Medicare Review Choice Demonstration for Home Health Services (Pre-Claim Review)
On April 1, 2017, the Centers for Medicare and Medicaid Services (CMS) paused its Pre-Claim Review Demonstration for Home Health Services in Illinois while it worked to revise the demonstration to incorporate more flexibility and choice for providers, and to make risk-based changes that would reward providers who comply with Medicare home health policies. On May 31, 2018, CMS issued a notice about the revised demonstration, now called the Review Choice Demonstration for Home Health Services. The proposed program would give providers in 5 demonstration states an initial choice of 3 options: pre-claim review of all claims, postpayment review of all claims, or minimal postpayment review with a 25% payment reduction for all home health services. CMS will implement the demonstration for Home Health and Hospice Medicare Administrative Contractor Jurisdiction M (Palmetto) providers operating in Illinois, Ohio, North Carolina, Florida, and Texas for 5 years, with the option to expand to other states in the Palmetto Jurisdiction.
APTA’s Primary Concerns
The Review Choice Demonstration will inhibit beneficiary choice and access to care, increase costs to the already burdened health care system, and do nothing to support the agency’s goals to shift toward rewarding value-based care. The administrative and financial costs associated with complying with the demonstration’s requirements threaten the financial and clinical viability of home health agencies (HHAs), particularly low-volume and rural agencies. Agencies will be forced to reduce wages or eliminate positions altogether to compensate for the increase in costs required to comply with the demonstration’s requirements. Consequently, patient access to home health services will drastically decline, leading to poor clinical outcomes and diminished quality of life.
CMS continues to subject HHAs to complex and burdensome Medicare pilot programs and demonstrations. Imposing another program, the Review Choice Demonstration, will further increase the administrative and financial burdens on HHAs without addressing the home health system’s vulnerabilities. The demonstration is a duplicative process of oversight that will only add to the burdens that already plague providers. CMS should allocate its time and resources to target specific HHAs whose behavior suggests fraudulent activity, rather than penalizing agencies that have established records of compliance with existing rules and regulations.
Efforts to Date
What Congress Can Do
Please contact your members of Congress to communicate with CMS and share stakeholders’ concerns associated with the Review Choice Demonstration and its potential impact on beneficiary access to quality care. Congress should recommend that CMS postpone the Review Choice Demonstration and move forward only when the agency can ensure that beneficiary access to home health services will not be threatened.
The U.S. Preventive Services Task Force posted a draft research plan on diet and physical activity counseling for cardiovascular disease prevention in adults with cardiovascular risk factors. The draft research plan is available for review and public comment from June 14, 2018 through July 11, 2018. To review the draft research plan and submit comments, go here.
APTA will be submitting comments in advance of the July 11 deadline. AGPT encourages you to review the draft research plan and send your feedback to (email@example.com) so that APTA may incorporate the feedback into their comments. We also encourage you to submit individual comments! (It's very easy to do, as USPSTF is soliciting comments in an online survey format).
Information about this comment opportunity will also be posted to APTA’s regulatory advocacy webpage.
FY 2019 Inpatient Rehabilitation Facility Prospective Payment System Proposed Rule: This rule includes plans simplify quality reporting and remove the Functional Independence Measures (FIM ™) from the IRF Patient Assessment Instrument beginning FY 2020. CMS also included within the proposed rule a request for information (RFI) to improve interoperability among providers. APTA will be submitting comments on the proposed rule as well as the RFI on interoperability.
Deadline for Comments: Tuesday, June 26, 2018
Review the proposed rule
Take Action: Submit comments | APTA's advocacy template letter (.doc)
CMS Pre-Claim Review Demonstration for Home Health Services: The Centers for Medicare and Medicaid Services (CMS) has published a notice detailing its plan to restart its pre-claim demonstration (.pdf) (now termed Review Choice Demonstration) for home health agencies in 5 states (Illinois, Ohio, North Carolina, Florida, and Texas) to counter fraudulent claims in the home health setting. States included in the demonstration will have 3 options for participation: pre-claim review, post-claim review, or no review in exchange for an automatic 25% payment reduction.
Deadline for Comments: Monday, July 30, 2018
Review information about the demonstration
Take Action: Summit comments | Submit comments using APTA's advocacy template letter (.doc)
If a rule from the US Centers for Medicare and Medicaid Services (CMS) is adopted as proposed, physical therapists (PTs) and physical therapist assistants (PTAs) who work in skilled nursing facilities (SNFs) could find those facilities facing some major changes in payment. Those changes could include a new case-mix methodology system and altered therapy reporting requirements, according to CMS.
The rule won't be finalized until later this year. In the meantime, CMS is asking for public comments on its proposal. APTA has made it easy for you to participate.
APTA offers a template letter for PTs and PTAs who want to comment on the proposed 2019 skilled nursing facility prospective payment system (SNF PPS) and the plans for implementation of the Patient-Driven Payment Model (PDPM) to replace the Resource Utilization Groups Version IV (RUG-IV). Among other comments, the letter encourages CMS to take a careful look at how proposed coding requirements associated with the PDPM would "pose significant administrative, financial, and compliance burdens on SNFs."
Posted as a Microsoft Word file, the letter was created with the technical formatting that CMS is accustomed to, but it also includes areas that can be personalized with details and examples from the individual PT's or PTA's practice. Those personal touches can help to underscore the messages that the letter's shared elements deliver to CMS with a unified voice.
APTA's May 16 "Insider Intel" program covered the proposed SNF rule. A recording of the full session is now available.
Among the most important public health findings over the last two decades has been that there are a number of factors, beyond medical care, that influence health and contribute to premature mortality. The Bipartisan Policy Center has worked extensively to highlight the importance of one such factor—safe, affordable housing—recognizing that the integration of health and housing has the potential to improve health outcomes and reduce costs borne by the health care system.
There are many ongoing and productive partnerships between the Departments of Housing and Urban Development (HUD) and Health and Human Services (HHS) at this nexus of health and housing. Generally, these collaborations help the departments to break down their siloed decision-making, more fully capitalize on their respective expertise, maximize limited funding, and more efficiently and impactfully fulfill both their missions. Yet their work is far from finished; pressing challenges make continued and close collaboration between the two departments during the Trump administration more important than ever.
In any administration, given limited resources, limited time, and a host of pressing challenges, only certain priorities can rise to the top. To better understand the priorities of the new leadership teams in HUD and HHS, we conducted dozens of interviews with housing and health experts, stakeholders, and HUD and HHS staff—career and politically appointed. We also relied on the input of a bipartisan advisory group of former HUD and HHS leaders.
In addition to this qualitative outreach effort, the departments’ strategic plans and President Trump’s proposed 2019 budget also provided us with a guide to the administration’s key priorities. For FY2019, the president requests $1,216 billion for HHS and $42 billion for HUD. The requests reflect strategic and analytical input from across the two departments. From these sources, we have identified promising process and programmatic areas for partnership opportunities.
Sen. Susan Collins (R-Maine) and Sen. Bob Casey (D-Pennsylvania) introduced legislation on May 21st that would ensure communities across the U.S. have access to health professionals and other critical supports improving care for older adults. The bipartisan Geriatrics Workforce Improvement Act (S.2888) (read it at https://eldercareworkforce.files.wordpress.com/2018/05/s2888.pdf) echoes similar bipartisan legislation proposed in the U.S. House of Representatives, the Geriatrics Workforce and Caregiver Enhancement Act (HR 3713) (read it at https://www.congress.gov/bill/115th-congress/house-bill/3713).
The Eldercare Workforce Alliance (AGPT is a member), in partnership with the American Geriatrics Society and the National Association for Geriatric Education, have been working relentlessly with Congress and advocates to reauthorize the Title VII geriatrics programs over the past few years. Amy York, Executive Director of the Eldercare Workforce Alliance, stressed the importance of this legislation earlier this month, “Our nation faces a severe and growing shortage of eldercare professionals with the skills and training to meet the unique healthcare needs of older adults. EWA is committed to supporting the Geriatrics Workforce Improvement Act because it expands the only federal geriatrics training program. That’s an investment in an eldercare workforce that can support well-coordinated, high-quality care for all older Americans.”
Going to NEXT? Join us for this special joint Academy event!
Combined AGPT/ANPT Social Networking Event at NEXT
Lafayette’s Restaurant and Bar, Friday, June 29th 2018, 6:30-8:30 PM in the Tap Room with h'orderves and cash bar.
Lafayette’s is located on the 2nd Level of beautiful Pointe Orlando within walking distance of the Convention Center and many major hotels. http://lafayettes.com/orlando/
Jessie Van Swearingen, a University of Pittsburgh associate professor of physical therapy, has focused on older adults’ mobility and falls prevention issues for the past 20 years as part of her research interests.
Aging Edge sought out Dr. Van Swearingen for an Expert Q&A due to a recent Centers for Disease Control and Prevention report indicating that both the number and rate of fatal falls among adults 65 and older have been steadily increasing. The CDC says about one of every four older adults falls in a year. In 2016 those resulted in 29,668 deaths, and the mortality rate attached to such falls has been increasing about 3 percent annually.
Aging Edge: What’s the simplest way of explaining why older people fall with such frequency, when they didn’t do so earlier in adulthood?
Van Swearingen: Many systems in the body contribute to walking and staying on your feet, and there are age-associated decline with all of those. The combination of those declines tends to be a recipe for losing the ability to stay upright.
Aging Edge: Which aspects of decline matter most in this?
Van Swearingen: The change is less in people who stay active and healthy, but in general people lose strength and most of the senses decline some. Your vision gets worse, your hearing gets less clear, the automatic responses that help keep you on your feet slow down.
Aging Edge: Are people aware of the changes, and so should become more cautious?
Van Swearingen: Actually, fear of falling is a huge risk factor for falls. When I’m 55, I’m not worried about falling, but when I’m 70, maybe my son or daughter says, “Hey, hope you don’t fall, Mom.” Now the pressure on you goes up. People start thinking about walking more and staying on their feet.
Assisting with the Academy's booth is a great way to volunteer and meet other therapists in your field. If you are interested in staffing the booth, please visit https://geriatricspt.org/events/next/2018/ to sign-up today. All volunteers are entered into a drawing to win a free year of Academy membership!
The Cognitive and Mental Health SIG would like to share with you a youtube video link that speaks to how we can all clinically assess and address feelings of job burnout. It speaks to physicians, but we can change the script ourselves from MDs to physical therapists, physical therapist assistants, students, residents, and physical therapy doctors.
The video is < 5.5 minutes long and describes a straight-forward 3-step process to clinicially assessing job burnout and real action steps to correct it. It is hoped you think it is worth your time and worth sharing/discussing with your colleagues in team conferences and in local chapter meetings. We always love to hear from you! Please keep sending your comments on content and project development ideas to Lise McCarthy, CMHSIG Chair at firstname.lastname@example.org. Last, if you like and appreciate the content posted on the CMHSIG webpage so far, please do sign up to be a member at https://geriatricspt.org/special-interest-groups/ as this is the only way to really let the Board of Directors and the CMHSIG leadership know we are on the right track in developing content that supports and represents your needs.
The video can be accessed at:
Become a Board Certified Clinical Specialist! The American Board of Physical Therapy Specialties (ABPTS) is now accepting applications for the 2019 Geriatrics initial
certification exam cycle.
Access to the online application and candidate materials are available through the ABPTS website at http://www.abpts.org/Certification/Geriatrics/
The application deadline for Specialist Certification in Geriatrics is July 31, 2018. For more information, contact the Specialist Certification Program at 800/999-2782, ext.
8520; or email@example.com.
On May 8, 2018, the Centers for Medicare & Medicaid Services (CMS) released the agency’s first Rural Health Strategy intended to provide a proactive approach on healthcare issues to ensure that the nearly one in five individuals who live in rural America have access to high quality, affordable healthcare.
“For the first time, CMS is organizing and focusing our efforts to apply a rural lens to the vision and work of the agency,” said CMS Administrator Seema Verma. “The Rural Health Strategy supports CMS’ goal of putting patients first. Through its implementation and our continued stakeholder engagement, this strategy will enhance the positive impacts CMS policies have on beneficiaries who live in rural areas.”
The agency-wide Rural Health Strategy, built on input from rural providers and beneficiaries, focuses on five objectives to achieve the agency’s vision for rural health:
Approximately 60 million people live in rural areas – including millions of Medicare and Medicaid beneficiaries. CMS recognizes the many obstacles that rural Americans face, including living in communities with disproportionally higher poverty rates, having more chronic conditions, being uninsured or underinsured, as well as experiencing a fragmented healthcare delivery system with an overworked and shrinking health workforce, and lacking access to specialty services.
This new strategy focuses on ways in which the agency can better serve individuals in rural areas and avoid unintended consequences of policy and program implementation.
For more information on the Rural Health Strategy, please visit: http://go.cms.gov/ruralhealth. There is also a fact sheet available at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-05-08.html.
The Residency/Fellowship SIG proundly supports geriatric residencies and is excited to announce the recipients of scholarships to assist with offsetting costs associated with geriatric residency work. Congratulations to the following Academy members: Sarah Evans/University of Minnesota; Lashia Hicks/Brooks IHL Geriatric Residency; Mary Hood/St. Catherine's/Villa Maria; Ashley Kinsey/Durham VA Medical Center; Matthew Mucha/Louis Stokes Cleveland VA and Alexandra Piersanti/Creighton University.
AGPT welcomes discussion on all APTA House of Delegates Motions and in particular this year we are asking for your help. Packet 1 previous can be found in the APTA Community Site, under House of Delegates (HOD) and Packet 1 Preview.
Specifically, we would request your help with promoting RC 56-18 AMEND: BYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION TO ALLOW SECTIONS TO VOTE IN THE HOUSE OF DELEGATES. This motion would allow the Section Delegates within the HOD to vote on policy and candidates for national office. Currently, the Section Delegates are not permitted to vote in our association and thus their ability to represent issues of practice and specialty content are limited to discussion, but not the final outcome of voting. We encourage you to read this motion and the support statement to help you better understand the rationale. If you support the section vote- please reach out to your chapter delegates (who are the only ones who can vote!) to share your thoughts. Like any political issue- your representatives need to hear from constituents to influence the outcome! You can find your chapter delegates via
Guidelines and directions for applying can be found at https://foundation4pt.org/funding-opportunities/research-grants/all-research-grant-information/
Maximum Geriatric Research Grant (GRG) amount is $40,000. Funds are available for research done in U.S. institutions only. GRG funds may be used in support of salary, fringe benefits and direct expenses.
The Academy of Geriatric Physical Therapy is pleased to announce Management of Falls and Fall Prevention in Older Adults written by Mariana Wingood, DPT, PT, GCS, CEEAA and edited by Barbara Billek-Sawhney, PT, EdD, DPT, GCS is now available in the APTA Learning Center.
Falls are major concern for older adults! Physical therapists play a key role in fall prevention, as well as treating falls and fall related injuries. With evidence-based practice the functional mobility and quality of life of older adults may be improved, while decreasing the national fall related statistics. This information will provide clinicians with the appropriate multi-factorial assessment and interventions to set their patient up for success!
Each year APTA honors outstanding achievements on the part of its members in the areas of overall accomplishment, education, practice and service, publications, research, and academic excellence. Award recipients are recognized in June with a ceremony and reception at NEXT Conference & Exposition.
Please join us in congratulating the following AGPT Members who have been recognized by APTA's Honors and Awards Program. We are so proud of all of you!
Cathy Ciolek, PT, DPT, GCS, FAPTA/Catherine Worthingham Fellow of the APTA
Gregory Hicks, PT, PhD, FAPTA/Catherine Worthingham Fellow of the APTA
Carmen Cooper-Oguz, PT, DPT, MBA, CWS, WCC/Lucy Blair Service Award
Jill Heitzman, PT, DPT, CWS, GCS, NCS/Lucy Blair Service Award
Jake Jakubiak Kovacek, PT/Lucy Blair Service Award
Greg Hartley, PT, DPT, GCS/Lucy Blair Service Award
Ronald Barredo, PT, DPT, EdD/Lucy Blair Service Award
Martha Eastlack, PT, PhD/Lucy Blair Service Award
Linda Horn, PT, DScPT, MHS, GCS, NCS/Lucy Blair Service Award
James Smith, PT, DPT, MA/Lucy Blair Service Award
Amy Smith, PTA/Outstanding Physical Therapist Assistant Award
Nicole Dawson, PT, PhD, GCS/Margaret L Moore Award for Outstanding New Academic Physical Therapy Faculty Member
Patricia Kluding, PT/Jack Walker Award
David Sinacore, PT, PhD, FAPTA/Jack Walker Award
Robin Marcus, PT, PhD, OCS/Jack Walker Award
Manoah Carrel, SPTA/McMillan Scholarship Award for Student Physical Therapist Assistants
Kyongho Pak, SPTA/Minority Scholarship Award for Student Physical Therapist Assistants
APTA has a new mission, and it's all about bringing people together.
"Building a community that advances the profession of physical therapy to improve the health of society" is now the official mission statement for APTA. Developed by the APTA Board of Directors after the 2017 House of Delegates entrusted the Board to update and maintain the association's mission, the statement is strongly integrated with APTA's vision statement for the profession of physical therapy: "Transforming society by optimizing movement to improve the human experience."
"The vision statement APTA adopted in 2013 positions the association as an outward-facing organization committed to positive change," said APTA President Sharon L. Dunn, PT, PhD. "Our new mission statement articulates the association's role in that change—by being a place of engagement, where multiple perspectives can be brought together in support of advancing physical therapist practice to create pathways toward a healthier society."
According to Dunn, as the APTA Board of Directors explored the creation of a new mission statement, members realized that in many ways the association already is living out its mission.
"Our emphasis on being better together, our recommitment to diversity and inclusiveness, and our energized and connected members pointed the way toward this new mission statement," Dunn said. "We believe it's a forward-looking mission, but it's also a mission firmly rooted in our profession's values and its history of compassion, concern for society, and willingness to make bold moves.
Physical Therapists with the CEEAA designation demonstrate expert clinical decision-making skills in designing and applying an effective examination and exercise prescription and measuring the effectiveness and reflecting the current evidence of exercise for all aging adults. The process to attain the credential of "Certified Exercise Expert for Aging Adults" is to complete formal didactic education, and to participate in supervised and mentored skills development, home-based reflection, and critical thinking.
Three courses of two days each will address evidence-based examination and different and increasingly complex aspects of exercise design and delivery. The three courses are designed to build on each other; however, Courses 1 and 2 can be taken out of sequence but Course 3 must be taken last. After each course there is an online exam to be completed within 3 months of the course. Participants get two tries to achieve a 75% passing score. There is one practical test that is done onsite either course 2 or 3. While all attendees will receive continuing education credit, the tests/practical exam must be completed successfully to achieve the CEEAA designation.
MCPHS University - Worcester Campus
10 Lincoln Square
Worcester, MA 01608
March 17-18, 2018
April 28-29, 2018
July 14-15, 2018
University of Indianapolis
1400 East Hanna Avenue
Indianapolis, IN 46227
June 2-3, 2018
July 28-29, 2018
September 15-16, 2018
West Coast University
590 N Vermont Avenue
Los Angeles, CA 90004
August 18-19, 2018
September 29-30, 2018
The CEEAA series has historically sold out the last several years so register early to assure your spot.
For registration and more information, please visit http://www.geriatricspt.org/events/courses/CEEAA/