Patients in North Carolina soon will have the right to choose their physical therapist (PT) under their health benefits plan and ensure that PT services will be covered. SB 656, sponsored by State Sen Jim Davis (R) and advocated for by the North Carolina Chapter, was signed by North Carolina Gov Beverly Perdue (D) on June 29 and goes into effect October 1. SB 656 specifies that whenever an insurance policy provides for certification of disability that is within the scope of practice of a licensed PT, the policyholder, insured, or beneficiary will have the right to choose the provider of the services.
According to Chapter President Dean McCall, PT, DPT, OCS, the chapter initiated the legislation after reports began surfacing that some patients were unnecessarily driving more than 90 miles and having to wait 3 to 4 weeks before being seen by other providers, when they could have been seen in their home town by their local physical therapist. In addition, SB 656 states that when any health benefit plan, subscriber contract, or policy of insurance issued by a health maintenance organization, hospital or medical service corporation, or insurer provides for coverage for, payment of, or reimbursement for physical therapist services, the insured or other persons entitled to benefits under the policy will be entitled to coverage or reimbursement for the services.
As of July 1, 89 new accountable care organizations (ACOs) began serving 1.2 million people with Medicare in 40 states and Washington, DC. In total, 154 organizations now participate in Medicare shared savings initiatives, serving over 2.4 million Medicare patients across the country.
Federal savings from the Medicare Shared Savings Program (MSSP), and other initiatives related to ACOs, could amount to $940 million over 4 years. All ACOs that succeed in reducing the rate of growth in the cost of care while providing high-quality care may share in the savings to Medicare. Five of the new ACOs applied for a version of the program that allows them to earn a higher share of any savings by also being held accountable for a share of any losses if the costs of care for the beneficiaries assigned to them increase.
The selected ACOs, announced yesterday by the Centers for Medicare and Medicaid (CMS), operate in a wide range of areas of the country, and almost half are physician-driven organizations serving fewer than 10,000 beneficiaries, demonstrating that smaller organizations are interested in operating as ACOs. Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas that they are serving.
To ensure high quality of care, ACOs will report performance on 33 measures relating to care coordination and patient safety, use of appropriate preventive health services, improved care for at-risk populations, and patient and caregiver experience of care.
Beginning this year, new ACO applications will be accepted annually. The application period for organizations that wish to participate in MSSP beginning in January 2013 is August 1 through September 6.
Check out APTA's ACO webpage for resources such as FAQs, podcasts, assessment tools, and summaries on ACO regulations. APTA's video series on innovative models of care illustrates ways physical therapists can play an important role in ACOs and other integrated care models.
Regular Wii Fit workouts proved as effective as a robust walking routine in reducing the risk for falling in older people with mild Alzheimer disease (AD), says a Medscape Medical News article based on a study published online June 13 in Journal of Aging Research.
Researchers at the University of Arkansas for Medical Sciences assessed fall risk with 3 tests of balance and gait in 22 elderly people enrolled in 1 of 2 exercise interventions. Eleven participants were assigned to a supervised walking program, and 11 used the Wii Fit yoga, strength-training, and balance games. Each group exercised 5 times weekly for 30 minutes over 8 weeks.
The participants were tested with the Berg Balance Scale (BBS), the Tinetti Test (TT), and Timed Up and Go (TUG) test before they began exercising, at the 4-week point, and after 8 weeks. Research participants lived in an assisted-living facility.
Both groups showed improvements on all 3 tests, with no statistically significant difference between the groups. Both groups began with a BBS score of less than 45, indicating a high risk for falls, and significantly improved those scores over time. But group-by-time interactions failed to reach significance for any measure.
In an intragroup analysis, at 8 weeks the Wii Fit group showed statistically significant improvements in BBS and TT scores. Wii Fit TUG scores did not reach significance.
In the walking group, an intragroup analysis showed a significant improvement in TT scores. However, although BBS and TUG scores trended toward improvement, they failed to reach statistical significance.
Robert P. Friedland, MD, chair and professor of neurology at the University of Louisville, Kentucky, who was not involved in the research, calls the study a "relatively limited observation." He added that the mean age of the participants—79.3 years for the Wii Fit group and 81.6 years for the walking group—rather than the disease probably led to their balance issues.
Men have a greater number of knee ligament injuries than women, despite research suggesting that women's knees are more prone to anterior cruciate ligament (ACL) tears and surgeries to fix them, says an article by Reuters based on study in American Journal of Sports Medicine.
For this study, researchers included knee injuries across the entire Swedish population, not just among players of particular sports or in certain regions. They used a nationwide database of patients to see how many Swedes had knee ligament injuries and how many had surgical repairs between 2002 and 2009. Overall, 56,659 people in Sweden tore a knee ligament during the 7-year study period—an average of 78 tears for every 100,000 Swedish citizens.
Men accounted for about 34,000 of the tears, or 60%. Men also had 59% of the reconstructive surgeries associated with knee ligament injuries.
Swedish women tended to experience ACL injuries at a younger age—between the ages of 11 and 20, versus 21 to 30 for men.
When the researchers looked just at the age groups with the highest injury rates, men still had far more knee troubles. The numbers worked out to about 144 tears per 100,000 women between 11 and 20 years old, and 225 tears per 100,000 men aged 21 to 30.
Darin Padua, director of the Sports Medicine Research Laboratory at the University of North Carolina at Chapel Hill, said he was not surprised by the findings. Padua, who was not involved with the research, added that the results help to show that both men and women should be taking part in injury prevention programs, the article says.
Physician-hospital consolidation for the purpose of enhanced bargaining power with payers does not lead to true integration or enhanced hospital performance, according to an updated issue brief by the Robert Wood Johnson Foundation (RWJF) that examines the effect of hospital mergers on prices, costs, and quality of care.
Consolidation between physicians and hospitals is of great interest because of both the potential that consolidation has for creating integration, and the impetus created by the Affordable Care Act's push toward creating accountable care organizations and emphasis on bundled payments. In theory, says the brief, there are substantial gains to be made from consolidation—especially when consolidation leads to integration and the elimination of unnecessary duplication of services.
However, the brief also points to concerns that consolidation may have adverse impacts on competition. Hospital consolidation generally results in higher prices. When hospitals merge in already concentrated markets, the price increase can be dramatic, often exceeding 20%.
Additionally, hospital competition improves quality of care. This is true under both administered price systems such as Medicare and the United Kingdom's National Health Service, and market-determined pricing such as the private health insurance market.
The full 2006 synthesis and updated brief are available on RWJF's website.