In comments sent Tuesday to the Centers for Medicare and Medicaid Services (CMS) on the proposed 2013 Medicare physician fee schedule, APTA recommends multiple revisions to CMS' plan for collecting information on beneficiaries' functional limitations as part of payment reform. "While APTA strongly supports gathering information to develop an alternative to the current arbitrary payment limits (or "caps") on Medicare therapy services," the association says, "… CMS's proposal is overly complex and burdensome and may not result in the collection of meaningful and accurate patient information that could be used to develop an alternative payment system."   

Following the July 6 release of the proposed rule, APTA immediately began communicating with various stakeholder groups, including the American Hospital Association, the American Occupational Therapy Association, the American Speech-Language-Hearing Association, American Stroke Association, and APTA components about CMS' intention to require therapists to report patients' functional limitations. In a meeting with CMS officials on August 27, APTA urged the agency to keep this particular provision as simple as possible to ensure that the requirements are not excessively onerous for physical therapists and do not cause delays in payment for therapy services.    

Specifically, APTA recommends that therapy associations and organizations and CMS collaborate to develop core items in the future that could be used in any tool to standardize data collection. Instead of reporting on primary and secondary functional limitations as described in the rule, APTA recommends that therapists report the information regarding the patient's functional limitation using 1 of 4 specific categories and that CMS establish another G code that would be the "catch all" for functional limitations that do not fit into the 4 categories. Additionally, the association urges against the collection of goal data at this time, comments on the 12-level severity scale, and suggests changes to the proposed frequency of reporting. APTA also provides CMS with a detailed outline of how the agency could implement claims-based therapy data collection in 3 phases that would "decrease provider burden, while still providing CMS with some useful beneficiary information regarding functional limitations." 

APTA also remarks on the proposed 27% percent reduction in the Medicare physician fee schedule conversion factor, prepayment review, and the therapy cap. The association comments extensively on the extension and implementation of the Physician Quality Reporting System (PQRS)—voicing its concern over the use of 2013 data to inform the 2015 payment adjustments given the continued low participation rates and overall lack of awareness of programmatic changes to PQRS. 

This week APTA responded to 4 specific questions posed by the Centers for Medicare and Medicaid Services (CMS) in its proposed rule for Medicare hospital outpatient prospective and ambulatory surgical center payment systems (OPPS) for calendar year 2013.   

The questions are in relation to implementation of the Medicare Part A to Part B Rebilling Demonstration. In this demonstration, participating hospitals are allowed to receive 90% of the allowable Part B payment for Part A short-stay claims that are denied on the basis that the inpatient admission was not reasonable and necessary. The hospitals can rebill denied Part A claims as Part B services and be paid additional reimbursement when an inpatient admission is found not reasonable and necessary. CMS' questions involve setting parameters regarding the amount of time a patient can remain on observation status, establishing specific clinical criteria for admission and payment, aligning hospital payment rates more closely with the resources used to provide outpatient care, and having case management and utilization review staff available in hospitals outside of regular business hours to improve the accuracy of admission decisions. 

Additionally, APTA notes its support for 3 proposed changes to the IRF Quality Reporting Program. The changes seek to harmonize the processes for the maintenance of technical specifications and measure removal from the IRF quality program with other quality reporting programs such as those in inpatient hospital settings.

Individuals with knee osteoarthritis, regardless of the involvement of 1 or both knees, perform and perceive their functional ability similarly, say authors of an article published online in Arthritis Care & Research. This suggests that clinicians need to consider other factors, such as how long the disease has been progressing or how functional abilities have changed, when treating patients with knee osteoarthritis, the authors add.  

The functional abilities of patients with symptomatic and radiographic diagnosed unilateral (N=84) or bilateral (N=68) knee osteoarthritis were evaluated with self-reports and performance-based tests. Self reports included the Knee Outcome Survey, Global Rating Scale, and Physical Component of Short Form-36; functional tests included Timed Up-and-Go, Stair Climbing Test, and 6-Minute Walk. Separate MANOVAs were performed separately for men and women to determine if perception (self-reports) and performance (functional tests) were dependent on the number of involved knees.

No significant main effects were observed in functional performance between groups for either sex. Similarly, the perception measures did not differ between groups. In general, individuals diagnosed with unilateral and bilateral knee osteoarthritis both performed functional tasks and perceived their functional ability similarly.

APTA members Joseph A. Zeni, PT, PhD, and Lynn Snyder- Mackler, PT, ScD, SCS, FAPTA, coauthored the article.

The National Football League (NFL) will donate $30 million to the Foundation for the National Institutes of Health in support of research on serious medical conditions prominent in athletes and relevant to the general population.

With this contribution, NFL becomes the founding donor to a new Sports and Health Research Program, which will be conducted in collaboration with institutes and centers at the National Institutes of Health (NIH). Specific plans for the research to be undertaken remain to be developed, but potential areas under discussion include concussion; chronic traumatic encephalopathy; the potential relationship between traumatic brain injury and late life neurodegenerative disorders, especially Alzheimer disease; chronic degenerative joint disease; the transition from acute to chronic pain; sudden cardiac arrest in young athletes; and heat and hydration-related illness and injury.

The announcement of the philanthropic gift, the largest that NFL has given in the league's 92-year history, coincides with the release of a study that found that professional football players are more likely to die from neurological disorders than other men.

The study, published online in Neurology, looked at death rates for more than 3,400 pros who played for at least 5 years from 1959 to 1988. For players in speed positions, such as quarterback, running back, and linebacker, death rates for Alzheimer disease and amyotrophic lateral sclerosis combined were 4 times higher than for men in the general population, says a HealthDay News  article. The researchers also looked at death rates for Parkinson disease but found no difference from the general population.

While the study appears to support recent research showing an increase of diseases that damage brain cells among football players, it does not prove that playing pro ball is the cause. Other factors, including the football field surface and looser safety guidelines during the study period, may have played a role, experts say.

Also, chronic traumatic encephalopathy, a relatively new diagnosis associated with concussions and repeated blows to the head, might have been the actual or partial cause of death for some, says the article. 

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.