PHYSICIAN FALL PREVENTION FAQS

Are falls by older adults a serious problem?

Yes, millions of adults over 65 fall each year.

  • More than 25% of adults over 65 fall each year, but less than half tell their doctor
  • Falling once doubles a patient’s chances of falling again
  • One out of five falls causes a serious injury
  • Falls are the most common cause of traumatic brain injuries
  • More than 95% of hip fractures are caused by falling
  • 25% of older adults who fracture a hip from a fall will die within 6 months
  • Medical costs for falls total more than $50 billion per year with Medicare and Medicaid paying about 75% of these costs.

Does research support PT/OT for fall prevention?

Yes, research clearly shows that PT/OT and related exercise can substantially reduce the chances of falling. JAMA recently published a systematic review of 283 randomized clinical trials of fall prevention interventions for participants aged 65 and over showing that PT/OT reduced the chances of falling by over 50%.

What PT/OT is provided to help prevent falls?

  • Balance, strength and gait training
  • Fall experts also recommend that physicians order an OT home falls risk assessment

What other interventions have been proven to help prevent falls?

  • Vision screen
  • Medication screen

How many of our patients can benefit from fall prevention PT/OT?

Virtually any patient who has had a decline in his or her balance or leg strength due to age, injury or disease can benefit from fall prevention PT/OT. Physical therapists or their assistants can do a 10-minute falls screen to identify these patients.
It is safe to assume that at least 50% of Medicare patients can benefit from falls prevention PT/OT.

Is PT/OT for fall prevention covered by Medicare?

Yes. Medicare will cover PT/OT to help prevent falls if a patient has fallen in the past 12 months, or has experienced a decrease in balance or leg strength that affects his or her ability to confidently walk or stand, or uses a cane or walker and would like to walk without either. Basically, Medicare pays for skilled therapy necessary improve a patient’s condition or to prevent or slow further deterioration of a patient’s condition.

Will Medicare Advantage plans cover fall prevention PT/OT?

Yes, Medicare Advantage plans cover PT/OT covered by Medicare. Also, many MA plans provide additional benefits for fall prevention, such as grab bar installation.

As a physician group, can we provide PT/OT to our Medicare patients to help prevent falls?

Yes, the in office ancillary services exception in the Stark rules essentially allows physician groups to provide PT/OT at the same location in which group physicians practice or in other space leased or owned by the group. However, the Stark rules do not allow physician groups to provide PT/OT in patient’s homes, including having an occupational therapist (or anyone else) do a falls risk assessment and facilitate modifications to help reduce falls. However, we can help arrange home falls risk assessments with independent local occupational therapists.