Among the conclusions of the June 2013 MACPAC report is that more research is needed on how nonphysician practitioners could improve access to care for Medicaid enrollees with disabilities.

The Medicaid and the State Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) released its Report to the Congress on Medicaid and CHIP last week. The report, issued annually, includes a chapter on access to care for adults with disabilities. Based on large-scale population surveys, provider and stakeholder data, consumer interviews and other qualitative data, and state Medicaid program data, MACPAC reported that access to health care among Medicaid-only enrollees with disabilities is comparable to that of other insured persons with disabilities; that unmet need among Medicaid-only enrollees with disabilities is lower than that of individuals with disabilities covered by private insurance or Medicare only; and that preventive services are underused among Medicaid enrollees with disabilities, although findings vary by service.

In addition to the need for research on nonphysicians and access to care, MACPAC reported that other areas in need of further research are the impact of enabling services on access to care, disability competency and accessibility in Medicaid provider networks, and evaluation and best practices in risk-based managed care and in service delivery for enrollees with disabilities.

Also in the report are chapters on Medicaid and CHIP eligibility and coverage for maternity services, the newly implemented increase in Medicaid physician payment for primary care services, the availability of data on Medicaid and CHIP that can be used for oversight and program monitoring, ways to improve the effectiveness of program integrity efforts, and the interaction between Medicaid benefits and the health insurance exchanges.

A web-based prototype crowdsourcing platform that lets users propose and support health-related research topics got a boost from the Patient-Centered Outcomes Research Institute (PCORI) last week with a $40,000 top prize in the PCORI Challenge.

WellSpringboard, being developed by researchers from the University of Michigan at Ann Arbor, is designed to enable patients to propose, endorse, and pledge funds for research topics. Researchers then would apply for the funding to conduct studies on those topics.

Other prize winners in the PCORI Challenge included these:

• ACTONNECT allows users to search patient forums and other sites for health information and share the results graphically.
• ResearchMatch is a national registry of potential study volunteers and researchers.
• Estenda's Community-Driven Research lets patients, caregivers, and researchers share and rank ideas and establish collaborations.
• S.T.A.R. Initiative is a mobile app that connects African-American women with researchers and educational curricula.

APTA's PT in Motion explored crowdsourcing for health care research in its February 2013 issue.

WCPT representatives from the World Confederation for Physical Therapy (WCPT) were in Geneva last month at the World Health Assembly, the governing body of the World Health Organization (WHO) that meets annually. Not only did WCPT participate in discussions on disability during the main assembly, the representatives were also involved in the launch of the World Health Professions Alliance statement on collaborative practice and met with the WHO Disability and Rehabilitation Team and its partner organizations.

"A global shortage of physical therapists and other rehabilitation professions is affecting access to health services to people with disabilities," said WCPT in a statement to the World Health Assembly on May 22.

As statements of good intentions on improving access evolve into global action plans, WCPT said it will continue to do all it can to raise our profession’s profile with the world’s health decision makers and ensure that the expertise of physical therapists is utilized.

To help prevent and reduce the severity of work-related injuries, the National Institute for Occupational Safety and Health (NIOSH) has launched the Center for Workers' Compensation Studies. The center will analyze trends in work-related injuries and illnesses and will coordinate with other organizations to integrate workers' compensation data with other health-related data.

"This is important because coordinated workers compensation research has been conducted mostly at large commercial insurers, state-based insurers, or industry organizations, which have not always distributed their data or research findings widely," NIOSH said in its June newsletter announcing the center.

Given certain scenarios, consumers surveyed by the Association of American Medical Colleges preferred to see a physician assistant or nurse practitioner over a physician if their visit could be as little as 1 day sooner. The survey report was published in the June issue of Health Affairs and reported by ModernPhysician.com.

When simply asked who they would rather see in a practice with a physician, physician assistant, and nurse practitioner, 50.4% preferred the physician, 29.9% had no preference, and 22.8% preferred a nonphysician. But when 2 scenarios were presented, the responses changed:

1. Patients could see a physician tomorrow or see a nonphysician today for a worsening cough—59.6% preferred a same-day visit with a nonphysician; 15.1% had no preference or were unsure.
2. Patients could see a physician in 3 days or see a nonphysician in 1 day for frequent headaches—66.6% preferred the next-day visit with a nonphysician; 11.3% had no preference or were unsure.

The report was based on a survey of 2,053 adults who indicated that they or a physician believed that they needed medical care at least once in the past 12 months.

The final rule on the Affordable Care Act’s (ACA) Small Business Health Options Program (SHOP) amends proposed regulations regarding triggering events and special enrollment periods for qualified employees and their dependents. It also implements a transitional policy regarding employees’ choice of qualified health plans (QHPs) in the SHOP. The Department of Health and Human Services released the final rule May 31.

As part of the ACA’s provisions on affordable health insurance exchanges, a SHOP in each state will help qualified small businesses provide health insurance options for their employees. The Centers for Medicare and Medicaid Services (CMS) said business owners will have access to the program beginning October 1, and employee coverage is to begin January 1, 2014.

APTA will post a summary on www.APTA.org in the near future.

The Department of Health and Human Services (HHS) said its final rule on employment-based wellness programs, released yesterday, supports workplace health promotion and prevention as a means to reduce the burden of chronic illness, to improve health, and to limit growth of health care costs, all while ensuring that individuals "are protected from unfair underwriting practices that could otherwise reduce benefits based on health status."

The final rule continues to support "participatory wellness programs," which generally are available without regard to an individual’s health status. These programs reimburse or reward employees for such initiatives as joining a fitness center, attending health education seminars, or completing a health risk assessment with no obligation to take further action.

The rules also outline standards for nondiscriminatory "health-contingent wellness programs." These generally reward individuals who meet a specific standard related to their health; for example, quitting or cutting down on tobacco use; achieving a specified cholesterol level, weight, or body mass index; or, if the individual fails to meet these goals, taking certain other healthy actions.

The maximum reward that employers may offer employees under appropriately designed wellness programs is 30% of the total cost of employee-only coverage under the plan, except for tobacco-use program rewards, which max out at 50%. The final rule also requires that health-contingent wellness programs be reasonably designed, be uniformly available to all similarly situated individuals, and accommodate recommendations made at any time by an individual’s physician based on medical appropriateness.

The final rule, issued jointly by HHS, the Internal Revenue Service, and the Department of Labor, will be effective for plan years beginning on or after Jan. 1, 2014.

Meanwhile, a recent Wall Street Journal article reported that nearly 90% of employers offer incentives, financial rewards, or prizes to employees who work toward specified wellness goals, up from 57% in 2009. The article continues with pros and cons of popular types of programs.

Unlike paper medical records that Hurricane Katrina soaked and batted about in the Gulf Coast winds in 2005, electronic health records (EHR) from the Oklahoma City area remained intact and available throughout most of the recent tornado that struck the suburb of Moore, reported ModernHealthcare.com.

Oklahoma's Secure Medical Records Transfer Network (SMRTnet) stores records for more than 2 million people and connects 90% of the hospital beds in the area, and while communication between SMRTnet and Norman Regional Health System (NRHS) was down for 7 hours at one point, it remained open to other networked hospitals. Many patients from Moore Medical Center had been evacuated to the Norman Regional Hospital and HealthPlex about 10 miles away; both are part of NRHS.

Despite the diffusion of Moore patients from their local facility to places across the metro area, spokespeople for the hospital systems said they were able to get needed information to providers via SMRTnet.

The global bodies for the 5 leading health professions, representing more than 26 million health professionals worldwide, are calling for a new emphasis on collaborative practice. Health professions working together around the world can lead to improved health services and a more effective use of resources, they say.

The World Health Professions Alliance (WHPA), which brings together the World Confederation for Physical Therapy, the International Council of Nurses, the International Pharmaceutical Federation, the World Dental Federation, and the World Medical Association, issued a statement during the World Health Organization's 66th World Health Assembly this week.

WHPA calls on governments to fund health system structures that support interprofessional collaborative practice, promote shared learning in education programs, and encourage health professionals to respect each others' expertise.

Marilyn Moffat, PT, DPT, PhD, DSc (hon), GCS, CSCS, CEEAA, FAPTA, president of the World Confederation for Physical Therapy said: "Effective interprofessional collaborative practice brings benefits in every area of health services-from health promotion through injury prevention to condition management. Working together, professionals can effectively address pressing societal health needs such as the growing burden of noncommunicable diseases and their risk factors."

Physical therapists and physical therapist assistants who want to better understand the health insurance exchange initiative that resulted from the Affordable Care Act, also being called the health insurance marketplace, can tune in to webinars from the Centers for Medicare and Medicaid Services (CMS).

Repeated several times throughout June and July, these training opportunities are broken into 2 levels:

Level 1: Health Insurance Marketplace 101. A 1-hour high-level overview of the accomplishments of the Affordable Care Act and a basic introduction to the marketplace (exchanges) highlighting who is eligible and how the marketplace will work.

Level 2: Understanding the Health Insurance Marketplace. A 2-hour detailed review of the marketplace (exchanges), including eligibility, enrollment, plan structure, Medicaid expansion, and the streamlined application.

The training sessions are free but first-come-first-served, with a limit of 200 people per session. CMS said, however, that it will add sessions if there's high demand.