is with a heavy heart that I share the news of the sudden passing of our friend
and colleague, APTA Board Member Dave Pariser, PT, PhD," says APTA
President Paul A. Rockar Jr, PT, DPT, MS, in a statement released this morning.
"Dave was an outstanding gentleman and professional whose friendship,
devoted service, and leadership we will sorely miss."
member of APTA since 1981, Pariser served in various capacities within APTA
and the Kentucky and Louisiana chapters, including on APTA's Nominating
Committee, as Louisiana Chapter president, and as chair of the legislative
committees for both the Louisiana and Kentucky chapters. Most recently, he was
elected in June 2011 by APTA's House of Delegates to serve on the Board of
Directors. Pariser received numerous awards in recognition of his service,
including the Dave Warner Award for Distinguished Service (Physical Therapist
of the Year) from the Louisiana Chapter (2001) and induction into the chapter's
“Hall of Fame” in 2006 for career achievement.
Rockar's full statement on APTA's website.
has created a tribute page for members of
the physical therapy community and others to share their memories about
Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule that has important
implications for Medicaid beneficiaries who require rehabilitative and
habilitative services and devices.
the rule, CMS proposes changes to provide states more flexibility to coordinate
Medicaid and the Children's Health Insurance Program (CHIP) eligibility
notices, appeals, and other related administrative procedures with similar
procedures used by other health coverage programs authorized under the
Affordable Care Act (ACA), such as coordination of benefits between Medicaid
and health plans offered in the health insurance exchanges (Exchanges).
CMS is soliciting comments on whether the habilitative benefit should be
offered in parity with the rehabilitative benefit under the Medicaid program
(as they must be under the Exchanges). Additionally, CMS requests input on
whether the state defined habilitative benefit definition for the Exchanges
should apply to Medicaid or states should be allowed to separately define
habilitative services for Medicaid. Habilitative and rehabilitative benefits
are part of the mandatory essential health benefits (EHB) established by the
ACA to ensure that certain health plans offered in Exchanges provide this
baseline of coverage, benefits, and services to their enrollees.
December 2012, CMS released guidance
to help states align Alternative Benefit Plans under Medicaid programs with the
EHB requirements. In that guidance, CMS stated that it intended for the provisions
of the EHB proposed rule, released on November 20, generally to
apply to Medicaid, but noted that it would address EHB in future rulemaking.
newly released proposed rule also proposes to update and simplify the complex
Medicaid premiums and cost-sharing requirements, to promote the most effective
use of services, and to assist states in identifying cost-sharing flexibilities.
will comment on the proposed rule. Comments are due February 13.
a study evaluating the
financial impact of providing early physical therapy for intensive care
patients, researchers at Johns Hopkins found that the
up-front costs are outweighed by the financial savings generated by earlier
discharges from the intensive care unit (ICU) and shorter hospital stays
"The evidence is growing that
providing early physical and occupational therapy for intensive care patients—even
when they are on life support—leads to better outcomes," says Dale M.
Needham, MD, PhD, senior author of the study. "Patients are stronger and
more able to care for themselves when they are discharged."
Hospital administrators' concerns
about costs have been cited as barriers to implementing early rehab programs in
the ICU. "However, our study shows that a relatively low investment up
front can produce a significant overall reduction in the cost of hospital care
for these patients," Needham says. "Such programs are an example of
how we can save money and improve care at the same time."
For the study, the researchers
developed a financial model based on actual experience at The Johns Hopkins
Hospital's medical intensive care unit (MICU) and projections for hospitals of
different sizes with variable lengths of stay.
The Johns Hopkins MICU admits about
900 patients each year. In 2008, the hospital created an early rehabilitation
program with dedicated physical therapists and occupational therapists, which
added about $358,000 to the cost of care annually. However, by 2009, the length
of stay in the MICU had decreased an average of 23%, down from 6.5 days to 5 days,
while the time spent by those same patients as they transitioned to
less-intensive hospital units fell 18%. Using their financial model, the
authors estimated a net cost saving for the hospital of about $818,000 per
year, even after factoring in the up-front costs.
The researchers then analyzed the
potential impact of early rehabilitation services in 24 different scenarios,
accounting for variations in the number of ICU admissions, cost savings per day
and reductions in length of stay.
found that in 20 out of the 24 scenarios, hospitals would have an overall cost
savings by providing early rehabilitation to patients in the ICU, and in the 4
remaining scenarios, using the most conservative assumptions, there was a
modest net cost increase of up to $88,000 per year.
APTA member Michael
Friedman, PT, MBA, is a coauthor of the study.
innovative models of care video series includes an interview with a physical
therapist who was instrumental in starting an early physical therapy program
for patients in a Houston hospital's ICU.
new policy statement by the American
Heart Association (AHA) encourages clinicians to assess cardiorespiratory
fitness with the hope that researchers can gather more information on aerobic
fitness and its related variables to identify individuals who might be at risk
for adverse clinical outcomes.
AHA writing committee also advocates for the creation of a national registry
that includes data on cardiorespiratory fitness that would allow researchers to
track aerobic fitness over long periods of time, just as is being done with
other variables such as cholesterol, blood pressure, physical activity levels,
and body weight, among others. It also would provide more information on
normative aerobic fitness levels in subsets of the population.
According to a Heartwire article, one of the goals of the national
registry is to increase awareness about the importance of cardiorespiratory
fitness. Many of the assessments are performed in exercise centers and research
settings, but not as frequently in clinical practice.
While information is available in
pockets of the country, including data from the Aerobics Center Longitudinal Study, the hope is more information
would allow researchers to determine normative cardiorespiratory fitness
levels, via direct measurements of VO2, in groups stratified by age,
gender, and body composition in large samples representative of the US
The registry also would help define
normative values of aerobic fitness across strata of physical activity levels.
of the AHA policy statement, Leonard
Kaminsky, PhD, told Heartwire that "physical activity is simply a behavior, and while
both are inversely associated with the risk of cardiovascular disease, there
are factors that contribute to aerobic fitness than other physical activity
levels, including age and genetics. In addition, cardiorespiratory fitness is a
more clinically meaningful measure than self-reported physical-activity levels,
which are prone to considerable error."
APTA member Ross
Arena, PT, PhD, is a coauthor of the statement, which was published online
ahead of print January
7 in Circulation.
A new APTA podcast that focuses on
screening for physical inactivity distinguishes between physical activity and
physical fitness, explains the use of physical activity to screen for issues of
impaired physical fitness, and provides information on what to do with the
results of the screen. It also gives examples illustrating various types of
patients and the role that physical activity plays in their overall
upcoming Board of Directors meeting will be broadcast online for APTA members
when the Board convenes January 20 in San Diego.
open sessions of the meeting will be livestreamed, and archived video will be
available through February 10 at www.apta.org/Livestream. The agenda for
the meeting, which includes a generative session on membership development
initiatives and a fiduciary session, is posted on the same page.
is the second time that the Board meeting has been livestreamed, following a similar broadcast
in November and December of last year.
and health care providers have formed 106 new accountable care organizations (ACOs), bringing the nationwide number
of Medicare beneficiaries included in ACOs to about 4 million.
to the Department of Health and Human Services (HHS), the new ACOs include a
diverse cross-section of physician practices across the country. Roughly half
of all ACOs are physician-led organizations that serve fewer than 10,000
beneficiaries. Approximately 20% of ACOs include community health centers,
rural health centers, and critical access hospitals that serve low-income and
The new group includes 15 advance payment model ACOs, physician-based or rural providers who would benefit from
greater access to capital to invest in staff, electronic health record systems,
or other infrastructure required to improve care coordination. Medicare will
recoup advance payments over time through future shared savings. In addition to
these ACOs, last year the Centers for Medicare and Medicaid Services (CMS)
launched the Pioneer ACO Program for
large provider groups able to take greater financial responsibility for the
costs and care of their patients over time.
ACOs must meet quality standards to ensure that savings are achieved
through improving care coordination and providing care that is appropriate,
safe, and timely. CMS has established 33 quality measures on care
coordination and patient safety, appropriate use of preventive health services,
improved care for at-risk populations, and patient and caregiver experience of
care. Federal savings from this initiative are up to $940 million over 4 years.
For more information on ACOs, visit www.apta.org/ACO/.
your colleagues on March 8 for APTA's groundbreaking virtual event, Innovation Summit:
Collaborative Care Models, which will focus on the current and future role of
physical therapy in ACOs and other integrated models of care.