Performance Improvement MONITOR ... - Reflectx Staffing

REhAb ThERAPy NEwS
apta: Cms releases 2011 mediCare pHysiCian
fee sCHedule final rule
The Centers for Medicare and Medicaid Services (CMS) released
the 2011 Medicare Physician Fee Schedule Final Rule, which,
is disappointing to report, contains significant cuts to outpatient
therapy services that will negatively impact physical therapists and
millions of patients. Under a new multiple procedure payment
reduction (MPPR) policy, physical therapists will see a 7%-9%
reduction in payment for these services starting January 1, 2011.
The association is deeply concerned about this policy. APTA has
worked diligently these past few months educating CMS, White
House officials, the Medicare Payment Advisory Commission
(MedPAC) and other policymakers about the detrimental effect
the MPPR policy will have on physical therapists and the patients
we serve. The initial MPPR proposal called for an 11%-13%
cut in payments and, while our actions did have an impact, we
are nonetheless seriously troubled by this final rule. This lesser
reduction of 7%-9% will still mean disturbing repercussions for
outpatient therapy providers and their patients. As such, APTA
is now aggressively exploring all legal, regulatory, and legislative
options to negate the MPPR policy.
APTA believes this policy is unjustified, as it is based on flawed
analysis conducted by CMS in the agency's effort to avoid duplication
of payment when multiple services are furnished during a session
or day. As we know, the practice expense values for the codes
reported by physical therapists had already been reduced to avoid
duplication during the Relative Value Update Committee (RUC)
review process, thus making the MPPR an unfair and unnecessary
policy. In addition, CMS only examined the median number of units
in private practice therapists' offices and physician offices, which
account for approximately 35% of expenditures. Data from skilled
nursing facilities, hospitals, rehabilitation agencies, and comprehensive
outpatient rehabilitation facilities, which account for the remaining
65% of expenditures, were not taken into account. And, CMS
excluded all dates of service during which one unit of service is billed,
further skewing the data on which this policy is based.
Lastly, the final fee schedule rule includes several other provisions
important to physical therapists, including the implementation
of the $1,870 therapy cap without an exceptions process, the
projected cut in the sustainable growth rate/conversion factor of
approximately 30%, and the expiration of the geographical practice
cost index (GPCI) floor. Also in the rule, CMS discusses options
for therapy payment alternatives, quality reporting under the
physician quality reporting initiative (PQRI), and application of a
MPPR policy for therapy services under Medicare Part B.
APTA will work to ensure that CMS establishes payment policies
that guarantee appropriate payment for the high quality services we
provide our patients. The Association is committed to being a leader
in policy change and in developing payment models that accurately
reflect the care and treatment provided by physical therapists.
Source: American Physical Therapy Association, http://www.apta.org/AM/
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ENTID=77196
internet-Based reHaB is a viaBle treatment
option following knee surgery
Knee replacement patients undergoing telerehabilitation - a unique
Internet-based postoperative rehabilitation program that can be
conducted from the patient's home - experience the same results
as patients who undergo traditional postoperative rehabilitation,
according to a new study published in the Journal of Bone and Joint
Surgery ( JBJS). Telerehabilitation is becoming a popular alternative
for patients who live in remote areas and who have no access to
traditional rehabilitation centers.
"The concept for telerehabilitation is a decade old; however, wellconducted
research studies demonstrating its benefits and potential
are rare," said study author Trevor Russell, PhD, School of Health
and Rehabilitation Science, University of Queensland, Brisbane,
Australia. "This study offers measurable evidence that such
technology can be used to provide effective rehabilitation services
for knee replacement patients."
Rehabilitation following knee replacement surgery is essential to
ensure patients regain flexibility, strength and mobility," Dr. Russell
said. "Patients who do not have regular access to rehab services
after surgery are unlikely to achieve maximum results following
knee replacement. Telerehabilitation ensures patients can have
access to rehabilitation programs."
Study Details:
• The researchers enrolled 65 patients who underwent TKA
and randomized them to receive six weeks of either traditional
outpatient rehab services or Internet-based outpatient rehab.
• For the purposes of this study, patients in the telerehab group
performed their therapy in a hospital room designed and
furnished to replicate a typical home environment.
• Patients in the telerehabilitation group received rehab through realtime
(live video and audio) interaction with a physical therapist
via an Internet-based system. Therapy sessions were limited
to 45 minutes and consisted of self-applied techniques under
the guidance of the remote therapist, along with exercises and
education in the postoperative management of the affected knee.
Although specially-designed equipment was used during the study,
Dr. Russell said in the future, telerehabilitation should be available
to patients with a home computer and other readily available
components. "The telerehabilitation system used in this study was
custom-made and consisted of a computer, an echo-cancelling
microphone, a web camera, custom software and an Internet
connection," Dr. Russell said. "The components are packaged in
a robust case for transportation. It is feasible that in the future
patients could use their own home computer with downloaded
software, provided they had a webcam and microphone of suitable
quality and a broadband Internet connection."
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