"I am so excited by the December issue and these 10 articles that I'm really considering changing my path and going out to see if I can help develop acute care specialization and become a practicing clinician again," says PTJ Editor in Chief Rebecca Craik, PT, PhD, FAPTA, at the conclusion of the latest Craikcast. 

Joining Craik this month in discussing the articles that complete the 2-part PTJ Special Series on Rehabilitation for People With Critical Illness are coeditors Patricia Ohtake, PT, PhD, Dale Needham, MD, and Dale Strasser, MD. The group also discusses quality improvement research, a key topic of the articles in the February edition of the critical care special series. The first part of the series was published in the December 2012 issue.    

As part of APTA's strategic plan, one of the goals for 2013 is to better enable physical therapists to consistently use best practice to improve the quality of life of their patients and clients. To achieve this goal, APTA is supporting the development of clinical practice evidence-based documents. This initiative aims to provide structure, process, and resources for the development of Clinical Practice Guidelines (CPG) and Clinical Practice Appraisals (CPA) that enable the translation of research into physical therapist practice. In order to facilitate the development of clinical practice documents and other high quality evidence summaries, APTA is offering financial and training support to sections for this purpose.

Proposals for CPG/CPA development must focus on clinical practice areas that are important and relevant to the practice of physical therapy. The proposal must be supported and submitted by an APTA section. Each proposal will be considered individually and will be awarded in part or in full depending on the priorities of the association and the strength of the proposal.  

Proposals for the current review cycle are due on March 18. For more information or for a copy of the proposal submission document, contact Anita Bemis-Dougherty, director, Practice Department, at anitabemis-dougherty@apta.org or 800/999-2782, ext 3176.

In a retrospective cohort obtained from electronic medical records and insurance claims data, initial physical therapy management following a new primary care low back pain (LBP) consultation was not associated with increased health care costs or utilization of specific services. The authors of this article, which appears online in Archives of Physical Medicine and Rehabilitation, write that additional research is needed to examine the cost consequences of initial management decisions made following a new consultation for LBP.

Records and data were examined on 2,184 patients aged 18 and older with a new consultation for LBP from 2004-2008 in single health care delivery system in the United States. Patients were categorized as receiving initial physical therapy management if care occurred within 14 days after consultation.

Total health care costs for all LBP-related care received in the year following consultation were calculated from claims data. Predictors of utilization of emergency care, advanced imaging, epidural injections, specialist visits, and surgery were identified using multivariate logistic regression. Generalized linear model was used to compare LBP-related costs based on physical therapy utilization and identify other cost determinants.

Initial physical therapy was received by 286 of 2,184 patients (13.1%) and was not a determinant of LBP-related health care costs or utilization of specific services in the year following consultation. Older age, mental health or neck pain comorbidity and initial management with opioids were determinants of cost and several utilization outcomes.

APTA member Julie M. Fritz, PT, PhD, ATC, is the article's lead author. APTA members Gerard P. Brennan, PT, PhD, Stephen J. Hunter, PT, DPT, OCS, and John S. Magel, PT, DSc, OCS, FAAOMPT, are coauthors.

Monday, February 11, is the deadline to submit nominations for the Federal Government Affairs Leadership Award and the APTA Public Service Award.

The Federal Government Affairs Leadership Award is presented annually to an active APTA member who has made significant contributions to APTA's federal government affairs efforts, and has shown exemplary leadership in furthering the association's objectives in the federal arena.

The APTA Public Service Award is presented annually to individuals who have demonstrated distinctive support for the physical therapy profession at a national level. Individuals from the following categories are eligible for nomination of this award: members of Congress, congressional staff members, members of a state legislature, federal agency officials, health and legislative association staff, and celebrities or other public figures.

APTA's Board of Directors will select award recipients during its March 2013 conference call. Awards will be presented at the Federal Advocacy Forum to be held April 14-16 in Washington, DC. Submit nominations by February 11 to Stephanie Sadowski.

APTA's summary of a recently released HIPAA final rule includes important information for physical therapists related to modifications of the Privacy, Security, and Enforcement Rules embedded in the HITECH Act, changes to the HIPAA Enforcement Rule to incorporate the increased and tiered civil money penalty structure, the adoption of breach notification requirements for unsecured data, and adjustments to the HIPAA Privacy Rule as required by the Genetic Information Nondiscrimination Act to increase privacy protections for genetic information. 

Association members can access the document on the Health Information Technology webpage under "APTA Summaries" and the HIPAA webpage.

In a meeting with APTA yesterday, the Centers for Medicare and Medicaid Services (CMS) clarified the impact of the therapy cap on patients who receive outpatient therapy services in critical access hospitals (CAHs). CMS stated that for 2013, when a patient receives outpatient therapy services from a critical access hospital, the services will count toward dollars accrued toward the therapy cap. For example, if a  patient receives $2,000 of outpatient therapy services in a CAH and upon discharge goes to a private practice to continue therapy services, the private practice would need to obtain an exception (in this case use the KX modifier).

However, CMS clarified that for 2013 the therapy cap does not apply to outpatient therapy services provided within CAHs themselves. This means that if the patient continued treatment in the critical access hospital, after exceeding $1,900 in therapy services, there would be no need to seek an exception through the automatic process. That is, the CAH would not need to submit the claim with a KX modifier. Also, if the patient exceeds $3,700 and continues care in CAH, the hospital would not need to obtain an exception through the manual medical review process.

APTA had been seeking clarification on this issue from CMS since the January 1 passage of the American Taxpayer Relief Act of 2012 (HR 8), which extended the current 2-tier therapy cap exceptions process through 2013. The agency advised APTA last month that it was working with its general counsel for interpretation of the legislative language.   

APTA's comments to the Senate Finance Committee's May 2012 request for input from health care stakeholders on 3 areas critical to Medicare and Medicaid reforms—program integrity, payments, and enforcement—have been included in the committee's recently released report titled "Opportunities to Curb Waste, Fraud and Abuse in Medicare and Medicaid."

Specifically, the Senate Finance Committee writes about eliminating self referral in 2 sections of the report. Under the Beneficiary Protection section, the committee notes "concern that over-broad application of the Stark law exception for physician in-office ancillary services compromises patient care by incentivizing overutilization." The committee references "increasing enforcement of existing laws, such as the Stark law" under the area titled Enforcement.  

More than 160 stakeholders in the health care community submitted comments to the Senate Finance Committee's request. During the 113th Congress, 6 Senators plan to work with key committees of jurisdiction, the Government Accountability Office, the Department of Health and Human Services Office of the Inspector General, and interested stakeholders to develop a more detailed list of administrative recommendations and potential legislative actions.  

APTA's comments can be found on the association's Self Referral webpage.

More than 530 physical therapists, physical therapist assistants, and physical therapy students from Indiana gathered at the statehouse on January 30 to show their support for HB 1034, which would provide direct access to physical therapists. Over 50 legislators joined the members of the physical therapy profession for lunch and to discuss the bill. 

State Sen Pat Miller and state Reps Dave Frizzell and Matt Ubelhor spoke to the crowd and confirmed their commitment to passing direct access legislation. Indiana is 1 of only 3 states with no form of direct access to physical therapy treatment, and the only state without direct access to a physical therapy evaluation. Many Indiana Chapter members held signs with the messages: "49 states allow you to see your PT directly … not Indiana" and "Hoosiers deserve direct access to physical therapists."

The House Public Health Committee hearing for HB 1034 will be held February 6. The chapter is coordinating a team of chapter members to speak in support of the bill. If it is approved by the committee, the bill would then go to the full House of Representatives for consideration.

Photos of the January 30 event are available here.