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  • 2014 Budget Deal Includes SGR Patch, Therapy Cap Exceptions Extension

    The $1.014 trillion federal budget compromise passed by Congress includes a 3-month "fix" that will prevent implementation of Medicare payment cuts associated with the sustainable growth rate (SGR). The temporary patch is intended to allow the House and Senate time to finalize legislation that would permanently repeal the flawed SGR formula.

    The patch prevents a 20.1% cut to the conversion factor in the physician fee schedule and extends the current therapy cap exceptions process. In past years, the so-called "doc fix" was approved for an entire year—this time, legislators hope to use the first 3 months of 2014 to hammer out details of a plan that would not only end the SGR but could include a repeal of the therapy cap. APTA has created a webpage that explains the SGR reform proposals on the table.

    Under the 3-month extension of the therapy cap exceptions process, physical therapists will continue using the KX modifier at the 2014 cap level of $1,920 and will be subject to the manual medical review process when a patient reaches $3,700 in annual spending.

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

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

    Venous Ulcer Treatment Research Lacking

    If there is a single best way to dress and treat venous leg ulcers, it can't be confirmed through existing research. That's the conclusion reached by a research group from the federal Agency for Healthcare Research and Quality (AHRQ) after a systematic review that found "little evidence exists" for the effectiveness of one approach over another.

    The AHRQ study (.pdf) conducted by the Johns Hopkins University Evidence-Based Practice Center (EPC) focused on advanced wound dressings, systemic antibiotics, and venous surgery to evaluate which approach best facilitated healing. The EPC reviewed more than 10,000 research articles and narrowed its analysis to 60 studies that met research criteria. Methods reviewed included simple wound dressings, advanced wound dressings, dressings that incorporated biological elements such as human skin cells, use of systemic antibiotics, and venous surgery.

    In the end, researchers found research lacking and were unable to point to any approach as preferable. "We found a paucity of well-designed well-controlled studies, as well as a lack of standard case definitions or approaches to managing confounders and interactions," the report stated. "Most studies were not blinded, and the results are therefore subject to reporting and ascertainment bias."

    Absent from the report is any mention of the role movement can play in the management of venous ulcers. No physical therapists (PTs) were included in the key informant, technical expert, or peer reviewer groups that participated in the creation of the report; however, APTA did provide comments on a draft version of the report just released as well as a separate draft report on future research. In those comments, APTA representatives pointed out that the report on future research needs contained no discussion of exercise and gait training to optimize venous pump as a treatment option, and suggested that exercise prescription or walking to manage venous ulcers be included.

    The EPC group will release a "disposition of comments" document 3 months after the online publication of its initial report. APTA will review the current report, disposition information, and report on future research needs to determine the best way to communicate with AHRQ on the benefits of physical activity in treatment.

    APTA's Section on Electrophysiology and Wound Management offers resources for PTs interested in the latest developments in this area.

    Foundation Grants Fund PT Research on Wide Range of Topics

    Physical therapy's role in improving the lives of individuals with Alzheimer disease, meeting developmental challenges of infants born preterm, and enhancing recovery after anterior cruciate ligament (ACL) reconstruction will be the focus of research funded by grants from the Foundation for Physical Therapy (Foundation).

    Three physical therapists (PTs) have each received $40,000 in support of research that Foundation Board of Trustees President William G. Boissonnault, PT, DPT, DHSc, FAPTA, FAAOMPT, said will "contribute to our profession's scientific advancement." The grants, recipients, and research areas are:

    • Magistro Family Foundation Research Grant – Eric Vidoni, PT, MSPT, PhD, research assistant professor in the Department of Neurology at University of Kansas Medical Center. Vidoni's research will focus on the physical and psychological effects of individualized activity programs for individuals with Alzheimer disease.
    • Miami-Marquette Challenge Research Grant – Ryan Mizner, PT, MPT, PhD, assistant professor, University of Montana. Mizner's 2-year project will look at the effects of a bodyweight reduction instrument to deliver graded exercise on the outcomes of ACL reconstruction.
    • Pediatric Research Grant – Stacey Dusing, PT, MS, PhD, associate professor, Virginia Commonwealth University. Dusing's research will center on the efficacy of the Supporting Play, Exploration, & Early Development Intervention (SPEEDI) in improving reaching and problem solving skills in infants at high risk for developmental disabilities.

    The Foundation also announced the recipients of this year's Florence P. Kendall Doctoral Scholarships awarded to outstanding PTs in their first year of study toward a doctoral degree. Winners for the 2013–2014 academic year are Timothy Faw, PT, DPT, NCS, Ohio State University; Brian Loyd, PT, DPT, University of Colorado – Denver; and Justin Staker, PT, MPT, University of Minnesota. Each recipient was awarded $5,000.

    The awards were made possible through donations to the Foundation, which has provided over $13 million in research grants, fellowships, and postprofessional doctoral scholarships to more than 500 emerging scientists. Press releases announcing the latest grant and scholarship recipients are available at the Foundation website.