Article By:  PT in Motion, www.apta.org

Patients with low back pain (LBP) who see a single physical therapist (PT) throughout their episode of care may be less likely to receive surgery and may have lower downstream health care costs, researchers suggest in a study published in the December issue of PTJ (Physical Therapy). “Limiting the number of physical therapy providers during an episode of care might permit cost savings,” authors write. “Health care systems could find this opportunity appealing, as physical therapy provider continuity is a modifiable clinical practice pattern.”

Authors examined data from nearly 2,000 patients in Utah’s statewide All Payer Claims Database (APCD) to look for associations between continuity of care for LBP patients and utilization of related services such as advanced imaging, emergency department visits, epidural steroid injections, and lumbar spine surgery in the year after the first primary care visit for LBP. APTA members John Magel, PT, PhD; Anne Thackeray, PT; and Julie Fritz, PT, PhD, FAPTA, were among the authors of the study.

Patients were between the ages of 18 to 64 who saw a PT within 30 days of a primary care visit for LBP. Researchers excluded patients with certain nonmusculoskeletal conditions; neurological conditions, such as spinal cord injury, that could affect patient management; and “red flag” conditions such as bone deficit or cauda equina syndrome.

Researchers found that greater provider continuity significantly decreased the likelihood of receiving subsequent lumbar spine surgery, noting that “disparate management strategies across a variety of providers might inhibit or prolong the recovery in a patient with a worsening condition and contribute to the patient eventually receiving lumbar surgical intervention.” They also note that a strong therapeutic alliance is associated with improved outcomes.

Contrary to authors’ expectations, high provider continuity was not associated with decreased use of advanced imaging, steroid injections, or emergency department visits. “The timing of physical therapy for LBP might have a greater impact on these outcomes than does provider continuity,” they suggest. Researchers did find a link between use of these services and the presence of comorbidities, previous lumbar surgery, and use of prescription opioids or oral steroids.

The average cost of care in the year following the initial primary care visit was $1,826 per patient. Costs were slightly less, at $1,737, for the 90% of patients with high provider continuity but rose to $2,577 for patients with a lower level of provider continuity.

While the study’s findings do not identify any cause-and-effect relationships, “it seems reasonable that physical therapists should consider approaches to managing patients with LBP that limit provider discontinuity,” authors write.

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HTS Receives INALA Industry Award

HTS is excited and honored to receive the Industry Award from the Indiana Assisted Living Association (INALA).  HTS was nominated by Justus Senior Living which own and operate 6 independent and assisted living communities in the Indianapolis and surrounding area. HTS has partnered with Justus to provide exceptional outpatient therapy.

“HTS continues to be a true partner in our communities. They take a proactive approach and when a resident has a unique diagnosis, they go the extra mile to communicate and educate staff. They are helpful and offer creative solutions, but at the same time are totally appropriate. Our residents trust the therapists and appreciate their courteous approach. The HTS Staff Work well with community teams. At the corporate level we are able to communicate openly and honestly, sharing many of the same values. They truly represent what partnership means.”

Thank you for sharing this thoughtful testimonial. We are extremely happy to work with each of our communities to ensure the residents receive the best care possible. We are honored to receive this award from the INALA Industry Awards. Click here to see all of the 2018 INALA award winners.

About INALA

Indiana Assisted Living Association’s (INALA) mission is to promote the interests of the assisted living industry in Indiana and to enhance the quality of life for the population it serves. The Indiana Assisted Living Association believes assisted living brings a housing option to seniors which offers quality housing and caring assistance in the least prescriptive manner, provided by individuals with the highest professional standards. The Association encourages a residential environment that enhances social interaction and promotes the quality of life. Click here to learn more about INALA.

In this picture: Amanda Green, Executive Director of Marketing/Strategic Development, LaChelle Henkle-Weaver, INALA Board President, Aretoula Nahas, Director of Outpatient Therapy.


 

Speak with your doctor to find out how therapy could benefit you!

By: Christa Roberts, PT, MPT, RAC-CT and Eleisha Wilkes RN, RAC-CT

The details of proposed rule LSA #18-251 were published on October 4, 2018 by the Indiana Family and Social Services Administration, and introduces plans to revamp the Medicaid program integrity requirements. LSA #18-251 is extensive and impacts the bulk of business facets for Indiana Medicaid providers, including claims filing time limits, medical record retention, provider enrollment, sanctions, audits, and provider appeals.

LSA #18-251 consolidates existing rules, clarifies requirements and adds new program integrity requirements affecting Medicaid providers. Some of the more significant changes are as follows:

  • Currently, providers have up to one year from the date of service to submit an original claim; however, under the proposed rule, providers would have to submit claims for payment within 180 days of the date of service or the claim would be denied (effective January 1, 2019).
  • Providers will be subject to a medical record retention for financial records period of 3 years following submission to Indiana Medicaid (there is currently no record retention policy).
  • The proposed rule consolidates and adds new provider enrollment requirements.
  • Medicaid payment suspension procedures authorized by Federal law are outlined.
  • A new section is added regarding provider exclusions and readmissions (specifically, the rule lists various offenses that could result in an exclusion and sets a duration of up to 3 years for such exclusion).
  • A new section describes prepayment review processes and procedures (previously only available in agency manuals).
  • The proposed rule revises existing Medicaid overpayment provisions to align with changes in Indiana law (adds a 3-year look back period for audits initiated after July 2, 2019, though may be extended to 7 years under certain circumstances).
  • Administrative appeals procedures are consolidated and changed to align with Indiana law.

LSA #18-251 is open for public comment until the public hearing, which is preliminarily scheduled for October 26, 2018. A copy of the proposed rule can be reviewed at: www.in.gov/legislative/iac/20181003-IR-405180251PRA.xml.pdf

 


 

Speak with your doctor to find out how therapy could benefit you!

Indiana hospitals are racking up millions of dollars in penalties for having too many patients return for care within a month of discharge.

Sixty-six Hoosier hospitals—including 17 in central Indiana—will see their Medicare payments docked next year by a total of about $12 million as a result of having patients readmitted within 30 days. That’s up from $9 million in penalties three years ago.

The federal government says readmissions are often unnecessary and cost taxpayers tens of billions of dollars a year for treatments that should have been caught the first time around, or were not followed up adequately.

So for the seventh consecutive year, it is using the pressure of lower reimbursements to get hospitals to improve their numbers.

Hospitals, for their part, say they are working with patients every way they can think of to keep readmissions at a minimum.

Many are sending patients home with a thick, detailed packet of discharge instructions and a month’s worth of medications. Hospitals send nurses and aides to discharged patients’ homes to see how they are doing. In some cases, patients are given vouchers for cabs or van shuttles to get to their primary care physicians for follow-up visits.

Still, the penalties keep climbing.

“It’s getting more difficult,” said Brian Tabor, president of the Indiana Hospital Association. “Hospitals have picked a lot of the low-hanging fruit in terms of strategies. And so the work gets harder and harder.”

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Hospitals are going to be looking to post-acute providers now more than ever to step-up their game. This spring, HTS launched THRIVE a turn-key system to promote successful care transitions following a post-acute stay. Our proprietary clinical programs are just another way that we move our clients forward as leaders of rehabilitation in the markets they serve. Contact us today to learn how partnering with HTS can help improve outcomes and reduce readmissions.

 


October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 


Speak with your doctor to find out how therapy could benefit you!

HTS is excited to collaborate with our partners for a successful transition to the new Medicare payment model. Our ongoing focus on clinical quality, patient-centered programs, and functional outcomes has prepared our staff in advance to succeed under PDPM. In addition to implementing proprietary clinical program efficacy analysis, HTS has assessed the financial impact of PDPM and is committed to supporting our partners through the challenges of adapting to the new reimbursement model.

HTS will be providing PDPM solutions that include:

  • Staff Education and Training in Critical Areas such as Section GG and ICD.10 Coding
  • PDPM Live Trainings for Partners and Staff in Multiple Locations
  • Internal System Transitions
  • RUGs IV to PDPM Facility-specific Impact Analysis

Our alliance with Proactive Medical Review, the PDPM experts currently providing education on this topic to 25 states, allows us to uniquely provide our partners with additional support for strategic planning, MDS coding efficacy, and nursing best practices.

Patient-Driven Payment Model (PDPM) training dates:

  • Friday, September 21 – Evansville, IN
  • Thursday, October 4 – Fort Wayne, IN
  • Thursday, October 11 – Louisville, KY
  • Tuesday, October 16 – Greenwood, IN
  • Tuesday, October 23 – Kokomo, IN
  • Friday, November 9 – Edmonton, KY
  • Thursday November 15—Phelps, KY

We remain optimistic considering the enormous changes we are facing with this new payment model. As partners in therapy, you can be confident in our resources and unmatched expertise to navigate this change while working together toward a successful transition.

If you have any questions at all about this information, please contact us directly.

National Physical Therapy Month is a celebration held each October by the American Physical Therapy Association (APTA). PT month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapists are movement experts who can help you overcome pain, gain and maintain movement, and preserve your independence, often without the need for surgery or long-term use of prescription drugs. Physical therapy is a cost-effective treatment that allows patients to participate in a recovery plan designed for their specific needs.

Goals of physical therapy include:

  • Restore physical function
  • Improve the ability to ambulate
  • Strengthen the body affected by injury/illness
  • Reduce pain and inflammation
  • Education and prevention

We offer comprehensive rehabilitation services including physical, occupational and speech therapy. Our therapists are experts in treating conditions affecting adults ages 50+. Therapy is a cost-effective treatment that allows patients to participate in a recovery plan designed for their specific needs to regain function and independence for a better quality of life.

For more information, contact www.htstherapy.com.

 


October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 


Speak with your doctor to find out how therapy could benefit you!

 

Resource: APTA, www.apta.org

The Q4FY15 release of the Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through September 2015 is now available for download through the PEPPER Resources Portal. To obtain your SNF’s PEPPER, the Chief Executive Officer, President, Administrator or Compliance Officer of your organization should:

  1. Review the Secure PEPPER Access Guide.
  2. Review the instructions and obtain the information required to authenticate access. Note: A new validation code will be required. A patient control number or medical record number from a claim for a traditional Medicare FFS beneficiary with a “from” or “through” date in September 1-30, 2015 will be required.
  3. Visit the PEPPER Resources Portal.
  4. Complete all the fields.
  5. Download your PEPPER.

The SNF PEPPER will be available to download for approximately two years.

Revised in this release: The “Therapy RUGs” target area has been discontinued.

 


About SNF PEPPER

PEPPER is an educational tool that summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data to support internal auditing and monitoring activities. PEPPER is distributed by TMF® Health Quality Institute under contract with the Centers for Medicare & Medicaid Services.

The U.S. Food and Drug Administration (FDA) released Consumer Guidance regarding portable bed rails safety and tips for caretakers on December 19, 2013. The recommendations were released because of the continuing injuries and deaths related to entrapment and falls associated with bed rail products. Overall, there is no standard definition for bed rails but they are typically divided into three distinct types: adult portable bed rails, child portable bed rails, and hospital bed rails. Adult portable bed rails are different from hospital beds, which feature a unified system of mattress, frame, and rails. Read more

The PEPPER report compares your skilled nursing facilities to peers nationally on key measures identified by the OIG as potentially high risk areas for improper Medicare payments. PEPPER data will be shared with both the Medicare Administrator Contractor (MAC) and the Recovery Audit Contractor (RAC.) Read more

Section 603(c) of the American Taxpayer Relief Act of 2012 (ATRA) changed the payment liability for denials resulting from the outpatient therapy caps from beneficiaries to providers effective January 1, 2013. Medicare systems were not updated in time to accurately represent this change on provider remittance advices (RAs). Medicare contractors may have already processed therapy cap denials for services provided in 2013. These denials incorrectly report on RAs beneficiary liability (Group Code “PR”) when liability legally rests with the provider (Group Code “CO”). Read more