A new podcast discusses how and why APTA adopted a position on medically necessary physical therapy services and provides physical therapists with a framework for using the definition to demonstrate and evaluate the value of physical therapy services.

APTA's position is modeled after Model Contractual Language for Medical Necessity, developed by the Center for Health Policy at Stanford University. The key pillars of the concept presented in this model and discussed in detail in the podcast are authority, purpose, scope, evidence, and value.

Firefighters are more likely to be injured while exercising than while putting out fires, according to an article published online in Injury Prevention. But carrying patients is the task most likely to cause injuries that require time off from work.

Researchers looked at data for injuries sustained while at work for 21 fire stations serving the metropolitan area of Tucson, Arizona, between 2004 and 2009. The 650 employees included firefighters, paramedics, engineers, inspectors, and battalion chiefs. The average age was 41 years, and all but 5% were men.

During the study period, the average annual incidence of new injuries was 17.7 per 100 employees, most of whom were in their 30s and 40s.

Injuries sustained while exercising accounted for a third of the total, despite the fact that exercising is designed to keep employees in good physical condition, in a bid to stave off the risk of injury while doing their job.

A further 1 in 6 injuries (17%) were caused while transporting patients, and just over 1 in 10 were sustained during simulated training drills. Sprains and strains were the most common type of injury (between 40% and 85%), followed by cuts and bruising. Most (95%) of the injuries were minor in nature.

Only 1 in 10 injuries occurred during firefighting, but a greater proportion of these were more serious. But almost half of time off work for injuries was caused by strains and sprains sustained while transporting patients.

A new trend in health care—the free-standing emergency department (ED)—is drawing criticism from lawmakers and advocates of affordable health care in Washington state who call the facilities "cash cows for hospitals," says an article in The Seattle Times. 

Hospitals throughout the Puget Sound region are building "spiffy new free-standing emergency rooms and entire hospital towers with expanded ERs, and drastically remodeling existing ones." In addition, the hospitals are aggressively marketing their EDs, promoting amenities from valet service to private rooms.

Hospital-industry leaders say that building new EDs will save money by enabling better, more efficient care. Virginia Mason Medical Center's chief executive, Gary Kaplan, MD, argues that good design saves money by saving staff time, reducing the chance of errors, and allowing a faster, more complete patient workup, the article says. Virginia Mason recently opened an $8 million ED in a new pavilion in Seattle.

Arguments by hospital leaders haven't won over critics concerned about health costs for the state's government and businesses. According to health economists, health care isn't like other commodities in which increasing supply drives down prices. 

Efforts to regulate hospital building and ED expansion haven't worked. The state, through its Certificate of Need program, lost in its attempt to block Swedish Medical Center's Issaquah expansion, and it has no power to curtail free-standing EDs. A bid by Medicaid officials to cut nonemergency ED costs was derailed after physicians and hospitals sued. Bills by lawmakers targeting hospital expansion and accountability didn't pass last session, says the Times.

Results of a study that compared the effectiveness of 2 different volumes of resistance training (RT) combined with aerobic training in residential cardiac rehabilitation (CR) show that nearly doubling the volume of RT as part of a residential CR program does not yield further improvement in strength and cardiovascular risk factors.   

This randomized prospective cohort study, conducted at a center for inpatient CR, included 295 patients aged 62.7±11.7 (mean ± SD). Patients were randomly divided into 2 groups (group 1 and group 2) with different volumes of RT; 2 sets × 12 repetitions (group 1) and 3 sets × 15 repetitions (group 2) per session, 2 times per week. Each RT session consisted of 10 different resistance exercises. In addition, patients completed continuous moderate intensity aerobic training composed of cycle ergometry 6 times per week for 17±4 minutes and walking 5 times per week for 45 minutes.

At entry and after 26±4 days of CR, blood pressure, heart rate, maximal oxygen consumption, maximal power determined during cycle ergometry, strength determined via RT, and blood biochemistries were assessed. Data were analyzed via a 2-way (group × time) repeated measures analysis of variance.

Statistical analysis revealed equivalent improvements in exercise capacity, muscular strength, hemodynamics, and blood chemistries regardless of RT volume.

This article is available in the October issue of Archives of Physical Medicine and Rehabilitation.  

The United States Bone and Joint Initiative (USBJI) offers grant mentoring workshops that enable early-career basic and clinical investigators to work with experienced researchers in musculoskeletal research to assist them in securing funding and other skills required for pursuing an academic career.

This program is open to promising junior faculty, senior fellows, or postdoctoral researchers nominated by their department or division chairs. It also is open to senior fellows or residents who are doing research and have a faculty appointment in place or confirmed. Basic and clinical investigators, without or with training awards (including K awards), are invited to apply. Investigators selected to take part in the program attend 2 workshops, 12-18 months apart, and work with faculty between workshops to develop their grant applications. The unique aspect of this program is the opportunity for attendees to maintain a relationship with a mentor until their application is funded. 

The deadline to apply for the April 13-15, 2012, workshop in Toronto, Ontario, is January 15, 2012.

Last week, President Obama nominated Marilyn B. Tavenner to succeed Don Berwick, MD, who will step down as the administrator of the Centers for Medicare and Medicaid Services (CMS) at the end of this week.   

Obama nominated Berwick in April 2010, but he never received a Senate confirmation hearing. His temporary appointment was to expire at the end of the year. 

Tavenner, a nurse and former secretary of Virginia’s Department of Health and Human Resources who served as Berwick's principal deputy, is described as "more of a manager and less of a visionary" than Berwick, says an article in the New York Times. She has worked nearly 35 years in the health care profession, including almost 20 years in nursing, 3 years as a hospital CEO, and 10 years in various senior executive-level positions for Hospital Corporation of America. She served on the boards of the American Hospital Association and the Virginia Hospital Association.