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  • Medical Home Models Continue to Report Positive Outcomes

    Patient-centered medical home (PCMH) initiatives across the US are continuing to report mostly good news, with demonstrated decreases in cost of care, visits to emergency departments (EDs), and inpatient admissions.

    The outcomes were documented in an annual update of evidence (.pdf) produced by the Patient-Centered Primary Care Collaborative, which reviewed 20 studies (13 peer-reviewed, 7 industry-generated) released between August 2012 and December 2013. While report authors describe supporting evidence as in its "early" stages and warn that the update itself is not "a formal peer-reviewed meta-analysis," they write that the evidence "suggests that when fully transformed primary care practices have embraced the PCMH model of care, we find a number of consistent, positive outcomes."

    Among the findings:

    • Reductions in costs were reported in 12 of the 20 studies (8 of the 13 peer-reviewed analyses, and 4 of the 7 industry analyses), with the same numbers reporting decreases in ED visits.
    • Inpatient admissions were reported as decreasing in 4 of the industry analyses and 4 of the peer-reviewed studies.
    • While 4 of the peer-reviewed studies reported improvements in patient access to care, only 1 of the industry analyses reported improvements in this area.
    • Improvements were also cited in readmission rates, overall population health indicators, and preventive services, though less consistently than reported improvements in cost and ED visits.

    Authors of the update wrote that the latest reports bolster the argument that the benefits of the PCMH model tend to accrue over time, and that primary care practices could see significant improvements in outcomes if other policy changes are put in place that shift care away from the fee-for-service model "to one that rewards quality, efficiency, and innovation." The report cited the potential end to the flawed sustainable growth rate (SGR) now being discussed in Congress as a change that could significantly help the move toward new models of care.

    The patient-centered medical home concept has been an area of focus at APTA for some time. APTA has engaged in advocacy to ensure that physical therapists (PTs) have a voice in the development of medical home models, and has supported the development of the Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services. In addition, APTA offers a series of videos on collaborative care models, including a presentation on the PT's role in the medical home.

    Health Care Loses 6k Jobs in December

    Health care employment in the US reported its weakest month since 2010, with about 6,000 jobs shed in December 2013. The largest drops were in ambulatory health care, hospital, and home health care services, while residential services and outpatient centers saw slight increases of 1,000 and 4,000 jobs, respectively.

    The latest report (.pdf) from the federal Bureau of Labor Statistics (BLS) reflects what Bloomberg Businessweek says could be a "blip" in an industry that is thought of as a consistent job producer, albeit one that has slowed its growth in 2013. The health care employment numbers were part of a lackluster jobs report that pegged unemployment at 6.7% nationally.

    Analysts are unsure about the source for the December drop in health care jobs. While most agree that the sluggishness is likely related to an overall decline in health care spending, there are differing theories about whether the drop in spending is due to new approaches to care, a lingering "hangover" from the economic recession, or a combination of both.

    Most of APTA's projections continue to show physical therapy as a growing profession, with projected unmet demand ranging from 13,638 to 27,820 over the next 5 years depending on the attrition rate of physical therapists (PTs) over time. The total number of licensed PTs is projected to rise from about 176,000 to between 203,000 and 232,000 by 2020. The supply and demand data are part of a suite of resources on the physical therapy workforce available on APTA's website.

    Exercise Trumps Surgery in NPR Report on Back Pain

    The idea that exercise can be more effective than surgery as a way to manage back pain may be well known to physical therapists, but National Public Radio (NPR) has spread the word to a much wider audience.

    A report broadcast on January 13 features the stories of several patients who suffered from back pain, some of whom underwent surgery for their conditions. In all the cases featured, exercise was the only factor that brought relief or helped them manage the pain.

    Reporters Patti Neighmond and Richard Knox focused on a "back pain bootcamp" program run by James Rain, MD, a physiatrist near Boston. The program is focused on rehabilitative techniques that reporters say help individuals "learn to ignore their pain."