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  • CDC: 1 in 4 Americans Have Multiple Chronic Conditions, With Wide Variation Among States

    According to the US Centers for Disease Control and Prevention (CDC) one-quarter of the US adult population has multiple chronic conditions (MCCs), but that average doesn't reflect regional differences, which include state MCC rates as low as 1 in 5 residents to a high of more than 1 in 3.

    The report, based on results of a 2014 National Health Interview Survey of 36,697 results, tracks the prevalence of adults who reported having 2 or more of 10 chronic conditions: arthritis, cancer, chronic obstructive pulmonary disease, coronary heart disease, diabetes, hepatitis, hypertension, stroke, or weak or failing kidneys. Respondents included Medicare beneficiaries and the privately insured.

    Researchers analyzed the data by state and region, sex, and age groupings (18-44, 45-64, 65 and older). Here's what they found:

    • The national average doesn't tell the whole story. The national rate of 25.7% for MCCs contains significant variations when broken down by the 9 regions used in the study. Regionally, the Pacific area (Alaska, Hawaii, Washington, Oregon, California) registered the lowest MCC average at 21.4%, while the East South Central region (Alabama, Kentucky, Mississippi, Tennessee) reported the highest rate, with 1 in 3 residents (34.5%) experiencing MCCs. Other regions above the national average were East North Central (28.4%), New England (26.5%), South Atlantic (26.5%), and West South Central (26.4%). The Middle Atlantic, Mountain, and West North Central regions reported averages lower than the national rate (24.1%, 24.9%, and 23.4%, respectively).
    • States reported wide variation. This is where things got even more dramatic: researchers found that in Colorado, the MCC rate was less than 1 in 5 (19.0%)—the lowest in the country. Kentucky, the state with the nation's highest rate of MMCs, was slightly more than double that rate, with 38.2% of residents reporting MCCs. Kentucky was followed by Alabama (35.8%), West Virginia (34.6%), Mississippi (34.2%), and Montana (33.2%) as the states with the 5 highest rates in the country. At the low end, the District of Columbia (19.2%), Alaska (19.6%), California (20.1%), and Wyoming (20.4%) reported rates close to Colorado's.
    • Rates varied by sex, with the margin varying by region. Nationally, women experienced a higher prevalence of MCCs than men, at 27.2% compared with 24.1% for men, but regionally those differences fluctuated. Differences were widest in the Mountain region (women at 28.1% compared with men at 21.5%) and East North Central region (women at 31.4% compared with men at 25.3%). For both sexes, the East Central region reported the highest rates (36.3% for women, 32.3% for men), with the lowest rates coming from the Pacific region (women at 21.9%, men at 20.9%).
    • Age distribution wasn't surprising. Prevalence of MCCs was lowest for the 18-44 age group (7.3%) and highest among adults 65 and older (61.6%). The 45-64 group reported a 32.1% rate. The rate for the oldest group is consistent with an earlier Medical Expenditure Panel Survey that estimated the presence of MCCs at 66% for adults 65 and older in 2012.
    • MCC prevalence tends to echo other disease patterns. The CDC researchers also found that MCC prevalence overlapped with both the "stroke belt" (all of Mississippi, parts of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia) and the "diabetes belt" (all of Mississsippi and parts of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia).

    APTA has actively advocated for the physical therapy profession's role in addressing chronic conditions, and earlier this year provided comments to a US Senate work group focused on improving the health care system's response to the issue. In addition, the 2015 House of Delegates adopted the position Health Priorities for Populations and Individuals (RC 11-15) "to guide [APTA's] work in the areas of prevention, wellness, fitness, health promotion, and management of disease and disability." The priorities include active living, injury prevention, and secondary prevention in chronic disease and disability management. APTA highlights the role of the physical therapist and physical therapist assistant in the treatment of chronic conditions through its prevention, wellness, and disease management webpage.

    The APTA Learning Center offers several resources to learn more about the physical therapy's role in addressing chronic disease, including offerings on developing exercise programs for individuals with chronic heart disease, management models for individuals with diabetes and chronic heart disease, physical therapy for cancer survivors, and the role of home health physical therapy in addressing chronic conditions.

    EMG Lab Accreditation Process Recognizes Role of PTs

    Thanks to the collaborative work of several groups committed to making the case for physical therapists (PTs) as qualified providers of electrodiagnostic studies, the landscape for lab accreditation has changed in ways that create opportunities for PTs, all while following standards more rigorous than previously existing systems.

    The new lab accreditation is an effort of the Federation of Electrodiagnostic Laboratory Accreditation (FELA). But as the name implies, FELA is a group effort, created when members of the American Academy of Clinical Electrodiagnosis (AACE), the American Congress of Electroneuromyography (ACE), and APTA's Academy of Clinical Electrophysiology and Wound Management (ACEWM) came together around a shared goal—creating a program that allows PT-run labs to achieve accreditation.

    According to Greg Ernst, PT, PhD, member of AACE, the idea began 4 years ago. "There was already a lab accreditation process developed by the American Association of Neuromuscular and Electrodiagnostic Medicine [AANEM]," he said. "However, the AANEM accreditation requires that each lab, and all satellite labs, have a physician that performs electrodiagnostic studies—PTs could only function as technicians."

    So Ernst, ACE President Elaine Armantrout, PT, DSc, and Rick McKibben, PT, DSc, chair of ACEWM's clinical electrophysiology practice group, set out to create an accreditation program that would not only acknowledge the PT's ability to oversee electrodiagnostic labs, but would be based on standards that exceeded those created by AANEM. Joining the effort were Robert Sellin, PT, DSc, David Greathouse, PT, PhD, and John Palazzo, PT, DSc. Ernst, Armantrout, McKibben, Sellin, Greathouse, and Palazzo are all board-certified specialists in clinical electrophysiologic physical therapy. Greathouse, additionally, is a Catherine Worthingham Fellow of the American Physical Therapy Association.

    "We all agreed that FELA should be as inclusive and open as possible while maintaining strict adherence to what is needed to represent quality and integrity in an accreditation process," Armantrout explained. "FELA applicants can be from any discipline as long as their state licensure allows, which sets us apart from AANEM's accreditation, to which only neurologists and physiatrists can apply. We think that by restricting the accreditation in that way, the public and payers are misled, and it implies that there aren't other qualified providers, such as PTs."

    Besides the more open qualifications for accreditation, Ernst points to 3 other areas that make FELA distinct from the AANEM path:

    • A higher bar for "exemplary accreditation." While both FELA and AANEM offer 2 levels of accreditation—"regular" and "exemplary"—the requirements to achieve exemplary status through FELA are tougher than the ones used by AANEM, Ernst said
    • Emphasis on waste, fraud, and abuse training. Ernst said that FELA requires evidence of Centers for Medicare and Medicaid Services training on avoiding waste, fraud, and abuse. The AANEM program doesn't.
    • Cost. "The FELA lab accreditation process is less than half the cost of the AANEM accreditation," Ernst said.

    "The accreditation program is completely optional at this stage," Ernst added. "We developed FELA to help show third-party payers and the public that PTs and the labs [where they practice] can provide safe and quality care in the field of electrodiagnostics."

    Defense Department Makes Big Change in Tricare Vendors

    In a major shift, the Department of Defense (DOD) has selected Humana Military and Health Net Federal Services to manage its Tricare health insurance system, parting ways with UnitedHealthcare. The new contracts, worth a combined $59 billion, apply to the program that serves US military members and their families.

    The new contracts will also be built around a new condensed regional system: instead of separate contracts for North, South, and West regions, DoD has established only 2 coverage regions—East and West. Health Net Federal was assigned the $18 billion contract for the 21-state West region, while Humana now has the contract for the 32-state East region, worth $41 billion. Previously, Humana had managed the South region, UnitedHealthcare had managed the East region, and Health Net had managed the West region.

    According to an article in Military.com, DoD is describing the change as a "reorganization," rather than a rebidding process, that will "simplify the system for both government and users."

    "If the contracts are managed well and the handoff is smooth, the change should have very little impact on Tricare beneficiaries, including Tricare for Life users," according to the Military.com article. "But the relationship between beneficiary and contractor can quickly go bad when payments to providers are slow to process or the contractor kicks back to the patient bills for services that should be covered."

    Representatives from DoD say the change will make it easier for beneficiaries to move from region to region, and will facilitate the use of electronic health records (EHR). Federal News Radio reported that under the new contracts, Health Net and Humana will be required to handle all referrals to outside providers electronically and to "ensure private providers can interface" with the EHR system DoD is rolling out in its military treatment facilities.

    APTA is aware that the Tricare reorganization may create issues related to physical therapy reimbursement, and will work on behalf of the membership to address them with DoD and the managed care companies.

    In order to assist APTA in monitoring the effects of the change on physical therapists and physical therapist assistants, members are encouraged to share their experiences with the Tricare changes by emailing advocacy@apta.org with name, member ID, and contact information for staff follow-up.

    CMS Expands Mandatory Bundling Program to Cardiac Care, Including Rehab

    The Centers for Medicare and Medicaid Services (CMS) has announced the latest in its move toward value-based payment systems—this time through the introduction of a mandatory bundling program for care associated with bypass surgery and heart attacks, including provisions that would incentivize the use of cardiac rehabilitation.

    The demonstration plan announced by CMS would affect hospitals in 98 randomly selected metropolitan areas and would work much like the Comprehensive Care for Joint Replacement (CJR) model implemented this year. Similar to CJR, the new bundling plan would reimburse providers a set amount for an entire episode of care, from admission to 90 days after the patient is discharged. Medicare would create targets for spending, and if the total spending is less than the Medicare target, the hospitals may be eligible to receive additional payment from Medicare. If hospitals spend more than the Medicare target, they could be required to pay back Medicare for some portion of the difference. And like CJR, the cardiac bundling plan is mandatory for hospitals in those areas.

    Also included in the cardiac demonstration proposed rule: a proposal to extend the CJR bundling provisions beyond hip and knee arthroplasty to include patients undergoing care for hip and femur fractures. The project would launch July 1, 2017, and last for 5 years.

    "Just like CJR, the model is mandatory and extends to metropolitan statistical areas [MSAs] that include the 67 areas already covered in CJR," said Roshunda Drummond-Dye, APTA director of regulatory affairs. "If PTs want to formally collaborate with hospitals to share in incentive payments, they must negotiate contractually. But the bottom line is, if they are included in one of the identified MSAs and they treat patients within 90 days from discharge from the hospitals after a heart attack, bypass, or hip surgery, the care they provide will count toward the bundle."

    The cardiac program also includes an initiative that would promote the use of cardiac rehabilitation during the 90-day period after discharge. According to a fact sheet from CMS, the initial payment would be $25 per cardiac rehab service for each of the first 11 services paid for by Medicare. After 11 services are paid for by Medicare for a beneficiary, the payment would increase to $175 per service. "Clinical studies have found completing a rehabilitation program can lower a patient’s risk of heart attack or death," CMS writes. "Increasing the use of cardiac rehabilitation services has the potential to improve patient outcomes and help keep patients healthy and out of the hospital."

    Drummond-Dye says that the expanding use of bundling programs is part of a larger shift toward value-based payment models—and something PTs need to be tuned into.

    "One key proposal that uniquely affects PTs is the provision to make CJR and other bundled payment models qualify as alternative payment models under [the Medicare Access and CHIP Reauthorization Act, or MACRA]," Drummond-Dye said. "At first glance, this is good news for our providers, as this gives them more opportunities to participate in alternative payment models and quality programs under MACRA—it's something that APTA advocated for in our comments, and, essentially, CMS listened."

    Meanwhile, APTA advises that PTs stay on top of patient data and evidence to make the bundling models work for them.

    "It is imperative that PTs know the composition of the patient population they treat and have clinical evidence on the outcomes of their care for this patient population," Drummond-Dye said.

     APTA intends to provide comments on the cardiac bundling demonstration by the September 24 deadline, and continues to track implementation of CJR.

    The APTA CJR webpage contains extensive information on both the nuts-and-bolts of the program and the considerations physical therapists should weigh when making practice decisions. The online resource also includes links to evidence-based clinical information and community programs, as well as a free webinar on the system.

    Study: 10 Modifiable Risk Factors Associated With 90% of Strokes Worldwide

    Ten modifiable risk factors are associated with 90% of strokes, according to a recently published international study (abstract only available for free). Risk factors include physical inactivity, hypertension, poor diet, obesity, smoking, cardiac causes, diabetes, alcohol use, stress, and increased lipid levels.

    The case-control study was “phase 2” of the larger INTERSTROKE study. According to lead author Martin McDonnell in a related Lancet podcast, the goals of this study were to describe and quantify stroke risk factors and identify any “regional variations by population characteristics or stroke subtype.”

    Researchers examined patient data from 142 participating facilities in 32 countries representing all continents (26,919 participants and 13,472 controls). Participants were assessed with a variety of measures, as well as MRI or CT imaging and blood and urine samples, within 5 days of acute first stroke.

    While all 10 factors were found to be significant overall, their relative importance varied by region. For example, lack of regular physical activity was associated with 59.9% of strokes in China, but was associated with only 4.7% of strokes in Africa. And while waist-to-hip ratio was associated with approximately 37% of strokes in Southeast Asia and Western Europe/North America/Australia, it was associated with only 2.8% of strokes in Eastern and Central Europe and the Middle East. The single constant: hypertension, which researchers determined was the leading cause of stroke in all 6 regions.

    One unusual finding McDonnell noted was that in South Asia, lower diet quality was actually associated with lower stroke risk. Similarly, higher alcohol intake was associated with a lower stroke risk in Western Europe/North America/Australia, which was not the case with all other regions.

    Because hypertension was associated with 48% of strokes worldwide, McDonnell asserts, addressing it is the “key to stroke prevention.” Authors hope the results can “support the development of both global and region-specific programs to prevent stroke."

    APTA offers multiple resources on the role physical therapists (PTs) and physical therapist assistants play in addressing prevention and wellness, including a 2-part podcast on the inactivity epidemic (part 1, part 2) and a recorded presentation on physical activity and the PT.

    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.

    Study: Early Physical Therapist Management for Neck Pain Makes Sense for Patients, PTs, and Payers

    According to a new study, providing physical therapy within 4 weeks after an individual first experiences neck pain is a win-win-win proposition for physical therapists (PTs), payers, and most importantly, patients. Researchers found that getting to a PT early not only achieved more improvement per $100 spent, but actually doubled a patient's odds of decreased disability compared with patients who were treated after a delay of more than 4 weeks.

    Researchers tracked 1,531 patients using an outcomes management system maintained by Intermountain Healthcare, a private nonprofit system, to analyze changes to disability and pain scores through an episode of neck pain. Patients were included if they had 2 more visits to a PT over fewer than 180 days, and if they recorded scores of 10 or greater on the Neck Disability Index (NDI) and 2 or greater on the Numerical Pain Rating Scale (NPRS).

    Patient records were then divided into 2 groups: 1 group of 451 patients who reported experiencing symptoms for fewer than 4 weeks, and a second group of 1,080 patients who reported symptoms that were present for 4 weeks or longer. Here's what researchers found:

    For the early therapy groups, the odds of achieving a minimal clinically important difference (MCID) in disability doubled for the early-therapy group—and increased by nearly as much for pain.
    Researchers found, on average, that patients were twice as likely to achieve at least a 19 percentage point change in the NDI, and were 1.82 times more likely to record a drop of at least 1.3 points on the 10-point NPRS.

    The greater decreases in disability and pain translated into more bang for the health care buck.
    Early-therapy patients averaged a 2.27 percentage point improvement in disability scores per $100 spent, compared with later-therapy patients, whose disability scores dropped by 1.22 percentage points per $100.

    PTs and patients were able to achieve more improvement per-session when physical therapy started earlier—what authors describe as "more efficient care."
    On average, early-therapy patients saw disability scores drop by 3.44 percentage points per visit, compared with a 1.81 percentage point drop for the later-therapy group. Pain scores followed a similar pattern, with pain dropping by .57 points for the early-therapy patients, compared with a .42 percent drop for the later-therapy group.

    Authors of the study, published in BMC Health Services Research, write that the findings support the "value proposition" for early physical therapy, with benefits reaching payers, PTs, and patients: payers realize lower costs, PTs can make a bigger difference, and patients experience changes that not only improve their lives, but lower their indirect costs through decreases in work absenteeism and disability.

    Researchers conclude that, similar to earlier research supporting early physical therapy for treatment of low back pain, their study contributes to the conversation around health care's shift away from fee-for-service models, and toward value-based care.

    "Policymakers and payers contribute to the value equation by designing health policies that promote access and use of timely, appropriate, health care services," authors write. "The implication of these findings suggests that a health care system that provides pathways for patients to receive early [PT] management of neck pain may realize improved patient outcomes, increased efficiency in delivery of care, and greater value."

    Authors of the study include Maggie Horn, PT, DPT, MPH, PhD, Gerard Brennan, PT, PhD, Steven George, PT, PhD, Mark Bishop, PT, PhD, and Jeffrey Harman, PhD.

    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.

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    Anti-Identity Theft Changes to Medicare Cards Coming

    How might changes to Medicare card numbers affect your practice? The Centers for Medicare and Medicaid Services (CMS) has some thoughts, but would like your input, too.

    On Wednesday, July 27, CMS will host a "listening session" to discuss its social security number removal initiative (SSNRI), a plan to end Medicare card numbers that are based on a beneficiary's social security number. The change is mandated under the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) as a way to reduce opportunities for identity theft.

    The session will run from 1:00 pm to 4:00 pm, ET, and will include a presentation on the SSNRI by CMS staff as well as a question-and-answer period. Registrants will be sent the CMS presentation in advance.

    Participants can register online, and are advised to call in 15 minutes before the session starts. CMS will also be accepting written comments on the SSNRI through August 3.

    HHS: 29% of Rehab Hospital Patients Experience Adverse Events, Temporary Harm During Stays

    Close to 1 in 3 Medicare beneficiaries in independently-run rehabilitation hospitals experience adverse or temporary harm events during their stay—and nearly half of those events are preventable, according to a new report from the Department of Health and Human Services (HHS) inspector general.

    The report, part of a series that also analyzed adverse events in acute care hospitals (ACHs) and skilled nursing facilities (SNFs), involved reviews of a "representative sample" of 417 Medicare beneficiaries who were discharged from independently-run (as opposed to hospital-based) rehab hospitals in March 2012. Nurse screeners identified cases that indicated adverse events, and a panel of physicians evaluated the events to rate severity, as well as to assess the possibility that the event could have been prevented. Here's what they found:

    Overall, the rehab hospitals' rates were in line with ACHs and SNFs.
    Earlier HHS studies found harm rates of 27% for ACHs and 33% for SNFs. The 29% harm rate for the rehabilitation hospitals isn't much different.

    46% of the events were "clearly" or "likely" preventable, 51% weren't, and the remaining 3% were unclear.
    The 46% rate was further broken down according to whether the event was "likely" preventable (38% of all cases) or "clearly" preventable (8% of all cases). The 51% of "not preventable" events were described as ones in which "harm could not have been avoided given the complexity of the patient's condition or care required." Authors of the report write that when it came to the preventable events, "reviewers frequently cited as factors the provision of appropriate treatment in a substandard way and failure to adequately monitor a patient's progress" as elements leading to the event.

    Out of 158 events, 112 were classified as "temporary harm events," with the rest described as more serious "adverse events" that resulted in longer stays, transfers to ACHs, permanent harm, interventions to sustain the patient's life, or death.
    Authors estimate that temporary harm events make up about 18% of all events. Less than 1% of patients experience an event that leads to death, while 1.7% experience a "cascade event"—a series of multiple harm events related to a single cause.

    Falls were associated with 4% of all events.
    Of the 158 adverse events studied, 6 were related to falls. Pressure ulcers were cited in 8%, venous thromboembolism, deep vein thrombosis, or pulmonary embolism in 2%, and edema/volume overload in 1%.

    Nearly 1 in 4 Medicare patients who experienced an event were transferred to an ACH.
    That ratio includes both patients admitted as inpatients and patients who had outpatient emergency department visits only. Authors estimate that those ACH admissions and visits cost Medicare about $92 million annually.

    As for what to do about lowering the rates of harm, authors recommend that the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare and Medicaid Services (CMS) include rehabilitation hospitals among its targets for education and training. Additionally, the report calls for AHRQ and CMS to collaborate on the creation of a list of potential events that would "go beyond conventional postacute care issues (eg, falls, pressure ulcers) and include a comprehensive range of possible patient harm, emphasizing the unique case mix in rehab hospitals and the rehabilitation needs of affected patients." According to the report, CMS and AHRQ have agreed with the recommendations.

    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.

    $12.5 Million PCORI Grant Will Fund Research on Team Approach to Pain Management

    A recently announced $21 million grants program includes a $12.5 million award for a project that will investigate the effectiveness of interdisciplinary teams that include a physical therapist (PT) in creating "integrative" pain management options to avoid reliance on opioids.

    The grants program, sponsored by the Patient-Centered Outcomes Research Institute (PCORI), will support research related to the management of chronic pain, with a goal of reducing opioid use. The largest award was provided to a University of Minnesota project that will evaluate 2 approaches in the treatment of veterans with chronic pain: one approach that pairs a pharmacist and supervising physician to determine a medication plan and create a telemedicine-based care program, and a second approach that establishes a team including a physician, psychologist, and PT to create a plan "that encourages integrative pain management options, such as exercise, in addition to medication," according to a PCORI news release.

    The second grant award, for $8.5 million, will go to a University of Wisconsin-based research team investigating the effectiveness of mindfulness meditation and cognitive behavioral therapy in the treatment and management of low back pain.

    This is not the first time PCORI has acknowledged the role of PTs in improving patient outcomes. Early in 2015, the group—an independent, nonprofit organization authorized by Congress in 2010—announced nearly $28 million in support for 2 research projects led by PTs.

    Opioids in the News: Congress Passes Opioid Bill, Medical Marijuana for Pain, the Path From Pain to Addiction, More

    The opioid abuse epidemic, and its relationship to the US health care system's approach to pain treatment, continues to make news. Here are some of the latest reports and features.

    The good news: Congress passed a bill addressing the opioid epidemic, and Obama has promised to sign it.
    The compromise bill awaiting President Barack Obama's signature is largely focused on providing help for the addicted, including allowing more people to have access to naloxone, the drug that can reverse an opioid overdose. The legislation also establishes a grants program, administered through the Department of Health and Human Services, that helps states and community organizations improve treatment and recovery programs, and allows police to divert the addicted to treatment rather than jail.

    The bad news: the bill lacks adequate funding.
    While some legislators applauded the bill as a good first step in battling the epidemic, critics pointed out that the bill does not include funding. Members of Congress say they will take up funding in a separate bill.

    A tragic story of 1 man's journey from pain, to prescription opioid addiction, to heroin.
    Oregon National Public Radio reports on John, a carpenter who now lives in his truck and uses heroin to counter pain from an old injury. Initially treated with opioids, John's prescriptions were reduced, leaving him in pain and ready to seek out illegal drugs.

    Wearable technologies could play a role in the fight against opioid abuse.
    A company has developed a wristband equipped with biosensors that can help identify when an individual with an addiction has relapsed.

    Could the use of medical marijuana for pain treatment help to decrease opioid use rates?
    In "What Can't Medical Marijuana Do," the Atlantic looks at claims that in states with legal medical marijuana, opioid prescriptions for pain treatment are as much as 12% lower than in states that prohibit medical marijuana.

    One state's attempt to curb opioid abuse through its Medicaid program has created controversy …
    Maryland Medicaid beneficiaries with opioid addictions had been receiving suboxone film to help curb their cravings. Claiming that the drug, delivered in the form of a paper strip, is too easily diverted and winds up being itself abused, the program has switched to Zubsolv tablets. Individuals who receive the treatment say it doesn't work nearly as well. "This is taking patients who are stable, who are doing really well, and saying we're going to do something to disturb how well you're doing," 1 physician told National Public Radio.

    … While other states look at the relationship between opioid addiction and housing.
    Government and community leaders from some Northeast states gathered recently to talk about how individuals addicted to opioids often face homelessness or substandard housing, and how improvements in affordable housing could in turn decrease drug use.

    APTA has added its voice to the effort to curb opioid abuse through its national #ChoosePT campaign, an initiative to promote physical therapy as a safe and effective alternative to the use of opioids in the treatment of pain. Housed at MoveForwardPT.com/ChoosePT, the #ChoosePT campaign will unfold throughout 2016 and include national online advertising, TV and radio public service announcements, and other targeted advertising and media outreach. APTA is also a member of the White House’s working group addressing the opioid epidemic.