USPSTF Recommends Exercise to Prevent Falls in Older Adults

Medscape | By Heidi Splete

Exercise interventions are recommended to help prevent falls and fall-related morbidity in community-dwelling adults aged 65 years and older who are at increased risk of falls, according to a new recommendation statement from the U.S. Preventive Services Task Force (USPSTF) (JAMA. 2024 Jun 4. doi: 10.1001/jama.2024.8481).

Falls remain the leading cause of injury-related morbidity and mortality among older adults in the United States, with approximately 27% of community-dwelling individuals aged 65 years and older reporting at least one fall in the past year, wrote lead author Wanda K. Nicholson, MD, of George Washington University, Washington, and colleagues.

The task force concluded with moderate certainty that exercise interventions yielded a moderate benefit in fall reduction among older adults at risk (grade B recommendation)

The decision to offer multifactorial fall prevention interventions to older adults at risk for falls should be individualized based on assessment of potential risks and benefits of these interventions, including circumstances of prior falls, presence of comorbid medical conditions, and the patient's values and preferences (grade C recommendation), the authors wrote.

The exercise intervention could include individual or group activity, although most of the studies in the systematic review involved group exercise, the authors noted.

The recommendation was based on data from a systematic evidence review published in JAMA (2024 Jun 4. doi: 10.1001/jama.2024.4166). The task force reviewed data from 83 randomized trials published between January 1, 2016, and May 8, 2023, deemed fair to good quality that examined six types of fall prevention interventions in a total of 48,839 individuals. Of these, 28 studies involved multifactorial interventions and 27 involved exercise interventions.

Overall, multifactorial interventions and exercise interventions were associated with a significant reduction in falls (incidence rate ratio, 0.84 and 0.85, respectively).

Exercise interventions were significantly associated with reduced individual risk of one or more falls and injurious falls but not with reduced individual risk of injurious falls. However, multifactorial interventions were not significantly associated with reductions in risk of one or more falls, injurious falls, fall-related fractures, individual risk of injurious falls, or individual risk of fall-related fractures.

Although teasing out the specific exercise components that are most effective for fall prevention is challenging, the most commonly studied components associated with reduced risk of falls included gait training, balance training, and functional training, followed by strength and resistance training, the task force noted…

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APTA Advocacy Network Newsletter — June 2024 Edition 

Advocacy Doesn’t Take a Vacation

With the start of summer, the focus often turns to cookouts, baseball, time with family, and vacations. However, advocacy never takes a vacation, especially in an election year. We are in the seventh inning stretch of the 118th session of the U.S. Congress, which will conclude its business this December. The question is just how much business will be done between now and December, given the summer recess and fall election. Will Congress be able to hit any health care policy home runs in these last seven months? 

As noted in the last edition of the APTA Advocacy Network newsletter, Medicare payment reform has been heating up on Capitol Hill. There is talk that there could be a draft proposal possibly released later this summer from a special senate workgroup, comprised of six senators (three Republicans and three Democrats), on a package of first steps toward Medicare payment reform. 

Click here to continue reading. 

CHAP Synopsis of Calendar Year 2025 Home Health Prospective Payment System

The proposed Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin (IVIG) Items and Services Rate Update; and Other Medicare Policies proposed rule (CMS-1803-P) was posted on the Federal Register Public Inspection desk on 6/2/2024. The comment period is 60 days from the publish date in the Federal Register. Instructions for submitting comments are included at the beginning of the rule.  Providers are strongly encouraged to review the rule in its entirety and submit comments to CMS. The process to submit comments is outlined at the beginning of the rule. 

Click to read the highlights of the proposed rule.  

[Updated] CMS Proposed Over 4% Cut to Home Health Medicare Payments in 2025

Home Health News | By Andrew Donlan

The U.S. Centers for Medicare & Medicaid Services (CMS) published its FY 2025 home health proposed payment rule [last]Wednesday. With it, the agency signaled that more significant cuts could be on the way for providers.

To rebalance the Patient-Driven Groupings Model (PDGM) and make it budget neutral, at least according to its internal methodology, CMS is proposing a permanent prospective adjustment to the CY 2025 home health payment rate of -4.067%.

For CY 2023 and CY 2024, CMS previously applied a 3.925% reduction and a 2.890% reduction, respectively.

“This adjustment accounts for differences between assumed behavior changes and actual behavior changes on estimated aggregate expenditures due to the CY 2020 implementation of the PDGM and the change to a 30-day unit of payment,” CMS wrote in a fact sheet on the proposed rule.

The CMS proposed rule includes a CY 2025 home health payment update of 2.5%, which is offset by an estimated 3.6% decrease related to the PDGM rebalancing and an estimated 0.6% decrease that reflects a proposed fixed dollar loss…

Continued cuts

Over the last few years, CMS has generally proposed large cuts, then finalized smaller cuts. But even when the cut is lowered between the proposed and final rule, providers lose out on those finalized cuts.

So, for instance, even a 1.7% cut may not appear very large. But an over 4% permanent cut is extremely significant.

Additionally, CMS also mentioned the clawbacks it intends to collect from the industry for perceived past overpayments. Those now sit at about $4.55 billion.

“The Administration has repeatedly expressed its support for care in the home, recognizing it as a high quality, lower cost alternative to institutional care settings that expands access to Medicare beneficiaries in the location in which they prefer to receive care: Their homes,” Stacey Smith, the vice president of public policy at AccentCare, said in a statement shared with Home Health Care News. “The home health community has repeatedly offered solutions to CMS that would reduce spending, while at the same time maintaining payment levels for those agencies that deliver high quality care and play by the rules. Yet CMS persists in its mathematical gymnastics that will give rise to nothing short of inferior health outcomes, lower patient satisfaction and stranding at-risk, older adults in higher cost, institutional care settings.”…

In addition to the cuts, CMS is also proposing: a recalibration Adjustment (LUPA) system, including an occupational therapy LUPA add-on factor; further delineations for the home health wage index; and more…

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[Details can be found in the CMS fact sheet. The proposed rule is posted to the Federal Register here, with comments due August 26, 2024.]