The Centers for Medicare and Medicaid Services (CMS) issued updates today to the Medicare Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs) that include provisions that reduce regulatory burdens and help providers to operate more efficiently. CMS estimates that annual savings to hospitals from the final rule on CoPs could exceed $900 million in its first year.

CoPs are federal health and safety requirements ensuring high-quality care for all patients. Hospitals and CAHs must meet these conditions to participate in Medicare and Medicaid. The final rule includes the following provisions that provide more flexibility and recognize the key role of nonphysician practitioners, such as physical therapists, in providing care:

• Broadens the concept of "medical staff" to allow hospitals the flexibility to include other practitioners as eligible candidates for the medical staff with hospital privileges to practice in the hospital in accordance with state law. All practitioners will function under the rules of the medical staff.

• Allows hospitals the flexibility to use standing orders and requires that protocols must be based on nationally recognized and evidence-based guidelines and recommendations.

• Eliminates the requirement for authentication of verbal orders within 48-hours and defers to state law to establish authentication time frames.

• Makes permanent the previous temporary requirement that all orders, including verbal orders, must be dated, timed, and authenticated by either the ordering practitioner or another practitioner who is responsible for the care of the patient and who is authorized to write orders by hospital policy in accordance with state law.

A copy of the rule is available at this link.

In a final rule released today, the Centers for Medicare and Medicaid Services (CMS) has removed the outdated personnel qualifications language in the current Medicaid regulations and cross referenced them to the updated Medicare personnel qualifications for physical therapists and occupational therapists. (Personnel qualifications can be found under 42 CFR §484.4.)

The final rule has the potential to ensure that certain physical therapists are not excluded from providing services under Medicaid. In addition, it strengthens the consistency of standards across Medicare and Medicaid. APTA has worked since 2010 to eliminate the outdated qualifications.

Specifically, APTA is hopeful that today's rule is a major victory for many foreign-trained physical therapists, in states such as New York, who were previously considered qualified to treat Medicaid patients but were told around 2010-2011 that they were no longer considered qualified to provide services under Medicaid. 

In response to comments received regarding certain states that have excluded PTs from treating Medicaid patients due to being trained in foreign countries, CMS states in the final rule, “If practices at the State level are prohibiting individuals from meeting Medicaid qualifications, we suggest addressing those concerns with the State Medicaid Agency."

CMS' comments also stated that, although the Medicaid regulations are silent on the use of physical therapist assistants for Medicaid services, "States utilizing PT or OT assistants would be well served to follow the Medicare definition found at 42 CFR §484.4, to ensure consistency across programs."

Under Medicare, physical therapists are licensed providers in all states and physical therapist assistants are licensed providers in the majority of states. As licensed providers, the state practice act governs supervision requirements. Some state practice acts mandate more stringent supervision standards than Medicare laws and regulations. In those cases, the physical therapist and physical therapist assistants must comply with their state practice act.  More information can be found on APTA's Use of Physical Therapist Assistants (PTAs) Under Medicare webpage.  

The American College of Rheumatology (ACR) recently updated its 2000 recommendations for hip and knee osteoarthritis (OA) and developed new recommendations for hand OA. The guidelines include nonpharmacologic therapies, such as exercise supervised by a physical therapist for knee and hip OA.  

The guidelines, which use clinical scenarios representing patients with symptomatic hand, hip, and knee OA are based on the "best available evidence of benefit and safety/tolerability" of both nonpharmacologic and pharmacologic interventions, in addition to the consensus judgment of clinical experts from a wide range of disciplines. They are published in the April 2012 issue of Arthritis Care & Research.  

According to the Technical Expert Panel, patients with symptomatic knee and hip OA should be enrolled in an individualized exercise program commensurate with their ability to perform these activities. The panel also calls for the use of thermal agents and manual therapy in combination with exercise supervised by a physical therapist.

Because there were few high-quality randomized controlled trials of interventions for hand OA published in the peer-reviewed literature, the panel made no strong recommendations for this indication. However, the panel recommends that all patients with hand OA be evaluated by a health professional, either their primary care provider or a physical therapist or occupational therapist for their ability to perform activities of daily living. Based on the evaluation, patients could receive assistive devices as necessary, instruction in joint protection techniques and in the use of thermal agents for relief of pain and stiffness. 

APTA members G. Kelley Fitzgerald, PT, PhD, and Carol A. Oatis, PT, PhD, served on the panel. 

Free, full text of the guidelines is available from ACR.

During Women's Health Week, which is celebrated May 13-19, APTA is partnering with its Section on Women's Health to build awareness of women's health issues that can be prevented and treated by a physical therapist with its #overshare initiative. APTA will host a 1-hour program on Move Forward Radio and a Twitter party, both on May 15 at 7 pm ET. Women across the country can listen online and call the show to ask questions or submit them in advance via Twitter by tweeting @MoveForwardPT and using the hashtag #overshare. APTA members Pamela Downey, PT, DPT, WCS, of Miami and Rebecca Stephenson, PT, DPT, WCS, of Medfield, Massachusetts, and Los Angeles gynecologist Judith Reichman, MD, author of Slow Your Clock Down: The Complete Guide to a Younger, Healthier You, will discuss women's health issues, covering everything from incontinence and pregnancy to fitness and bone health. APTA also has published a free, downloadable e-book, Women’s Health Across the Lifespan, to support the initiative, which will be available the day of the show at www.moveforwardpt.com/womenshealth. Read more about the initiative in the press release. 

APTA responded to FoxNews.com regarding a May 2 article, "How can chiropractors benefit your health?" in which Keith Overland, president of the American Chiropractic Association, said that chiropractic treatment may include "combinations of chiropractic manipulation, physical therapy, and rehabilitative procedures for many musculoskeletal problems." APTA tells Fox News, "'Physical therapy' is not a generic term. It describes only those services provided by a licensed physical therapist. Chiropractors may provide some of the same treatment modalities as physical therapists, but they should portray their services as chiropractic and not as 'physical therapy.'" 

Patients who received physical therapy early after an episode of acute low back pain had a lower risk of subsequent medical service usage than patients who received physical therapy at later times, say authors of an article published April 20 in Spine. Medical specialty variations exist regarding early use of physical therapy, with potential underutilization among generalist specialties, they add.  

For this retrospective cohort study, the authors analyzed a national sample of the Centers for Medicare and Medicaid Services' physician outpatient billing claims. Patients were selected who received treatment for low back pain between 2003 and 2004 (n = 439,195). To eliminate chronic low back conditions, patients were excluded if they had a prior visit for back pain, lumbosacral injection, or lumbar surgery within the previous year. Main outcome measures were rates of lumbar surgery, lumbosacral injections, and frequent physician office visits for low back pain during the following year.

Based on logistic regression analysis, the adjusted odds ratio for undergoing surgery in the group of enrollees that received physical therapy in the acute phase (<4 weeks) compared with those receiving physical therapy in the chronic phase (>3 months) was 0.38, adjusting for age, sex, diagnosis, treating physician specialty, and comorbidity. The adjusted odds ratio for receiving a lumbosacral injection in the group receiving physical therapy in the acute phase was 0.46, and the adjusted odds ratio for frequent physician office usage in the group receiving physical therapy in the acute phase was 0.47.

APTA member Charles R. Scoville PT, DPT, recently was named a finalist for a Samuel J. Heyman Service to America Medal—an award that pays tribute to America's dedicated federal workforce. Honorees are chosen based on their commitment and innovation, in addition to the effect of their work on addressing the needs of the nation.

Scoville, who served in the US Army for 29 years, is chief at Amputee Patient Care at Walter Reed National Military Medical Center. Established in 2003, the program has helped service members with amputation lead active lives, with some returning to duty, through a novel sports medicine approach. The internationally recognized program combines traditional medical and counseling services with a physically active regime for severely wounded service members.

According to an announcement in this week's Washington Post, some of the 1,450 injured service members who have been through the program have gone on to complete triathlons, climb Mount Everest, and compete in gymnastics, skiing, rowing, and other sports.

The Mayo Clinic recently joined with www.theheart.org to provide the latest news and events in the world of cardiology. The Mayo Clinic webpage provides video forums in which Mayo Clinic faculty dissect the latest trials and trends in research and patient care, a new podcast series addressing cardiology issues, the latest thoughts and reflections from the leaders of the Mayo Clinic's heart program, and a set of links to valuable Mayo Clinic resources.

The Foundation for Physical Therapy now is accepting applications for the 2012 Florence P. Kendall Doctoral Scholarships, the 2012 Foundation Research Grant, and the 2012 Magistro Family Foundation Research Grant.

The application requirements and structures for these opportunities have been updated. Be sure to review all guidelines and instructions carefully before beginning an application.

The deadline for all applications is August 15, noon, ET. E-mail the Foundation or call 800/875-1378 with questions.