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  • APTA Continues Advocacy on Cap and Cuts Solution; Encourages Members to Monitor Latest Updates

    Congress recessed last week without reaching a deal on sequestration or taking action to extend the Medicare therapy cap exceptions process and avoid cuts to the sustainable growth rate (SGR) formula. The Senate resumed legislative business this week. Yesterday, House Speaker John Boehner issued notice that the House will return on Sunday, in hopes that legislators can reach a deal on the fiscal cliff before December 31. However, at this time it is uncertain whether a fiscal cliff deal will be voted on by the deadline. Thus far, congressional negotiators have indicated that an SGR "fix" and a provision to extend the cap exceptions process would be carried in the larger fiscal cliff package.  

    APTA is continuing its lobbying efforts to extend the cap exceptions process and prevent SGR payment cuts. Over the next few days, you can weigh in with Congress via APTA's Legislative Action Center and look for information and updates on APTA's Latest Legislative Action webpage as the December 31 deadline approaches. You also can check APTA's Medicare Therapy Cap and Medicare Physician Fee Schedule webpages for up-to-date information.

    To help members comply with several new policies that will go into effect next week, APTA has posted "What You Need To Know on January 1, 2013" at www.apta.org/LegislativeAction/.  

    Using MI in the Clinic: A Student's Perspective

    In a new APTA podcast, Kim Redlin, a third-year doctor of physical therapy student at St Catherine University, shares how she has incorporated motivational interviewing (MI) into her interactions with patients. Specifically, Redlin describes how while working with a patient who had knee replacement surgery she was able to obtain meaningful information about the patient's efforts to quit smoking that "slowly opened the door" for her to provide education about behavior change. Redlin also discusses how MI "can be a real challenge for both students and professionals." She asks, "[Y]ou want to make sure that all boxes get checked – get informed consent, get a pain rating, get a range of motion measurement, use an outcome measure, but how often is there a box to check for addressing health behaviors and talking about change?"

    This podcast is the fourth in a series on behavior change.

    APTA podcasts are prerecorded discussions and interviews, not live events. Members can listen to podcasts at their convenience by clicking on the links provided in News Now articles, visiting www.apta.org/podcasts/, or subscribing to APTA podcasts on iTunes.

    New in the Literature: Squatting as a Clinical Marker of Function After Total Knee Arthroplasty (Am J Phys Med Rehabil. 2013;92(1):53-60.)

    In patients who have primary unilateral knee arthroplasty, as rehabilitation visits increased there was a direct association to improved interlimb weight-bearing symmetry when squatting to 60 degrees, say authors of an article in American Journal of Physical Medicine & Rehabilitation

    For this study, the percentage of body weight placed over both limbs during stand and 30- and 60-degree squats in 38 patients (25 women and 13 men) who had primary unilateral knee arthroplasty was determined. An asymmetry index was used as a marker that could discriminate between patients who perceived at least moderate difficulty with functional tasks and those who perceived only slight or no difficulty with functional activities based on the physical function dimension of the Western Ontario McMaster Universities Osteoarthritis index approximately 1 week after surgery. Stepwise regression was conducted to determine whether clinical characteristics predicted weight-bearing asymmetry at discharge.

    At initial visit (first observation), compared with the uninvolved side, individuals placed significantly less body weight over the involved or operated limb for stand and 30- and 60-degree squats. Results were similar at last rehabilitation visit (second observation). Identifying at least moderate self-reported difficulty with functional tasks based on the receiver operator characteristic curve for the asymmetry index for the stand position was 0.64, whereas for the 30- and 60-degree squats, the area under the curve was 0.81 and 0.89, respectively. At discharge from rehabilitation, there was a moderate to good direct relationship (r = 0.70) between the number of rehabilitation visits completed and the weight-bearing asymmetry index for the 60-degree squat.

    APTA member Mark D.Rossi, PT, PhD, CSCS, is the article's lead author. APTA members Thomas Eberle, PT, DPT, DMT, FAAOMPT, Denis Brunt, PT, EdD, Marlon Wong, PT, DPT, OCS, MTC, and Matthew Waggoner, PT, DPT, MTC, are coauthors.    

    New Standards Call for Less Intensive Blood Pressure Goals for People With Diabetes

    The American Diabetes Association is recommending changes in blood pressure goals for people with diabetes and clarifying how frequently people with type 1 diabetes should test their blood glucose levels.

    The revised recommendations include raising the treatment goal for high blood pressure from <130 mm Hg to <140 mm Hg, based on several new meta-analyses showing there is little additional benefit to achieving the lower targets. Clinical trials have demonstrated health benefits to achieving a goal of <140 mm Hg, such as reducing cardiovascular events, stroke, or nephropathy, but limited benefit to more intensive blood pressure treatment, with no significant reduction in mortality or nonfatal heart attacks. There is a small but statistically significant benefit in terms of reducing risk of stroke, but at the expense of a need for more medications and higher rates of side effects.

    The new standards also clarify when people who are taking multiple daily doses of insulin (MDI) or using insulin pumps, typically those who have type 1 diabetes, should test their blood glucose levels. Previously, the standards called for those taking insulin to test "3 or more" times throughout the day, a recommendation that was sometimes misinterpreted to mean that 3 times per day was sufficient. Recognizing that the frequency of testing will differ by individual and by situation, the new standards do not specify the number of times that testing should occur but instead focus on the conditions under which testing should occur. For example, the standards now specify that patients on MDI or insulin pumps should test prior to meals and snacks, occasionally after eating, at bedtime, before exercise, when they suspect low blood glucose, after treating low blood glucose levels until they return to normal, and "prior to critical tasks such as driving."

    Additionally, the new standards highlight that for patients on less intensive regimens or noninsulin therapies, self-monitoring of blood glucose needs to be linked to educating the patient about how to use the information about glucose levels appropriately. These patients must also be educated about how frequently they need to test and under what conditions.

    The new guidelines will be published in a special supplement to the January issue of Diabetes Care as part of the association's revised Standards of Medical Care, which are updated annually to provide the best possible guidance to health care professionals for diagnosing and treating adults and children with all types of diabetes. The standards are based upon the most current scientific evidence, which is reviewed by the association's multidisciplinary Professional Practice Committee.

    More Than 1,400 Hospitals Penalized Under Readmissions Reduction Program

    Medicare is rewarding 1,557 hospitals with bonuses and reducing payments to 1,427 others based on their readmission rates for heart attack, heart failure, and pneumonia, says a Kaiser Health News  article.

    The biggest bonus is going to Treasure Valley Hospital, a physician-owned, 10-bed hospital in Boise, Idaho, that is getting a 0.83% increase in payment for each Medicare patient. Auburn Community Hospital, a nonprofit near Syracuse, New York, is facing the biggest cut, losing 0.9% of every payment.

    On average, hospitals in Maine, Nebraska, South Dakota, Utah, and South Carolina will fare the best. Hospitals in the District of Columbia, Connecticut, New York, Wyoming, and Delaware are among the worst, the article says. 

    Results for hospitals within the same system often varied. For instance, in Rochester, Minnesota, the Mayo Clinic's Methodist Hospital will get a bonus. But Mayo's flagship St Mary's Hospital, also in Rochester, will lose money. Michael Rock, MD, an orthopedic surgeon at the Mayo Clinic, said that Medicare's scoring system tends to favor hospitals such as Methodist, which primarily does elective surgeries, over hospitals with lots of trauma and emergency cases, which St Mary's handles.

    Under the Affordable Care Act's Hospital Readmissions Reduction Program, Medicare will begin adjusting payments next month through September 2013 and will retroactively apply the changes to payments made in the last 3 months of this year.

    The bonuses and penalties do not apply to money Medicare pays hospitals for capital expenses, to teach residents, or to treat large numbers of low-income patients. Hospitals with too few cases and ones that only offer specific specialties, such as psychiatry, long-term care, rehabilitation, and cancer treatment, are exempted. Maryland hospitals also are excluded because the state has a unique reimbursement arrangement with the federal government.

    In August, Kaiser Health News reported that more than 2,000 hospitals were expected to be penalized.

    Physical therapists can help serve an important role in patient care transitions and care coordination and can help reduce readmissions by providing recommendations for the most appropriate level of care to the health care team prior to and during care transitions. For more information and to find clinical practice and patient education resources to reduce readmissions, visit APTA's Hospital Readmissions webpage

    APTA Urges CMS Officials to Stop Cuts for EMG/NCV Services

    On December 20, APTA, the American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular & Electrodiagnostic Medicine, and American Academy of Neurology met with Jonathan Blum, deputy administrator and director of the Centers for Medicare and Medicaid Services (CMS), to discuss cuts for electromyography/nerve conduction velocity (EMG/NCV) services that will go into effect January 1, 2013. Other CMS officials attended the meeting via videoconference.   

    Representatives from the 4 associations explained that the payment cuts to providers would be between 40%-70%. APTA discussed the fact that most physical therapists (PTs) who provide EMG/NCV do so exclusively (100% of their practice). Additionally, many of these PTs serve patients in rural areas and often drive long distances to treat them. Thus, the deep cuts could have a detrimental impact on patient access to these services.   

    The associations requested that CMS phase in the cuts over a 4-year period to allow time to revisit the values for NCV studies before such draconian cuts become effective. Blum stated that CMS did not have legal authority to do such a phase-in, nor would it be possible to change the values for 2013; however, CMS would consider changing the values for 2014.

    Blum stated that CMS is concerned with any effects that the reductions in payment for EMG/NCV codes would have on Medicare beneficiaries. He said that CMS would study the impact of the cuts over the next year. Blum continued that he would be open to consulting with the organizations over the next month to identify ways that CMS could track the impact, specifically through claims forms. If CMS identifies a negative impact, the agency would likely take steps to calibrate the payment differently for 2014. Further discussion related to NCV studies is expected.

    On December 6, APTA sent an action alert urging association members to contact their members of Congress about the scheduled payment cuts. Four days later, APTA and more than 120 other organizations concerned about the impact of the 2013 cuts to reimbursement for electrodiagnostic procedures sent a coalition letter to congressional leadership and committees. 

    Be a Part of APTA's 'Fit After 50' Initiative

    Are you helping patients who are aged 50 or older to maintain their fitness and mobility? Are you a PT or PTA aged 50+ who is "walking the walk" by staying active and mobile as you age? If the answer is "yes" to either of these questions, APTA wants to hear from you. E-mail public-relations@apta.org with a brief description, and we’ll arrange a brief video recording of you while you are at the Combined Sections Meeting to post on www.apta.org/FitAfter50.

    2012 APTA State Award Winners Announced

    APTA presented its 2012 State Legislative Leadership Awards December 1 at the State Policy and Payment Forum in Alexandria, Virginia. For their individual leadership on legislation advancing or defending Vision 2020 in the state arena, APTA's Board of Directors (Board) awarded the 2012 State Legislative Leadership Award to Phil Moe, PT, of South Dakota, and Emmett Parker, PT, MS, ATC, of Alabama. Moe was recognized for his work to successfully pass legislation to limit patient copays for physical therapy. Parker was recognized for his leadership on the passage of legislation that made Alabama the 47th state with direct access to physical therapy.

    In recognition of their long-term commitment to their chapters' advocacy activities over several years and for consistently providing assistance in the statehouse, the Board awarded the 2012 APTA State Legislative Commitment Award to David Morris, PT, PhD, of Alabama, and Kathleen Picard, PT, of Minnesota. Morris was recognized for his many years of service supporting the Alabama Chapter's legislative efforts on a variety of issues, including infringement challenges, POPTS, and this year's direct access campaign. Picard's leadership has been invaluable to the Minnesota Chapter's success in advocating on a variety of state legislative and regulatory issues, including the recent repeal of a burdensome prior authorization process in the state's medical assistance program. Read more at www.apta.org/StateAdvocacy/LegislativeLeaderAward/.

    Physical Therapist Ranks Fifth in Best Health Care Jobs Report

    Yesterday, US News & World Report released its annual Best Jobs report. For 2013, physical therapist ranks fifth among the best health care jobs and eighth among the top 100 jobs. Physical therapist assistant ranks ninth in the best health care jobs category.  

    Interactive Map Provides Latest Updates on Exchanges

    Use this updated interactive map from The Commonwealth Fund to review the status of state action on state health insurance exchanges and view key aspects of existing exchanges, state legislation, and executive orders. Details include information on exchanges' governance, board membership

    New Webinar: Reporting Functional Limitations on Claim Forms

    Beginning January 1, 2013, outpatient therapy providers will need to report information about their Medicare patient’s functional limitations on the claim form. This reporting requirement will apply to outpatient physical therapy, occupational therapy, and speech language pathology services provided in hospitals, critical access hospitals, skilled nursing facilities, comprehensive outpatient rehabilitation facilities (CORFs), rehabilitation agencies, home health agencies (when the beneficiary is not under a home health plan of care), and in private offices of therapists, physicians and nonphysician practitioners. A new APTA webinar recording provides information regarding the new functional limitation reporting as you implement the requirement in your practice. Specific information is provided on which new codes to report, documentation, and claims submission. The video can be found on the Functional Limitation Reporting Under Medicare webpage under General Information.  

    BJD Issues Call for Action in Wake of Global Burden of Disease Study

    Following the December 13 publication of the Global Burden of Disease Study 2010 (GBD 2010) in The Lancet, The Bone and Joint Decade (BJD) issued a call for urgent action by the World Health Organization, the United Nations, and by national governments and for explicit plans to respond to the study's results and the new ranking that shows that musculoskeletal conditions have an enormous and growing impact in all regions of the world.

    According to BJD's call to action, GBD 2010 shows that musculoskeletal conditions are the second greatest cause of disability globally. Back pain causes the most disability across the globe, with osteoarthritis showing the greatest increase in the last 20 years.

    GBD 2010 is the largest ever systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries, and health risk factors. The results show that infectious diseases, maternal and child illness, and malnutrition now cause fewer deaths and less illness than they did 20 years ago. As a result, fewer children are dying every year, but more young and middle-aged adults are dying and suffering from disease and injury, as noncommunicable diseases become the dominant causes of death and disability worldwide. Since 1970, men and women worldwide have gained slightly more than 10 years of life expectancy overall, but they spend more years living with injury and illness.

    GBD 2010 includes 7 articles, each containing data on different aspects of the study (including data for different countries and world regions, men and women, and different age groups). Accompanying comments include reactions to the study's publication from World Health Organization Director-General Margaret Chan and World Bank President Jim Yong Kim. The study is described by Lancet Editor-in-Chief Richard Horton, BSc MB FRCP FMedSci, as "a critical contribution to our understanding of present and future health priorities for countries and the global community."

    APTA is a founding member of the United States Bone and Joint Initiative, which is part of the international BJD. 

    New in the Literature: Locomotor Rehabilitation of Individuals With Chronic Stroke (Arch Phys Med Rehabil. 2012, Dec 4. [Epub ahead of print])

    Authors of an article published in Archives of Physical Medicine and Rehabilitation say their study is the first step toward discerning the underlying factors contributing to improved walking performance in individuals with chronic stroke.

    For this study, 27 patients with hemiparetic stroke (17 left hemiparesis, 19 men, age: 58.7 + 13.0 years, 22.7 + 16.4 months poststroke) were stratified based on a walking speed change of greater than (responders) or less than (nonresponders) 0.16 m/s. Paired sample t-tests were run to assess changes in each group, and correlations were run between the change in each variable and change in walking speed.

    The patients participated in a 12-week locomotor intervention incorporating training on a treadmill with body weight support and manual trainers accompanied by training overground walking. Motor control, balance, functional walking ability, and endurance were collected at pre- and postintervention assessments.

    Eighteen responders and 9 nonresponders differed by age (responders=63.6 years, nonresponders=49.0 years) and the lower extremity Fugl-Meyer (responders=24.7, nonresponders=19.9). Responders demonstrated an average improvement in walking speed of 0.27 m/s as well as significant gains in all variables except daily step activity and paretic step ratio. Conversely, the nonresponders demonstrated statistically significant improvements only in walking speed and endurance. However, the walking speed increase of 0.10 m/s was not clinically meaningful. Change in walking speed was negatively correlated with changes in motor control in the nonresponder group, implying that walking speed gains may have been accomplished via compensatory mechanisms.

    APTA member Mark G. Bowden, PT, PhD, is the article's lead author. APTA members Andrea L. Behrman, PT, PhD, FAPTA, and Chris M. Gregory, PT, PhD, are coauthors.

    New Workers' Compensation Resources Now Available

    APTA has developed new workers’ compensation resources for members. The resources include a market basket comparison of maximum fee schedule rates in all 50 states and the District of Columbia, as well as state summaries of workers' compensation regulations pertinent to physical therapy services. The link to the map can be found on APTA's Workers' Compensation webpage.

    If you have any questions, comments, or corrections regarding your state's workers' compensation page, contact advovcacy@apta.org.

    Education Added to Categories Available for PTA Recognition of Advanced Proficiency

    The PTA Recognition of Advanced Proficiency Program now recognizes physical therapist assistants (PTAs) who have achieved advanced proficiency as educators. Eligibility requirements include APTA membership, 5 years of teaching experience with 900 total contact hours of teaching, including 180 hours in the past year; 60 contact hours of continuing education, 45 in topics related to education; excellent references; and evidence of a minimum of 3 volunteer experiences.   

    For complete details and to download application forms, visit APTA's website. The next application deadline is February 1, 2013. 

    CER Projects to Study Rehab for Stroke, Nonsurgical Spinal Stenosis Treatment

    The Patient-Centered Outcomes Research Institute (PCORI) yesterday approved 25 awards, totaling$40.7 million over 3 years, to fund patient-centered comparative clinical effectiveness research (CER) projects under the first 4 areas of its National Priorities for Research and Research Agenda.

    The projects approved for funding include those that will study rehabilitation services for survivors of acute ischemic stroke, nonsurgical treatment methods for patients with lumbar spinal stenosis, and a patient-centered risk stratification method for improving primary care for back pain. Other projects seek ways to improve patient-clinician communication, reduce selected health disparities, and improve the way health care systems operate.

    The projects were approved by PCORI's Board of Governors through a competitive, multi-stage review process that incorporated patients, caregivers, and other stakeholders in the evaluation of proposals. Applications were evaluated on scientific merit, engagement of patients and other stakeholders, methodological rigor, and fit within PCORI's research priorities and research agenda.

    The awards are part of PCORI's first cycle of primary research funding and selected from among nearly 500 completed applications submitted earlier this year.

    Insufficient Exercise a Barrier to Decreasing CVD Deaths

    Poor exercise and eating habits could be the game-changer in the fight against heart disease and stroke deaths, according to the American Heart Association's (AHA) "Heart Disease and Stroke Statistical Update 2013."

    Between 1999 and 2009, the rate of deaths from cardiovascular disease (CVD) fell 32.7%, but still accounted for nearly 1 in 3 deaths in the nation. However, according to projections in the 2013 report, heart health may only improve by 6% if current trends continue. The biggest barriers to success are projected increases in obesity and diabetes, and only modest improvements in diet and physical activity. On a positive note, smoking, high cholesterol, and high blood pressure rates are projected to decline.

    Among heart disease and stroke risk factors, the most recent data show:

    • 68.2% of adults are overweight or obese; 34.6% are obese; 31.8% are normal or underweight.
    • 31.8% of children ages 2-19 are overweight or obese.
    • 32% of adults report no aerobic activity.
    • 17.7% of girls and 10% of boys, grades 9-12, report fewer than 1 hour of aerobic activity in the past week.
    • 13.8% of adults have total cholesterol of 240 mg/dL or higher.
    • 33% of adults have high blood pressure; African-Americans have among the highest prevalence of high blood pressure (44%) worldwide.
    • 8.3% of adults have diagnosed diabetes; 8.2% have undiagnosed diabetes; 38.2% have prediabetes.

    AHA says it plans to focus on population-based ways to improve health factors for all Americans. Some of these include:

    • Working with health care systems to support and reward providers who help patients improve their health behaviors and manage their health risk factors.
    • Working with insurers to cover preventive health services and reward positive health behaviors and medication adherence.
    • Working with the education community to make changes in schools that support healthy diets and physical activity for children.
    • Building comprehensive worksite wellness programs.
    • Building healthier communities with improved access to healthier foods and green space for physical activity.

    "Americans need to move a lot more, eat healthier and less, and manage risk factors as soon as they develop," said Alan S. Go, MD, chair of the report's writing committee. "If not, we’ll quickly lose the momentum we've gained in reducing heart attack and stroke rates and improving survival over the last few decades."

    Free full text of the article is available in Circulation

    How Do You Stand By Your Brand?

    The physical therapist brand positions us as experts in restoring and improving motion in people's lives, and we continue to build our brand by providing consistent, quality physical therapy experiences. If you will be attending the Combined Sections Meeting (CSM), e-mail public-relations@apta.org with a brief description of how you are living the physical therapist brand and we'll arrange a brief video recording of you while you are at CSM to post on www.apta.org/BrandBeat.

    Health Plan Premiums and Deductibles Soar From 2003-2011

    Average premiums for employer-sponsored family health insurance plans rose 62% between 2003 and 2011, from $9,249 to $15,022 per year, according to a new Commonwealth Fund report. The report, which tracks state trends in employer health insurance coverage, finds that health insurance costs rose far faster than incomes in all states. Workers also are paying more out-of-pocket as employee payments for their share of health insurance premiums and deductibles have more than doubled.

    The report, State Trends in Premiums and Deductibles, 2003-2011: Eroding Protection and Rising Costs Underscore Need for Action, finds that total health insurance premiums now amount to 20% or more of annual median family incomes in 35 states, affecting 80% of the US working-age population.

    In 2011, average annual premiums for family plans ranged from about $12,400 to $13,500 in the lowest-cost states to more than $15,000 a year in 21 states. Premiums averaged from $16,000 to nearly $17,000 in Delaware, Alaska, Connecticut, Vermont, New York, the District of Columbia, New Hampshire, and Massachusetts, which have the highest average family premiums.

    While average family premiums jumped an average of 62% from 2003 to 2011, median family income rose just about 11%. The increase in premiums ranged from 42% in the lowest-growth state, Tennessee, to 76% in the highest-growth state, New York. Twenty-seven states had increases of 60% or more.

    The report also finds that employees' premium shares grew. The average annual amount an employee paid toward a family health insurance plan rose from $2,283 in 2003 to $3,962 in 2011—a 74% increase.

    Deductibles more than doubled from 2003 to 2011, increasing an average of 117% per person during the 8 years the report studied. In 2011, 78% of workers faced deductibles, up from 52% in 2003. Workers in small firms with fewer than 50 employees typically face higher deductibles than those working for larger firms.

    If historical trends continue, family premiums will reach $24,740 by 2020, an increase of 65% from 2011, says the report.

    The report and an interactive map featuring premiums in each state are available on The Commonwealth Fund's website.

    Podcast Addresses Collaboration Among Rehab Professionals in Telehealth

    "[F]or telehealth to become a reality, rehab professionals and patients/clients must demand more of their personal and overall health care delivery systems," says Alan Lee, PT, DPT, PhD, CWS, GCS, in a new APTA podcast titled Telehealth: Recent Trends, the Importance to Physical Therapy and its Future.  

    Christopher Peterson, PT, DPT, hosts the podcast, the third in a series on telehealth, which also features Bambang Parmanto, PhD, and Tammy Richmond, OT, FAOTA. Lee, Parmanto, and Richmond describe how telehealth practice may develop over the next 10-15 years and discuss the opportunities for collaboration between rehabilitation professionals. Specifically, Parmanto notes the development of common telepractice among rehab professionals "to help toward sharing technologies and sharing outcome data from the service being provided." The group also addresses key areas that need to be addressed for telehealth opportunities to become a reality, such as payment and licensure.

    APTA podcasts are prerecorded discussions and interviews, not live events. Members can listen to podcasts at their convenience by clicking on the links provided in News Now articles, visiting www.apta.org/podcasts/, or subscribing to APTA podcasts on iTunes.

    Need for Educated, Credentialed Fitness Professionals Tops Trends for 2013

    For the sixth consecutive year, the American College of Sports Medicine (ACSM) has ranked the need for educated and certified health and fitness and clinical exercise program professionals as the top fitness trend.

    For its survey, ACSM received more than 3,340 responses from health and fitness professionals from almost every continent—Asia, Europe, Australia, Africa, North America, and South America. Specific countries included the United States, Australia, Canada, China, France, Germany, Japan, India, Italy, and Russia. Demographics of the survey respondents included 67% female across a wide variability in ages and 48% having more than 10 years of experience in the industry.

    Strength training ranked second for the second year in a row. Body weight training, which ranked third, appeared for the first time in the trend survey because it has only now become popular (as a defined trend) in gyms around the world, says ACSM. Programs aimed specifically at the problem of childhood obesity, weight loss programs, and fitness programs for older adults placed fourth, fifth, and sixth, respectively.

    The trend toward creating incentive programs to stimulate positive healthy behavior change as part of employer-based health promotion programming and health care benefits ranked 15th.

    Outcome measurements placed 17th in the survey. This is the first time this trend toward accountability has made it into the top 20 spots.  

    Free full text of the article is available in the November/December issue of Health & Fitness Journal.

    Record-breaking Attempt to Sail Around World to Raise Funds for Foundation

    At age 76, Stanley V. Paris, PT, PhD, FAPTA, FAAOMPT, will attempt to sail around the world alone and unassisted in fewer than 150 days. In the process he hopes to break several records and raise funds and awareness for the Foundation for Physical Therapy.

    Records Paris is set to break:

    • oldest person to circumnavigate under sail nonstop and unassisted
    • fastest to circumnavigate in a monohull cruising boat
    • first to circumnavigate nonstop, unassisted, and entirely green

    With a gift of $100 ($150 per couple/$200 per family or business) your name will be displayed on the exterior of the Kiwi Spirit, so you too can sail around the world with Stanley Paris!

    To donate, go to http://kiwispirit.kintera.org/ or call 800/875-1378.

    Hear about Paris's record-breaking efforts in his own words in this video, and follow his adventure on Facebook.

    Board Adopts 2013 Strategic Plan and Public Priorities for 2013-2014, Advances Vision Proposal

    On November 28-December 1, APTA's Board of Directors (Board) met to fulfill a very important yearly function—adopting the association's Strategic Plan. During the 4-day meeting, the Board looked to the newly adopted plan to help guide its discussion and actions on various association initiatives.

    The Board adopted the APTA Strategic Plan after a rich discussion on the 4 goals of the plan—effectiveness of care, patient- and client-centered care across the lifespan, professional growth and development, and value and accountability. Objectives under each goal—17 in all—were prioritized earlier this year by the Board. Resources toward the objectives in the plan are determined based on the priorities, so higher-level priorities receive more resources.

    The objectives that were given the highest priority by the Board included the development of the outcomes registry and the advancement of a more appropriate payment system.

    Action toward such a payment system for outpatient physical therapy services—called the Physical Therapy Classification and Payment System (previously known as the Alternative Payment System)—is under way.  The Board received a report from the task force working on the new payment system. As APTA finalizes its draft of the proposed payment system, a comprehensive communication, public relations, education, and professional development plan will be developed to maximize the opportunity for a successful transition. An outline of the proposed plan will be presented to the Board in January 2013. A final plan will go to the Board in June 2013. The final draft of the proposed payment system  is expected to go through several AMA groups and committees for vetting and valuation in 2013 and 2014. At this time, APTA is on target for a 2015 implementation of a new payment system.    

    Other important priorities contained in the strategic plan include increasing the number and use of best practice guidelines to reduce unwarranted variation in care, in support of the goal toward effectiveness of care; exploring innovative learning opportunities, in support of the goal toward professional growth and development; and advocating for health policies that embrace value, safety, access, and integrity, in support of the goal toward value and accountability. Activities in progress or planned for 2013 to help achieve these objectives include continuing to expand the content in PTNow, APTA's online clinician's portal to evidence-based practice; adding a virtual attendance component to onsite APTA learning venues; and monitoring and influencing health care reform regulation.

    Strategies and metrics for all 17 objectives have been developed and will enable APTA's Board to track their progress throughout 2013. Progress on the plan will be communicated to the members throughout the year.

    In adopting the Strategic Plan, the Board recognized that it is a "bridge between Vision 2020 and a new vision to be considered in 2013." A proposal for that new vision also was discussed at the meeting, with the Board reviewing a report by the Vision Task Force. As the ultimate decision-maker on the vision of the association, the House of Delegates will consider the proposal in June 2013.

    In other meeting activity, the Board approved a 2013 operating budget with revenue of $42,398,480, expenses of $42,398,480, and zero net revenue. It was noted that almost 24% of total expenses directly fund Strategic Plan goals.

    Nine public policy objectives and strategies were adopted during the meeting, representing the critical public policy issues the association anticipates will advance physical therapist practice, education, and research in 2013-2014. The objectives and strategies include advancing a payment model(s) that promotes the value of physical therapists (see Physical Therapy Classification and Payment System above), eliminating physician referral for profit in physical therapy, and improving access to physical therapy services in integrated service delivery systems, such as accountable care organizations. The 2013-2014 priorities, developed with input from members and the Public Policy and Advocacy Committee, will be available to association members shortly. In keeping with the Board's focus on public policy priorities, a generative discussion was held on the determination of scope of practice issues. Board and staff members discussed possible mechanisms that could be used to review and analyze existing, new, and emerging fields of physical therapy practice to determine if APTA should endorse, recognize, or exclude the areas as part of the professional scope of practice. 

    The Board also took action on several new initiatives related to policy and advocacy:

    • Noting the need to effectively advocate for the inclusion and integration of physical therapy in emerging payment models, the Board voted to identify or establish and promote criteria/decision support tool(s) to ensure that patients and clients have meaningful access to appropriate physical therapy in all integrated payment models, such as a bundled payment system.
    • The Board approved the development of a pilot program that would make select grassroots and advocacy resources available for nonmember audiences, such as physical therapists and physical therapist assistants, legislative staff, other health care providers, and patient advocates. Opening up access to selected resources would allow enhanced collaborative opportunities in regulatory and legislative priorities.
    • With the formation of state exchanges and the recent release of the essential health benefits proposed rule, and in response to members seeking assistance with language for use in negotiations with legislators, payers, and policy makers, the Board adopted Essential Health Benefits Recommendations as a Board policy. This new policy provides definitions of "rehabilitation" and "habilitation" and guiding principles for these definitions.   

    In the coming months, the Board will begin to consider the future relationship between APTA and the Commission on Accreditation in Physical Therapy Education (CAPTE). US Department of Education (USDE) regulations, new Council for Higher Education Accreditation (CHEA) criteria, and a perceived conflict of interest between APTA and CAPTE, have prompted discussion about and initial exploration into whether CAPTE should become partially or fully independent of the association. As such, APTA will gather financial data, confirm the various USDE and CHEA requirements impacting CAPTE, collect information on the 2 proposed models, and consult with the Academic Council, the Education Section, and other interested parties so that the Board can make a recommendation that would best serve the interests of education programs, the association, and CAPTE.           

    To promote governance processes and structures that optimize policy development, the Board voted to develop motions for the 2013 House that will allow necessary Board discussion and action on the House of Delegates governance proposal. Data gathered by the Governance Proposal Board Work Group to inform its work as well as the report submitted to the Board have been posted to the Governance Review Community. The materials can be found in the Governance Review Community Reference Materials folder with document titles that begin with the words 'House Governance Proposals.'

    For the first time, the Board meeting was livestreamed. APTA members can watch the video archive of the meeting until December 15 (refer to the agenda posted on the livestream webpage to narrow down the date and time of the discussions summarized above). The language for motions voted upon during this meeting is not considered final until the minutes of this meeting are approved by the Board. Final motion language will be reflected in the minutes of the November 2012 Board of Directors meeting, which will be approved and posted online in December.  

    Functional Limitation Reporting vs PQRS: Understanding the Differences

    APTA has posted a new chart to help members understand the differences between the Physician Quality Reporting System (PQRS) program and a congressionally mandated functional limitation reporting program that begins January 1, 2013. The chart can be found on APTA's Functional Limitation Reporting Under Medicare webpage.

    The Middle Class Tax Relief Act of 2012 mandated that the Centers for Medicare and Medicaid Services (CMS) begin functional limitation data collection on January 1, 2013, for Medicare beneficiaries. The new functional limitation reporting will be done through nonpayable G-codes that are similar in their appearance to PQRS quality data codes. The functional limitation reporting will be visit-driven and must be completed on evaluation, every 10th visit, and at discharge. All practice settings that provide outpatient therapy services must include this information on the claim form. Specifically, the policy will apply to physical therapy, occupational therapy, and speech-language-pathology services furnished in hospitals, critical access hospitals, skilled nursing facilities, comprehensive outpatient rehabilitation facilities (CORFs), rehabilitation agencies, home health agencies (when the beneficiary is not under a home health plan of care), and in private offices of therapists, physicians, and nonphysician practitioners.

    Simultaneously, attention is increasing on PQRS as the program changes from an incentive-based program to a penalty program, with the 2013 year being pivotal to the program's changeover, informing both the 2013 bonus and the 2015 penalty. PQRS, the quality reporting program for Medicare Part B, was implemented in 2007. Physical therapists are eligible professionals in this reporting program and can report a variety of measures, including pain assessment on initial evaluation and a measure related to the use of a functional assessment tool. Reporting under the PQRS program is tied to CPT codes. Therapists reporting under this program submit quality data codes for the selected measures with CPT code 97001 and sometimes with 97002.

    New in the Literature: Measuring Outcomes in Patients With Spinal Stenosis (Spine J. 2012;12(10):921-931.)

    Results of a study published in The Spine Journal indicate that the Oswestry Disability Index, Modified Swiss Spinal Stenosis Scale (SSS), and Patient Specific Functional Scale possess adequate psychometric properties to be used in the outcome assessment of patients with lumbar spinal stenosis. However, further investigation is needed to validate these findings in other samples of patients with lumbar spinal stenosis and nonspecific low back pain, the authors add.  

    This cohort secondary analysis of a randomized clinical trial of patients with lumbar spinal stenosis receiving outpatient physical therapy included 55 patients (mean age, 69.5 years; standard deviation, ±7.9 years; 43.1% females).

    Outcome measures were the Modified Oswestry Disability Index, SSS, Patient Specific Functional Scale, and Numeric Pain Rating Scale (NPRS).

    All patients completed the Oswestry Disability Index, SSS, Patient Specific Functional Scale, and NPRS at the baseline examination and at a follow-up. In addition, patients completed a 15-point Global Rating of Change at follow-up, which was used to categorize whether patients experienced clinically meaningful change. Changes in the Oswestry Disability Index, SSS, Patient Specific Functional Scale, and NPRS were then used to assess test-retest reliability, responsiveness, and minimum levels of detectable and clinically important differences.

    The Oswestry Disability Index was the only outcome measure to exhibit excellent test-retest reliability with an intraclass correlation coefficient of 0.86. All others ranged between fair and moderate. The Oswestry Disability Index, SSS, and Patient Specific Functional Scale exhibited varying levels of responsiveness, each of which was superior to the NPRS. The minimal clinically important difference for the outcome measures for persons with lumbar spinal stenosis were:

    • Oswestry Disability Index—5 points
    • SSS— 0.36 and 0.10 for symptoms subscale and functional subscale, respectively
    • Patient Specific Functional Scale—1.3
    • NPRS—1.25 for back/buttock symptoms, 1.5 for thigh/leg symptoms

    APTA member Joshua A. Cleland, PT, PhD, OCS, is the article's lead author. APTA members Julie M. Whitman, PT, T, DSc, OCS, FAAOMPT, Robert S. Wainner, T, PhD, ECS, OCS, FAAOMPT, and John D. Childs, PT, PhD,MBA, are coauthors.

    CDC Releases New Falls Prevention Toolkit

    The Centers for Disease Control and Prevention's (CDC) new STEADI Tool Kit gives health care providers information and tools to assess and address their older patients' falls risk.

    The STEADI (Stopping Elderly Accidents, Deaths and Injuries) Tool Kit is based on a simple algorithm adapted from the American and British Geriatric Societies' Clinical Practice Guideline. It includes basic information about falls, case studies, conversation starters, and standardized gait and balance assessment tests (with instructional videos). In addition, there are educational handouts about falls prevention specifically designed for patients and their friends and family.

    APTA members who are experts in falls prevention assisted CDC with the development of the toolkit, specifically with the evidence based community falls prevention programs. Additionally, APTA staff appear in several videos on tests that were recorded at APTA.

    A link to the toolkit also is available on APTA's Balance and Falls webpage under "Related Resources."

    Federal Government Affairs Leadership Award and APTA Public Service Award Nominations Due February 11

    Do you know of an APTA member who this year 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 2012? Nominate him or her for the Federal Government Affairs Leadership Award or the APTA 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 APTA Public Service Award is presented annually to individuals who have demonstrated distinctive support for the physical therapy profession at a national level. Individuals from the following categories are eligible for nomination of this award: 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.

    APTA's Board of Directors will select award recipients during its March 2013 conference call. Awards will be presented at the Federal Advocacy Forum to be held April 14–16, 2013, in Washington, DC.

    Submit your nominations by Monday, February 11, 2013, 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.

    December Craikcast Now Available

    Guest Editor and PTJ Editorial Board Member Patricia Ohtake, PT, PhD, joins Editor in Chief Rebecca Craik, PT, PhD, FAPTA, in this month's Craikcast, which highlights the articles in the December issue Special Series on Rehabilitation for People With Critical Illness. Ohtake summarizes the articles, and Craik adds her thoughts on important research conducted by established authors in the field, including physical therapists from across the United States and from Australia. Ohtake also discusses a 2-fold challenge of the critical care and rehabilitation communities—to continue to develop effective rehabilitation interventions and to increase awareness of postintensive care syndrome.    

    The special series will be published in 2 issues—December 2012 and February 2013.     

    VA Proposes to Amend Regulations to Add Certain Service-connected Conditions Associated With TBI

    The Department of Veterans Affairs (VA) published a proposed rule on December 10 to amend regulations regarding certain service-connected conditions associated with traumatic brain injury (TBI). Under the amendment, veterans who have a service-connected TBI and are also diagnosed with Parkinsonism, dementia (pre-senility, Alzheimer type), unprovoked seizures, hypopituitarism, or depression will have those diagnoses classified as service-connected secondary conditions if they manifest within 3 years of a moderate to severe TBI or within 12 months of mild TBI. Diseases related to hypothalamo-pitutitary changes must manifest within 12 months of moderate to severe TBI. This new service-connected diagnoses may impact disability status and related VA compensation.

    HHS Issues FAQs on Exchanges, Market Reforms, and Medicaid

    Yesterday, the Department of Health and Human Services (HHS) released an FAQ document on state health insurance Exchanges, other market reforms, and Medicaid expansion. The document includes a section on what states should expect if they opt for a federally operated Exchange, including how states can work with the federal government to ensure the needs of a particular state are being met. HHS reiterates that there is no deadline for a state to declare to the federal government its intention to participate in Medicaid expansion to individuals at and below 133% of the federal poverty level (FPL) and that states have flexibility to start and stop the expansion. However, the federal match rates for medical assistance to states for this expansion population are tied to specific calendar years by law (eg, 100% support for newly eligible adults in 2014, 2015, and 2016). Additionally, HHS clarified that the law does not provide for a phased-in or partial expansion to less than 133% of the FPL, something some states had been considering but were unsure if it was an allowable option.

    APTA Member Patrice Winter Blogs on Boomer Café

    In support of APTA's Fit After 50 campaign, spokesperson Patrice Winter, PT, DPT, MHA, FAAOMPT, blogs on Boomer Café about how she manages to stay active and fit as she nears age 60.

    Study Finds Association Between Knee Replacement and Weight Gain

    A new study finds that knee replacement surgery may raise a person's risk of gaining weight, says a Reuters News  article based on a study published in Arthritis Care & Research.   

    For this study, lead investigator Daniel Riddle, PT, PhD, FAPTA, and his group used a patient registry from the Mayo Clinic in Rochester, Minnesota, which collected information on 917 knee replacement patients before and after their procedures.

    The researchers found that 5 years after surgery, 30% of patients had gained at least 5% of their weight at the time of the surgery.

    In contrast, fewer than 20% of those in a comparison group of similar people who had not had surgery gained equivalent amounts of weight in the same period.

    Riddle's team said that this degree of weight gain can lead to "meaningful effects on cardiovascular and diabetes-related risk as well as pain and function."

    One possible explanation for the counter-intuitive results, experts said, is that if people have spent years adapting to knee pain by taking it easy, they don't automatically change their habits when the pain is reduced, reports Reuters.

    "After knee replacement we get them stronger and moving better, but they don't seem to take advantage of the functional gains," said Joseph Zeni, PT, PhD, a physical therapy professor at the University of Delaware, who was not part of the study. "I think that has to do with the fact that we don't address the behavioral modifications that have happened during the course of arthritis before the surgery."

    Part of the explanation for the weight gain could be the age at which patients get surgery. People in their 50s and 60s tend to gain weight, anyway. Still, in light of the lower rates of weight gain in the comparison group, which was also middle aged and older, Riddle said something else may also be at work.

    In fact, the team found that patients who had lost weight before their surgery were slightly more likely to gain weight afterwards—perhaps because when people lose weight in anticipation of an event, such as surgery, they are more likely to put it back on after they're achieved the goal, says the article.

    CMS Updates 2013 PQRS Measures of Significance to PTs

    The Centers for Medicare and Medicaid Services has released the updated measures specifications for the Physician Quality Reporting System (PQRS) for the 2013 reporting year, which include changes to 3 measures of importance to physical therapists—Body Mass Index Screening (#128), Pain Assessment (#131), and Functional Outcome Assessment (#182). The measure specifications provide program participants with important information 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.

    Practitioners also should note that additional quality data codes have been added to measures #128 and #131. CMS has made changes to the definition of an existing quality data code for measure #182. 

    • Measure #128, the Body Mass Index Screening measure, has a new quality data code G8938: BMI calculated, patient not eligible/not appropriate for follow-up plan.
    • Measure #131, the Pain Assessment and Follow-up measure, has a new quality data code G8939: pain assessment documented, follow-up plan not documented, patient not eligible/appropriate. 
    • Measure #182, the Functional Outcome Assessment measure, has an additional definition for quality data code G8942, which now is reported to reflect functional outcome assessment documented, no functional deficiencies identified, care plan not required, or functional outcome assessment and care plan documented in the previous 30 days.

    Physical therapists who currently are participating or plan to participate in the Calendar Year 2013 PQRS program are strongly encouraged to review the 2013 measures specifications for those measures that they are planning to report in 2013. APTA will revise all podcasts for those measures with changes in 2013.

    See the new 2013 measures specifications for further details located on APTA's PQRS webpage under the "2013 PQRS Measure Details" section.

    Call for Member and Nonmember Volunteers: PTA Education Feasibility Study Work Group

    APTA is seeking volunteers to serve on a new work group that will prepare a plan for responding to the House motion on a Feasibility Study for Transitioning to an Entry-Level Baccalaureate Physical Therapist Assistant Degree (RC20-12), including identifying data needs, sources, and collection methods. Members interested in serving on the PTA Education Feasibility Study Work Group must first complete the volunteer profile form found on the Volunteer Interest Pool page (log on to the APTA website before accessing this link). Once the profile is submitted, click on the "Current Volunteer Opportunities" button and select "PTA Education Feasibility Study Work Group" to be considered. Encourage your colleagues, including those involved in the education, work, and career development of PTAs, to serve on this important work group. The deadline for submission is December 31. Interested nonmembers should contact Janet Crosier for assistance.

    Innovation Summit: What it Means to You and the Profession

    In this new APTA podcast, Tony Delitto, PT, PhD, FAPTA, and Jason Richardson, PT, DPT, OCS, describe the importance of APTA's Innovation Summit: Collaborative Care Models in helping to prepare physical therapists to participate in bundled payment initiatives and accountable care organizations.

    On March 8, 2013, physical therapists, physicians, large health systems, and policy makers will come together at the Innovation Summit to discuss the current and future role of physical therapy in integrated models of care. Be a part of this groundbreaking event by attending the Summit via livestream. Visit www.apta.org/innovationsummit/ for a list of speakers, moderators, and panelists; registration and programming information; and the names of 18 PT innovators who have been selected to share their innovative practice models with their colleagues during the meeting.   

    APTA podcasts are prerecorded discussions and interviews, not live events. Members can listen to podcasts at their convenience by clicking on the links provided in News Now articles, visiting www.apta.org/podcasts/, or subscribing to APTA podcasts on iTunes.

    Final 2012 'Lunch and Learn' to Address Dieting and Weight Loss

    Mark your calendar for the Osteoarthritis Action Alliance (OAAA) Partners' final 30-minute "Lunch and Learn" of 2012. On December 12, noon ET, Steven Heymsfield, MD, executive director of Pennington Biomedical Research Center of the Louisiana State University System, will present Facts and Myths about Dieting and Weight Loss. Call 877/278-3632 and enter code 0208132#. Slides will be posted before the call. This event will be recorded and archived on OAAction.org.

    APTA is a member of OAAA.

    New Podcast: Reporting Under the Group Practice Reporting Option for 2013

    In 2013, physical therapists (PTs) will be eligible to participate in the Physician Quality Reporting System (PQRS) under the Group Practice Reporting Option (GPRO) for the first time, as a result of changes in the group practice definition and changes to the reporting methods for data submission under GPRO. A new APTA podcast explains the some of the important differences that PTs should consider before deciding whether to report as an individual physical therapist or as a part of a physical therapy practice under the GPRO option. The accompanying transcript also includes charts illustrating how these 2 reporting options work from a data analysis standpoint.

    For more information and resources on PQRS, go to www.apta.org/PQRS/

    APTA podcasts are prerecorded discussions and interviews, not live events. Members can listen to podcasts at their convenience by clicking on the links provided in News Now articles, visiting www.apta.org/podcasts/, or subscribing to APTA podcasts on iTunes.

    Patients With RA Have More Complications After TJA

    Patients with rheumatoid arthritis (RA) have more complications after total joint arthroplasty (TJA) than patients with osteoarthritis (OA) and are at notably higher risk for dislocation of replaced hip joints, according to a Medscape Medical News article based on a systematic review published online November 28 in Arthritis & Rheumatism.

    The analysis included 40 reports published between 1990 and 2011 that describe primary TJA of the hip or knee in patients with RA (n = 2,842) or OA (n = 61,861). Outcomes included revision, hip dislocation, infection, 90-day mortality, and venous thromboembolic events.

    The researchers found that patients with RA had double the risk for hip dislocation after total hip arthroplasty compared with patients with OA. Adjustments were made for age, sex, surgical approach, and surgeon's volume.

    Infection risk was up to a 10-fold increase in patients with RA after total knee arthroplasty, particularly in patients with prior infection in the replaced joint, prior infection in any joint, or longer duration of operating. There was no association between infection risk and perioperative systemic corticosteroid use or withdrawal of biologic treatment before surgery. However, meta-analysis was not completed due to variable definitions of infection and preoperative antibiotic protocols, the article says.  

    Johannes Cornelis Schrama, MD, who was not involved in the study, told Medscape Medical News that that the researchers do not appear to have overlooked any major factors in their analysis, but he was cautious about possible clinical application. "It is difficult to define clinical implications other than possible preventive measures [against infection] in patients undergoing [total knee arthroplasty]," he said. 

    Individual Insurance Market Passes on MLR Savings to Consumers in 2011

    Consumers saw nearly $1.5 billion in insurer rebates and overhead cost savings in 2011 due to the Affordable Care Act's (ACA) medical loss ratio (MLR) provision requiring health insurers to spend at least 80% of premium dollars on health care or quality improvement activities or pay a rebate to their customers, according to a new Commonwealth Fund report. Consumers with individual policies saw substantially reduced premiums when insurers reduced both administrative costs and profits to meet the new standards. While insurers in the small- and large-group markets achieved lower administrative costs, not all of these savings were passed on to employers and consumers, as many insurers increased profits in these markets.

    The report, Insurers' Responses to Regulation of Medical Loss Ratios, looks at how insurers selling policies for individuals, small-employer groups (up to 100 workers), and large-employer groups (more than 50 or 100 workers, depending on the state) in every state reacted to ACA's MLR requirement between 2010, the year just before the new rule took effect, and 2011, the first year the rule was in place.

    The authors find that in the individual insurance market, improvements were widespread: 39 states saw administrative costs drop, 37 states saw MLRs improve, and 34 states saw reductions in operating profits. Some states stood out for significant improvements. In New Mexico, Missouri, West Virginia, Texas, and South Carolina, MLRs improved 10 percentage points or more, while administrative costs dropped $99 or more per member in Delaware, Ohio, Louisiana, South Carolina, and New York.

    However, the report finds that in small- and large-group markets, MLRs were largely unchanged, and while spending on administrative costs dropped, profits increased. For example, in the small-group market, administrative costs were reduced by $190 million, profits increased by $226 million, and the medical loss ratio remained at 83%, unchanged from 2010. In the large-group market, insurers reduced administrative costs by $785 million, increased profits by $959 million, and kept their medical loss ratio at 89%, also unchanged from 2010.

    The authors note that while insurers in the individual market have a less stringent medical loss ratio requirement—80%, as opposed to 85% in the large-group market—their traditionally higher overhead costs and lower MLRs mean they have to work harder to reach the new standard. As a result, these insurers lowered both administrative costs and profit margins, therefore reducing growth in premiums.  

    Conversely, insurers in the small- and large-group markets generally already have MLRs in the range of the required 85%, so while they reduced administrative costs, they had the option of turning those cost savings into profits instead of passing them along to consumers. In light of rising profits and falling administrative costs, the authors suggest it is possible insurers took profit increases in the small- and large-group markets to offset the reduced profits in the individual market. And because many insurers sell policies in all three markets, any reduction in administrative costs could have been spread across all of a given insurer’s lines of business.  

    The authors conclude that stronger measures—such as rate regulation, tighter loss-ratio rules, or enhanced competitive pressures—may be needed to ensure that administrative costs are reduced in all markets and savings are passed along to consumers.

    Roll Call Features APTA in Article on Potential Medicare Payment Cuts

    APTA is featured in an article in Roll Call about looming Medicare cuts, including the expiration of the Medicare therapy cap exceptions process. With negotiations on the fiscal cliff taking center stage, "It's our responsibility to make sure that some of these long-standing beneficiary-focused, rehabilitation-focused things aren't lost in all that static," says Justin Moore, PT, DPT, APTA vice president public policy, practice, and professional affairs.

     "We're doing a lot to try to put the patient face on the therapy cap issue specifically."

    On Monday, APTA and the Therapy Cap Coalition participated in an advocacy drive that brought together almost 50 associations, organizations, and patient groups to urge Congress to "Stop the Cap!"

    Roll Call posted the article online Tuesday evening; it is running in today's print issue of the paper. RollCall is widely by members of Congress and their staff. 

    New in the Literature: Behavior Change (Physiother Theory Pract. 2012;28(8):571-587.)

    Physical therapists (PTs) can effectively counsel patients with respect to lifestyle behavior change, at least in the short term, say authors of a systematic review published in the November issue of Physiotherapy Theory and Practice. PTscan be effective health counselors individually or within an interprofessional team, they add.  

    For this review, the authors searched databases including MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Database of Systematic Reviews from 1950 to July 2010. Studies were limited to the English, German, and Dutch languages. They evaluated methodological quality using the Downs and Black tool.

    Seven source articles with a mean quality score of 16.57 ± 4.24 points (range: low = 0; high = 28) were retrieved. Given considerable methodological heterogeneity, the studies were compared in a narrative synthesis. The target populations, types and periods of interventions, outcome measures, and findings were analyzed.

    According to the authors, multiple health behavior change needs to be a primary 21st century clinical competence in physical therapy. Future studies will establish the degree to which effective health counseling augments physical therapy as well as health outcomes, in the long and short term.

    APTA recently launched a podcast series on behavior change that provides information on key theories and models and their value to physical therapists and physical therapist assistants. The podcasts and other resources can be found on APTA's Health Behavior Change webpage.

    APTA Named 'Provider of the Month' by National MS Society

    APTA recently was chosen from more than 250 nationwide provider organizations to be the National Multiple Sclerosis Society's Nationwide Service Provider of the Month for November 2012. This award was developed in 2011 to show appreciation toward provider organizations and to ensure that they receive the attention they deserve for serving clients affected by multiple sclerosis (MS).

    The society promotes the Nationwide Service Provider of the Month in many ways across the organization:

    • A special bulletin is sent to the 35 information and referral specialists in the society's national call center to alert them of the provider and suggest they make appropriate referrals to the provider.
    • A special summary is sent to all programs staff at the society's 45 chapters to ensure they know of the provider and are referring applicable clients as appropriate.
    • The provider is featured as the Provider of the Month on the society's Facebook page, which has more than 136,000 followers. As of December 3, the post regarding APTA's selection as Provider of the Month garnered 112 likes, 5 shares, and 8 comments. 

    Proposed Rule Expands on Programs to Protect Consumers

    On Friday, the Department of Health and Human Services (HHS) released a proposed rule expanding on the standards set forth in 2 final rules published in March related to reinsurance, risk adjustment, and risk corridors programs and the establishment of Exchanges and qualified health plans. These programs aim to ensure that insurance plans compete on the basis of quality and service and not on attracting the healthiest individuals.

    Key proposals in the draft Notice of Benefit and Payment Parameters for 2014 include:

    • Reducing disincentives for health insurance issuers to enroll people with preexisting conditions by using a risk adjustment methodology that assists health plans that cover individuals with higher health care costs and helps ensure that those who are sick have access to the coverage that they need. CMS also outlines the agency's proposed approach to validating risk adjustment data to instill confidence in the program. States that are running an Exchange and their own risk adjustment program can propose a different methodology.

    • Stabilizing premiums in the individual market for health insurance by adopting uniform reinsurance payment parameters for the transitional reinsurance program, which is a 3-year program designed to reduce medical risk for issuers and thereby reduce premiums for enrollees. CMS proposes that a state may supplement the HHS reinsurance payment parameters, but must pay for those supplementary parameters with additional state reinsurance collections or state funds (instead of funds collected by HHS under the national contribution rate). CMS also proposes a per-capita rate under which contributions would be collected annually by HHS from all applicable health insurance issuers and group health plans, exclusion of certain types of plans from the reinsurance contribution requirement, and standards governing the calculation of contributions.

    • Protecting health insurance issuers against uncertainty in setting premium rates by accounting for profits and taxes in the temporary risk corridors program and aligning this program with the medical loss ratio program.

    • Helping low- and moderate-income Americans afford health insurance in Exchanges by making advance payments of premium tax credit to issuers on behalf of certain individuals. CMS is proposing that issuers provide cost-sharing reductions at the point of service for eligible individuals and that CMS directly reimburse issuers for these payments.

    • Charging health insurances issuers participating in a federally facilitated Exchange a user fee that would be commensurate with fees charged by state-based Exchanges.

    Watch the Board of Directors Meeting Broadcast Until December 15

    APTA members can view archived video of the recent Board of Directors meeting livestream until December 15 at www.apta.org/Livestream.

    Also at that page, members can provide feedback on the content of the meeting or the livestream itself, which was APTA's first broadcast of that kind.

    Based on viewer interest and feedback, APTA will determine whether and how often to livestream future meetings.

    CMS Issues Pre-regulation Guidance Aligning EHB Proposed Rule and Medicaid ABPs for New Expansion Population

    The Centers for Medicare and Medicaid Services (CMS) recently released guidance to help states align Alternative Benefit Plans (ABPs) under Medicaid programs with the Essential Health Benefit (EHB) requirements. Prior federal Medicaid law (Deficit Reduction Act of 2005, §1937 of the Social Security Act) has allowed states to design Medicaid benefit packages under their state plans. The Affordable Care Act (ACA) made changes to §1937 that become effective on January 1, 2014, which are:

    • any ABP that will cover the optional Medicaid expansion population under the ACA must cover EHB  as described in ACA
    • the Mental Health Parity and Addiction Equity Act applies to Alternative Benefit

    CMS intends for the provisions of the recent EHB proposed rule, released on November 20, generally to apply to Medicaid. However, modifications will be provided in future rulemaking that will apply when furnishing EHB services to Medicaid beneficiaries. CMS' State Medicaid Director letter says, "[s]ection 1937 coverage options are a starting point for states to establish their [ABPs], and the process for ensuring coverage of and, as necessary, adding EHBs will mirror steps taken by issuers in the individual and small group markets … "

    For states to develop a benefit plan that meets the ACA provisions, CMS proposes that (1) states initially choose a coverage option from the choices in §1937 and (2) then determine whether the §1937 option is one of the options that is available for defining EHBs in the individual and small group market (there is overlap between these options).

    In future regulations, CMS intends to propose the following provisions, among others:

    • The supplementation process for ensuring coverage of the 10 EHB categories is to be the same as proposed in ACA.
    • The following EHB definition/options are to be adapted to Medicaid: (1) Habilitative Services: States will define the benefit and will request comment on the parameters for this benefit. (2) Pediatrics: For children enrolled in Medicaid, all medically necessary services generally are covered under the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit. Therefore, EHB supplementation is not necessary. (Note that EPSDT covers children to age 21; whereas, pediatric services under the EHB proposed rule would cover children for services under age 19.)
    • Free choice of qualified providers continues.

    States that wish to establish a new §1937 ABP or to modify an existing ABP substantially are required to publish public notice for public comment from stakeholders prior to submitting their State Plan Amendment to CMS.

    Researchers Call for Providers to 'Embrace' Social Media in Prevention, Management of Childhood Obesity

    Health care providers should embrace social media's potential as a tool for promoting healthy behavioral change in children who are overweight and obese, says a new American Heart Association scientific statement published online in the association's journal Circulation. 

    The writing group evaluated research on Internet-based interventions to lose weight, increase physical activity, and improve eating habits.

    "The studies we looked at suggest that more parental involvement and more interaction with counselors and peers was associated with greater success rates for overweight children and teens who participated in an online intervention," says Jennifer S. Li, MD, MHS, chair of the writing group, in an AHA press release.  

    Variables that influenced success were whether the rest of the family was involved in the intervention, the degree of back-and-forth communication and feedback with a counselor or support group, and the frequency with which kids and adolescents logged on and used the programs.

    People who are overweight or obese tend to share a home or spend their leisure time with others who are overweight or obese, according to research.

    "Athletes tend to hang out with athletes, and overweight kids hang out together, so they reinforce each other's eating habits or preferences for recreational activities," Li said.

    About 95% of 12- to 17-year-old children have Internet access at home and/or in school, so online social network health interventions should be explored as an effective way to prevent or manage excessive weight, Li said.

    However, the downsides to social media include exposure to cyber bullying, privacy issues, "sexting," and Internet addiction that can cause sleep deprivation, Li adds.

    The authors recommend clinicians, policy makers, and researchers ensure privacy protection, monitor outcomes, and harness the strength of a health promotion social network to devise interventions that initiate and sustain behavior changes such self-monitoring, goal-setting, and problem-solving.

    More research is needed to provide data on overweight and obese adolescents to determine whether differences in gender, ethnicity, geographic location, and socioeconomic status affect the efficacy and level of engagement with social media and technologically based weight management interventions, says AHA.

    For information on APTA's social media policy and resources that can help PTs and PTAs stay informed, engage with peers on professional issues, and share the benefits of physical therapy with consumers, go to APTA's Social Media Tips & Best Practices webpage.

    PTJ Publishes First Part of Special Series on Rehabilitation and Critical Care

    PTJ's December issue features the Special Series on Rehabilitation for People With Critical Illness: Taking the Next Steps. Editorials by Editor-in-Chief Rebecca Craik, PT,PhD, and guest coeditors Patricia Ohtake, PT, PhD, Dale Strasser, MD, and Dale Needham, MD, PhD, introduce the special series.

    The special series will be published in 2 issues—December 2012 and February 2013. The series presents recent advances in managing critical illness across the continuum of care, from the intensive care unit (ICU) to the community setting. The series also raises awareness of the essential role that physical therapists and rehabilitation and critical care professionals play in this growing patient population. The articles in the December issue showcase important research conducted by established authors in the field, including physical therapists from across the United States and from Australia. In February 2013, articles will highlight innovative quality improvement initiatives, discuss key considerations for the profession, illustrate educational strategies, and describe novel cases.

    Using Motivational Interviewing in Conversations With Patients

    In a new APTA podcast, MarySue Ingman, PT, DSc, describes the use of motivational interviewing (MI) when talking to patients about making changes in their lifestyle and presents the key concepts of MI—expressing empathy, supporting self-efficacy, rolling with resistance, and developing discrepancy. She also offers listeners specific MI techniques that they can use with patients, such as asking open-ended questions and demonstrating reflective listening. Ingman illustrates how the techniques can be used with an example in which a physical therapist has to have a conversation with a patient about smoking or a sedentary lifestyle. 

    This podcast is the third in a series on behavioral change. Look for a podcast later this month that will provide an example of using MI with a student. The other podcasts in this series can be found on APTA's Health Behavior Change webpage.

    APTA podcasts are prerecorded discussions and interviews, not live events. Members can listen to podcasts at their convenience by clicking on the links provided in News Now  articles, visiting www.apta.org/podcasts/, or subscribing to APTA podcasts on iTunes.