Why Don't We Stick to Home Physiotherapy Exercises?

MedicalXpress | By Ben-Gurion, University of the Negev

The lack of persistence in home physiotherapy exercises is a well-known problem hindering the effectiveness of treatment. It is especially evident in vestibular rehabilitation (exercises to treat dizziness and balance problems).

Researchers from the Ben-Gurion University of the Negev analyzed the barriers to conducting regular home exercises and have published recommendations to overcome them in The Journal of Neurologic Physical Therapy.

Vestibular rehabilitation addresses abnormalities in the vestibular system, such as dizziness, gait instability, sensitivity to movement, and blurred vision. Treatment is especially effective when consistently practiced at home.

To find a solution to the lack of consistent practice at home, a research group from the Department of Physiotherapy at Ben-Gurion University approached 39 patients doing vestibular rehabilitation and experienced physiotherapists to identify barriers.

They found six barriers: motivation (lack of confidence in the effectiveness of the practice, boredom, and lack of internal drive); increased symptoms during the practice (temporary worsening of dizziness during or after the exercises); difficulties in time management (difficulty integrating practice into daily routine); lack of feedback and guidance (patients' limited understanding of how exercises should be done and their effect); psychosocial factors (what will the environment think?); and related medical deficiencies (such as neck pain and migraines).

The research team formulated recommendations for clinicians, which can significantly improve treatment outcomes and patients' quality of life. Thus, for example, to increase motivation—personal interaction and follow-up by a clinician would allow for greater attention to the exercises, availability, and feedback conversations on the performance of the exercises—including initiated phone calls, text messages to patients in between visits to the clinic, would nurture motivation for the practice. Investing time and money should also increase motivation. In terms of time management—personalizing the exercises to fit into the patient's daily routine.

For example, practice a little bit at a time throughout the day and/or write in a daily diary. Patient guidance—the exercise instructions should include an explanation of the importance of the exercises, the expected symptoms, and the expected recovery time. Documenting improvement by providing quantitative and visual feedback, such as charts and graphs, should encourage continued practice.

"Our study provided a broad perspective for data analysis by both patients and treating physicians," explained Prof. Shelly Levy-Tzedek, who led the research. "Identifying the common barriers to practice allowed us to build strategies that could improve adherence to home practices and, as a result, the effectiveness of treatment. This is a study that can be applied in any clinic and to any patient, and therefore an important guide for therapists."

More information: Liran Kalderon et al, Barriers and Facilitators of Vestibular Rehabilitation: Patients and Physiotherapists' Perspectives, Journal of Neurologic Physical Therapy (2024). DOI: 10.1097/NPT.0000000000000470
 

Reinstatement of LTSS Members Following March 31, 2024 Termination

Dear Members, Family Members, Advocates, Case Management Agencies, County Leaders and other community members:

As previously communicated, the Department of Health Care Policy & Financing (HCPF) is working towards temporarily pausing terminations for Long-Term Services and Support (LTSS) members. However, a number of LTSS members received a termination for various reasons effective March 31, 2024. We have reinstated these members as of April 1, 2024. 

Impacted members who received a termination notice for March 31, 2024 will be receiving or have already received a new notice of action letter indicating an approval effective as of April 1, 2024. Electronic messages to impacted members were sent between Saturday, March 23rd and Friday, March 29th. Mailed notices were sent between Monday, March 25th and Monday, April 1st.

If an LTSS member reaches out to you because they received a termination effective March 31, 2024, please share this information with them, as those not receiving their communications electronically may be delayed in receiving a communication via USPS mail.  

Please know that keeping LTSS members connected to vital services is our number one priority. We are working through both short, mid, and long-term solutions to remedy eligibility issues and other system transformation challenges as quickly as possible. Thank you for your continued partnership and for using our escalations form when needed so we can help members stay connected to services.

To review and access Notice of Action Letters, review this step by step guide in English or Spanish. 

Bonnie Silva, Director

Office of Community Living
 

 

CMS Releases Fiscal Year (FY) 2025 Hospice Wage Index and Payment Rate Update, Quality Reporting Proposed Rule

NHPCO Regulatory Alert

[Last Thursday] at 4:15 p.m. ET, the fiscal year (FY) 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program proposed rule was posted for public inspection at the Federal Register. The Centers for Medicare & Medicaid Services (CMS) has released a fact sheet accompanying the proposed rule. Comments on the proposed rule are due by May 28, 2024.

Key provisions include:

  • Proposed Payment Rate Increase. CMS is proposing a 2.6% increase for FY 2025, which reflects a 3.0% market basket percentage increase, decreased by a 0.4 percentage point productivity adjustment.

  • Proposed Hospice Cap Amount. CMS proposes a hospice cap amount for the FY 2025 cap year of $34,364.85, which is equal to the FY 2024 cap amount ($33,494.01) updated by the proposed FY 2025 hospice payment update percentage of 2.6%.

  • Hospice Outcomes and Patient Evaluation (HOPE) Data Collection Tool. CMS proposes to begin collecting HOPE patient-level data collection data on or after October 1, 2025, which would replace the existing Hospice Item Set (HIS).

  • Quality Measures. CMS proposes two new quality process measures based on HOPE data, including ‘Timely Reassessment of Pain Impact’ and ‘Timely Reassessment of Non-Pain Symptom Impact.’ Implementation of these measures would begin in FY 2028.

  • CAHPS® Hospice Survey. CMS is making several changes to the CAHPS® Hospice Survey, including the addition of a web-mail mode survey option.

  • Hospice Conditions of Participation (CoPs). CMS proposes to align Medicare hospice payment and CoP requirements by clarifying that the medical director, physician designee if the medical director is unavailable, or a physician member of the hospice interdisciplinary group may review patient clinical information and certify a patient’s terminal illness.

  • Change to Statistical Areas. CMS proposes to update the labor market delineations based on the 2020 Decennial Census. This may result in changes to the wage index rate for some hospices. The 5% cap on wage index decreases year over year will be applied to these changes.

  • Request for Information. The proposed rule includes a request for information regarding the potential implementation of a separate payment mechanism to account for high-intensity palliative care services under the hospice benefit, including chemotherapy, radiation, and transfusions.

NHPCO has begun a review of the proposed rule and will release a detailed analysis in the coming days. NHPCO will also be hosting a webinar on rule provisions on April 25, 2-3 p.m. ET. Any questions can be directed to [email protected] with ‘FY 2025 Hospice Wage Index’ in the subject line.
 

NAHC-NHPCO Collaboration Update: CEO Search Initiated

NAHC Report 

As the National Association for Home Care & Hospice (NAHC) and the National Hospice & Palliative Care Organization (NHPCO) continue working to create a new, combined organization to serve, support, and advocate for the national community of serious-illness and care-at-home providers, the Steering Committee that is leading the effort has selected Russell Reynolds Associates to conduct a national search for the inaugural CEO of the new organization. The position specification can be reviewed at on the NAHC website or NHPCO website. To share recommendation and/or express direct interest please reach out to Danielle Lafhaj at Russell Reynolds: [email protected].

Town Hall Meeting: The Steering Committee, comprised of Board Members of both NHPCO and NAHC, continues its commitment to engaging with members and stakeholders throughout the process. The third in a series of Town Hall meetings is now scheduled for 4-5pm ET on Thursday, April 25. This is your opportunity to have your questions answered by the leaders spearheading this process.

Additional info: For background information, a list of Steering Committee Members, and other details about this collaborative effort, see the NAHC or NHPCO website.
 

MedPAC Recommends MA Program ‘Overhaul’ in Report to Congress

McKnight’s Home Care / By Adam Healy
 
In its March report to Congress, the Medicare Payment Advisory Commission recommended policymakers make sweeping changes to address serious, ongoing issues with the Medicare Advantage program. 
 
“A major overhaul of MA policies is urgently needed,” MedPAC’s experts wrote in their report.
 
The commission outlined several issues that have plagued MA beneficiaries and other stakeholders in recent years. These include limited information regarding the quality of MA plans, payment disparities between MA and traditional Medicare beneficiaries, a lack of transparency surrounding private plans’ use of supplemental benefits, and more. And as MA enrollment continues to grow, these problems may only get worse, according to MedPAC.
 
Quality bonus program flaws 
 
One of the most pressing concerns is beneficiaries’ access to MA plans’ quality information, according to the commission. While these plans currently use the MA quality bonus program to help consumers distinguish between plans, this may not be enough to promote informed consumer decision-making. Many of the program’s quality measures do not actually reflect beneficiaries’ real outcomes or experiences, MedPAC said, giving customers an imperfect or incomplete picture of their potential health plan. 
 
“To make informed choices about enrolling in an MA plan, beneficiaries need good information about the quality and access to care provided by MA plans in their local market,” the report said. “Congress should replace the current MA quality bonus program with a new MA value incentive program.”
 
Despite these issues, Medicare spends roughly 22% more per beneficiary for MA enrollees compared to those enrolled in traditional Medicare, according to MedPAC. A significant portion of this money helps fund nonmedical supplemental benefits, which include in-home supportive services, but there is little transparency surrounding utilization rates and health outcomes resulting from these benefits. And, still, providers contracted with MA plans often see only a fraction of the reimbursement that they would have otherwise received from traditional Medicare for their services…

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