Senate Passes Bill With Cap Exceptions, Fee Schedule, and GPCI Provisions  

Legislation passed by the Senate on Wednesday contains three important provisions for physical therapy patients and providers. The Tax Extenders Act of 2009 (HR 4213) extends the therapy cap exception process until December 31; freezes payments at the 2009 level under the Medicare physician fee schedule, preventing the 21.2% reduction until September 30; and re-instates the Geographical Practice Cost Indices (GPCI) floor at 1.0 for the remainder of 2010, which increases payments to certain rural providers.  

The bill now has to be passed by the House of Representatives and signed by the president before becoming law.

Last week the Temporary Extension Act of 2010 (HR 4691) was signed into law suspending the 21.2% reduction in payments to providers under the Medicare physician fee schedule and reinstating the therapy cap exceptions process until March 31.

PTs Take the Stage at Obama's Health Care Speech at Arcadia University 

Before President Obama spoke on health care reform at Arcadia University on Monday, Gregory Turner, PT, DPT, delivered the invocation and Jan Tecklin, PT, MS, led the Pledge of Allegiance. Turner is a member of Arcadia's 2010 physical therapy graduating class. Tecklin is a professor in the university's Department of Physical Therapy. Click here for pictures of Arcadia staff and students.  

In his speech, Obama presented three major points of his plan -- to reform the insurance industry, to provide the coverage for uninsured Americans, and to bring down the costs of health care. He said that the money saved will be put into training "doctors and nurses… physician assistants and therapists.” He also said that "there are great programs here at Arcadia."   

The president has asked Congress to pass a health care bill in the next couple weeks. He told the audience at Arcadia that "Congress owes the American people a final up or down vote on health care."

Follow this link to pictures of the event.

Executive Order Expands Use of Payment Recapture Audits

President Obama signed an executive order this week aimed at cracking down on waste and fraud in Medicare, Medicaid, and other government programs through the expanded use of payment recapture. The new initiative authorizes the use of private auditors to detect and recover fraudulent claims; these private auditors will be paid a percentage of their recovery. This program builds on the Centers for Medicare and Medicaid Services' Recovery Auditor Contractor (RAC) program. The president specifically cited the RAC pilot successes in California and New York in his remarks on health insurance reform in St Charles, Missouri.    

Keeping up to date on compliance issues can be challenging. Medicare statutes, rules, and requirements are constantly changing and policies vary greatly depending upon the setting in which PTs practice. Hear from Medicare experts about the latest developments and forecasted changes in the program. Plan to attend "Emerging Issues in Medicare: What Every PT Needs to Know to Comply With the Laws and Regulations" at PT 2010, June 18, 8 am-11 am, and "What Clinicians Should Know: Medicare Claims and Appeals" June 19, 8 am-11 am. Click here for more information on PT 2010, to be held at the Hynes Convention Center in Boston.    

APTA Urges for Awareness of Nation's Uninsured  

APTA is urging residents across the country to contact their local elected officials and members of the media to draw attention to the problem of the nation's uninsured during "Cover the Uninsured Week" March 14-20.

APTA is a supporting organization of the observance, designed to raise awareness of the plight of 46 million uninsured Americans, including 9 million children, and the effect it is having on the country's health care system. The observance comes at a critical time as final health reform legislation is currently being considered by Congress.

For online resources and more information on how you can join this effort, visit www.covertheuninsured.org.

Putting Together an Electronic Press Kit

An electronic press kit (EPK) with information on a CD or flash drive is a great way to provide physical therapy information to the media. APTA recommends that your kit includes brand messaging and the material found in the links on the association's recently launched EPK Web page. Your EPK should contain information about the physical therapy profession, appropriate news releases, downloadable brochures and tips, and specific information relative to your chapter and/or section or practice.

Practice Tips

NIH Reports Now on 'Bookshelf' 

More than 70 searchable reports by the National Academies now are available online at the National Library of Medicine (NLM) Bookshelf. The reports include workshop summaries and   formal reports that were funded by the National Institutes of Health (NIH) and produced by the four organizations that comprise the National Academies: the National Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, and the National Research Council. In order to provide the reports quickly, NLM initially makes the reports available in PDF format. As soon as possible, NLM makes available a final online HTML version of each report, with active links for references, glossary words, and other resources.

New in Research

Footnote: What's New in the Literature  

Interventions such as supervised or individualized exercise therapy and self-management techniques may enhance exercise adherence, say authors of a systematic review that assessed the effects of interventions to improve exercise adherence for people with chronic musculoskeletal pain (CMP). However, the authors add, high-quality, randomized trials with long-term follow up that explicitly address adherence to exercises and physical activity are needed and a standard validated measure of exercise adherence should be used consistently in future studies. The review was published January 20 in The Cochrane Database of Systematic Reviews (2010, Issue 2). 

Researchers searched the trials registers of relevant Cochrane Review Groups, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, Science Citation Index, Social Science Citation Index, and reference lists of articles to October 2007. They also consulted experts for unpublished trials. Selection criteria included randomized or quasi-randomized trials evaluating interventions that aimed to improve adherence to exercise and physical activity in adults with pain for 3 months and over in the axial skeleton or large peripheral joints. Two of the four authors independently assessed the quality of each included trial and extracted data. Researchers contacted study authors for missing information.

The review included 42 trials with 8,243 participants, mainly with osteoarthritis and spinal pain. Methods used for improving and measuring adherence in the included trials were inconsistent. Two of the 17 trials that compared different types of exercise showed positive effects, suggesting that the type of exercise is not an important factor in improving exercise adherence. Six trials studied different methods of delivering exercise, such as supervising exercise sessions, refresher sessions, and audio or videotapes of the exercises to take home. Of these, five trials found interventions improved exercise adherence. Four trials evaluated specific interventions targeting exercise adherence; three of these showed a positive effect on exercise adherence. In eight trials studying self-management programs, six improved adherence measures. One trial found that graded activity was more effective than usual care for improving exercise adherence. Cognitive behavioral therapy was effective in a trial in people with whiplash-associated disorder, but not in trials of people with other CMP. In the trials that showed a positive effect on adherence, association between clinical outcomes and exercise adherence was conflicting.

APTA members can access full text articles published in the Cochrane Database of Systematic Reviews through Open Door.

Few CE Studies Compare Medications With Nonpharmacologic Interventions  

An analysis of comparative effectiveness (CE) studies finds that few compare medications with nonpharmacologic interventions, and few examine safety or cost-effectiveness, say researchers from the University of Southern California, Los Angeles, and Harvard Medical School, Boston.

Michael Hockman, MD, and Danny McCormick, MD, MPH, examined the characteristics and prevalence of CE research concerning medications published between June 2008 and September 2009 in the six general medicine and internal medicine journals with the highest impact factors. They identified 328 studies evaluating medications and their effect on cardiovascular disease, rheumatologic and orthopedic conditions, neurologic disorders, and pulmonary disease, among others. Of the 328 studies, 104 were CE studies.

Of the 104 CE studies, 43% compared two or more medications with each other; 11% compared medications with non-pharmacologic interventions; 31% compared different pharmacologic strategies; and 15% compared different medication doses, durations or frequencies of treatment, or different medication formulations. Nineteen percent of the CE studies focused on safety and 2% included cost-effectiveness analyses.

The authors add that of 212 randomized trials, 46% used an active comparator or active therapy; the remainder used an inactive control, such as placebo. Active-comparator trials were less likely (44%) than trials with inactive controls (66%) to report positive results.

The study is published in the March 10 issue of JAMA.

Membership Matters

Application Deadline for Government Affairs Intern Position Nears   

The deadline to submit applications for APTA's R. Charles Harker summer internship program is April 1. The 3-month internship, beginning in May or June, is a great opportunity to be immersed in federal and private payment policy, grassroots, as well as state and federal government affairs. Applicants must be matriculated students in a postbaccalaureate physical therapy program, have experience or education in the legislative/regulatory arena, have an interest in public policy, and be members of APTA. Interns will work on site at APTA headquarters in Alexandria, Virginia, and be paid the current hourly rate set by APTA’s Human Resources Department. For more information or to apply, contact Monica Herr in Federal Government Affairs at 703/706-3156. Applicants must include a resume, a letter indicating experience and interest in the arena of public policy, and an essay (not to exceed 1 page) describing what he or she hopes to gain from the experience of work in APTA's Government and Payment Advocacy Unit.  

Call for Nominees to the FSBPT Examination Committees

APTA is asking physical therapist members to consider serving on a Federation of State Boards of Physical Therapy (FSBPT) examination committee. Under the 1989 Transfer Agreement of the physical therapy licensing examination and a more recent settlement agreement, APTA is entitled to seat candidates for at least 40% of the positions on FSBPT Examination Development Committees (EDC-PT and EDC-PTA) and the Item Bank Review Committees (IBRC-PT and IBRC-PTA). This year APTA will be providing one nominee for the EDC-PT and one for the IBRC-PT.

APTA nominees to all committees will be physical therapists and active APTA members. Experience as National Physical Therapy Examinations item writers or American Board of Physical Therapy Specialties writers is desired but not required. The description of the committees provides additional information. For the EDC-PT the nominees must have expertise in 1) integumentary, 2) neuromuscular, or 3) pediatrics. For the IBRC-PT the nominees must have experience in 1) integumentary, 2) musculoskeletal, or 3) cardiovascular/pulmonary.

To submit for nomination, complete the Personal Information Form and submit it with a current resume/CV by April 30 to Brandy Bradley in the Department of Practice. Please contact Brandy Bradley with any questions.

Click of the Week

Loan Forgiveness Legislation

Student loan debt is a significant burden to physical therapists and many times limits practice opportunities, particularly in rural and underserved areas. APTA's Education and Workforce Center can help members learn more about legislation that has been introduced to add PTs to the National Health Service Corps (NHSC) for the purpose of qualifying for loan repayment programs. The Web page provides links to the bills and letters of support.