APTA's 2011 Annual Report now is available online. Read reports by APTA's president and treasurer, the House of Delegates, and components and check out the many accomplishments the association achieved last year. Year-end financial information also is available.    

Hear how 3 APTA members use the association's position Physical Therapy Model Benefit Plan (MBP) Design to ensure consumer access to physical therapy services in 2 new podcasts in a series on MBP.

Steve Levine, PT, DPT, MSHA, who has nearly 20 years of experience as a consultant to physical therapy providers, local and national third-party payers, regulators, and case management agencies, explains how standardizing coverage guidelines can help address issues such as under- or overutilization of services. Levine calls MBP "an effective tool to use with third-party payers, regulators, and health policy makers to ensure that coverage design meets the needs of all of the stakeholders who will be affected by the coverage policies enacted by those who control the physical therapy coverage benefit."  

Private practitioner Mick Bates, PT, uses MBP "to explain to my patients what 'good' coverage looks like when it comes to physical therapy so they can get the most of what they do have and negotiate for better coverage with their employers and carriers at renewal." Bates, who serves on the West Virginia Chapter's Reimbursement Committee, says the committee uses MBP as part of a tool kit for patients to file complaints with the insurance commissioner over coverage denials for medically necessary services. The committee also plans to use it in an upcoming meeting with the medical director and executive director of the Public Employees Insurance Association to negotiate for improved physical therapy coverage within the insurance plan for state employees.  

Hear more from Levine and Bates in Physical Therapy Model Benefit Plan Design: From Position to Practice, Part I.

In Part II, Carole Galletta, PT, MPH, insurance relations chair for the Pennsylvania Chapter, describes how the chapter uses MBP to educate payers and support its efforts aimed at reducing out-of pocket payments and separating physical therapy benefit limits from other disciplines. She says, "…I think MBP provides us with an opportunity to clarify just what physical therapists do, to enlighten payers with our definition of medically necessary care, to identify how excessive cost sharing limits patient access to care, and to emphasize how physical therapy services can reduce disability and clinical costs."   

Based on new evidence on the effectiveness and harms of primary care-relevant interventions to prevent falls in community-dwelling older adults, the US Preventive Services Task Force (USPSTF) recommends physical therapy or exercise and vitamin D supplementation to prevent falls in community-dwelling adults aged 65 years or older who are at increased risk for falls.

USPSTF does not recommend automatically performing an in-depth multifactorial risk assessment in conjunction with comprehensive management of identified risks to prevent falls in community-dwelling adults aged 65 years or older, because it says the likelihood of benefit is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of the circumstances of prior falls, comorbid medical conditions, and patient values.

In extensive comments to USPSTF, APTA commended the task force for "its focus on physical therapy and the role that it plays in reducing the societal burden that falls present as the number one cause of injury among adults ages 65 and older." APTA also stated that it was "deeply concerned with the statement that 'the benefit is small' for multifactorial risk assessments in Recommendation 2." The association added, "… we feel that the approach to quantifying the effect of the risk assessment is misrepresentative given the unique considerations for falls prevention evaluation. A risk assessment may, in fact, not be appropriate for every member of the population, but a falls screening as outlined by the American Geriatrics Society and British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons is an important consideration to justify those individuals for which a multifactorial risk assessment is very impactful."

The recommendations and supporting documents are posted on USPSTF's website.A summary for patients is available in Annals of Internal Medicine.  

APTA recently revised its Balance and Falls webpage, which includes a variety of patient care resources, consumer education materials, and links to CEU courses.

Poorer performance preoperatively on the Six-Minute Walk Test (6MW), Stair Climbing Test (SCT), and Timed Up and Go Test (TUG) was related to poorer performance in the same measure after total knee arthroplasty (TKA), say authors of a study designed to develop a preliminary decision algorithm predicting functional performance outcomes to aid in the decision of when to undergo TKA. Age and decreased mental health were secondary predictors of poorer performance at 6 months on the TUG and SCT, respectively. These measures may help further develop models that predict thresholds for poor outcomes after TKA, the authors add.

One hundred and nineteen patients undergoing primary unilateral TKA were evaluated before and 6 months after TKA. A regression tree analysis using a recursive partitioning function was performed with TUG time, 6MW distance, and SCT time as measured 6 months after TKA as the primary outcomes. Preoperative measures of functional performance, joint performance, anthropometrics, demographics, and self-reported status were evaluated as predictors of the primary outcomes 6 months after surgery.  

Individuals taking 10.1 or more seconds on TUG and aged 72 years or older before surgery had the poorest performance on TUG 6 months after surgery. Individuals walking less than 314 meters on 6MW before surgery had the poorest performance on 6MW 6 months after surgery. Individuals taking 17 or more seconds to complete SCT and scoring less than 40 on the SF-36 mental component score before surgery had the poorest performance on SCT 6 months after surgery.

APTA member Michael J. Bade, PT, is lead author of the article, which is published in Journal of Orthopaedic Research. APTA members Joseph A. Zeni, PT, PhD, Jennifer E. Stevens-Lapsley, PT, MPT, PhD, and Lynn Snyder-Mackler, PT, ScD, SCS, FAPTA, are coauthors.

A combination of mobile technology and remote coaching holds promise in encouraging healthier eating and physical activity, say researchers at the National Institutes of Health who examined the best way to change multiple health behaviors in adults. Free, full text of the article is available in Archives of Internal Medicine. 

The scientists studied 204 adults who were overweight or obese and had a diet high in saturated fat and low in fruits and vegetables. The participants also engaged in little daily physical activity and had high amounts of sedentary leisure time.

Each participant was assigned to 1 of 4 groups:

• increase fruit and vegetable intake and increase time in moderate/vigorous physical activity
• increase fruit and vegetable intake and reduce time in sedentary leisure activities
• decrease fat intake and increase time in moderate/vigorous physical activity
• decrease fat intake and decrease time in sedentary leisure activities

Participants received mobile devices and were trained on entering information about their daily activities and eating patterns. Coaches studied the data received and then phoned or e-mailed participants to encourage and support healthy changes during the 3-week study. Participants also were asked to continue to track and submit their data over a 20-week follow-up period. Financial incentives for reaching study goals during the study and continuing participation during the follow-up period were offered.

All 4 groups showed improvements in reaching the assigned health goals, with the most striking results occurring in the group asked to increase fruit and vegetable intake and reduce sedentary leisure activities. After 20 weeks, this group's average daily servings of fruits and vegetables increased from 1.2 to 2.9. The group's average minutes per day of sedentary leisure activity dropped from 219.2 to 125.7, and the percentage of saturated fat in daily calories went from 12 to 9.9.

"Via technology, we will soon be able to deliver fully automated and configurable multiple risk factor interventions that monitor progress continuously and can be delivered throughout the day every day," William T. Riley, PhD, says in accompanying commentary on the study. "It remains an empirical question, however, whether these technological advances improve outcomes, reduce costs, or both."

A model of care adopted in Australia, England, Israel, and Canada that allows patients who are chronically ill with acute medical problems to receive hospital services in their homes is gaining attention in the United States, says a Kaiser Health News article. 

Hospital-at-home programs fundamentally refashion care by "testing traditional notions of how services should be delivered when people become seriously ill." In most programs, physicians examine the patient daily, and nurses and aides visit up to 3 times a day, often for an extended period. Programs currently are offered by Presbyterian Healthcare Services in Albuquerque, New Mexico, and through the Veterans Health Administration in Portland, Oregon; Honolulu; Boise, Idaho; and New Orleans.

In a study of 3 hospital-at-home programs published in 2005 in Annals of Internal Medicine, researchers demonstrated that patient outcomes were similar or better, satisfaction was higher, and costs were 32% less than traditional hospitalizations. The programs in the study focused on people with 4 conditions—chronic obstructive pulmonary disease, congestive heart failure, pneumonia, and cellulitis.

Resistance from Medicare and private insurers is the biggest problem these programs face, the article says. Traditional fee-for-service Medicare does not pay for hospital-at-home services, although individual private Medicare Advantage plans may do so. 

In addition, physicians may find the new model of care intimidating. Starting a program requires a considerable up-front investment of time and money. Furthermore, "keeping beds full is a financial mandate for most hospitals." However, that may change as hospitals and physicians form accountable care organizations that call for providers to restructure how health care is delivered while participating in the financial rewards and risks of those changes, says the article.