In 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. 

The 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 the testing.

Studies 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.

Showing 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.

The 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.

A new 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 Spanish.

Learn more about the role of physical therapists in palliative care at APTA's Hospice and Palliative Care webpage.

Exercise and 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.

"The 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 trials.

The 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.