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  • CMS Issues Final 2014 Physician Fee Schedule Rule

    The final 2014 Medicare physician fee schedule rule (.pdf) released by the Centers for Medicare and Medicaid Services (CMS) sets the therapy cap amount on outpatient services at $1,920. In addition, the rule announces a 20.1% reduction in Medicare payment rates for physical therapists (PTs), physicians, and other health care professionals—a cut linked to the flawed sustainable growth rate (SGR) formula being discussed in Congress.

    The new rule also updates payment amounts for physical therapists, physicians, and other health care professionals, makes changes to the Physician Quality Reporting System (PQRS), and revises other payment policies.

    The final rule’s 20.1% reduction is to the conversion factor used to determine Medicare payment rates, a reduction generated by the flawed SGR formula. Since 2003, Congress had enacted legislation preventing the reduction every year. The president’s budget calls for averting these cuts and finding a permanent solution to this problem, and Congress is currently working to address an alternative payment method that would include permanent repeal of the SGR. If Congress does stop the 20.1% payment cut, the aggregate payment for outpatient physical therapy services due to changes in practice expense, work, and malpractice relative value units would remain unchanged from 2013.

    Aside from setting the therapy cap at $1,920 for 2014, the rule makes changes to payments to critical access hospitals (CAHs) beginning January 1, 2014. Despite strong objections from APTA and other stakeholders, the rule subjects CAHs to the therapy caps, as well as any potential extension of the therapy cap exceptions processes, in the same manner as other providers of outpatient therapy services. The therapy cap automatic exceptions process and the manual medical review process, applicable to outpatient therapy expenditures exceeding $3,700 per beneficiary, will expire on December 31, 2013, unless Congress acts to extend them. APTA is working aggressively to have Congress address the therapy cap through repeal or extension of the exceptions processes.

    CMS has finalized its proposal, supported by APTA, to require that individuals performing “incident-to” services in the physician’s office must meet any applicable state requirements, including licensure. This would enable the federal government to recover funds paid if services are not furnished in accordance with state law.

    PQRS will see major changes for 2014. Physical therapists, physicians, and other eligible professionals will be able to avoid the 2016 2.0% PQRS penalty by reporting at least 3 individual measures via claims or registry for 50% or more of eligible Medicare patients in the 2014 reporting period. Though opposed by APTA and other stakeholders, CMS will increase the number of PQRS quality measures that providers must report either via claims or registry from 3 to 9 to qualify for the 0.5% bonus payment in 2014. CMS will maintain the current 12-month calendar year reporting period for the PQRS program but will eliminate the option to report on measures groups via claims.

    APTA submitted extensive comments in response to the proposed rule that was issued in July 2013. The final rule with comment period will appear in the December 10 Federal Register. APTA will post a detailed summary of the final rule shortly.

    Congressional discussions on SGR and therapy cap repeal will be taking place soon. Join APTA's grassroots efforts to call for an end to both flawed policies on December 2. Find out how to make your voice heard.

    2014 Outpatient Payment Rule Released by CMS

    The Centers for Medicare and Medicaid Services (CMS) has issued a new rule for the Outpatient Prospective Payment System (OPPS) that will create 29 comprehensive Ambulatory Payment Classifications (APCs) to handle payment for the most costly device-dependent services, require direct supervision for a range of outpatient services in critical access hospitals (CAHs), and increase the payment rates under the OPPS by 1.7 %. The new rule will be effective January 1, 2014; however, CMS will delay implementation and final configuration of the new 29 comprehensive APCs until 2015.

    The comprehensive APCs would treat all individually reported codes as components of a comprehensive service, resulting in a single prospective payment based on the cost of all individually reported codes. CMS will make a single payment for the comprehensive service based on all charges on the claim, and charges for services that cannot be covered separately by Medicare Part B or that are not payable under the OPPS will not be reimbursed. Although physical therapy services are typically paid separately under Medicare Part B, some therapy services would be considered part of the comprehensive service based on several factors. In general, physical therapy services that occur in the perioperative period would be paid under the comprehensive APC payment.

    The new rule also establishes a direct supervision requirement for outpatient therapeutic services in CAHs, a change that CMS believes will ensure quality and safety. Additionally, the rule reiterates the requirement in the physician fee schedule that the therapy cap must be applied to CAHs.

    APTA submitted comments regarding the proposed rule and will continue to monitor the effect that these provisions will have on physical therapy. APTA will post a detailed summary of the final rule shortly.

    Early Mobility, Ongoing Rehabilitation at Center of Media Attention on Post-ICU Care

    Physical therapists (PTs) have long understood that mobility plays a key role in a patient's recovery from the Intensive Care Unit (ICU), but now national-profile articles are bringing this fact to a much wider audience. In recent articles in The Wall Street Journal and The Atlantic, physical therapy is being identified as 1 of several post-ICU treatments that can reduce the risk of long-term cognitive and physical impairment after stays in the ICU.

    WSJ reported on November 25 on the prevalence of post-intensive care syndrome, a condition that includes brain dysfunction, post-traumatic stress symptoms, depression, fatigue, and muscle weakness.

    Researchers quoted for the story pointed to the importance of "hard-core physical and mental rehabilitation" in successful recovery and asserted that "post-ICU patients need the same kinds of occupational and physical therapy as heart attack and stroke survivors."

    A related essay in the November 21 Atlantic by Daniela J. Lamas, MD, touches on the long-term challenges faced by patients treated in ICUs and advocates for treatment approaches that acknowledge that release from the ICU "is not a victory narrative now, but one person's unfinished story."

    The articles echo earlier pieces of reporting that appeared on National Public Radio and other outlets, most of which were sparked by a Vanderbilt University report on post-ICU conditions.

    PTs play a key role in successful treatment of patients in ICUs, recently released from the units, and throughout the post-acute care continuum. APTA offers multiple resources on ICU-related practice, including a video on collaborative care models in the ICU and continuing education on promoting early mobility. The latest evidence-based research, including an article titled "Innovative Mobility Strategies for the Patient With Intensive Care Unit-Acquired Weakness: A Case Report," are available through PTNow, APTA's research access tool.

    Sen Kirk Thankful for Rehabilitation Professionals

    When Time magazine asked Sen Mark Kirk (R-Ill) to share what he was thankful for, he came right to the point. "I am thankful for the more than 300,000 physical and occupational therapists in the U.S.," he wrote, adding that without these professionals "there is no way I could have returned to the U.S. Senate … after I suffered a massive stroke in January 2012."

    The statement from Kirk appeared in the November 25 issue of the magazine, which asked several public figures "to share what they're grateful for." Kirk described how he recovered from the ischemic stroke he suffered less than a year ago thanks to the work of his rehabilitation team, and how his experiences inspired him to introduce a "Stroke Agenda" that seeks legislative changes to enhance stroke research and rehabilitation access. APTA has worked with Sen Kirk to advance these efforts, and supported his introduction of the Rehabilitation Improvement Act (S 1027) targeted at advancing rehabilitation research within the National Institutes of Health (NIH). Sen Tim Johnson (D-NM) introduced the bill with Kirk.

    "Having a stroke shouldn't mean the end of a productive life," Kirk wrote. "Physical and occupational therapists make a major difference in countless Americans' lives, including the life of this U.S. senator."

    Sen Kirk's return to the U.S. Senate was documented in an NBC video, and photos of Kirk in rehabilitation are available at the Huffington Post.

    APTA's Health Care Reform Resources Expanded

    New APTA resources available online are helping members understand health care reform and giving them a way to communicate their experiences in this changed—and changing—landscape.

    The association's efforts to keep physical therapists (PTs) and physical therapist assistants (PTAs) informed are centered at the Health Care Reform webpage, where members can access detailed information on the health insurance marketplaces, Medicaid expansion, new delivery models, payment changes, and program integrity efforts under the Affordable Care Act (ACA). Resources touch on everything from collaborative care models to managing a Medicare claims audit under the new law.

    PTs and PTAs can also get a handle on how some of the components of health care reform affect physical therapy through APTA's Making Sense of Health Care Reform series. This set of articles highlights pressing issues including essential health benefits, "grace period" provisions, and the Small Business Health Options program. Each article provides background and explanation of the issue, implications and tips for practice, and links to more resources.

    In addition to background and context, members can let APTA know how reform is affecting them by way of the APTA Feedback Form, a quick and easy way to share complaints, problems, and questions with association staff—and, when appropriate, with the Centers for Medicare and Medicaid Services (CMS). Feedback provided by PTs and PTAs will help to inform APTA's future advocacy efforts on these issues.

    APTA Monitoring CMS as Fee Schedule Deadline Approaches

    The Center for Medicare and Medicaid Services (CMS) is nearing its November 27 deadline for issuing rules on the 2014 Physician Fee Schedule, and APTA will be posting information on the provisions in the final rule impacting physical therapy as soon as possible after release.

    In October, CMS announced that it would extend its deadline for release of the rules because of the 16-day government shutdown that began earlier that month. The rules will affect Medicare payment rates, payment policies for critical access hospitals, and procedures related to the Physician Quality Reporting System, among other areas.

    APTA staff remains in close contact with CMS and will share information on the basics of the new rules as they are made available. More detailed summaries will be available through APTA in the days after the initial announcement.

    December 2013 Board of Directors Meeting to Be Broadcast Online

    APTA's upcoming Board of Directors meeting will be broadcast online for APTA members, December 5-7.

    All open sessions of the meeting will be livestreamed, and the broadcast archive will remain available until the next Board livestream in February 2014.

    Topics on this meeting's agenda include the strategic plan, 2014 budget, models of physical therapist service delivery, clinical practice guidelines, and a report on the Foundation for Physical Therapy.

    A full agenda of all topics with approximate broadcast times is available to download from the livestream page: www.apta.org/Livestream.

    CMS Says Cardiac Rehab Should Be Covered for CHF

    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.

    Foam Mattresses Could Mean Longer Spans Between Repositioning for Pressure Ulcers

    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.

    CMS Releases Medicare Home Health Final Rule for 2014

    The Centers for Medicare and Medicaid Services (CMS) released the final rule for the Home Health Prospective Payment System for 2014. The rule affects services provided by home health agencies under Medicare Part A beginning January 1, 2014.

    The national standardized 60-day episode payment for 2014 is set at $ 2,869.27, and the national per-visit rate for CY 2014 for physical therapy services is $132.40. CMS projects that Medicare payment to home health agencies in calendar year 2014 will be reduced by $200 million.

    The rule finalizes the following policies:

    • Home health payment rates will see an updated market basket increase of 2.3% that is in turn reduced through home health rebasing.
    • As a result of rebasing, a $80.95 (3.5%) reduction will be applied to the national standardized 60-day episode payment rate each year from 2014 - 2017.
    • Three Low-Utilization Payment Adjustment (LUPA) add-on factors will be used in calculating the LUPA. This affects skilled nursing, physical therapy, and speech-language pathology when that discipline is the first skilled visit in a LUPA episode—either as the only episode or an initial episode among adjacent episodes.
    • A total of 170 ICD-9-CM diagnosis codes will be removed within home health PPS Grouper diagnosis groups.
    • Two claims-based measures will be adopted: Re-hospitalization during the first 30 days of home health and emergency department use without hospital readmission during the first 30 days of home health.
    • Payments to rural home health areas will be increased by 3 percent and applied to the national standardized 60-day episode payment rate.

    The policies in the final rule will become effective January 1, 2014. APTA will provide a full summary of the final rule in the coming days.

    Ask Congress to Add Therapy Cap Repeal to SGR Legislation on December 2

    Legislation that would end the sustainable growth rate (SGR) will soon be discussed in a Senate committee, and grassroots efforts could play a big role in how that discussion takes shape. The Senate Finance Committee will be considering the proposed legislation on December 12, making the next 2 weeks a crucial time for communicating physical therapy's position on both SGR and the therapy cap to lawmakers and the public.

    The advancement of the SGR legislation provides an opportunity for addressing the importance of also ending the therapy cap. APTA is calling on all physical therapists (PTs), physical therapist assistants (PTAs), students, patients/clients, and others to contact their legislators on Monday, December 2, and ask them to include a full repeal of the cap in the SGR legislation.

    APTA recommends 2 ways to get involved in the efforts to fix these flawed policies that harm patients and restrict access to therapy services:

    • E-mail your legislators. APTA members can e-mail their legislators by logging in to the Legislative Action Center, while patients and clients can reach their legislators via the Patient Action Center. Both constituencies can also download the APTA Action app and use the “Take Action” button to contact their members of Congress.
    • Get involved on social media. APTA is encouraging supporters to change their Facebook and Twitter profile pictures to the “Stop the Therapy Cap” logo on December 2 and then share APTA’s Facebook posts or tweet their legislators using prewritten messages provided by APTA. Legislators' Facebook pages and Twitter handles can be easily found through the Congressional Directory button on the APTA Action app. Appropriately-sized images can be downloaded from the therapy cap grassroots campaign webpage.

    For more information about the grassroots campaign on December 2, e-mail advocacy@apta.org.

    Not Much Time Left to Share Your NPTM Activities

    There's still time to share your National Physical Therapy Month celebration and recognition photos and stories with colleagues all over the world, but you'd better hurry: The APTA public relations staff is now making its last call for submissions to its NPTM celebration page.

    The page is a great way to show how physical therapy restores and improves motion in people’s lives. Submissions could include a wide range of activities, including photos of state recognitions of NPTM, or local facility events. E-mail a brief description and at least 1 photo (300 dpi) to the APTA public relations staff.

    Walk Time, Not Intensity, May Be Most Important in Stroke Risk Reduction

    A new study has reaffirmed a link between stroke reduction and walking in older men—but the link has more to do with time spent walking than intensity of the activity.

    In an article published in the November 14 issue ofStroke, British researchers report on data involving 3,357 ambulatory men who took part in a 10-year study related to heart health. The men ranged in age from 60 to 80 and were grouped according to time spent walking, among other factors.

    Researchers found that over the 10-year period, the men who spent more time walking every week (8 to 14 hours) reduced risk of stroke by about 33% over those who spent minimal time walking (0 to 3 hours a week). That finding wasn't surprising in itself, but when researchers compared distance/speed data among time cohorts, they found no significant association between distance and risk reduction. In other words, time spent walking mattered more than pace.

    "Among community-dwelling older men we observed … a strong inverse dose-response association between time spent walking and risk of stroke, independent of walking pace, vigorous physical activity, established, and novel risk factors," authors wrote. "Results suggest that total volume of walking rather than the intensity is important for stroke prevention."

    APTA cites the role of physical activity in stroke reduction in resources aimed at patients, physical therapists, and policymakers. Members can provide their patients with a handout on stroke prevention (.pdf, listed under "Neurology"), and can share information on this topic with others by downloading resources at APTA's Issue Briefs webpage.

    PT Research Center Announces Major Contributions From Chapters, Sections

    The first Center of Excellence (COE) in the United States solely dedicated to research relevant to physical therapist (PT) practice received a major boost this week, when the Foundation for Physical Therapy announced that APTA chapters and sections have contributed more than $1 million to its fundraising campaign.

    In a press release (.pdf) issued November 19, APTA President Paul Rockar, Jr, PT, DPT, MS, is quoted as saying that sections and chapters "have demonstrated their commitment to meeting the complex health care needs of society" through the contributions, which will "help provide the science base for identifying the most effective ways to organize, manage, and finance high-quality care and improve patient safety."

    Foundation President William G. Boissonault, PT, DPT, DHSc, FAPTA, FAAOMPT, thanked the APTA chapters, sections, and individuals for contributions that are helping the research center reach its $3 million goal for 2013. The funding will help both the COE and the foundation itself by allowing for expansion of grants and scholarships, he said.

    The foundation is developing an application process for a $2.5 million, 5-year grant to an institution or health systems network to help develop and manage the COE training program. Contributions to the Foundation for Physical Therapy can be made online or sent to its headquarters at 1111 North Fairfax Street, Alexandria, VA 22314.

    Government Affairs and Public Service Awards Nominations Due January 10, 2014

    Do you know of an APTA member who in 2013 has gone above and beyond to advocate on behalf of the physical therapy profession at the federal level? Is there a legislator, staffer, or public figure who has championed physical therapy causes in 2013? Nominate them for the Federal Government Affairs Leadership Award or the Public Service Award.

    The Federal Government Affairs Leadership Award is presented annually to an active APTA member who has made significant contributions to APTA's federal government affairs efforts and has shown exemplary leadership in furthering the association's objectives in the federal arena.

    The Public Service Award is presented annually to an individual who has demonstrated distinctive support for the physical therapy profession at a national level. Individuals from the following categories are eligible for nomination: members of Congress, congressional staff members, members of a state legislature, federal agency officials, health and legislative association staff, and celebrities or other public figures.

    Recipients will be selected in February by the APTA Board of Directors and the awards will be presented during APTA’s Federal Advocacy Forum to be held April 6-8, 2014, in Washington, DC.

    Nominations must be submitted by Friday, January 10, to Stephanie Sadowski at stephaniesadowski@apta.org or by fax to 703/706-8536. If you have questions, call Stephanie Sadowski at 800/999-2782, ext 3127.

    New Practice Guidelines Address Treatment of Torticollis, Ankle Sprain, Shoulder Mobility

    The latest evidence-based clinical practice guidelines for ankle sprain and instability, adhesive capsulitis, and congenital muscular torticollis (CMT) have been added to PT Now, the APTA member resource for evidence-based practice information.

    The ankle and shoulder guidelines developed by the Orthopaedic Section establish recommendations for screening, diagnosis, examination, and intervention, as well as appropriate outcome measures. The guidelines also seek to provide information for policymakers and payers on the practice of orthopedic physical therapy.

    The Section on Pediatrics took a similar approach to the development of guidelines for treatment of CMT, an idiopathic postural deformity evident shortly after birth. The guidelines are the result of a critical appraisal of literature and expert opinion, and include 16 action statements for screening, examination, intervention, and follow-up. The CMT guidelines also offer resources for classification of severity and flow sheets for referral paths.

    In addition to the clinical practice guidelines, PT Now provides APTA members with free access to a wide variety of evidence-based resources including condition-specific clinical summaries, patient cases, and valuable tests and measures. APTA is supporting the sections in the development of clinical practice evidence-based documents as part of the association's strategic objectives.

    APTA Launches Action App In Time for Final Push to Stop the Therapy Cap

    Members, patients, and supporters of physical therapy can now stay up-to-date on the latest legislative and regulatory news by downloading the free APTA Action app. The smartphone app was designed to help providers and patients stay engaged in APTA’s advocacy efforts and will be a valuable tool in grassroots efforts to end the therapy cap and fix the sustainable growth rate (SGR).

     The APTA Action app allows individuals to:

    • Take action on federal issues impacting the physical therapy profession
    • Look up members of Congress and see if they have cosponsored APTA’s bills
    • Donate to PT-PAC
    • Join PTeam to receive e-mail updates on federal legislative and regulatory news, and action alerts when it is time to contact their members of Congress
    • Review talking points for issues impacting the physical therapy profession
    • Send APTA feedback after a meeting with a legislator, attending a town hall or a fundraiser, or hosting a practice visit
    • Share their advocacy activities with friends and colleagues on Facebook, Twitter, and Tumblr
    • View the congressional schedule and upcoming APTA events
    • View APTA’s Twitter feed and the latest videos from the Public Policy, Practice and Professional Affairs Department

    The app debuts at a crucial time in the efforts to end the therapy cap and fix the SGR. APTA will launch the next grassroots push to stop the therapy cap on December 2, 30 days from the expiration of the exceptions process. Supporters who download the app and join PTeam by December 1 will be able to easily contact legislators on December 2 using the app's "Take Action" button.

    The free app can be downloaded by searching “APTA Action” in the iTunes or Google Play stores. For more information about the APTA Action app and how to get involved in the Stop the Therapy Cap campaign, visit APTA’s grassroots webpage or e-mail advocacy@apta.org.

    APTA wants to see where you use your APTA Action app. Take a photo using the app in fun, creative places and post it on Twitter using the hashtag #PTAdvocacy. Let’s get a photo from every state to show members across the country getting involved.

    Concussion Legislation Reintroduced

    Important concussion legislation supported by APTA has been reintroduced in Congress. Developed with input from the association, the Protecting Student Athletes From Concussions Act (HR 3532) establishes guidelines around prevention, identification, treatment, and management of concussions in school-age children, and acknowledges the role that physical therapists (PTs) have in evaluating and treating these injuries.

    The legislation has been reintroduced by Reps Tim Bishop (D-NY) and George Miller (D-CA), and would require states to implement concussion safety and management plans that include return-to-play requirements and academic supports. Additionally, the bill requires that any student who suffers a concussion be immediately removed from any participation in school sports until he or she receives a written release from a health care professional. Physical therapists (PTs) are explicitly listed as one of the professionals qualified to make these return-to-play decisions. APTA advocated for the legislation when it was initially introduced in 2011 and worked with members of Congress on the recent reintroduction.

    Related work continues around the reintroduction of a similar piece of legislation, the Concussion Treatment and Care Tools Act (ConTACT) (HR 3113/S 1516) introduced by Sen Robert Menendez (D-NJ) and Rep Bill Pascrell (D-NJ). Though not passed into law when it was first introduced, the ConTACT bill helped to establish a workgroup within the Centers for Disease Control and Prevention (CDC) assigned to developing guidelines for mild traumatic brain injury (MTBI). APTA members Anne Mucha, PT, DPT, MS, NCS, and John DeWitt, PT, DPT, SCS, represent the role of PTs on the CDC workgroup.

    The latest iteration of the ConTACT Act bill calls for the establishment of national guidelines drawn from the CDC workgroup recommendations on best practices for diagnosis, treatment, and management of MTBI in school-aged children. The legislation also provides for grants to help states implement these guidelines. APTA will continue to advocate for these pieces of legislation as opportunities arise to support the CDC workgroup recommendations and the role of the PT in concussion management.

    APTA believes that concussion should be managed and evaluated by a multidisciplinary team of licensed health care providers that includes a PT and offers multiple resources. The association has developed policy resources at both state and federal levels, while practice-focused online concussion resources include a series of podcasts, a PT's guide to concussions, and access to evidence-based practice research through the PT Now webpage.

    PT Leader Helen Hislop Dies

    Physical therapy leader, educator, and author Helen Hislop, PT, PhD, FAPTA, has died near her home in High Point, North Carolina. She was 84.

    Chair of the Department of Biokinesiology and Physical Therapy at the University of Southern California (USC) until her retirement in 1998, Hislop was also a widely read author of journal articles and textbooks, including Daniels and Worthingham's Muscle Testing, Techniques of Manual Examination and Performance Testing (co-author). Hislop contributed to APTA in many capacities, serving as editor of Physical Therapy from 1961 to 1968, on the Board of Directors from 1976 to 1982, and playing a leading role in the development of the postprofessional education program. Her work in education and research helped to shape the profession of physical therapy as it exists today.

    Hislop's skills as a critical thinker and writer were recognized in 1991 when APTA established the Helen J. Hislop Award for Outstanding Contributions to Professional Literature. Hislop was herself the recipient of several major honors during her lifetime, including the Golden Pen Award, the Lucy Blair Service Award, and inclusion as a McMillan lecturer. She was named a Catherine Worthingham Fellow in 1983.

    Hislop received her undergraduate education at Central College in Pella, Iowa, and her certificate in physical therapy and master's degree, and doctoral degrees in Physiology from The University of Iowa. She contributed an oral history that is available for loan from the APTA library.

    Look for a full tribute to Hislop in an upcoming issue of Physical Therapy.

    Patient-Focused Urinary Incontinence Resources Now Available From AHRQ

    In its third-ever online "decision aid" tool, the federal Agency for Healthcare Research and Quality (AHRQ) is focusing on women's urinary incontinence (UI), with information on the effectiveness of nonsurgical approaches to treatment.

    The newest AHRQ Decision Aid is a multimedia suite of patient-centered offerings on UI; it includes videos, graphics, in-depth explanations of various treatment approaches, and a self-assessment tool designed to help women understand possible treatment plans and identify possible questions to ask their health care providers. The resource is based on an AHRQ-funded review of 905 studies of nonsurgical approaches to UI conducted in 2012, and is the third such aid produced by AHRQ. Previous aids addressed prostate cancer and osteoporosis.

    After research conducted in 2008 suggested that as many as one-quarter of American women are affected by pelvic floor disorders such as UI, APTA reemphasized its recommendation that women consider examination and treatment from a physical therapist. In 2010, APTA provided guidance to AHRQ (.pdf) in its research efforts around UI, and the association offers several resources to members and the public, including the APTA Section on Women's Health and the PT's Guide to Incontinence. PTs looking for evidence-based research on UI treatment can find resources via the PT Now portal.

    NIH Funded Post-Acute Care Study Needs PTs

    A National Institutes of Health (NIH)-funded study is looking for physical therapists (PTs) with expertise with older adults in a post-acute care setting. Participation in the research, being conducted by the University of Pennsylvania School of Nursing, will be compensated.

    Selected PTs would join a team of physicians, nurses, and social workers to review case summaries on an interactive website to determine post-acute care referrals. In order to qualify, PTs must have at least 5 years of recent experience caring for adults or conducting research in discharge planning, acute or transitional care, geriatrics, rehabilitation, hospice, long term care, or home care. Participants must also have an understanding of the transitional care needs of patients discharged from acute care to other levels of care.

    PTs from all parts of the country are needed. More information on the research, set to begin in winter of 2014, can be obtained by contacting the program by December 13, 2013.

    Patient Satisfaction May Be Related to Staff Work Relationships

    A new survey tool focused on relationships among members of a clinic staff is not only holding up to measurement scrutiny, but is indicating a direct correlation between the quality of staff working relationships and patient satisfaction.

    The study appears in the latest issue of The Annals of Family Medicine, and describes the development of the Work Relationship Scale (WRS), a 19-item questionnaire focused on "the perceived quality of work relationships" among clinic staff. Questionnaires were administered to all staff in 17 Veterans Administration (VA) primary care clinics in south and central Texas. A total of 457 staff completed the survey, with 247 staff members participating in semistructured interviews. Statistical reviews confirmed the validity of the WRS as a measurement tool.

    When researchers compared the questionnaire results to the results of the VA Survey of Healthcare Experiences of Patients (SHEP) for the same clinics, they found a significant correlation between high WRS scores and patients' positive ratings in the areas of "overall rating of personal doctor/nurse" and "overall rating of health care." The authors wrote that "Clinic member relationships appear to have a significant impact on patient perceptions of care and should be assessed as part of efforts to improve delivery."

    And what makes for a high-scoring clinic? According to the report, "considerable differences emerged in patterns of communication and relating" between the low and high-scoring clinics, with low scorers more likely to rely heavily on e-mail for communication, and high scorers tending to use more face-to-face communication. High-scoring clinics also demonstrated a level of trust and ease in communication throughout all staff roles, while low-scoring clinics reported "reservations" about relationships with less directly-related staff and upper level management.

    PTs Helping Philippines Recover From Haiyan

    Physical therapists (PTs) from outside the Philippines have arrived on the islands to join their peers and other medical professionals in relief efforts in the wake of typhoon Haiyan. According to a report from the World Confederation for Physical Therapy (WCPT), some of the first PTs on the scene were part of 2 UK-based teams, and more are expected to join the efforts as other organizations arrive in the country.

    The WCPT report stated that the PTs joining the relief work are attached to a UK-based international trauma response team, with Handicap International readying teams of emergency specialists—including rehabilitation professionals—to join the providers the organization had in the Philippines before the disaster.

    According to USA Today, the area hardest hit by the typhoon is in dire need of adequate medical facilities and professionals, and relief is just now beginning to arrive more than a week after the event. Suggestions for how to donate to and help relief efforts can be found on several websites, including this Huffington Post report.

    UIW Library Renamed in Honor of Geneva Johnson

    Physical therapy leader and Catherine Worthingham Fellow Geneva Johnson, PhD, PT, FAPTA was recognized last week when the University of the Incarnate Word (UIW) School of Physical Therapy renamed its library in her honor. The new Geneva R. Johnson Library will include her own holdings as well as materials being received from Case Western Reserve University in Ohio, where she served as the program's first director of the master's program.

    Dedication ceremonies took place on November 8 at the library, located on the UIW campus in San Antonio, Texas. Johnson has been an APTA leader for many years, having served in numerous positions including as a member of the CAPTE review panel, the association's history committee, and in official capacities at the Iowa, Texas, Georgia, and Ohio chapters. In her work as a physical therapy educator, Johnson's many contributions were instrumental in reshaping curriculum and refining clinical supervision.

    In its online announcement of the library dedication, the UIW School of Physical Therapy described Johnson as an inspirational figure in the profession. The posting quoted Johnson as saying that "physical therapy is the work of our hands, of our head, and of our heart," and stated that the library in her name will help students "incorporate this philosophy in their personal and professional lives."

    Researchers Identify Widespread Use of Opioids in Nonsurgical Patients

    A study of more than 1 million adult hospital admissions has revealed a high rate of opioid prescriptions for nonsurgical patients, with over 43% receiving the medications during their stay, and over half of that population receiving opioids on the day of discharge. Researchers also identified a pattern of high-dosage prescription and significant regional variations.

    In the study, researchers reviewed records of nonsurgical admissions between 2009 and 2010 from 286 nonfederal acute care hospitals. Authors found that 43% of the 1.14 million nonsurgical patients received opioids, with the average dose equivalent to about 68 milligrams of oral morphine per day. Additionally, researchers identified spikes in use: of the patients receiving opioids, 23% received dosages of 100 milligrams or more on at least 1 day of hospitalization. The research was conducted by a team from Beth Israel Deaconess Medical Center and published online November 13 in the Journal of Hospital Medicine.

    The use of opioids was not confined to the days of hospitalization, according to the research, which found that 26% of patients were also administered opioids on the day of discharge. Authors believe that the common practice of tapering patients off these drugs means that as many of half of these patients also received a prescription for opioid medication to be taken after discharge.

    The study also identified variations in use among hospitals in different parts of the country, with hospitals in the West reporting an opioid use rate about 37% higher than use rates in the Northeast, which reported the lowest rate. In addition, researchers found a correlation between frequency of prescription and risk of opioid-related complications.

    A significant portion of nonsurgical hospital admissions are for patients with musculoskeletal injuries, and physical therapists (PTs) must often assess the impact of opioids and other pain medications on early mobility in the hospital as well as on later interventions. APTA offers several resources on this topic, including a 2-part course on the drugs used to treat pain and inflammation, and research on opioids and exercise available via the PT Now portal.

    Rockar and UPMC Host Congressman Murphy

    Concussion management, the therapy cap, SGR, and the National Health Service Corps were among the topics discussed when Congressman Tim Murphy (R-PA) visited APTA President Paul Rockar Jr, PT, DPT, MS, last week at Rockar's office at the University of Pittsburgh Medical Center (UPMC).

    "The discussions were very positive and it is obvious the congressman has a profound interest in concussion management," said Rockar, adding that Murphy was "very supportive" of UPMC's concussion clinic and programs. The November 4 meeting between Murphy, Rockar, and congressional and UPMC staff lasted about an hour.

    APTA encourages its members to schedule practice visits with legislators to demonstrate what physical therapists and physical therapist assistants do on a daily basis, and to show the value of physical therapy. These personal visits help educate members of Congress about the issues that impact the profession and provide constituents with an opportunity to talk with their legislator about how physical therapy has improved their lives.

    APTA has several resources available to help members schedule practice visits with their legislators, including the practice visit guide. Members interested in hosting a practice visits can contact APTA’s Government Affairs Department at advocacy@apta.org for more information.

    Overview of AHRQ Projects Points to Importance of Health IT

    A new report from the federal Agency for Healthcare Research and Quality (AHRQ) assembles the results of 12 grant studies that, combined, show that effective use of health care IT can play a significant role in improving outcomes, increasing patient engagement, and lowering costs—particularly for patients moving to or from ambulatory care settings.

    The report, titled "Findings and Lessons From the Improving Management of Individuals With Complex Healthcare Needs Through Health IT Grant Initiative" (.pdf) tracks the work of a dozen projects awarded AHRQ grants in 2007. The grant initiative is 1 in a 5-part series and a component of AHRQ's Ambulatory Safety and Quality Program, which AHRQ states was designed "to improve the safety and quality of ambulatory health care in the United States."

    In the document, AHRQ discusses how grant research informs 5 major content areas: novel approaches to providing high-quality care, integration of patient information across transitions, shared decision making and patient-clinician communication, strategies for IT adoption, and the impact of health IT on outcomes. Almost all projects "demonstrated the potential of EHRs [electronic health records] and PHRs [personal health records] to effectively move evidence-based information to the point of care, including the transfer of structured information between clinical data systems," according to the report.

    The projects themselves included the implementation of information exchange systems for ambulatory care providers treating patients in rural areas recently discharged from the hospital, the creation of computer-assisted telephone call systems to monitor patient self-care after discharge, and various care coordination projects aimed at using IT to better manage care of patients with multiple comorbidities. AHRQ characterized the results of the projects as "timely and relevant to better serve patients with complex health care needs."

    APTA offers several resources on IT and EHRs, including a webpage devoted to the use of EHRs. The association describes the EHR as a system that "puts a complete medical record at providers' fingertips" and a resource that "can be used to help inform the clinician of trends in care delivery or various aspects of care" through access to evidence-based practice data.

    MedPAC Discusses SGR, Other Issues

    The most recent meeting of the Medicare Payment Advisory Commission (MedPAC) touched on the need for reform of postacute care (PAC) payment systems, the role of accountable care organizations (ACO), and the advisability of taking a measured approach to advocating for the repeal of the sustainable growth rate (SGR) to avoid stalling current momentum in Congress.

    APTA staff attended the 2-day meeting, which also included discussions on quality measures for self-care and mobility, and uniform pricing for similar services in PAC settings. The commission addressed both short- and long-term initiatives, and targeted topics for future meetings to address issues such as current approaches to improving primary care, rebalancing payment under the physician fee schedule, reforming payment for graduate medical education, and evaluation of the medical home model.

    A significant portion of the meeting focused on the SGR and the status of congressional discussions around ending the flawed policy. The commission noted the progress being made, with Chairman Glenn Hackbarth recommending that MedPAC reiterate its previously shared positions and avoid adding recommendations that would slow progress. APTA is engaged in a grassroots effort to end both the SGR and the therapy cap and offers a Legislative Action Center for its members, as well as a Patient Action Center for consumer supporters. Details on the therapy cap and APTA’s grassroots campaign to end it are available at APTA's Advocacy webpage.

    Post Story Emphasizes Access to PT as Key to Pro Athlete Recovery

    File under "hardly startling": Quick access to a physical therapist (PT) and availability of cutting-edge rehabilitation equipment are 2 of the biggest reasons why professional athletes seem to mend so much more quickly than their amateur counterparts, says a recent article in the Washington Post.

    The story, which appears in the November 13 issue of the Post, looks at the attention given to pro athletes' injuries within seconds of an incident, compared with amateurs who take a wait-and-see approach or who have trouble locating an appropriate provider quickly. Reporter Laura Hambleton writes that "for many pros, it is the hours of intensive daily attention from highly experienced physical therapists, along with specialized rehabilitation equipment and exercises, that make their rehab and yours quite different."

    Hambleton's story quotes APTA members Jason Craig, PT, DPhil, MCSP, and Kala Flagg, PT, 2 Washington, DC-area PTs who have worked with elite-level athletes. Craig described how waiting for treatment can make an injury worse, while Flagg pointed out that in addition to the availability of services and level of personal investment in home therapeutic equipment, professional athletes are constantly training their bodies to prevent injury in the first place.

    The issue of the Post that featured the pro athlete story also contained a report on muscle imbalance that includes quotes from Robert Gillanders, PT, DPT, OCS, who describes the tendency of people to do "exercises they like, rather than exercises they need." This kind of lopsided exercise can lead to muscle imbalances that can cause ongoing pain and discomfort.

    National Faculty Mentor Award Recognizes Dave Pariser

    Former APTA Board Member Dave Pariser, PT, PhD, has been posthumously honored as both the inaugural recipient of a national NCAA faculty mentor award and the award's namesake. Beginning this year, the NCAA Division II Dr Dave Pariser Faculty Mentor Award will recognize faculty who embody the former Bellarmine University instructor's dedication to student development.

    Bellarmine physical therapy student Megan Davis nominated Pariser and delivered a speech on his service to the university and the larger Louisville, Kentucky, community as part of the ceremonies honoring him at the Faculty Athletic Representatives Association meeting in Baltimore, Maryland, on November 8. Also present were Pariser's wife, Gina Pariser, PT, PhD, and daughters Ada and Kayla. Gina Pariser accepted the award on behalf of her husband.

    Pariser was an active member of APTA who served in many capacities at the national as well as the Louisiana and Kentucky chapter levels. In 2011, he was elected to the APTA Board of Directors, where he served until his death in January 2013.

    At Bellarmine University, Pariser focused his scholarship and clinical work in the areas of orthopedics/musculoskeletal problems, gerontology, and advocacy/public policy, but he was widely known and respected for his dedication to mentoring student athletes. His work in the community touched on many areas, including coaching youth sports, and serving on boards for a youth camp and his daughters' high school marching band.

     Parisers - NCAA Honor - 11/12/13
    On hand to honor Dave Pariser were (from left): Kayla Pariser, Gina Pariser, NCAA President Mark Emmert, Ada Pariser, and Megan Davis.

    Virtual Town Hall for Motion Concepts to the 2014 House of Delegates

    A new series of virtual town halls will enable members and delegates to share and offer input on motion concepts for the 2014 House of Delegates (House).

    The Reference Committee and House officers will lead the first virtual town hall on Tuesday, November 19, 8:30 pm–9:30 pm ET. Town hall participants will be able to share motion topics and provide input on topics shared by others. Participation is open to all APTA members.

    Participants can sign up for the town hall via the Virtual Town Hall Sign-Up Sheet posted to the House of Delegates Community in the Shared Documents Folder. The deadline to add a concept to the discussion lineup or sign up as an attendee is November 15 at 5:00 pm ET.

    More Research on Falls Prevention, Other Screenings for Older Adults Recommended to Congress

    A recent report has alerted Congress to the need for more evidence-based research in preventive care for older adults—including more work focused on physical screenings and falls prevention.

    In its third annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services (.pdf), the US Preventive Services Task Force (USPSTF) warns of "significant gaps in key areas of knowledge" around preventive services for older adults, it and urges Congress to take a lead in promoting research that would fill in those gaps. The committee identified "high priority" research needs in 5 key areas: screening for dementia; screening for physical and mental well-being; preventing falls and fractures; screening for vision and hearing problems; and avoiding unintended harms of medical procedures.

    In its discussion of falls and fractures among older adults, USPSTF writes that "more research is needed to develop and validate practical tools that can be used … to better identify older adults who are at substantial risk for falls" and that "clinical trials are also needed on the effectiveness of interventions … for the prevention of falls." APTA offers its members evidence-based resources on falls through its PT Now webpage as well as through Open Door, its portal to current research works. In addition, APTA provides physical therapists (PTs) and patients with education on exercise prescriptions for balance and falls prevention, a pocket guide on falls risk reduction (.pdf) and an online community where members can share information about falls prevention.

    USPSTF is a volunteer group of experts created in 1984. The Patient Protection and Affordable Care Act charged the task force with making annual reports to Congress on needs in evidence-based research around preventive care. The 2013 report marks the group's third—previous reports focused on the need for research on kidney, cervical cancer, and prostate cancer screenings (2012), and gaps in research on screenings for heart disease, colorectal cancer, hepatitis C, and hip dysplasia in newborns (2011).

    Activity Limitation Rates Rising Faster Than Predicted

    Overall arthritis rates rose as expected in the United States between 2010 and 2012, but the incidence of arthritis-attributable activity limitation (AAAL) exceeded projections, with an estimated 22.7 million Americans—nearly half of the estimated 52.5 million with arthritis—suffering with symptoms that limited normal physical activity. The federal Centers for Disease Control and Prevention (CDC) released the numbers this week and called for "greater use of evidence-based interventions" to battle the effects of AAAL.

    The CDC report on arthritis and AAAL summarizes the results of the National Health Interview Surveys (NHIS) conducted in 2010, 2011, and 2012, and compares these to its predictions for the disease. In its projections CDC estimated that arthritis would affect 55.7 million Americans by 2015—an estimate that it says is still on target given the new numbers. What surprised the CDC was the rate of increase of AAAL, which has passed the 22 million mark predicted for 2020, and "might exceed the 25 million projection for 2030."

    Editorial notes accompanying the report point to the incidence of comorbidities such as heart disease and diabetes as contributing to the higher-than-expected rise in AAAL and recommend greater attention to education and exercise. "An opportunity for collaboration is the dissemination of information regarding evidence-based self-management education and physical activity interventions that have been proven to reduce pain and improve function, mood, confidence to manage health, and quality of life," the report states. "The physical activity interventions recommended are appropriate exercise regimens intended to reduce activity limitations and … assuage concerns over aggravating the condition." The APTA website offers multiple resources on exercise and arthritis, including an online course focused on exercise prescription for older adults with osteoarthritis.

    New Additions to APTA Member Value Programs

    You have 3 new benefits to consider under APTA’s member value programs: the PT Clinician app, Office Depot discounts, and VPI pet insurance.

    The PT Clinician app, available through AppGiraffe, helps promote communication with your patients by giving them a way to interact with you outside the office. It’s customizable, with features such as appointment scheduling, an exercise library, directories, coupons, and geo-fencing.

    Under the Office Depot discount program, you can save up to 80% on online purchases, qualify for free shipping, and get discounted printing and copying.

    VPI pet insurance, available through Marsh US Consumer, is a veterinarian-recommended pet health insurance provider. Policies reimburse you for eligible veterinary expenses related to surgeries, hospitalization, X-rays, prescription medications, and more.

    Take advantage of these and other APTA member value programs, such as car rental discounts, personal and professional insurance programs, and credit cards.

    Going ALL-In for Newly Discovered Ligament

    The mystery of a 134-year-old anatomical "enigma" has finally been solved with the announcement of a new knee ligament. Described in 1879 only as a "pearly resistant fibrous band," the newly named anterolateral ligament (ALL) could affect tibial rotation and the pivot shift phenomenon, according to researchers.

    The presence of the ligament was verified through examination of 41 cadaveric knees, which, with 1 exception, included the ALL. A recounting of the research (abstract only) that led to the discovery was published in the October 2013 issue of the Journal of Anatomy, and word quickly spread to major news organizations such as the Huffington Post and Time.

    Researchers describe the ALL as a "well defined structure" that is situated "at the prominence of the lateral femoral epicondyle, slightly anterior to the origin of the lateral collateral ligament." It follows an oblique course to the anterolateral aspect of the proximal tibia, with its insertion on the tibia "grossly located between Gerdy's tubercle and the tip of the fibular head, definitely separate from the iliotibial band (ITB)."

    While the authors cite the need for more research on the ALL, they hypothesize that the ligament plays the role of a stabilizer for internal rotation, and speculate that the ALL could play a part in "rotary knee instability patterns witnessed in many [anterior cruciate ligament] deficient knees."

    Exercise Advice May Not Be Widely Given to Patients With Arthritis, Sciatica

    Advising exercise to patients with osteoarthritis or sciatica may be a highly recommended approach to treatment, but it's an approach that may not be widely used by physicians, according to a recent factorial experiment (abstract). Researchers found that out of 192 primary care physicians studied, fewer than a third said that they would advise physical activity as part of a course of treatment for patients presenting symptoms of either condition. The results of the study were published online in early October in Arthritis Care & Research.

    In the experiment, the physicians watched 2 videos of (actor) patients who presented with pain from undiagnosed sciatica or knee osteoarthritis that had been diagnosed. Afterwards, the physicians were interviewed to find out what recommendations they would make.

    Results showed that 30.2% of physicians would give exercise advice to the osteoarthritis patient, and 32.8% would provide this advice to the patient presenting with sciatica. The study pointed to a general tendency for physicians with fewer years in practice to advise lifestyle changes more frequently than their more veteran peers. These newer physicians were also found to be more likely to prescribe nonsteroidal anti-inflammatory drugs, but less likely to order tests.

    The low rate of exercise advice runs counter to widely accepted recommendations from the American College of Rheumatology and the American Pain Society. APTA's Physical Therapist's Guide to Osteoarthritis of the Knee webpage provides information on why exercise plays an important role in treatment, and the association's PTNow research portal provides members with access to evidence-based research on physical therapy and sciatica.

    Residency Board Seeks Credentialing Committee Members

    The American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) is seeking a cadre of members with diverse clinical expertise to serve on the Credentialing Services Committee. The committee comprises trained reviewers identified by the Credentialing Services Council as having experience and/or expertise relevant to program credentialing. Committee members review applications and visit program sites undergoing credentialing.

    Members interested in being considered for service on the committee must complete the application on the ABPTRFE website by December 31, 2013. The Credentialing Services Council will make appointments on February 3, 2014. Notification regarding appointments will be sent by February 28, 2014.

    Selected members must be available for training at APTA headquarters in Alexandria, Virginia, in October 2014. Exact dates will be set after the appointments are made. APTA will reimburse all travel expenses for this meeting.

    FDA Issues Mobile Medical App Guidelines

    The federal Food and Drug Administration (FDA) says that it is taking a "risk-based" approach to its oversight of mobile medical apps and will focus its enforcement efforts on apps "that present a greater risk to patients if they do not work as intended." The announcement of the enforcement approach accompanied the FDA's release of its final guidance resource (.pdf) for developers of the technologies.

    The guidance and enforcement information was released in draft form in July 2011, and the final document is now part of the resources available on the FDA's mobile medical applications webpage. For the most part, the agency's enforcement attention will be on apps that "are intended to be used as an accessory to a regulated medical device" or "transform a mobile platform into a regulated medical device." In addition to technologies that would monitor the heart and other organs, regulated apps would also include those that measure degree of tremor, monitor eye movement relative to balance disorders, and control settings of a neuromuscular stimulator.

    Other apps that meet the FDA's definition of a "device" but do not present significant risk to the patient would likely not be subjected to review—something the FDA calls its "enforcement discretion." These would include apps that use video and games to encourage users to do physical therapy exercises at home and apps that allow users to record and evaluate activities related to exercise and diet.

    According to the FDA, the guidance is an attempt to provide consumer protection services to the rapidly growing market for health-related apps, a segment of app technology that industry experts predict will be present on 50% of all smartphones and tablets by 2018.

    Podcast on Updated FLR Guidelines Now Available

    Physical therapists (PTs) can now download the latest information on changes to the Center for Medicare and Medicaid Services' (CMS) guidelines on functional limitation reporting (FLR) as an APTA podcast. The podcast helps PTs understand how to report evaluative procedures for additional limitations to those already being reported.

    The new guidance is included in the Frequently Asked Questions document (.pdf) on the CMS Therapy Services website. APTA has updated its functional limitation reporting website to reflect the new information.

    More Than 800K Messages Call for an End to the Therapy Cap

    Physical therapists (PTs), physical therapist assistants (PTAs), and their supporters harnessed the power of social media to help generate more than 876,000 social media messages sent simultaneously to call for an end to the Medicare therapy cap. The impressive November 4 blast was part of a grassroots effort to bring even more energy to the issue now that Congress faces a deadline fewer than 60 days away.

    PTs and PTAs were part of 2,012 people who used a technology called Thunderclap that leverages individual social media accounts for a 1-time simultaneous blast to all participants' friends and followers on Facebook and Twitter. The event was designed to draw attention to the therapy cap issue as the House Ways and Means and Senate Finance committees work on legislation that could include an end to the caps and the sustainable growth rate (SGR).

    APTA is urging members to visit the Legislative Action Center to find out how to add their voices to the campaign to end the therapy cap, while patients and nonmembers can access APTA's Patient Action Center to learn how to help. Details on the therapy cap and APTA’s grassroots campaign to end it are available at APTA's Advocacy webpage.

    Quadriceps Atrophy Present in Patients With PFP

    A recently published literature review and meta-analysis has determined that there may be a link between patellofemoral pain (PFP) and quadriceps atrophy, and authors believe the findings "support the rationale for use of quadriceps strengthening as part of a rehabilitation program for PFP."

    The analysis, published in the November 2013 issue of the Journal of Orthopaedic & Sports Physical Therapy, reviewed 10 studies that focused on patients with PFP and no coexisting pathology. Measurement of quadriceps size was obtained with a tape measure, through ultrasound, or by way of magnetic resonance imaging (MRI), and all studies included baseline data.

    The study's authors found that the presence of atrophy was more reliably detected through imaging techniques than with girth measurements but that the atrophy did exist to such an extent that quadriceps-strengthening exercises could be "an important consideration" in rehabilitation. Authors acknowledge that this suggestion differs from research that "has led many clinicians to shift their focus toward more proximal factors in PFP rehabilitation."

    PFP is common, particularly among young athletes, and accounts for as much as 25% of all reported knee pain. APTA's guide to PFP recognizes the role that quadriceps-strengthening may play in rehabilitation and provides information on PFP that PTs can share with patients. More broadly focused information on knee pain is also available at the PT's guide to knee pain webpage.

    Effort to End Therapy Cap Enters Crucial Stage

    The APTA grassroots campaign to end the Medicare therapy cap and sustainable growth rate (SGR) formula has intensified in light of the looming 60-day deadline for Congress to take action, with the association calling on physical therapists (PTs), physical therapist assistants (PTAs), patients, and supporters to add their voices now to the movement advocating for long-overdue changes.

    Congress has until December 31 to address the Medicare therapy cap. If no action is taken by then, a hard cap on outpatient therapy services could go into effect in 2014. Similarly, if no action is taken on the SGR, providers could face a 24% reduction in payments.

    While the Senate Finance and House Ways and Means Committees released a legislative framework for SGR reform last week, the draft did not include a repeal of the Medicare therapy cap. Language in the draft does indicate that the committees are continuing to look at the Medicare extenders to reach a bipartisan, bicameral agreement, making grassroots advocacy especially important at this stage in the process. APTA urges its members and all other supporters to contact their legislators as soon as possible and ask them to permanently fix the cap in the sustainable growth rate (SGR) reform package, or if such a change isn't possible this year, to extend the therapy cap exceptions process through 2014.

    APTA has several tools that make it easy to contact legislators. Members can take action on their computers using the Legislative Action Center and can even sign up for an e-mail reminder alert by joining the PTeam. Patients and nonmembers can e-mail their legislators using the Patient Action Center.

    For more information about the Medicare therapy cap and APTA’s grassroots campaign to stop it, visit the Medicare therapy cap webpage or e-mail advocacy@apta.org.

    PTs Have 'Tremendous Opportunity' in Medicare's Shift to Quality Reporting

    While the media focuses on high-profile website problems and political debates, physical therapists (PTs) may find that for them, some of the biggest news around the Patient Protection and Affordable Care Act has to do with how payment systems will emphasize quality of care—and how that quality will be measured. The role of the PT in the new health care reporting landscape is the focus of an article (member login required) in the November issue of PT in Motion, the magazine of APTA.

    The Centers for Medicare and Medicaid Services (CMS) are making a "fundamental shift in the health care system" toward quality measurement, writes Heather Smith, PT, MPH, APTA program director of quality. She states that these quality measures "afford PTs a tremendous opportunity to demonstrate their value in the health care system" by delivering the kinds of outcomes that will be of increasing importance in future reimbursement models. The Medicare quality reporting programs are likely to influence reporting among private payers, making the PT's role even more crucial.

    Smith's article includes an overview of the health care settings that have adopted quality programs, explanations of the aims and strategies of the move toward quality reporting, and definitions of the various measure categories. PT in Motion is available free to APTA members in both online and print versions.

    Details Still to Come on Proposal to End SGR

    Details on a recently released bipartisan framework that would drop the sustainable growth rate (SGR) from the Centers for Medicare and Medicaid Services' payment methodology and shift to alternative payment models (APMs) are still being developed, and APTA will be monitoring the proposal as specifics are worked out.

    The draft being considered by the Senate Finance and House Ways and Means Committees is still in its earliest stages and lacks many important details. The framework proposes an end to the current flawed SGR system, a freeze on payment rates until 2023, and the development of a value-based performance payment program.

    As expected, the proposal as initially drafted does not address Medicare extenders, including the Medicare therapy cap, or any offsets to the cost of this legislation; however, language in the framework indicates that discussion on these issues continues, with the goal being to find bipartisan solutions. APTA is monitoring the development of the framework and will share more information once details come into focus.

    The draft framework comes at a time when APTA is urging its members to join a grassroots effort to call on Congress to end both the SGR and the therapy cap. The effort will be amplified on November 4, when physical therapists (PTs), physical therapist assistants (PTAs), and their supporters engage in a concentrated e-mail and social media effort to help legislators understand the importance of putting an end to both policies. There is still time to join this effort by signing up for the November 4 Thunderclap and finding out more about how to contact legislators.

    For more information about APTA’s grassroots campaign to stop the Medicare therapy cap and end the SGR, visit the Advocacy webpage or e-mail advocacy@apta.org.

    Updated FLR Guidelines Address Reporting on Additional Evaluative Procedures

    The Centers for Medicare and Medicaid Services (CMS) updated its guidance on functional limitation reporting (FLR) around reporting evaluative procedures that are for different limitations in addition to those currently being reported.

    The new guidance is included in the Frequently Asked Questions document (.pdf) on the CMS Therapy Services website and provides instructions on how to report these additional procedures and functional limitations while continuing to report on the primary limitations. CMS provides the following answer:

    "You should report the evaluative procedure furnished for a second/different functional limitation other than the primary functional limitation for which ongoing reporting is occurring as a one-time visit (i.e., report all three G-codes in the code set for the functional limitation that most closely matches that for which the evaluative procedure was furnished). The ongoing reporting of a primary functional limitation is not affected when all three G-codes in a code set are reported for the evaluative procedure furnished for a second functional limitation. Note: The reporting of all three G-codes for the evaluative procedure for a second functional limitation and the ongoing reporting of a primary functional limitation can both occur on the same date of service."

    APTA has updated its functional limitation reporting webpage to reflect the new information and will create a podcast about the update during the week of November 4.