A recently-released study cites a dramatic rise in the number of children being treated for traumatic brain injuries (TBI) in emergency rooms, but the cause for the increase may be harder to pin down. Increased public awareness of concussion symptoms and treatment, however, may be one important reason behind the rise.

The study, available in the October issue of Pediatrics, found that while visits for TBI rose by 92% between 2002 and 2011, the rate of hospitalization remained relatively unchanged—about 10%. Researchers involved in the study point to a variety of possible reasons for the rise, including wider involvement in sports activities and an increased intensity of those activities by children who are generally bigger and faster than previous generations. Researchers found that skateboarding, inline skating, skiing, and sledding were the activities with the highest admission rates.

The findings also contained some good news. Because the study also showed that injury severity actually decreased as visits increased, authors theorize that the biggest reason for the rise may be due to a better-educated public, able to recognize the potential signs of concussion and aware of the need for quick treatment.

Physical therapists can access a range of information on concussion, including the advocacy work being taken on by APTA, by visiting the APTA website.

The federal government began a shutdown today that will affect daily operations of most federal agencies. At the time of writing, congress has yet to reach an agreement on a federal budget, leaving both duration of the shutdown and the final outcome of the budget for the next fiscal year uncertain.

Payment for services provided to Medicare beneficiaries should not be impacted in the near term, according to the Centers for Medicare and Medicaid Services, which stated that Medicare Administrative Contractors will continue to perform all functions related to Medicare fee-for-services claims processing and payment during the shutdown. Additionally any ongoing Medicare provider enrollment applications, revalidations or changes to enrollment will also continue to be processed.

Members of APTA who are employed by the federal government should check with their agencies to find out about individual impacts. The Washington Post has published a helpful interactive guide on agency responses to the shutdown.

Staff at APTA will continue to update members regarding congressional negotiations to resolve the budget impasse.

A new module in the Agency for Healthcare Research and Quality (AHRQ) Comprehensive Unit-based Safety Program (CUSP) can help clinical teams learn how to engage patients and families in their care. Based on a field-tested guide for engaging patients and families, the CUSP Patient and Family Engagement Module includes PowerPoint slides, speaker notes, demonstration videos and tools to improve communication and patient safety in the hospital setting. This module helps clinicians:

• Explore the roles and characteristics of patient and family advisors
• Understand the relationship between communication and patient safety
• Prepare for the patient’s discharge
• Communicate adverse events to patients and family members

Download the CUSP Patient and Family Engagement Module.

Learn more about CUSP.

Read the AHRQ Guide to Patient and Family Engagement in Hospital Quality and Safety.

The sixth annual National Falls Prevention Awareness Day (FPAD) was observed yesterday, the first day of fall, per US Senate resolution S.248 passed on September 19.

FPAD is spearheaded by the National Council on Aging (NCOA) to promote and increase public awareness about how to prevent and reduce falls among older adults. This year's theme, Preventing Falls—One Step at a Time, seeks to unite professionals, older adults, caregivers, and family members to play a part in raising awareness and preventing falls. The past few weeks, APTA generated congressional support for the resolution and will continue to work with coalition stakeholders on increasing patient awareness on falls prevention and finding support in Congress for falls prevention initiatives.

Additional information and resources can be found at the following links:

• www.ncoa.org/improve-health/center-for-healthy-aging/falls-prevention/falls-prevention-awareness.html
• www.apta.org/BalanceFalls/

Beginning on "a date that will be announced in calendar year 2014," physical therapists (PTs) who order durable medical equipment (DME) for their patients will have to show that they met face-to-face with the patient within 6 months of writing the order. The Centers for Medicare and Medicaid Services (CMS) has put off setting a deadline for compliance to this requirement, which was mandated by the Affordable Care Act, saying that some suppliers and providers may need more time to establish needed protocols.

Many providers and suppliers already know about and follow the policy, CMS commented in the September 9 notice, adding that they should continue to do so. CMS said it will address questions about the policy and will update its website at www.cms.gov/medical-review with any new information.

While the federal deficit is expected to continue shrinking over the next few years, it gradually will grow again, mostly from expenses related to the government's health care programs and Social Security, reported the Congressional Budget Office (CBO) this week.

The deficit shrank this year to its smallest size since 2008: roughly 4% of gross domestic product, compared with a peak of almost 10%, said CBO in its 2013 Long-Term Budget Outlook (.pdf). CBO cited the reasons as the economy's gradual recovery from the 2007–2009 recession, the waning budgetary effects of policies enacted in response to the weak economy, and other changes to tax and spending policies. If current laws governing taxes and spending were generally unchanged—an assumption that underlies CBO's 10-year baseline budget projections—the deficit would fall to 2% by 2015.

However, CBO projects that budget deficits would gradually rise again under current law, mainly because of increasing interest costs and growing spending for Social Security and health care programs (Medicare, Medicaid, the Children's Health Insurance Program, and subsidies to be provided through health insurance exchanges). CBO expects interest rates to rebound in coming years from their current unusually low levels, sharply raising the government's cost of borrowing.

The Joint Commission's proposed standards for an optional memory care certification within the nursing and rehabilitation center accreditation program are out for field review, and your comments can help shape final standards. Comments are due October 16, 2013.

The Joint Commission emphasizes that these optional certification requirements would be in addition to the accreditation requirements that will apply to all Joint Commission-accredited long-term care organizations. While accreditation requirements address the prevalence of dementia in nursing homes, says the Joint Commission, the optional certification will recognize organizations for their dementia care specialization, particularly for organizations providing specialized dementia care in a distinct unit or area. Key areas that distinguish the memory care optional certification requirements from the accreditation requirements include the role of the coordinator, staff education and training, feature of the physical environment, and activity programming.

To comment, follow the instructions on the standard field reviews page—download and review the proposal, then submit comments by October 16 via an online survey, an online form, or e-mail to the Joint Commission. Direct any questions you have to Jennifer Tarpey, Department of Standards and Survey Methods, 630/792-5919 or jtarpey@jointcommission.org.

Practitioners have until September 23 to comply with provisions of the final rule that earlier this year extensively modified the privacy, security, and enforcement regulations established under the Health Insurance Portability and Accountability Act of 1996, or HIPAA.

The final rule expanded many of the requirements to business associates of covered entities that receive protected health information, such as contractors and subcontractors. If a covered entity did not have a business associate agreement in place by January 25 this year that was compliant with the previous HIPAA regulations, it must enter into one by September 23. However, entities that did have HIPAA-compliant business agreements place as of January 25 may get a 1-year extension to revise their agreements, as long as they did not or do not renew those agreements between March 26 (the date the new rule took effect) and September 23. Any agreement that is renewed after September 23 must comply with the new rule, which also increases the penalties for noncompliance to a maximum of $1.5 million per violation.

The changes also strengthen the Health Information Technology for Economic and Clinical Health (HITECH) Breach Notification requirements by clarifying when breaches of unsecured health information must be reported to HHS.

The new rule also expands individual rights under HIPAA, and by September 23 these rights must be added to the Notice of Privacy Practices (NPP) that providers give to new patients. For example, patients can ask for a copy of their electronic medical record in an electronic form, and they can instruct their provider to restrict disclosures to a health plan concerning treatment for which the individual has paid out of pocket in full. The rule also sets new limits on how information is used and disclosed for marketing and fundraising purposes and prohibits the sale of individuals' health information without their permission.

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

Yet another report from the Government Accountability Office (GAO) concludes that when physicians provide certain services in their own facilities instead of referring the service to an outside lab, the number of procedures increases, and costs go up. GAO released "Higher Use of Costly Prostate Cancer Treatment by Providers Who Self-Refer Warrants Scrutiny" yesterday.

This third of 4 reports in GAO's self-referral investigation covered prostate cancer–related intensity-modulated radiation therapy (IMRT) services between 2006 and 2010. Among the findings are that self-referred services grew by 46% annually, from 80,000 in 2006 to 366,000 in 2010, while non-self-referred services decreased by 1% each year, from 490,000 to 466,000. In 2009, providers who self-referred Medicare patients with prostate cancer were 53% more likely to refer the patients for IMRT than for other less costly treatments. GAO estimated that, even including a $91 million decrease in expenditures by the non-self-referring provider groups, the higher rate of IMRT by self-referrers led to an overall increase in IMRT Medicare costs of $47 million between 2006 and 2010. The report also suggested that financial interest in one type of treatment over other less costly procedures may negatively affect a provider's decision-making process and, ultimately, patient care. Additional findings and conclusions are in the report.

Studies such as this have prompted at least 1 member of Congress to act. Yesterday Rep Jackie Speier (D-CA) introduced the Promoting Integrity in Medicare Act, announcing during a press conference that it is intended to remove physical therapy and other health care services from the in-office ancillary services (IOAS) exception, which allows for self-referral. APTA and its partners in the Alliance for Integrity in Medicare, or AIM Coalition, strongly support this move to exclude these services from the IOAS exception.

In its first 2 reports, GAO investigated self-referral in advanced imaging services and anatomic pathology, also concluding financial self-interest was driving the increases in referrals and spending.

APTA anticipates the last—and most telling for our profession—report in the series, on physical therapist services, later this year.

Instead of jumping to 6.8%, federal undergraduate student loan interest rates rise this year from 3.4% to 3.9%, as a result of the Bipartisan Student Loan Certainty Act. Graduate rates drop from 6.8% to 5.4% and Parent PLUS rates to 6.4%. For all 3 programs, the interest rate is fixed for the life of the loan.

After a month of negotiations, US House of Representatives passed the bill on July 31, and the President Obama now is expected to sign it. (The Senate passed the bill earlier in July.) This legislation lowers interest rates for undergraduate and graduate Stafford loans and for Parent PLUS loans beginning July 1, 2013.

Interest rates will be calculated using a formula based on the 10-year Treasury note. Students lock in the rate in effect at the time they take out a loan, but future rates could vary based on the market. With this in mind, this legislation also puts a cap on interest rates in the future: 8.25% for undergraduates, 9.5% for graduates, and 10.5% for PLUS loans.