This month's PTJ includes several articles that illustrate clinical decision making by physical therapists, highlighting opportunities for screening and referral and for screening and thoughtful clinical intervention. Hear Editor in Chief Rebecca Craik, PT, PhD, FAPTA, summarize articles on direct access, exercise prescription for fall prevention, using the six-minute walk test for people with traumatic brain injury, hippotherapy for children, and more in her latest Craikcast.  

The May issue also includes 2 engaging case reports and a health policy perspective on the role of physical therapists in smoking cessation.

Getting adequate physical activity, maintaining a healthy weight, and eating a healthy diet can reduce the chance of recurrence of many cancers and increase the likelihood of disease-free survival after a diagnosis, say new guidelines from the American Cancer Society. The guidelines encourage survivors to aim to exercise for at least 150 minutes per week, and to include strength training exercises at least 2 days per week. 

The society has issued previous reports outlining the evidence on the effect of nutrition and physical activity on cancer recurrence and survival. However, this is the first time the evidence has been strong enough to release formal guidelines for survivorship. For this report, a group of experts in nutrition, physical activity, and cancer survivorship evaluated the scientific evidence and best clinical practices related to optimal nutrition and physical activity after the diagnosis of cancer. Among the review's conclusions:

• Evidence strongly suggests that exercise is not only safe and feasible during cancer treatment, but that it can also improve physical functioning, fatigue, multiple aspects of quality of life, and may even increase the rate of completion of chemotherapy.
• Physical activity after cancer diagnosis is associated with a reduced risk of cancer recurrence and improved overall mortality among multiple cancer survivor groups, including breast, colorectal, prostate, and ovarian cancer.
• Among breast cancer survivors, physical activity after diagnosis has consistently been associated with reduced risk of breast cancer recurrence and breast cancer-specific mortality.

The recommendations also include specific guidance for people diagnosed with breast, colorectal, endometrial, ovarian, lung, prostate, head and neck, and hematologic cancers. It also includes a section with answers to common questions about alcohol, organic foods, sugar, supplements, and several other areas of interest.

Free, full text of Nutrition and Physical Activity Guidelines for Cancer Survivors is available online in CA: A Cancer Journal for Clinicians. 

In recognition of Older Americans Month, the Department of Health and Human Services urges older Americans to stay active, take care of their health, and be involved in their communities. This year's theme Never Too Old to Play encourages older adults to maintain their health by taking advantage of Medicare's preventive benefits that include a yearly wellness visit, tobacco use cessation counseling, and a range of free screenings for cancer, diabetes, and other chronic diseases.

Visit the Older Americans Month website for resources and tools to help plan and promote events and activities honoring older Americans this month.

The Centers for Medicare and Medicaid Services (CMS) today issued a long-awaited transmittal (2457) implementing certain provisions of the Middle Class Tax Relief and Job Creation Act of 2012 (HR 3630) related to the therapy cap.

Physical therapists should be aware of the following dates and requirements: 

• Starting October 1, 2012, the cap will be applied to hospital outpatient settings until December 31, 2012. Critical access hospitals are excluded from the cap.
• Claims processing requirements associated with the cap will apply to hospitals on/after October 1, 2012 (eg, the exceptions process using the KX modifier). However, in calculating the dollar amount accrued toward the cap beginning October 1, 2012, claims paid for hospital outpatient therapy services since January 1, 2012, will be included.
• Contractors will provide the total amount accrued toward the therapy cap on all applicable screens and inquiry mechanisms.
• Claims for services above the therapy cap for which an exception is not granted will be considered a benefit (statutory) denial, and therefore the beneficiary will be liable for payment for the services. It is advisable as a courtesy (but not mandatory) for the provider to give the patient an Advance Beneficiary Notice (ABN) in circumstances for which the patient may need to pay out of pocket.
• Starting October 1, 2012, providers must identify on the claim form the physician/NPP certifying the therapy plan of care in the “referring provider” field. Claims processing instructions will indicate where this information is to be reported on the claim form. Claims will be returned as unprocessable if this information is not included.

CMS will issue a Medlearn Matters article on these instructions shortly.

Transmittal 2457 does not provide information on the medical review process. CMS is still in the process of determining how to proceed with implementation of manual medical review for claims that exceed $3,700.

Patients in Alabama will soon be able to be evaluated and, in certain cases, treated by physical therapists (PTs) without first having to obtain a physician referral. With the enactment of Alabama House Bill 163, Alabama becomes the 47th state to achieve some form of direct access. 

HB 163, sponsored by state Rep Ed Henry and signed by Gov Robert Bentley yesterday, goes into effect July 1. Prior to implementation of HB 163, PTs were prohibited from performing a physical therapy evaluation unless the patient had a referral. The new law provides for direct access to evaluation, fitness, wellness, and prevention services, and for treatment under certain conditions.

The legislation, which faced significant opposition, primarily from physician groups, is the culmination of many years of difficult work by the Alabama Chapter. Despite numerous obstacles, fierce and well-financed opponents, and the devastation of the April 27, 2011, tornado, the chapter was able to obtain a compromise from opponents on the bill that allowed its passage by the legislature. Per APTA's Strategic Plan, the chapter was provided direct access grants in 2011 and 2012 from the association.

Read more about the chapter's advocacy efforts in APTA's press release.

Emmett Parker, PT, MS, ATC, legislative chair for the Alabama Chapter, addresses attendees at a rally in 2011 at the Alabama State House in support of direct access to physical therapist services. 

APTA encourages physical therapist members to consider serving on a Federation of State Boards of Physical Therapy (FSBPT) examination committee. Under the 1989 Transfer Agreement of the physical therapy licensing examination and a more recent settlement agreement, APTA is entitled to seat candidates for at least 40% of the positions on the FSBPT Examination Development Committees. This year APTA will be providing 1 nominee for the Examination Development Committee-PTA (EDC-PTA), and 1 nominee for the Item Bank Review Committee-PT (IBRC-PT).

APTA nominees to all committees must be physical therapists and active APTA members. Experience as National Physical Therapy Examinations (NPTE) item writers or American Board of Physical Therapy Specialties (ABPTS) writers is desired but not required. For the EDC-PTA, the nominees must have expertise in neuromuscular, cardiovascular/pulmonary, musculoskeletal, or pediatrics; for the IBRC-PT, the nominees must have expertise in pediatrics, musculoskeletal or neuromuscular.

To apply for nomination, complete and submit a Personal Information Form and a current résumé/CV by May 30 to Brandy Bradley in the Clinical Practice Department.