APTA has posted summaries of recent notices from the Centers for Medicare and Medicaid Services (CMS) that update the payment rate used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) and for inpatient rehabilitation facilities (IRFs) for fiscal year 2013. The notices are effective October 1, 2012. Neither notice contains any substantive policy changes, and so there is no comment period for them.

For the SNF PPS, the overall economic impact of the payment update is an estimated $670 million in increased payments to SNFs during fiscal year 2013. The market basket increase factor is 2.5%, which is reduced by a 0.7% multi-factor productivity adjustment. The result is a payment percentage update of 1.8% for the year. The SNF summary is available to APTA members on the Medicare Payment and Policies for Skilled Nursing Facilities webpage under the "APTA Summaries" heading.

For the IRF PPS, the update provides a 1.9% net increase, resulting in an overall economic impact of $140 million during fiscal year 2013. The notice also includes the continued implementation of quality measures for IRF settings. The IRF summary is available to APTA members on the Medicare Payment and Policies for Hospitals webpage under the "Inpatient Rehabilitation/APTA Summaries" heading.

With the cost of employer-provided health care benefits at large US employers expected to rise another 7% next year, employers are considering a variety of cost-control measures, including asking workers to pay a greater portion of premiums but also sharply boosting financial rewards to engage them in healthy lifestyles, according to a new survey by the National Business Group on Health, a nonprofit association of 342 large employers.

Six in 10 employers plan to increase the percentage of the premium paid by employees in 2013, although the majority of those employers indicated that the increase would be by a small amount (less than 5%).

While many employers continue to adopt cost-sharing provisions, survey respondents now consider consumer-directed health plans (CDHPs) and wellness initiatives to be more effective at stemming cost than shifting costs to employees. According to the survey, 43% cited a CDHP as the most effective cost-control tactic followed by wellness programs (19%). Less than 1 in 10 (9%) respondents reported increased employee cost-sharing as the most effective tactic. Last year, cost shifting was cited as the most effective measure.

The survey found that employers continue to experiment with and perfect the best ways to incorporate financial incentives into wellness programs. While nearly half of respondents (48%) use incentives to encourage participation in programs, some employers are basing incentives on specific health outcomes. More than 4 in 10 (44%) provide an incentive based upon tobacco-use status while 29% base awards upon achievement of outcomes such as BMI or cholesterol levels. About 22% apply surcharges to employees who do not participate in certain programs.

Additionally, employers plan to sharply increase the incentive amount for maintaining a healthy lifestyle or participating in a wellness program. Among employers that offer incentives, the median amount employees can earn will jump 50% from $300 this year to $450 next year. The median incentive amount that dependents can earn is expected to increase from $250 this year to $375 in 2013.

The survey also found that employers are continuing to make adjustments to their benefit plans to comply with additional provisions of the health reform law. Half of all respondents (50%) indicated that they no longer have any annual benefit limits in place, while 32% reported that they did not make any changes to their annual limits this year. Among employers making changes for 2013, the most common benefits requiring adjustments to their annual limits were mental health and substance abuse (9%) and rehabilitative services and devices (9%).

The survey, based on responses from 82 of the nation's largest corporations, was conducted in June 2012 prior to the Supreme Court's announcement to uphold the health care reform law.

Six in 10 adults now get physical activity by walking, according to the Centers for Disease Control and Prevention (CDC). To enhance walking spaces and help more people become physically active, physical therapists can work with their community leaders to:

• Consider walking when creating long-range community plans.
• Consider designing local streets and roadways that are safe for people who walk and other road users.
• Create opportunities to let community residents use school tracks or gyms after school hours.
• Maintain existing sidewalks and walking paths.
• Promote walking paths with signs and route maps that are easy to read.

For more ideas on promoting walking in your community, visit CDC's website.