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  • IMPACT Act Standardizing Postacute Care Data Signed Into Law

    Legislation that would standardize data used across postacute care (PAC) settings has been signed into law and will join a larger package of reforms. APTA worked to influence this legislation.

    The Improving Medicare Post-Acute Care Transformation (IMPACT) Act signed by President Barack Obama on Monday directs the US Department of Health and Human Services (HHS) to standardize patient assessment data, quality, and resource use measures for PAC providers including home health agencies (HHAs), skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and long-term care hospitals (LTCHs).

    The House and Senate passed the legislation in September.

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

    The new law will:

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

    The Committees that introduced this legislation have provided a summary (pdf) that can be accessed on their website. In the coming months, details of the legislation will be developed through the implementation process. APTA will be engaged with regulators throughout this process and will continue to provide updates to APTA membership about the application of this law.

    Acupuncture No Better Than Sham for Chronic Knee Pain in Adults 50+

    Regardless of whether it's delivered traditionally or through a more high-tech laser version, acupuncture doesn't appear to have any benefit over sham procedures when it comes to reducing moderate-to-severe knee pain in adults 50 and over, according to a new study in the October 1 issue of the Journal of the American Medical Association (JAMA) (abstract only available for free).

    Researchers in Australia studied treatments of 282 patients who were 50 or older and had been experiencing moderate to severe knee pain on most days for a period of time longer than 3 months. The patients were divided into 4 groups: a needle acupuncture group, a laser acupuncture group, a sham laser acupuncture group, and a control group. Acupuncture treatments were conducted 1 to 2 times weekly for 12 weeks. Both acupuncturists and patients did not know if they were involved in the sham or actual laser treatment, but there was no sham treatment used in the needle-based acupuncture group.

    When the researchers compared self-reported knee pain and function at baseline, 12 weeks, and after 1 year, they found "no significant differences in primary outcomes between active and sham acupuncture at 12 weeks … or 1 year."

    "Although needle and laser acupuncture improved pain after treatment compared with control, improvements were not sustained at 1 year and were of clinically unimportant magnitude," authors write. "Improvement in … physical function with needle acupuncture relative to control at 12 weeks was of a clinically irrelevant magnitude and did not persist at 1 year. Furthermore, this improvement was not different from sham laser."

    "Among patients older than 50 years with moderate to severe chronic knee pain, neither laser nor needle acupuncture conferred benefit over sham for pain or function," they conclude. "Our findings do not support acupuncture for these patients."

    Although researchers acknowledged that the study size suffered due to the numbers of patients declining treatment during the course of the study (ranging from 13% o 19%), they argue that the design of the study—patients didn't know they would be participating in an acupuncture study until after recruited to reduce drawing participants with positive attitudes about the intervention—strengthens the findings.

    Still, they write, the findings "likely only apply to patients with clinically diagnosed osteoarthritis and moderate or severe pain … and may not be generalizable to end-stage radiographic disease."

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

    White House Summit, Forum Focus on Health and Fitness for Americans With Disabilities

    A White House summit and research forum on improving health and fitness for people with disabilities included presentations from 2 leaders in physical therapy, and brought more attention to a national disability inclusion program that the APTA Student Assembly helped to promote.

    The 2-day program began with a White House summit on Monday, October 6, followed by a series of presentations from researchers the next day. The event was aimed at shining a spotlight on the "I Can Do It, You Can Do It" (ICDI) program, which seeks to improve levels of inclusion in activity, nutrition, and obesity programs in education settings from K-12 to university levels.

    The APTA Student Assembly has spread the word about the ICDI program, and several physical therapy education programs have become ICDI "Advocates," promoting the program's message of inclusion and better education.

    The October 7 research forum focused on looking at research gains and gaps in improving the health and quality of life of children with disabilities. Speakers included Diane Damiano, PT, PhD, chief, Functional & Applied Biomechanics in Rehab Medicine at the National Institutes of Health, and Alan Jette, PT, PhD, FAPTA, director of the Health and Disability Research Institute at Boston University.

    The event was sponsored by the President's Council on Fitness, Sports, and Nutrition, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.