In 2013, physical
therapists (PTs) will be eligible to participate in the Physician Quality
Reporting System (PQRS) under the Group Practice Reporting Option (GPRO) for
the first time, as a result of changes in the group practice definition and
changes to the reporting methods for data submission under GPRO. A new APTA podcast explains
the some of the important differences that PTs should consider before deciding
whether to report as an individual physical therapist or as a part of a physical
therapy practice under the GPRO option. The accompanying transcript also includes charts illustrating how these 2
reporting options work from a data analysis standpoint.
information and resources on PQRS, go to www.apta.org/PQRS/.
APTA podcasts are prerecorded
discussions and interviews, not live events. Members can listen to podcasts at
their convenience by clicking on the links provided in News Now articles, visiting www.apta.org/podcasts/, or subscribing to APTA podcasts on iTunes.
with rheumatoid arthritis (RA) have more complications after total joint
arthroplasty (TJA) than patients with osteoarthritis (OA) and are at notably
higher risk for dislocation of replaced hip joints, according to a Medscape Medical News article based on a
systematic review published online November 28 in Arthritis
The analysis included 40 reports published between 1990 and 2011 that
describe primary TJA of the hip or knee in patients with RA (n = 2,842) or OA
(n = 61,861). Outcomes included revision, hip dislocation, infection, 90-day
mortality, and venous thromboembolic events.
The researchers found that patients with RA had double the risk for hip
dislocation after total hip arthroplasty compared with patients with OA.
Adjustments were made for age, sex, surgical approach, and surgeon's volume.
Infection risk was up to a 10-fold increase in patients with RA after total
knee arthroplasty, particularly in patients with prior infection in the
replaced joint, prior infection in any joint, or longer duration of operating.
There was no association between infection risk and perioperative systemic
corticosteroid use or withdrawal of biologic treatment before surgery. However,
meta-analysis was not completed due to variable definitions of infection and
preoperative antibiotic protocols, the article says.
Johannes Cornelis Schrama, MD, who was not involved in the study, told Medscape Medical News that that the
researchers do not appear to have overlooked any major factors in their
analysis, but he was cautious about possible clinical application. "It is
difficult to define clinical implications other than possible preventive
measures [against infection] in patients undergoing [total knee
arthroplasty]," he said.
saw nearly $1.5 billion in insurer rebates and overhead cost savings in 2011
due to the Affordable Care Act's (ACA) medical loss ratio (MLR) provision
requiring health insurers to spend at least 80% of premium dollars on health
care or quality improvement activities or pay a rebate to their customers,
according to a new Commonwealth Fund report. Consumers with
individual policies saw substantially reduced premiums when insurers reduced
both administrative costs and profits to meet the new standards. While insurers
in the small- and large-group markets achieved lower administrative costs, not
all of these savings were passed on to employers and consumers, as many
insurers increased profits in these markets.
The report, Insurers' Responses to
Regulation of Medical Loss Ratios, looks at how insurers selling policies for
individuals, small-employer groups (up to 100 workers), and large-employer
groups (more than 50 or 100 workers, depending on the state) in every state
reacted to ACA's MLR requirement between 2010, the year just before the new
rule took effect, and 2011, the first year the rule was in place.
authors find that in the individual insurance market, improvements were
widespread: 39 states saw administrative costs drop, 37 states saw MLRs
improve, and 34 states saw reductions in operating profits. Some states stood
out for significant improvements. In New Mexico, Missouri, West Virginia,
Texas, and South Carolina, MLRs improved 10 percentage points or more, while
administrative costs dropped $99 or more per member in Delaware, Ohio,
Louisiana, South Carolina, and New York.
the report finds that in small- and large-group markets, MLRs were largely
unchanged, and while spending on administrative costs dropped, profits
increased. For example, in the small-group market, administrative costs were
reduced by $190 million, profits increased by $226 million, and the medical
loss ratio remained at 83%, unchanged from 2010. In the large-group market,
insurers reduced administrative costs by $785 million, increased profits by
$959 million, and kept their medical loss ratio at 89%, also unchanged from
authors note that while insurers in the individual market have a less stringent
medical loss ratio requirement—80%, as opposed to 85% in the large-group
market—their traditionally higher overhead costs and lower MLRs mean they have
to work harder to reach the new standard. As a result, these insurers lowered
both administrative costs and profit margins, therefore reducing growth in
insurers in the small- and large-group markets generally already have MLRs in
the range of the required 85%, so while they reduced administrative costs, they
had the option of turning those cost savings into profits instead of passing
them along to consumers. In light of rising profits and falling administrative
costs, the authors suggest it is possible insurers took profit increases in the
small- and large-group markets to offset the reduced profits in the individual
market. And because many insurers sell policies in all three markets, any
reduction in administrative costs could have been spread across all of a given
insurer’s lines of business.
authors conclude that stronger measures—such as rate regulation, tighter loss-ratio
rules, or enhanced competitive pressures—may be needed to ensure that
administrative costs are reduced in all markets and savings are passed along to
APTA is featured
in an article in Roll Call
about looming Medicare cuts, including the expiration of the Medicare therapy
cap exceptions process. With negotiations on the fiscal cliff taking center
stage, "It's our responsibility
to make sure that some of these long-standing beneficiary-focused,
rehabilitation-focused things aren't lost in all that static," says Justin Moore, PT, DPT, APTA vice
president public policy, practice, and professional affairs.
"We're doing a lot to try to put the
patient face on the therapy cap issue specifically."
On Monday, APTA and the Therapy Cap Coalition participated in
an advocacy drive
that brought together almost 50 associations, organizations, and patient groups
to urge Congress to "Stop the Cap!"
Roll Call posted the
article online Tuesday evening; it is running in today's print issue of the
paper. RollCall is widely by members of Congress and their staff.
therapists (PTs) can effectively counsel patients with respect to lifestyle
behavior change, at least in the short term, say authors of a systematic review published in
the November issue of Physiotherapy
Theory and Practice. PTscan be
effective health counselors individually or within an interprofessional team,
this review, the authors searched databases including MEDLINE, EMBASE, CINAHL,
PsycINFO, and the Cochrane Database of Systematic Reviews from 1950 to July
2010. Studies were limited to the English, German, and Dutch languages. They
evaluated methodological quality using the Downs and Black tool.
source articles with a mean quality score of 16.57 ± 4.24 points (range:
low = 0; high = 28) were retrieved. Given considerable methodological
heterogeneity, the studies were compared in a narrative synthesis. The target
populations, types and periods of interventions, outcome measures, and findings
to the authors, multiple health behavior change needs to be a primary 21st
century clinical competence in physical therapy. Future studies will establish
the degree to which effective health counseling augments physical therapy as
well as health outcomes, in the long and short term.
recently launched a podcast series on behavior change that provides information
on key theories and models and their value to physical therapists and physical
therapist assistants. The podcasts and other resources can be found on APTA's
Health Behavior Change webpage.
out the NPTM 2012 Member Celebrations
webpage and see how some of your colleagues celebrated the profession this