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  • Deadline Approaches to Adopt Version 5010

    Although the Centers for Medicare and Medicaid Services (CMS) has delayed enforcement of Version 5010 transaction standards used for electronic health care claims until March 31, 2012, the official deadline to adopt the standards is January 1, 2012.

    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.

    ACO Podcast Series: Innovation Center Initiatives

    APTA recently released a fifth podcast in a special series on Accountable Care Organizations (ACOs). This latest podcast focuses on the work of the Center for Medicare and Medicaid Innovation (Innovation Center) in the area of integrated models of care, specifically the Advanced Payment Initiative and the Pioneer ACO model.

    The Advance Payment Initiative developed by the Innovation Center is designed for organizations participating as ACOs in the Medicare Shared Savings Program. Through this initiative, selected participants in 2 types of organizations in the Shared Savings Program will receive advance payments that will be recouped from the shared savings they earn as indicated in their agreements with the Centers for Medicare and Medicaid Services (CMS). Under the Advance Payment Initiative, participating ACOs will receive 3 types of payments.

    The Pioneer ACO Model seeks to support experienced organizations in transitioning from a fee- for-service payment structure to a system that is more closely aligned with improved quality of care and outcomes. CMS recently released brief descriptions of the 32 organizations selected to participate in the Pioneer ACO Model.

    A transcript of the prerecorded podcast also is available.

    New Hospital Guidelines Have Significant Implications for PTs

    This article has been temporarily removed. An update will be provided the week of January 2.

    UPDATE: Please see the article titled "New Medicare Conditions of Participation Guidelines for Hospital-based Outpatient Settings" posted January 4 for information on these new guidelines.   

    New in the Literature: McKenzie Method (Spine. 2011;24:1999-2010.)

    In patients with low back pain for more than 6 weeks presenting with centralization or peripheralization of symptoms, the McKenzie method is slightly more effective than manipulation when used adjunctive to information and advice, say authors of an article published in the November issue of Spine

    A total of 350 patients with low back pain (>6 weeks) with centralization or peripheralization of symptoms with or without signs of nerve root involvement were enrolled in this randomized controlled trial. The main outcome was the number of patients with treatment success defined as a reduction of at least 5 points or an absolute score below 5 points on the Roland Morris Questionnaire. Secondary outcomes were reduction in disability and pain, global perceived effect, general health, mental health, lost work time, and use of medical care.

    Both treatment groups showed clinically meaningful improvements in this study. At 2 months follow-up, the McKenzie treatment was superior to manipulation with respect to the number of patients who reported success after treatment (71% and 59%, respectively). The number needed to treat with the McKenzie method was 7. The McKenzie group showed improvement in level of disability compared with the manipulation group reaching a statistical significance at 2 and 12 months follow-up. There also was a significant difference of 13% in the number of patients reporting global perceived effect at end of treatment. None of the other secondary outcomes showed statistically significant differences.

    Foundation-Funded Researcher's Study Featured on Newswires

    Alzheimer Disease biomarkers and a low body mass index (BMI) are linked in the development of the disease, according to a study led by APTA member Eric Vidoni, PT, PhD, and recently published in Neurology. The study was mentioned in the online editions of US News & World Report, CBS News, and CNN Health. Vidoni was the recipient of a 2009 New Investigator Fellowship Training Initiative (NIFTI) postdoctoral research fellowship from the Foundation for Physical Therapy, which provided partial funding for the study.

    For this study, Vidoni and colleagues analyzed cross-sectional data from participants enrolled in the Alzheimer Disease Neuroimaging Initiative (ADNI) with PET imaging using Pittsburgh Compound B (PiB, n = 101) or Cerebrospinal fluid (CSF) analyses (n = 405) for β-amyloid peptide (Aβ) and total tau. They assessed the relationship of CSF biomarkers and global PiB uptake with BMI using linear regression controlling for age and sex. They also assessed BMI differences between participants who were and were not considered biomarker positive. Finally, they assessed BMI change over 2 years in relationship to Alzheimer Disease biomarkers.

    According to their findings, no dementia, mild cognitive impairment (MCI), and Alzheimer Disease groups were not different in age, education, or BMI. In the overall sample, CSF Aβ (β = 0.181), tau (β = −0.179), tau/Aβ ratio (β = −0.180), and global PiB uptake (β = −0.272) were associated with BMI, with markers of increased Alzheimer Disease burden associated with lower BMI. Fewer overweight individuals had biomarker levels indicative of pathophysiology. These relationships were strongest in the MCI and no dementia groups.

    Vidoni’s 2-year Foundation funded NIFTI research fellowship supported work on his project titled "Cardiorespiratory Fitness and Executive Function in Early Alzheimer’s Disease," which was completed at the University of Kansas (KU) Medical Center. He recently received a KL2 Career Development Award, and currently acts as the assistant director of KU’s Alzheimer Disease Center, a designated National Alzheimer Disease Center by the National Institutes of Health, as well as a research assistant professor in the Department of Neurology at the University of Kansas Medical Center.

    Visits to ED for Arm Fractures Expected to Rise With Aging Baby Boomers

    A new study suggests that number of people who go to the emergency department (ED) for a broken arm could rise by nearly a third by 2030, when the youngest baby boomers turn 65, says an article by Reuters

    Researchers analyzed data on 28 million ED visits across the United States in 2008 and found 370,000 cases of humerus fractures. Children ages 5-9 accounted for the highest overall number of humerus breaks, but the arm injuries also spiked among women after age 40 and men after age 60. The researchers report that 38.7 million Americans were 65 or older in 2008, but in 2030, that number will be 71.5 million. In their article, published in Arthritis Care Research, the researchers project 490,000 ED visits for humerus breaks in that year, with much of the increase likely to be among older Americans.

    The highest number of proximal humerus breaks, an injury often associated with falls, was seen in both men and women after age 45. Those rates kept rising until about age 84. Women were more than twice as likely as men to have proximal humerus break, and saw an uptick in the breaks starting after age 40, which the researchers attributed to lost bone density, says Reuters.

    Fractures near the elbow were the second most common upper-arm fracture. Children under age 15 accounted for almost 65% of those.

    Nearly 90% of upper-arm breaks were caused by falls, prompting the authors to call for "[r]igorous safety measures to reduce falls and improved preventive treatments of osteoporosis."

    New Center to Speed Movement of Discoveries From Labs to Patients

    In a move to re-engineer the process of translating scientific discoveries into new drugs, diagnostics, and devices, the National Institutes of Health (NIH) recently established the National Center for Advancing Translational Sciences (NCATS). Working closely with partners in the regulatory, academic, nonprofit, and private sectors, NCATS will strive to identify and overcome hurdles that slow the development of effective treatments and cures.

    To meet the goals of NCATS, NIH is reorganizing a wide range of preclinical and clinical translational science capabilities within NIH into an integrated scientific enterprise with new leadership and a new agenda.

    NCATS will include the following programs:

    • Bridging Interventional Development Gaps, which makes available critical resources needed for the development of new therapeutic agents
    • Clinical and Translational Science Awards, which fund a national consortium of medical research institutions working together to improve the way clinical and translational research is conducted nationwide
    • Cures Acceleration Network, which enables NCATS to fund research in new and innovative ways
    • FDA-NIH Regulatory Science, which is an interagency partnership that aims to accelerate the development and use of better tools, standards, and approaches for developing and evaluating diagnostic and therapeutic products
    • Office of Rare Diseases Research, which coordinates and supports rare diseases research
    • Components of the Molecular Libraries, which is an initiative that provides researchers with access to the large-scale screening capacity necessary to identify compounds that can be used as chemical probes to validate new therapeutic targets
    • Therapeutics for Rare and Neglected Diseases, which is a program to encourage and speed the development of new drugs for rare and neglected diseases

    The formation of NCATS was a recommended by the NIH Scientific Management Review Board in December 2010 to create a new center dedicated to advancing translational science. 

    Legislation Passed Today to Prevent Caps and Cuts for 2 Months

    December 23, 2011: The House of Representatives passed legislation today to extend the payroll tax break, fee schedule update, rural payment update, therapy cap exception extension, and other end of the year provisions. The Senate also passed the measure this morning and it was signed by the President this afternoon. This will prevent the 27.4% fee schedule reduction on January 1, 2012, maintain the 1.0 GPCI floor on rural payments, and provide for a continuation of the exceptions process to the $1,880 therapy cap until February 29, 2012.

    When Congress returns next year, attention will turn to the conference committee assigned to hammer out a deal between the two chambers to prevent these cuts and caps effective March 1, 2012. But the differences remain large over how to pay for the deal. The profession must continue to remain vigilant to prevent this from happening next year.

    If you're not currently part of APTA's Grassroots Network, PTeam, sign up today. PTeam will be the main source of information for legislative updates and breaking news on the effort to pass legislation to extend the therapy cap exceptions process.

    December 31 Deadline Approaches: Caps and Cuts Uncertain

    As the end of the year approaches, lack of congressional action on legislation to address the 27.4% Sustainable Growth Rate (SGR) cut and extension of therapy cap exceptions process signifies a need to be prepared for potential changes in payment for services on January 1, 2012. While APTA continues to advocate for a compromise before the new year, a resolution remains uncertain.

    Though both the House and the Senate have passed legislation containing a fix for the SGR and an extension of the therapy caps exceptions process, the differences among the 2 bills are significant. Congress still has time to resolve these issues before the end of the year. However, APTA recommends that physical therapists be as prepared as possible if the SGR and cap go into effect January 1, 2012. Below are 3 scenarios the profession could face on January 1, 2012:

    • Scenario 1 -- Congress passes legislation before the end of the year stopping the 27.4% cut, extending the therapy cap exceptions process, and extending the Geographical Practice Cost Indices (GPCIs) work floor. 
    • Scenario 2 -- Congress does not pass legislation stopping the 27.4% cut and extending the GPCI work floor by the end of the year. APTA has prepared a FAQ document addressing this scenario.
    • Scenario 3 -- Congress does not extend the therapy cap exceptions process before the end of the year. Information about this scenario can be found in this FAQ document.  

    While a resolution to these potentially devastating issues is still uncertain, now more than ever it remains critical that APTA members stay involved in the fight for the profession and patients.

    APTA members are urged to contact their members of Congress to express their support for a package that contains a 2-year extension of the SGR fix and therapy cap exceptions process as outlined in the House bill. Association members also can use APTA's Legislative Action Center to e-mail members of Congress on these pressing issues. In addition, request that your patients contact Congress on this issue through APTA's Patient Action Center. This site is designed to educate patients on the issue and to provide easy access to form e-mails and letters for them to contact Congress.

    If you're not currently part of APTA's Grassroots Network, PTeam, sign up today. PTeam will be the main source of information for legislative updates and breaking news on the effort to pass legislation to extend the therapy cap exceptions process and avoid the 27.4% cut.

    Update: Legislation passed December 23, 2011, to prevent caps and cuts for two months. Read this article.

    Foundation Awards Kendall Scholarships, Research Grants

    The Foundation for Physical Therapy recently awarded Florence P. Kendall Doctoral Scholarships for the 2011-2012 academic year to Ryan Marker, PT, DPT, University of Colorado, Denver; Jennifer Reneker, PT, MSPT, Kent State University; and Bahar Shahidi, PT, DPT, University of Colorado, Denver.

    The $5,000 Kendall Doctoral Scholarship is awarded annually to outstanding physical therapists as they begin their first year of graduate studies toward a postprofessional doctoral degree.  

    Two physical therapists each have received $40,000 research grants from the Foundation in support of their projects to evaluate the effectiveness of physical therapy interventions.

    The Magistro Family Foundation Research Grant has been awarded to Kristin Archer, PT, DPT, PhD, an assistant professor at Vanderbilt University Medical Center, for her 2-year project Cognitive-Behavioral-based Physical Therapy: Improving Surgical Spine Outcomes.

    Jill Heathcock, PT, MPT, PhD, an assistant professor at Ohio State University, is the recipient of the Pittsburgh-Marquette Challenge Research Grant for her 1-year project Transcranial Magnetic Stimulation (TMS) on Children With Hemiparesis.

    House Rejects 2-Month Fix Approved by Senate; Caps and Cuts Remain Unresolved

    This afternoon, the House of Representatives decided not to vote on the Reid-McConnell Amendment to the Middle Class Tax Relief and Job Creation Act of 2011 (HR 3630), which was passed by the Senate and provided a 2-month fix to the Sustainable Growth Rate (SGR) and the therapy cap exceptions process along with other Medicare provisions. Instead, the House voted to create a conference committee to negotiate the differences between the House and Senate passed bills.

    If the House and Senate cannot come to an agreement on a package before December 31 the therapy cap will go into effect without an exceptions process on January 1, 2012. Furthermore, a scheduled 27.4% cut to provider payments under the Medicare physician fee schedule will be implemented.

    It is critical that Congress address these devastating caps and cuts as soon as possible. APTA members are urged to contact their members of Congress to express their support for a package that contains a 2-year extension of the SGR fix and therapy cap exceptions process as outlined in the House bill.

    If you're not currently part of APTA's Grassroots Network, PTeam, sign up today. PTeam will be the main source of information for legislative updates and breaking news on the effort to pass legislation to extend the therapy cap exceptions process and avoid the 27.4% cut.

    New PQRS Podcasts: Preparing for 2012

    As recently reported in News Now, physical therapists (PTs) will be able to participate in reporting a new measure in 2012—the Functional Outcome Assessment Measure (#182)—as part of the Physician Quality Reporting System (PQRS). Measure 182 is designed for patients with documentation of a current functional outcome assessment using a standardized functional outcome assessment tool and documentation of a care plan based on identified functional outcome deficiencies. A new podcast describes which patients are eligible for the measure and outlines the codes PTs should use in their reporting. A transcript and slideshow accompany the prerecorded podcast, which includes a case scenario of a patient who presents for an initial evaluation with a chief complaint of low back pain.      

    To help APTA members successfully participate in PQRS, the association has developed an audit tool that allows PTs to assess their performance in reporting throughout the year and automatically calculates the success rate for each measure that is reported through claims. An audit tool podcast walks listeners through the tool and provides an example of how a clinic manager uses the tool to assess the performance of 3 physical therapists in reporting for the medication measure. A transcript and slideshow accompany the podcast.

    New in the Literature: Physical Fitness Training for Stroke (Cochrane Database Syst Rev. 2011 Nov 9;11:CD003316)

    Although the effects of physical fitness training on death, dependence, and disability after stroke are unclear, there is sufficient evidence to incorporate cardiorespiratory training that involves walking within poststroke rehabilitation programs to improve speed, tolerance, and independence during walking, say authors of a meta-analysis published in November in the Cochrane Database of Systematic Reviews. 

    The authors searched the Cochrane Stroke Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, SPORTDiscus, and 5 additional databases. They also searched ongoing trials registers, handsearched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field.

    Selection criteria included randomized trials comparing either cardiorespiratory training or resistance training, or both, with no intervention, a nonexercise intervention, or usual care in stroke survivors. Two review authors independently selected trials, assessed quality, and extracted data. The authors analyzed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses.

    The analysis included 32 trials, involving 1,414 participants, which comprised cardiorespiratory (14 trials, 651 participants), resistance (7 trials, 246 participants), and mixed training interventions (11 trials, 517 participants). Five deaths were reported at the end of the intervention and 9 at the end of follow-up. The majority of the estimates of effect were not significant. Cardiorespiratory training involving walking improved maximum walking speed (mean difference [MD] 8.66 meters per minute), preferred gait speed (MD 4.68 meters per minute), and walking capacity (MD 47.13 meters per 6 minutes) at the end of the intervention. These training effects were retained at the end of follow-up. Mixed training, involving walking, increased preferred walking speed (MD 2.93 meters per minute) and walking capacity (MD 30.59 meters per 6 minutes), but effects were smaller and there was heterogeneity among the trial results. There were insufficient data to assess the effects of resistance training. The variability in the quality of included trials hampered the reliability and generalizability of the observed results.

    High Court Sets Dates to Hear Health Care Law Arguments

    The Supreme Court will hear 5.5 hours of oral arguments on the health care reform law March 26-28, 2012, according to Reuters.

    On March 26 the court will hear 1 hour of arguments on whether the legal challenges to the requirement that all Americans buy insurance must wait until after that part of the law has taken effect in 2014 and the penalty for failing to comply is imposed.

    The court is slated to hear 2 hours of arguments on March 27 on the constitutional issue that is "at the heart of the battle -- whether Congress overstepped its powers by adopting the insurance purchase requirement known as the individual mandate," Reuters says.

    On March 28, the court will hear 90 minutes of arguments on whether the rest of the law can survive if the mandate is struck down. On that same day, it will hear 1 hour of arguments on whether Congress "improperly coerced the states to expand the Medicaid program."

    A ruling is expected by the end of June 2012.

    Senate Bill Extends Cap Exceptions Process, SGR for 2 Months

    On Saturday, the Senate passed the Middle Class Tax Relief and Job Creation Act of 2011 (HR 3630) with amendment that would extend several Medicare provisions for 2 months, requiring Congress to take up the issues again in February 2012. Specifically, the Senate's amendment would extend the therapy cap exceptions process by continuation of the current KX modifier at $1,880 and keep the Medicare Physician Fee Schedule Sustainable Growth Rate (SGR) at the current payment rate until February 29, 2012. The Geographic Practice Cost Index (GPCI) also would be extended at the current level until March 1, 2012.  

    The House version of the bill, which passed December 13, addressed the Medicare provisions for 2 years with modifications to the cap exceptions process that included a manual review. The House is expected to vote on the Senate's bill late today.   

    If you're not currently part of APTA's Grassroots Network, PTeam, sign up today. PTeam will be the main source of information for legislative updates and breaking news on the effort to pass legislation to extend the therapy cap exceptions process and avoid the 27.4% cut.

    Increase in Knee Pain Not Solely Attributed to Obesity and Osteoarthritis

    Even though the prevalence of knee pain has risen during the last 20 years, obesity and osteoarthritis account for only part of the increase, according to a Medscape Medical News  article based on a study published this month in Annals of Internal Medicine.

    For this analysis, researchers evaluated results from 6 National Health and Nutrition Examination Surveys (NHANES) conducted between 1971 and 2004, and from 3 exam periods in the Framingham Osteoarthritis (FOA) Study carried out between 1983 and 2005. Participants in both studies were asked whether they experienced knee pain most days. In addition, participants in the FOA study underwent bilateral weight-bearing radiographs of their knees to assess the presence and extent of osteoarthritis. Radiographs were combined with self-reported knee pain to define symptomatic knee osteoarthritis.

    The researchers found that from 1974-1994, several ethnic groups in the NHANES study, namely, non-Hispanic white and Mexican-American men and women and black women, experienced a 65% increase in age- and BMI-adjusted knee pain. Among FOA participants, the prevalence of age- and BMI-adjusted knee pain and symptomatic osteoarthritis approximately doubled in 20 years among women, and tripled among men.

    Remarkably, the researchers saw no such trend among FOA participants in terms of the prevalence of radiographic evidence of osteoarthritis. "[T]he age- and BMI-adjusted prevalence of radiographic knee osteoarthritis did not substantially change over this same period for men  and actually may have decreased for women," the article says.

    An accompanying editorial says clinicians should "carefully consider, from the signs and symptoms of the patient presenting with knee pain, a broad differential diagnosis. Not all knee pain in middle-aged and older adults is the result of osteoarthritis."

    Blog: Physical Therapy and the 'Triple Aim' of Health Care

    In the 21 months since health care reform legislation passed, much discussion has revolved around the "Triple Aim" of health care. Learn more about the Triple Aim and how physical therapy can help achieve its objectives of improving the experience of care, improving the health of populations, and reducing per capita costs of health care in today's Moving Forward blog post

    HHS Issues Proposal to Define Essential Health Benefits

    The Department of Health and Human Services (HHS) today issued its long-awaited proposal to define essential health benefits (EHB) under the Affordable Care Act. Of particular importance to physical therapists is the agency's proposal to cover the 10 categories of services identified in the statute, which include rehabilitative and habilitative services and devices.

    Under the intended approach, states have flexibility to develop their plans around 4 benchmark plan types:

    • 1 of the 3 largest small group plans in the state
    • 1 of the 3 largest state employee health plans 
    • 1 of the 3 largest federal employee health plan options
    • the largest HMO plan offered in the state's commercial market  

    HHS believes this will allow states to tailor their plans based on its population's unique needs. The agency states, "To meet the EHB coverage standard, HHS intends to require that a health plan offer benefits that are "substantially equal" to the benefits of the benchmark plan selected by the state and modified as necessary to reflect the 10 coverage categories. This is the same equivalency standard that applies to plans under CHIP. Similar to CHIP, HHS intends to propose that a health insurance issuer have some flexibility to adjust benefits, including both the specific services covered and any quantitative limits provided they continue to offer coverage for all 10 statutory EHB categories."

    Specific to habilitative services, HHS is considering 2 options if a benchmark plan does not include coverage for habilitative services: (1) Habilitative services would be offered at parity with rehabilitative services -- a plan covering services such as physical therapy, occupational therapy, and speech therapy for rehabilitation must also cover those services in similar scope, amount, and duration for habilitation; or (2) As a transitional approach, plans would decide which habilitative services to cover, and would report on that coverage to HHS. HHS would evaluate those decisions, and further define habilitative services in the future.

    Based on the states' ability to tailor the plans and consider adding optional services or increased numbers of visits, it is important that APTA's state chapters continue to educate and foster relationships with their state agencies to ensure that rehabilitative services are optimized in the plans. 

    APTA will respond to the HHS bulletin before the January 31, 2012, deadline. The association also will provide resources to members to use at the state level.

    Medicare to Implement Prior Authorization Demonstration Project for Power Mobility Devices in 2012

    Under a demonstration announced in November, Medicare will implement a prior authorization process for all power mobility device claims in 7 high risk states—California, Illinois, Michigan, New York, North Carolina, Florida, and Texas. The purpose of the project is to circumvent the ability to get fraudulent claims through Medicare's claims payment systems.

    The project will occur in 2 stages. During the first stage, claims for power mobility devices will be on 100% prepayment review beginning for dates of service on or after January 1, 2012. The second stage will implement prior authorization for these claims in which the durable medical equipment Medicare Administrative Contractors will review the claims and postmark a notification of denial or approval within 10 days. For more information, physical therapists can view the resources created by the Centers for Medicare and Medicaid Services for the December 2 special open door forum on this issue.

    PTJ Launches Mobile Web Site

    PTJ recently launched its mobile Web site, which is a more streamlined version of PTJ Online. The mobile site is compatible with most smartphones and tablet devices and includes:

    • access to full text and PDFs, January 1999 to present
    • access to PTJ's legacy archives, January 1980 through December 1998 (PDF only)
    • accepted manuscripts published ahead of print 
    • figure/table-only views
    • keyword, title, and author search capabilities
    • fully linked reference lists
    • PTJ's podcasts

    Bookmark the Web site today and have PTJ at your fingertips whenever you need it. 

    APTA Communities Unavailable December 16-20

    APTA Communities will be unavailable beginning December 16, 3 pm ET, until as late as December 20, 5 pm ET, as APTA makes upgrades to the collaboration platform.

    As a result of the upgrade, APTA Communities will have a familiar yet improved look and feel, with more detailed navigation menus and breadcrumbs and a "ribbon" menu for more intuitive content authoring and management.

    APTA Communities allow groups to collaborate based on shared interests or responsibilities through discussion forums, document sharing, and more.

    New CPT Codes for EMG Effective January 1

    The 2012 version of CPT includes 3 add-on codes and introductory language for needle electromyography (EMG) performed in conjunction with nerve conduction studies. This document includes a description of the new codes and guidance for their use. The codes are available for physical therapists (PTs) to report effective January 1, 2012. However, PTs should check payer policy to determine coverage of the codes.

    New in the Literature: Sit-to-Stand Test (Clin Rehabil. 2011 Nov 11. [Epub ahead of print])

    The 5-repetition sit-to-stand test is a reliable and valid test to measure functional muscle strength in children with spastic diplegia, say authors of an article published online in Clinical Rehabilitation.  

    For this study, the authors tested 108 children with spastic diplegia and 62 with typical development, ages 5-12 years, in the hospital, laboratory, or home. For test-retest reliability, 22 children with spastic diplegia were tested twice within 1 week. The main measure was the time needed to complete 5 consecutive sit-to-stand cycles as quickly as possible.

    The intraclass correlation coefficients of intra-session reliability and test-retest reliability were 0.95 and 0.99 respectively. The minimal detectable difference was 0.06 rep/sec. The convergent validity of the 5-repetition sit-to-stand test was supported by significant correlation with 1-repetition maximum of the loaded sit-to-stand test, isometric muscle strength, scores of Gross Motor Function Measure, and gait function (r or rho = 0.40-0.78). For known group validity, children with typical development and children classified as Gross Motor Function Classification System level I performed higher rates of 5-repetition sit-to-stand than children classified as level II; children classified as level II performed higher rates than level III.

    US Health Care Delivery System Not Fit for Modern Times, Says Berwick

    The United States has "set up a [health care] delivery system that is fragmented, unsafe, not patient-centered, full of waste, and unreliable," Donald Berwick, MD, told Kaiser Health News on Monday. "Despite the best efforts of the workforce, we built it wrong. It isn't built for modern times."

    Berwick, who stepped down from his post as administrator of the Centers for Medicare and Medicaid Services (CMS) earlier this month, said health reform is changing how physicians and hospitals are paid and care is delivered care through such new arrangements as Accountable Care Organizations (ACOs). But he said it is unclear whether such efforts would produce results quickly enough to hold off critics, including most Republicans, who want to make more radical changes that would shift more of the burden to beneficiaries.

    Berwick said during his tenure at CMS his most challenging decisions involved state requests to cut Medicaid benefits and writing regulations to encourage physicians and hospitals to form ACOs to work more closely, while not making the requirements overly burdensome.

    He also criticized state efforts to limit hospital coverage for Medicaid recipients, currently under review by federal regulators. Hawaii has proposed a 10-day coverage limit on some enrollees; Arizona has proposed a 25 day limit. "If a patient needs twenty days, the patient should get twenty days," he said.

    The best way to provide care is through "managed care done right," Berwick said, but if states are not ready to take on the responsibility, it can lead to restrictions that prevent people from getting the care they need.

    IFC Aims to Promote Physical Activity Opportunities for Students With Disabilities

    Despite the benefits of physical activity, individuals with disabilities are not getting the same amount of activity and athletic opportunities as individuals without disabilities, says a new publication based on the proceedings of the Strategic Planning Policy Conference on Physical Activity for Students with Disabilities, which took place June 21-22. The publication promotes awareness of the importance of physical activity for people with disabilities, advocates for physical activity across the spectrum of disabilities, develops policies that are responsive to the needs of people with disabilities, and creates resources that are helpful for program development.

    Physical Activity and Sport for People with Disabilities also contains an integrated strategic plan for the Inclusive Fitness Coalition (IFC) to advance school-based sports and physical activity opportunities for students with disabilities. The plan includes long- and short-term goals; target audiences; and activities related to advocacy, education, community organization/program development, and legal consultation and research. 

    IFC is a national coalition of more than 150 organizations dedicated to addressing the policy, environmental, and societal issues associated with the lack of inclusion and access to physical activity among people with disabilities. The conference proceedings were edited by APTA member Toby Long, PT, PhD, FAPTA.   

    New Podcast: Student Loan Repayment

    Student loan repayment for physical therapists is 1 of APTA's legislative priorities to pursue policies to enhance the physical therapy workforce. One of the most prominent programs is through the National Health Service Corps, which is described in a new APTA podcast that outlines several loan repayment options that exist for physical therapists and physical therapist assistants. 

    A transcript of the prerecorded podcast is available on the podcast Web page. 

    Bill to Add PTs to Armed Forces Health Professions Scholarship

    Legislation introduced on December 8 by Sen Susan Collins (R-ME) would add physical therapists (PTs) and occupational therapists (OTs) to the Armed Forces Health Professions Scholarship, which currently offers tuition assistance for physicians, dentists, nurse practitioners, optometrists, psychologists, physician assistants, pharmacists, and veterinarians serving in the Army, Navy, and Air Force.

    Collins had proposed the addition of PTs and OTs to the scholarship program in an amendment to the National Defense Authorization Act of 2012. In talking points on the amendment, which was not considered due to time limitation on debate, she said that data provided by the Department of Defense indicates there is a shortage of both PTs and OTs in the Air Force and the Navy—in active duty, reserve, civilian, and contractor positions. Collins called the inclusion of PTs and OTs an "important insurance policy against a shortfall of these medical professionals who help our wounded warriors return to living full and independent lives."

    APTA is awaiting word on how the bill (S 1976) is expected to move through the legislative process.   

    APTA Launches Holiday-Themed Contest for Consumers

    Today, APTA launched its "12 days of Fitness" scavenger hunt contest. The goal of the holiday-themed contest is to expand Move Forward's presence on Twitter and Facebook and drive traffic to MoveForwardPT.com to learn who and what physical therapists treat and where patients can find one. At 10 am ET from December 12-23, APTA will post a clue to its consumer Twitter and Facebook pages linking new and current followers back MoveForwardPT.com to find the clue’s answer. Participants will have to watch a video or read content to find the correct answer and submit it by midnight ET. Three winners will be selected at random to receive a prize. Encourage your patients, colleagues, friends, and families to participate in the contest.

    Keiser Joins Foundation's Partner in Research Program

    The Foundation for Physical Therapy recently announced that Keiser Corporation has joined the Partners in Research program as a Silver Level Partner. 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.

    Keiser, founded in 1976, designs, manufactures, and sells devices that individuals can use to build their strength and power.

    House Bill Includes SGR Fix, Extends Cap Exceptions Process

    Today, the House of Representatives released language of the health care provisions in the Middle Class Tax Relief and Job Creation Act. The bill updates the Medicare Physician Fee Schedule Sustainable Growth Rate (SGR) for 2012 and 2013 by 1% -- negating a scheduled 27.4% reduction in payments to providers, including physical therapists who bill under the fee schedule. The bill also provides a 2-year extension of the therapy cap exceptions process with modifications. As currently written, the bill creates a 2-stage exceptions process. In this 2-stage process, physical therapists would submit claims using the KX modifier when the $1,880 cap is reached. At $3,700 a manual review would be required to ensure that the plan of care is medically necessary. APTA is reviewing this and other provisions of the bill, including the application of these provisions in the outpatient hospital setting and federal agency reporting on the new process.

    The House is expected to vote on the bill next week. Early next week the Senate is expected to release its version of the bill. Both chambers need to pass their respective bills and send them to conference for a final bill to be drafted and sent back to both the House and Senate for full votes. Thus, today's action by the House is just the beginning of what promises to be a long and uncertain week on Capitol Hill.

    Registration Deadline Approaches for Medicare 2012 Audio Conference

    Registration closes December 12 for APTA's Medicare 2012 - The Year Ahead for Outpatient Physical Therapy audio conference, which will be held December 15, 2pm-3:30pm, ET.

    New Medicare payment policies that will take effect in 2012 can have a significant impact on physical therapist practice and payment for outpatient therapy services. Find out the latest information on the new 2012 Medicare fee schedule payment rates, the therapy cap, the Physician Quality Reporting System, provider enrollment, Medicare Administrative Contractor activities, and more.

    Coding and payment policy expert Steve Levine, PT, DPT, MSHA, joins Gayle Lee, JD, APTA’s director of federal payment policy and regulatory affairs, to provide critical information about Medicare’s new rules affecting coverage and payment for physical therapy services in 2012. During a Q&A session following the overview, participants may ask questions directly to the experts. Learn more.

    Registration ends December 12 at 11:00 pm, ET, or as soon as all available spaces are filled. Register online today, or call APTA Member Services at 800/999-2782, ext 3395.

    If you can't participate live in the live event, you may purchase the downloadable file, which includes the audio conference recording and handouts, for the same price. The file will be available after January 1, 2012.

    December Craikcast: Looking at Disability in a New Light

    In PTJ's December Craikcast, Editor in Chief Rebecca Craik, PT, PhD, FAPTA, discusses the special issue "Advances in Disability Research" with its co-editors, Alan Jette, PT, PhD, FAPTA, and Nancy Latham, PT, PhD. Themes in this month's issue include the movement in disability research that celebrates disability as a form of diversity, the development of measures for people with disabilities toward quality of life or participation, and the need to for physical therapists to think beyond impairments when considering outcomes and quality of life for patients. 

    2012 PQRS Measure Information Now Available

    The Centers for Medicare and Medicaid Services has released the updated measures specifications for the Physician Quality Reporting System (PQRS) for the 2012 reporting year, which include 2 major changes of importance to physical therapists—the ability to participate in reporting for the Functional Outcome Assessment Measure (#182) and changes to the existing Pain Assessment Measure (#131). The measure specifications provide program participants with important information regarding such as the measure definition, reporting instructions, and the qualifying case information (numerator and denomination definitions), which include the relevant quality data codes for reporting.

    Physical therapists will be eligible to participate in reporting for an additional individual measure in the 2012 reporting year—Measure #182: Functional Outcome Assessment. The Functional Outcomes Assessment measure requires documentation of a current functional outcome assessment using a standardized functional outcome assessment and documentation of a care plan based on identified functional outcome deficiencies. APTA will create a new podcast before the year's end to provide practitioners with additional details around reporting for this measure.

    Practitioners also should note that major changes have been made to the quality data reporting codes for Measure #131, the Pain Assessment Measure. The quality data codes for this measure have been changed for 2012; the 2011 quality data codes for this measure cannot be used in the 2012 reporting year. 

    See the new 2012 measures specifications for further details located on APTA's PQRS Web site under the "2012 PQRS Measure Details" section.

    New Resources Available to Assist State Advocacy Efforts on Fair PT Copays

    There are growing national concerns regarding the increasing financial burden of out-of-pocket expense for the health care consumer, especially as it relates to physical therapy services. Under certain health plans, copayments for physical therapy services, some as high as $60 per visit, exceed the reimbursement paid by the plan to the provider of care. In addition, in many states and health insurance contracts, the physical therapist (PT) is classified under the specialist designation, which increases the financial burden to the patient by imposing higher copayments and thus restricts access to physical therapy services. High copayments for physical therapy have recently been cited as a reason that some consumers opt to reduce their frequency of care or forgo medically necessary care—running the risk of worsening the underlying condition and/or risking reinjury, thus potentially negatively impacting patient care outcomes.

    APTA supports state legislation that provides for fair physical therapy copays and prevents cost-shifting to the patient as a result of categorizing physical therapists under the specialist designation. Building on the successful legislative effort earlier this year by the Kentucky Chapter to enact fair PT copays legislation in that state, APTA's Government Affairs and Payment Advocacy Unit has begun developing resources for chapters to advocate on this issue at the state level. A number of state chapters are currently coordinating with APTA State Government Affairs on possible 2012 state legislation. Be sure to check out the new resource Web page.  

    Gaps in Care After Discharge Common for Adults

    One in 3 adult patients aged 21 and older who are discharged from a hospital to the community does not see a physician within 30 days of discharge, according to a new national study by the Center for Studying Health System Change (HSC). Even 90 days after discharge, 17.6% still had not seen a physician, nurse practitioner, or physician assistant.  

    Many adults who do not see a physician after discharge are at high risk of readmission because of chronic conditions or physical activity limitations, according to the study, which used 2000-2008 data from the nationally representative Medical Expenditure Panel Survey to estimate the prevalence of hospital readmissions for all causes—other than obstetrical care—for adults aged 21 and older.

    About 1 in 12 adults (8.2%) aged 21 and older discharged from a hospital to the community was readmitted within 30 days, according to the study, and 1 in 3 adults (32.9%) was rehospitalized within 1 year of discharge.

    Other key findings include:

    • Thirty-day readmission rates are much higher for people who are sicker.
    • Among adults aged 21 to 64, readmission rates were highest for people with public coverage, mainly Medicare or Medicaid.
    • The vast majority of people admitted to a hospital reported having a usual source of care (90%). Only about a third of people with a usual source of care reported that after-hours care was available, and about one-fifth said it was difficult to contact their usual source of care by phone about a health problem. One in 10 reported difficulty getting to their usual source of care, which may reflect long travel times or lack of transportation.

    On an annual basis, expenditures were $16.3 billion for hospital readmissions up to 30 days after discharge. While much of the policy focus has been on changing payment incentives in Medicare to decrease readmissions, private insurance pays for a greater share of 30-day readmissions (about 47%) than does Medicare (about 40%).

    New in the Literature: Acute Postburn Rehabilitation (J Burn Care Res. 2011 Oct 5. [Epub ahead of print])

    In patients with burns, using the Nintento Wii appears to improve anxiety, active range of motion (AROM), function, and enjoyment at a faster rate compared with patients who do not use the gaming device, say authors of an article published in Journal of Burn Care & Research. Presence (immersion into a virtual environment) minimally changed between successive treatment sessions for those in the Wii group, they add.

    For this study, participants were alternated and stratified based on the location of burn into Wii or control treatment groups. Joints of interest with limited AROM were the shoulder, elbow, wrist, hip, knee, and ankle. All participants received 3 consecutive sessions of passive range of motion and predetermined joint-specific exercises. This was followed by either designated Wii games or therapist-chosen interventions (control). Data from 23 participants aged 20 to 78 years were analyzed.

    The difference in mean slopes suggested that the Wii group experienced less pain than the control group over time. Although statistical significance was not reached in any category, feasibility was supported, and the overall pattern for outcomes was positive for the Wii group, the most favorable being for pain reduction. Future research with larger sample sizes is warranted to explore best practice with video game technology throughout the continuum of burn rehabilitation with appropriate prescriptions, say the authors.

    Fitness More Important Than Weight in Lowering Death Risks

    In a study of more than 14,000 people, maintaining or improving fitness was associated with a lower death risk even after controlling for Body Mass Index (BMI) change, according to the American Heart Association.

    Researchers used maximal treadmill tests to estimate physical fitness (maximal metabolic equivalent of task [METs]), and used height and weight measurements to calculate BMI. They recorded changes in BMI and physical fitness over 6 years. After more than 11 years of follow-up, researchers determined the relative risks of dying among men who lost, maintained, or gained fitness over 6 years. They accounted for other factors that can affect outcomes, including BMI change, age, family history of heart disease, beginning fitness level, changes in lifestyle factors, and medical conditions.

    The authors found:

    • Every unit of increased fitness (MET,) over 6 years was associated with a 19% lower risk of heart disease and stroke-related deaths and a 15% lower risk of death from any cause.
    • Becoming less fit was linked to higher death risk, regardless of BMI changes.
    • BMI change was not associated with death risks.

    One possible explanation for these results, says AHA, is that about 90% of the men were either normal weight or overweight at the beginning of the study. Among people who are obese, changes in BMI might have a significant effect on death risks. It's unclear whether these results would apply to people who are severely obese.

    Because the study was mostly done in white middle- and upper-class men, it's difficult to know whether the results apply to other racial and socioeconomic groups. Women would likely have similar results as the men in the study, said lead author Duck-chul Lee, PhD.

    The study is published in Circulation: Journal of the American Heart Association. 

    CMS Enhances Online Presence

    The Centers for Medicare and Medicaid Services (CMS) relaunched its Website, www.cms.gov, yesterday, making information more accessible for patients, partners, providers, states, advocates, and others who interact with the agency. The site is anticipated to be more user-friendly and has enhanced search capabilities. The Center for Medicaid and Chip Services also launched www.medicaid.gov, which focuses on policies related to Medicaid and the Children's Health Insurance Program. The Affordable Care Act (ACA) mandates Health and Human Service agency transparency, and the Web site serves to demonstrate this through information sharing and program information freely accessible to individuals, states, and other stakeholders. The Web site includes federal policy guidance, ACA implementation status, lists of state-approved and pending waivers, and state-specific data and program information. 

    CMS is asking for public input on how to improve the site. Physical therapists are encouraged to submit ideas or comments to CMS's Idea Factory.

    Improving Adolescent and Young Adult Health Through Healthy People 2020

    On December 13, noon to 1:30 pm ET, the US Department of Health and Human Services will present an overview of the adolescent health topic area in Healthy People 2020, the connection between Healthy People 2020 and education, and action steps that health care and public health professionals can take to improve adolescent health. 

    Register to attend the Webinar to learn about and discuss issues surrounding the Healthy People 2020 adolescent health topic area and related objectives.

    Rheumatologists Issue New Guides for Pain Measurements

    New guidelines for measuring pain in patients with rheumatic conditions recommend that clinicians use the Numeric Rating Scale for Pain (NRS Pain) for estimating patients' pain intensity and the Short Form-36 Bodily Pain Scale (SF-36 BPS) for evaluating pain in the context of overall health status, says an article by Medscape Medical News based on a review published online last month in Arthritis Care & Research.  

    The review, part of the journal's special issue titled "Patient Outcomes in Rheumatology, 2011," includes the Visual Analog Scale for Pain (VAS Pain), NRS Pain, McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), SF-36 BPS, and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Details on questionnaire content, ease of use, and measurement properties are included in the review of each questionnaire. The review also discusses the strengths and weaknesses of each questionnaire.

    The authors also recommend the ICOAP for assessment of osteoarthritis-related pain.

    2012 APTA State Legislative Grants Announced

    APTA will provide state legislative grants to 5 chapters to assist with their 2012 state legislative advocacy efforts. The state chapters receiving grants for the upcoming year are Alabama, Indiana, Michigan, Mississippi, and South Carolina. Each year APTA selects from chapters that have submitted grant applications requesting financial assistance toward implementation of their state legislative agendas, as well as to defend against infringement. Grants are awarded to state chapters that meet the required criteria and whose legislative advocacy works toward the fulfillment of Vision 2020.

    Therapy Cap Exceptions Process to Expire in 29 Days

    Unless Congress takes action, the therapy cap exceptions process will expire December 31. Yesterday, APTA called on its grassroots network to urge Congress to pass legislation before December 31 to extend the therapy cap exceptions process and avoid the scheduled 27.4% cut in provider payments under the Medicare physician fee schedule.    

    Join your colleagues in this important advocacy effort. Take action through APTA's Legislative Action Center and sign up for APTA's grassroots network, PTeam. PTeam will be the main source of information for legislative updates and breaking news on the effort to pass legislation to extend the therapy cap exceptions process and avoid the 27.4% cut.

    2012 Slate of Candidates Posted

    The 2012 Slate of Candidates for APTA National Office now is available on APTA's Web site. It also can be found in the House of Delegates community documents. The Candidate Web page, including candidate statements, will be posted on February 3, 2012. Elections for national office will be held at the 2012 House of Delegates on June 4, 2012. Contact Peyton Zeek in APTA's Governance Department for additional information.

    Sisto Receives ACRM Fellow Award

    APTA member Sue Ann Sisto, PT, MA, PhD, FACRM, recently was named a Fellow of the American Congress of Rehabilitation Medicine (ACRM). ACRM is the world's leading interdisciplinary rehabilitation research organization. The Fellow of ACRM designation recognizes individuals who make significant contributions to the field of rehabilitation and to ACRM for at least 5 consecutive years, have an outstanding record of professional service, and have a sustained record of contributions of national significance to medical rehabilitation in the areas of clinical practice, research, education, and administration. Sisto has been a member of ACRM since 1998 and served on numerous committees over the years. Her greatest contribution was the development of the SCI networking group, which she was instrumental in elevating to ACRM’s SCI special interest group (SIG) in 2009. She has served on the Board of Governors as member at large, secretary, vice president and now president-elect. Sisto is the first physical therapist to receive the ACRM Fellow designation. 

    Sisto is professor of physical therapy and director of research in rehabilitation sciences at Stony Brook University. She has been a physical therapist for more than 32 years and specializes in pathokinesiology. Her doctoral studies at New York University were funded by grants from the National Institute on
    Disability and Rehabilitation Research and the Foundation for Physical Therapy.

    Her current research direction is recovery of locomotion in spinal cord injury (SCI), but her grants and publications span broad areas of rehabilitation outcomes with neurological/orthopedic patients. Sisto has served on multiple grant review panels and is the associate editor for the Journal of Spinal Cord Injury Medicine. Her textbook on SCI rehabilitation was published in 2009. Sisto has served on various National Institutes of Health review committees and is chair of the Rehabilitation Advisory Board grant review panel for Shriners Hospital for Children. She has served on APTA's Scientific Review Committee and the Nomination Committee and currently is vice chair of the Neurology Section’s Spinal Cord Injury SIG.

    Medicare to Cover Preventive Services for Obesity

    Preventive services for obesity now will be included under Medicare and can be provided by primary care physicians or primary care practitioners only (nurse practitioners, clinical nurse specialists, or physician assistants) in primary care settings only.

    Under the regulations, announced on Tuesday by the Centers for Medicare and Medicaid Services, physical therapists do not currently fit all the requirements to provide obesity intensive preventive therapies, which include:

    1. Screening for obesity in adults (BMI measurement; BMI ≥ 30 kg/m2);
    2. Dietary (nutritional) assessment; and
    3. Intensive behavioral counseling and behavioral therapy through high-intensity interventions, including diet and exercise. 

    Additionally, any behavioral intensity therapy should meet the 5-A framework recommended by the US Preventive Services Task Force:

    1. Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
    2. Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
    3. Agree: Collaboratively select appropriate treatment goals and methods based on the patient's interest in and willingness to change the behavior.
    4. Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
    5. Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.

    Primary care physicians in non-primary care settings are not precluded from conducting an obesity screening, then referring the patient to a primary care setting for further obesity therapy to be conducted by the primary care physician or primary care practitioner.

    APTA is gathering the necessary supportive data to demonstrate the value of physical therapy interventions in reducing obesity and to advocate for inclusion of physical therapists in obesity prevention.