FALL PREVENTION FAQS

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.

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%.

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

• Vision screen
• Medication screen

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.

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.

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.

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.