In The News

CMS: Private Practices Must Continue Direct Supervision of PTAs Providing RTM

APTA

The final 2023 Medicare Physician Fee Schedule contained some good news around supervision in the use of remote therapeutic monitoring by PTAs by allowing less-burdensome general supervision of PTAs in rehab agencies, comprehensive outpatient rehab facilities, and other institutional providers of physical therapy. However, due to some inconsistencies in the rule, private practices were left hanging: Do they continue to provide direct supervision in these instances, or can they too move to general supervision?

APTA asked CMS that question, and the agency responded directly to the association. The answer: Private practice settings should continue direct supervision of PTAs providing RTM, citing a section of the rule requiring direct supervision of PTAs in private practice settings across activities. That clarification is consistent with APTA's initial advice that providers in this setting take a conservative approach until the regulatory fog lifted.

The provision cited by CMS is the target of ongoing APTA advocacy efforts. APTA supports a move to general supervision in outpatient practice under Medicare for all activities, and advocated for federal legislation to do just that. Ultimately, that legislation wasn't acted upon in the previous Congress, but the association is pressing for the issue to be taken up in the recently seated 118th Congress.

Need to learn more about RTM coding issues? Check out the APTA Practice Advisory on the use of remote therapeutic monitoring codes under Medicare.

 

Medicare to Look More Closely at Antipsychotic Use in Nursing Homes

MedPage Today / By Joyce Frieden

WASHINGTON -- The Centers for Medicare & Medicaid Services (CMS) announced actions on Wednesday that would put greater scrutiny on antipsychotic prescribing in nursing homes as well as let consumers know about citations the homes are disputing.

"President Biden issued a call to action to improve the quality of America's nursing homes, and HHS is taking action so that seniors, people with disabilities, and others living in nursing homes receive the highest quality care," HHS Secretary Xavier Becerra said in a press releaseopens in a new tab or window. "No nursing home resident should be improperly diagnosed with schizophrenia or given an inappropriate antipsychotic. The steps we are taking today will help prevent these errors and give families peace of mind."

 

CMS said that beginning this month, it will "conduct targeted, off-site audits to determine whether nursing homes are accurately assessing and coding individuals with a schizophrenia diagnosis. Nursing home residents erroneously diagnosed with schizophrenia are at risk of poor care and prescribed inappropriate antipsychotic medications," which are "especially dangerous" to nursing home residents because the side effects can be devastating, and can even lead to death.

Chris Laxton, executive director of AMDA -- The Society for Post-Acute and Long-Term Care Medicine, an association of nursing home medical directors, told MedPage Today that while his group has "always supported accountability around the appropriate use of antipsychotic medications," capturing overall antipsychotic use is a crude measure of appropriate care.

"We know that no two facilities are alike in terms of their patient population," Laxton said. "Some may have a greater need for appropriate antipsychotic prescribing."

He added that there "are patients with dementia and psychosis for whom antipsychotics are helpful and not categorized as inappropriate." He also warned that facilities may become hesitant to take patients with legitimate diagnoses and need for antipsychotics because it will make their overall rate go up and cause increased scrutiny.

"There's certainly a question about inappropriate diagnoses of schizophrenia and antipsychotic prescribing," Laxton said. "On the other hand, we need measures that don't create a situation where nursing homes refuse to accept patients or where diagnoses are driven by a desire not to be penalized."

David Gifford, MD, MPH, chief medical officer of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), said in a statement that antipsychotic use in nursing homes has fallen by 40% over the last decade, and noted: "In many cases, physicians not directly affiliated with the long-term care facility are diagnosing patients and prescribing these medications."

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2023 Fee Schedule Calculator Now Available to APTA Members

APTA

Changes to the 2023 Medicare Physician Fee Schedule made by U.S. Centers for Medicare & Medicaid Services will directly affect the calculations used to determine payment. To help you navigate the new landscape, APTA has updated one of its most popular resources — the outpatient therapy fee schedule calculator.

This tool helps participating and nonparticipating PTs determine 2023 Medicare payment and compare rates with the previous year. Presented as spreadsheet, the calculator incorporates the new conversion factor values, the 50% multiple procedure payment reduction, sequestration-related adjustments, and Merit-based Incentive Payment System factors.

Getting Up to Speed on the 2023 Fee Schedule

The revised calculator is just one indication that, for better or worse, the dust is settling around the 2023 physician fee schedule, which was finalized in November and partially adjusted by Congress in late December.

Need to catch up? Here are a few APTA resources that can help.

Final 2023 Fee Schedule: What You Need to Know
Part 1: Payment — cuts, therapy thresholds, updated calculations, and more
Part 2: Remote monitoring, supervision, telehealth skin substitutes, chronic pain management
Part 3: MIPS, quality measures, MIPS Value Pathways, and more

Adjustments to the Fee Schedule Made by Congress
Our Dec. 20, 2022, article summarizes the ways the fee schedule and other issues were affected by the omnibus spending package approved by Congress and signed into law on Dec. 29.

APTA Statement on the Need to Reform the Fee Schedule
APTA President Roger Herr, PT, MPA, describes how continued payment reductions in the fee schedule — and Congress' insufficient response in 2022 — point to the need for an overhaul of the entire system.

 

Colorado (Again) Changes Rules on How Employers Must Compensate Employees Using Paid Leave

Littler Publications | Dec 20, 2022

Effective January 1, 2023, regulations under Colorado’s Healthy Families and Workplaces Act (HFWA) will again change how employers calculate the rate of pay when employees use paid sick and safe leave and/or public health emergency leave. Although employers might welcome certain changes to the pay rate calculation rules, the fact is that these new regulations amount to the third time that Colorado’s Department of Labor & Employment (CDLE) has revised the pay rate calculation rules since the HFWA first took effect in mid-2020. Thus, pay rate calculations under the HFWA are a moving target, making compliance a challenge. Learn More

 

Debt Ceiling Fight Looms Over Medicare, Medicaid

Axios | Peter Sullivan
 
House Republicans don't have much of a path to get major health care changes passed with a Democratic Senate and president, with one possible exception: the debt ceiling fight. 
 
Why it matters: It's not clear which spending cuts House Republicans will push for in exchange for expanding the government's borrowing authority later this year — but at least some say health care programs like Medicare and Medicaid should be on the table. 

  • Others, mindful of how the mere talk of entitlement cuts has brought political repercussions, are saying they want to steer clear of the programs. 

What they're saying: "We're going to have to look at the whole board," conservative Rep. Barry Loudermilk (R-Ga.) told Axios, including mandatory spending like Medicare and Medicaid. "The easiest to start with is discretionary, but the main driver of the national debt is the mandatory."

  • "Everything's on the table," he added. 
  • Asked about entitlement reform, Speaker Kevin McCarthy told reporters Thursday that "as Republicans we will always protect Medicare and Social Security," but did not get into specifics. (He also did not mention Medicaid).
  • "We will protect that for the next generation going forward, but we are going to scrutinize every single dollar spent," he added. 

What to watch: Rep. Morgan Griffith (R-Va.), a Freedom Caucus member who is also on the Energy and Commerce Committee, said any changes to Medicare would not take place immediately.

  • "Anytime we talk about those cuts people always panic," he told Axios. "Nobody needs to panic. If we're going to do something, it will be out in the future years a long way out and people will understand it and will have time to adjust for it."
  • He cited the possibility of raising the Medicare eligibility age from 65 to 67 as one possible change, while keeping it lower for people who had careers doing manual labor and have trouble continuing to work later in life. 

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