"It is with a heavy heart that I share the news of the sudden passing of our friend and colleague, APTA Board Member Dave Pariser, PT, PhD," says APTA President Paul A. Rockar Jr, PT, DPT, MS, in a statement released this morning. "Dave was an outstanding gentleman and professional whose friendship, devoted service, and leadership we will sorely miss."

A member of APTA since 1981, Pariser served in various capacities within APTA and the Kentucky and Louisiana chapters, including on APTA's Nominating Committee, as Louisiana Chapter president, and as chair of the legislative committees for both the Louisiana and Kentucky chapters. Most recently, he was elected in June 2011 by APTA's House of Delegates to serve on the Board of Directors. Pariser received numerous awards in recognition of his service, including the Dave Warner Award for Distinguished Service (Physical Therapist of the Year) from the Louisiana Chapter (2001) and induction into the chapter's “Hall of Fame” in 2006 for career achievement. 

Read Rockar's full statement on APTA's website.    

APTA has created a tribute page for members of the physical therapy community and others to share their memories about Pariser.   

The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule that has important implications for Medicaid beneficiaries who require rehabilitative and habilitative services and devices.

In the rule, CMS proposes changes to provide states more flexibility to coordinate Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices, appeals, and other related administrative procedures with similar procedures used by other health coverage programs authorized under the Affordable Care Act (ACA), such as coordination of benefits between Medicaid and health plans offered in the health insurance exchanges (Exchanges).    

Specifically, CMS is soliciting comments on whether the habilitative benefit should be offered in parity with the rehabilitative benefit under the Medicaid program (as they must be under the Exchanges). Additionally, CMS requests input on whether the state defined habilitative benefit definition for the Exchanges should apply to Medicaid or states should be allowed to separately define habilitative services for Medicaid. Habilitative and rehabilitative benefits are part of the mandatory essential health benefits (EHB) established by the ACA to ensure that certain health plans offered in Exchanges provide this baseline of coverage, benefits, and services to their enrollees.

In December 2012, CMS released guidance to help states align Alternative Benefit Plans under Medicaid programs with the EHB requirements. In that guidance, CMS stated that it intended for the provisions of the EHB proposed rule, released on November 20, generally to apply to Medicaid, but noted that it would address EHB in future rulemaking.

The newly released proposed rule also proposes to update and simplify the complex Medicaid premiums and cost-sharing requirements, to promote the most effective use of services, and to assist states in identifying cost-sharing flexibilities. 

APTA will comment on the proposed rule. Comments are due February 13. 

In a study evaluating the financial impact of providing early physical therapy for intensive care patients, researchers at Johns Hopkins found that the up-front costs are outweighed by the financial savings generated by earlier discharges from the intensive care unit (ICU) and shorter hospital stays overall.

"The evidence is growing that providing early physical and occupational therapy for intensive care patients—even when they are on life support—leads to better outcomes," says Dale M. Needham, MD, PhD, senior author of the study. "Patients are stronger and more able to care for themselves when they are discharged."

Hospital administrators' concerns about costs have been cited as barriers to implementing early rehab programs in the ICU. "However, our study shows that a relatively low investment up front can produce a significant overall reduction in the cost of hospital care for these patients," Needham says. "Such programs are an example of how we can save money and improve care at the same time."

For the study, the researchers developed a financial model based on actual experience at The Johns Hopkins Hospital's medical intensive care unit (MICU) and projections for hospitals of different sizes with variable lengths of stay.

The Johns Hopkins MICU admits about 900 patients each year. In 2008, the hospital created an early rehabilitation program with dedicated physical therapists and occupational therapists, which added about $358,000 to the cost of care annually. However, by 2009, the length of stay in the MICU had decreased an average of 23%, down from 6.5 days to 5 days, while the time spent by those same patients as they transitioned to less-intensive hospital units fell 18%. Using their financial model, the authors estimated a net cost saving for the hospital of about $818,000 per year, even after factoring in the up-front costs.   

The researchers then analyzed the potential impact of early rehabilitation services in 24 different scenarios, accounting for variations in the number of ICU admissions, cost savings per day and reductions in length of stay.

They found that in 20 out of the 24 scenarios, hospitals would have an overall cost savings by providing early rehabilitation to patients in the ICU, and in the 4 remaining scenarios, using the most conservative assumptions, there was a modest net cost increase of up to $88,000 per year.

APTA member Michael Friedman, PT, MBA, is a coauthor of the study.

APTA's innovative models of care video series includes an interview with a physical therapist who was instrumental in starting an early physical therapy program for patients in a Houston hospital's ICU.

A new policy statement by the American Heart Association (AHA) encourages clinicians to assess cardiorespiratory fitness with the hope that researchers can gather more information on aerobic fitness and its related variables to identify individuals who might be at risk for adverse clinical outcomes.

The AHA writing committee also advocates for the creation of a national registry that includes data on cardiorespiratory fitness that would allow researchers to track aerobic fitness over long periods of time, just as is being done with other variables such as cholesterol, blood pressure, physical activity levels, and body weight, among others. It also would provide more information on normative aerobic fitness levels in subsets of the population.

According to a Heartwire article, one of the goals of the national registry is to increase awareness about the importance of cardiorespiratory fitness. Many of the assessments are performed in exercise centers and research settings, but not as frequently in clinical practice.

While information is available in pockets of the country, including data from the Aerobics Center Longitudinal Study, the hope is more information would allow researchers to determine normative cardiorespiratory fitness levels, via direct measurements of VO₂, in groups stratified by age, gender, and body composition in large samples representative of the US population.

The registry also would help define normative values of aerobic fitness across strata of physical activity levels. Chair of the AHA policy statement, Leonard Kaminsky, PhD, told Heartwire that "physical activity is simply a behavior, and while both are inversely associated with the risk of cardiovascular disease, there are factors that contribute to aerobic fitness than other physical activity levels, including age and genetics. In addition, cardiorespiratory fitness is a more clinically meaningful measure than self-reported physical-activity levels, which are prone to considerable error."

APTA member Ross Arena, PT, PhD, is a coauthor of the statement, which was published online ahead of print January 7 in Circulation.   

A new APTA podcast that focuses on screening for physical inactivity distinguishes between physical activity and physical fitness, explains the use of physical activity to screen for issues of impaired physical fitness, and provides information on what to do with the results of the screen. It also gives examples illustrating various types of patients and the role that physical activity plays in their overall health. 

APTA's upcoming Board of Directors meeting will be broadcast online for APTA members when the Board convenes January 20 in San Diego.

All open sessions of the meeting will be livestreamed, and archived video will be available through February 10 at www.apta.org/Livestream. The agenda for the meeting, which includes a generative session on membership development initiatives and a fiduciary session, is posted on the same page.

This is the second time that the Board meeting has been livestreamed, following a similar broadcast in November and December of last year.

Physicians and health care providers have formed 106 new accountable care organizations (ACOs), bringing the nationwide number of Medicare beneficiaries included in ACOs to about 4 million.

According to the Department of Health and Human Services (HHS), the new ACOs include a diverse cross-section of physician practices across the country. Roughly half of all ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries. Approximately 20% of ACOs include community health centers, rural health centers, and critical access hospitals that serve low-income and rural communities.

The new group includes 15 advance payment model ACOs, physician-based or rural providers who would benefit from greater access to capital to invest in staff, electronic health record systems, or other infrastructure required to improve care coordination. Medicare will recoup advance payments over time through future shared savings. In addition to these ACOs, last year the Centers for Medicare and Medicaid Services (CMS) launched the Pioneer ACO Program for large provider groups able to take greater financial responsibility for the costs and care of their patients over time.

ACOs must meet quality standards to ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely. CMS has established 33 quality measures on care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care. Federal savings from this initiative are up to $940 million over 4 years.

For more information on ACOs, visit www.apta.org/ACO/.

Join your colleagues on March 8 for APTA's groundbreaking virtual event, Innovation Summit: Collaborative Care Models, which will focus on the current and future role of physical therapy in ACOs and other integrated models of care.