The Centers for Medicare and Medicaid Services (CMS) will hold
a special open door forum (ODF) on October 22, 2:00
pm-3:30 pm ET, to allow providers to ask
questions about the manual medical review of therapy services that exceed
During this special ODF
(conference call only), CMS will discuss therapy documentation requirements and
answer any questions providers may have. CMS requests that providers who order
or provide therapy services nationally participate in the call. The therapy cap
applies to all Part B outpatient therapy settings and providers in:
Participants may submit
questions prior to the special ODF to email@example.com.
participate, call 866/ 501-5502 and enter conference ID 44803009.
newest publication, Adult Fitness Examination: A Physical Therapy Approach,
brings together a series of tests and measures that enables physical therapists
to build lifelong health and wellness plans with their asymptomatic adult
by APTA member Dan Millrood, PT, MEd,
and Charlotte Chua, PT, DPT, this groundbreaking assessment tool contains the
ready-to-use instructions and resources PTs need to identify, quantify, and qualify
key components of physical health and wellness.
educators, it's a textbook that addresses educational objectives related toprevention,
health promotion, fitness, and wellness.
Adult Fitness Examination includes:
Adult Fitness Examination (AFE-001, $34.99 for APTA members) from APTA's online bookstore.
foot ulceration (DFU) is associated with a nearly 2-fold increased risk for
all-cause mortality above that of diabetes alone, says a Medscape Medical News article based on a meta-analysis published in Diabetologia.
authors included 8 studies in their analysis. The studies were published
between 1996 and 2011 and reported on a total 17,830 patients with 81,116
patient-years of follow-up. Patients with both type 1 and type 2 diabetes were
included in all but 1 study, in which all patients had type 2 diabetes.
3,095 patients with DFU had a significantly longer duration of diabetes (12.72
years) compared with the 14,735 patients without DFU (7.19 years). The
prevalence of coronary artery disease was significantly higher among patients with
DFU (31.4% vs 14.7%), as was that of both hypertension (57.6% vs 35.7%) and
hypercholesterolemia (47.6% vs 11.1%).
follow-up, there were a total 3,619 deaths from any cause. The population with
DFU had a 1.89 pooled relative risk for all-cause mortality compared with the
patients with diabetes without DFU. Unadjusted rates of all-cause mortality
were 99.9 per 1,000 person-years for the population with DFU vs 41.6/1,000 in
the group with diabetes only.
analysis of 3,138 patients in 4 studies for whom information on cardiovascular
mortality was available showed that rates of fatal myocardial infarction and
fatal stroke also were higher among patients with DFU. However, the overall
proportion of deaths resulting from cardiovascular causes was almost the same
in the DFU and non-DFU groups—43.6% of the 117 DFU patients and 44.2% of the
952 diabetes-only patients.
higher mortality rate in patients with DFU may also "relate to their more
advanced stage of diabetes, with greater overall disease burden and
noncardiovascular complications of foot ulceration such as sepsis," Medscape says.
acknowledgement of legislation effective
October 1, the Right to Choose a Physical Therapist,
Blue Cross Blue Shield (BCBS) of North Carolina has revised its corporate medical
policy to include electrodiagnostic studies that are
provided by a licensed physical therapist who currently is listed on APTA's website
as a board-certified clinical electrophysiologic specialist per the American
Board of Physical Therapy Specialties.
North Carolina Chapter worked diligently for 3 years with state legislators and
BCBS of North Carolina, citing physical therapists' education and clinical
preparation to provide these services. After being assured that qualified PTs
provide evidence-based, outcome-based, and cost-effective health care that encourages
collaboration of the health care team, BCBS adopted the policy reflecting the
ability of PTs certified in clinical electrophysiology to independently perform
on the effects of pay-for-performance have found mixed results and raise a
number of questions that require more research and experimentation, says a new Health Affairs issue brief.
The brief summarizes the results of 9
studies that looked at public and private pay-for-performance initiatives. Two
studies focus on the Centers for Medicare and Medicaid Services' Premier
Hospital Quality Incentive Demonstration project. The first study found that
hospitals in the demonstration initially showed promising improvements in
quality compared with a control group. However, the effects were short lived. After
the fifth year of the demonstration, there were no significant differences in
performance scores between participating hospitals and a comparison group of
hospitals not in the project. In the second study, which analyzed 30-day
mortality rates for patients with acute myocardial infarction, congestive heart
failure, pneumonia, or coronary artery bypass graft surgery between 2004 and
2009, the results showed no difference in mortality rates between hospitals in
the Premier demonstration and a control group of nonparticipating hospitals.
greater success is the Medicare Physician Group Practice Demonstration, a pilot
project that ran from 2005 to 2010, awarding bonuses to physicians in 10 large
physician group practices if they achieved lower cost growth than local
controls and met quality targets. Researchers at Dartmouth College and the
National Bureau for Economic Research found an improvement in quality but
modest reduction in the growth of spending for most Medicare beneficiaries.
Cost reductions were greatest for the 15% percent of patients with dual eligibibility,
typically low-income people who qualify for both Medicaid and Medicare and who
often have complex, chronic conditions.
brief also examines studies on Medicare's Hospital Value-based Purchasing
Program, Medicaid-focused health plans in California, and safety net providers.
In a Health Affairs blog post, 3 policy experts discuss how
monetary rewards can undermine provider motivation and worsen performance, suggesting
that pay-for-performance initiatives might backfire.
campaign recently launched by the Joint Commission provides information to
patients about how and when to get palliative care, and offers examples of questions
that palliative care providers may ask them and questions that they can ask
providers. The educational campaign is part of the Joint
Commission's Speak Up program that urges people to take an active role in their
health care. Speak Up brochures are available in English and
more about the role of physical therapists in palliative care at APTA's Hospice
and Palliative Care webpage.
healthy eating reduce body fat and preserve muscle in adults better than diet
alone, according to a study funded and conducted by the National Institute of
Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National
Institutes of Health (NIH).
NIDDK senior investigator Kevin Hall, PhD, analyzed
the individual effects of daily strenuous exercise and a restricted diet by examining data from 11
participants from the reality television program "The Biggest Loser."
Researchers measured body fat, total energy expenditure, and resting metabolic
rate 3 times: at the start of the program, at week 6, and at week 30, which was
at least 17 weeks after participants returned home. Participation in the
program led to an average weight loss of 128 pounds, with about 82% of that
coming from body fat, and the rest from lean tissue.
Hall used a mathematical computer model of human
metabolism to calculate the diet and exercise changes underlying the observed
body weight loss. Because the TV program was not designed to directly address
how the exercise and diet interventions each contributed to the weight loss,
the computer model simulated the results of diet alone and exercise alone to estimate
their relative contributions.
At the competition's end, diet alone was calculated to
be responsible for more weight loss than exercise, with 65% of the weight loss
consisting of body fat and 35% consisting of lean mass such as muscle. In
contrast, the model calculated that exercise alone resulted in participants
losing only fat, and no muscle. The simulation of exercise alone also estimated
a small increase in lean mass despite overall weight loss.
The simulations also suggest that the participants
could sustain their weight loss and avoid weight regain by adopting more
moderate lifestyle changes, such as 20 minutes of daily vigorous exercise and a
20% calorie restriction, than those demonstrated on the television program.
most important thing for ACL surgery patients is to start physical therapy
early and rigorously," says Rick W. Wright, MD, in a Medical News Today article about his systematic review published in Journal
of Bone and Joint Surgery. "It can be difficult at first, but it's
worth it in terms of returning to sports and other activities."
Wright and his colleagues in the Department of Orthopedic
Surgery at Washington University School of Medicine identified 85 articles on treatment following reconstructive ACL surgery from
2006 to 2010 through multiple search engines. Twenty-nine Level-I or II studies
met inclusion criteria and were evaluated with use of the CONSORT (Consolidated
Standards of Reporting Trials) criteria. The authors included studies on postoperative
bracing, accelerated strengthening, home-based rehabilitation, proprioception
and neuromuscular training, and 6 miscellaneous topics investigated in single
authors also found that bracing following ACL reconstruction is not beneficial,
but home-based rehabilitation can be successful. Neuromuscular interventions,
while not harmful to patients, are not likely to yield large improvements in
outcomes and should not be performed to the exclusion of strengthening and
range-of-motion exercises. Vibration training may lead to faster and more
complete proprioceptive recovery, but further evidence is needed.