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  • Heart Health Month Celebrations Begin Tomorrow

    Join the American Heart Association, WomenHeart: The National Coalition for Women with Heart Disease, Health and Human Services Secretary Kathleen Sebelius, and other leading health experts in kicking off American Heart Month February 1 at 5:30 pm-6:30 pm ET with a Webinar discussion on the state of women's heart health. Learn about the new Million Hearts campaign, a national initiative to prevent 1 million heart attacks and strokes over 5 years, and the latest advances in women's heart research.

    National Wear Red Day is February 3.  

    APTA Urges Against Limiting Language in Essential Health Benefits Categories

    Today, APTA submitted comments to the Department of Health and Health and Human Services (HHS) in response to its December 2011 guidance bulletin, the Center for Consumer Information and Insurance Oversight's (CCIIO) January 27 bulletin, and the Institute of Medicine's (IOM) report titled Essential Health Benefits: Balancing Coverage and Cost. IOM's report reiterates that the determination of essential health benefits (EHB) should be based on a national standard of evidence-based medicine divorced from politics and policymakers' influence. Under the Affordable Care Act, rehabilitative and habilitative services must be offered in the states' affordable health care exchanges as a mandatory benefit in the basic health plan. HHS' secretary is tasked with further defining each mandatory category of services. APTA and other stakeholders have urged the secretary not to overly define the categories so that practitioners have the flexibility to provide both the type and frequency of care that is medically necessary for the individual. 

    Under HHS' intended approach, states have flexibility to use an existing health plan as a "benchmark" for the items and services included in the EHB package, choosing from among these 4 plans:

    • 1 of the 3 largest small-group plans in the state
    • 1 of the 3 largest state employee health plans 
    • 1 of the 3 largest federal employee health plan options
    • the largest HMO plan offered in the state's commercial market  

    CCIIO provides a list of the products with the 3 largest enrollments in the small-group market in each state using data from HealthCare.gov.

    Based on the states' ability to tailor the plans and consider adding optional services or increased numbers of visits, it is important that APTA's state chapters continue to educate and foster relationships with their state agencies to ensure that rehabilitative services are optimized in the plans. 

    Nominating Committee Report Now Available

    The Nominating Committee Report for the 2012 election cycle now is available on the House of Delegates Community. The report provides nomination statistics and lists nomination information for members recommended for a national office position if they have provided written consent for publication.

    Contact Peyton Zeek  with questions.

    APTA Member Logo Available for Download

    Here's a great way to enhance your connection to APTA: Use the official APTA member logo on your marketing communications.

    As an added member benefit, APTA's member logo now is available for members to use on promotional items such as office stationery, note pads, business cards, fliers and brochures, Web pages of the individual member or the member's company, print ads, and telephone book listings.

    Use of the association's member logo helps reinforce your individual commitment to the profession and to the principles and standards set forth in APTA's Code of Ethics for the Physical Therapist and Standards of Ethical Conduct for the Physical Therapist Assistant.

    Examples of the appropriate use of APTA's member logo are outlined in the APTA Graphic Standards Manual available on the Use of APTA Logo Web page. Members can read the Terms of Use and download the logo.

    If you have questions about use of the logo, contact APTA's Public Relations Department at public-relations@apta.org or 800/999-2782 ext 3248.

    New NIH Fact Sheet Explains AIC Test to Diagnose Diabetes, Prediabetes

    A new resource from the National Institutes of Health (NIH) explains the A1C test to diagnose type 2 diabetes and prediabetes, and to monitor blood glucose levels of people with type 1 and type 2 diabetes.

    The A1C Test and Diabetes fact sheet covers a wide range of information, including:

    • how the test works
    • other blood tests for type 2 diabetes and prediabetes
    • accuracy of blood tests
    • where to learn more about A1C tests in people with hemoglobin variants
    • A1C targets

    Originally, the A1C test had been recommended only for monitoring diabetes. But in 2009, an international committee of experts convened by the American Diabetes Association, International Diabetes Federation, and European Association for the Study of Diabetes recommended expanding the use of the test to include diagnosing type 2 diabetes and prediabetes. Because the A1C test does not require fasting, experts hope more people will be checked for prediabetes and type 2 diabetes.

    The standard blood glucose tests for diagnosing type 2 diabetes and prediabetes—the fasting plasma glucose test and the oral glucose tolerance test (OGTT)—measure blood glucose in a person who has not eaten anything for at least 8 hours. The OGTT also measures blood glucose 2 hours after a person drinks a glucose-containing beverage. To confirm positive results, people should return on a different day to repeat the tests. The A1C test should also be repeated to confirm a diagnosis.

    Physical therapists who manage patients with diabetes can find APTA's Pocket Guide: Physical Fitness and Type 2 Diabetes on the Physical Fitness for Special Populations Web page. 

    Many Patients With RA Lack Motivation to Exercise

    Because 2 in 5 adults (42%) with rheumatoid arthritis (RA) are inactive, public health initiatives need to address the lack of motivation to exercise and promote the benefits of physical activity in this population, say authors of an article published online in Arthritis Care & Research.

    The researchers analyzed data on 176 patients with RA, 18 years of age or older, enrolled in a randomized controlled trial to assess the effectiveness of an intervention promoting physical activity. The team evaluated pre-intervention data for inactivity that was defined as no sustained 10-minute periods of moderate-to-vigorous physical activity during a week. They also assessed the relationships between inactivity and modifiable risk factors, such as motivation for physical activity, obesity, and pain.

    Results show that 42% of RA patients were inactive—participating in no moderate-to-vigorous physical activity periods of at least 10 minutes during a 7-day period of objective activity monitoring. Researchers found that 53% of study participants lacked strong motivation for physical activity and 49% lacked strong beliefs in the benefits of physical activity. These 2 modifiable risk factors account for 65% of excess inactivity in this study group.

    While previous research relied on self-reported physical activity measures, the strength of the current study lies in the use of accelerometers—a device used to measure acceleration and movement—to objectively assess physical activity in participants, say the authors. 

    The National Institute for Arthritis and Musculoskeletal and Skin Diseases funded this study.

    Registration Open: 2012 Federal Advocacy Forum

    Be a part of this important time in the history of your profession and join your colleagues for the 2012 Federal Advocacy Forum April 22-24. At the event, you will hear from decision makers on Capitol Hill, learn to effectively communicate with your elected officials, receive an update on the legislative and regulatory issues affecting the physical therapy profession, and lobby your members of Congress on behalf of your profession.

    The programming for the 2012 Federal Advocacy Forum will begin April 22 with an evening reception. April 23 will be dedicated to advocacy programming and preparation for your hill visits. The event will conclude with the opportunity for you to take your message directly to your members of Congress April 24. 

    The number of CEUs earned for this event is pending. In order to claim CEU credit, you must attend the live event and complete the online posttest with at least 70% accuracy. The online posttest will be available on APTA's Learning Center by April 24.

    For a full agenda and more information about this event, visit the Federal Advocacy Forum Web page. APTA encourages you to get the word out to friends and colleagues and bring someone along with you. Register now and bring your voice to Capitol Hill on behalf of your profession. 

    This year's Federal Advocacy Forum will be held in conjunction with a larger event, APTA's Leadership Forum, which integrates APTA's Board of Directors meeting, the Leadership Symposium for New Component President and Executive Teams, and the Federal Advocacy Forum. Participation at other events is not required to attend the Federal Advocacy Forum.

    Decline in Diabetes-related Lower-limb Amputations

    The rate of leg and foot amputations among US adults aged 40 and older with diagnosed diabetes declined 65% between 1996 and 2008, according to a study by the Centers for Disease Control and Prevention published Tuesday in Diabetes Care. 

    For the study, researchers calculated nontraumatic lower-extremity amputation (NLEA) hospitalization rates, by diabetes status, among people aged 40 years and older on the basis of National Hospital Discharge Survey data on NLEA procedures and National Health Interview Survey data on diabetes prevalence.

    The researchers found that the age-adjusted rate of diabetes-related lower-limb amputations was 3.9 per 1,000 people in 2008 compared with 11.2 per 1,000 in 1996. In addition, among people with diagnosed diabetes in 2008, men had higher age-adjusted rates of leg and foot amputations than women (6 per 1,000 vs 1.9), and blacks had higher rates than whites (4.9 per 1,000 vs 2.9). Adults aged 75 years and older had the highest rate—6.2 per 1,000—compared with other age groups.

    "NLEA continues to be substantially higher" in people with diabetes than those without and "disproportionately affects people aged ≥75 years, blacks, and men," the authors write. "Continued efforts are needed to decrease the prevalence of NLEA risk factors and to improve foot care among certain subgroups within the US diabetic population that are at higher risk."

    APTA-FSBPT Collaboration: Developing Models of Continuing Competence

    For many years, APTA and the Federation of State Boards of Physical Therapy (FSBPT) have discussed and collaborated on continuing competence. Following the publication of a joint paper in 2010 to generate discussion on continuing competence and to move the conversation forward, members of APTA and FSBPT boards of directors met in early in 2011 to discuss several topics, including continuing competence.

    On Monday, APTA and FSBPT sent a joint communication to members that provided the 2011 discussion topics and outlined APTA's and FSBPT's preferred approach to developing models of continuing competence. The communication also provides information on voluntary tools that FSBPT has developed for state licensing boards.      

    For further information or to ask questions, contact Janet Bezner at janetbezner@apta.org or Susan Layton at slayton@fsbpt.org.

    New in the Literature: Classification Methods for Lumbar Impairments (J Man Manip Ther. 2010;18:197-204.)

    The majority of patients with lumbar impairments who are classified based on initial clinical presentation by manipulation and stabilization clinical prediction rules (CPRs) also are classified as derangements whose symptoms centralized, say authors of an article published in Journal of Manual & Manipulative Therapy. Manipulation and stabilization CPRs may not represent a mutually exclusive treatment subgroup, but may include patients who can be initially treated using a different classification method, they add.  

    Eight physical therapists practicing in 8 diverse clinical settings classified patients typically referred to rehabilitation by McKenzie syndromes (McK) (eg, derangement, dysfunction, and posture, pain pattern classification (eg, centralization [CEN], not centralization [Non CEN], and not classified [NC]), manipulation CPR (positive, negative), and stabilization CPR (positive, negative). Prevalence rates were calculated for each classification category by McK, pain pattern classifications (PPCs), and manipulation and stabilization CPRs. Prevalence rates for McK and PPCs were calculated for each CPR category separately.

    Data from 628 adults (mean age: 52±17 years, 56% female) were analyzed. Prevalence rates were:

    • McK-- derangement 67%, dysfunction 5%, posture 0%, other 28%
    • PPC -- CEN 43%, Non CEN 39%, NC 18%
    • manipulation CPR -- positive 13%
    • stabilization CPR -- positive 7%

    For patients positive for manipulation CPR (n = 79), prevalence rates for derangement were 89% and CEN 68%. For patients positive for stabilization CPR (n = 41), prevalence rates for derangement were 83% and CEN 80%.

    Call for Proposals: Innovative Health Care Delivery and Payment Models

    Are you putting forth a proposal for the Center for Medicare and Medicaid Innovation Health Care Innovation Challenge Grants? If not, are you participating in a health care model that incorporates a patient-centered medical home or implements bundled payments? If the answer is "yes" to either of these questions, APTA wants to hear from you.

    APTA is working to support members in their success within these models. In addition, the association wants to connect you with your peers who are working within similar models, allowing you to share both your opportunities and challenges.

    Please send a brief (approximately 100 words) description of your model of practice along with your name and contact information to memberfeedback@apta.org.

    PCORI Proposal Focuses on 5 Broad Priorities

    Yesterday, the Patient-Centered Outcomes Research Institute (PCORI) released its draft national priorities for patient-centered comparative clinical effectiveness research. The draft plan does not single out any specific diseases or interventions to study, but rather proposes 5 broad areas in which to focus the institute's efforts. Those areas are:

    • comparing assessments of prevention, diagnosis, and treatment options
    • improving health care systems
    • communicating and disseminating research findings 
    • addressing disparities
    • accelerating patient-centered and methodological research

    PCORI now seeks public comments on whether these draft priorities and research agenda capture the areas where more evidence is needed to support decision making. In addition, PCORI will hold forums during the comment period (January 23-March 15), including focus groups in cities across the country and a National Patient and Stakeholder Dialogue in Washington, DC, February 27, in which anyone can participate either in person or via Webcast.

    PCORI will review all of the input received and use it to revise the draft priorities and agenda before it adopts them. Once the initial priorities and agenda are adopted, PCORI will issue its first funding announcements for primary research in May. 

    New Guidelines Emphasize Physical Activity in Cancer Prevention

    Adopting a physically active lifestyle can help achieve and maintain a healthful weight and affect the levels of some hormones that contribute to cancer formation, say new guidelines recently issued by the American Cancer Society (ASC).  

    ASC's guidelines are revised approximately every 5 years by a national panel of experts in cancer research, prevention, epidemiology, public health, and policy. They reflect the most current scientific evidence related to dietary and activity patterns and cancer risk. The guidelines focus on recommendations for individual choices regarding diet and physical activity patterns, but they recognize that choices occur within a community context that either facilitates or creates barriers to healthy behaviors. Therefore, the experts present recommendations for community action to accompany the 4 recommendations for individual choices to reduce cancer risk.

    Specific to physical activity, ASC says, "Although the optimal intensity, duration, and frequency of physical activity needed to reduce cancer risk are unknown, approaching and exceeding 300 minutes of moderate intensity activity per week or 150 minutes of vigorous activity per week is likely to provide additional protection against cancer." For people who are inactive or just beginning an exercise program, "engaging in activity levels below the recommended minimum can still be beneficial." Furthermore, because children who are engaged in physical activity are more likely to remain active as adults, and because physical activity plays a critical role in weight maintenance, children and adolescents should be physically active at moderate to vigorous intensities for at least 1 hour per day, with vigorous activity occurring at least 3 days per week. 

    In addition to adopting a physically active lifestyle, the guidance calls for people to eat a healthful diet, with an emphasis on fruits and vegetables, and limit alcohol consumption.

    The guidelines are published in the January/February issue of CA: A Cancer Journal for Clinicians.

    SSRIs Linked With Increased Falls Risk in Nursing Home Residents

    Nursing home residents with dementia who use average doses of selective serotonin reuptake inhibitors (SSRIs) are 3 times more likely to have an injurious fall than similar people who don't use these drugs, according to the British Pharmacological Society.

    SSRIs are generally considered the treatment of choice for nursing home residents with dementia and who have depression. The risk of falling increases as people take higher doses.

    Researchers recorded the daily drug use and daily falls in 248 nursing home residents with dementia from January 2006 until January 2008. Data about the residents' day-by day drug use came from a prescription database, and information on falls and subsequent injuries came from a standardized incident report system. In total, they collected a dataset of 85,074 person-days.

    The mean age of the participants was 82 years. The prescription records showed that antidepressants had been used on 13,729 (16.1%) days, with SSRIs being used on 11,105 of these days.

    The incident reports showed that 152 of the 248 residents (61.5%) sustained 683 falls, corresponding to a fall incidence of 2.9 falls per person-year. Thirty-eight residents had a single fall; 114 fell more frequently. Of the 220 falls recorded, 10 resulted in hip fractures, 11 in other fractures, and 198 in injuries such as grazes, open wounds, sprains, bruises, and swellings. One person died after falling.

    The risk of having an injurious fall increased threefold for residents taking SSRIs, from an absolute daily risk of 0.09% for a female aged 80 not taking an SSRI, to 0.28% for a female aged 80 taking 1 defined daily dose of SSRIs. Similar increases in absolute daily risk were found for both men and women, for different ages.

    Check out APTA's Balance and Falls Web page for patient care and consumer resources, in addition to CEU courses related to falls and balance.

    Audit Resources Now Available

    A new APTA Web resource can help PTs prepare for and successfully get through a Medicare claims audit. The Medicare Claims Audits Web page provides audit tools such as a form for conducting a self audit, an auditing entities chart, information on hiring an attorney, and a link to the Centers for Medicare and Medicaid Services' brochure on the appeal process. The page also links to APTA's Defensible Documentation resource; information on enrolling in Medicare; Medicare local coverage decisions; handling fraud and abuse media coverage; Medicare denials, audits, and appeals; and coding and billing information. 

    APTA Announces New Staff Structure

    This week, APTA announced the new staff structure that will take effect February 1. The new staff structure is designed to ensure APTA is properly aligned to achieve its goals (as identified by the House of Delegates and the Board of Directors) by providing for more efficiency, enhancing role clarity, building more trust across the association, and making the association more effective.

    Helpful information about the new staff structure is available for members on APTA's Web site, including:

    • staff structure charts;
    • brief descriptions of all departments;
    • a listing of individual staff, their titles, and contact information; and
    • a document on frequently asked questions (FAQs).

    During the deliberations on the staff structure reforms the following criteria were used to guide decisions:

    • Would a change provide for more efficiency (reduce duplication/redundancies)?
    • Would a change provide role clarity for APTA's units, departments, and individual staff?
    • Would a change help to better address staff performance?
    • Would a change enhance trust among staff across the association?
    • Would a change provide for more effectiveness?

    An association should comprehensively review its staff structure on a regular basis to ensure that the association is properly aligned to achieve its goals. It has been 4 years since APTA's staff structure was comprehensively reviewed. While a staff structure review may not always lead to realignment, in this case we believed it was necessary due to significant changes in our association, the profession, and the external world. 

    If you have any questions about the new staff structure at APTA, contact John Barnes, chief executive officer at APTA, at johnbarnes@apta.org.

    Coding and Compliance Audio Conference: Registration Closes January 23

    Time is running out to register for the Basic Essentials for Physical Therapist Coding and Compliance audio conference, to be held January 26, 2 pm-3:30 pm, ET.

    Register by January 23, 11 pm ET, to find out the top payment challenges for physical therapy and get practical advice on how to address them to ensure you get the revenues you deserve. During the Q & A session following the presentation, participants may ask questions directly to expert rehabilitation consultant Helene Fearon, PT.

    White House Seeks Physical Activity Champions of Change

    The White House Champions of Change program is seeking recommendations of individuals and organizations that are increasing access to physical activity for children and young adults. APTA members can nominate themselves or colleagues who work to increase access to physical activity for children through some/all of the following:

    • organized or competitive activities for teams and/or individuals, including youth with disabilities;
    • unstructured play;
    • school-based activities, including physical education, recess, and activity breaks;
    • outdoor activities that promote time in nature; and
    • after-school or summer programs.

    Submit nominations by midnight January 23 by using this form.

    The White House Champions of Change program highlights the stories and examples of citizens across the country that represent President Obama's vision of out-innovating, out-educating, and out-building the rest of the world through projects and initiatives that move their communities forward. Since the 2009 launch of Let’s Move, Michelle Obama has focused on ensuring that the nation's children eat healthier and become more physically active. Last April, the White House hosted a Champions of Change event to highlight the work of chefs in improving school nutrition programs. 

    Medicare Demonstration Projects Fall Short in Reducing Spending

    Of 10 major demonstration projects aimed at enhancing the quality of health care and improving the efficiency of health care delivery in Medicare's fee-for-service program, most do not reduce Medicare spending, says a new report by the Congressional Budget Office (CBO).

    CBO evaluated the outcomes of 10 demonstration projects that focused on disease management and care coordination or value-based payment. In nearly every program involving disease management and care coordination, spending was either unchanged or increased relative to the spending that would have occurred in the absence of the program, when the fees paid to the participating organizations were considered.

    Results from demonstrations of value-based payment systems were mixed. In 1 of the 4 demonstrations examined, Medicare made bundled payments that covered all hospital and physician services for heart bypass surgeries. Medicare's spending for those services was reduced by about 10% under the demonstration. Other demonstrations of value-based payment appear to have produced little or no savings for Medicare.

    The report also provides several lessons learned. Programs that collected timely data on when their patients' health problems developed or became exacerbated and where they were treated seemed better able to coordinate and manage their patients' care. Furthermore, programs that smoothed transitions (for example, by providing additional education and support to patients moving from a hospital to a nursing facility or between a primary care provider and a specialist) tended to have fewer hospital admissions.

    Substantial changes to payment and health care delivery systems will probably be necessary for programs involving disease management and care coordination or value-based payment to significantly reduce spending and either maintain or improve the quality of care provided to patients, CBO says. 

    Most Women With Normal BMD Can Safely Delay Follow-up Scans

    Many women whose bones test normal at age 65 can safely wait as long as 15 years before having a second bone density test, says a New York Times  article based on a study published today in NEJM

    The researchers studied 4,957 women, 67 years of age or older, with normal bone mineral density (BMD) or osteopenia and no history of hip or clinical vertebral fracture or of treatment for osteoporosis. At 15 years, fewer than 1% of women with normal bone density when they entered the study, and fewer than 5% with osteopenia, developed osteoporosis in the following 15 years. The researchers report that osteoporosis would develop in less than 10% of older, postmenopausal women during rescreening intervals of approximately 15 years for women with normal bone density or mild osteopenia, 5 years for women with moderate osteopenia, and 1 year for women with advanced osteopenia.

    According to the Times, bone density screening became popular after Fosamax, the first bisphosphonate, was approved in the mid 1990s. Physicians were "overly enthusiastic" in prescribing it for women whose bone density was "lower than normal but not in a danger zone, keeping women on the drug indefinitely." Now they are more likely to prescribe bisphosphonates for older patients and recommend against them for most younger postmenopausal women with osteopenia.  

    The study is expected to change the way physicians think about bone density screening, the Times says.

    Section on Research Pledges $30,000 to Foundation

    APTA's Section on Research has pledged to donate $30,000 over the next 3 years to support research in physical therapy.

    "The Foundation [for Physical Therapy] put research on the map, and by helping to develop physical therapist investigators, the Foundation was instrumental in building a culture of research," said Section President Christopher Powers, PT, PhD. "Now that we have that culture, it is a matter of sustaining it and bringing it to the next level."

    In addition to the 3-year pledge, the section also donated $5,000 to the Jayne L. Snyder Endowment Fund, in memory of Snyder, who passed away in October.

    Read more in this press release.

    Heard on the Hill: Therapy Cap Update

    Due to the comprehensive nature of the payroll tax holiday and federal unemployment benefits legislation passed December 23, 2011, it was difficult for congressional members to agree on long-term solutions on Medicare provisions, such as the Sustainable Growth Rate (SGR) and the therapy cap exceptions process. The 2-month extension of the cap exceptions process and SGR allows Medicare patients to continue to receive care above the current therapy cap amount of $1,880 and ensures that PTs will not see a 27.4% reduction in payment under the physician fee schedule until February 29.

    Find out what APTA is doing this month to advocate for a long-term solution to the therapy cap exceptions process and a reformed payment system in this new Heard on the Hill prerecorded podcast and transcript

    New in the Literature: Hippotherapy (Phys Occup Ther Pediatr. 2011 Nov 29. [Epub ahead of print])

    Authors of a systematic review that examined the efficacy of hippotherapy or therapeutic horseback riding (THR) on motor outcomes in children with cerebral palsy (CP) report in Physical & Occupational Therapy in Pediatrics that it appears the interventions have positive effects on gross motor function. However, they add, the current literature on hippotherapy and THR is limited. Large randomized controlled trials using specified protocols are needed to more conclusively determine the effects on children with CP.

    The researchers searched databases for clinical trials of hippotherapy or THR for children with CP. Nine articles were included in the review. Although the current level of evidence is weak, the authors synthesis found that children with spastic CP, Gross Motor Function Classification System (GMFCS) levels I-III, aged 4 years and above are likely to have significant improvements on gross motor function as a result of hippotherapy and THR. Evidence indicates that 45-minute sessions, once weekly for 8-10 weeks, result in significant effects.

    Videos Highlight Innovative Practice in ICUs, Using Evidence to Improve Care

    Two new APTA videos and accompanying handouts illustrate how early physical therapy in intensive care units (ICUs) and using evidence can help reduce health care costs and improve patient care. APTA members Christiane Perme, PT, CCS, and Gerard P. Brennan, PT, PhD, outline the opportunities available to physical therapists (PTs) who are ready to take on new challenges, particularly those related to Accountable Care Organizations (ACOs) and integrated health care systems, in today's health care environment. Other videos highlight a prospective surveillance cancer model and improving health through fitness

    Looking for more information on ACOs? Check out FAQs on the Medicare Shared Savings Program and Pioneer Models, a new ACO definitions handout, and a dispelling ACO myths chart. In addition, ACO assessment checklists are available for PTs in private practice and PTs practicing in health care organizations with ACO status.     

    Changes to PQRS Measure 131 Outlined in New Podcast

    A new podcast provides additional detail about 2 major changes in 2012—frequency of reporting and the quality data codes—to Physician Quality and Reporting System (PQRS) Measure 131: Pain Assessment and Follow-Up. A case study, which also is included in the podcast transcript, takes listeners through 3 scenarios using the measure's new codes. 

    Guide Focuses on Unintended Consequences of EHRs

    A thorough and honest assessment of an organization's readiness should take place before choosing an electronic health record (EHR), says an online resource designed to help health care organizations anticipate, avoid, and address problems that can occur when implementing and using EHRs.  

    The Guide to Reducing Unintended Consequences of Electronic Health Records, prepared by RAND Corporation for the Agency for Healthcare Research and Quality, aims to provide practical, troubleshooting knowledge and resources to primary EHR users, such as chief information officers, directors of clinical informatics, information technology specialists, and clinicians involved in the implementation of an EHR. However, frontline EHR users, such as health care providers, also may find the guide useful.

    Four modules address how to avoid, understand and identify, and remediate unintended consequences of EHRs. Tools and examples are available for both current and future EHR users, in addition to 15 case examples that outline issues encountered and provide solutions and lessons learned.    

    Call for Applications: Student Ushers Needed for PT 2012

    APTA now is accepting applications for student ushers for PT 2012, June 6-9, Tampa, Florida. The usher program provides APTA student members the opportunity to attend PT 2012 and meet conference speakers and APTA leaders. The application deadline is February 20. Applicants must be current APTA student members. Students who are selected and successfully complete their assignment will be reimbursed for their conference registration fee. More information and a downloadable application may be found on the Annual Conference ushers Web page.   

    New Model Sets Forth Principles to Guide Development of Physical Therapy Benefits

    APTA recently developed the Physical Therapy Model Benefit Plan Design (MBP) to ensure access to physical therapy services by informing decisions regarding coverage of physical therapy services in insurance benefit plans. The MBP describes the role and value of physical therapists and physical therapy services and sets forth principles to guide development of physical therapy benefits. It also provides definitions and references to support the position. The MBP should be used by insurers, employers, individual insurance plan subscribers, and public policymakers when considering insurance benefit plan design. It also is a tool for physical therapists to advocate for appropriate access to and coverage of physical therapist services for their patients and clients.

    A new APTA podcast and transcript provide background information about development of the MBP, which was adopted last month by APTA's Board of Directors, and an overview of what is in the model benefit plan.

    Fee Schedule, MPPR Calculators Updated

    APTA recently updated its Medicare physician fee schedule and its multiple procedure payment reduction (MPPR) calculators to determine payment amounts under Medicare for January and February to reflect the 2-month extension of the fee schedule update and other Medicare provisions signed into law December 23, 2011.

    If Congress does not take action by February 29, a 27.4% payment cut will go into effect. Sign up today for PTeam to receive the latest news on legislation to fix the Sustainable Growth Rate and extend the therapy cap exceptions process, which also expires February 29.

    Prospective Surveillance Model Emerges as Standard of Care for Breast Cancer Treatment

    Early diagnosis and treatment of breast cancer-related lymphedema by a physical therapist can significantly reduce costs and the need for intensive rehabilitation, according to an article published in the January issue of PTJ.  

    The study, led by APTA member Nicole Stout, PT, MPT, CLT-LANA, compared a prospective surveillance model with a traditional model of impairment-based care and examined the direct treatment costs associated with each program. Treatment and supply costs were estimated based on the Medicare 2009 physician fee schedule. Researchers estimated that treatment for breast cancer-related lymphedema costs $636.19 a year when the prospective surveillance model was used vs $3,124.92 for traditional treatment of advanced lymphedema.

    Read more about the study in APTA's press release.

    UF Study: Education Combined With Exercise Lowers Back Pain Rate in Soldiers

    A program of core strengthening exercises was no better than traditional sit-ups for preventing back pain in soldiers, according to a new University of Florida (UF) study. But combining both exercise programs with a brief educational session on back pain strategies did lower the incidence of treatment for back pain.

    The Prevention of Low Back Pain in the Military study involved 4,325 US Army soldiers stationed at Fort Sam Houston in Texas who were completing a program for combat medic training. Participants were randomized by company into 1 of 4 treatment groups of exercises alone, or exercises paired with educational sessions. The exercise programs were completed as a group under the supervision of a drill instructor once a day, 5 days a week for 12 weeks. The education program consisted of 1 45-minute group session led by study personnel that provided information on low back pain and strategies for recovering from mild back injury.

    The researchers tracked participants' incidence of low back pain for 2 years following the intervention. There was no difference in health care visits for back pain in the treatment groups that received exercises only, but among the groups that also received the education program, there was a 3% decrease in seeking health care for low back pain. The decrease may seem small, researchers say, but because back pain is such a common health issue in the military, even a small decrease could lessen the burden on the health care system.

    "It was our hypothesis that the core stabilization exercises would have some protective effect for back pain and maybe the combination of the core stabilization exercises and the education program would be the most effective, but as it turns out, adding the education to either of the exercise programs was the only place where we saw the benefit," said lead investigator and APTA member Steven George, PT, PhD, an associate professor in the UF College of Public Health and Health Professions' department of physical therapy.

    Low back pain is among the most frequent causes of medical visits and lost-duty time in the military health system, said co-investigator and APTA member Lt Col John Childs, PT, PhD, director of musculoskeletal research at Keesler Air Force Base and associate professor at the US Army-Baylor University doctoral program in physical therapy at the Army Medical Department Center and School in San Antonio.

    APTA members Lt Col Deydre Teyhen, PT, PhD, OCS, and Jessica Dugan, PT, coauthored the study. 

    NIDRR Seeks PT Reviewers for Standing Panels

    Physical therapists (PTs) are encouraged to apply to become peer reviewers for the National Institute on Disability and Rehabilitation Research (NIDRR) to evaluate Field Initiated Project (FIP) applications. NIDRR receives more than 250 FIP applications per year. NIDRR uses standing panels to enhance continuity, provide for more extensive feedback, and obtain the services of better-qualified reviewers, including those with disabilities and those from diverse backgrounds.

    Generally, peer reviewers serve for 3-year terms on the standing panels with 1 review per year.  Individuals may be qualified to be peer reviewers on the basis of education and training or some combination of personal and professional experience with disability. Federal government employees are not eligible to serve as peer reviewers for NIDRR.

    If you are interested in nominating yourself or someone else to serve as a reviewer, submit the following 3 items to David Keer at david.keer@ed.gov: 

    1. a statement indicating willingness to serve on an FIP standing review panel,
    2. a few sentences summarizing areas of expertise, and
    3. an attached copy of a CV or resume.

    The standing panels NIDRR uses are in the areas of: (1) employment outcomes; (2) health and function; (3) technology for access and function; (4) participation and community living; and (5) statistics, outcomes research, disability studies, rehabilitation science, and policy. Each panel has 7 reviewers. In any given year the dates of the review might not work for an individual reviewer, hence a large pool of potential FIP reviewers is needed.

    The review panel meets (via teleconference) for 3 consecutive full-time days to discuss the panel's assigned proposals. About 4 weeks prior to the review, NIDRR mails each reviewer the 16-20 proposals that the panel will discuss.

    January PTJ: A 'Spectacular' Way to Start the New Year

    Abandoning her "traditional linear approach" in this month's Craikcast, PTJ  Editor in Chief Rebecca Craik, PT, PhD, FAPTA, summarizes the research reports in the January issue by 4 themes—psychology, home-based physical therapy, measurement tools, and common assumptions made by clinicians. Craik also provides insights on the issue's technical report, 2 case reports, and 2 perspectives, including Stout et al's article on the direct costs of a prospective surveillance model and a traditional model of care in patients with breast cancer-related lymphedema.

    New in the Literature: Supervised Strengthening Exercises (J Rehabil Med. 2011 Nov 29 [Epub ahead of print]).

    Physical therapist-supervised rehabilitation with strengthening exercises of the rotator cuff and scapula stabilizers seems to be superior to home exercises focusing on mobility for improving shoulder function after arthroscopic acromioplasty, say authors of an article published online in Journal of Rehabilitation Medicine.

    Thirty-six participants entered this randomized, single-blinded, clinically controlled study; 13 of the participants in the physical therapy group and 16 in the home group fulfilled all the assessments. For 12 weeks following surgery, participants performed either supervised physical therapy or home exercises. Follow-ups were conducted periodically for 6 months after surgery to evaluate shoulder function, pain (Constant-Murley [CM]), and disabilities of the arm, shoulder, and hand ([DASH] scores), and health-related quality of life.

    The physical therapy group exhibited significantly greater improvements in CM and DASH scores. After treatment, the between-group mean difference in CM scores was 14.2 points. At the 6-month follow-up, the between-group mean difference in DASH scores was 13.4 points.

    APTA 'Joins Forces' to Support Service Members and Families

    Today, APTA attended the launch of a new Joining Forces initiative aimed at increasing the involvement of health care associations and the providers they represent in the identification of traumatic brain injury, posttraumatic stress disorder, and post-combat depression in military members. The initiative partners the health care community with federal agencies to develop resources and educational materials to fully engage providers in meeting the needs of the nation's service members with these conditions, and their families. APTA is 1 of only 2 therapy associations invited to participate in the initiative.

    At the launch, attendees heard briefs at the National Intrepid Center of Excellence from several directorates of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, a presentation on the journey of a wounded warrior from the battlefield to Walter Reed National Military Medical Center, and took a tour of the National Intrepid Center of Excellence. A session held at the White House continued with briefs from the Veterans Administration and a strategy session to forge a plan for the way ahead.  

    APTA also attended a preconference strategy session last night at the residence of the Vice Chairman of the Joint Chiefs of Staff, Admiral James Winnefeld.

    Hospitals Underreport Patient Harm Events, Says OIG

    Hospital incident reporting systems only capture about 14% of patient harm events experienced by Medicare beneficiaries, says a new report by the Office of Inspector General (OIG) of the Department of Health and Human Services. Events are underreported in part, says OIG, because of staff misperceptions about what constitutes patient harm. In the absence of clear event reporting requirements, administrators classified 86% of unreported events as either events that staff did not perceive as reportable (62% of all events) or that staff commonly reported but did not report in this case (25%). 

    In OIG's investigation of 189 hospitals, all hospitals reported using incident reporting systems designed to capture instances of patient harm, although administrators acknowledged that information about how often events occur is incomplete. The investigation also revealed that nurses most often reported events, typically identified through the regular course of care.  

    To help educate hospital staff about the full range of patient harm that occurs in hospitals and assist hospital administrators in assessing incident reporting systems, OIG recommends that the Agency for Healthcare Research and Quality and Centers for Medicare and Medicaid Services (CMS) collaborate to create a list of potentially reportable events and provide technical assistance to hospitals in using the list. The agencies could promote the list through guidance and training documents aimed at hospitals, other health care settings, clinical education settings, and guidance documents for state and accrediting surveyors.

    Because hospital accreditors tend to focus on how event information is used rather than how it is collected, OIG also recommends that CMS provide guidance to accreditors regarding surveyor assessment of hospital efforts to track and analyze events and scrutinize survey processes when approving accreditation programs.

    APTA Releases Practitioners Toolkit for Incorporating PT Services in the ED

    A new toolkit to help incorporate physical therapist (PT) practice in the emergency department (ED) setting now is available for APTA members. The toolkit describes recent trends in ED care, explains why building interprofessional relationships in the ED is crucial in this high-pressure and time-sensitive setting, and offers concrete steps for planning and establishing PT services in the ED.  The many potential benefits of PTs in the ED setting—including increased patient satisfaction, decreased cost of unnecessary care, increased treatment and the number of service options, improved patient function and outcomes, and increased productivity and operations within the ED—are discussed, in addition to the types of patients and conditions managed by PTs in the ED. The toolkit also outlines the skills, knowledge, and abilities that a PT should possess to ensure success in the ED environment. Three case studies represent unique situations that are not unusual to the ED and illustrate the use of differential diagnosis and systematic problem solving.

    Access the toolkit via the Physical Therapist Practice in the Emergency Department Web page, which also provides links to APTA's podcast series on PT practice in the ED and educational courses. Contributors to this new resource include APTA members from the Federal Physical Therapy Section, Education Section, Section on Pediatrics, Section on Research, Orthopaedic Section, Acute Care Section, Section on Health Policy and Administration, Cardiovascular & Pulmonary Section.  

    OIG Ramps Up Compliance Education With Videos

    The Office of Inspector General (OIG) of the Department of Health and Human Services recently released the first of 11 short video and audio presentations for health care providers on top health care compliance topics, including physician self-referral, the False Claims Act, and the federal anti-kickback statute.

    Also new from OIG is a provider compliance widget that can be embedded in non-OIG Web sites, allowing easier access to OIG provider compliance materials. Users can click on the widget, which contains a hyperlink to the OIG Provider Compliance Training Web page, where they can access the latest videos and audio podcasts on compliance issues and information from previous educational sessions.

    APTA Projects Future Supply and Demand of Physical Therapists

    In an effort to determine a more accurate picture of the physical therapy workforce and aid workforce planning, APTA's Workforce Task Force has developed a model to project supply and demand of physical therapists through 2020. Using the model to manipulate data collected through APTA member surveys, the Federation of State Boards of Physical Therapy, and federal and other sources, the task force projected a either shortage or surplus of physical therapists in 3 different scenarios. The model includes multiple variables that may impact the future workforce, such as physical therapist attrition rates, the number of full- and part-time personnel, and the percentage of the US population with health care insurance. The model is easily updated to reflect changes in physical therapy education program graduation rates, employment patterns, health care reform, and other factors. APTA will continue to monitor the health care environment, make any necessary modifications to the model, and communicate changes to members and the public.

    An explanation of the how the model was developed, a description of the possible scenarios, and graphs illustrating the projections are available on APTA's Physical Therapy Workforce Data page.

    USA Today Features Intel's Early Access to Physical Therapy Model

    Workers with routine back pain at Intel's plant in Oregon are "much happier" these days due to collaboration among Intel, 2 local health care systems, and a health insurer that has reduced the waiting time to see a physical therapist from 19 days to 48 hours, reports USA Today

    In addition to the Intel model, the article highlights the collaborative effort at Virginia Mason Medical Center in Seattle and other partnerships that have formed to tackle the problems of unsatisfactory quality and rising health costs.

    According to the article, Intel workers are completing their treatment in 21 days, compared with 52 days in the past. The cost per patient has dropped 10% to 30% due to fewer unnecessary physician visits and diagnostic imaging tests. In addition, the workers are "more satisfied and return to work faster."

    Spanish-speaking Pediatric PTs Needed for HVO Assignment

    Pediatric physical therapists (PTs) who speak Spanish are needed for 2-week minimum assignments in Nicaragua. Housing is available for approximately $50 a night at local guest house. Contact Health Volunteers Overseas' (HVO) program department for additional information.

    Obesity, Physical Inactivity Expected to Contribute to Cancer Deaths in 2012

    About one-third of cancer deaths in 2012 will be caused by tobacco use, and another third will be related to overweight or obesity, physical inactivity, and poor nutrition, according to the American Cancer Society's annual report, Cancer Statistics, 2012.

    Released yesterday, the report says that death rates continue to decline for lung, colon, breast, and prostate cancers, which are responsible for the most cancer deaths. However, there has been an increase in the past decade of people developing some less common cancers, including pancreas, liver, thyroid, and kidney cancer.

    A total of 1,638,910 new cancer cases and 577,190 deaths from cancer are projected to occur in the United States in 2012. Between 1990/1991 and 2008, the most recent year for which data is available, overall death rates decreased by about 23% in men and 15% in women. This translates to more than 1 million cancer deaths that were avoided.

    The rates of new cancer cases and cancer deaths vary quite a bit among racial and ethnic groups. For all cancer sites combined, African-American men have a 15% higher rate of new cancer cases and a 33% higher death rate than white men. African-American women have a 6% lower rate of new cancer cases, but a 16% higher death rate than white women. However, in the past decade, African-American men had the most rapid decline in death rates, at 2.4% per year.

    A companion piece to the report, Cancer Facts & Figures 2012 highlights cancers with increasing incidence trends. Despite a decline in the rates of the most common cancers, there has been an increase in the rates of several less common cancers: pancreas, liver, thyroid, kidney, melanoma of the skin, esophageal adenocarcinoma (a kind of esophagus cancer), and some kinds of throat cancer associated with HPV (human papillomavirus) infection.

    CMS Delays Prepayment Review and Prior Authorization of PMD Demonstration

    The Centers for Medicare and Medicaid Services (CMS) recently delayed the implementation of the Prepayment Review and Prior Authorization for Power Mobility Devices (PMD) demonstration so it can carefully consider the many comments/suggestions regarding the demonstration, including those from APTA. The demonstration was scheduled to begin January 1. The agency will provide at least 30 days’ notice before the demonstration begins.

    In its comments, APTA called for CMS to eliminate the prepayment review phase (Phase I) and delay implementation of the demonstration until the prior authorization phase (Phase II) is available for PMD claims.

    CMS also delayed the Recovery Audit Prepayment Review demonstration.

    APTA members are encouraged to use resources from the National Coalition for Assistive and Rehab Technology (NCART) when advocating for policy changes that are needed to provide adequate access to Complex Rehab Technology (CRT) with legislators, the public, private third‐party payers, and other policy makers. An educational video titled "Complex Rehab Technology -- Essential for health. Essential for life" provides an introduction from the perspectives of people who rely on CRT for their health and independence, physicians that prescribe it, and consumer organizations that work to protect access to CRT..

    New Medicare Conditions of Participation Guidelines for Hospital-based Outpatient Settings

    APTA currently is in discussion with the Centers for Medicare and Medicaid Services (CMS) regarding new interpretive guidelines that were issued November 18, 2011. This recent interpretation states that rehabilitation services must be ordered by a qualified practitioner who is responsible for the care of the patient and who has medical staff privileges to write orders for these services. CMS' Conditions of Participation rules apply to both inpatient and outpatient hospital-based settings and apply not only to Medicare beneficiaries but to all patients who receive services at the hospital. 

    APTA believes that this new interpretation is inconsistent with the current regulation and that it poses problems for physical therapists and their patients in hospital-based settings. The association is working diligently to get further clarification from CMS and will keep members updated as soon as more information is available.

    New in the Literature: Distal Sensorimotor Polyneuropathy (Diabetes Res Clin Pract. 2011 Nov 28. [Epub ahead of print])

    Distal sensorimotor polyneuropathy (DPN) results in a remarkable functional imbalance that may expose patients with diabetic neuropathy to danger of falling during daily activities and becomes more severe as the severity of neuropathy aggravates, say authors of an article published online in Diabetes Research and Clinical Practice.    

    The authors designed a case-control study to test the ability of 214 patients with DPN and healthy people to control functional balance using the Berg Balance Scale (BBS). Furthermore, the correlation between diabetic neuropathy examination (DNE) and BBS scores were calculated using Spearman's correlation coefficient. Comparison of 2 groups showed a significant decline in the overall score of BBS in patients with DPN versus the healthy control group. The most challenging tasks for patients with DNP were single leg stance, tandem standing, and forward reaching, followed by standing unsupported with feet together, sit to stand, stand to sit, transfers, standing unsupported with closed eyes, and placing the alternative foot on a step or stool while standing unsupported. There was a significant strong negative (r=-0.77) correlation between DNE and BBS scores.

    Videos Explain Concepts of Health Care Reform

    The Robert Wood Johnson Foundation's new series of animated educational videos aim to help patients and health care consumers understand how the new benefits and provisions of the Affordable Care Act (ACA) will affect them. The short videos tackle 5 common terms of ACA implementation. Share the videos with patients, friends, and family or post them to your Web site to help people gain a clearer understanding of what the law means for them.

    Prepare for 2012 Policies and Regulations: Register Today for Coding Seminars

    APTA's Coding, Payment & Practice Applications for Outpatient Rehabilitation Services seminars will kick off later this month. Don't miss this opportunity to attend 1 of 4 seminars in a city near you and help prepare for changes in 2012.    

    This 2-day course is designed to educate physical therapy professionals and their administrative staff about the best possible methods to deal with changing policies and regulations that affect outpatient therapy services. The seminar provides vital information that physical therapists, physical therapist assistants, and administrative staff need to know in applying these methods to everyday practice. Case studies will demonstrate best practices in the areas of coding, documentation, and compliance with third-party policies. Valuable resources will help attendees navigate through the health care reform environment. 

    The first seminar will be held January 20-21 in Fort Lauderdale, Florida. Others will follow February 24-25 in Baltimore, March 16-17 in Kansas City, Missouri, and April 20-21 in San Francisco. 

    Study Showing No Effect of Exercise on Gestational Diabetes Raises Questions

    Researchers in Norway found that when they randomly assigned 855 pregnant women to either exercise 3 times a week or to regular prenatal care alone, the exercisers were no less likely to develop gestational diabetes, says an article by Reuters

    All of the women in the clinical trial were in their 18-22-week range of pregnancy. Women in the exercise program took an hour-long class once a week for 12 weeks—low-impact aerobics, plus strengthening and stretching exercises. They also were given an at-home workout to do twice a week.

    By the third trimester, 7% of the exercise group had been diagnosed with gestational diabetes, versus 6% of the comparison group.

    According to Reuters, Rita W. Driggers, MD, an obstetrician and director of the maternal-fetal medicine fellowship program at Washington Hospital Center in Washington, DC, who was not involved in the study, said that the findings do not mean exercise is no help to pregnant women.

    She noted that only 55% of women in the exercise group actually stuck with their routine and only 13% of the women in the study were exercising at a moderate to high intensity 3 times a week when they entered the study—the level the exercisers were asked to adopt.

    The study's lead author said 1 possible explanation for the results is "that starting exercise in the second trimester is too late." Signe N. Stafne, PT, suggests that exercise before pregnancy and in early pregnancy could be more important, "due to the metabolic changes that occur in early pregnancy."

    The women in this study also were at relatively low risk for gestational diabetes because they were in the normal weight range, on average, when they entered the study. A study focused on women who are overweight and obese—who are at increased risk of gestational diabetes—might produce different results, Reuters says. 

    Full text of this study is available in the January issue of Obstetrics & Gynecology.