Posted February 17, 2012

This is a great article from the NASAL about the significant changes pending on the therapy cap exceptions process.

 

Today, conferees are signing the conference agreement that includes an extension of the therapy cap exceptions process through December 31, 2012.  We expect the House and Senate to vote on the agreement either today or tomorrow.

At this point, we have a summary of the “Health-Related Provisions in the Middle Class Tax Relief and Job Creation Act of 2012″ (Conference Agreement) prepared by health committee staff and its details on the extension are vague.  The summary language is similar to the House-passed version from December in some respects.  When actual bill text is released, we will see more detail as to how the reformed exceptions process will be structured.  Also, the original House language saved money over 10 years due to extending the therapy cap to the hospital outpatient setting.  This summary does not indicate any savings, instead it indicates a cost, so it is possible that there have been some tweaks to that specific provision.

Other provisions of interest to NASL members:

• Physician Payment Rates-freezes payment rates at their current level through December 31, 2012;
• Physician Work Geographic Adjustment – extends the floor on the adjustment to the work portion of payments for physician services that account for the geographic area where a physician practices;
• Bad Debt-phases down SNF’s ability to get bad debt reimbursed;
• Resets Clinical Lab Payment Rates-reduces payment rates for clinical lab services by 2% in 2013.

As soon as we have more information, we will send it to NASL members.  Below is the exact section from the Agreement on the exceptions process.  To view entire summary, [Click Here].

Section 3005 – Outpatient Therapy Caps – This provision extends the therapy caps exceptions process through December 31, 2012, with modifications that will require that the physician reviewing the therapy plan of care be detailed on the claim, reject all claims above the spending cap that do not include the proper billing modifier, and provide for a manual review of all claims for high cost beneficiaries to ensure that only medically necessary services are being provided.  Furthermore, the spending caps ($1,880 in 2012), which have been in effect since 2006, would be extended to the hospital outpatient department setting to prevent a shift in the site of service to higher cost settings once enforcement of the current exceptions process begins.  Exempting these services in the HOPD setting made sense when the hard therapy cap was in place, but it no longer makes sense with the exceptions process.  Additionally, HHS is required to collect data to assist in reforming the payment system for therapy services.  MedPAC is required to recommend improvements to the outpatient therapy benefit to reflect the individual needs of patients.  CBO estimates this provision would increase spending by $700 million from 2012 through 2022.

Posted January 13, 2012

by

Deborah Connery, LCSW

Director of Consultation at The Comprehensive Group

 

edited by

Becky Lerner

 

Activity Professionals are key players in the world of healthcare. It is also a profession that is expected to grow exponentially over the next few years, especially in the senior housing and long-term care industry.

Through program development, Activity Professionals help seniors and persons with disabilities structure their leisure time in ways that meet their cognitive, social, emotional, physical, and spiritual needs. Programs typically include exercise, arts and crafts, cooking, games, dance, music, community outings, and religious activities; although, what is included in a program is limited only by the creativity and vision of the Activity Professional. And because work environments vary, there are plenty of opportunities to get involved. Activity Professionals work in nursing homes, hospitals, senior housing facilities, and residential care environments. Most importantly, the profession, as a whole, is dedicated to fun, exploration, and life’s pure enjoyments.

Activity Professionals come from varying backgrounds. A college degree is not necessarily required, but specialized training in therapeutic interventions for specific areas such as: older adults; adults and children with mental and physical disabilities; and adults with cognitive impairment, such as Alzheimer’s disease, is beneficial for anyone looking to work in an Activity Department. Seminars, community college courses, and workshops are readily available to potential and existing Activity Professionals.

The Comprehensive Group has special affection for the hardworking Activity Professionals we support in nursing homes, assisted living communities, senior retirement communities, and hospitals. Our consultants have worked in these various communities and so know firsthand both the thrills and operational hardships of the mission of helping seniors and disabled people realize their fullness of purpose and leisure.

We are dedicated to providing Activity Professionals with the education and resources they need to design leisure programs that engage and excite participants. We know that BINGO is here to stay, yet life can be so much more. We love to see seniors branching out into culinary programs, fine art programs, innovative exercise and social programs that promote much-needed peer relationships. We don’t see barriers when it comes to activities. We see opportunities for a quality of life residents never dreamed they could have outside their own homes.

Through our 36-hour Activity Director Courses, 6 hour Activity Assistant Workshops, Dementia Workshops for Activity Professionals and CNAs, and specialized on-site consultation services, we encourage Activity Professionals to continue to grow and remain excited about designing programs for the people they serve.

January 22-28, we send a loud “We Love You!” to the Activity Professionals in Chicagoland and beyond. You are providing a quality of life service to your residents, which makes all the difference between growing and growing older. Kudos to you from The Comprehensive Group during Activity Professionals Week and beyond!

Posted December 21, 2011

With healthcare reform taking on an urgent tone as 2011 comes to an end, this article by colleagues Polsinelli Shughart does a great job of explaining what, exactly, is on the line.

House Passes 2-Year Doc Fix and “Medicare Extenders” Package

The House on December 12 passed legislation by a vote of 234-193 that includes a 2-year “fix” to the Medicare sustainable growth rate for physician reimbursement.  The bill would prevent the scheduled 27.4 cut in Medicare physician payments and instead increase the payment rates by 1 percent in 2012 and an additional 1 percent in 2013.  The legislation also would extend the therapy caps exceptions process through December 31, 2013 with some modifications to the current process.  The legislation would require that the physician reviewing the therapy plan of care be detailed on the claim.  Claims above the spending cap that do not include the proper billing modifier would be rejected.  A manual review would be required for all claims for high cost beneficiaries.  The spending cap for 2012 would be $1880 and this cap would be extended to the hospital outpatient department setting.  The Congressional Budget Office estimated the therapy caps provision of the legislation would reduce spending by $1.7 billion over 10 years. The legislation relaxes current restrictions on physician-owned hospitals by allowing those facilities that were under construction but did not have a Medicare provider number as of December 31, 2010 to open and operate under the whole hospital exception to the Stark antitrust laws.  The bill includes a reduction of $6.8 billion for hospital outpatient payments for evaluation and management and a reduction in Medicare “bad debt” payments that the CBO estimated would reduce spending by $10.6 billion over 10 years.  The legislation also would increase Medicare premiums by 15 percent for high-income beneficiaries.  Senate Majority Leader Harry Reid (D-NV) said the bill would not pass the Senate.  Reid said, “The bill passed by House Republicans tonight is a pointless, partisan exercise. The Senate will not pass it and the president has said he will veto it.” The American Hospital Association (AHA) and eight other hospital groups sent a letter to Congress stating their strong opposition to using reductions in Medicare payments to hospitals and Medicaid funding to offset the scheduled physician payment cut.  AHA is urging its members to oppose the cuts.  The letter to Congress is available here.

Posted November 9, 2011

by
Ashley Annen, OTR/L, CLT

edited
by Becky Lerner

 

Lymphedema is one of the most poorly-understood, underestimated, and least-researched diagnoses in the medical world. That is why it is so important to increase awareness by educating all healthcare professionals as well as affected communities: patients, their families and friends, and those especially vulnerable to the condition. I first found out about Lymphedema by glancing through a continuing education course catalog and realized that I had no idea what it was. It refers to a medical condition where swelling occurs, generally, in the arms or legs, although it can technically occur anywhere in the body. This occurs when protein-rich lymph fluid accumulates in the interstitial tissue, connective tissue between our cells, as a result of a blockage in the lymphatic system.

How does this happen? The two main causes of Lymphedema are: genetics (Primary) or the result damaged lymph nodes or lymph vessels from surgery, radiation, cancer, infection, or various other causes (Secondary). Some common symptoms of Lymphedema include: swelling; heaviness, fullness, or a tight feeling in the affected area; restricted movement in the joint; abnormal difficulty fitting into clothes, shoes, or jewelry; recurring infection; hardening or thickening of the skin; and feelings of discomfort in the affected area.

Swelling may range from mild, hardly-noticeable changes in the affected area to extreme swelling that can make functionality
difficult. Unfortunately, there is no cure for Lymphedema as of yet, but there are ways to manage it.

The first step is to be properly diagnosed by a doctor. Plain and simple, a clear diagnosis must be presented in order to qualify for treatment.

The next step is to be evaluated by a Certified Lymphedema Therapist to determine an individually-tailored treatment regimen to reduce swelling and control pain.

Possible treatment techniques range from manual therapy to compression bandaging.

• Manual lymphatic drainage (MLD) is a type of gentle massage that encourages the flow of lymph fluid out of the affected limb.
• Compression Bandaging, or wrapping, helps keep the lymph fluid from returning to the affected limb by keeping pressure on the area.
• Exercises that focus on gentle contraction of the muscles in the area are common for Lymphedema in one of the limbs, the most common form.
• Compression Garments are an at-home treatment that, similar to compression bandaging, prevent the limb from swelling in the future.

To reduce the risk of developing Secondary Lymphedema, there are precautions to take. First, be careful! Avoid injury to the
affected area. If a limb is affected, elevate it as much as possible. Avoid tight clothing, and maintain good skin care to prevent infections.

Lymphedema does not need to be a life-long, debilitating condition. The sooner diagnosis and treatment begin, the better overall quality of life can be achieved. Please help us raise awareness of Lymphedema and all who are affected by it. For more information, visit The National Lymphedema Network, The Mayo Clinic,  or contact us with questions.

 

 

Posted October 13, 2011

by Julie Bringas

 

I decided that I wanted to be a physical therapist when I was a junior in high school. “How,” you ask?

Well, I knew I was a “people-person” as so many of us are, and always felt drawn to the healthcare industry. I didn’t have the aspiration to go to school long enough to be a doctor and I was not interested in becoming a nurse. But as a Spanish assignment, I had to interview two professionals from different professions at my high school Career Fair. I found a physical therapist.

She was young and enthusiastic. And aside from my misconception that being a physical therapist meant giving massages, she enlightened me to the possibilities of physical therapy: the opportunities to work with everyone from
babies to seniors and the wide variety of work settings. I was immediately captured; it was perfect.

I became a physical therapist and worked with the senior population. It gave me great joy, not to just work with the patient, but to be involved with their families including spouses, children and grandchildren. I felt that I was able to inspire patients to do more than they thought they could, and there was nothing more gratifying to me than seeing a patient stroll out of the therapy department having entered unable to walk.

Now, 20 years since graduation, I am still proud of my profession and feel satisfied knowing that I have, and continue to, positively impact so many lives over the years. I hold a position that allows me to educate consumers and clients as to the benefits of physical therapy services and wellness programming. I work for a company that employs outstanding therapists who are extremely dedicated to their patients; and I personally feel like I have greater impact in promoting the profession at large. Certainly, I miss the hands-on contact with seniors on occasion. But when I go to our client sites, I always have a positive attitude and am excited to talk to the patients and get that face-to-face interaction that I so enjoyed.

During this PT Month, I reflect on the reasons I became a physical therapist, and ask you to do the same. I am thankful to work for a company that embraces its employees, providing exceptional opportunities for career growth and continuing education.

Posted September 23, 2011

September 23 marks a new day of awareness in the state of Illinois.  Governor Quinn declared this day as “Older Adult Falls Prevention Day.” Aside from coinciding with the first day of Fall, Older Adult Falls Prevention Day (OAFPD) brings to light a topic that, inevitably, will be relevant to everyone. Whether you’re in the rehabilitation field, or simply caring for a parent, grandparent, or guardian, learning how to prevent a fall could be essential to staying healthy and functional. The Comprehensive Group celebrates OAFPD not just with “Stop Falls” signage and flashing buttons, but it takes a moment to remind its employees to spread the word of how to keep our older adult population safe by using fall prevention strategies.

In addition to company-wide initiatives to raise awareness, the Centers for Disease Control and Prevention posts some great safety tips online ranging from home care to staying active. Making sure medication is updated, installing grab bars, making everyday items easily accessible are all on the list as well as implementing coordination and balance exercises such as Tai Chi and yoga.

For other ideas on falls prevention and awareness activities, visit The Center for Healthy Aging.