the possibility that the event could have been prevented. Here’s what they found:
Overall, the rehab hospitals’ rates were in line with ACHs and SNFs.
Earlier HHS studies found harm rates of 27% for ACHs and 33% for SNFs. The 29% harm rate for the rehabilitation hospitals isn’t much different.
In a combination of changes that codify longstanding guidance and expand definitions, the Department of Health and Human Services (HHS) will very soon implement an anti-discrimination rule that could alter the ways some providers and payers manage care.
Beginning July 18, health care providers and payers that accept federal dollars will be subject to a provision of the Affordable Care Act barring discrimination in care and coverage on the basis of race, color, national origin, age, disability, and sex. As with other similar changes at the federal level, the new rules include gender identity discrimination in the definition of sex discrimination—meaning, among other things, that individuals must be allowed to enter the restrooms, hospital wards, or other gender-restricted areas that are consistent with their gender identity.
More indications that the US health care system soon could be looking at pain in a new way: just days after the release of national guidelines recommending nondrug and nonopioid approaches in the treatment of chronic pain, the US Department of Health and Human Services (HHS) unveiled a “National Pain Strategy” (NPS) that calls for extensive efforts to rethink the way pain is treated, improve access to that treatment, and strengthen research and education across health care disciplines.
Development of the plan began in 2011, after an HHS-commissioned report from the National Institute of Health’s Institute of Medicine called for nationwide improvements in data collection on pain and its treatment, evaluations of the availability and effectiveness of care, public and professional education on pain, and translational and clinical research. The NPS released March 18 attempts to serve as a roadmap for accomplishing those improvements.
The Office of Inspector General (OIG) of the US Department of Health and Human Services (HHS) has turned its attention to skilled nursing facilities (SNFs), where it alleges that Medicare payments have “greatly exceeded SNF costs for therapy for a decade.” Those increases in SNF billing resulted in $1.1 billion in Medicare payments during 2012 and 2013 alone, with about 80% of that increase attributable to the use of “ultrahigh” therapy, the OIG claims.
According to a report released September 30, the payment system for therapy in SNFs provides a “strong financial incentive” for facilities to bill for higher levels of therapies, even when those therapies may not be needed by certain patients. In particular, they write, the differences between the cost of therapy and Medicare payments for that therapy skew heavily toward providing ultrahigh levels of therapy—720 minutes or more a week per patient–for which facilities receive an average of $66 a day over costs, compared with $11 over costs for low therapy, according to CMS estimates.
Some of the OIG findings were reported in advance by the New York Times, which quoted Daniel R. Levinsion, HHS inspector general, as saying that the data collected for the report show that some nursing homes were attempting to “optimize revenues” by taking advantage of the payment system.
Creators of a US Department of Health and Human Services (HHS)-sponsored falls prevention program are claiming that the combination of home visits, calls, education, and evaluations they employed not only reduced falls risk and incidence, but resulted in lower rates of long-term care use—and an actual return on investment.
In an article published in the June issue of Health Affairs, researchers report on a 3-year study of the Living Independently and Falls-free Together (LIFT) program, a falls-prevention intervention aimed at community-dwelling individuals 75 and older. The program was launched in 2008; the study was conducted between 2008 and 2011.
Researchers evaluated the program by tracking falls and long-term care usage among 5,754 individuals who had private long-term care insurance but who were not receiving claims payments at baseline. The individuals—all community-dwelling and at least 75 years old—were then divided into 3 groups: an intervention group that participated in the LIFT program, a control group that did not, and an “administrative control group” that agreed to participate in the LIFT program but had no additional contact with study staff beyond that agreement. This group was created to help researchers evaluate differences without worries about behavior changes due to contact with study staff.
The newest round of extensive Medicare part B payment data released by the US Department of Health and Human Services (HHS) is already making headlines for the “vast trove” of payment data on more than 950,000 providers, including just over 39,000 physical therapists (PTs).
On June 1, CMS released the second set of data, this one from 2013, on providers who received $90 billion in Medicare payments. The report also includes data on the 100 most common Medicare hospital stays.
Again this year, data on PTs included only services and procedures provided by or under the supervision of individuals enrolled in the Medicare Part B program as PTs in private practice. Not included were PTs providing services in hospitals, skilled nursing facilities, or rehabilitation agencies. In cases in which a PT in private practice billed Medicare for the services of physical therapist assistants (PTAs), those costs were attributed to the supervising PT.