APTA: Working for You

House Passes Legislation to Avoid Medicare Cuts 

Yesterday, the House of Representatives voted 243-183 to stop a 21.2% scheduled cut in Medicare payments for providers set to go into effect on January 1, 2010. The Medicare Physician Payment Reform Act of 2009 (HR 3961) also would update the physician fee schedule conversion factor in 2010 by the 1.2% increase in the Medicare Economic Index. Under HR 3961 annual updates beginning in 2011 would be determined by a new sustainable growth rate (SGR) methodology with two categories of physician services, each with separate allowed expenditure targets, update adjustment factors, and conversion factors. The categories are:

• evaluation and management services and Medicare covered preventive services (updated annually by the gross domestic product plus 2%)
• all other services (updated annually by the gross domestic product plus 1%)

HR 3961 will go to the Senate for consideration. See article below for details on the Senate's comprehensive reform package released earlier this week. Click here to read about HR 3962, the overall reform package passed by the House on November 7.     

Direct Access Demonstration Project, Extension on Cap Exceptions Process, SGR Fix Included in Senate Bill

Senate Democrats released their comprehensive reform package on Wednesday following weeks of negotiations to meld separate health care reform bills passed by the Health, Education, Labor, and Pensions (HELP) and Finance committees.

The Patient Protection and Affordable Care Act (PPACA) contains a 1-year extension on the therapy caps exceptions process and a 1-year fix to the sustainable growth rate (SGR), which would prevent payment cuts to providers in 2010 and provide a .5% increase under the Medicare physician fee schedule. The bill also charges the Centers for Medicare and Medicaid Services' Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries in rural areas. PPACA would cost $848 billion and require most people to buy insurance. Workers whose employers do not offer affordable coverage would be able to shop for policies in new state-based "exchanges." Insurance companies would have to abide by new rules that would ban practices such as denying coverage based on preexisting conditions.

The Senate is expected to vote tomorrow on a procedural motion to start debate on the bill.   

The House of Representatives passed its overall reform package, the Affordable Health Choices for America Act (HR 3962) on November 7. Yesterday, the House passed a standalone measure (HR 3961) that would provide a long-term fix to the SGR (see previous article for details.) HR 3961 will be taken up by the Senate separate from The Patient Protection and Affordable Care Act.     

With the cap exceptions process set to expire December 31, APTA is urging Health and Human Services Secretary Kathleen Sebelius and members of Congress to temporarily extend the exceptions process until the House and Senate complete work on comprehensive reform. “Even a short-term enforcement of the therapy caps would have a negative impact on beneficiaries, causing some to deny themselves necessary rehabilitation services for fear of exceeding the limits,” APTA said.             

APTA Shows Support for Rural TECH Legislation

On Monday, APTA sent a letter to Sen Tom Udall (D-NM) expressing support for his introduction of the Rural TECH (Telemedicine Enhancing Community Health) Act (HR 3578). The bill includes a number of provisions to enhance the implementation of telehealth technologies, such as the expansion of stroke telemedicine services under Medicare, the inclusion of physical therapy and rehabilitation within stroke telehealth services, and a number of demonstration projects to investigate the implementation of telemedicine services to a variety of beneficiaries. Sen Udall hopes to bring forth his bill as an amendment to the Senate's health care reform legislation.

Providers Earn $92 Million in 2008 PQRI Program 

Last month the Centers for Medicare and Medicaid Services (CMS) paid approximately $92 million in incentive payments to 85,000 Medicare providers, including physical therapists, who participated in the 2008 Physician Quality Reporting Initiative (PQRI). A total of 153,600 providers participated in the 2008 program. Providers who qualified for an incentive payment for successful participation in the 2008 program earned a 1.5% bonus payment on their total allowed charges for 2008. Confidential feedback reports also were made available to help providers determine their success rate.  

Payments for the 2009 program are slated for mid to late 2010. In 2010, physical therapists and other health care providers will continue to earn a 2% bonus payment for successful participation. CMS is finalizing the measure specifications for the 2010 program and will make them available shortly. More information about the PQRI program, including resources on how to interpret your bonus payment and feedback report, can be found on APTA's Web site at www.apta.org/pqri.

Health IT Web Page Launched

APTA recently launched a Health Information Technology (HIT) Web page to help physical therapists better understand the role that HIT can play in their practice. The page provides information about state grants to promote HIT planning and implementation, HIPAA's Privacy Rule and HIT, security practices in a HIT environment, and the Office of the National Coordinator for Health Information Technology -- the federal entity charged with coordination of nationwide efforts to implement HIT. APTA comments and statements on HIT initiatives also are posted.

Bone Health and Diabetes Handouts Now Available

Two new members-only handouts that explain the role of physical therapists in ensuring optimal bone health and helping patients manage diabetes now are available. Download these handouts and others from APTA's Public Relations Resource Center and distribute to your patients.  

The information also has been added to APTA's consumer Web site.  

Could New Mammography Recommendations Impact Health Care Reform 

For weeks, the issue of health care reform has dominated the news. But over the past couple of days, another topic has given health care reform a run for its money -- the release of new recommendations by an independent federal task force that say women ages 40 to 49 should no longer receive routine screening mammograms or be encouraged to perform monthly breast self examinations.

"As physical therapy professionals, it's in our nature to empower patients to take charge of their own health," says APTA President Scott Ward, PT PhD. "It's what we do every day. So, in many ways the new recommendations seem counterintuitive.

"On the other hand, our profession understands and embraces the importance of evidence-based decision-making. In fact, our very own 'Vision 2020' underscores the importance of providing 'evidence-based services throughout the continuum of care' and improving quality of life for society."

Where do these new recommendations leave physical therapists? Post your thoughts at APTA's Moving Forward blog.

Practice Tips

Quick Reference for Activity Guidelines  

The Physical Activity Guidelines for Americans At-A-Glance: A Fact Sheet for Professionals is designed for busy health care providers as a quick desk-side reference to the 2008 Physical Activity Guidelines for Americans published by the US Department of Health and Human Services.

Living the Brand: Targeting Patients in Communications

When preparing consumer-oriented advertisements and press releases, and patient communications, remember that the target audience for patients is between the ages of 35-70, representing the three waves of the Baby Boomer generation, as well as the first wave of Gen Xers. The common denominator of this disparate group is a desire to take charge of their health, a willingness to be open minded, and a sense of redefining what it means to be "old."

Learn more about living the brand at www.apta.org/brandbeat.

New in Research

Footnote: What's New in the Literature

The single tests of painful arc, external rotation resistance, and Neer are useful screening tests to rule out subacromial impingement syndrome (SAIS) in patients with shoulder pain, say authors of a study led by APTA member Lori Michener, PT, PhD, ATC, and published in the November 2009 issue (Vol 90 Issue 11) of Archives of Physical Medicine and Rehabilitation. The single tests of painful arc, external rotation resistance, and empty can are helpful to confirm SAIS. The reliability of all tests is acceptable for clinical use. Based on reliability and diagnostic accuracy, the single tests of the painful arc, external rotation resistance, and empty can have the best overall clinical utility. The cut point of 3 or more positive of 5 tests can confirm the diagnosis of SAIS, while less than 3 positive of 5 rules out SAIS.

In a prospective, blinded study conducted in an orthopedic surgeon shoulder clinic, researchers evaluated patients with shoulder pain (n=55, mean age=40.6 years) with five physical examination tests for SAIS: Neer, Hawkins-Kennedy, painful arc, empty can (Jobe), and external rotation resistance tests. Surgical diagnosis was the reference standard.

Main outcome measures were diagnostic accuracy calculated with a receiver operating characteristic (ROC) curve and sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood ratio (−LR). A forward stepwise binary logistic regression analysis was used to determine the best test combination for SAIS. An ROC curve analysis also was used to determine the cut point of the number of tests discriminating between the presence and absence of SAIS. Kappa coefficients and percent agreement assessed interrater reliability.

The ROC analyses revealed a significant area under the curve (AUC) (AUC=.67–.72) for all tests, except for the Hawkins-Kennedy. The tests with a +LR greater than or equal to 2.0 were the painful arc (+LR=2.25), empty can (+LR=3.90), and the external rotation resistance tests (+LR=4.39). Tests with −LR less than or equal to 0.50 were the painful arc (−LR=.38), external rotation resistance (−LR=.50), and Neer tests (−LR=.35). The regression analysis had no specific test combinations for confirming or ruling out SAIS. The ROC analysis was significant (AUC=.79), with a cut point of 3 positive tests out of 5 tests. Reliability was moderate to substantial agreement (κ=.45–.67) for the painful arc, empty can, and external rotation resistance tests and fair strength of agreement (κ=.39–.40) for the Neer and Hawkins-Kennedy tests.

Meniscal Tears Increasing in Children  

Although more children have been diagnosed in recent years with meniscal tears, prospects for a full recovery are high, according to an article by Reuters based on a literature review published this month in the Journal of the American Academy of Orthopaedic Surgeons. 

"Seventy-five to 90% of children who have meniscal tears heal successfully when they are treated appropriately," said study co-author Dennis Kramer, MD, an attending orthopedic surgeon at Children's Hospital Boston and instructor in orthopedic surgery at Harvard Medical School. "In adults, the success rate is often less than 50%. A child's physiology is different than an adult's. They are growing and therefore have a greater blood flow to the meniscus. This helps in the healing process."

The study says that several factors are contributing to the increase in diagnosis of meniscal tears in children, including more participation in sports, where knee injuries often occur; an increase in the number of health care professionals who are aware of and recognize the signs of meniscal tears; and the use of magnetic resonance imaging to better diagnose tears.

Health Care Headlines

International Day of Persons with Disabilities to be Observed December 3

The United Nations recently launched its theme for the International Day of Persons with Disabilities, Making the Millennium Development Goals Inclusive: empowerment of persons with disabilities and their communities around the world.

The day is observed on December 3 and aims to promote an understanding of disability issues, the rights of people with disabilities and gains to be derived from the integration of people with disabilities in every aspect of the political, social, economic, and cultural life of their communities.

Follow this link for more information about the day and suggestions on how it can be observed.  

Membership Matters

NPTM Celebrations Now Online

PTs, PTAs, and students of physical therapy celebrated this year's National Physical Therapy Month (NPTM) theme, "Move Forward. Physical Therapy Brings Motion to Life" by holding educational seminars, participating in walks and runs, generating local and national media coverage for the profession, volunteering their time, and raising money and food for worthy causes. Click here or photos of your colleagues' events and efforts.

Advocacy Challenge Inspires Students to Invest in Future of Profession  

Students from academic programs across the country can compete against one another by participating in a new challenge called Advocacy Activities by documenting their experiences and submitting records to APTA's Grassroots Advocacy Department. Scores will be tallied based on point values. The winner will be announced each year at National Student Conclave. The winning academic program will be honored with the opportunity to select an APTA staff or Board of Directors member to speak at their school.

For more information on the challenge or to begin participating, visit www.apta.org/studentadvocacychallenge or e-mail advocacy@apta.org.

Miami-Marquette Challenge Kicks Off, Proceeds Benefit Foundation for Physical Therapy

The annual Miami-Marquette Challenge is under way. This year, 56 schools pledged to raise more than $200,000 to support the Foundation for Physical Therapy's mission of providing funds for physical therapy research and research doctoral programs. Prizes will be awarded to the top fund raising schools, including two new awards -- the Foundation Award of Excellence (for raising $10,000 or more) and the Foundation Award of Merit ($6,000 or more). Make a contribution in honor of your school by completing a donation form. The deadline to make donations is May 5, 2010. If your school is not already on the list of participants but you would like to join, complete the Pledge to Participate form. For more information on the Miami-Marquette Challenge, visit the Foundation's Web site.

Click of the Week

Job Search  

Search for jobs by category (eg, director, staff), practice setting, practice area, geographical location, and salary range; post resumes; access career management resources, and scan course offerings on APTA's job search Web page.