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  • New PTNow Blog Starts the Conversation About Evidence in Practice

    There's a lot of talk out there about bringing evidence into practice. So how about a conversation?

    APTA has launched a new blog on its PTNow.org website aimed at energizing thought and sparking dialogue about the role of evidence-informed practice in physical therapy. The blog will provide physical therapists (PTs) with a place to have ongoing discussions about how to move information synthesis into practice reality—from implementing changes in a patient-centered environment, to keeping up with the latest practice strategies, to finding out how other specialties are approaching the challenge.

    The blog is intended to be provocative and dynamic: Readers are encouraged to react, engage, and share their own experiences and ideas.

    The blog is part of an expanded, interactive PTNow website intended to serve as the best single place for PTs to find the evidence they need to enhance practice, and to engage peers and experts in relevant discussions. The PTNow blog joins a suite of PTNow resources including clinical summaries, tests and measures, case examples, clinical practice guidelines and Cochrane Reviews, and PTNow ArticleSearch, a revamped version of the search resource formerly known as Open Door.

    APTA Candidate Information Now Posted

    Candidates for APTA elected positions have been announced and APTA members can learn more about them at the association's candidate webpage.

    The webpage includes links to candidate statements and biographical information for each member running for APTA Treasurer, Speaker of the House, Director (3 positions), and Nominating Committee (2 positions). Elections will be held at the APTA House of Delegates session in June.

    Candidates are:

    • For Treasurer – Elmer Platz, PT (New Jersey)
    • For Speaker – Susan R. Griffin, PT, DPT, MS, GCS (Wisconsin); William F. McGehee, PT, MHS (Florida)
    • For Director (3 positions available) - Jeremy S. Angaran, PT, DPT, OCS (Hawaii); Susan A. Appling, PT, DPT, PhD, OCS (Tennesse); Jennifer E. Green-Wilson, PT, MBA, EdD (New York); Matthew R. Hyland, PT, PhD, MPA (New York); Kathleen K. Mairella, PT, DPT, MA (New Jersey); Sheila K. Nicholson, PT, DPT, JD, MBA, MA (Florida)
    • For Nominating Committee (2 positions available) - Susan M. Chalcraft, PT, MS (Washington); Secili H. DeStefano, PT, DPT, OCS (Virginia); Linda K. Eargle, PT, DPT, CEEAA, MinEd (Florida); Dode Jackson, PT (Washington)

    More information on the elections process and links to related governance resources can be found on the Nominations and Elections webpage. Contact Amber Neil with any questions.

    Looking For Evidence? Open the Door to PTNow ArticleSearch

    For physical therapists (PTs) looking to put evidence into practice, life just got a little better: APTA has retooled one of its most popular evidence-based practice (EBP) resources to make it easier to find and more intuitive to use.

    Open Door, the search tool that puts PTs in touch with the latest in EBP, has been relocated to PTNow.org and renamed PTNow ArticleSearch. PTNow ArticleSearch maintains all the functionality of Open Door, and allows APTA members to track favorite research topics, access APTA section journals, and analyze interventions through ProQuest's Medical Evidence Matters service. All old links to Open Door will redirect to the new site.

    The change is part of an effort to further strengthen PTNow as the physical therapy profession's best single tool to help PTs find the evidence they need to enhance practice. PTNow ArticleSearch joins a suite of PTNow resources including clinical summaries, tests and measures, case examples, clinical practice guidelines and Cochrane Reviews, and a new blog that will help keep the site dynamic and interactive.

    Questions? Need more information? Contact the PTNow ArticleSearch staff.

    2014 PQRS Changes Discussed

    The Physician Quality Reporting System (PQRS) has changed for 2014, and physical therapists (PTs) need to understand what's different. APTA provides the resources that will keep you up-to-date.

    APTA is producing podcasts that address both the overall changes and changes to individual measures in PQRS, including current medications (#130), pain assessment (#131), falls plan of care (#155), and functional outcome assessment (#182).

    Transcripts for these podcasts are available now, and the audio portions of the podcasts will be posted in early February. The podcasts and other resources can be found on APTA's PQRS webpage.

    Only 1 in 10 Receive Palliative Care Worldwide

    Around the world, 90% of people in need of palliative care don't receive it, according to a new study released by the World Health Organization (WHO) and the Worldwide Palliative Care Alliance (WPCA). The report, which focused on end-of-life care, shows that the bulk of the need is related to noncommunicable diseases including stroke, cancer, and heart disease.

    The study found that over 20 million people require palliative care at the end of life, with nearly 70% of those in need being adults over 60, and 9% being children. According to a press release announcing the report, "the number of people requiring this care rises to at least 40 million if all those that could benefit from palliative care at an earlier stage of their illness are included."

    Nearly 80% of need is centered in low and middle-income countries, according to the report, but even among higher-income countries palliative care is not necessarily part of routine plans of care. The report's authors write that only 20 countries have "advanced integration of palliative care with wider health services."

    "Despite increasing calls for palliative care to be recognized as a human right, there remains much to be done before palliative care is accessible to the worldwide community," the report states.

    Physical therapists (PTs) play a crucial role in palliative care plans, particularly among patients poststroke or those with progressive illnesses of the lungs, heart, and brain. APTA has created a webpage focused on the physical therapy and palliative/hospice care that includes policy statements, videos, and resource directories.

    Knowledge of the Physical Therapist Brand Could Win You an iPad Mini

    What could be better than being a physical therapist well-versed in how to build consumer trust? Being a physical therapist well-versed in how to build consumer trust who also just happens to own an iPad mini.

    From now until March 28, APTA members who read The Successful Physical Therapist, learn the 4 key brand behaviors that build consumer trust, and take the post-quiz will be entered to win an iPad mini and thereby up their tech hipness quotient a notch or two. So what are you waiting for? Enter today!

    Download the resource and get lots of useful information on the brand at www.APTA.org/BrandBeat.

    Back Pain, Arthritis Costs Exceed $200 Billion Per Year

    While often not as high in per capita costs as other disabling conditions, sheer prevalence makes back pain and arthritis the most costly conditions requiring rehabilitation in the US, according to a recent study. Authors of the study estimate total combined costs of back pain and arthritis to be over $200 billion per year, exceeding total costs associated with spinal cord injury, traumatic brain injury, stroke, multiple sclerosis, and limb loss.

    The study, published in the January 23 issue of the Archives of Physical Medicine and Rehabilitation (abstract only available for free), examined research published between 2008 and 2013 that focused on cost factors—both in terms of direct treatment costs and larger economic/workforce costs—associated with 8 selected conditions: back pain, osteoarthritis, rheumatoid arthritis, limb loss, stroke, spinal cord injury, and traumatic brain injury. Among the 65 articles selected for review, almost all involved national surveys.

    The results of analysis showed that back pain and arthritis carried the largest overall price tag, mostly due the reach of the conditions—over 100 million people annually, according to study's authors. "Back pain and arthritis make their impact by sheer numbers in the population," they wrote. "Even if each affected individual misses just a few days of work on average, or has their productivity slightly impaired, the cumulative results across the affected population can amount to tens of billions of dollars in lost wages and reduced work capacity each year."

    Findings were different when it came to per capita costs, where authors cited traumatic brain injury as carrying "enormous" costs to the individual. Similarly, stroke—the second-costliest condition in the study—was cited as carrying a high per capita cost, with average cost of ischemic stroke estimated at $140,000 per individual. When necessary, costs in the study were adjusted to 2013 dollars.

    Authors cited several limitations in the study, including the lack of recent data that sometimes forced them to rely on older data used as a primary source in the reviewed studies. Additionally, researchers acknowledged the likelihood that comorbidities play a role in overall cost estimates. "While our table does appear to attribute all the cost and disability to a single diagnosis, this may not be the case," they wrote. "Individuals with a stroke may also have an amputation or arthritis, and this may be the source for some of their disability. Thus, there is likely a much more subtle interplay at work that is beyond the scope of this paper."

    APTA has a long history of involvement in the development of information and resources on low back pain and osteoarthritis. Some of the resources available to physical therapists (PTs) include a MoveForward webpage on low back pain, the PT's Guide to Osteoarthritis, clinical practice guidelines on low back pain (.pdf) and hip osteoarthritis (.pdf), and a Learning Center presentation on manipulation for low back pain.

    Feedback Needed on First Draft of Revised Accreditation Criteria

    The first draft of revised criteria for physical therapist (PT) and physical therapist assistant (PTA) education programs is now available for review, and the Commission on Accreditation in Physical Therapy Education (CAPTE) is seeking input both online and at the upcoming 2014 Combined Sections Meeting (CSM) in Las Vegas.

    The document is being made available at the CAPTEwebpage related to the project. The draft, created by CAPTE's Criteria Revision Group (CRG), is intended to be the basis for a set of revised criteria that will guide accreditation decisions. As part of its refinement process the CRG is hoping to receive feedback from interested parties including faculty, university and program administrators, practitioners, students, alumni, and employers.

    The CRG offers 2 ways to provide input—via an online survey with a February 24 deadline, and at an in-person hearing during the CSM. The hearing is scheduled for Tuesday, February 4 at 6:30 pm in Galileo-1003, 1004, 1005 on the first level of the Venetian, the host hotel. The survey is easy to complete, but the CRG advises participants that they must enable cookies and be sure to use the same computer and web browser if they decide to complete the survey over more than 1 session.

    Revisions developed as a result of this round of commentary will be made available for later comment. The CRG will meet in early March to discuss feedback received from the surveys and CSM session.

    Questions about the process? Need more information? Contact CAPTE staff.

    Innovative PT Center of Excellence Reaches $3 Million Mark

    In what it describes as an effort aimed at "changing the face of physical therapy" the Foundation for Physical Therapy (Foundation) announced that it has raised $3 million to fund a program dedicated to training physical therapists in health services research. The Foundation's Center of Excellence is set to launch in 2015 thanks to donations from APTA, many of its state chapters, APTA components, and a long list of corporate and private donors.

    The Center of Excellence for Health Services/Health Policy Research (COE) will focus on significantly expanding the number of physical therapist (PT) investigators specializing in research around health services and policy. The project was created in response to a lack of sufficient data related to physical therapy in services/policy research, and a shortage of PTs with the skills to conduct this kind of research.

    Work to bridge these gaps will begin when the Foundation awards a $2.5 million grant to launch and manage the COE. Current Foundation plans are to begin accepting letters of intent later in 2014 and to grant the award in 2015. The Foundation will continue to raise funds for the campaign to strengthen its ability to offer health services/health policy research grants and scholarships along with clinical research awards.

    In a Foundation press release (.pdf), Foundation Board of Trustees President William G. Boissonnault, PT, DPT, DHSc, FAPTA, FAAOMPT, thanked all who participated in the fundraising efforts and stated that the financial support "Will put us on the road to changing the face of physical therapy, securing our place in the future of health care, and dramatically improving the quality of care we provide to our clients."

    Contributions to the Foundation are tax-deductible and can be made online or sent to Foundation headquarters at 1111 N Fairfax Street, Alexandria, VA 22314. For more information, e-mail Foundation staff or call 800/875-1378.

    Treadmill Training's Benefits Mixed for Individuals Poststroke

    For people who have had a stroke and are unable to walk at the outset of treatment, treadmill training is not likely to aid their progress toward walking independently—but for patients with stroke who are ambulatory, the intervention may significantly improve endurance and speed. These were the broad conclusions reached in a recent review of 44 trials and 2,658 participants.

    The research, to be published in the Cochrane Database of Systematic Reviews (abstract only available for free at this time), focused on "randomized or quasi-randomized controlled and crossover trials of treadmill training and body weight support, individually or in combinations, for the treatment of walking after stroke." Authors focused on outcomes related to walking speed, endurance, and dependency.

    "Overall, the use of treadmill training with body weight support did not increase the chances of walking independently compared with other physiotherapy interventions," the researchers wrote. Still, while results were at best mixed for patients with stroke unable to walk, authors noted that those who could walk "appear to benefit most from this type of intervention" and that "improvements in walking endurance in people able to walk may have persisting beneficial effects."

    APTA's PTNow can put you in touch with evidence-based practice resources, including information on interventions related to stroke. The association's consumer guide to stroke is available on APTA's MoveForwardPT.com website.

    Omron Healthcare Named APTA Strategic Business Partner

    Omron Healthcare Inc, a manufacturer of personal wellness products, has been named a Strategic Business Partner of APTA. Omron is most widely known for its transcutaneous electrical nerve stimulation (TENS) therapy devices.

    In an APTA press release, APTA President Paul A. Rockar Jr, PT, DPT, MS, stated, “We are pleased to welcome Omron Healthcare to APTA’s Strategic Business Partners family."

    Ranndy Kellogg, chief operating officer at Omron Healthcare Inc, said, “The American Physical Therapy Association is a leading professional organization working to improve quality of life for all people, and we are thrilled to work with them.” He added that “It’s a natural partnership for us as we share the same passion to help Americans who are in pain.”

    The APTA Strategic Business Partner program seeks to enhance business relationships and develop meaningful partnerships with for-profit companies by offering services and marketing opportunities that provide mutual benefits to partners and APTA. For further information on the APTA Strategic Business Partner program, visit the Strategic Business Partners webpage.

    Group Urges President to Acknowledge Physical Activity in SOTU Address

    While the upcoming State of the Union address will almost certainly include remarks about the economy, foreign policy, and health care, if President Barack Obama listens to a suggestion from APTA and more than 100 other organizations and companies, the speech may also include a nod to the importance of physical activity.

    In a letter to the White House delivered last week, a long list of signatories including the American Council on Exercise, the Arthritis Foundation, NIKE Inc, University of Tennessee – Chattanooga, and APTA thanked the president for the administration's promotion of healthy lifestyles through the "Let's Move" campaign, and they urged him to keep the momentum going by mentioning physical activity as a crucial component in the overall health of the country, both physical and economic.

    "Physical activity has been shown to reduce health care costs, prevent chronic disease, enhance productivity, and improve quality of life," the letter states. "With its ability to treat and prevent obesity, diabetes, heart and bone disease, and other chronic conditions, exercise is powerful medicine indeed."

    The State of the Union address is scheduled for January 28 at 9:00 pm Eastern time.

    IOM Seeking Comment on Clinical Trials Data Sharing

    In a health care world that places increasing emphasis on outcome data, some of the richest information from clinical trials can be the least accessible because of barriers to sharing. Now the US National Academy of Sciences' Institute of Medicine (IOM) is looking for ways to solve those access problems and asking for feedback on the issue.

    In a recently released report titled Discussion Framework for Clinical Trial Data Sharing: Guiding Principles, Elements, and Activities, a specially formed IOM committee outlines its progress on efforts to rethink data restrictions that, if relaxed, "could facilitate new analyses and a deeper understanding of a particular therapy or condition," in the committee's opinion. The report states that "a cultural change" has taken place in current thinking about data sharing, and that "the conversation … has moved from whether it should happen to how it should be carried out."

    The committee's efforts to identify ways to carry out greater data sharing include gathering input from the providers and researchers. The group is particularly interested in feedback on global implementation, the timing and prioritization of sharing, mitigating risks, enhancing incentives, and measuring impact, and has produced a guideline for providing public comment (.pdf).

    New Website Supports Ending Inappropriate Physician Self-Referral

    The fight to end inappropriate physician self-referral has been boosted by the launch of a new website that will highlight the issue, support legislation aimed at curbing the practice, and help physical therapists (PTs) and others learn how to take action to advocate for needed change.

    The Alliance for Integrity in Medicare (AIM) coalition's new online presence is designed to educate providers, legislators, and the public on the impact of physician self-referral on the Medicare system, and to solidify support for the Promoting Integrity in Medicare Act (HR 2914), a recently introduced bill that seeks to close self-referral loopholes. These loopholes allow physicians to refer their Medicare patients for certain ancillary health care services owned by and contained within the physician's practice—an approach that results in unnecessary use of services, higher costs, and potential risk to patient health.

    APTA is a founding member of AIM, which also includes laboratory, radiation oncology, and medical imaging groups. The new website offers background on the issue, links to studies that confirm the damaging effects of self-referral, a press kit, and ways to easily take action and support the coalition's efforts.

    APTA has been working for years on Capitol Hill to fight physician self-referral. Find out more about this issue at APTA's self-referral webpage, and take action now by asking your legislators to close the self-referral loophole. Contact the APTA advocacy staff for more information.

    MPPR Calculator Helps PTs Navigate Payment System

    Congress has until March 31 to take action on payment formulas including the sustainable growth rate (SGR): until then, physical therapists (PTs) need to know how to determine current payment for services. At APTA, there's a calculator for that.

    The 2014 multiple procedure payment reduction (MPPR) calculator is now live on APTA's Medicare webpage. From now until March 31, PTs must follow an MPPR policy that implements a 50% payment reduction to the practice expense value of approximately 44 codes, with payment calculated based on code combinations. The APTA calculator is designed to help PTs identify those payments.

    The baseline payment formulas now in place are temporary ones, intended to provide Congress with time to take action to extend, modify, or end the flawed SGR. Last year, legislators moved closer than ever to eliminating the SGR, and proposals are still being discussed. APTA has created a webpage with detailed information on the proposals.

    APTA is actively involved in the SGR reform process and will be asking PTs, physical therapist assistants, educators, patients, and supporters to contact their legislators when Congress is poised to take action on this issue. Members interested in joining APTA’s advocacy efforts to reform the SGR and repeal the therapy cap can sign up for PTeam.

    CMS Releases Summary of Manual Changes Based on Jimmo v Sibelius Agreement

    The US Center for Medicare and Medicaid Services' Medicare Learning Network (MLN) has released a summary of updates (.pdf) made to the Medicare Benefit Policy Manual as a result of the settlement agreement reached in Jimmo v Sebelius.

    The settlement agreement, reached in January 2013, reinforced Medicare's policy that when skilled services are required to maintain the patient’s current condition or to prevent or slow further deterioration, coverage cannot be denied because of the lack of potential for improvement.

    World Congress Seeks PT Presenters, Instructors

    Physical therapists (PTs) interested in participating as presenters at the next World Confederation of Physical Therapy (WCPT) Congress (Congress) in Singapore will need to pay close attention to their calendars over the coming weeks: WCPT has set February 14 as the deadline for submission of proposals to conduct a pre- or post-Congress course and has announced that it will open its call for presentation abstracts on March 17. The event will be held May 1-4, 2015.

    Congress courses are organized by recognized experts, and focus on applied knowledge and skills. According to the announcement from WCPT, the selection committee "is particularly interested in seeing proposals that are evidence based, address significant contemporary issues and innovations in physical therapy, and include perspectives from low-income countries." Submission information is available at the WCPT website.

    Abstract presentations during the Congress will range from standard 8- and 10-minute platform sessions to poster presentations and a new "rapid 5" format that limits presenters to 5 slides in 5 minutes. Information on the proposal process is available from WCPT. Deadline for submission is October 31, 2014.

    Also set for February: the release of details on the focused symposia to be featured at the Congress. The 90-minute sessions are intended to draw together researchers and practice experts to "explore the implications of the latest research and thinking as well as debate controversies," according WCPT.

    Sitting Connected With Heart Failure in Men

    The flurry of news and magazine articles last year proclaiming that "sitting is the new smoking" may have been a bit hyperbolic, but apparently there's at least 1 thing a sedentary lifestyle has in common with tobacco use: increased risk of heart failure in men, even with low to moderate exercise.

    The conclusion is drawn from an article (abstract only available for free) recently published in Circulation, the journal of the American Heart Association, and has received wide attention in newspapers and other media. The study focused on lifestyles of 84,170 men aged 45 to 69 and the incidence of heart failure (HF) over time. Researchers found that while high rates of physical activity did reduce risk of HF, low to moderate exercise had less of an impact on HF rates among men who also spent relatively long periods of time sitting.

    The men in the study were divided according to a formula that assessed energy use relative to self-reported physical activity over 3 months, and sorted according to their estimations of daily time spent "watching television, sitting at a computer, or reading" outside of work. The sedentary rates were categorized as low (less than 2 hours a day), medium (3-4 hours a day), and high (more than 5 hours a day). Researchers also recorded other demographic and behavioral data, including ethnicity, alcohol consumption, education, income, and various health conditions at baseline.

    Overall, researchers found that men who spend 5 or more hours a day sitting were 34% more likely to develop HF than men who sit less than 2 hours a day outside work. Additionally, the increased risk linked to sitting was not eliminated by low to medium levels of physical activity. "Our results strengthen the developing position that too much sitting is detrimental to cardiovascular health, independent of regular physical activity," authors wrote.

    You can share information with your patients and clients on the negative impacts too much sedentary time by connecting them to the APTA MoveForward webpage on sitting.

    Mobile Technology Risks and Tips Now Featured on HealthIT.gov

    Smart phones, tablets, and the ability to wirelessly connect to files and other information can enhance service to patients and clients—but they can also create serious problems if providers aren't aware of how misuse of the technology could violate provisions of the Health Insurance Portability and Accountability Act (HIPAA). A new webpage at the federal HealthIT site sponsored by the US Department of Health and Human Services (HHS) is aimed at helping health care professionals understand the privacy implications of portable devices that have become nearly ubiquitous.

    The "Your Mobile Device and Health Information Privacy and Security" webpage includes text and video designed to help individual providers learn about risks of handheld and wireless technologies, and steps that can be taken to maintain privacy. Though not intended to serve as the definitive source to ensure compliance with state and federal law, the webpage includes tips on how to secure mobile devices, how to reduce the risk of unauthorized access of information in the event of theft, and how to develop organizational policies and procedures around portable devices. The webpage also features links to more detailed documents from the HHS Office for Civil Rights Health Information Privacy.

    APTA's HIPAA webpage can help you stay on top of privacy issues. APTA members can also access a July 2013 Learning Center webinar that discusses new HIPAA requirements including rules about the use of mobile technology.

    HHS Updates Practice Guidelines on Knee OA, Falls Prevention

    Aerobic walking programs for the management of knee osteoarthritis (OA) and recommendations for falls assessment and prevention are among the clinical practice guidelines recently approved by the federal Agency for Healthcare Research and Quality's National Guideline Clearinghouse (NGC).

    The NGC's update of the Ottawa Panel evidence-based clinical practice guidelines for aerobic walking programs in the management of osteoarthritis focuses on the efficacy of various programs for adults over 40 with knee OA, and analyzed outcomes for walking programs that feature any combination of strength training, health education, behavioral components, and multicomponent exercises. The review evaluated outcomes based on pain level, quality of life, and functional status.

    The falls guidelines are an update of National Collaborating Centre for Nursing and Supportive Care clinical practice guidelines developed in 2004 by the National Institute for Clinical Excellence. The recently announced NGC evidence reviews included analyses of risk identification methods, assessment tools, reduction of psychosocial impacts of falls, rehabilitation methods, the role of care setting in intervention approaches, and educational needs of patients and their families.

    NGC is an initiative of the US Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ). NGC was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans.

    APTA views the development of clinical guidelines as a crucial component in reducing unwarranted variation in care. Learn more about the importance of these guidelines at APTA's webpage devoted to the development of clinical practice guidelines, and access a wide range of guidelines through PTNow, the association's resource for evidence based practice information.

    Calling All PT Innovators – Innovation 2.0 Now Seeking Proposals

    APTA has opened its call for proposals from members interested in taking part in Innovation 2.0, a funding and mentoring program offering up to $150,000 to support new approaches to service delivery and payment. Members have until February 13 to complete the proposal process.

    Innovation 2.0 builds on the success of APTA's 2013 Innovation Summit by seeking out innovators who are connecting the dots from feasibility studies to meaningful outcomes and moving great ideas from small-scale use to wide applicability.

    Members interested in submitting a proposal should begin by visiting the Innovation 2.0 webpage. The webpage contains complete instructions, applicant requirements, a list of topics that will be considered, and a link to the proposal submission form. Proposals must be received by February 13. Winning applications will be announced on March 10.

    Successful applicants will attend a workshop May 8-9 to discuss their projects and receive feedback from researchers and other clinicians. After the workshop, APTA will announce which finalists will receive funding and in-kind services from APTA to pursue their projects.

    An optional letter of intent is due to APTA by January 20. The letter should be sent to Innovation 2.0 staff and should include contact information for the project leader, name of the organization, and a brief description of the model. Applicants who do not send a letter of intent may still submit proposals.

    Questions? Need more details? Contact the Innovation 2.0 staff.

    Foundation Researchers Will Share Results at CSM

    The role of comorbidities in physical therapist services and a study on day-to-day walking of older adults with knee pain from osteoarthritis will be featured during the Foundation for Physical Therapy's research briefing at this year's Combined Sections Meeting (CSM) in Las Vegas.

    Laurie King, PT, PhD, 2011 Clagett Family Research Grant recipient, and Dan White, PT, ScD, 2011 Geriatric Research Grant recipient, will present on their Foundation-supported research. Foundation President William G. Boissonnault, PT, DPT, DHSc, FAPTA, FAAOMPT, will also give an update on the current activities of the Foundation.

    The event is scheduled for Monday, February 3, from 6:30 pm to 8:00 pm at the Venetian Hotel, Bellini 2102. Please RSVP by January 27 if you plan to attend the briefing.

    More information on the speakers and their research (.pdf) is available on the Foundation’s website.

    Innovation 2.0 Deadline January 20

    APTA members have a Monday, January 20, deadline to submit letters of intent to let staff know if they will be making a proposal to receive funding and mentoring through the association's Innovation 2.0 program.

    APTA's Innovation 2.0 program will offer up to $150,000 to support innovation in service delivery and payment in a wide range of areas from the integration of physical therapy into collaborative care models to management of patients and clients that focuses on reducing hospital readmissions. The complete list of proposal areas can be found on APTA's Innovation 2.0 webpage.

    Interested candidates should submit a letter of intent to APTA Innovation 2.0 staff by January 20. The letter should include contact information for the project leader, name of the organization, and a brief description of the model. The formal call for proposals will begin January 17 with a February 13 deadline.

    Though not required in order to submit the formal proposal, candidates are encouraged to submit letters of intent to help APTA staff prepare for the review process.

    Questions? Need more details? Contact the Innovation 2.0 staff.

    Changes to CPT Editorial Process Emphasize Transparency

    Recently announced changes to the American Medical Association's (AMA's) Current Procedural Terminology (CPT) editorial process emphasize greater transparency and collaboration, and could bolster opportunities for physical therapists (PTs) to work with APTA to ensure the codes accurately reflect practice.

    The changes put in place are the result of input received by AMA from stakeholder organizations. According to an AMA press release, the new approaches are designed to "increase transparency and fairness" in the process through more in-person meetings beyond the CPT editorial and advisory committee, more wide and proactive communication about requested code changes, and the establishment of a "medical advisor" to facilitate the process with staff and applicants new to the CPT process.

    APTA works closely with AMA and other associations during the CPT editorial process, and relies on input from PTs to get the best possible information on how the system works at the individual practitioner level. The information received by APTA is extremely important to the work the association is doing on the Physical Therapy Classification and Payment System.

    APTA continues to work toward an accurate payment system that recognizes and promotes the clinical judgment of the physical therapist as well as improving quality of care. Contact advocacy staff with your questions.

    APTA Committee Members Needed

    Here's a great new year's resolution: get more involved in APTA.

    The call for volunteers to serve on APTA committees is open now through February 11. Members interested in serving on the Ethics and Judicial, Finance and Audit, Leadership Development, and Public Policy and Advocacy committees, or the Awards subcommittees, are encouraged to let APTA know of their willingness to participate. APTA relies heavily on its volunteers, who in turn gain valuable leadership and growth opportunities while working with some of the most outstanding physical therapists in the country.

    The first step is to complete an interest profile on the Volunteer Interest Pool webpage. Once completed, click on the "Apply for Current Opportunities" button and select the committee you're interested in joining. Complete details on all committees can be found on APTA's Volunteer Groups webpage.

    New Wound Treatment Code Available to PTs

    A new code for the use of a modality to heal wounds using sound energy has been made available to physical therapists (PTs) in the 2014 version of the Current Procedural Terminology (CPT) document maintained by the American Medical Association (AMA).

    The new active wound care management code—97610—replaces Category III code 0183T. The modality uses acoustic energy to atomize saline and deliver ultrasound energy by way of a continuous mist to the wound bed and surrounding tissue, and is identified as "low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day."

    Always check payer policy to determine coverage of this code. For more information on CPT codes, visit APTA's Coding and Billing webpage.

    KHN Article: Private Insurers Could Dampen Access to Habilitative Services

    While the Affordable Care Act (ACA) contains provisions that aim to increase patient access to habilitative services, rules around how states approach "essential health benefits" requirements could weaken the intended outcome, according to a recent article in Kaiser Health News (KHN).

    KHN reporter Michelle Andrews explored the ways in which individual states are responding to the ACA requirements to identify "benchmark" insurance plans that define the essential health benefits that will be covered in the health insurance exchanges. These essential benefits must include rehabilitative and habilitative services, but states are allowed some leeway in how habilitative services are defined. Andrews wrote that some policy experts are concerned that this leeway will allow insurers to "find ways to sidestep the new requirement."

    According to the article, states can choose to handle the definition of habilitative services in 1 of 3 ways—by directly establishing the definitions, by requiring that insurance companies establish habilitative benefits at parity with rehabilitative benefits, or by allowing the insurance companies to decide how to cover habilitative services. The KHN story reports that "fewer than half of states have explicitly defined the services that are covered under habilitative services or required parity with rehabilitative services," leaving private insurers to create their own definitions.

    The problem, according to Andrews' sources, is that private insurance companies may craft policies in ways that do little to actually increase habilitative coverage. A possible approach described in the article involves the substitution of more extensive rehabilitation coverage while reducing habilitative coverage—an allowable tradeoff when items are within the same health benefit category.

    Essential health benefits are more clearly defined in Medicaid and the Children's Health Insurance Program (CHIP), where enrollees have access to habilitative services as defined by rules released in summer of 2013. APTA contributed comments during the creation of the rule and offers an explanation of essential health benefits as well as summaries of the ruling.

    Mechanical Traction's Benefits Documented

    A recent study is helping to strengthen the argument that mechanical traction can lead to greater improvements than exercise alone in patients with cervical radiculopathy.

    In a study (abstract only available for free) in the Journal of Orthopaedic and Sports Physical Therapy, 86 patients with cervical radiculopathy were divided into 3 treatment groups: exercise alone, exercise and use of an over-the-door home traction device, and exercise and mechanical traction delivered at clinic sessions. Participants reported on pain and movement at 4 weeks, 6 months, and 12 months after completion of the program.

    Authors of the study wrote that the results "more strongly favored the effectiveness of cervical traction delivered in supine using a motorized device than prior studies" that may have been affected by patient selection and other factors. At all reporting intervals, patients who underwent mechanical traction reported lower scores on neck disability, neck pain intensity, and arm pain intensity, with "particularly notable" improvements at the later follow-ups.

    Although patients who were assigned the in-home over-the-door traction device in addition to exercise tended to fare better than the exercise-only group, the improvements still lagged behind the mechanical traction group. Researchers described the differences as "an interesting result considering the patients provided the home unit could continue using the device beyond the study treatment period while those receiving mechanical traction could not."

    Looking for more evidence-based research? Visit PTNow for access to the information you need, including clinical practice guidelines for the diagnosis and treatment of cervical radiculopathy from degenerative disorders.

    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."

    Stanley Paris Ends Sail Early

    More than 6 weeks after beginning his journey, adventurer and physical therapist Stanley Paris, PT, PhD, FAPTA, FAAOMPT, has been forced to abandon his attempt to solo circumnavigate the globe nonstop. Paris announced that he would be heading to land in Cape Town, South Africa, in the face of rigging problems and other equipment failures that made continuation "foolish in the extreme."

    At age 76, Paris was attempting to break the speed and age record for the solo voyage, and had hoped to complete the journey in 120 days. Though he was forced to delay his start date to December 2 due to weather, during the following weeks Paris reported good progress despite some unfavorable winds and an injury.

    When rigging and other equipment began to malfunction, Paris reported the conditions to the designers of his yacht, the Kiwi Spirit, as well as to the support group helping him execute his plan. Their shared opinion: end the attempt. "I think the widespread failures across so many systems would have kept a crewed grand prix boat on shore," the president of the yacht design company wrote to Paris. "To have this combination of problems in your injured state is inviting disaster… Please make the prudent decision and stop."

    In his blog, Paris described how he viewed the news "I should say I am sorry to disappoint so many," he wrote. "But there is one thing I can say and that is, 'I tried,' and that my spirit did not give up until those that I must respect made it clear to me that it was over." Paris stated that he will not attempt the journey again because "I have asked enough of my wife and family already."

    The attempt by Paris was made in part to bring attention to the Foundation for Physical Therapy, where he serves on the Board of Trustees. His sailing efforts have helped to raise over $250,000 for the Foundation.

    Vitamin D May Reduce Falls Risk

    Older adults given vitamin D and calcium supplements may reduce their risk for falls, according to a consensus opinion published in the Journal of the American Geriatrics Society.

    Researchers found that a minimum daily vitamin D supplement of 1,000 international units accompanied by calcium (common calcium dosages ranged between 500 and 1,200 milligrams per day) could help reduce the risk of falls and the severity of injury when falls do occur. The research group supported the recommended daily average of 4,000 international units from all sources, and recommended use of vitamin D2 or D3 as supplements. D2 is appropriate for use by vegetarians.

    Authors wrote that "although there is no evidence that age alone is a risk factor for low vitamin D levels, lack of exposure to sunlight in long-term care settings" is associated with the drop. The opinion is based on research that included an extensive review of all meta-analyses published before 2008 on the relationship of vitamin D, calcium supplementation, and falls in older adults, as well as Medline literature reviews for articles published between 2006 and 2009.

    APTA provides education on exercise prescriptions for balance improvement and falls prevention, and offers other resources for physical therapists, such as how to develop consumer events on balance, falls, and exercise, and information on evidence-based falls programs. Members can also access an APTA pocket guide on falls risk reduction (.pdf) as well as take part in an online community where members can share information about falls prevention.

    End to Therapy Cap Still on the Table

    Though the legislative process is far from over, a possible end to the therapy cap is still very much in play now that Congress has reconvened.

    This week, the House Energy and Commerce Health Subcommittee held a hearing focused on Medicare extenders, including the therapy cap that places an annual financial limit on outpatient therapy. The good news: several members of the committee voiced support for an end to the cap being included with a bill to permanently end the flawed sustainable growth rate (SGR), with Energy and Commerce Health Subcommittee Vice Chairman Rep Michael C. Burgess (R-TX) stating flatly that the therapy cap "made no sense when it was first passed several years ago, and guess what? It still makes no sense." A video of the hearing, beginning with comments from Rep Burgess, is available on YouTube.

    In December 2013, Congress voted for a 3-month SGR "patch" and an extension of the therapy cap exceptions process to give legislators time to work out the details of a proposal that could permanently end both. While proposals to end the SGR are included in both Senate and House versions of the legislation, provisions to permanently reform the Medicare extenders are included only in the Senate bill. APTA has created a webpage that explains the SGR reform proposals on the table. Because these issues are still awaiting final votes, grassroots efforts need to continue.

    APTA staff is monitoring the progress of these issues on Capitol Hill and evaluating how APTA members and supporters can most effectively make their voices heard as the discussions evolve. In the meantime, APTA encourages members to visit the Legislative Action Center to stay engaged.

    APTA will continue to work members of Congress to ensure the final reform package includes policies that reflect the interests of physical therapists and physical therapists assistants, and the patients and clients we serve. Members interested in joining APTA's advocacy efforts to reform SGR and repeal the therapy cap can sign up for PTeam.

    Are You An Innovator? Funding, Support May Be Available

    APTA members who are taking new approaches to models of care now have an opportunity to receive funding and mentoring through a new program offered by the association, but submission deadlines are soon.

    APTA's Innovation 2.0 program will offer up to $150,000 to support innovation in service delivery and payment in a wide range of areas from the integration of physical therapy into collaborative care models to management ofpatients and clients that focuses on reducing hospital readmissions. The complete list of proposal areas can be found on APTA's Innovation 2.0 webpage.

    Interested candidates begin by submitting a letter of intent to APTA Innovation 2.0 staff by January 20. The letter should include contact information for the project leader, name of the organization, and a brief description of the model. The formal call for proposals will begin January 17 with a February 13 deadline.

    Successful recipients will attend a workshop May 8-9 to discuss their projects and receive feedback from researchers and other clinicians. Finalists will receive funding and in-kind services from APTA to pursue the projects.

    Innovation 2.0 builds on the success of APTA's 2013 Innovation Summit, a groundbreaking event that brought together physical therapists, physicians, large health systems, and policy makers to discuss the current and future role of physical therapy in integrated models of care.

    Questions? Need more details? Contact the Innovation 2.0 staff.

    Only 25% of US Youth Meet Daily Exercise Goal

    Despite a 4-year-old national initiative to encourage at least 1 hour of moderate-to-vigorous physical activity every day, only about a quarter of US youth are actually meeting that goal. The findings were part of a Centers for Disease Control and Prevention (CDC) report (.pdf) that examined activity patterns in 2012.

    The study used self-reported data on youth aged 12-15 to get a picture of activity rates broken down by sex, weight status, and type of activities. Among the findings:

    • Though 24.8% of youth reported daily moderate-to-vigorous physical activity, 60.2% of males and 49.4% of females reported engaging in this level of activity at least 5 days a week.
    • Small percentages of youth reported engaging in no physical activity on any day of the week—6.4% for males, and 8.7% for females.
    • Researchers defined the gap in every-day activity rates among males (27%) and females (22.5%) as "not a statistically significant difference."
    • Among males, normal-weight and overweight boys engaged equally in every-day activity (29.5%), but the rate dropped off for obese boys (18%). Among females, the rates did not differ as dramatically, with 24.1% of normal-weight girls, 20.1% of overweight girls, and 19.5% of obese girls reporting daily moderate-to-vigorous activity.
    • The most popular activities for males were basketball (48%), running (33.5%), and football (27.4%); females' top activities were running (34.9%), walking (27.6%), and basketball (21.4%).

    Check out the article in the November 2013 issue of PT in Motion (free to APTA members) for an overview of how physical therapists and physical therapist assistants are working to increase rates of activity in youth.

    Lack of Cognitive Rest Can Impede Concussion Recovery

    A new study supports the consensus view that for young people recovering from concussions, too much cognitive activity too soon can actually slow the return to normal functioning.

    The findings are reported in the January 6 issue of Pediatrics (abstract only available for free), and involved reports on cognitive activity over a series of visits on 335 patients aged 8-23 who suffered a concussion. The study group was composed of 62% males with 19% of the entire group reporting loss of consciousness and 37% reporting amnesia at the time of injury. Mean duration of symptoms was 43 days.

    Researchers divided the participants into quartiles based on self-reports of cognitive activities between visits. The ratings ranged from "minimal cognitive activity" (no reading, no homework, fewer than 5 text messages per day, fewer than 20 minutes per day of screen-based activity) to "full cognitive activity" (no restrictions on cognitive activity). The study revealed that the participants who reported full cognitive activity soon after concussion had a markedly slower recovery rate than those who restricted higher-level mental work.

    Authors noted that the differences occurred only between the most active quartile and the rest, and were not graduated based on the levels reported. "This seems to suggest that while limiting cognitive activity is associated with shorter duration of symptoms, complete abstinence from cognitive activity may be unnecessary," the authors wrote, adding that the study seems to indicate that the negative effects of cognitive activity appear to take place during the earlier phases of recovery.

    Physical therapists (PTs) play an important role in the treatment of individuals who have suffered concussions. Get the latest information on these injuries and what’s being done to reduce them at the APTA traumatic brain injury webpage.

    'Simple' Measures Reduce MRSA Rates in Long-Term Care Facilities

    Adherence to "a simple bundle of infection prevention and control strategies" has significantly reduced the incidence of methicillin-resistant staphylococcus aureus (MRSA) infections in Veterans Administration (VA) long-term care facilities.

    According to a press release (.pdf) from the American Journal of Infection Control, a study published this month reveals that the 133 facilities studied experienced a 36% overall decrease in MRSA infections, despite an overall rise in admissions of individuals with MRSA colonizations. The study was conducted over the span of 42 months.

    The decrease was attributed to the protocols outlined in the VA's MRSA Prevention Initiative (.pdf), an approach that involves patient screening, use of gowns and gloves, hand hygiene, and "an institutional culture change focusing on individual responsibility for infection control," according to the press release. The prevention initiative also calls for the creation of a MRSA Prevention Coordinator at each facility.

    The prevention measures have already proven effective in acute care settings, and the new study indicates that they can be just as valuable in long-term facilities.

    Check out the APTA MRSA webpage for more information on the role of physical therapists and physical therapist assistants in reducing these infections.

    Foundation Raises Over $150K at Private Practice Conference

    The Foundation for Physical Therapy raised over $150,000 for the Center of Excellence (COE) for Health Services/Health Policy Research Campaign during the 2013 APTA Private Practice Conference and Exposition, an achievement reached in large part through support from APTA Private Practice Section (PPS) board members and the Institute of Private Practice Physical Therapy.

    The 2013 PPS annual conference was held in November in New Orleans. There, PPS and Institute board members supported the Foundation's fundraising efforts as a way to respond to the physical therapy profession's urgent need for data supporting innovative practice models, access to evidenced-based physical therapy services, and efforts to attain fair reimbursement. PPS has been a strong supporter of the Foundation for more than a decade, donating nearly $300,000 including a $120,000 contribution to the COE initiative in 2013.

    In a press release, Foundation President William G. Boissonnault, PT, DPT, DHSc, FAPTA, FAAOMPT, is quoted as saying, “We are extremely grateful to the leadership of the Private Practice Section and the Institute of Private Practice Physical Therapy, and the PPS members." The recent donations will help the Foundation reach its goal of surpassing the $3 million needed to fully establish the COE, an institution that will train the next generation of physical therapist investigators.

    Contributions to the Foundation for Physical Therapy are tax-deductible and can be made online or sent to its headquarters at 1111 North Fairfax Street, Alexandria, VA 22314. For more information, e-mail Barbara Malm or call 800/875-1378.

    Humana Temporarily Ceases Overpayment Recovery

    The Humana health insurance corporation has put its overpayment recovery efforts on hold while it considers how it will implement its plan to apply the Multiple Procedure Payment Reduction (MPPR) policy. Prior to this announcement, the company was requiring physical therapists (PTs) to pay back portions of reimbursement that Humana claimed exceeded MPPR standards.

    Humana began applying the Multiple Procedure Payment Reduction (MPPR) policy on Medicare Advantage and commercial insurance plan payments for physical therapy in 2013, a change that resulted in payment reductions to PTs and overpayment recoveries. APTA staff has been in communication with Humana representatives to express concern over the way Humana implemented the policy. In a recent conference call with APTA staff, Humana representatives reported that the company is "no longer in recovery mode."

    Additionally, Humana representatives indicated that due to calculation errors, some recovery amounts were too high, and the company would refund PTs who experienced excessive recoveries. Additional discussions are expected regarding Humana’s future plans for policy implementation.

    APTA remains concerned about the administrative burden on providers subjected to MPPR through overpayment recovery instead of on initial payment and will continue to discuss this issue with Humana representatives. Your direct experiences and documentation can support this discussion: send an e-mail to advocacy@apta.org with your name, member ID, and contact information for staff follow-up.

    Brain-Controlled Exoskeleton Will Be Featured at World Cup

    A teenager who is paralyzed will use a mind-controlled robotic exoskeleton to stand, walk, and kick the first ball at the opening of the World Cup soccer tournament this June.

    The exoskeleton, which surrounds the lower body, is controlled by brain activity transmitted to electrodes that transmit wireless signals to a wearable computer that generates the exoskeleton's movements. The exoskeleton contains sensors that send important information about movement—such as force, rolling off the toe, and kicking off—back to the wearer, either through electronic vibrations or a visual monitor.

    Tentative plans for the debut were first reported in the Washington Post last spring. Since that time, plans have solidified and reports of an official debut are now circulating. A brief video on the project is also available on YouTube. The technology was developed by the Walk Again Project, a nonprofit collaborative centered at the Duke University Center of Neuroengineering.

    Learn more about how robotic devices are used in physical therapy: APTA offers podcasts that provide an overview and information on interventions, and the association's Learning Center offers a continuing education course that covers rehabilitation robots, technology differences, current uses, promising patient populations, evidence supporting the use of robotics, and other topics.

    WSJ Article Focuses On Special Rehabilitation Needs of Student Athletes

    A recent Wall Street Journalarticle highlights the special approaches that must be taken with young athletes and the role physical therapy plays in ensuring that treatment is appropriate for musculoskeletal systems that are still growing. The story also includes details of how a Florida physical therapist (PT) worked with 2 student athletes—and inspired 1 to study to become a PT.

    Reporter Laura Landro writes about how increases in the number and severity of sports injuries among student athletes are focusing greater attention on the impact of treatment on growth plates and other issues specific to pediatric patients. With more intensive sports programs and year-round competition becoming more common, providers must be acutely aware of how to structure rehabilitation in ways that can allow a student to return to a sport without risking longer-term damage, she reports.

    The WSJ story includes an account of how APTA member Whitney Chambers, PT, DPT, OCS, helped 2 Florida student athletes recover after an injury. Chambers describes the approach she took to treat a high school football player who tore his anterior cruciate ligament and a young soccer player who suffered a labrum tear. According to the article, the football player is planning to return to the sport in college, while the soccer player will play only recreationally—while pursuing a career in physical therapy at Florida State University.

    Health Care Spending Growth Low Again

    The residual impacts of the economic recession are the primary drivers behind relatively low growth in US health care spending in 2012, according to a recent report from the Centers for Medicare and Medicaid Services (CMS). The report cites a 3.7% growth in overall spending during the year, with a slight drop in the overall portion of the economy devoted to health care, from 17.3% in 2011 to 17.2% the following year.

    The report from the CMS Office of Actuary (abstract only available for free) states that while faster spending growth occurred in hospital, physician, and clinical services, overall growth was tempered by slower rates in prescription drugs and nursing home services. Private insurance spending growth also remained low due to the slow economic recovery, according to report's authors.

    The 3.7% growth rate is consistent with trends that began in 2009, and have fluctuated between 3.6% and 3.8% annually since.

    Theft of Unencrypted Health Records Results in $150K HHS Fine

    A stolen flashdrive containing patient records has resulted in a $150,000 federal fine for violation of the Health Insurance Accountability and Portability Act (HIPAA). According to the US Department of Health and Human Services (HHS), this case marks the first settlement over noncompliance with the Health Information Technology for Economic and Clinical Health (HITECH) Act.

    The fine is part of a resolution agreement (.pdf) with Adult & Pediatric Dermatology PC, of Concord, Massachusetts (APDerm), owners of the stolen drive. According to the HHS announcement of the agreement, the unencrypted drive was in a computer bag taken from an employee's locked car and contained records on approximately 2, 200 patients. The drive has not been recovered.

    In addition to the financial penalty, APDerm has agreed to participate in a corrective action plan involving the creation of multiple risk analyses and regular progress reports to HHS. The HHS Office for Civil Rights investigation revealed that APDerm had not conducted sufficient risk analyses and did not implement required policies, procedures, and workforce training around electronic protected health information.

    Although physical therapists (PTs) are not yet required to adopt electronic health records (EHR) under the Medicare and Medicaid Meaningful Use programs, most clinicians involved in electronic submission of patient information are subject to HIPAA rules. APTA provides resources on complying with the complex HIPAA Omnibus Rule on APTA's HIPAA webpage.

    More information on the HIPAA Omnibus rule requirements—and more examples of data breaches like the one described in this story—are featured in an APTA Learning Center webinar.

    Fake Surgery Just as Good as the Real Thing for Meniscus Tears

    Actual surgery is no better than simulated surgery in treatment of individuals with nontraumatic degenerative meniscal tears and no osteoarthritis, according to a study recently published in the New England Journal of Medicine.

    In the study (abstract only available for free), researchers identified 146 patients aged 35–65 with nontraumatic meniscal tears and randomly assigned them to receive either a partial meniscectomy or a "sham" procedure that only simulated the surgery. All study participants received similar postoperative care that included an exercise program and analgesics as needed.

    After 12 months, researchers found no significant differences in recovery between the patient groups, with similar levels of improvement in Lyshom and Western Ontario Meniscal Evaluation Tool scores and comparable ratings for knee pain after exercise. Study authors caution that the findings apply only to individuals with degenerative medial meniscus tears and no osteoarthritis.

    The recent study supports earlier research that found physical therapy to be just as effective as surgery for meniscal tears. These findings were recognized by APTA in March 2013.

    Today's Need-to-Know: 2014 Medicare Payment Changes

    Before adjourning for the holidays, Congress passed the Pathway for SGR Reform Act of 2013, temporarily preventing a scheduled physician fee schedule payment cut from taking effect on January 1, 2014, and extending the therapy cap exceptions process. The temporary patch expires March 31, 2014, giving the House and Senate until then to finalize legislation that would permanently repeal the flawed sustained growth rate (SGR) formula that has vexed physical therapists, physicians, and other health care professionals since it was enacted in 1997.

    Other changes included in the 2014 Medicare physician fee schedule final rule also affect physical therapist practice and payment for 2014. Below is a summary of the changes and their timelines.

    Effective January 1–March 31, 2014:

    • A 0.5% update in the conversion factor for providers, making the 2014 conversion factor for these 3 months $35.8228
    • An extension of the existing 1.0 geographic practice cost index (GPCI) work floor
    • An extension of the therapy cap exceptions process at $1,920 annually for all outpatient settings
    • An extension of the manual medical review process for therapy services that exceed $3,700 annually for all outpatient settings

    Effective January 1–December 31, 2014:

    • Application of the therapy cap in critical access hospitals for 2014, in the same manner as all other providers of outpatient therapy services
    • To avoid the year 2016 2.0% payment penalty under the PQRS program, a requirement for physical therapists in private practice to report at least 3 individual measures via either claims or registry; or, to receive a 0.5% bonus payment in 2014 as well as avoid the 2016 penalty, a requirement to report 9 measures or, if 9 measures are not applicable, to report the number that apply

    APTA will provide member resources and update its fee schedule calculator in the coming days on its 2014 Changes Webpage. This page includes summaries of the 2014 final rules, a 2014 FAQ on Medicare changes, and summaries of the House and Senate SGR reform proposals being worked on when Congress returns from the holiday recess.

    The Senate is expected to return on January 6 and the House on January 7. Congress will resume negotiations on the proposals and begin discussing how to pay for the cost of the SGR reform legislation.

    APTA will continue to work with members of Congress to ensure the final reform package includes policies that reflect the interests of physical therapists and the patients we serve. Members interested in joining APTA's advocacy efforts to reform SGR and repeal the therapy cap can sign up for PTeam.

    Heart Disease Risk Lowered By Increasing Steps Per Day

    Simply increasing the number of steps taken per day can lower the chances for heart disease among individuals at high risk for type 2 diabetes, according to a study that involved more than 9,300 people in 40 countries.

    In the study, researchers tracked physical activity of participants in a 2002–2004 program for individuals with impaired glucose tolerance and existing cardiovascular disease or at least 1 other cardiovascular risk factor. The researchers tracked steps-per-day for all participants for 1 year and continued to follow up to monitor cardiovascular events for 6 years.

    The study found that when looking at steps-per-day averages over the study period, every 2,000-step increment reduced risk of heart disease by 10%. Additionally, researchers noted, risk fell an additional 8% for every 2,000 additional steps per day achieved by participants who increased their activity from baseline averages. The findings are reported in the December 20, 2013, edition of The Lancet(abstract only available for free).

    Researchers also wrote that the positive effects could be observed regardless of body weight or starting level of activity.

    APTA offers multiple resources for physical therapists interested in learning more about the role of physical therapy in the treatment of diabetes. Continuing education offerings include an introduction to type 2 diabetes and a discussion of physical therapy's perspective on prevention and management. The association also offers a pocket guide to physical fitness and type 2 diabetes (.pdf).

    CMS to Propose New Rule on Emergency Preparedness

    The Centers for Medicare and Medicaid Services (CMS) has found significant gaps in emergency preparedness among its providers, and is proposing regulations that would require providers and suppliers to meet planning, training, and communication standards.

    "We believe that currently, in the event of a disaster, health care providers and suppliers across the nation would not have the necessary emergency planning and preparations in place to adequately protect the health and safety of patients," CMS states in the proposed rule. "Thus, we are proposing these emergency preparedness requirements to establish a comprehensive, consistent, flexible, and dynamic regulatory approach" to the issue of emergency preparedness.

    Though the 453-page document (.pdf) includes provisions that vary depending on the type of provider or supplier, the rules are built around 4 basic standards: risk assessment and planning, development of policies and procedures, establishment of a communication plan, and ongoing training and testing of staff.

    CMS writes that the concerns about preparedness were brought to light after the 9/11 attacks, with further weaknesses exposed during hurricane Katrina, tornado events in Missouri and Oklahoma, and the H1N1 pandemic in 2009. "We concluded that current emergency preparedness requirements are not comprehensive enough to address the complexities of actual emergencies," the rules state.

    The proposed rule will be published in the Federal Register on December 27. Public comments will be accepted for 60 days afterwards.

    APTA offers several resources at its disaster preparedness webpage as well as at its webpage focused on physical therapy in the emergency department.