The introduction of the supine sleep position to reduce the prevalence of Sudden Infant Death Syndrome has not altered the timing or sequence of infant rolling abilities, say authors of an article published online in Early Human Development. This information is valuable to health care providers involved in the surveillance of infants' development, they add. Original normative age estimates for these 2 motor abilities are still appropriate. 

The aim of this study was to compare the order and age of emergence of rolling prone to supine and supine to prone before the introduction of back to sleep guidelines and 20 years after their introduction. The original normative data for the Alberta Infant Motor Scale (AIMS) were collected just prior to the introduction of back to sleep guidelines in 1992. Currently these norms are being reevaluated. Data of rolling patterns of infants 36 weeks of age or younger from the original sample (n=1,114) and the contemporary sample (n=351) were evaluated to compare the sequence of appearance of prone to supine and supine to prone rolls (proportion of infants passing each roll) and the ages of emergence (estimated age when 50% of infants passed each roll).

According to the results, the sequence of emergence and estimated age of appearance of both rolling directions were similar between the 2 time periods.

APTA, in conjunction with the Therapy Cap Coalition, is launching a national grassroots campaign to "Stop the Therapy Cap" on Monday, December 3. The patient impact of the cap is the theme of Monday's campaign. Almost 50 associations, organizations and patient groups will be sending action alerts to their members. With about 30 days left until expiration of the therapy cap exceptions process, the goal is to create a significant surge in Congressional e-mails and phone calls urging members of Congress to stop the therapy cap from taking effect in 2013.  

APTA has provided association members form letters and e-mails in its Legislative Action Center. To access the materials, log in to the website, click "Take Action" under "Stop the Medicare Therapy Cap and Prevent SGR Payment Cuts," and follow the instructions. If you have time, personalize the e-mail and let Congress know how the cap impacts your patients.

Congress has been very clear: it will not take action without input from constituents. If you only send 1 advocacy e-mail or make 1 advocacy phone call this year, do it on Monday. 

APTA will send out an Action Alert Monday morning with talking points and instructions for contacting your legislators. Also, ask your patients to e-mail or call their members of Congress on Monday using APTA’sPatient Action Center. For more information on APTA's advocacy efforts, visit the Medicare Therapy Cap website.

Time is running out! Take 5 minutes on Monday and contact your legislators. You can make a difference and help prevent a hard Medicare therapy cap of $1,900 from being implemented in 2013.

Allowing patients to e-mail their clinicians and access their records online is associated with more, not fewer, telephone calls, office visits, and clinical services in general, says a Medscape Medical News article based on a study published in the November 21 issue of JAMA.  

Researchers studied the effect of an online Web portal for patients enrolled in Kaiser Permanente (KP) Colorado. The portal, called My Health Manager (MHM), connects to KP's electronic health record system. MHM allows patients access test results, request medicine refills, schedule nonurgent appointments, and exchange messages with their clinicians on nonurgent health issues.

The authors measured the use of health care services by 44,321 users of MHM before and after KP Colorado adopted the system compared with health care use by an equal number of nonusers. All patients in the study were continuously enrolled in KP Colorado for at least 2 years from March 2005 through June 2010.

Lead author Ted Palen, MD, PhD, MSPH, and coauthors found that the number of office visits by MHM users increased by 0.7 per member per year compared with nonusers. Telephone encounters rose at a smaller rate of 0.3 per member per year. The rates of after-hours clinic visits, emergency department encounters, and hospitalizations per 1,000 members per year rose significantly, by 18.7, 11.2, and 19.9, respectively. These patterns held true whether the patients were younger or older than 50 years, says the article.  

In contrast, a 2007 KP study of this issue in the organization's Northwest region reported that office visits decreased between 7% and 10% for patients using the patient portal. At that time, however, only 6% of KP Northwest patients were signed up for it. Today, roughly 50% of all KP patients, and about 60% of those in Colorado, are logging on.

Online access might have helped patients take more responsibility for their health care, which led them to use more services, Palen told Medscape Medical News. Or perhaps patients who signed up for MHM were already likely to use more services because of clinical characteristics that the study failed to control for. Future research will try to tease out cause and effect, he said.

An even more important question to answer, said Palen, is the effect of the online clinician–patient relationship on clinical outcomes. If virtual visits lead to more face-to-face visits, does a patient's health necessarily improve as a result?

As a follow-up to the issuance of the Home Health Prospective Payment System Calendar Year (CY) 2013 Final Rule, the Centers for Medicare and Medicaid Services (CMS) has updated its website to clarify that the therapy provisions will be effective for episodes beginning on or after January 1, 2013. This clarification can be found under the first bullet on the CMS HHA Center Webpage.

In the CY 2013 final rule published November 2, CMS finalized 3 revisions regarding the requirement that a qualified therapist complete a functional reassessment of the patient at the 14th and 20th visits and every 30 days:

1.      If a qualified therapist missed a reassessment visit, therapy coverage would resume with the visit during which the qualified therapist completed the late reassessment, not the visit after the therapist completed the late reassessment.

2.      When multiple therapy disciplines are involved, if the required reassessment visit was missed for any one of the therapy disciplines for which therapy services were being provided, therapy coverage would cease only for that particular therapy discipline.

3.      In cases where the patient is receiving more than one type of therapy, qualified therapists must complete their reassessment visits during the 11th, 12th, or 13th visit for the required 13th visit reassessment and the 17th, 18th, or 19th visit for the required 19th visit reassessment. However, CMS also states in instances in which patients receive more than one type of therapy, if the frequency of a particular discipline, as ordered by a physician, does not make it feasible for the reassessment to occur during the specified timeframes without providing an extra unnecessary visit or delaying a visit, then it will still be acceptable for the qualified therapist from each discipline to provide all of the therapy and functionally reassess the patient during the visit associated with that discipline that is scheduled to occur closest to the 14th Medicare-covered therapy visit, but no later than the 13th Medicare-covered therapy visit. Likewise, a qualified therapist from each discipline must provide all of the therapy and functionally reassess the patient during the visit associated with that discipline that is scheduled to occur closest to the 20th Medicare-covered therapy visit, but no later than the 19th Medicare-covered therapy visit. 

APTA is working with CMS to address issues that may arise regarding implementation of these provisions.

For a comprehensive summary of the final rule, visit APTA's website. E-mail advocacy@apta.org with questions regarding implementation of the 2013 functional reassessment requirement changes.

On Monday, AARP featured a guest blog post by APTA President Paul A. Rockar Jr, PT, DPT, MS, on its personal health blog. Rockar explains how APTA's Fit After 50 campaign aims to educate people aged 50 and older about the importance of staying fit and active and discusses the role that physical therapists play in restoring and improving motion in people's lives at any age.     

The Office of Civil Rights released guidance Monday regarding methods for de-identification of protected health information (PHI) in accordance with the HIPAA Privacy Rule. This guidance is intended to assist covered entities  understand what is de-identification, the general process by which de-identified information is created, and the options available for performing de-identification.

The guidance, posted on the Department of Health and Human Services' website, explains the 2 methods that can be used to satisfy the Privacy Rule's de-identification standard—Expert Determination and Safe Harbor—using a question-and-answer format and provides a glossary of terms related to de-identification.

APTA's Health Information Technology (HIT) webpage provides resources and updates on HIT program development and legislation, in addition to APTA's efforts with federal policymakers to educate them as to the importance of including physical therapists in HIT initiatives moving forward.  

November's Visualizing Health Policy, JAMA's monthly infographic series created by the Kaiser Family Foundation (KFF), takes a look at Medicare: who is covered by the program; what proportion of Medicare beneficiaries use at least 1 medical service in a year; how health care spending per person is growing more slowly for Medicare than for private insurance; and how rising health care costs and a growing population pose fiscal challenges to keeping Medicare solvent in the years ahead.

Archived infographics are available on KFF's website.

APTA members have just 3 more days to submit nominations to the Fit After 50 Member Challenge. If you know a physical therapist or physical therapist assistant (must be an APTA member; it can be you) who is age 50 or older, fit, and encourages others to be active and fit, complete the brief online nomination form and submit it by November 30.

Researchers who found that the combination of statin treatment and increased fitness boosts survival in patients with dyslipidemia are calling for the medical profession, society, and governments to make concerted efforts to promote fitness, says a Heartwire article.

Following a group of veterans with dyslipidemia for an average of 10 years, Peter F. Kokkinos, PhD, and colleagues show that both statin therapy and increased fitness lower mortality significantly and independently of other clinical characteristics.

Participants in the study were assigned to 1 of 4 fitness categories based on peak metabolic equivalents achieved during exercise testing and 8 categories based on fitness status and statin treatment. The primary end point was all-cause mortality adjusted for age, body-mass index, ethnic origin, sex, history of cardiovascular disease, cardiovascular drugs, and cardiovascular risk factors. Researchers ascertained mortality from Veterans Affairs records on December 31, 2011.

During a median follow-up of 10 years, 2,318 participants died. Mortality risk was 18.5% (935/5,046) in people taking statins vs 27.7% (1,386/4,997) in those not taking statins.

In patients who took statins, risk of death decreased as fitness increased; for highly fit individuals the hazard ratio (HR) was 0.30 compared with a HR of 1 for the least fit.

For patients not treated with statins, the HR for least fit participants was 1.35. This HR progressively decreased to 0.53 for those in the highest fitness category compared with the least-fit group treated with statins.

The study is published online in The Lancet. In an accompanying editorial, Pedro C Hallal PhD, and I-Min Lee, MD, MPH, ScD, say that Kokkinos and colleagues "add to the large body of work on the benefits of physical activity or fitness for health. Irrespective of whether patients were prescribed statins, the physically fittest participants had a 60% to 70% reduction in all-cause mortality rates during follow-up, compared with the least fit."