• Tuesday, September 23, 2014RSS Feed

    Boston Globe Looks at Effects of Pulling the Plug on EHRs

    Electronic health records (EHRs) may be an important part of needed improvements to health care, but according to a recent article in the Boston Globe, EHRs have 1 potentially problematic quality—they can be turned off.

    So what happens when health care providers lose access?

    In the September 22 edition of the Globe, reporter Christopher Rowland retells the story of a small medical practice in Presque Isle, Maine, that got into a billing dispute with its EHR vendor and one day found itself unable to access any of its 4,000 patients' records. The clinic's vendor, a Germany-based health technology company called CompuGroup, admits that it is denying access until the bills are paid.

    According to CompuGroup, the clinic owes more than $20,000 in maintenance fees it refused to pay for 10 months. According to the clinic, when CompuGroup bought out the original vendor, it began charging unreasonable fees and would not respond to complaints. Now, the clinic argues, patient care is at risk.

    The Globe article uses the CompuGroup scenario to explore the unintended consequences that could arise after "physician practices and hospitals across the country rushed to cash in on $30 billion in federal subsidies for [EHR] systems starting in 2009." According to the article, "as contracts were inked by the thousands in the past few years, say legal experts, not enough thought was given to what happens when the computer systems stop working correctly, vendors or providers struggle financially or go out of business, or parties have a falling out."

    Rowland writes that while reports of cases similar to the Presque Isle practice's are "rare," a federal judge in Wisconsin "expressed little sympathy" for a clinic that was denied EHR access after withholding payments to its vendor in a billing dispute.

    According to Matt Elrod, PT, DPT, MEd, NCS, senior specialist in APTA's department of clinical practice, the Globe article spotlights an important EHR issue. "Prior to signing any contract, it's crucial to understand what will happen to the data and records if there is a separation from the vendor." he said. "Providers need to have legal counsel review these contracts to ensure that care for the patient is not jeopardized, and that the contract clearly identifies who owns and retains that data, and how that data will be accessed if an agreement is dissolved."

    The Globe article quotes Tetyana Buescher, general counsel of CompuGroup Medical USA, as saying that the clinic “had a lot of opportunities to resolve this, including getting on a payment plan; they chose not to do that. You can make an inference about … who is at fault in endangering patients, if that is the case."

    APTA offers several resources on information technology and EHRs, including a webpage devoted to the use of EHRs.

    Tuesday, September 23, 2014RSS Feed

    APTA Shares Its Consumer Outreach Approach With Other Organizations

    APTA has authored the latest installment in the US Department of Health and Human Services "Be Active Your Way" blog that promotes organization-to-organization conversations about connecting with the public on physical activity issues. In that post, the association makes 1 thing clear: for APTA, helping the public understand physical therapy's ability to transform society requires an "all of the above" approach.

    The blog post uses APTA's efforts to educate the public on pediatric back pain as an example of this multi-format approach, and describes how its efforts to support National School Backpack Awareness Day capitalized on a variety of social media and traditional media outlets.

    As with nearly all APTA-sponsored consumer awareness pushes, the pediatric back pain effort relies heavily on MoveForwardPT.com, APTA's consumer-oriented website, but also attempts to stretch the association's reach through partnerships with prominent bloggers outside APTA who are enthusiastic about spreading the word.

    "We have had marked success using this multifaceted approach," according to the blog, "garnering high-profile placements in many top-tier electronic and print publications, including WebMD, Grandparents.com, The Washington Post, The New York Times, and Consumer Reports, to name just a few."

    The "Be Active Your Way" blog is the official blog of the Physical Activities Guidelines program of the US Office of Disease Prevention and Promotion.

    Monday, September 22, 2014RSS Feed

    75% of US Adults 45 and Older Not Meeting Strength Training Recommendations

    Only about one-quarter of US adults over 45 are meeting federal recommendations for strength training—and the percentages drop even lower in certain age and other demographic groups, according to a new study from the US Centers for Disease Control and Prevention (CDC).

    Researchers for the CDC used data from the 2011 Behavioral Risk Factor Surveillance System to examine the strength training activities of more than 333,000 adults 45 and over. What they found was that only 23.7% of the population met the US Department of Health and Human Services recommendation that adults 45 and older participate in activities targeting all major muscle groups at least 2 days per week.

    While no subgroup studied met the goal, variations did exist. Among those variations:

    • When compared with respondents 45-54 years old (26% compliance), individuals aged 55-64 were 10% less likely to meet strength training recommendations. The 65-74 age group was 8% less likely than the youngest cohort, and those aged 75-84 were about 20% less likely to meet the goals than the 45-54 group, with a compliance rate of 20.2%.
    • Normal-weight respondents (BMI of 18.5-24.9) met the recommendations at a 30.2% rate; overweight (BMI of 25-29.9) reported a 24.9% rate, obese individuals (BMI of 30 or more) reported a rate of 19.9%. Underweight individuals (BMI of 18.5 or below) reported a 24.2% compliance rate.
    • Females (21.9%) were less likely to meet the goals than males (25.9%).
    • College graduates had a 34.2% compliance rate, compared with an 18.5% rate among those with high school diplomas only and a 14.4% rate among respondents with less than a high school diploma.
    • Individuals with annual income over $50,000 complied at 30.6%, with rates declining as income declined. Those reporting income less than $15,000 per year only had a 16% compliance rate.

    "Our findings indicate that there continues to be a precipitous decline in participation in muscle strengthening activities associated with aging, and that this decline does not stop at age 65," authors write. "The information gained through this research could be used to help identify which sociodemographic subgroups are most in need [of intervention]."

    The importance of appropriate strength training was acknowledged in APTA's recently released list of "5 Things Physical Therapists and Patients Should Question" created as part of the American Board of Internal Medicine Foundation's Choosing Wisely® campaign. The list of APTA recommendations includes one that advises against under-dosed strength training for older adults, and instead promotes matching "frequency, intensity, and duration of exercise to the individual's abilities and goals."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Monday, September 22, 2014RSS Feed

    Study: Functional Restoration Initiated Early Results in Big Savings

    When it comes to interdisciplinary functional restoration (FR) for chronic disabling occupational musculoskeletal disorders (CDOMDs), the earlier the better, according to a new study, which found that FR programs initiated within the first 8 months after the disabling event can lead to health care and economic cost savings of up to 72%, or about $170,000 per claim.

    The study, e-published ahead of print September 7 in the Journal of Occupational Rehabilitation (abstract only available for free), examined financial and socioeconomic outcomes from 1,119 participants with CDOMDs who received FR at different points from the onset of CDOMD—1 group 4-8 months afterwards, a second group 9-18 months afterwards, and a third group receiving FR after 18 months. The groups were matched for demographics and injured musculoskeletal regions.

    Researchers looked at outcomes 1 year after rehabilitation and found that in terms of return-to-work rates, work retention percentages, and additional health care utilization, all 3 groups were similar, with overall rates of 88% for return to work, 80% for work retention, and small rates of additional health care utilization.

    However, big differences were uncovered when the authors looked at overall medical costs and disability benefits/productivity losses, with the early-intervention group demonstrating savings of 64% and 80%, respectively, over the intermediate and late-FR groups. Additionally, researchers estimated that the actual cost of rehabilitation was up to 56% less when FR was initiated early on.

    "Early rehabilitation is more likely to be a cost-effective solution compared to cases that progress [for 8 months or more] and receive FR as a treatment of 'last resort,'" authors write.

    In addition to cost-savings, authors write that early FR "may potentially prevent or mitigate the development of complex psychosocial barriers to treatment, including depression, narcotic dependence, and complex sequelae of comorbid psychopathology."

    While authors acknowledge several limitations to their study—for instance, the study did not include the costs of prescription medications used during the postrehabilitation period—they write that the findings "are consistent with the general principle … that one of the 'first principles to avoid delayed recovery' is critical in enhancing cost-effectiveness of care for acute and chronic musculoskeletal disorders."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Monday, September 22, 2014RSS Feed

    Limited Space Available for ICD-10 Testing; Application Deadline October 3

    The first end-to-end testing of Medicare's system for processing claims using the new International Classification of Diseases, 10th Revision (ICD-10) will allow approximately 850 health care providers to see a claim through from submission to remittance advice. APTA is encouraging members to sign up for the program before the October 3 deadline as a good way to gauge their own practice's readiness for the change.

    The testing program will run the week of January 26-30, 2015, and will allow a sample group of providers to work with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractors to evaluate the system for processing the new codes. That testing process will include submission of claims with ICD-10 codes to the fee-for-service claims system, adjudication of claims, and the production of accurate remittance advices.

    The Centers for Medicare and Medicaid Services (CMS) is targeting a broad cross-section of providers and will select testing participants based on needs for the study. Volunteers can apply through their MAC's website but must do so by October 3. The MACs and CEDI will notify the volunteers who have been selected and provide them with information by October 24.

    CMS is planning additional end-to-end testing later in 2015, and more information on the testing process is available online. The ICD-10 codes are scheduled to be implemented on October 1, 2015.

    Need more information on what the change to ICD-10 means for your practice? Visit the APTA ICD-10 webpage, which includes background and resources.

    Friday, September 19, 2014RSS Feed

    'Choosing Wisely' List Subject of Move Forward Radio Episode

    APTA's contribution to the national Choosing Wisely campaign,released earlier this week, is designed to encourage conversations between physical therapists (PTs) and patients to avoid waste and improve care. Move Forward radio is helping to get that conversation started.

    To help consumers understand the list and be better informed, Move Forward Radio dedicated an episode to the list of "5 Things That Physical Therapists and Patients Should Question." 'It's really important that patients be involved in decision making about their care, and that they're really comfortable asking questions about the care that's recommended for them,' APTA's senior director of clinical practice and research, Nancy White, PT, DPT, OCS, told Move Forward Radio.

    In the episode, Tara Jo Manal, PT, DPT, OCS, SCS, discusses each of the "5 Things" and explains terminology and concepts found in the list such as "passive physical agents," "under-dosed strength-training programs," and "continuous passive motion machines."

    Manal emphasizes that it isn't a list of 5 things that should always be forbidden.

    Manal says that other than the recommendation related to whirlpools for wound management, "which we have really moved past in current practice," the list is about setting the stage for informed conversations. "It's important that patients realize that this list … is not a list of things that are inherently dangerous," she says. "They really are things that should be discussed."

    "If a therapist is doing interventions that are on this list, I think it's a very reasonable conversation to say, 'Is this really adding to my rehabilitation?' Or, 'Might we be able to spend our time [together] in a more productive way?'"

    PTs are encouraged to use the resources at MoveForwardPT.com to share the Choosing Wisely information with their patients and clients.

    Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as podcasts via iTunes.

    APTA members are encouraged to alert their patients and clients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be e-mailed to consumer@apta.org.

    Friday, September 19, 2014RSS Feed

    Postacute Care Data Reform Legislation Passes Both Houses

    Legislation that would standardize data used across postacute care (PAC) settings has now passed in both houses of Congress and could soon become part of larger reforms. APTA has been working to influence this legislation.

    The Improving Medicare Post-Acute Care Transformation (IMPACT) Act now approved by both the House and Senate would instruct the US Department of Health and Human Services (HHS) to standardize patient assessment data, quality, and resource use measures for PAC providers including home health agencies (HHAs), skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and long-term care hospitals (LTCHs).

    The House passed the legislation last week by voice vote. Late on September 18, the Senate did the same.

    APTA and other supporters of the legislation believe standardization would allow HHS to compare quality across PAC settings, improve hospital and PAC discharge planning, and use this standardized data to reform PAC payments in the future.

    The legislation will:

    • Require PAC providers to begin reporting standardized patient assessment data at times of admission and discharge by October 1, 2018, for SNFs, IRFs, and LTCHs and by January 1, 2019, for HHAs.
    • Require new quality measures on domains beginning October 1, 2016, through January 1, 2019, including functional status, skin integrity, medication reconciliation, incidence of major falls, and patient preference regarding treatment and discharge.
    • Require resource use measures by October 1, 2016, including Medicare spending per beneficiary, discharge to community, and hospitalization rates of potentially preventable readmissions.
    • Require the Secretary of HHS to provide confidential feedback reports to providers. The Secretary will make PAC performance available to the public in future years.
    • Require MedPAC and HHS to study alternative PAC payment models due to Congress in 2016 and 2021-2022, respectively.
    • Require the Secretary to develop processes using data to assist providers and beneficiaries with discharge planning from inpatient or PAC settings.

    The congressional committees have provided a summary (.pdf), including timelines.

    Thursday, September 18, 2014RSS Feed

    TBI Reauthorization Now Approved by Both Houses of Congress

    Government-sponsored research and data collection on traumatic brain injury (TBI) has support from both houses of Congress, now that the US Senate has approved the TBI Reauthorization Act (S. 2539). The House passed its version of the legislation earlier this summer. APTA was among the organizations advocating for the bills.

    The measure passed in the Senate is substantially similar to the House version, with some differences in funding amounts and a Senate request that the US Centers for Disease Control and Prevention (CDC) review evidence on management of TBI in children. If the bills are reconciled and signed into law, the act will provide funding to the CDC, the National Institutes of Health, and the Health Resources and Services Administration for programs supporting TBI research and individuals with brain injury.

    Advocacy for the reauthorization is part of a broad APTA push to bring attention to TBI and rehabilitation in general. APTA's efforts include involvement in the Joining Forces initiative, promotion of the Protecting Student Athletes From Concussions Act (H.R. 3532) (.pdf), participation in a congressional Brain Injury Awareness Day in March, and a fly-in that allowed APTA members to speak with members of Congress and their staff on the importance of rehabilitation research (see related News story). Concussion management awareness was also the focus of this year's student-led Flash Action Strategy, which resulted in the largest concussion-related grassroots effort in APTA history.

    APTA provides extensive resources to its members on the role of physical therapy in brain injury treatment and recovery, and offers a TBI webpage that includes continuing education courses and links to other interest groups.

    Wednesday, September 17, 2014RSS Feed

    NPR Features APTA's List of '5 Things Physical Therapists and Patients Should Question'

    APTA's list of "5 Things Physical Therapists and Patients Should Question" is reaching a wider audience by way of a recent National Public Radio (NPR) story in "Shots," its medical news blog.

    In her story "Farewell Heating Pad: Physical Therapists Say It Doesn't Help," reporter Nancy Shute summarizes APTA's recommendations by noting a "pattern" in the list. "The emphasis is on physical activity, and on doing it yourself with the guidance of a physical therapist so you work hard enough to get stronger and don't get hurt."

    The recommendations covered in the NPR story are now part of the American Board of Internal Medicine Foundation's Choosing Wisely® campaign. APTA member Anthony Delitto PT, PhD, FAPTA, who chaired the workgroup that reviewed member-submitted suggestions for the list, is quoted in the story.

    A downloadable copy of the list with accompanying citations (.pdf) is available at APTA's Center for Integrity in Practice website, and a detailed consumer-friendly explanation of the list is available through APTA and Consumer Reports, which partnered with the association in the creation of the brochure.

    APTA's list for Choosing Wisely is one part of the association's broad Integrity in Practice campaign. Check out the Center for Integrity in Practice for additional resources, including a primer on preventing fraud, abuse, and waste, and an online course on compliance and professional integrity.

    Wednesday, September 17, 2014RSS Feed

    Help Bring Attention to Falls Prevention Awareness Day

    Thinking about fall? Think about falls—or more precisely, how to prevent them.

    September 23 is the first day of autumn, which also happens to be national Falls Prevention Awareness Day (FPAD), and APTA is encouraging its members to spread the word on the importance of reducing fall risk and the important role that physical therapists (PTs) and physical therapist assistants (PTAs) can play in the effort.

    The National Council on Aging (NCOA) is once again providing extensive online resources to promote the day, which was recognized through events held in 47 states last year. The site includes links to a FPAD toolkit, a webinar, media resources, and a list of suggested activities.

    APTA also offers a wealth of resources on balance and falls, most of them accessible via the association's Balance and Falls webpage. Offerings range from consumer-focused information including a video, a PT's guide to falls, handouts on falls prevention and physical therapy and the balance system (members-only .pdfs), to PT- and PTA-focused information on how to develop community events on balance, falls, and exercise.

    In addition to planning and consumer-related resources, members can also access several continuing education courses related to falls at the Balance and Falls page, and the PTNow evidence-based practice resource includes a clinical practice guideline on falls and fall injuries in the older adult and a clinical summary on falls risk in community-dwelling elderly people.

    Doing something special in recognition of Falls Prevention Awareness Day? E-mail Anita Bemis-Dougherty to share what you’re doing, or take photos of your falls awareness events and share them on Twitter by including the @APTAtweets handle.