The Centers for Medicare and Medicaid Services (CMS) is proposing that Medicare coverage be expanded to cover cardiac rehabilitation (CR) for patients with chronic heart failure (CHF).
The proposed CMS decision memo issued November 21 outlines the process that the agency took to research outcomes around CR. Counter to its 2009 finding that "there was little evidence in the existing literature that supported CR," the latest review conducted by CMS definitively concludes that "exercise intervention is beneficial and can be safely performed by selected patients with CHF."
APTA submitted comments that supported access to rehabilitation for CHF patients, but advocated that physical therapy be made available outside the CR program and covered under the existing Medicare outpatient therapy benefit. This allowance would ensure that patients with CHF "have access to the most clinically effective rehabilitation services at the appropriate time, in the appropriate setting, and by the most appropriate provider," according to the APTA comments.
CMS is accepting public comments on the proposed decision memo until December 21, 2013. APTA plans to submit additional comments on the proposal.
The standard 2-hour patient repositioning schedule to minimize pressure ulcers could be stretched to 3 or 4 hours with the use of high-density foam mattresses, according to a recent study funded in part by the National Institutes of Health (NIH).
The study as reported in the October 2013 issue of the Journal of the American Geriatrics Society involved 942 consenting residents aged 65 and older at 27 nursing homes in the United States and Canada. All subjects were rated as having moderate to high risk of pressure ulcers based on the Braden Scale.
Subjects were divided into groups that received repositioning every 2, 3, or 4 hours for 3 weeks while lying on high-density foam mattresses. In addition to normal care and prevention measures (heel protector boots, barrier creams, incontinence briefs, etc), participants engaged in their normal activities including standing, bathing, and going to therapy "as usual."
At the end of the study, researchers determined that "there was no difference in [pressure ulcer] incidence over 3 weeks of observations between those turned at 2, 3, or 4-hour intervals," a finding that authors attribute to the use of the newer high-density foam mattresses. Researchers believe that the foam mattresses "effectively redistribute pressure" better than typical spring mattresses.
Management of wounds, including pressure ulcers, is the focus of an APTA online course for physical therapists (PTs). The association's Move Forward patient-focused resources include a PT's guide to pressure ulcers, and PTs interested in evidence-based practice research on the topic can access articles through APTA's PT Now online resource service.
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