In response to a troublesome provision included in the fiscal cliff package passed by Congress on Tuesday, APTA is advising members to monitor APTA's website and the Legislative Action Center specifically for upcoming action alerts regarding efforts to avert the increased multiple procedure payment reduction (MPPR) included in the American Taxpayer Relief Act of 2012 (HR8).

Set to be implemented on April 1, the provision applies the MPPR to therapy services at 50%, up from 20% for office settings and 25% for facility settings. APTA estimates the application of a 50% MPPR policy will reduce payments by approximately 6%-7%. This reduction will be partially offset by a 4% increase that resulted from the Centers for Medicare and Medicaid Services' (CMS) use of new survey data of practice expenses conducted by APTA. Coupled together, APTA expects the net overall decrease for outpatient therapy services to be between 2%-3%, a lower cut than expected. Nevertheless, APTA will advocate to fix this flawed policy. The association soon will call on APTA members to make their voices heard on Capitol Hill.

The increase to a 50% MPPR was recently endorsed by the Medicare Payment Advisory Commission (MedPAC). Despite months of aggressive lobbying efforts to reject the provision, Congress ultimately included this and a number of other spending cuts in the fiscal cliff package to offset other health care related provisions, including the prevention of the 26.5% fee schedule cut and the extension of the therapy cap exceptions process.

Once policy options are assessed, APTA will issue additional alerts to PTeam. If you're not a member of PTeam, sign up today to receive the alerts. In the meantime, APTA members are encouraged to learn more about this and other important provisions included in the legislation through the resources provided on APTA's 2013 Medicare Changes: January 2013 webpage at www.apta.org/Payment/Medicare/2013/Changes/. These resources include a statement by APTA's president on HR8, a congressional summary, a 2013 Medicare therapy cap FAQ, and a 2013 Physician Fee Schedule and MPPR FAQ.

Additionally, APTA has updated the MPPR calculator to help association members determine their reimbursement for services based on the MPPR only. 

Safe patient handling (SPH) programs do not appear to inhibit patient recovery, say authors of a retrospective cohort study conducted in a rehabilitation unit in a hospital system. Fears among therapists that the use of equipment may lead to dependence may be unfounded, they add.

For this investigation, the authors enrolled consecutive patients (N=1,291) over a 1-year period without an SPH program in place (n=507) and consecutive patients over a 1-year period with an SPH program in place (n=784). The SPH program consisted of administrative policies and patient handling technologies. The policies limited manual patient handling by staff. Equipment included ceiling- and floor-based dependent lifts, sit-to-stand assists, ambulation aides, friction-reducing devices, motorized hospital beds and shower chairs, and multihandled gait belts. The main outcome measure was the mobility subscale of the FIM.

Patients who were rehabilitated in the group with SPH achieved similar outcomes to patients rehabilitated in the group without SPH. A significant difference between groups was noted for patients with initial mobility FIM scores of 15.1 and higher after controlling for initial mobility FIM score, age, length of stay, and diagnosis. Those patients performed better with SPH.

APTA member Marc Campo, PT, PhD, OCS, is the article's lead author. APTA member Heather Margulis, PT, is coauthor. The article is available in this month's Archives of Physical Medicine and Rehabilitation.

Two themes emerge in this month's PTJ, says Editor in Chief Rebecca Craik, PT, PhD, FAPTA, in her January Craikcast. The first theme, which reflects back on PTJ's December 2011 Special Issue on Advances in Disability Research, calls for physical therapists to go beyond measurements of impairments and consider other variables when evaluating outcomes following interventions. Craik notes that 4 papers in the current issue "certainly have gone beyond the impairment level in looking at outcome measures." The second theme, motor control and motor learning, can be found in articles on intermanual transfer in patients with upper-limb amputation, body-scaling, and mastering motivation in toddlers.      

Responding to a charge from the 2012 House of Delegates to revise Vision 2020 to "reflect the vision of the profession of physical therapy and its commitment to society beyond 2020," the Vision Task Force sent a revised vision to the APTA Board of Directors for consideration at its November 2012 meeting. The Board will forward the proposed vision to the 2013 House of Delegates for consideration. Information about the proposed vision has been posted and is available for members and delegates to review. Please direct your comments about the vision to your chapter or section delegates or directly to the members of the Vision Task Force.

The Foundation for Physical Therapy recently launched a new effort that enables students, faculty, and members of the community to collectively raise funds for physical therapy research. Built around the concept of training for a triathlon, physical therapy programs will form teams, and team members will log the number of miles they each swim, bike, and run on the Log 'N Blog website. Register today!

The relationship between health care spending and quality of care is "totally unclear," say researchers in a Reuters Health article about their meta-analysis of 61 studies that compared health care spending with outcomes on both small hospital-wide scales and broader state-wide levels.

Some of the studies looked at whether hospitals that spent more money per patient had fewer in-hospital deaths, or if their physicians and nurses better followed guidelines. Others compared states' Medicare spending with how well their older residents were treated for a range of conditions.

"The bottom line was that no matter how you drill down into the results, at every level the results are just all over the map," Peter S. Hussey, PhD, the study's lead investigator, told Reuters Health.

Twenty-one of the 61 studies showed higher spending was tied to better outcomes for patients, such as fewer deaths. However, 18 studies found a link between more spending and worse outcomes, and 22 showed no difference or an unclear association based on spending.

Many of the studies compared certain types of spending with potentially unrelated outcomes. Others didn't take into account how sick patients were initially when looking at how they fared in different situations, the article says.

Hussey and colleagues conclude that future studies should focus on what types of spending are most effective in improving quality and what types of spending represent waste.

The findings are published in the January 1 issue of Annals of Internal Medicine.

Yesterday, the House and Senate passed legislation to bring the nation back from the "fiscal cliff" that includes 5 important provisions for physical therapists. The bill has been sent to President Obama for his signature.

The American Taxpayer Relief Act of 2012 (HR 8) freezes the Medicare conversion factor for 2013 at the 2012 level, averting a 26.5% cut to physical therapists and other providers under the physician fee schedule, and continues the 1.0 GPCI work value floor through 2013. The legislation also extends the current 2-tier therapy cap exceptions process ($1,900 automatic KX modifier process, $3,700 manual medical review, and application of the therapy cap to hospital outpatient department) for 1 year. Additionally, in a provision that APTA has called "unjustified, capricious, and poor public policy," the bill applies the multiple procedure payment reduction (MPPR) to therapy services at 50%, up from 20% for office settings and 25% for facility settings, beginning April 1. APTA estimates the application of a 50% MPPR policy will reduce payments by approximately 6-7%. This reduction will be partially offset by a 4% increase that resulted from the Centers for Medicare and Medicaid Services' (CMS) use of new survey data of practice expenses conducted by APTA. Coupled together, APTA expects the net overall decrease for outpatient therapy services to be between 2%-3% beginning April 1. APTA will update the MPPR calculator on its website in the coming days. APTA will advocate to stop the implementation of the MPPR provision.

HR 8 also postpones sequestration cuts until March 1. Under these cuts Medicare providers would see a 2% reduction in payment. The National Institutes of Health and other federal agencies would see reductions of 7%-8%.  

Read this statement by APTA President Paul A. Rockar Jr, PT, DPT, MS, on HR 8. A summary of the legislative provisions and offsets (savings) to HR 8 is available on APTA's website.    

Several other policies of importance to physical therapists went into effect January 1. Under the functional limitations reporting requirement for Medicare Part B services, physical therapists must include nonpayable G-codes and modifiers on claim forms to capture data on the beneficiary's functional limitations at the outset of the therapy episode, at a minimum of every 10th visit, and at discharge. To ensure a smooth transition, the Centers for Medicare and Medicaid Services has set forth a testing period from January 1 until July 1. After July 1 claims submitted without the appropriate G-codes and modifiers will be returned unpaid.

In addition, physical therapists who successfully participate in the Physician Quality Reporting System in 2013 can obtain a 0.5% bonus payment in 2013 and 2014 and will avoid penalties of 1.5% in 2015. 

APTA will continue to provide updates and post resources to help members comply with 2013 Medicare policies.  

Early-career physical therapist investigators are encouraged to apply for the United States Bone and Joint Initiative (USBJI) Young Investigators Initiative Program. This distinctive and well-regarded career development and mentoring program pairs promising new musculoskeletal investigators with experienced researchers who offer counsel on securing funding and other survival skills required for pursuing an academic career.

This grant mentoring workshop series is open to promising junior faculty, senior fellows, or postdoctoral researchers nominated by their department or division chairs. It also is open to senior fellows or residents who are doing research and have a faculty appointment in place or confirmed and have a commitment to protected time for research. Basic and clinical investigators, with or without training awards (including K awards), are invited to apply.

Participants, who will be assigned mentors, attend 2 workshops, 12 to 18 months apart. The next workshop for new participants will take place April 26-28 in Chicago. Participants will receive a solid grounding in proposal writing and have a chance to watch as experienced researchers review grant proposals in a mock study section. They also will meet 1-on-1 with their mentors over the course of the workshop.

When the group reconvenes for the second workshop, participants are expected to have submitted a grant proposal for government, foundation, military, or industry funding. For the second workshop, participant-mentor activities are built around responding to summary statements and study section comments, and strategizing to address other issues relating to performing and funding research. Participants are encouraged to take advantage of ongoing consultation with mentors through the remainder of the application process, until funding is secured.

The deadline to apply for the April workshop is January 15. Visit USBJI's website for application information.

APTA is a founding member of USBJI.