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  • Changes Coming to PQRS Measures Specifications in 2014

    Physical therapists (PTs) will be facing changes to Physician Quality Reporting System (PQRS) measures specifications in the new year. The changes recently announced by the Centers for Medicare and Medicaid Services (CMS) affect areas including current medications, pain assessment, falls plan of care, and functional outcome assessment.

    PTs planning to participate in PQRS in 2014 are strongly encouraged to review the 2014 measures specifications, which contain information on how a measure is defined and how to report, and the qualifying case information that includes quality data codes for reporting.

    APTA has updated its PQRS resources to reflect the 2014 measures changes at the association's PQRS webpage. Further details on the changes can be found at the CMS PQRS How to Get Started webpage. Also, check out the most recent and timely Physical Therapy and PQRS in 2014: How to Report Successfully  webinar, recorded December 19. This was the most popular paid webinar recorded in 2013.

    NYT: New Study Identifies 'Nuanced' Range of Adaptation to Disabilities

    A New York Times article cited physical therapy as an important way for older adults to maintain independence and remain in one of a "more nuanced" set of groupings recently analyzed in a large-scale study of how older Americans adapt to disability.

    The NYT article focused on a study published in the American Journal of Public Health (abstract only available for free) that looked at 38 million older adults enrolled in Medicare. Researchers divided these older adults into 5 categories that moved past the more common "disabled" vs. "independent" dichotomy, instead creating levels of independence delineated by use of assistance and attitudes about daily living.

    According to the NYT article, researchers estimate that 56% of older Americans are living independently with no assistance or through the use of one of more assistive devices such as hearing aids, grab bars, and shower seats. At the other end of the spectrum, an estimated 20% of older adults rely on assistance with at least one task, or require nursing home care.

    Of particular interest to researchers were the remaining 26% of older adults who reported that they had cut back on their range of daily activities yet do not acknowledge that they face limitations (6%) or who do acknowledge that some activities are difficult, but continue to live without assistive measures (18%). According to researchers, individuals in these categories are at risk for losing independence without some form of intervention, including physical therapy. The lead researcher is quoted in the article as saying that “Finding ways to promote independence and wellbeing in these groups, now that we’ve identified them, is an important public health goal."

    The full research article will be available through ProQuest at APTA's Open Door after publication in an issue of the journal.

    Free Arthritis, Bone Health Programming Available

    The US Bone and Joint Initiative (USJBI) is offering free programming to help physical therapists (PTs) and other providers educate the public about arthritis and bone health.

    The two programs—"Fit to a T" and "Experts in Arthritis"—feature a PowerPoint presentation, question and answer segment, and handout materials. USJBI works with requesting individuals or facilities to arrange for presenters and promote the event.

    "Fit to a T" is a bone health program designed to provide steps to prevent or slow down bone disease to avoid breaks. Aimed at individuals from 40 – late 60s, seniors, and others at risk for breaking a bone, the program also delivers information on prevention, detection, diagnosis, and treatment of osteoporosis.

    "Experts in Arthritis" is a more general program that focuses on osteoarthritis, rheumatoid arthritis, and juvenile arthritis, and includes information on care and treatment options. The program is designed to help raise awareness of the conditions.

    Requests for the program can be made directly to USJBI at the organization's website or by phone at 847/430-5054. APTA offers additional resources tailored to the role of the PT in the treatment of bone and joint conditions, including a PT guides to Osteoarthritis and Osteoporosis, as well as general information on bone health and continuing education on aging joints.

    Clickable Cheer

    Nearing holiday crunch time and still feel like you haven't seen enough people wearing ridiculous things on their heads? We've got you covered.

    APTA staff are extending their warmest greetings to members in the form of a holiday video that celebrates the association's accomplishments, our ongoing work, and the importance of themed headwear. Members of the 180-person Alexandria, Virginia, office can be observed delivering cheer while dressed in attire best described as "North Pole casual."

    A special treat: stay tuned past the end of the "official" video for outtakes that provide a window into the raw and highly-charged merriment that was harnessed to create the greeting.

    No elves were harmed in the making of this video.

    Professional Regulation Will Be Focus of Global Conference

    The big—really, really big—picture of health professions regulation will be the topic of an international conference in May 2014, and physical therapy is one of the disciplines that will be joining the conversation.

    "Health Professional Regulation—Facing Challenges to Act in the Public Interest" will be held May 17–18 in Geneva, Switzerland, and will bring together health professionals and regulators from around the world to explore approaches to regulation including competency-based models. The meeting is being hosted by the World Health Professions Alliance (WHPA) and will take place immediately before the World Health Organization’s World Health Assembly in Geneva.

    More information and registration materials can be accessed through the conference website. WHPA is an alliance of global organizations representing more than 26 million of the world’s physical therapists, physicians, dentists, nurses, and pharmacists, in more than 130 countries. APTA is a member of the World Confederation for Physical Therapy, which is a part of WHPA.

    Medicaid Guide Now Available

    The federal Medicaid and CHIP Payment and Access Commission (MACPAC) has released an important resource on regulations. The resource is available for free online.

    The Reference Guide to Federal Medicaid Statute and Regulations (.pdf) helps health care providers understand the statutory framework of a Medicaid system that has seen expansion and other changes under the Patient Protection and Affordable Care Act. Medicaid supports about 73 million people in the United States.

    More information on Medicaid and its relationship to physical therapy can be accessed through the APTA Medicaid webpage.

    Visiting Paris in December Could Be Tricky

    Are you bobbing in the water somewhere in the Atlantic Ocean between Africa and South America, and feel like discussing the future of physical therapy research? Keep an eye out for physical therapist and all-around adventurer Stanley Paris, PT, PhD, FAPTA, FAAOMPT, as he sails by. Just don’t expect him to chat too long—the man has places to be.

    Paris, 76, is now well into the first 30 days of his attempt to break the world record for the oldest and fastest person to sail around the world solo. He began the journey on December 2 and hopes to complete the trip in 120 days. He remains confident about his bid, though he got off to a slow start due to inclement weather.

    Paris is taking on the challenge in part to raise funds for the Foundation for Physical Therapy, where he serves on the Board of Trustees. To date, his efforts have helped to raise over $200,000 for the Foundation.

     2013 - 12 - 20 - Paris Sail

     You can track his progress in map form and get a firsthand account of the adventure by following his blog.

    Help Stanley Paris bring more attention to the need for research in physical therapy: find out how to donate in honor of the sail and how your name can be added to the hull of the Kiwi Spirit upon her return. Visit www.foundation4pt.org for details.

    Get Ready For Innovation 2.0

    In the wake of APTA's highly popular 2013 Innovation Summit, the association is launching Innovation 2.0, a new program that will provide funding awards and 1-on-1 guidance to innovators who are developing or participating in new ways to promote the role of physical therapy in collaborative care models.

    On January 9, APTA will begin accepting letters of intent from applicants who are engaged in innovations in models of care that include accountable care organizations, patient-centered medical homes, bundled payment systems, and patient management of chronic conditions. APTA will provide funding and in-kind services to selected applicants, and engage participants in individual work with experts and leaders to further promote the impact of physical therapy on these emerging models.

    Innovation 2.0 is designed to assist the physical therapy community in connecting the dots from feasibility studies to meaningful outcomes and to help move great ideas from small-scale use to wide applicability.

    Detailed information on how to submit your letter of intent as well as the formal application process will be released in January. Spread the news and stay tuned for more information at the beginning of the year.

    NIH Seeking Input From PTs on Activity and Disease Prevention

    The National Institutes of Health (NIH) Common Fund wants to identify potential research on the molecular-level connection between physical activity and disease prevention, and is looking to the physical therapy community for input.

    According to an alert from NIH, the intent behind this effort is no less than to "identify potential next steps for moving the entire biomedical research enterprise forward in this area." The work is being overseen by leaders from the National Institute on Aging, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the National Institute of Diabetes and Digestive and Kidney Diseases, with broad support throughout NIH.

    Physical therapists interested in providing input on this project can submit information at the project's Request for Information webpage. Deadline for submission is December 31.

    On Move Forward Radio: PT Helps Former NFL Player Make the Move to Endurance Sports

    In this week’s episode of Move Forward Radio, former professional football player Don Davey describes how he decided to compete in an ironman competition after retirement from professional football, and how Mike Ryan, PT, ATC, of the Jacksonville Jaguars, helped him reach that goal.

    Ryan, himself a competitive ironman, knew that making Davey's dream possible would require the former defensive tackle to dramatically reshape his body through training regimens built to accommodate football-related injuries. With Ryan's guidance, Davey has now competed in several ironman events.

    Ryan is the head certified athletic trainer/physical therapist of the Jacksonville Jaguars. In addition to taking care of professional football players, Ryan is a 6-time ironman triathlete.

    Move Forward Radio typically airs twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as a podcast via iTunes.

    Move Forward Radio and other MoveForwardPT.com resources provide PTs with great ways to educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be e-mailed to consumer@apta.org.

    Knee OA Presentation Now Available

    Physical therapists and physical therapist assistants can learn more about knee osteoarthritis (OA) through a free 30-minute presentation now available online.

    The "Lunch and Learn" program features Daniel White, PT, ScD, NCS, a research assistant professor at Boston University, and focuses on epidemiology and how to increase activity for individuals affected by knee OA.

    The program is sponsored by the Osteoarthritis Action Alliance, a national coalition of concerned organizations mobilized by the Arthritis Foundation and the Centers for Disease Control and Prevention (CDC). APTA is a part of the alliance.

    Car Rental Discounts Available for APTA Members

    APTA members traveling over the holidays can get discounts on rental cars, thanks to special programs from Avis and Budget.

    Both companies are offering savings of up to 25% for APTA members and will allow the use of additional online coupons to further reduce prices. Reservations can be made through the Avis website or by phone at 1-800-331-1212 (mention AWD number T031200), and through the Budget website or by phone at 800/445-2848 (mention BCD number X570900).

    Budget is also offering $25 toward a future rental through its "Budget Bucks" program. More information on the program is available at the Budget website.

    NIH and NFL Award Grants for TBI Research

    A partnership created by the National Institutes of Health (NIH) and the National Football League (NFL) will be awarding over $14 million in grants for research focused on the long-term effects of traumatic brain injury (TBI) and the development of better ways to diagnose and measure concussions.

    The Sports and Health Research Program issued a press release on December 16 announcing that 8 projects have been selected for the funding. Two major research efforts will receive $6 million each, and over $2 million in additional funding will be spread out over 6 pilot projects mostly focused on ways to better detect concussion presence and severity.

    The $6 million grants will be used to pursue research around chronic traumatic encephalopathy (CTE). One project will seek to define a range of specific features of the disorder, and to distinguish these features from other conditions such as Alzheimer disease and amyotrophic lateral sclerosis. The second project will investigate the relationship between the effects of TBI and various features of CTE, with the aim of identifying markers to help diagnose the degenerative effects of TBI.

    The pilot grants are intended to support initial research into concussion. Grants were awarded to the following projects:

    • development of a portable eye tracking device that can be used on the sidelines to diagnose concussion and monitor severity;
    • investigation into the function of adolescents who have been cleared to return to play and the role of microRNAs as potential biomarkers for concussions and recovery;
    • evaluation of Spotlight, a mobile application designed to track progress of an individual from the time of concussion until return to play;
    • analysis of gamma-amino butyric acid (GABA) levels, a chemical important to brain function, in adolescents who have and have not suffered concussion;
    • research into whether somatosensory information processing could serve as a biomarker for concussion and recover in youth aged 13–17; and
    • study of the changes in metabolites in mice after concussion and whether the changes can be revealed in blood samples.

    The Sports Health Program is a partnership between NIH, the NFL, and the Foundation for the National Institutes of Health. In 2012, the NFL donated over $30 million to the NIH Foundation for research into injuries that affect athletes.

    Early Exercise Can Reduce Depression in Parkinson Patients

    A pilot study has found that exercise can be an effective way to reduce depression symptoms among individuals with Parkinson disease (PD), particularly if the exercise program is implemented as soon as possible after diagnosis.

    The project followed 31 patients who were randomized into an early start group or a delayed start group. While researchers found no substantial differences in scores on the Unified Parkinson Disease Rating Scale among the groups, the patients in the early start group scored "significantly better" on the Beck Depression Inventory. The research was published in Parkinsonism & Related Disorders (abstract only available for free).

    Early exercise is an important component in managing the symptoms and side effects of PD. APTA offers several resources on the role physical therapy can play in treatment, including a PT's Guide to Parkinson Disease, a Move Forward radio broadcast on the topic, and evidence-based practice research that can be accessed through PTNow.

    Foundation Researcher Receives Major Grant Award

    A former Foundation for Physical Therapy (Foundation) grant recipient has been awarded a $1.7 million grant to continue work she began with Foundation funding.

    Kristin Archer, PT, DPT, PhD, assistant professor at Vanderbilt University Medical Center, was awarded $1.7 million Patient Centered Outcomes Research Institute (PCORI) grant on December 17 for her project "Comparative Effectiveness of Postoperative Management for Degenerative Spinal Conditions." Pilot information for this project was funded in part by the Foundation's 2011 Magistro Family Foundation Research Grant.

    Archer's research is focused on patients recovering from lumbar spine surgery and will compare 2 approaches delivered over the phone: cognitive-behavioral-physical therapy (CBPT) emphasizing self-management and an education program about postoperative recovery. The study will identify important patient outcomes, the impact of CBPT on these patient-centered outcomes, and the ways in which CBPT can improve outcomes in various patient subgroups. A project summary is available at the PCORI website.

    The project is one of 82 grants recently announced by PCORI, which is providing $191 million in funding for a range of work focused on patient outcome research.

    PCORI is a nonprofit organization authorized by Congress as part of the Patient Protection and Affordable Care Act. The organization's research is intended to give patients a better understanding of the prevention, treatment, and care options available, and the science that supports those options.

    New Resource Helps Explain Medicare - Medicaid Dual Eligibility

    Physical therapists who work with patients who qualify for both Medicare and Medicaid now have a tool that could help them navigate through some the complexities of dual eligibility, thanks to a guide jointly created by Medicaid and Medicare commissions.

    Though it may not have the most exciting title, the Beneficiaries Dually Eligible for Medicare and Medicaiddata book (.pdf) could prove to be a useful read for providers treating individuals in this special category. Individuals who are dually eligible tend to have multiple chronic conditions and difficulties with activities of daily living that can complicate the coordination of care.

    The joint analysis was created by the Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP Payment and Access Commission (MACPAC), and is available at both agencies' websites.

    2014 Budget Deal Includes SGR Patch, Therapy Cap Exceptions Extension

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

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

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

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

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

    Venous Ulcer Treatment Research Lacking

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

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

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

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

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

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

    Foundation Grants Fund PT Research on Wide Range of Topics

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

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

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

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

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

    Vets Will Receive Benefits for TBI-Linked Conditions

    The US Department of Veterans Affairs (VA) will be making it possible for veterans with traumatic brain injury (TBI) to receive additional disability payments for 5 conditions that have been connected with brain trauma.

    The new regulation will go into effect January 16, 2014, and will provide a way for veterans with Parkinsonism, seizures, certain dementia, depression, or hormone deficiency diseases to receive the additional payments if the conditions appeared after moderate-to-severe TBI. In a press release announcing the decision, the VA pointed to a National Academy of Sciences Institute of Medicine study that supported a strong link between the TBI and the 5 conditions.

    According to an article in Stars and Stripes, VA does not characterize the change as a new entitlement, but as a more direct path to payment. The current system allows for the additional benefits, but only after veterans submit medical documentation verifying a link between their TBI and the second condition. The new system will not require the documentation, but will base benefit eligibility on the severity of the TBI and the length of time between the brain injury and the onset of the second condition.

    Nearly 300,000 veterans have been found to have brain injuries since 2000, according to the Department of Defense.

    APTA has been a strong advocate for the important role physical therapy can play in treatment and management of TBI. Access more resources at the association's TBI webpage.

    Physical Therapy Named a 'Top Job' for 2014

    Physical therapists (PTs) have been listed among the career paths with the strongest recent growth and most potential for expansion in the future, with rates of increase greater than registered nurses and database administrators, among others.

    According to rankings from Forbes magazine, PTs are the fifth strongest-growth professionals, behind software developers and market research analysts, but ahead of web developers and petroleum engineers. The ratings were based on a recent study (.pdf) by Career Builder and Economic Modeling Specialists Inc.

    The Career Builder study projects that the US workforce will grow by 4.4% 2013–2017 and estimates the PT workforce to increase by 13% during the same time. The study's total projected number of PTs in the workforce is roughly similar to projections generated by the APTA Workforce Task Force, which has created supply and demand scenarios based on rates of attrition and other factors.

    Magazine Looks to PT for Winter Sports Advice

    A national publication has turned to a physical therapist (PT) and APTA spokesperson for advice on how to approach the winter months. And his take? Get moving.

    Spry magazine asked Robert Gillanders, PT, DPT, OCS, to comment on how winter sports can create opportunities for new levels of calorie burn through outdoor activities that most people don't engage in year-round. Gillanders said that activities such as cross-country skiing and even sledding are a way of not only "tricking your body" into more intense exercise but helping to relieve winter blahs. "People who exercise outdoors are happier, more satisfied, less depressed," he told Spry. Gillanders' comments appear in the December 13 online edition.

    Spry is a monthly magazine focused on lifestyle, diet, recreation, and leisure activities that promote health and wellness.

    APTA Board: Success With 2013 Strategic Plan Sets the Stage for 2014 Goals

    With most of the objectives of APTA's 2013 Strategic Plan met, the Board of Directors adopted new targets for 2014. The 4 goals of the Strategic Plan remain the same—effectiveness of care, patient- and client-centered care across the lifespan, professional growth and development, and value and accountability. The board agreed on updated objectives under each goal that the association will pursue next year.

    As in 2013, the highest priority objectives are development of the physical therapy outcomes registry (PTOR) and advancement of a more appropriate payment system, which APTA has proposed as the physical therapy classification and payment system (PTCPS). For PTOR, APTA aims to launch a pilot by the end of February and fully launch the registry by year-end. For PTCPS, APTA and other stakeholders continue the process that was begun last year, which includes submitting a coding proposal to the AMA CPT Editorial Panel and educate physical therapists in using the proposed system. The association is on track to implement the system, if all approvals are met, in 2015.

    Other important priorities also are contained in the 2014 Strategic Plan:

    • To reduce unwarranted variation in care, APTA will continue to add relevant clinical practice guidelines (CPGs) by helping with guideline development within our profession and evaluating and endorsing other health disciplines’ CPGs (see related story on the process for endorsing CPGs).
    • APTA will continue to encourage PTs to use valid tests and measures in their examination, evaluation, and treatment of patients by making them easy to access through PTNow.
    • APTA will continue its efforts to expand direct access, investigate the effects of physician self-referral arrangements, and help members navigate the health insurance exchanges created by the Affordable Care Act.
    • More education, tools, and guidance will help PTs and PTAs comply with payment policy, documentation, and coding requirements.
    • PTs and PTAs will be encouraged to provide prevention and wellness services, with tools being developed to measure the prevalence of these services among APTA members.
    • Based on learning domains APTA is developing that define major areas of competence, the association, including its sections and chapters, will identify the areas of highest priority for continuing education offerings.

    While the 2014 Strategic Plan is an extension of the 2013 plan that was based on APTA's former Vision 2020, it is a "bridge" to the new vision that APTA adopted at the June House of Delegates—"Transforming society by optimizing movement to improve the human experience."

    The association's outward facing new vision is apparent in many 2014 Strategic Plan objectives that promote practice in collaborative care models and encourage interprofessional collaboration in education. The 2015 Strategic Plan will be based on the new vision.

    Strategies and metrics for the plan’s objectives have been developed and will enable APTA's Board to track their progress throughout 2014. Progress on the plan will be communicated to members throughout the year.

    To see the full discussion on this and other topics from the December Board of Directors meeting, watch the archived livestream of all open sessions.

    APTA Board: 2014 Budget Is Balanced, Continues Strong Support for Strategic Plan

    The $43.5 million 2014 APTA operating budget will continue to devote the majority of discretionary funds to the APTA strategic plan.

    The budget adopted by the APTA Board of Directors during its December meeting at APTA headquarters predicts a 7.1% increase in revenues with a small use of investment gains to balance out expenditures for a break-even budget for the year.

    Similar to the 2013 budget, the newly approved plan continues to designate the majority of the association's "discretionary" funds—money not tied to basic operating activities or offset by direct revenue—to fulfillment of the APTA strategic plan. Strategic priorities (see related story) funded in the budget include the Physical Therapy Outcomes Registry and a physical therapy classification and payment system that promotes high-quality care, reflects the clinical reasoning and judgment of the physical therapist, and maximizes healthcare resources. The budget approved by the board assigns nearly 64% of these funds to strategic plan activities, an amount that represents 22.7% of all APTA expenses.

    To see the full discussion on this and other topics from the December Board of Directors meeting, watch the archived livestream of all open sessions.

    APTA Board: Guide to PT Practice 3rd Edition Slated for Online Release by Fall 2014

    The profession's definitive description of who physical therapists (PTs) are, what they do, and how they do what they do is poised to release its third edition by fall 2014. The tentative release date and some of the revisions to expect were reported during the Board of Directors December meeting.

    In addition to other changes to the Guide to Physical Therapist Practice, first published in 1997, the third edition will be an online-only resource, as the continued evolution of the Guide includes links and references to many other online resources that shouldn’t be separated from the Guide itself. A printed book version can't offer the same connectedness to these other resources, the Board report indicated, and the Guide will lose its full usefulness if it's applied or studied in a vacuum.

    Other changes are in store, too. Language will shift to International Classification of Functioning, Disability and Health (ICF) terminology, which APTA adopted in 2008, after the last edition of the Guide was published. The Catalogue of Tests and Measures, introduced in the second edition electronic version, will be archived and available to members, but no longer updated or intended for practical use. Instead, Guide users will find relevant tests and measures within the PTNow website.

    Also, the Preferred Physical Therapist Practice Patterns will be available as an online educational tool separate from the Guide, and the range of visits and ICD-9 codes will be removed. With the third edition focusing on the core audiences of clinicians and the academic community, the inclusion of ICD codes was deemed to be unwarranted, especially in light of the pending implementation of ICD-10, which would require APTA to revise all ICD coding in the Guide.

    To see the full discussion on this and other topics from the December Board of Directors meeting, watch the archived livestream of all open sessions.

    APTA Board: Governance Documents to Be Reviewed, Reorganized

    The APTA Board of Directors has decided that it's time the association untangle and clarify the approximately 370 positions, standards, guidelines, policies, and procedures (PSGPP) created through its history in a multiyear review process.

    At its December meeting, the Board reviewed a report that described the "challenges" to the current PSPPG documents. Among the issues cited by the work group that submitted the report were unclear definitions, overlap among policies, inconsistent wording and format, complicated organization, and content that is at times too detailed to work as policy.

    In response, APTA will begin a comprehensive review of all elements of the PSGPP, and the Board will forward a proposed revision to Standing Rule 21 of the association, which contains definitions for 5 different types of viewpoints and administrative directives. The suggested change reduces the 5 different categories in favor of characterizing all PSGPP documents as binding documents (primarily the Code of Ethics and Standards of Ethical Conduct), policy, and procedure. Neither recommendation was aimed at changing the intent of any PSGPP document but only at creating greater consistency and usefulness.

    Pending approval of the new definitions by the House of Delegates, staff and volunteers will begin PSGPP reviews, provide regular progress reports to the Board, and bring proposed revisions to the Board and House, but no firm completion date for the project was set.

    To see the full discussion on this and other topics from the December Board of Directors meeting, watch the archived livestream of all open sessions.

    APTA Board: Reports on New Care Models Will Undergo Further Analysis

    Two APTA task force reports on potential physical therapy models of care will be getting a closer look before being reconsidered by the APTA Board of Directors for presentation to the House of Delegates. The Board asked for the additional analysis, including review by an external policy analyst, at its December meeting to get a better understanding of the benefits and risks of pursuing models of care that might widen the range of who could provide services under the direction and supervision of a physical therapist.

    The reports were in response to resolutions passed by the House that began with a charge to study whether physical therapists (PTs), physical therapist assistants (PTAs), and physical therapy aides should be the only participants involved in the delivery of physical therapist services. The then-named Health Care Professionals and Personnel Involved in the Delivery of Physical Therapy Task Force began looking at this issue in 2011; the following year, the House expanded on the range of issues to be studied by adding a separate charge that APTA "explore practice models that are responsive to the needs of society and adaptable to our changing health care environment."

    The APTA Board of Directors responded by folding the new work into the research already started by the 2011 task force, and renaming the group the Models of Physical Therapy Services Delivery Task Force. The 2013 progress reports created by this task force generated lengthy discussion over 2 days at the December Board meeting held at APTA headquarters in Alexandria, Virginia.

    The task force's reports addressed all elements in the resolution and the charge from the House, which included analysis of impact on patient/client access, quality, and cost of physical therapist services in the context of new models of health care delivery; impact of new models of service delivery on personnel standards under Medicare, referral for profit, term and title protection, direct access, and other policies; and the ramifications of potential use of the new model(s) by other qualified providers of rehabilitation or therapy services, such as physicians.

    The Board voted to hold off on adoption of the reports until further review. The analysis would cover the entire reports with particular attention paid to how more expansive care models would be implemented in light of scope of practice issues, supervision requirements, and professional licensure requirements for a range of health care professionals.

    The Board will revisit the reports—and the additional analysis—at its January 2014 meeting, and it will forward its adopted reports to the 2014 House of Delegates prior to APTA’s Combined Sections Meeting.

    To see the full open discussion on this and other topics from the December Board of Directors meeting, watch the archived livestream of all open sessions.

    APTA Board: New Endorsement Process Could Increase Use of Clinical Practice Guidelines

    APTA is set to launch an endorsement process that could help significantly increase the use of clinical practice guidelines (CPGs) in physical therapist practice. The plan, which would create a rigorous review system for internally and externally developed CPGs, was approved by the APTA Board of Directors at its December meeting.

    Currently, APTA directly facilitates the development of CPGs through its sections, but the process can take 3–4 years to complete. Under the new plan, APTA will also review relevant internally and externally developed CPGs for their quality from a scientific perspective. This process will provide clinicians with high-quality useful CPGs that could help improve care for patients and clients.

    The 3-step system begins with staff review to ensure the proposed CPG's accessibility, currency, and consistency with APTA policy. Guidelines passing this review advance to the association's PTNow Evidence-Based Practice Library (EBPL) team, which conducts a critical appraisal to ensure quality. Finally, the EBPL team will recommend endorsement or non-endorsement of the CPGs to the APTA Board. The Board will verify that the process for endorsement was completed properly..All officially endorsed guidelines will be designated with a special icon that will help APTA members easily recognize the status.

    The endorsement system is part of the 2013–2014 APTA Strategic Plan to reduce unwarranted variation in care by increasing the number of peer-reviewed CPGs available to members.

    To see the full discussion on this and other topics from the December Board of Directors meeting, watch the archived livestream of all open sessions.

    APTA Board: 'Accreditation' to Replace 'Credentialing' for ABPTRFE

    The American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) will soon use the more appropriate term "accreditation" to describe a process it currently calls "credentialing." The terminology change, approved by the APTA Board of Directors at its December meeting, will not go into effect until after the 2014 session of the House of Delegates.

    The proposed change arose as part of an ABPTRFE effort to refine its policies and standards to ensure alignment with industry standards, and to position the organization for recognition by outside entities such as the US Department of Education and the Council for Higher Education Accreditation. In its report to the Board of Directors, ABPTRFE stated that "credentialing" is widely regarded as a recognition associated with individuals, and "accreditation" is the term more appropriate for recognition of programs.

    The Board approved the new terminology with a proviso that the change would not go into effect until after the House meets in June.

    To see the full discussion on this and other topics from the December Board of Directors meeting, watch the archived livestream of all open sessions.

    End to SGR and Therapy Cap Part of Wide-Ranging Medicare Package

    The House of Representatives and the Senate could reach agreement early next year on proposals to permanently repeal the flawed sustainable growth rate (SGR) formula and possibly end the therapy cap. These legislative packages are part of a shift in the health care system away from the current fee-for-service system and toward programs focused on quality outcomes. APTA has created a webpage with detailed information on the proposals.

    While an agreement looks possible, it will not be reached before the House and Senate adjourn for the holidays. In the meantime, Congress is expected to pass a 3-month SGR patch early next week to prevent a 20.1% cut to the conversion factor announced by CMS in the physician fee schedule and extend the current therapy cap exceptions process. This short-term fix would be effective January 1–March 31, 2014, and will give the House and Senate time to reach a final agreement on the SGR reform package. The Senate is expected to return on January 6 and the House on January 7. Congress will resume negotiations and begin discussing how to pay for the cost of the legislation.

    APTA has been a strong advocate for repeal of the therapy cap and SGR, and worked with committees in the House and Senate to include several APTA public policy priorities in the SGR reform packages now being discussed.

    Senate Proposal

    The Senate Finance Committee proposal includes a range of actions on the SGR and various Medicare extenders. The Senate plan:

    • Repeals the SGR formula and freezes baseline outpatient Medicare payments for 10 years (providers could receive payments above the base rate by participating in value-based incentive programs and transitioning to alternative payment models).
    • Repeals the Medicare therapy cap effective upon passage of the legislation, eliminating the requirement for a KX modifier at $1,900 and the need for yearly extensions.
    • Keeps manual medical review at $3,700 through 2014, then transitions to a new medical review program in 2015. The new program would use prior authorization to allow therapists to request blocks of visits. The Secretary of Health and Human Services would determine the level at which prior authorization applies and what services are subject to review.
    • Calls for a new data collection system to replace current functional limitation reporting procedures to be operational in or around 2017.
    • Requires claim forms submitted in 2015 to indicate whether the outpatient therapy services provided were rendered by a physical therapist assistant (PTA).
    • Extends the 1.00 work floor for the geographic practice cost index (GPCI) through 2014. In 2015 the floor would become 0.995, and in 2016 and beyond, the floor would be set at 0.99.

    House Proposal

    The proposal passed by House Ways and Means Committee repeals the SGR formula but does not include a repeal of the Medicare therapy cap or changes to any other Medicare extenders. During the hearing, Reps Xavier Becerra (D–-CA) and Erik Paulsen (R-MN) spoke about the need to address the Medicare therapy cap in the final SGR reform package. ChairDavid Camp (R–MI) agreed that the Medicare extenders need to be addressed and said that he intends work on these issues as the SGR legislation moves forward in the House.

    The proposal passed by the House committee:

    • Repeals the SGR formula and allows for a 0.5% payment increase each year until 2017.
    • After 2017, launches a system to make providers eligible for payment increases through value-based quality incentive programs and alternative payment systems.

    No action can be taken on the reform package until both chambers return in 2014. APTA will continue to work with members of Congress and their staff to best position the profession throughout the legislative process.

    How You Can Get Involved

    APTA will continue to work with members of Congress to advocate for the profession and will be seeking your help to best position physical therapy throughout the legislative process. Members interested in joining APTA’s advocacy efforts to reform SGR and repeal the therapy cap can sign-up for PTeam.

    EDs Need to Switch From 'Front Door' to 'Front Porch'

    According to a recent analysis, the pressures of an aging US population should cause emergency departments (EDs) to rethink delivery of care based on cooperative interdisciplinary decision-making, including comprehensive discharge planning involving physical therapists (PTs) when appropriate.

    The report, "Transforming Emergency Care for Older Adults," (abstract only available free) appears in the December 2013 issue of the health care policy journal Health Affairs and describes how EDs can respond to the "silver tsunami" affecting nearly all areas of health care. The article's authors assert that success will require EDs to seize "opportunities to transform the emergency department's … role as the 'front door' of the hospital to becoming the 'front porch,'" where treatment is provided with attention to what happens after the patient leaves the ED.

    Among the recommendations included in the analysis are the use of evaluative measures of cognitive function and discharge risk assessments, and the creation of "comprehensive discharge planning that includes shared decision-making." The plan should also include a high level of involvement with care transitions and "appropriate specialty consultation, such as physical therapy or home services, or both," authors write.

    The article warns that these new models of care for EDs that employ "much needed care-coordination" could, in the short term, increase ED lengths-of-stay and costs. However, authors assert that the changes create an opportunity for "pivotally improving patient health outcomes and facilitating optimal shared decision making while reducing admissions, ED revisits, and overall care costs."

    Health Affairs recently held a briefing on the latest thoughts on EDs, and has made video and other materials available online for free. PTs can find out more about the integral role of physical therapists in emergency care at APTA's webpage devoted to physical therapy practice in EDs.

    PT Keysor Elected Chair of Key Osteoarthritis Group

    APTA member Julie Keysor, PT, PhD, has been elected to lead the Physical Activity Work Group of the Osteoarthritis Action Alliance (OAAA). APTA is a member of the alliance.

    Keysor is the director of the Center for Enhancing Activity and Participation Among Persons With Arthritis at Boston University. She is a member of APTA's Geriatrics, Orthopaedics, and Research sections.

    The Osteoarthritis Action Alliance is a national coalition of concerned organizations mobilized by the Arthritis Foundation and the Centers for Disease Control and Prevention.

    Concussions Less Frequent at Higher Altitudes

    High school athletes at higher elevations experience 31% fewer concussions than athletes closer to sea level, and the difference may have something to do with the "tight fit" created inside the skull when altitude increases intracranial pressure.

    A recent study published in the Orthopaedic Journal of Sports Medicine looked at nearly 6,000 high school athlete concussions from across the US by examining data collected between 2005–2006 and 2011–2012 through the National High School Sports-Related Injury Surveillance System. After dividing incidents by the altitude at which they occurred, researchers found a strong correlation between lower concussion rates and higher elevations, with athletes playing at over 600 feet experiencing fewer concussions in both competition and practice settings.

    Researchers pointed to several factors that could contribute to the differences, but stated that what seems to happen is that higher altitudes reduce intracranial compliance—essentially, the amount of give that allows the slosh effect associated with concussions—and create a situation "similar to having an airbag deploy or 'bubble wrap' inflate and thus prevent damage to structures within a container."

    The study's authors call for more research in the relationship between altitude, intracranial pressure, and concussion, and point to recent studies that reduced brain injury in rats by as much as 83% through altering brain fluid dynamics. They wrote that "future research is warranted to test the hypothesis that mitigating slosh in the human cranium via mild jugular vein compression will reduce or diminish severity of concussion."

    APTA believes that concussion should be managed and evaluated by a multidisciplinary team of licensed health care providers that includes a PT. The association has developed policy resources at both state and federal levels, while practice-focused online concussion resources include a series of podcasts, a PT's guide to concussions, and online learning opportunities on when to return to sport and managing concussions with an interprofessional team. Members can also access evidence-based practice research through the PTNow webpage.

    Latest Thought on Emergency Department Care Available Online

    The past, present, and future of emergency department (ED) care were recently explored in a briefing hosted by Health Affairs, and the entire event and other materials are now available free online.

    The December 4 event brought experts together to focus on ED issues related to integrated networks of care, reinventing emergency care, quality management, access, cost/payment, and disaster preparedness. Among other topics, speakers addressed the increased need for more coordinated care that involves a wider range of health care professionals.

    Health Affairs is a monthly journal focused on health policy.

    Find out more about the integral role of physical therapists in emergency care: check out APTA's webpage devoted to physical therapy practice in EDs.

    Get 'Insider Intel' On Hot Topics in Medicare, Health Reform, and More

    Functional limitation reporting, the therapy cap, 2014 fee schedule payment rates, and the Centers for Medicare and Medicaid's manual changes reflecting the "improvement standard" will take center stage for APTA’s next "Insider Intel" program on December 16.

    The 30-minute call-in program will begin at 1:00 pm, ET. To register for a spot in the session, e-mail advocacy@apta.org with "December 16 Call" in the subject line.

    "Insider Intel" Q&A call-ins are dedicated to specific hot topics in policy and payment, free to APTA members.

    Can't join the live discussion? Recordings of the calls are available on the APTA website afterwards.

    Senate and House Propose End to SGR, Therapy Cap Repeal Also Discussed

    House and Senate proposals now on the table would end the sustainable growth rate (SGR) formula that has confounded adequate payment to Medicare providers since its inception. The Senate version also suggests a permanent repeal of the Medicare therapy cap. The proposals are scheduled for discussion this week.

    Both proposals—created by the Senate Finance and House Ways and Means committees—repeal the current SGR formula and freeze payment rates for 10 years. During this 10-year period providers are eligible to earn payment above the base level through value-based performance programs and alternative payment models.

    The Senate Finance Committee proposal also includes a full and immediate repeal of the Medicare therapy cap. However, manual medical review would remain in place at the $3,700 level through 2014, followed by the development of a modified medical review process beginning in 2015.

    The Senate proposal also calls for the creation of a new data collection system to replace the current functional limitation reporting system and includes language directing the Secretary of Health and Human Services to explore new payment models for outpatient therapy. The bill also requires that beginning in 2015, claims for outpatient therapy include data on whether a physical therapist assistant provided the service.

    The House Ways and Means proposal focuses solely on repeal of the SGR formula and does not include a repeal of the therapy cap or any Medicare extenders. The House committee is expected to discuss its proposal sometime this week before adjourning on Friday, December 13.

    APTA continues to work with legislators and staff on the Senate Finance and House Ways and Means committees as these proposals make their way through the legislative process. APTA will provide additional resources for members and an analysis of the impacts on the physical therapy profession after this week's discussions.

    Mothers Today Less Physically Active Than 1960s Moms

    Today's mothers are spending an average of 12.5 hours less per week on physical activity (PA) than mothers in the 1960s—a difference that researchers are describing as a "significant reallocation" of time to sedentary activities that could contribute to a potential public health crisis.

    The findings, published in the December Mayo Clinic Proceedings, examined data contained in the American Heritage Time and Use Study, an activity log program that has captured more than 50,000 diary days and 90 behavioral categories from mothers beginning in 1965.

    Researchers divided the mothers into 2 groups—those with children between the ages of 5 and 18 (mothers with older children or MOC), and those with children younger than 5 (mothers with younger children, MYC)—and reviewed activity logs over a 45-year period, 1965–2010.What they found, according to the authors, was alarming:

    • Weekly hours of PA in mothers of older children dropped from 32 to 20.9 hours per week, with a 7 hour-per-week rise in sedentary activity (SED) to 24.7 hours a week.
    • For mothers with younger children, the decrease in PA was even more significant, with weekly PA dropping from 43.6 hours per week to 29.7. The increase in SED was slightly less than the MOC group, up by 5.7 hours per week to a 22.7 hour-per-week average.
    • Energy expenditure decreased for both groups, with the MOC group showing a 1,238 drop in weekly calories burned and the MYC group burning 1,572 fewer calories per week. To offset this decrease and maintain their weight, mothers in the MOC group would need to consume 178 fewer calories per day than mothers in the 1960s, the researchers estimated; MYC would need to consume 225 fewer daily calories.
    • Stay-at-home mothers reported almost 2 times the decrease in physical activity as working mothers and higher rates of sedentary activity.

    Researchers attributed most of the difference to a significant rise in "screen-based media use" and wrote that "with each passing generation, mothers have become increasingly physically inactive, sedentary, and obese, thereby potentially predisposing children to an increased risk of inactivity, adiposity, and chronic [non-communicable diseases]."

    CMS Issues Information on Skilled Therapy Services and Maintenance Care

    The Centers for Medicare and Medicaid Services (CMS) has issued revised portions of the Medicare Benefits Policy and Claims Processing manuals to clarify coverage of skilled therapy services in maintenance care. The revisions were mandated as a result of the Jimmo v Sibelius settlement agreement reached in US District Court earlier this year.

    In the transmittal (.pdf), CMS reiterates its longstanding policy that skilled therapy services still may be covered even in situations where no improvement is possible, including when skilled services are needed to prevent deterioration. The transmittal also contains information on the documentation necessary for coverage determinations in skilled maintenance therapy.

    APTA is reviewing the transmittal and will provide a detailed summary in the coming days.

    Join CMS from 2:00 pm to 3:00 pm December 19 for a Medicare Learning Network conference call on how the Jimmo v Sibelius agreement will affect the services provided by physical therapists. Registration is open now, but spaces are likely to fill up quickly.

    WEDI Report Sees More Patient Control in Health Care's Future

    The influential Workgroup for Electronic Data Interchange (WEDI) has released what it calls a new "roadmap" for the future of health care, and a high level of consumer control is one of the primary destinations.

    The newest WEDI report (.pdf) comes 20 years after its initial examination of the use of technology in health care. The 1993 report played an influential role in the development of the Health Insurance Portability and Accountability Act (HIPAA) as well as the transition to standardized transaction formats in payment.

    The newest report focuses on 4 major areas: patient engagement, payment models, data harmonization and exchange, and "innovative encounter models." Although approaches and priorities differ in each area, the WEDI report emphasizes the need for greater coordination of technologies, both to make information-sharing more efficient and to provide consumers with a high degree of control over their own care and information.

    "Health IT is not the cure in and of itself but, when adequately deployed, can serve as a powerful change agent," the report states. "The rise of mobile and other technologies creates many opportunities for the healthcare industry to move forward together to solve many of the challenges that have plagued the American healthcare system."

    APTA Analyzes the 2014 Fee Schedule, Outpatient Prospective Payment System

    APTA members now have access to detailed information on how the 2014 Medicare physician fee schedule and the hospital outpatient prospective payment system (OPPS) will affect physical therapist practice. APTA staff has prepared analyses of the final rules that the Centers for Medicare and Medicaid Services (CMS) announced on November 27.

    APTA's fee schedule summary (.pdf) covers the new schedule's impact on payment, including the impact of the sustainable growth rate (SGR) and therapy cap. The summary also includes an analysis of the proposed changes to the physician quality reporting system (PQRS).

    The OPPS highlights (.pdf) document also addresses payment changes and provides analyses of the final Ambulatory Payment Classifications (APCs) as well as new rules around supervision of outpatient therapeutic services in critical access hospitals (CAHs).

    Both resources are free to APTA members, and have been added to the physician fee schedule and Medicare in hospital settings information on the APTA website.

    2014 Slate of Candidates Posted

    The 2014 Slate of Candidates for APTA national office is now available on the APTA website. It also may be found in the House of Delegates Community documents under "Nominations, Candidacy, and Elections." The candidate webpage, including candidate statements, will be posted on January 31, 2014. Elections for national office will be held at the 2014 House of Delegates on June 9, 2014. Please contact Amber Neil in APTA's Governance and Leadership Department for additional information.

    Marketing Tips Emphasize Diverse, Thoughtful Approach

    When it comes to marketing your physical therapist practice, don't get so caught up in all the new delivery methods that you forget the basics of knowing your audience, understanding yourself, and figuring out how you'll know when you've succeeded. That's 1 of the guiding principles of a special feature on "Marketing and Public Relations for the Physical Therapist" in the latest issue of PT In Motion, APTA's member magazine.

    In the article, APTA Director of Marketing and Creative Services Chanté Sedwick and Senior Public Relations Specialist Jennifer Rondon provide both big-picture considerations and practical tips on how to approach the sometimes-dizzying array of marketing options available. According to the authors, no single approach should be ruled out: social media is hot right now, but seemingly old-fashioned direct mail campaigns are still at least scanned by 78% of recipients.

    Sedwick and Rondon warn against rushing into any marketing or public relations effort without first taking the time to assess who the physical therapist (PT) wants to reach and the specific values that differentiate the PT from other providers—and, possibly, other physical therapist practices. While possibly not as exciting as diving into a Facebook-fueled ad campaign, developing a few basic operating assumptions can save time and money, and generate results. The authors offer several tips on how to get started on the process and move on to an overview of delivery methods.

    PT in Motion is a monthly magazine focused on hot issues in physical therapy and health care. The magazine is free to APTA members, and available in both hardcopy and online formats.

    Additional practical information on marketing your physical therapist practice and yourself can be found in APTA’s Business Skills in Physical Therapy: Strategic Marketing, 2nd Ed , a home-study course by Peter Kovacek, PT, DPT, MSA.

    CMS To Host Conference Call on 'Improved Standard' Agreement

    Physical therapists (PTs) can get the latest information on how the Jimmo v. Sibelius settlement agreement reached in US District Court will affect the services they provide under Medicare by joining in on a December 19 Medicare Learning Network conference call. Registration is open now, but spaces are likely to fill up quickly.

    The agreement reached in January reinforces Medicare's policy that when skilled services are required to provide care to slow or prevent further deterioration, coverage cannot be denied because of the lack of potential for improvement. The agreement has particular relevance to home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and outpatient physical therapy providers.

    The call will be held from 2:00 pm-3:00 pm, ET. Participation is limited, and continuing education credits may be available. To register, visit the MLN Connects Upcoming Calls webpage.

    No Rules Of The Road for Getting Behind the Wheel After Injury, Says NYT

    When is it safe to drive after an extremity injury? According to a recent article in the New York Times, even when the question is limited to a specific injury such as a broken wrist or sprained ankle, the considered answer from research boils down to a firm "it depends."

    NYT reporter Jan Hoffman looked at recent studies of postoperative driving and interviewed several orthopedic surgeons to find out what firm guidelines existed relative to getting back on the road after an injury or surgery. While there were some constants—no driving with a brace on the right leg, no driving if the wrist or elbow is immobilized, for example—there were few hard-and-fast rules, and many complicating factors.

    Some of these complicating factors include the kind of car being driven, individual driving habits, and lack of sleep due to pain. Additionally, Hoffman reported that surgeons are sensitive to the potential variations in recovery and often hesitate to make a specific recommendation for fear of legal repercussions should the patient get into an auto accident or aggravate the original injury by driving.

    Editor's note: be sure to check out the comments on the article posted by readers, many of whom describe their own experiences with recovery after injury/surgery.

    Modest Grassroots Activity Could Threaten Repeal of Therapy Cap

    Low participation among physical therapists (PTs), physical therapist assistants (PTAs), and their supporters could diminish legislator interest in permanent repeals of the therapy cap and sustainable growth rate (SGR) formula, which are set to be discussed in Congress. APTA urges its members to take any of the easy steps available to make their voices heard at this critical point in the process.

    Though it only takes a few minutes to participate, only 1% of APTA members have joined the grassroots effort to date, and time is running out. The Senate Finance and House Ways and Means Committees will be discussing legislative framework for a permanent solution to the sustainable growth rate (SGR) formula next week. During these committee meetings, legislators will also be reviewing Medicare extenders, like the therapy cap. It is essential that a full repeal of the cap is included in the SGR packages.

    Now is the time to contact legislators. If you are tired of the yearly extension system, you can help put an end to this unstable and unpredictable practice by taking action now. If the voices of PTs aren't strong enough, physical therapy could get lost in the shuffle of SGR reform.

    Everyone can get involved and help ensure patient access to outpatient therapy services for the long term by e-mailing their legislators. APTA members can use the Legislative Action Center and patients/non-members can use the Patient Action Center. You can also take action from your smart phone by downloading the free APTA Action app.

    Move Forward Radio Discusses Chronic Pain

    The latest episode of APTA's Move Forward Radio looks at chronic pain through 3 people who were part of a new Discovery Channel documentary on the subject and a physical therapist (PT) who treats chronic pain in his practice. APTA has also issued a press release on the episode.

    The Move Forward Radio episode includes Iraq war veteran Derek McGinnis, as well as Melanie Rosenblatt, MD, and American Chronic Pain Association CEO Penney Cowan. Also featured is John Garzione, PT, DPT, president of the Orthopaedic Section’s Pain Management Special Interest Group, who discusses the role of physical therapy for chronic pain.

    McGinnis, Rosenblatt, and Cowan were featured in Pain Matters, a documentary that features the stories of 6 individuals living with chronic pain, as well as the perspectives of several experts in pain management. The film can be viewed online and will be rerun on December 7 and 14 on the Discovery Channel.

    Designed to be of interest to consumers, Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as podcasts via iTunes.

    Feedback on a past episode? Great idea for a future episode? E-mail consumer@apta.org.

    PTs Get Expanded Code Choices in Maryland Medicaid System

    After more than 2 years of work by APTA and the Maryland Chapter, the fee schedule for Maryland's Medicaid program has been expanded to include additional procedure codes directly related to physical therapy.

    The additional CPT codes went into effect on December 1 for the Maryland Medical Assistance Program (MMA) and include a range of codes that more appropriately describe the services provided by physical therapists (PTs). Previously, the program's fee schedule was limited to 4 codes: PT evaluation, therapeutic exercise, unlisted therapeutic procedure, and manual therapy. APTA and the Maryland Chapter voiced concerns over the limitations of the codes.

    The added codes will strengthen increased patient access to physical therapy services achieved through the expansion of Medicaid under the Affordable Care Act (ACA). The new fee schedule can be found in the MMA provider manual (.pdf). Editor's note: some users may have to click "cancel" and "ok" to access the document.

    APTA Names HPSO, Hocoma, Parker Labs Strategic Business Partners

    APTA added 3 companies to its Strategic Business Partners program. Through the program, APTA seeks to enhance business relationships and develop meaningful partnerships with for-profit companies by offering services and marketing opportunities that provide mutual benefits to partners and APTA. The new partners are:

    Healthcare Providers Service Organization (HPSO), a division of Aon Affinity. HPSO and APTA have provided a variety of risk management resources to physical therapists (PTs), including claim report, a service that delivers 10 years of comprehensive professional liability and licensing protection claims data and trends.

    Hocoma USA, Inc., a Swiss medical technology company that provides robotic rehabilitation therapy to support patients with neurological diseases and injuries as well as those with low back pain. Products include Lokomat® for locomotion therapy, Armeo® for upper extremities, Erigo® for early rehabilitation and mobilization, and Valedo® for low back pain functional movement.

    Parker Laboratories, a manufacturer and marketer of ultrasound and electrormedical accessories and supplies. Parker Laboratories products include Aquasonic® 100 Ultrasound Transmission Gel, Protex™ Cleaner/Disinfectant for athletic training rooms, and Thermosonic® Gel Warmer.

    APTA issued press releases for HPSO, Hocoma, and Parker Laboratories as the partnerships were announced. For further information on the APTA Strategic Business Partner program, please visit the Strategic Business Partners webpage.

    Average Hospital Stay Was $10k in 2011; Musculoskeletal Conditions 2nd Largest Area of Cost

    From 1997 to 2011, the average cost of a hospital stay rose to $10,000, with the costs for stays for osteoarthritis and back problems increasing at more than 2 times the overall rate. In terms of the reason for stays, musculoskeletal conditions represented the second largest single area of costs, at 14%.

    The statistical brief (.pdf) released this month by the federal Agency for Healthcare Research and Quality's (AHRQ) Healthcare Cost and Utilization Project (HCUP) is based on data from community hospitals and reflects 95% of all discharges in the United States. Among the findings from the study:

    • In 2011, the average cost of a hospital stay was $10,000.
    • Between 1997 and 2011, costs rose at an annual inflation-adjusted rate of 3.6%. Consumer prices during that time rose at a 2.1% rate.
    • Adults aged 45–84 accounted for almost 66% of all costs and, at an average of $12,600, the highest mean cost per stay.
    • Stays billed to Medicare and Medicaid accounted for 63% of aggregate costs, and average Medicare costs were $1,900 higher than the overall figure.
    • Circulatory conditions accounted for 18% of hospital costs, followed by musculoskeletal conditions (14%) and respiratory conditions (11%). Other conditions represented between 5% and 9% of costs.
    • Osteoarthritis, spondylosis, and hip fracture were among the diagnoses with average stay costs more than 50% higher than the $10,000 average; however, hip fracture witnessed a decline in overall hospitalization rates, which reduced aggregate cost estimates.

    Established in 1988, HCUP contains the largest all-payer longitudinal database in the United States and uses state government data, hospital associations, private entities, and the federal government to create its studies.

    APTA offers information to physical therapists (PTs) and physical therapist assistants (PTAs) on how to reduce hospital stays and costs through minimizing risk of readmission, as well as how to keep up with current reporting requirements for inpatient care. Additionally, former APTA Board of Directors member Dianne Jewell, PT, DPT, PhD, CCS, serves on the National Quality Forum's (NQF) Ad-hoc Planned Readmissions Committee. Better still: minimize the risk of any hospital stay for hip fracture by learning about falls prevention.

    California Chapter and CAL-PT-FUND Make Major Pledge to Foundation

    The California Physical Therapy Association (CPTA), in collaboration with the California PT Fund (CAL-PT-Fund), has pledged $100,000 toward a Foundation for Physical Therapy project that would create the nation's first Center of Excellence for Health Services and Health Policy Research dedicated to training physical therapist researchers.

    The Foundation already has received more than $2 million of the $3 million needed to establish the center, which will be devoted to training the next generation of physical therapist (PT) investigators equipped with the skills to examine and analyze physical therapy delivery, organization, financing, and outcomes. The Center of Excellence will build on the Foundation's efforts to support scientifically based and clinically relevant research in physical therapy.

    The Foundation issued a press release on the pledge, and is encouraging other states to join California in making a commitment to development of the center. Individual tax-deductible contributions are also accepted and can be made online or by postal mail at 1111 North Fairfax Street, Alexandria, VA 22314. For more information, contact Barbara Malm or call 800/875-1378.

    Humana Acknowledges Problems With MPPR Adoption

    Physical therapists (PTs) who contract with Humana have been finding out about the managed care company's shift to the multiple procedure payment reduction (MPPR) policy the hard way—by being notified that they have to reimburse the company for payments they've already received. Humana has informed APTA that it plans on moving away from its practice of retroactive "overpayment recovery" and is working to fix errors in how the policy has been applied and calculated, but the insurer warns that it may be some time before all changes are in place.

    Earlier this year, Humana began applying the MPPR policy on Medicare Advantage and commercial insurance plan payments for physical therapy, a change that resulted in reductions in payments to PTs. APTA wrote a letter (.pdf) to the company in early October outlining concerns over both the flawed MPPR policy and Humana's implementation of it. Among the concerns APTA voiced were issues around lack of provider notification, the burden placed on PTs through overpayment recovery, the inappropriate ways Humana applies MPPR on a per-visit basis, and inaccuracies in Humana's overpayment recovery calculations.

    In its response letter (.pdf) to APTA, Humana acknowledged that it intended for the policy to be applied only to fee-for-service arrangements and identified 5 per-visit claims that it had incorrectly processed. The company also admitted that errors were made in MPPR calculations for some claims, and reported that it is reviewing all calculations and completing any corrections by the end of the year.

    Humana described its overpayment recovery system as "not ideal" and wrote that "it takes time to make the necessary changes to apply this payment policy on initial claims processing." However, the company provided no timeline for when it would make the shift away from retroactive reductions.

    APTA remains concerned about the administrative burden on providers subjected to MPPR through overpayment recovery instead of on initial payment and will continue to discuss this issue with Humana representatives in the coming weeks. Your direct experiences and documentation can support this discussion: send an e-mail to advocacy@apta.org with your name, member ID, and contact information for staff follow-up.

    Vision Differences Between Eyes Prevalent in Older Adults, Can Increase Falls Risk

    Older adults are at significant risk of developing vision differences between their eyes that, if undetected, could increase the likelihood of falls.

    A new longitudinal study (abstract) in Optometry and Vision Science found that nearly 1 in 3 adults develop significant vision differences in each eye (called anisometropia) by their late 70s, an incidence rate that "needs to be clearly emphasized to clinicians" to ensure appropriate correction, according to the study's authors. If left uncorrected, the condition can interfere with depth perception and other visual skills necessary to prevent falls.

    APTA identifies visual impairments as a significant contributor to falls and recommends interventions that address multiple risk factors.

    Need more information on falls prevention? Get evidence-based practice information through PTNow and Open Door, and download APTA's education on exercise prescriptions for balance and falls prevention and pocket guide on falls risk reduction (.pdf). Share falls prevention information and experiences with APTA's online community dedicated to the issue.

    Therapy Cap Repeal in Sight, But More Grassroots Action Needed

    A full repeal of the Medicare therapy cap could become part of congressional discussions on the sustainable growth rate (SGR)—but your voice is needed now to ensure that the repeal remains a priority on Capitol Hill.

    APTA has been meeting with the Senate Finance and House Ways and Means Committees to urge members to include a full repeal of the Medicare therapy cap in the SGR reform package currently under discussion. With less than 30 days until the expiration of the therapy cap exceptions process, grassroots involvement is more important than ever.

    There are several easy ways to take action right away:

    • E-mail your legislators. Use the Legislative Action Center or Patient Action Center to tell your members of Congress that the Medicare therapy cap must be addressed in order to ensure access to outpatient therapy services in 2014.
    • Use the power of social media. Visit the Medicare therapy cap grassroots webpage to download the Stop the Therapy Cap logo, and change your profile pictures on Twitter and Facebook. Then tweet your legislators or share APTA’s Stop the Therapy Cap messages to help promote awareness. Be sure to encourage your colleagues, patients, friends and family members to get involved too.
    • Take action from your smart phone. Download the free APTA Action app (available at both Apple and Google Play app stores) to find your legislator’s Facebook page and Twitter profile, and let your voice be heard.

    Legislators only have until December 31 to permanently repeal the cap or extend the exceptions process.

    Physical Therapist Paris Begins His Bid to Sail Solo Around the Globe

    Stanley Paris, PT, PhD, FAPTA, FAAOMPT, would tell you that physical therapists (PTs) are a diverse, multitalented group of professionals, but you'd have to catch him first—or at least wait until he returns from his attempt to become the oldest and fastest person to sail around the world solo.

    Paris, 76, began his attempt on December 2, and will attempt to complete the circumnavigation in 120 days. If successful, he will beat the current speed record by 1 month and the current age record by 22 years. Paris is also leveraging his attempt as a way to raise funds for the Foundation for Physical Therapy, where he serves on the Board of Trustees.

    The trip is being made on Paris's 63-foot yacht, the Kiwi Spirit, a craft that runs solely on wind and solar energy. Paris will document his journey and post videos and other information on his website, www.stanleyparis.com.

    Paris is a widely known PT who founded the University of St. Augustine (Florida) for Health Sciences. He has written more than 40 research articles and 1 textbook, The Spinal Lesion.

    Help Stanley Paris bring more attention to the need for research in physical therapy: find out how to donate in honor of the sail and how your name can be added to the hull of the Kiwi Spirit upon her return. Visit www.foundation4pt.org for details.