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  • Super Committee Fails; APTA Advocacy Efforts Turn to Year-End Medicare Package to Address SGR, Therapy Cap

    With the failure of the Super Committee to produce a deficit reduction package, sequestration will trigger cuts across all federal departments, including Medicare and other health programs, in January 2013. While congressional authorizing language protects Medicaid from cuts, 2% in savings will come from reductions in provider payments under Medicare. 

    APTA viewed a Super Committee package as a possible vehicle for resolution to the therapy caps. In the absence of a package, the association's efforts now turn to the more traditional method of extending the therapy cap exceptions process. APTA anticipates that the congressional health writing committees now will begin to craft a year-end Medicare package that will address both the expiring sustainable growth rate (SGR) and Medicare extenders provisions, including the therapy cap exceptions process. 

    Given a large portfolio of unfinished congressional business, it is imperative for APTA members to advocate for an exceptions process extension prior to the December 31 deadline. APTA will soon call on its grassroots network to help lead the way in this effort. If you're not a member of PTeam, sign up today to receive action alerts on this and other federal legislative issues. PTeam members also receive a quarterly newsletter on legislative activity on Capitol Hill.

    In the coming months, APTA also will monitor efforts to prevent sequestration from being implemented in 2013. In the wake of the Super Committee announcement, calls for congressional action to prevent sequestration from occurring have been heard on Capitol Hill. APTA will continue to analyze these proposals and advocate for the profession as this process moves forward.

    CMS Toolkit Aims to Increase Health Literacy

    A health literacy resource from the Centers for Medicare and Medicaid Services (CMS) provides a detailed and comprehensive set of tools to help health care providers write material that is easy to read, understand, and use. The 11-part toolkit is focused on creating written material intended for use by people eligible for or enrolled in Medicare, Medicaid, or the Children's Health Insurance Program—and by people who serve or assist them, such as family members and friends, outreach workers, agency staff, community organizations, and caregivers.  

    DJO Global Inc Joins Foundation's Partner in Research Program

    DJO Global Inc recently joined the Foundation for Physical Therapy's Partner in Research program as a Platinum Level Partner, with a donation of $25,000. The Partners in Research program recognizes corporate donors and sponsorships that support the Foundation's mission to provide doctoral scholarships, fellowships, and research grants to emerging physical therapist researchers.

    Dale Hammer, PT, MA, MHSA, senior vice president of global compliance and government relations at DJO Global announced the gift at a Foundation research luncheon held during the Private Practice Section's Annual Conference in Seattle earlier this month.

    New Podcast: Using APTA's Medical Necessity Definition

    A new podcast discusses how and why APTA adopted a position on medically necessary physical therapy services and provides physical therapists with a framework for using the definition to demonstrate and evaluate the value of physical therapy services.

    APTA's position is modeled after Model Contractual Language for Medical Necessity, developed by the Center for Health Policy at Stanford University. The key pillars of the concept presented in this model and discussed in detail in the podcast are authority, purpose, scope, evidence, and value.

    More Firefighters Injured During Exercise Than On the Job

    Firefighters are more likely to be injured while exercising than while putting out fires, according to an article published online in Injury Prevention. But carrying patients is the task most likely to cause injuries that require time off from work.

    Researchers looked at data for injuries sustained while at work for 21 fire stations serving the metropolitan area of Tucson, Arizona, between 2004 and 2009. The 650 employees included firefighters, paramedics, engineers, inspectors, and battalion chiefs. The average age was 41 years, and all but 5% were men.

    During the study period, the average annual incidence of new injuries was 17.7 per 100 employees, most of whom were in their 30s and 40s.

    Injuries sustained while exercising accounted for a third of the total, despite the fact that exercising is designed to keep employees in good physical condition, in a bid to stave off the risk of injury while doing their job.

    A further 1 in 6 injuries (17%) were caused while transporting patients, and just over 1 in 10 were sustained during simulated training drills. Sprains and strains were the most common type of injury (between 40% and 85%), followed by cuts and bruising. Most (95%) of the injuries were minor in nature.

    Only 1 in 10 injuries occurred during firefighting, but a greater proportion of these were more serious. But almost half of time off work for injuries was caused by strains and sprains sustained while transporting patients.

    Critics Condemn Free-Standing Emergency Departments

    A new trend in health care—the free-standing emergency department (ED)—is drawing criticism from lawmakers and advocates of affordable health care in Washington state who call the facilities "cash cows for hospitals," says an article in The Seattle Times

    Hospitals throughout the Puget Sound region are building "spiffy new free-standing emergency rooms and entire hospital towers with expanded ERs, and drastically remodeling existing ones." In addition, the hospitals are aggressively marketing their EDs, promoting amenities from valet service to private rooms.

    Hospital-industry leaders say that building new EDs will save money by enabling better, more efficient care. Virginia Mason Medical Center's chief executive, Gary Kaplan, MD, argues that good design saves money by saving staff time, reducing the chance of errors, and allowing a faster, more complete patient workup, the article says. Virginia Mason recently opened an $8 million ED in a new pavilion in Seattle.

    Arguments by hospital leaders haven't won over critics concerned about health costs for the state's government and businesses. According to health economists, health care isn't like other commodities in which increasing supply drives down prices. 

    Efforts to regulate hospital building and ED expansion haven't worked. The state, through its Certificate of Need program, lost in its attempt to block Swedish Medical Center's Issaquah expansion, and it has no power to curtail free-standing EDs. A bid by Medicaid officials to cut nonemergency ED costs was derailed after physicians and hospitals sued. Bills by lawmakers targeting hospital expansion and accountability didn't pass last session, says the Times.

    New in the Literature: Resistance Training (Arch Phys Med Rehabil. 2011; 92:1527-1533.)

    Results of a study that compared the effectiveness of 2 different volumes of resistance training (RT) combined with aerobic training in residential cardiac rehabilitation (CR) show that nearly doubling the volume of RT as part of a residential CR program does not yield further improvement in strength and cardiovascular risk factors.   

    This randomized prospective cohort study, conducted at a center for inpatient CR, included 295 patients aged 62.7±11.7 (mean ± SD). Patients were randomly divided into 2 groups (group 1 and group 2) with different volumes of RT; 2 sets × 12 repetitions (group 1) and 3 sets × 15 repetitions (group 2) per session, 2 times per week. Each RT session consisted of 10 different resistance exercises. In addition, patients completed continuous moderate intensity aerobic training composed of cycle ergometry 6 times per week for 17±4 minutes and walking 5 times per week for 45 minutes.

    At entry and after 26±4 days of CR, blood pressure, heart rate, maximal oxygen consumption, maximal power determined during cycle ergometry, strength determined via RT, and blood biochemistries were assessed. Data were analyzed via a 2-way (group × time) repeated measures analysis of variance.

    Statistical analysis revealed equivalent improvements in exercise capacity, muscular strength, hemodynamics, and blood chemistries regardless of RT volume.

    This article is available in the October issue of Archives of Physical Medicine and Rehabilitation.  

    Call for Applications: USBJI Young Investigators

    The United States Bone and Joint Initiative (USBJI) offers grant mentoring workshops that enable early-career basic and clinical investigators to work with experienced researchers in musculoskeletal research to assist them in securing funding and other skills required for pursuing an academic career.

    This program is open to promising junior faculty, senior fellows, or postdoctoral researchers nominated by their department or division chairs. It also is open to senior fellows or residents who are doing research and have a faculty appointment in place or confirmed. Basic and clinical investigators, without or with training awards (including K awards), are invited to apply. Investigators selected to take part in the program attend 2 workshops, 12-18 months apart, and work with faculty between workshops to develop their grant applications. The unique aspect of this program is the opportunity for attendees to maintain a relationship with a mentor until their application is funded. 

    The deadline to apply for the April 13-15, 2012, workshop in Toronto, Ontario, is January 15, 2012.

    Tavenner Nominated to Top CMS Post

    Last week, President Obama nominated Marilyn B. Tavenner to succeed Don Berwick, MD, who will step down as the administrator of the Centers for Medicare and Medicaid Services (CMS) at the end of this week.   

    Obama nominated Berwick in April 2010, but he never received a Senate confirmation hearing. His temporary appointment was to expire at the end of the year. 

    Tavenner, a nurse and former secretary of Virginia’s Department of Health and Human Resources who served as Berwick's principal deputy, is described as "more of a manager and less of a visionary" than Berwick, says an article in the New York Times. She has worked nearly 35 years in the health care profession, including almost 20 years in nursing, 3 years as a hospital CEO, and 10 years in various senior executive-level positions for Hospital Corporation of America. She served on the boards of the American Hospital Association and the Virginia Hospital Association. 

    CMS Delays Enforcement of Version 5010 for 3 Months

    The Centers for Medicare and Medicaid Services (CMS) has delayed enforcement of Version 5010 transaction standards used for electronic health care claims for 90 days. January 1, 2012, remains the official deadline to adopt Version 5010. However, CMS will wait until March 31, 2012, to begin enforcing the new standards.

    Implementation of Version 5010 is a prerequisite for using the updated ICD-10 CM diagnosis and ICD-10-PCS inpatient procedure code set in electronic health care transactions effective October 1, 2013. CMS' Office of E-Health Standards and Services (OESS) encourages all covered entities to work to become compliant with the new standards and to determine their readiness to accept the new standards as of January 1, 2012. While enforcement action will not be taken, OESS will accept complaints associated with compliance with Version 5010 transaction standards during the 90-day period beginning January 1, 2012. If requested by OESS, covered entities that are the subject of complaints must produce evidence of either compliance or a good faith effort to become compliant with the new standards during the 90-day period. 

    OESS is delaying the enforcement period based on industry feedback revealing that, with only about 45 days remaining before the January 1, 2012, compliance date, the number of submitters, the volume of transactions, and other testing data used as indicators of the industry’s readiness to comply with the new standards have been low across some industry sectors. OESS also has received reports that many covered entities are still awaiting software upgrades. 

    To help providers prepare for implementation of Version 5010 and ICD 10 code sets, CMS recently  released several new resources, including enforcement FAQs, Version 5010 and ICD-10 transition basics fact sheets, a Version 5010 readiness fact sheet, and a timeline widget.

    Sign up for industry e-mail updates and receive news and information about new resources to help ensure smooth transitions to Version 5010 and ICD-10.

    CMS to Issue CBR on Nerve Conduction Studies December 6

    On December 6 the Centers for Medicare and Medicaid Services (CMS) will release a national provider Comparative Billing Report (CBR) addressing nerve conduction studies.

    CBRs produced by Safeguard Services under contract with CMS contain data-driven tables and graphs with an explanation of findings that compare provider's billing and payment patterns to those of their peers located in their state and across the nation. These reports are not available to anyone except the providers who receive them. To ensure privacy, CMS presents only summary billing information. No patient or case-specific data is included. CBRs are designed to help providers conform with Medicare billing rules and improve the level of care they furnish to their Medicare patients. (View CBR samples at this link.)

    For more information, visit CBR Services' Web site or call the SafeGuard Services' provider help desk, CBR support team at 530/896-7080. 

    New Podcast Highlights Changes in ACO Final Rules, Opportunities for PTs

    Accountable Care Organizations (ACOs) give physical therapists the opportunity to participate in and create innovative interdisciplinary models of care that showcase the benefits of physical therapy—this is 1 of several key points outlined in the third APTA podcast in a special series on ACOs.

    The podcast focuses on the changes between the Medicare Shared Savings Program proposed and final rules, including the streamlining of the quality reporting program from 65 measures around 5 domains to 33 measures around 4 domains. Other changes include assigning patients to ACOs on a prospective process, which allows ACOs to have a better understanding of their patient mix prior to implementing clinical and quality programs to improve care and lower costs, and removing the condition of participation that 50% of the primary care physicians must meet the electronic health record "meaningful use" criteria to participate in an ACO.

    APTA Reauthorized as IACET CEU Provider

    The International Association for Continuing Education and Training (IACET) recently reauthorized APTA's status as an Authorized Provider, a designation that allows the association to offer IACET Continuing Education Units (CEUs), ensures licensing agencies and the physical therapy community of the quality of APTA's products, and serves as a benchmark for CE for the profession. 

    APTA has been an IACET Authorized Provider for 15 years. This is the association's third recognition period, which extends until July 2016 and includes all programs offered or created during that time.

    "APTA is proud of the quality and diversity of educational opportunities available to physical therapists and physical therapist assistants through APTA's Learning Center," said Marilyn Phillips, PT, MS, CAE, APTA's director of professional development. "To date, the Learning Center provides more than 400 different CE offerings in a wide variety of live and online formats. APTA's CE offerings feature current, best-practice content provided by nationally recognized experts. The association's partnership with IACET is a demonstration of APTA's commitment to serving as the benchmark for quality continuing education in physical therapy. IACET recognition based on the ANSI/IACET 2007 Standard is an assurance of quality CE products and processes."

    APTA, 1 of 3 physical therapy related organizations designated as an Authorized Provider, joins nearly 650 organizations around the world that have had their programs vetted by third-party experts in continuing education to ensure the highest possible standards are met. In order to achieve Authorized Provider status, APTA completed a rigorous application process, including a review by an IACET site visitor, and successfully demonstrated adherence to the ANSI/IACET 1-2007 Standard addressing the design, development, administration, and evaluation of its programs. APTA has pledged its continued compliance with the Standard, and is authorized to use the IACET name and Authorized Provider logo on promotional course material. In addition, APTA is linked to IACET's Web site and is recognized as offering the highest quality continuing education and training programs.

    2012 Budget to Focus on Strategic Priorities

    The 2012 budget aims to ensure that APTA's revenue growth is reasonable, its expense structure supports the desired growth in revenue, and the overall budget is financially stable. Initiatives funded in the 2012 budget tied to the association's 8 strategic priorities include APTA's national registry, a regional payment pilot, the health services research pipeline, and various quality proposals. Projects and programs to be funded in 2012 include PTNow (clinician portal), moveforwardpt.com (consumer portal), the development of a maintenance of certification approach to recertification in specialist certification, continued growth in certification (clinical specialists, residency and fellowship programs, clinical instructors), and numerous other ongoing important programs and services.

    A new process was used in crafting APTA's budget. Earlier this year the Board of Directors identified 8 Strategic Priorities from the Strategic Plan and directed staff to create a budget that provided increased resources in order to achieve these Strategic Priorities. 

    APTA's 2012 operating budget has revenue of $39,741,614, expenses of $39,741,614, and zero net revenue.

    Questions regarding the budget can be sent to robbatarla@apta.org.

    Supervised Treadmill Training Superior to Standard Treatment in Patients With PAD, Says AHA

    In patients on standard therapy (home walking plus the medication cilostazol) for peripheral artery disease (PAD), adding a supervised treadmill exercise program improved walking ability significantly better than stenting, according to research presented at the American Heart Association's (AHA) Scientific Sessions 2011.

    The study enrolled 111 patients with PAD, average age 64 years, from 29 centers in the United States. Sixty-one percent were male, and 80% were Caucasian. More than half smoked and nearly one-fourth had diabetes. Investigators randomized patients to home walking plus cilostazol or to the same approach plus 1 of 2 other interventions—supervised treadmill exercise or placement of a stent to reduce narrowing in the iliac artery.

    Six months after study enrollment, patients in the supervised exercise program significantly increased their average treadmill walking time (5.8 minutes), as did those who received stents (3.7 minutes). In contrast, patients who only exercised at home showed little improvement (1.2 minutes).

    Exercise treatment improved leg function and symptoms, but not blood flow to the leg.

    The study was published online yesterday in Circulation. 

    New in the Literature: Treadmill Training (Disabil Rehabil. 2011 Sep 28. [Epub ahead of print])

    Treadmill training with body weight support (TTBWS) and traditional walking training provided significant improvements in relearning walking ability after stroke, suggesting that similar outcomes can be obtained in the 2 modalities by systematic, intensive, and goal-directed training, say authors of an article published online September 28 in Disability and Rehabilitation.   

    Sixty patients referred for multidisciplinary primary rehabilitation were assigned into 1 of 2 intervention groups. One group received 30 sessions of TTBWS plus traditional training, the other received traditional training alone. Daily training was 1 hour. Outcome measures were Functional Ambulation Categories, Functional Independence Measure, shorter transfer and stairs, 10-meter walk test, and 6-minute walk test.

    Substantial improvements in walking and transfer were shown within both groups after 5 and 11 weeks of intervention. Overall, no statistical significant differences were found between the groups, but 12 of 17 physical measures tended to show improvements in favor of the treadmill approach.

    CMS Revises Outpatient Rehab Documentation Requirements Fact Sheet

    The Outpatient Rehabilitation Services: Complying With Documentation Requirements fact sheet describes common Comprehensive Error Rate Testing (CERT) Program errors related to outpatient rehabilitation therapy services and provides information on the documentation needed to support a claim submitted to Medicare for outpatient rehabilitation therapy services. Available from the Centers for Medicare and Medicaid Services' (CMS) Medicare Learning Network, the fact sheet also provides tips on how to avoid CERT errors and links to resources that offer detailed descriptions of Medicare requirements for outpatient rehabilitation therapy services.   

    This fact sheet and other documentation guidelines are posted on APTA's Documentation Web page.

    Pennsylvania Concussion Law Includes PTs

    A new law establishing standards for managing concussions and traumatic brain injuries in student athletes specifically includes physical therapists as part of the team of health care providers and officials who are designated to remove students from participation in an activity when a concussion is suspected.

    Publicly signed November 14 at the Lower Dauphin High School in Hummelstown, Pennsylvania, by Gov Tom Corbett, SB 200 also requires that students be evaluated and cleared for participation in writing by an appropriate health care provider trained in the evaluation and management of concussions and other brain injuries. A physical therapist designated by a physician also will be part of the health care team that makes this determination.

    More information on SB 200 is available in APTA's press release.

    CMS to Hold MDS National Conference for Long-term Care Industry

    Registration for the Centers for Medicare and Medicaid Services' (CMS) 2012 MDS National Conference now is open to all long-term care providers, provider associations, consultants, vendors, and organizations involved in the nation's nursing home facilities. The goal of this 2-day conference, which will be held March 6-7, 2012, and repeated on March 8-9, 2012, at the Hyatt Regency St Louis at the Arch in St Louis, is to address MDS 3.0 changes implemented in October 2011, MDS 3.0 changes for April 2012 (planned/unplanned discharge assessments), care area assessments and the care planning process, discharge planning as related to Section Q, and therapy assessment changes.

    Conference registration closes December 30. A block of hotel rooms at the government rate has been arranged for conference participants. Instructions for reserving a room within this block will be provided to confirmed participants.

    Visit the CMS MDS 3.0 Training Conference Information Web page for additional information.

    Comprehensive Summary Details Final HH PPS Rule

    APTA has prepared a comprehensive summary of the 2012 Home Health Prospective Payment System (HH PPS) final rule issued October 31, which decreases Medicare payments to home health agencies (HHAs) approximately 2.31% for calendar year 2012. The summary explains in detail the various provisions that result in payment decreases, case-mix revisions to case-mix weights, revisions to technical definitions, and a change to Medicare's face-to-face encounter requirement. In addition, the summary includes tables that illustrate the case mix adjustments and updated 60-day episode payment amount for both quality-reporting and non-reporting HHAs.

    APTA Fellow and Former Board Member Dies

    Dorothy R. Hewitt, PT, FAPTA, 93, who served as APTA's director of education in the 1950s and then as vice president of the Board of Directors (1958-1961), died November 9.

    Hewitt served in the US Army for 4 years during World War II as a physical therapist with the rank of First Lieutenant. Although recognized as a clinician first, she taught in several universities. She worked in private practice in Palo Alto, California, for 20 years before moving to Syracuse University where she was chair of the academic program in physical therapy until her retirement. 

    A memorial service will be held November 19 at 1:00 pm in the Maryfield Chapel, 1315 Greensboro Road, High Point, North Carolina, 27260. In lieu of flowers, donations may be made to Hospice of the Piedmont, 1801 Westchester Drive, High Point, North Carolina, 27262.

    More Oversight Needed on Health IT, Says IOM

    A new report from the Institute of Medicine (IOM) calls for the US Department of Health and Human Services (HHS) to publish a plan within 12 months to minimize patient safety risks associated with health information technology (IT) and report annually on the progress being made.

    IOM's report examines a broad range of health IT, including electronic health records, secure patient portals, and health information exchanges, but not software for medical devices. However, if HHS' secretary determines that progress toward improving safety is insufficient within a year, the US Food and Drug Administration (FDA) should exercise its authority to regulate these technologies. Concurrently, FDA should begin planning the framework needed for potential regulation so that the agency is ready to act if necessary, the report says.  

    HHS should establish a mechanism for both technology vendors and users to report health IT-related deaths, injuries, or unsafe conditions. Reporting events related to patient safety should be mandatory for vendors and voluntary, confidential, and nonpunitive for health care providers. In addition, IOM says Congress should establish an independent federal entity to investigate patient deaths, injuries, or potential unsafe conditions associated with health IT.

    The report also recommends that HHS fund a new Health IT Safety Council to evaluate criteria and develop methods for assessing and monitoring safety and measuring the impacts of health IT on safety. In addition, HHS should establish quality management principles and risk management processes in designing and implementing health IT products. The report adds that alerts in technology systems should be designed to have lower false-alarm rates, and computer interfaces need to be more intuitive for users.

    High Court to Hear Challenge to Individual Mandate

    The Supreme Court this morning agreed to hear appeals from the United States Court of Appeals for the 11th Circuit, in Atlanta, the first appellate review to find the individual mandate provision required in the 2010 health care reform law unconstitutional, says an article in the New York Times. The decision, issued in August from a divided 2-judge panel, said the mandate "overstepped congressional authority and could not be justified by the constitutional power to regulate commerce or to lay and collect taxes."

    If the high court finds the mandate unconstitutional, the justices also will decide how much of the Affordable Care Act "must fall along with it."

    Today's announcement sets the stage for oral arguments to begin by March 2012 and a decision to be issued in late June 2012, in the midst of the presidential campaign, the Times says. 

    CMS Posts List of Providers Requested to Revalidate Medicare Enrollment Information

    In response to provider requests, the Centers for Medicare and Medicaid Services (CMS) has posted a listing of providers who have been sent a request to revalidate their Medicare enrollment information. The listing contains the name and national provider identifier (NPI) of each provider sent a letter, and the date the letter was sent. To see the listing, click on "Revalidation Phase 1 Listing" in the downloads section of the Medicare Provider Supplier Enrollment Revalidation Page. (Users must widen each column in the spreadsheet to view the contents.) CMS will be updating this list monthly.

    Providers who are listed but have not received the request should contact their Medicare contractor.

    For more information on revalidation of Medicare provider enrollment, see the MLN  Matters article Further Details on the Revalidation of Provider Enrollment Information, revised on November 1.

    Guide Outlines Strategies to Improve Care for LGBT Community

    Admission, registration, and all other patient forms should provide options that are inclusive of lesbian, gay, bisexual, and transgender (LGBT) patients, says a new field guide from the Joint Commission that urges US hospitals to create a more welcoming, safe, and inclusive environment that contributes to improved health care quality for LGBT patients and their families. 

    Advancing Effective Communication, Cultural Competence, and Patient- and Family Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community features a compilation of strategies, practice examples, resources, and testimonials designed to help hospitals in their efforts to improve communication and provide more patient-centered care to their LGBT patients. According to the guide, using neutral and inclusive language when talking with patients will pave the way for more effective patient-provider communication and can make patients more comfortable with disclosing information relevant to their care. For example, health care providers should be aware of language or questions that assume heterosexuality, such as asking if the patient is married or making references to husbands or wives. 

    IDF: 183 Million People Unaware They Have Diabetes

    If no urgent action is taken, the number of people living with diabetes is expected to rise from 366 million in 2011 to 552 million by 2030, says the International Diabetes Federation's (IDF) 5th edition of the Diabetes Atlas released today on World Diabetes Day 2011. This equates to approximately 2 new cases every 10 seconds or almost 10 million per year. IDF also estimates that as many as 183 million people are unaware that they have diabetes.

    In some of the poorest regions in the world such as Africa, where infectious diseases have traditionally been the focus of health care systems, diabetes cases are expected to increase by 90% by 2030. At least 78% of people in Africa are undiagnosed and do not know they are living with diabetes. 

    Other figures released today show:

    • 80% of people with diabetes live in low and middle income countries.
    • 78,000 children develop type 1 diabetes every year
    • the greatest number of people with diabetes are between 40-59 years of age

    In the North America and Caribbean region in 2011, an estimated 37.7 million people live with diabetes and this is expected to increase by more than a third by 2030. IDF also estimates that 11.9 million people are living with diabetes in the region but are yet to be diagnosed.

    The release of these figures follow the September meeting of 193 heads of state and government at the United Nation's meeting in New York to agree on a political declaration on non-communicable diseases, including diabetes. 

    New in the Literature: Low Back Pain (Lancet. 2011;378:1560-1571.)

    Authors of a study that compared the clinical effectiveness and cost effectiveness of stratified primary care (intervention) with non-stratified current best practice (control) report that a stratified approach, by use of prognostic screening with matched pathways, will have important implications for the future management of back pain in primary care.

    For this study, 1,573 adults (aged ≥18 years) with back pain (with or without radiculopathy) consultations at 10 general practices in England responded to invitations to attend an assessment clinic. The 851 eligible participants were randomly assigned to the intervention group (n=568) and control group (n=283) by use of computer-generated stratified blocks with a 2:1 ratio. Participants in both groups were screened using the Keele STarT Back Screening Tool to stratify their prognostic risk. Treatment, including physical therapy, was standardized for the participants in the intervention group and matched according to their risk; whereas the participants in the control group received current best practice including referral for physical therapy. Primary outcome was the effect of treatment on the Roland Morris Disability Questionnaire (RMDQ) score at 12 months. In the economic evaluation, the authors focused on estimating incremental quality-adjusted life years (QALYs) and health-care costs related to back pain. Analysis was by intention to treat. (This study is registered, number ISRCTN37113406).

    Overall, adjusted mean changes in RMDQ scores were significantly higher in the intervention group than in the control group at 4 months (4.7 vs 3.0, between-group difference 1.81 [95% CI 1.06-2.57]) and at 12 months (4.3 vs 3.3, 1.06 [0.25-1.86]), equating to effect sizes of 0.32 (0.19-0.45) and 0.19 (0.04-0.33), respectively. At 12 months, stratified care was associated with a mean increase in generic health benefit (0.039 additional QALYs) and cost savings (£240.01 vs £274.40) compared with the control group.

    "For many years, the potential for targeting treatment has been emphasized as a research priority for back pain," the authors said in a press release. "The results of this trial provide the first evidence that a stratified management approach to target the provision of primary care significantly improves patient outcomes and is associated with substantial economic benefits compared with current best practice."

    This study was published October 29 in Lancet.

    Expectations in ED: Necessary Skills and Experience

    A fourth podcast in a series about the physical therapist's role in the emergency department (ED) features Stephanie Ciccarella, PT, MPT, in a discussion about the expectations and preferred skill set for physical therapists practicing in the ED. Specifically, Ciccarella speaks about the importance of differential diagnosis, clear communication in high-stress situations, and interdisciplinary relationships.

    Access the previous 3 podcasts on the Physical Therapist Practice in the Emergency Department Web page.

    Walmart Sets Sights on Dominating Primary Care, Says Kaiser

    In the same week that Walmart announced it would stop offering health insurance benefits to new part-time employees, the retailer sent out a request for information seeking partners to help it "dramatically ... lower the cost of health care ... by becoming the largest provider of primary health care services in the nation," says a Kaiser Health News article. The request asks firms to spell out their expertise in a wide variety of areas, including managing and monitoring patients with chronic, costly health conditions such as asthma, HIV, arthritis, depression, and sleep apnea.

    In addition to positioning itself to boost store traffic by expanding the number and types of services offered in its in-store medical clinics, analysts say, the move also would capitalize on growing demand for primary care in 2014, when the federal health law fully kicks in and millions more Americans are expected to have government or private health insurance.

    In-store medical clinics "could also be players in another effort in the health law" that encourages collaborations between providers who want to "win financial rewards for streamlining care and lowering costs." Paul Howard, a senior fellow with the Manhattan Institute for Policy Research, told Kaiser that Accountable Care Organizations might contract with in-store medical clinics. 

    While Walmart's efforts to partner with others on health care could help lower costs for some patients and increase access to primary care services, health policy experts also say it raises questions about the possibility of further fragmenting care in the US.  They also question whether patients seen by nurses or physician assistants at in-store clinics will have outcomes equal to those seen by physicians in more traditional practices.

    Partners are to be selected in January, the article says.

    Direct Access Study Featured in Bend Bulletin

    The Bend Bulletin recently highlighted the Health Services Research (HSR) study on direct access that found that patients who self refer to physical therapy had fewer visits and lower costs compared with patients who are referred by physicians. The article features study co-author Janet K. Freburger, PT, PhD, and several PTs who practice in Oregon.

    APTA's Public Relations Department was contacted by the reporter for this article. The association continues to roll out its communications plan on this important study to members, the media, and the public.

    New Resources for PT Managers and Practice Owners

    APTA recently posted 3 new resources for physical therapist (PT) managers to aid them in hiring great employees, understanding which questions are appropriate to ask during an interview and which questions should be avoided, and becoming familiar with the general requirements for employers

    Also new from APTA are definitions and explanations of several key terms and concepts that PT practice owners will likely face when securing office space for a physical therapy practice. 

    Implementing PQRS Into Your Practice

    Beginning in 2015, physical therapists and other health care providers who do not successfully participate in the Physician Quality Reposting System (PQRS) program will be subject to payment penalties. The Centers for Medicare and Medicaid Services finalized the use of the calendar year 2013 as the reporting period to inform the 2015 payment adjustment. Eligible providers, including physical therapists, who do not satisfactorily report data on quality measures for the reporting period between January 1, 2013, and December 31, 2013, will be subject to a 1.5% reduction in their fee schedule amount in 2015.

    APTA is creating new resources for members to assist them in their participation in the PQRS program. A new podcast series on implementing PQRS is available today and reviews PQRS basics, including information on getting started, teaching physical therapists the program, and billing and tracking performance. In addition, on November 16 APTA will host a live audio conference to provide members with an update to changes to the PQRS program for 2012.

    The Medicare PQRS program began in 2007 as a voluntary, incentive-based program for practitioners, such as physical therapists in the private practice setting, as a means to ensure high quality health care services for their beneficiaries. In 2012, and continuing through 2014, providers who successfully participate in the PQRS program will receive a 0 .5% bonus payment.

    Guidelines Emphasize Cardiac Rehab After Heart Attack, Bypass Surgery

    New guidelines developed by the American College of Cardiology Foundation and the American Heart Association emphasize for the first time the importance of participating in a cardiac rehabilitation program after a heart attack or bypass surgery, and of diagnosing and treating depression in heart disease patients.

    The guidelines recommend that patients with coronary heart disease and other vascular disease such as stroke and peripheral artery disease:

    • stop smoking and avoid exposure to tobacco smoke
    • get at least 30 minutes of exercise 5-7 days a week
    • reduce weight if overweight, obese, or have a large waist
    • get an annual flu shot
    • take low-dose aspirin daily unless a physician prescribes a higher dose or recommends against it because of medical contraindications

    In response to evidence from recent clinical trials, the guidelines make several changes in the recommended use of medications that reduce the tendency for blood clotting (antiplatelet agents/anticoagulants).

    New drugs that may be used instead of clopidogrel in combination with aspirin for patients receiving coronary stents, such as prasugrel or ticagrelor, now are included.

    The importance of adequate dosages for statin therapy (to lower cholesterol) for all patients with known atherosclerotic vascular disease also is emphasized. Low-dose aspirin therapy (75-162 mg) continues to be recommended for patients with known heart disease.

    The writing group deferred modifying recommendations on high blood pressure and high blood cholesterol levels because new guidelines are anticipated to be released in 2012 from panels of the National Heart, Lung and Blood Institute that work specifically on these issues.

    The guidelines are published in Circulation: Journal of the American Heart Association and Journal of the American College of Cardiology. 

    Treat Pediatric Low Back Pain Conservatively, Say Researchers

    Most cases of low back pain in children will get better with conservative management and do not need to be diagnosed with radiographic studies, which exposes them to too much radiation, says a Medscape Medical News article based on study results presented last week at the American Academy of Pediatrics (AAP) 2011 National Conference and Exhibition.

    Denis Drummond, MD, from the Children's Hospital of Philadelphia, Pennsylvania, and his team retrospectively reviewed the records of 2,846 children aged 10 to 19 years who were seen at their institution with low back pain between 2000 and 2008. Most (63%) were female, and the average age was 14 years.

    In 79% of the patients, the cause of their low back pain went undiagnosed. Over 90% had 3 or fewer office visits. Spondylolysis, which was diagnosed in 272 patients, was found by plain radiography in 234 patients, by bone scanning in 34 patients, and by computed tomography (CT) in 4 patients.

    Two-view and 4-view radiography was equally sensitive in diagnosing spondylolysis. The sensitivity of 2-view was 78%, and that of 4-view was 72%.

    The researchers also found that bone scans delivered significantly more radiation than both CT and 2- and 4-view radiography.

    "Our message is try and treat the low back pain conservatively," Drummond told Medscape. "If you want, you can do a 2-view x-ray at the first visit or else put them on physical therapy, and be patient. If they are 50% to 60% improved when you see them in 6 weeks, you're probably on the right track. If the pain is all gone at 3 months, get them ready to go back to sports or usual activities. If there is just as much pain at 6 weeks, go back to the old system of more investigation, but the majority will get better by then."

    RC3-11 Task Force Member Information Posted

    At its June 2011 meeting, the House of Delegates adopted a motion charging APTA's Board of Directors (Board) to review the current model of the physical therapist, physical therapist assistant, and physical therapy aide as the only participants involved in the delivery of physical therapist services and to identify other potential models for delivery of these services. This work is being conducted by a Board-appointed task force. During its July 26 meeting, the Board appointed individuals to serve on this task force by reviewing the skills and expertise needed to fulfill the task force's charge and identifying persons from the volunteer applicant pool with the skills and expertise needed. This task force is now formally named the Health Care Professionals and Personnel Involved in the Delivery of Physical Therapy Task Force. In response to inquiries from members about the experience and background of task force members, biographical information about the 11 task force members now is available. Direct any questions to RC3-11@apta.org.

    Section on Geriatrics Matches Foundation Geriatric Research Fund Donations

    APTA's Section on Geriatrics has authorized up to $50,000 to be matched dollar-for-dollar with donations made toward the Foundation’s Section on Geriatrics Fund through the end of 2011.

    Many grants awarded by the Foundation have been associated with aging-related topics. The section aims to augment the current balance in the Geriatrics Fund, which is designated for research grants. A substantial increase by the end of 2011 will allow for a Geriatric Research Grant to be awarded in 2012.

    NSC Elects 2011-2012 Board and Nominating Committee Members

    New Student Assembly Board of Directors and Nominating Committee members for 2011-2012 were elected during the 2011 National Student Conclave (NSC) in Minneapolis on October 22. All APTA student members who attended NSC had the opportunity to cast their vote for Student Assembly leaders.

    The following students were elected to the Board of Directors: Colleen Sullivan (Arcadia University), president; Nick Gigliotti (College of St Scholastica), vice president; Kenneth Swantek (University of Nebraska Medical Center), treasurer; Leiselle Pilgrim (UMDNJ – Rutgers Camden), secretary; and Samantha Letizio (Simmons College), director.

    Andrew Oliver fromSimmons College was elected student PT delegate. Amanda Rausch from Lake Area Tech was elected student PTA delegate.

    The Nominating Committee chair, elected in 2010, is Ashley Henk from LSU - Shreveport. Danielle Barnes from Howard University is Nominating Committee chair-elect; while Chukwuemeka Nwigwe from UMDNJ – Rutgers Camden was elected a Nominating Committee member. 

    Briefing Draws Attention to Proposed Cuts for Inpatient Rehab Services

    Lee Woodruff, of the Bob Woodruff Foundation, and CNN "Hero" Jordon Thomas shared their experiences with rehabilitation yesterday at a congressional briefing hosted by Sen Tim Johnson (D-SD) and the Coalition to Preserve Rehabilitation (CPR). The personal accounts of injury, healing, and rehabilitation underscored concerns with 3 Medicare proposals pending before the Joint Select Committee on Deficit Reduction, also known as the Super Committee, that would decrease funding for inpatient hospital rehabilitation services and limit access to these services.

    Johnson, who sustained a near fatal brain hemorrhage in 2006, said in a press release, "As someone who has seen the benefits of intensive rehabilitation services firsthand, it is important to make sure people understand the value of rehabilitation and how the federal investment in rehabilitation hospital services is cost-effective in the long term."

    APTA is a member of CPR, a coalition of national consumer, clinician, and member organizations with the goal of preserving access to medical rehabilitation services.

    November 2, 2011 - Wooddruff
    Lee Woodruff, wife of Bob Woodruff, the ABC News correspondent who sustained a traumatic brain injury in 2006 from a roadside bomb while covering a story in Iraq, said, "Behind the statistics and numbers are people and families, and that's who these cuts affect."

    November 2, 2011 - Thomas
    CNN Hero Jordan Thomas, who lost both legs in a scuba diving accident, told attendees that with the help of rehabilitation professionals he didn't ask "if" he could do something, rather he asked "when." 

    PT Named First Female Head Athletic Trainer in Major Sports

    APTA member Sue Falsone, PT, MS, SCS, ATC, on Monday was named the head trainer and physical therapist (PT) for the Los Angeles Dodgers, the first female head athletic trainer in the history of major professional sports, according to a Major League Baseball article.  

    Falsone became the first female PT in the Major Leagues when she was hired by the Dodgers in 2007 and worked in that role through the 2010 season. In addition to her new responsibilities, she will continue with Athletes' Performance (AP) as vice president of performance physical therapy and team sports and spearhead a new partnership between the Dodgers and AP to build a comprehensive physical development program for all levels of the organization.

    "This is special on so many levels," Falsone said of her appointment. "First, just to be entrusted by an organization like the Los Angeles Dodgers is special. Second, it's surprising it took to 2011 for [a woman named as head trainer] to happen. There are so many women on the high school and college levels that are athletic trainers, it was bound to happen, but it's surprising this is the first time."

    New in the Literature: Segmental Volume Changes and Lymphedema (PM&R. 2011 October 4. [Epub ahead of print])

    Serial interval assessment of limb volume segments may be an important clinical tool to detect early-onset lymphedema in patients with breast cancer before total limb volume (TLV) changes, say authors of an article published online October 5 in PM&R. At arm segments 10-20 cm and 20-30 cm, a significant volume increase was noted before the diagnosis of subclinical breast cancer–related lymphedema (BCRL). Segmental volume changes correlated to the TLV change. At segments 20-30 cm, the coefficient of determination was r2 = 0.952, and at 10-20 cm it was r2 = 0.845, suggesting that these segments predicted TLV changes, add the authors.  

    A total of 196 patients were enrolled in this prospective study conducted in a military hospital outpatient breast care center. Subclinical lymphedema developed in 46 of the patients. Limb volume data were available for 45 of the 46 patients from visits before the onset of lymphedema and were used in the analysis. The authors compared this group with an age-matched control group without BCRL from the same cohort (n = 45).

    Women were enrolled and assessed preoperatively. Baseline measures of limb volume were obtained with the use of optoelectronic perometry, and reassessment was conducted at 1, 3, 6, 9, and 12 months postoperatively. BCRL was identified in 46 of 196 women at an average of 6.9 months postoperatively. A retrospective analysis was conducted in which the authors examined volume changes over 4 10-cm segments of the limb at the visits before the onset of BCRL. By using repeated-measures multivariate analysis of variance, the authors compared segmental volumes between groups at preoperative baseline, time of diagnosis of BCRL, and time of follow-up after early intervention. Linear regression analysis was performed to determine the strength of the relationship between total limb volume change with segmental volumes at the time of diagnosis of BCRL.

    APTA Board of Directors member Nicole Stout, PT, MPT, CLT-LANA, led the study, which was coauthored by APTA members Lucinda A Pfalzer, PT, MA, PhD, FACSM, FAPTA, Charles McGarvey, PT, DPT, MS, FAPTA, and Barbara Springer, PT, PhD, OCS, SCS.

    Studies Support Yoga for Chronic Back Pain

    A 12-session, 3-month yoga program led to greater improvements in back function than usual care in patients with chronic low back pain, says a Medscape Medical News article based on a study published November 1 in Annuals of Internal Medicine. However, yoga did not yield greater reductions in pain or improvements in overall health compared with usual care. 

    The study involved 313 adults with chronic or recurrent low back pain. All of them received a back pain education booklet and usual care. In addition, 156 were offered Iyengar yoga classes (12 classes total, once weekly). The yoga classes were given by 12 yoga teachers who had extra training in back care. Each class lasted 75 minutes.

    Sixty percent of patients in the yoga group attended at least 3 of the first 6 sessions and at least 3 other sessions. In the first 3 months, 82% said they practiced yoga at home on their own, 65% were practicing yoga at home at 6 months, and 60% were practicing yoga at home at 12 months. At baseline, yoga and usual care group participants had mean Roland-Morris Disability Questionnaire (RMDQ) scores of 7.84 and 7.75, respectively. The researchers report that the yoga group had better back function at 3 months (the primary outcome) and at 6 and 12 months (secondary outcomes) than the usual care group, says Medscape.

    The yoga and the usual care groups had similar back pain and general health scores at 3, 6, and 12 months, and the yoga group had higher scores on the Pain Self-Efficacy Questionnaire at 3 and 6 months, but not at 12 months.

    The study notes that data were missing for the primary outcome for 21 yoga participants and 18 usual care participants, and differential missing data were observed (more so in the yoga group) for secondary outcomes.

    Additional support for yoga in chronic back pain comes from a study published online October 24 in the Archives of Internal Medicine. As reported by  Medscape, the study found that stretching, regardless of whether it is achieved via yoga classes or conventional stretching exercises, has moderate benefits in adults with moderately impairing chronic low back pain.

    In this comparative effectiveness study, the researchers found that yoga classes were more effective than a self-help book, but not more effective than stretching classes, in improving function and reducing symptoms resulting from chronic low back pain, with benefits lasting at least several months.

    Highlights of HH PPS Final Rule Posted

    Highlights of the final rule for the home health prospective payment system (HH PPS) for Calendar Year (CY) 2012 are available on APTA's Medicare Payment and Policies for Home Health Web page. The final rule includes a 2.31% (or $430 million) decrease in payment for home health agencies in CY 2012. In addition, the rule also includes structural changes to the HH PPS that affect payments to home health agencies therapy services, the removal of hypertension codes from the case-mix weights, revisions to the publicly reported quality measures, and patient satisfaction surveys.

    CMS Sets Cap at $1,880 in Final Physician Fee Schedule Rule

    The Centers for Medicare and Medicaid Services (CMS) released the final physician fee schedule rule for Calendar Year (CY) 2012, which sets the therapy cap on outpatient services (except outpatient hospital departments) at $1,880 beginning January 1, 2012. The therapy cap exceptions process will expire on December 31, 2011, unless Congress acts to extend it.

    The final rule calls for a 27.4% cut in Medicare payments—less than the 29.5% cut estimated earlier this year—for physicians, physical therapists, and other health care professionals based on the flawed sustainable growth rate formula (SGR). However, if Congress intervenes before the January 1, 2012, effective date, the aggregate impact of work Relative Value Units (RVU), practice expense RVU, and malpractice RVU changes for 2012 on physical therapy services is a positive 4% (noted on Table 84 on page 1176 of the rule). According to CMS, the Obama administration is "committed to fixing the SGR and ensuring these payment cuts do not take effect."

    CMS also will make changes in how it adjusts payment for geographic variation in the cost of practice. The agency is replacing some of the data sources—such as using data from the American Community Survey (ACS) in place of the Department of Housing and Urban Development (HUD) rental data and also using ACS data in place of the data currently used for non-physician employee compensation. CMS also will adjust its payments for the full range of occupations employed in physicians' office and will make other adjustments called for in prior year public comments.  

    The CY 2012 final rule also updates or modifies several physician incentive programs, including the Physician Quality Reporting System.

    APTA will post a detailed summary of the final rule next week.

    This article was updated November 4 to reflect when APTA's summary will be available.  

    Healthy People 2020 Calls for More Adults to Meet Aerobic and Muscle-Strengthening Objectives

    Yesterday, the US Department of Health and Human Services (HHS) presented the leading health indicators (LHI) for Healthy People 2020, which include a call to increase the proportion of adults who meet the federal physical activity guidelines for aerobic physical activity and muscle-strengthening activity.

    Healthy People 2020 provides a comprehensive set of 10-year, national goals and objectives for improving the health of all Americans. The program contains 42 topic areas with nearly 600 objectives that encompass 1,200 measures. LHIs are a small set of Healthy People 2020 objectives that are composed of 26 indicators organized under 12 topics considered high-priority areas for action.

    Other LHIs under the Nutrition, Physical Activity, and Obesity topic area include reducing the proportion of adults and children/adolescents (aged 2-19 years) who are obese from 34.0% to 30.6% and 16.2% to 14.6%, respectively.   

    To help increase access to health care services, Healthy People 2020 recommends increasing the number of people with medical insurance from 83.2% to 100% and increasing the percentage of people with a usual primary care provider from 76.3% to 83.9%.   

    One LHI has been identified under the diabetes objectives: to reduce the proportion of the population with diabetes with an A1c value greater than 9%.  

    APTA is a member of the Healthy People Consortium—an alliance of more than 350 national membership organizations. The association submitted comments to HHS on the Healthy People 2020 draft objectives.  

    CMS Develops New Change of Therapy, End of Therapy OMRA

    The Centers for Medicare and Medicaid Services (CMS) recently developed a new Change of Therapy (COT) Other Medicare Required Assessment (OMRA) for the skilled nursing facility (SNF) prospective payment system (PPS) and a mechanism to allow providers to report a Resumption of Therapy on an End of Therapy (EOT) OMRA. In addition, several new Assessment Indicators (AIs) were created to identify that a COT OMRA was completed and also to distinguish between cases where an EOT OMRA is performed with the resumption items completed and cases where an EOT OMRA is completed without the resumption items completed. The new AIs were introduced in chapter 6, section 6.4, of the new Minimum Data Set (MDS) manual

    As a result of these new AIs, CMS must add approximately 1,500 new Health Insurance Prospective Payment System (HIPPS) codes to the Fiscal Intermediary Shared System. The HIPPS master list will be updated within the next 2 weeks with these new codes.

    SNF and swing bed providers should continue to use HIPPS codes assigned by grouper on their claims. 

    November PTJ Themes: Measurement and Physical Therapy at Societal Level

    Questions about tests and use of test data in clinical decision making arise from a reading of 2 research reports and 1 technical report in this month's Physical Therapy (PTJ), as described by PTJ Editor in Chief Rebecca Craik, PT, PhD, FAPTA, in the  November Craikcast. Also in her monthly podcast wrap-up, Craik discusses the perspective pieces and a second theme—the role that physical therapists play in society at large. In addition, she provides her insights on the 42nd Mary McMillan Lecture "Learning: What Matters Most," presented by Gail M. Jensen, PT, PhD, FAPTA, and APTA's 2011 Presidential Address " Extraordinary in the Ordinary," delivered by R. Scott Ward, PT, PhD, at PT 2011 in National Harbor, Baltimore.   

    Insurers Look to Mergers to Further Growth Strategies

    Market saturation and margin-squeezing health care reform have prompted large managed health care companies such as Aetna, Cigna, and Humana to snap up smaller players to keep earnings growth alive, says a Wall St Journal (WSJ) article.  

    Last week, Cigna said it would buy HealthSpring for $3.8 billion, "giving it a foothold in the senior-citizen and Medicare markets." Cigna expects the deal, which boosted HealthSpring's share price by 33%, will increase its earnings per share in the first year.

    Also last week, Amerigroup, a large Medicaid insurer, said it would pay $85 million to acquire Health Plus' 320,000 members, WSJ reports. Some investors think smaller companies such as Coventry Health Care and Health Net could soon become targets, along with Medicaid specialists such as Centene, Molina Healthcare, and even Amerigroup.

    "We're on the verge of a massive amount of M&A [mergers and acquisitions]," Jim Lane, a money manager, told WSJ. "There's no organic growth left in this business except for pricing."

    Membership in managed-care plans offered through employers has fallen 5.4% from its 2000 peak, to 169.7 million people in 2009, the most recent year for which data exist.

    The biggest unknown for the industry is health care reform. If the Supreme Court overturns the health care law, managed-care stocks would get a boost, says the article. But if the law stands, it will favor more consolidation.

    CMS Issues Final Rule for 2012 Medicare HH Payment

    Payments to home health agencies (HHAs) are estimated to decrease by approximately 2.31% or $430 million in Calendar Year (CY) 2012, the net effect of a 1.4% payment update, the wage index update, and the case-mix coding adjustment, according to a final rule issued yesterday by the Centers for Medicare & Medicaid Services (CMS) that updates the home health prospective payment system (HH PPS) rates effective January 1, 2012.  

    The Affordable Care Act applies a 1% point reduction to the CY 2012 home health market basket amount. As the CY 2012 market basket is equal to 2.4%, the payment update for HHAs in CY 2012 will be 1.4%.

    CMS also reduced HH PPS rates in CY 2012 to account for additional growth in aggregate case-mix that is unrelated to changes in patients' health status. CMS has finalized a 3.79% reduction to the home health PPS rates for CY 2012 and an additional 1.32% reduction for CY 2013.

    This rule also finalizes structural changes to the HH PPS by removing 2 hypertension codes from the case-mix system, lowering payments for high therapy episodes, and recalibrating the HH PPS case-mix weights to ensure that these changes result in the same amount of total aggregate payments. These changes are intended to increase payment accuracy and reduce the growth in aggregate case-mix that is unrelated to changes in patients’ health status.

    Under current Medicare policy, a certifying physician or an allowed non-physician practitioner must see a patient prior to certifying a patient as eligible for the home health benefit. The rule also finalizes added flexibility to allow physicians who cared for the patient in an acute or post-acute facility to inform the certifying physician of their encounters with the patient in order to satisfy the requirement.

    Additionally, the rule describes planned improvements to the home health publicly reported quality measures.

    Look for APTA's highlights document on the rule tomorrow.   

    This article was updated at 4:16 pm to reflect when APTA's highlights document will be available.