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 $3,700. 

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:

• private practices
•  Part B skilled nursing facilities
•  home health agencies hospital
• outpatient departments rehabilitation agencies (outpatient rehabilitation facilities)
• comprehensive outpatient rehabilitation facilities

Participants may submit questions prior to the special ODF to therapycapreview@cms.hhs.gov. To participate, call 866/ 501-5502 and enter conference ID 44803009.

APTA's 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 clients.

Written 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.

For educators, it's a textbook that addresses educational objectives related toprevention, health promotion, fitness, and wellness.

Adult Fitness Examination includes:

• preparticipation health screening overview
• 16 ready-to-use examinations, complete with step-by-step instructions and full color photos; normative data, charts, flowcharts, illustrations; and notes and warnings (when to terminate testing)
• equipment supply checklist
• clinician workbook to promote easy, accurate record-keeping
• client take-home form to help clients follow treatment plans, track results, and stay motivated to achieve health and fitness goals

Order Adult Fitness Examination (AFE-001, $34.99 for APTA members) from APTA's online bookstore.

Diabetic 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.   

The 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.

The 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%).

During 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.

Further 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.

The 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.

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.