APTA illustrates several ways that the home health prospective payment system (HH PPS) can be revised to better reflect the role of physical therapists in home health, as well as bolster clinically appropriate practice patterns that improve quality of care and lower growth in expenditures, in comments submitted on September 4 to the Centers for Medicare and Medicaid Services (CMS). 

APTA's remarks focus heavily on therapy coverage requirements. While calling on CMS to begin the work of developing an alternative payment system for therapy services under the Medicare home health benefit, the association makes specific interim recommendations to alleviate the burdens associated with missed reassessment visits and alter provisions regarding coverage of compliant therapy disciplines and visit ranges.

In response to CMS' quality reporting proposal, APTA advocates for the alignment of HH measures with current measures under the inpatient prospective payment system. Specifically, the association asks that CMS apply consistent measures regarding emergency department use and readmissions.

Recognizing CMS' commitment to ensuring that home health payments are accurate and are not unduly influenced by practices not associated with changes in the patient's condition, APTA recommends that the agency find alternative ways to account for these nominal case-mix changes that do not impose further cuts to HH PPS.

Finally, APTA urges CMS to finalize its proposal to provide more flexibility in the physician face-to-face requirement. 

The Department of Veterans Affairs (VA) has amended its regulations to provide veterans with mobility, visual, or hearing impairments benefits to support the use of a service dog as part of the management of these impairments. The benefits include assistance with veterinary care, travel benefits associated with obtaining and training a dog, and the provision, maintenance, and replacement of hardware required for the dog to perform the tasks necessary to assist the  veterans.

APTA will provide a summary of the final rule on service dogs on its website shortly.

Researchers from McMaster University are seeking physical therapist (PT) participants for an 18-month study on Pain PLUS, a new free information service for evidence-based pain management. The purpose of this study is to compare 2 different methods of sharing pain research evidence, as well as the knowledge and decisions made by 4 different types of professionals—physicians, nurses, rehabilitation professionals, and psychologists—involved in pain management. One method of sharing will be sending e-mail alerts. The other method will be providing web-based resources. All participants will have access to both services for 9 months each.

For more information on Pain PLUS and how you can participate in this study, contact Margaret Lomotan at lomotam@mcmaster.ca or 905/525-9140, ext 27328, or visit http://plus.mcmaster.ca/PainPLUS/.

Despite evidence of the positive effect that exercise can have on cancer care and recovery, many patients with cancer are reluctant to exercise and few discuss it with their oncologists, according to a Mayo Clinic study published in the Journal of Pain and Symptom Management.

The study is part of a series of investigations looking at exercise habits among patients with cancer. For this investigation, researchers qualitatively analyzed semistructured interviews with 20 adults (half male and half aged 65 years or older) with Stage IIIB or IV nonsmall cell lung cancer. Participants were questioned about their levels of activity, the influence of their symptoms on their activities, perceived barriers and facilitators for exercise, and exercise-related instructions received from their professional caregivers.

"Participants overwhelmingly cited usual daily activities as their source of 'exercise,'" say the authors. Symptoms, particularly treatment-related, discouraged participation, with fear of harm being a significant concern only among younger women. Participants recognized exercise as important for physical and mental well being but seldom as a means to mitigate symptoms. Although respondents said they preferred to receive guidance from their oncologist, none reported receiving more than general encouragement to "stay active." Participants accepted a lack of direction as approval of their current activity levels. Additionally, participants appeared less receptive to guidance from ancillary health professionals, say the authors.

Non-US citizens under age 31 who have resided in the US and have been granted temporary relief under the Department of Homeland Security's June 15 Deferred Action for Childhood Arrivals (DACA) process will not be eligible for Pre-Existing Condition Insurance Plan (PCIP) coverage pending their removal determination.   

Last week, the Department of Health and Human Services (HHS) released a clarifying amendment to the interim final rule on the PCIP program. This amendment, effective immediately, revises the definition of "lawfully present" that was codified in the interim final regulation  on PCIPs (published July 30, 2010) to exclude this group from PCIP participation. 

The Affordable Care Act (ACA) prohibits non-grandfathered health insurance coverage issuers from denying health care coverage or inflating health insurance rates based on preexisting conditions. This section of the ACA takes effect in 2014, at which time coverage will be made available through the Affordable Health Insurance Exchanges. In the interim, ACA directs states or nonprofit entities to establish temporary high-risk health insurance pool programs to cover eligible US citizens with preexisting conditions.

The Centers for Medicare and Medicaid Services (CMS) will hold a special open door forum on the manual medical review of therapy claims September 5, 2 pm-3:30 pm, ET. If you wish to participate, dial 877/251-0301 and enter conference ID 23782155. This announcement and full participation instructions are available on CMS' website.

In the United States, September is associated with returning to school. This month's PTJ provides many opportunities for physical therapy educators to refer to outstanding research, says Editor in Chief Rebecca Craik, PT, PhD, FAPTA, in her monthly Craikcast podcast. Craik also urges faculty and students to listen to the 43^rd Mary McMillan Lecture, "Face the Storm," presented by Alan Jette, PT, PhD, FAPTA, in June at APTA's annual conference. 

Research topics in the September issue include predictors of chronic nonspecific low back pain, physical activity after total knee replacement, prevalence of McKenzie's classification categories among patients with extremity problems, walking activity in people poststroke compared with older adults without disability, and the use of electromagnetic fields used in stem-cell tissue engineering. Full text and a podcast of the 2012 APTA Presidential Address, delivered by R. Scott Ward, PT, PhD, also are available.   

Following an investigation and the issuance of new guidelines, the US Army has awarded nearly 1,000 Purple Hearts to soldiers who sustained concussive injuries in Iraq and Afghanistan, says an article by NPR.  

In 2010, NPR reported that some Army commanders and physicians "belittled" concussions and commanders "refused to award the Purple Heart to many soldiers who got concussions in combat because they didn't consider these 'real' injuries."

In August 2011, the US Army released a statement encouraging active-duty and reserve-component soldiers, as well as veterans, who were denied Purple Heart awards for concussive or mild traumatic brain injuries (MTBIs) to resubmit documentation for reconsideration of the medal. The statement says that since the Vietnam War, concussions and MTBIs as a direct result of an enemy action have warranted the award of the Purple Heart. "Nevertheless, field commanders have sometimes been unclear on what constituted concussion." With medical advances in the treatment and knowledge of concussion and MTBIs injuries, the Army says it now can "further identify the characteristics of the unseen wound and clarify guidance for entitlement to the Purple Heart."  

The new guidelines are "dry and technical," says NPR. But the message is: If a soldier is diagnosed with a concussion from an enemy explosion and he or she received treatment, then he or she deserves the Purple Heart.

However, with studies suggesting that tens of thousands of troops sustaining concussions in Iraq and Afghanistan, it looks like only a small portion of them have applied for Purple Hearts under the new guidelines. "Veterans advocates say that maybe most of those soldiers never got an official diagnosis, or maybe they don't know about the new guidelines. Or maybe they know about the guidelines, but they don't have the will to go through the red tape," says NPR.  

For information on programs that work collaboratively to provide and improve traumatic brain injury care for active duty military, veterans, and their eligible beneficiaries, visit APTA's Management of Wounded Warriors webpage. 

To help America's children develop healthy habits that can last a lifetime, health care providers, parents and caregivers, educators, and community leaders are encouraged to use the Department of Health and Human Services' (HHS) resources available through the President's Council on Fitness, Sports and Nutrition, Centers for Disease Control and Prevention, National Institutes of Health's We Can!! (Ways to Enhance Children’s Activity & Nutrition)® program, and Let's Move! initiative.

In addition, several new public-private partnerships are being launched across the nation to ensure that all kids experience the positive health benefits of daily physical activity and healthy eating. For example, the Partnership for a Healthier America and Olympic Team USA's recently committed to provide 1.7 million kids the opportunity to participate in free and low cost physical activity programs offered by the United States Olympic Committee (USOC), USOC National Governing Bodies for sport, and others over the next year.

Over the past 30 years, the childhood obesity rate in America has almost tripled. According to the CDC, in 2010, approximately 17% of children and adolescents aged 2-19 years were already obese.

According to the 2008 Physical Activity Guidelines for Americans, children and adolescents aged 6-17 years should spend 60 minutes or more being physical active each day.