DMEPOS Suppliers Urged to Oppose Restrictive Policy Changes

Physical therapists who supply patients with and bill Medicare for durable medical equipment and orthotics have until March 18 to request that the Centers for Medicare & Medicaid Services (CMS) exempt PTs from new restrictions. Revisions to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) Accreditation Quality Standards would enact new rules governing the location of suppliers' practices, the amount of liability insurance they must carry, and where they post their business name and office hours. A summary of the proposed changes is available on APTA's Web site.

APTA is urging PTs to write to CMS and request that PTs be exempted from policies intended to apply to commercial DMEPOS suppliers. To coordinate comments with APTA, please have them to the Government and Reimbursement Advocacy Unit, at govtaffair@apta.org, by March 11.

MedPAC to Congress: Fee Schedule Cuts Threaten Access

Scheduled annual cuts to the Medicare physician fee schedule conversion factor would threaten access to health services, according to an independent agency's report to Congress. The Medicare Payment Advisory Commission (MedPAC) on February 29 released its 2008 Report to the Congress: Medicare Payment Policy, which includes a wide range of policy recommendations regarding efficiency, quality of care, and payment rates.

APTA is drafting a summary of the report to post online. MedPAC is an independent congressional agency established by the Balanced Budget Act of 1997 to advise Congress on issues affecting Medicare.

ABN Forms Being Replaced

The Centers for Medicare & Medicaid Services (CMS) is replacing two Advanced Beneficiary Notices (ABNs) to offer new options regarding treatments that might not be covered by Medicare.

CMS is replacing the General Use and Lab ABNs with the ABN of Noncoverage. The new notice includes a mandatory field for cost estimates of items and services, is allowed to be used for voluntary notifications, and provides an option for beneficiaries to pay out-of-pocket, rather than submit a Medicare claim.

The revised form and instructions will be posted on Medicare's Beneficiary Notice Initiative (BNI) Web page.

New Osteoporosis Guidelines "Dramatically Alter" Evaluation and Treatment, Says NOF

The National Osteoporosis Foundation (NOF) recently released its new Clinician's Guide to Prevention and Treatment of Osteoporosis to help US health care providers make better treatment decisions and assess fracture risk for patients with low bone mass or osteoporosis. The new information is based largely on a report from the World Health Organization (WHO) detailing the WHO algorithm FRAX. This algorithm estimates the likelihood for a person to break a hip or other major bone due to low bone mass or osteoporosis over a period of 10 years.

NOF says the guide dramatically alters the way patients -- both men and women -- are evaluated and treated, and better identifies those at risk for fractures from low bone mass or osteoporosis. The guide uses the Absolute Fracture Risk methodology as the basis for making treatment decisions in patients with low bone mass or osteoporosis.  

Baylor Launches Wellness Program for Patients Having Joint Replacement Surgery

Patients undergoing joint replacement surgery at Baylor University Medical Center in Dallas are participating with other patients having the same procedure in a Joint Wellness Program that promotes wellness, camaraderie, and friendly competition to help ensure that each person has the best possible outcome.

The new approach to joint replacement surgery is part of a national trend in health care to offer patients a focused approach to recovery following surgery, says a Newswise article on the program. Joint Wellness now is available to patients undergoing total knee replacements at Baylor-Dallas, and the hospital plans to incorporate other procedures such as total hip replacements within the next 6 months.

Typically, patients are evaluated by a physical therapist the morning of the day after surgery and begin group therapy sessions that afternoon. Most are ready to go home by the third day. Traditionally, the average length of stay following a knee replacement is at least 4 days.

"We believe our patients are able to go home sooner because the staff dedicates personal attention to each patient in a well-coordinated fashion," says Fabian Pollo, PhD, executive director of the Baylor-Dallas Department of Orthopaedics. "This program was designed to improve post-operative rehabilitation and most importantly, the patient's experience by giving patients the knowledge and tools they need to make the transition from hospital to home as smooth as possible."

Before surgery, each patient is encouraged to attend a pre-operative education session where they learn what to expect before, during, and after their procedure. The program coordinator talks with each patient before surgery, during his or her stay, and after discharge to follow up on his or her recovery. In addition, family members are encouraged to assist patients during their hospital stay and when they return home. During recovery, patients wear their own clothes rather than a hospital gown.

Research Roundup - Diabetes

Hispanic children and adolescents who are overweight with normal blood glucose levels showed elevated markers for blood vessel inflammation that may predispose them to developing both type 2 diabetes and cardiovascular disease, says a study led by researchers from the Joslin Diabetes Center. The study was published in the March issue of Diabetes Care.

Another study in the same issue found that low cardiorespiratory fitness (CRF) and higher BMI were independently associated with incident type 2 diabetes. The protective effect of CRF was observed in individuals who were overweight or obese, but CRF did not eliminate the increased risk in these groups. Researchers noted that these findings underscore the critical importance of promoting regular physical activity and maintaining normal weight for diabetes prevention.

Americans who live with spinal cord injury do not appear to be at greater risk of developing carbohydrate and lipid disorders such as insulin resistance, diabetes, impaired glucose tolerance, and high or low blood cholesterol levels -- risk factors for heart disease -- than able-bodied people, says a study conducted for the Agency for Healthcare Research and Quality. Click here to view or download the report.

A new study presented at the American Academy of Orthopaedic Surgeons annual meeting shows diabetes can complicate hip and knee replacement recovery, according to a Newswise article. Patients with Type 1 diabetes are more likely to have complications than patients with Type 2 diabetes following the same surgery, and the problem is expected to increase rapidly as more patients with both diabetes types require hip and knee replacement procedures, the article says.

PTs in the News

Raquel Perlis, PT, is featured in an ABC segment about women who experience painful sex and how physical therapy can help. Perlis teaches women and their partners how to stretch and massage pelvic floor muscles. She also uses biofeedback, which visually displays the degree of muscle contractions on a computer screen. The need for this therapy is so great, Perlis has a 3-month backlog of patients and manages 10 women a day for painful sex, the article says.     

Ken Randall, PT, MHR, is featured in a Newson6.com article about a partnership between the Tulsa Ballet and the University of Oklahoma –Tulsa's physical therapy program. Randall and his students see Tulsa Ballet performers at least once a week. "Because they're dancing 8 hours a day, 40 hours a week, even more sometimes with performances, even the best athletes start to get aches and pains and so we're there to help them out," says Randall.

New on www.APTA.org

APTA recently launched a new Web page that contains information about human resources issues in the profession. Developed in response to perceived shortages of PTs as well as a House of Delegates motion requesting an emphasis on workforce issues within the profession, the site contains a report on vacancy and turnover rates within acute care hospitals. APTA members also can access a discussion forum to conduct interactive dialogues with colleagues including asking questions and providing information about human resources issues. Additional reports will be posted as information is collected. Visit the site and add your comments about the report in the discussion forum. The site can be found at this link or by going to www.apta.org/research and clicking on Physical Therapy Workforce.

PT 2008 Highlights Keynote Speaker Lee Woodruff

APTA will host Lee Woodruff, author, freelance writer, and contributing editor to ABC's "Good Morning America," as the keynote speaker for PT 2008: APTA's Annual Conference & Exposition, June 11-14, in San Antonio, Texas. As co-author of the best-selling book In an Instant, Lee Woodruff garnered critical acclaim for the compelling and humorous chronicle of her family's journey to recovery following her husband Bob's roadside bomb injury in Iraq. Appearing together on national television and radio since the February 2007 publication of their book, the couple has helped put a face on the serious issue of traumatic brain injury among returning Iraq war veterans, as well as the millions of Americans who live with this often invisible, but life-changing, affliction. Intense physical therapy was a huge part of Bob Woodruff's recovery and will be highlighted in this address.

For programming, housing, and registration information follow this link.

Footnote: What's New in the Literature

Both reduced volitional muscle activation (CAR) and lean muscle cross-sectional area (LMCSA) contribute to muscle weakness in persons with knee osteoarthritis (OA), according to an article in the March issue of Medicine & Science in Sports & Exercise (Vol 40, No 3). APTA members Stephanie C Petterson, PT, MPT, Stuart Binder-Macleod, PT, PhD, FAPTA, and Lynn Snyder-Mackler, PT, ScD, SCS, FAPTA, were coauthors.

The study's purpose was to identify determinants of quadriceps weakness among persons with end-stage knee OA. Participants were 123 people with Kellgren/Lawrence grade IV knee OA. Their mean age was 65. Quadriceps strength (MVIC) and volitional muscle activation (CAR) were measured using a burst superimposition test. Muscle composition (LMCSA) and fat CSA (FCSA)) were quantified using magnetic resonance imaging.

The leg with OA was significantly weaker, had lower CAR, and had smaller LMCSA than the contralateral limb. CAR explained 17% of the variance in the contralateral limb's MVIC compared with 40% in the OA limb. LMCSA explained 41% of the variance in the contralateral limb's MVIC compared with 27% in the OA limb. As with healthy older adults, the best predictor of strength in the contralateral, nondiseased limb was largely determined by LMCSA, but CAR was found to be the primary determinant of strength in the OA limb. Deficits in CAR may undermine the effectiveness of volitional strengthening programs in targeting quadriceps weakness in the OA population.

Site Watch

Reformplans.com. www.reformplans.com, is a news, opinion, and analysis site sponsored by the World Health Care Congress and aimed at expanding the dialogue about health care reform. The site is designed to serve as a resource to help those interested in the issues keep abreast of political, legislative, and other developments that affect health care reform in the United States.

The site includes briefs of the reform plans proposed by leading candidates and organizations, as well as a grid comparing those plans. Also included are proposals by other members of Congress and interest groups, as well as descriptions of reforms plans in place in several states and countries. 

Site Watch provides readers with links to Web sites that may be of interest. Provision of these links does not imply endorsement by APTA.