In a rule issued today, the Department of Health and Human Services (HHS) made final a 1-year proposed delay—from October 1, 2013, to October 1, 2014—in the compliance date for use of ICD-10 codes.

The rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013—a delay of 2 years from the compliance date initially specified in the 2008 proposed rule. In February, HHS announced it would postpone the 2013 deadline in an effort to address the provider community's concerns about administrative burdens. In April, HHS proposed the transition be delayed until October 2014.  

Today's final rule also establishes the standard for a national unique health plan identifier and a data element that will serve as an "other entity" identifier. This is an identifier for entities that are not health plans, health care providers, or individuals, but that need to be identified in standard transactions. The rule also specifies the circumstances under which an organization-covered health care provider, such as a hospital, must require certain noncovered individual health care providers who are prescribers to obtain and disclose a National Provider Identifier.

APTA's ICD-10 webpage has resources to help physical therapists understand the transition to the new code set.

Yesterday the Department of Health and Human Services released final rules related to electronic health records (EHR) and health information technology (HIT). While at this time physical therapists are not directly affected by the rules related to meaningful use under Medicare and Medicaid, they should remain aware of issues relating to HIT technology, particularly in this dynamic health care delivery environment.

The final rule on Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 2 specifies the necessary criteria eligible professionals (EP) and eligible hospitals (including critical access hospitals) must meet to receive incentive payments for achieving Stage 2 meaningful use requirements with their certified EHR systems. The rule also specifies payment adjustments for entities and providers that do not meet meaningful use requirements and other program requirements. Physical therapists are not yet defined as eligible professionals for demonstrating meaningful use and, therefore, are not subject to these payment adjustments for failing to demonstrate meaningful use. Certain criteria previously specified in regulations have also been revised, including certain Stage 1 criteria, such as allowing "states the option for their providers to calculate total Medicaid encounters or total needy individual patient encounters in any representative, continuous 90-day period in the 12 months preceding the EP or eligible hospital's attestation" for those participants in the Medicaid Incentive Program.

The second rule relating to EHR certification criteria identifies the implementation specifications and other technical standards that EPs' and hospitals' EHR systems must meet to be deemed certified for supporting meaningful use requirements. These systems must be capable of meeting these standards and specifications, at a minimum, by fiscal and calendar year 2014 to be able to support eligible entities in achieving their meaningful use requirements. Additionally, the rule revises the HIT permanent certification and changes the name to the ONC HIT Certification Program. This final rule is titled Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology.   

APTA will post summaries of both rules on the APTA website at a later date.

While physicians and hospitals are the beneficiaries of many of the federal government's initial efforts to encourage EHR system adoption, they will expect the other providers they work with, including physical therapists, to implement it as well. Patients also may begin to expect their providers to use EHRs to manage their care. Visit APTA's HIT webpage for resources and updates on HIT program development and legislation, as well as APTA's related advocacy efforts.

The American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) recently approved the APTA Education Leadership Institute (ELI) Fellowship as the first nonclinical credentialed postprofessional fellowship program. Official commencement of this prestigious credential begins August 31and will continue for a period of 5 years. The 2012 inaugural graduating class from the Education Leadership Institute will receive the designation of Fellow of the APTA Education Leadership Institute. The Education Leadership Institute will be recognized by ABPTRFE as a credentialed fellowship at APTA's 2013 Combined Sections Meeting in San Diego.

Applications for the class of 2013-2014 will be available on APTA's website on October 1, with the submission deadline on January 4, 2013, at 5 pm ET.

The Centers for Medicare and Medicaid Services (CMS) has posted a list on its website assigning providers to 1 of 3 phases for manual medical review when outpatient therapy services exceed $3,700. The list identifies phase I and phase II providers by their National Provider Identifier; those who do not appear on the list are included in phase III. The phases delineate the time frames during which the providers would be required to obtain advanced approval from their Medicare Administrative Contractor (MAC) in order to receive coverage for outpatient therapy services beyond $3,700.

• Phase I providers:  Subject to manual medical review October 1-December 31, 2012.

• Phase II providers:  Subject to manual medical review November 1-December 31, 2012

• Phase III providers:  Subject to manual medical review December 1-December 31, 2012.

Additional information regarding the therapy cap and the manual medical review process is available on APTA's website. CMS also provides a fact sheet and question-and-answer document regarding the process. MACs are expected to issue additional information about the process in the near future.

MoveForwardPT.com, APTA's official consumer information website, will host a series on concussion in sports called "Head in the Game." The series will premiere on Move Forward Radio on August 27 and culminate with a live broadcast on August 29 at 3 pm ET. Experts will discuss the latest advances in evaluation and treatment of sports concussions, and a physical therapist's role on the concussion management team. Listeners also will hear from a former NFL player who was forced to retire after suffering multiple concussions.

APTA will conduct targeted media outreach to local and national sports reporters at print, broadcast, and online outlets. For more information about the series and the guests, view the press release.

The "Head in the Game" series lineup is as follows:

• August 27, 10 am ET, prerecorded interview with Chris Miller, NFL quarterback, 1987-1995, 1999.

• August 28, 10 am ET, prerecorded interview with APTA member Anne Mucha, PT, MS, NCS. 

• August 29, 3 pm ET, live show with Kevin Guskiewicz, PhD, ATC, FACSM, and APTA member Mike Ryan, PT, ATC.

The level of evidence supporting workplace ergonomic design or training interventions, or both, for the prevention of work-related upper limb and neck musculoskeletal disorders (MSDs) ranges from moderate to very low quality, according to authors of a meta-analysis published online in Cochrane Database of Systematic Reviews. However, given there were multiple comparisons made involving a number of interventions and outcomes, the authors say that high-quality evidence is needed to determine the effectiveness of these interventions clearly.

The authors searched 13 databases for randomized controlled trials (RCTs) of ergonomic workplace interventions for preventing work-related upper limb and neck MSDs. They included only studies with a baseline prevalence of MSDs of the upper limb or neck, or both, of less than 25%.

Two review authors independently extracted data and assessed risk of bias. They included studies with relevant data that they judged to be sufficiently homogeneous regarding the intervention and outcome in the meta-analysis. They assessed the overall quality of the evidence for each comparison using the GRADE approach.

Thirteen RCTs (2,397 workers) were included in the analysis. Eleven studies were conducted in an office environment and 2 in a health care setting. The authors judged 1 study to have a low risk of bias. The 13 studies evaluated effectiveness of ergonomic equipment, supplementary breaks or reduced work hours, ergonomic training, a combination of ergonomic training and equipment, and patient lifting interventions for preventing work-related MSDs of the upper limb and neck in adults.

Overall, there was moderate-quality evidence that arm support with an alternative mouse reduced the incidence of neck/shoulder disorders (risk ratio [RR] 0.52) but not the incidence of right upper limb MSDs (RR 0.73), and low-quality evidence that this intervention reduced neck/shoulder discomfort (standardized mean difference (SMD) -0.41) and right upper limb discomfort (SMD -0.34). There also was moderate-quality evidence that the incidence of neck/shoulder and right upper limb disorders were not reduced when comparing alternative mouse and conventional mouse (neck/shoulder RR 0.62; right upper limb RR 0.91), arm support and no arm support with conventional mouse (neck/shoulder RR 0.67; right upper limb RR 1.09), and alternative mouse with arm support and conventional mouse with arm support (neck/shoulder RR 0.58; right upper limb RR 0.92). There was low-quality evidence that using an alternative mouse with arm support compared with conventional mouse with arm support reduced neck/shoulder discomfort (SMD -0.39). There was low- to very low-quality evidence that other interventions were not effective in reducing work-related upper limb and neck MSDs in adults.

The World Confederation for Physical Therapy (WCPT) is recruiting for its International Scientific Committee (ISC) for WCPT Congress 2015. Physical therapists who are APTA members are encouraged to submit applications to serve as a member of the ISC or ISC chair.

Qualifications; responsibilities; essential and desired experience, knowledge and skills, and attributes; and terms of reference can be found in the call for applications for ISC chair and ISC members. 

Applications must be supported by a WCPT member organization, region, or subgroup. To obtain a letter of support from APTA, PTs should send their CV and letter of application addressing the specifications outlined in the call to Rene Malone, APTA senior research coordinator, by 5 pm ET on September 5. 

Women who exercise 1-2 times a week are less likely to report low back pain and depression, say authors of a study that followed 3,482 pregnant women in Norway. Women exercising 3 or more times a week during pregnancy are less likely to report pelvic girdle pain and low back pain, although the result for low back pain was not found to be significant. Despite these benefits, few women follow current exercise prescriptions for exercise in mid-pregnancy, the authors add.    

The authors collected data by questionnaire in pregnancy weeks 17-21, pregnancy week 32, and at birth. Only 14.6% of the respondents followed the current exercise prescription for exercise during pregnancy (3 or more times a week for at least 20 minutes at moderate intensity). One-third of the study sample exercised less than once a week at pregnancy weeks 17-21. Women who exercised at least once a week at mid-pregnancy were more often primiparous, higher-educated, and less likely to have a prepregnacy body mass index of greater than 30 kg/m² than women exercising less than once a week.

The study is published online in British Journal of Sports Medicine. 

APTA's consumer e-book, Women's Health Across the Lifespan, and an APTA video explain how PTs can help pregnant women with low back pain. Share these and other women's health resources with your patients by linking to Move Forward from your website.     

The Congressional Budget Office (CBO) reduced its spending forecasts yesterday from earlier this year for Medicare by $19 billion for 2012 and by $169 billion over the coming decade, projecting total spending at $7.7 trillion for the 10 years ending in 2022, according to Reuters. 

The change reflects lower spending growth for physicians, hospitals, and prescription drugs since the US economy went into recession in 2007. CBO states the slower growth of Medicare is "consistent with slower growth in health care costs more generally in the economy." This is the third consecutive year that CBO has reduced its forecasts for Medicare spending, says the article.

CBO also predicted that Medicaid would also spend less money--$375 billion or 7% less than expected over the coming decade. This projection changed largely as the result of the Supreme Court's decision allowing states to choose whether or not to expand eligibility for coverage under their Medicaid programs.