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  • New in the Literature: Subacromial Impingement Syndrome (BMJ 2012 Feb 20 [Epub ahead of print])

    A specific exercise strategy that focuses on strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilizers is effective in reducing pain and improving shoulder function in patients with persistent subacromial impingement syndrome, say authors of an article published online in BMJ. By extension, they add, this exercise strategy reduced the need for arthroscopic subacromial decompression within the 3-month timeframe used in the study.

    This randomized, participant and single assessor blinded controlled study was conducted in an orthopedic department in a Swedish university hospital. Orthopedic specialists recruited 102 patients with longstanding (more than 6 months) persistent subacromial impingement syndrome that did not respond to earlier conservative treatment. 

    The specific exercise strategy consisted of strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilizers in combination with manual mobilization. The control exercise program consisted of unspecific movement exercises for the neck and shoulder. Patients in both groups received 5 to 6 individual guided treatment sessions during 12 weeks. In between these supervised sessions the participants performed home exercises once or twice a day for 12 weeks.

    The primary outcome was the Constant-Murley shoulder assessment score evaluating shoulder function and pain. Secondary outcomes were patients' global impression of change because of treatment and decision regarding surgery.

    Most (97, 95%) participants completed the 12-week study. There was a significantly greater improvement in the Constant-Murley score in the specific exercise group than in the control exercise group (24 points vs 9 points). Significantly more patients in the specific exercise group reported successful outcome (defined as large improvement or recovered) in the patients' global assessment of change because of treatment— 69% (35/51) vs 24% (11/46); odds ratio 7.6 (95% confidence interval 3.1 to 18.9). A significantly lower proportion of patients in the specific exercise group subsequently chose to undergo surgery—20% (10/51) vs 63% (29/46); odds ratio 7.7 (95% confidence interval 3.1 to 19.4).

    APTA Testifies at HHS Quality Subcommittee

    Yesterday, APTA testified on the use of functional mobility and self-management measures at the Department of Health and Human Services' (HHS) National Committee on Vital and Health Statistics Quality Subcommittee on Patient Quality Measures.

    Nearly 20 quality experts spoke on understanding patient/consumer health and health care decision-making needs and the measures and data to support health and decision making, using patient experience and satisfaction measures in assessing whether consumers/patients achieve their goals and expectations, and using patient preference measures in selection of insurance coverage, health providers, and treatment options. 

    APTA's testimony, delivered by Heather L. Smith, PT, MPH, program director of quality, included information about functional mobility measures that are currently being used. The association described barriers to adopting certain quality measures, such as practitioners' resistance to change, the time needed to administer and interpret results, and access and cost issues related to technology, as well as presented strategies that could be employed to overcome these barriers.    

    In addition to APTA, other panelists who presented on measures of functional mobility and self-management included John Hough, DrPH, MPH, MBA, from the National Center on Health Statistics, and Matt Stiefel, MPA, of Kaiser Permanente.

    South Dakota Law Protects Patients From Excessively High Copays

    Last week, South Dakota became the latest state to improve consumer protections from excessively high physical therapy copays when Gov Dennis Daugaard signed House Bill 1183, legislation promoted by the South Dakota Chapter.

    HB 1183 limits the amount a health insurer may charge a patient for an out-of-pocket copayment or coinsurance amount when he or she visits a physical therapist or occupational therapist. After the bill takes effect July 1, those copayment and coinsurance amounts cannot be higher than those charged when a patient visits a primary care physician or practitioner.

    Health insurers often categorize physical therapy as a "specialty" service, and typically require higher copays than primary care services—sometimes as high as $60 or more for a single visit. 

    "Legislators saw that this bill was all about patient access and affordability," said Ronald Van Dyke, PT, OCS, president of the South Dakota Chapter. "They wanted to make sure the people of South Dakota could access the physical therapy and occupational therapy care they need at a fair cost."

    Read more about House Bill 1183 in this APTA press release.   

    Last year, Kentucky enacted a similar copay protection law.

    Physical Therapist Named 'Best Job' in 2012

    US News & World Report yesterday issued its list of "best jobs"—ranking physical therapist as the fourth best job in health care and the eighth best overall job in 2012. The annual list includes jobs that are "hiring in droves, paying well, and providing room to grow." APTA Deputy Executive Director Janet Bezner, PT, PhD, is quoted in the article about how students can use internship opportunities to "to pay attention to what they like or don't like" and determine the type of patients and the size and style of practice that will best suit them.     

    Active Video Games Fall Short of Boosting Overall Physical Activity

    Children given video games that simulate activities such as boxing and dancing are no more physically active overall than children who play nonactive video games, says a HealthDay article based on a study published this month in Pediatrics.

    Researchers followed 78 children ages 9-12 who had never owned a Wii video game console. Half of the children choose from a selection of 5 active fitness-focused games. The other half chose from inactive games. After 6 weeks they were given an opportunity to choose another game. The children received needed accessories including balance boards, remote controllers, and resistance bands. Each child wore an accelerometer to measure physical activity. The belt could be taken off only when swimming or bathing, and the children kept a journal of when they removed it.

    Lead author Tom Baranowski, PhD, told HealthDay that the investigators expected to see a "substantial increase in physical activity in the group that played the active games, but not in the inactive game group" starting in the first week. They expected another surge when the children chose their second game.

    "But we found there was no difference in the level of the activity between the treatment and control groups. What we detected at baseline, before playing active video games, was exactly the same in weeks 1, 6, 7, and 12," Baranowski said.

    Pediatrician Christina Suh, MD, who was not part of the research team, said, "The take-home message is that on a population basis, it looks like using active video games is not an effective way of getting kids to be more active. In other words, if someone thinks of passing out Wii fitness consoles to kids in a public school district, for example, it probably wouldn't be effective in terms of its impact on public health."

    Exercise prescription for children needs to individualized, Suh added. "The key is figuring out what's really fun for that child." 

    Full text of the article is available through Pediatrics

    Order CSM 2012 Images and Downloads Now

    You now can order images and downloads from CSM 2012 from David Braun Photography Inc. To order, go to www.davidbraun.photoreflect.com and click on APTA CSM 2012. Enter the password windy12, click the GO button, select any day or event gallery link, and click on thumbnails to view larger images. Use the drop-down menu on the upper right to change between daily galleries. Prices for prints appear on the right when viewing an image. To order file downloads, click on the Digital Products link below the print prices. 

    Webinar Provides Governance Review Update

    In a recorded webinar, Shawne E. Soper, PT, DPT, MBA, APTA Board of Directors, Speaker of the House, provides an update on APTA's ongoing governance review on behalf of the governance review task force.

    The webinar provides a broad overview of the recommendations that will be brought to the Board of Directors for discussion at its April 20-24 meeting. (Please note that none of the recommendations have been adopted.) Delegates will be given the opportunity to discuss the governance review recommendations at forums held during the 2012 House. The Board will forward any recommendations that require a change in our bylaws to the House of Delegates for its consideration in 2013.

    APTA's governance review is designed to better align the governance structure in support of the strategic plan, clarify roles and responsibilities for the decision-making entities at all levels, and ensure that APTA's mission can be more readily achieved, among other benefits.

    Therapy Cap Resources Now Available

    On Wednesday, President Obama signed the Middle Class Tax Relief and Job Creation Act of 2012 (HR 3630), extending the therapy cap exceptions process for the remainder of 2012. The law mandates consistent use of the KX modifier upon reaching the $1,880 therapy cap and puts in place several reforms to the therapy cap policy.

    Starting October 1, claims that meet or exceed $3,700 in annual therapy expenditures will be subject to a manual medical review. The $3,700 threshold will be applied to the combined physical therapy/speech-language pathology cap; a separate $3,700 threshold will be applied to the occupational therapy cap. Also starting October 1, each request for payment must include the national provider identifier of the physician who currently periodically reviews the plan of care. Additionally, HR 3630 designates that the therapy cap along with the exceptions process should apply to the hospital outpatient setting no later than October 1. This provision, along with the full exceptions process, will expire at the end of 2012 unless Congress chooses to extend them into 2013.

    An information bulletin, podcast, and FAQs thoroughly outline these new provisions and also address 2 key reports mandated by the law to review methods to improve the outpatient therapy benefit and examine the manual medical review process.

    CMS Releases Stage 2 Requirements for EHR

    Yesterday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule for Stage 2 criteria for "meaningful use" for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.

    In the rule, CMS proposes to specify criteria that eligible health care professionals (EPs), eligible hospitals, and critical access hospitals must meet in order to qualify for an incentive payment, as well as introduce changes to the program timeline and detail payment adjustments. The proposed Stage 2 criteria focus on increasing the electronic capturing of health information in a structured format and the exchange of clinically relevant information between providers at care transitions.

    CMS also proposes new objectives that have greater applicability to specialty providers and additional criteria for reporting clinical quality measures.

    Physical therapists (PTs) are not defined as EPs at this time; therefore, they are not yet eligible for incentives under Medicare of Medicaid, but, accordingly, they will not be subject to penalties for failure to implement EHR systems. However, physicians and facilities that are included in the program will expect PTs with whom they share patients to use compatible EHR systems. A new APTA resource, Guide to Understanding and Adopting Electronic Health Records, can help PTs make decisions about selecting and implementing EHRs.

    New in the Literature: Optimal Intensity of Rehab (Arch Gerontol Geriatr. 2011 Dec 28. [Epub ahead of print])

    Intensive rehabilitative therapy significantly promotes physical and psychological function with pain reduction in older patients, say authors of an article published online in Archives of Gerontology and Geriatrics

    Researchers enrolled all patients with functional decline after an acute illness admitted to the post-acute care (PAC) unit of a community hospital in Taiwan between July 2007 and December 2010. Patients enrolled before April 2009 received usual rehabilitation (40 minutes per day 5 days per week). Patients enrolled after April 2009 received increased rehabilitation (80 minutes per day 5 days per week). Researchers measured functional improvement by comprehensive geriatric assessment (CGA) at admission and 4 weeks after admission to the PAC unit.

    Overall, 458 patients (mean age: 83.4±5.5 years, all males) completed PAC services. Compared with all dimensions in CGA, increased dosage of rehabilitative therapy showed significantly better improvement in daily living activities (Barthel index 28.8±18.4 vs 20.0±14.6), depressive mood (geriatric depression score short form -0.5±1.0 vs -0.1±0.5), and pain reduction (numerical rating scale -2.0±2.2 vs -0.9±2.1), but not in cognitive function (mini-mental status examination 2.9±3.3 vs 3.3.±5.2) and nutritional status (body mass index 0.3±0.9 vs 0.3±2.5).  

    Troubleshooting Version 5010: New Resources From APTA

    A new APTA Web page contains resources to help physical therapists transition to HIPAA Version 5010. In addition to implementation information, the association has designed an online complaint form for members who are having issues transitioning to the new standards. After the form is completed and submitted online, APTA will forward the issue to the Centers for Medicare and Medicaid Services.

    The official deadline to adopt Version 5010 was January 1. CMS will begin enforcement of the standards April 1.

    APTA Continues to Build ACO Resources

    As part of its ongoing efforts to educate members about Accountable Care Organizations (ACOs) and the opportunities to become a part of this new model of care, APTA is creating a list of ACOs throughout the country. This listing may not be all inclusive as ACOs develop and change their status through the expiration of contracts, or because APTA has not been notified of their existence. Updates will be added as new information is made available to the association.

    If you have information regarding ACOs in your area, or have questions regarding how to participate in an ACO, e-mail advocacy@apta.org.

    Last Call for Federal Government Affairs Leadership Award, Public Service Award Applications

    February 27 is the deadline to submit nominations for 2 advocacy awards that will be presented in April at the Federal Government Affairs Forum.      

    The Federal Government Affairs Leadership Award is presented annually to an active APTA member who has made significant individual contributions to APTA's Federal Government Affairs efforts and has shown exemplary leadership in furthering the association's objectives in the federal arena. The Public Service Award is presented annually to 1 or more individuals who have demonstrated unique support for the physical therapy profession at a national level. Individuals from the following categories are eligible for nomination: members of Congress/congressional staff members; members of a state legislature; federal agency officials; health/legislative association staff; and celebrities or other public figures. APTA's Board of Directors will choose award recipients in March. Award presentations will be held at the Federal Government Affairs Forum in Washington, DC. This year's Federal Advocacy Forum will be held in conjunction with a larger event, APTA's Leadership Forum, which integrates APTA's Board of Directors meeting, the Leadership Symposium for New Component President and Executive Teams, and the Federal Advocacy Forum. Participation at other events is not required to attend the Federal Advocacy Forum. Submit nominations by February 27 to Angela Boyd or fax to 703/706-8519. If you need a nomination form or have questions, call Angela Boyd at 800/999-2782, ext 3256.

    PT 2012 Early-bird Registration Open Until March 19

    Register before March 19 and get the best rates for PT 2012, APTA's Annual Conference & Exposition, June 6-9 in Tampa, Florida. PT 2012 offers more than 90 educational programs in 14 tracks, and includes the popular McMillan and Maley lectures and the Oxford Debate. Attendees can earn up to 21 contact hours.

    Register today and connect! Join your peers, recognized experts, and leaders for 3 days of valuable, relevant, invigorating professional development and networking.

    Treatment for Osteoarthritic Knees and Hips May Differ

    Duke University researchers who found that osteoarthritic knees, but not hips, are in a constant state of repair say that knee and hip osteoarthritis may need different treatment approaches.

    "This suggests the knee has capacity for repair we didn't know about and the main treatment strategy probably would need to focus on turning off the breakdown of knee tissue," says Virginia Kraus, MD, PhD, professor of Rheumatology and Immunology at Duke.

    The findings, published in Journal of Biological Chemistry, suggest that for hips, however, halting the degenerative process might not be enough. The hips would need a treatment to both stop degeneration and stimulate factors that could help to begin repair.

    The knee is very accessible for injections, so it would make sense to inject the knee with agents that could turn off the degradative processes, and these could be delivered periodically with close monitoring, Kraus said. A cocktail of drugs might be needed for the hip, however, both to halt the degradation and to stimulate the right type of reparative elements.

    Kraus and her team discovered a biomarker that is a measure of an altered (deaminated) protein, called D-COMP. In the circulation it signals hip degeneration and in cartilage it provides insight into the repair response of joint tissues. Kraus said this is the first biomarker specific to a particular joint site, and may be developed into a monitoring tool for hip-joint breakdown.

    The next step is to understand the reasons for the difference between knees and hips and also to use new tools to analyze the ankle for its level of repair response.

    Call for Abstracts: Bone and Skeletal Muscle Interactions

    Abstracts for a topical meeting of the American Society for Bone and Mineral Research (ASBMR), a founding member of the United States Bone and Joint Initiative, will be accepted until February 29. The meeting on bone and skeletal muscle interactions, July 17-18  in Kansas City, Missouri, will draw together leading muscle and bone researchers to exchange ideas, develop new collaborations, and accelerate the emerging scientific discoveries in the area of muscle and bone interactions. Information on abstract categories and submission criteria can be found on ASMBR's Web site. 

    Contact ASBMR for further information by e-mail or at 202/367-1161.

    IOM Outlines Strategies for 'Living Well' With Chronic Illness

    To improve the quality of life for people with chronic illnesses, models of chronic disease care should align the resources of community-based organizations, the health care delivery system, employers and businesses, the media, and the academic community, says a new report from the Institute of Medicine (IOM).

    Living Well with Chronic Illness: A Call for Public Action lays out a framework to guide the development and implementation of cross-cutting strategies that reduce the individual and societal burdens of chronic illness by helping people with chronic illnesses live well.

    Key findings of the report include:

    • All chronic illnesses hold the potential to worsen the overall health of the nation by limiting an individual's capacity to live well.
    • Evidence-based interventions aimed at preventing chronic disease (such as ending smoking, eating nutritious food, and limiting weight gain) need to be studied in people with 1 or more chronic illnesses to assess their effectiveness.
    • While a range of public policies have helped people with chronic illnesses, it is important to design and implement new public policies or explore promising approaches to further promote living well with chronic illnesses.
    • Enhanced collaboration among the public health, health care, and community nonhealth care sectors could produce better prevention and treatment outcomes for people living with chronic disease.

    IOM does not recommend a specific set of illnesses on which to focus public health action. Instead, it identifies 9 “exemplar” conditions that are diverse yet have various factors in common, including significant effects on the nation's health and economy. The conditions are arthritis, cancer survivorship, chronic pain, dementia, depression, type 2 diabetes, posttraumatic disabling conditions, schizophrenia, and vision and hearing loss.

    Two education sessions at PT 2012 will address the management of chronic illness. The Role of Physical Therapists in Public Health: Prevention and Management of Chronic Disease and Disability will be held June 8, 1 pm-3pm. The Management of Older Individuals With Chronic Illness: A Case-based Approach will be held June 8, 3 pm-5 pm.   

    Snyder Bequests $106K+ to Foundation

    The late Jayne Snyder, PT, DPT, MA, FAPTA, a prolific member of the physical therapy community who passed away last October, has left a bequest totaling more than $106,000 to the Foundation for Physical Therapy. 

    Snyder was a driving force in the physical therapy profession, devoting her life to community and political advocacy. She was the owner and founder of Snyder Physical Therapy PC in Lincoln, Nebraska, where she worked as a clinician treating patients in the areas of orthopedics and sports medicine. Snyder also served on the Foundation's Board of Trustees as president and chair for 6 years (1997-2003). Read more about Snyder's accomplishments and contributions to the physical therapy profession in this press release.

    OIG Podcast: Self-disclosing Violations

    A new podcast from the US Department of Health and Human Services' Office of Inspector General (OIG) outlines what physical therapists and other health care providers should do when they discover that they may have violated federal fraud and abuse laws. According to OIG's Provider Self-Disclosure Protocol, a provider should:

    1. Clarify the issue and confirm that it is a potential fraud issue. Issues that are only overpayments or innocent mistakes can be reported to a Medicare contractor through the normal refund process.
    2. Consult with a health care attorney who has experience dealing with federal health care programs. He or she will be helpful in confirming that there is a problem and what the options are for reporting it.
    3. Decide where to disclose the conduct. Disclosure to the local US Attorneys' Office may be appropriate depending on the conduct. Also, the Centers for Medicare and Medicaid Services has created a disclosure process specifically for Stark law violations.

    The podcast also gives tips on how to make a protocol resolution process go smoothly.

    A written transcript and video accompany the podcast. 

    CMS Revises Interpretative Guidelines for Rehabilitation in Outpatient Hospitals

    In response to concerns raised by APTA and other associations, the Centers for Medicare and Medicaid Services (CMS) revised interpretative guidelines (Transmittal 72) to eliminate the requirement that rehabilitation services furnished in outpatient hospital settings be ordered by a practitioner with medical staff privileges. The new guidance issued to the State Survey Agency Directors on February 17 is effective immediately and includes the following language:

    Requirements for Ordering Hospital Outpatient Services: Outpatient services in hospitals may be ordered (and patients may be referred for hospital outpatient services) by a practitioner who is:

    • responsible for the care of the patient;
    • licensed in, or holds a license recognized in the jurisdiction where he/she sees the patient;
    • acting within his/her scope of practice under state law; and
    • authorized by the medical staff to order the applicable outpatient services under a written hospital policy that is approved by the governing body. This includes both practitioners who are on the hospital medical staff and who hold medical staff privileges that include ordering the services, as well as other practitioners who are not on the hospital medical staff, but who satisfy the hospital's policies for ordering applicable outpatient services and for referring patients for hospital outpatient services.

    Previous Guidance Superseded: This guidance supersedes the guidance for ?482.56(b) (Tag A-1132) and ?482.57(b)(3) (Tag A-1163) found in SC-11-28 (May 13, 2011) and State Operations Manual (SOM) Transmittal #72 (November 18, 2011).

    The hospital's medical staff policy for authorizing practitioners to refer patients for outpatient services must address how the hospital verifies that the referring practitioner who is responsible for the patient's care is appropriately licensed and acting within his/her scope of practice.

    Resolving this issue has been a high priority for APTA and its members. APTA believes that this language is a significant improvement. The Survey and Certification Policy Memorandum in its entirety will be available on CMS's Web site next week.

    Legislation Includes Cap Exceptions Process With Provisions, Extends GPCI

    Today, the House of Representatives and Senate passed legislation to prevent a 27.4% payment cut to Medicare providers scheduled for March 1 and extend several other Medicare policies important to physical therapists. The measure extends the Geographic Practice Cost Index (GPCI) at the current level for the remainder of the year and includes a 10-month extension of the therapy cap exceptions process that will begin to create a path to a reformed therapy payment system.  

    Physical therapists will continue to use the KX modifier at the $1,880 cap for 2012. However, new provisions have been added to the cap exceptions process. Starting October 1, claims for patients who meet or exceed $3,700 in therapy expenditures will be subject to a manual medical review. The legislation designates that this medical review will be similar to the process used following implementation of the Deficit Reduction Act in 2006. The $3,700 threshold will be applied to a combined physical therapy and speech language pathology cap. A separate $3,700 threshold will be applied to the occupational therapy cap. Also beginning October 1, each request for payment must include the national provider identifier of the physician who reviewed the plan of care. In addition, the therapy cap with exceptions will apply to hospital outpatient departments no later than October 1 until the end of 2012. This provision will sunset at the end of 2012 unless Congress extends it into 2013. APTA will work with the Centers for Medicare and Medicaid (CMS) to determine the agency's plans for implementing this and other provisions contained in the legislation.

    The bill also calls for the Medicare Payment Advisory Commission to submit recommendations by June 15, 2013, to the House Energy and Commerce Committee, House Ways and Means Committee, and the Senate Finance Committee on ways to reform the payment system to ensure that the benefit is better designed to reflect individual acuity, condition, and therapy needs of the patient. The report will examine private sector initiatives related to outpatient therapy benefits.

    The committee's measure also directs the Department of Health and Human Services (HHS) to implement a claims-based data collection strategy to assist in reforming the Medicare payment system for outpatient therapy. The system will be designed to provide for the collection of data on patient function during the course of therapy services in order to better understand patient condition and outcomes. In proposing and implementing such a strategy, HHS will consult with relevant stakeholders.

    In addition, the General Accountability Office will issue a report by May 1, 2013, to the House Committee on Energy and Commerce, the House Ways and Means Committee, and the Senate Finance Committee on the implementation of the manual medical review process. The report is to include data on the number of beneficiaries and claims subjected to the process, the number of reviews conducted, and the outcome of the reviews.

    The bill will be sent to President Obama for signature. APTA staff will reach out to CMS in the coming weeks to begin a dialogue about implementation of this legislation and will provide further information to membership regarding guidance and timelines for these new provisions.

    APTA is analyzing this legislation and will provide more resources as they become available.

    CMS Issues Guidance and Clarification for Version 5010 Implementation

    In light of concerns about the transition to Version 5010, the Centers for Medicare and Medicaid Services (CMS) has issued guidance to help physical therapists and other providers troubleshoot some of the difficulties they may experience with claims submissions. The guidance includes information on how to handle claims that failed edits during the delivery process and what providers can do if they have difficulty receiving information from clearinghouses and/or billing services.

    Although CMS delayed enforcement of Version 5010 transaction standards used for electronic health care claims until March 31, the official deadline to adopt the standards was January 1.

    APTA is aware that some physical therapists are experiencing cash flow issues related to 5010 implementation. The association will launch a new Web resource shortly to help members navigate the issues surrounding the move to the new standards.   

    Act Fast: Free Health Care Reform Audio Conference Filling Up

    About half of the available spots have been reserved for a free audio conference on the challenges and opportunities that health care reform will bring in 2012. Join Justin Moore, PT, DPT, vice president of the Public Policy, Practice, and Professional Affairs Unit, as he examines how health reform initiatives address fee schedule updates, therapy caps, bundled payments for post-acute care, integrated delivery systems, prevention and wellness, and insurance reforms, in addition to contemporary issues surrounding the upcoming Supreme Court decision on the constitutionality of the law, the pressures on states to implement key provisions, and efforts in Congress to repeal, revise, and redirect funding related to the Affordable Care Act.   

    Register today for the March 22 audio conference. 

    HHS Delays ICD-10 Compliance Date

    In an effort to address the provider community's concerns about administrative burdens, Health and Human Services (HHS) Secretary Kathleen G. Sebelius today announced that HHS will postpone the date by which certain health care entities have to comply with ICD-10 codes. 

    The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013—a delay of 2 years from the compliance date initially specified in the 2008 proposed rule. 

    APTA will update association members on the new compliance date forthcoming from HHS.   For general information and APTA's summary on the ICD-10 final rule, go to APTA's ICD-10 Web page.  

    New in the Literature: Tai Chi in Patients With Parkinson Disease (N Engl J Med 2012; 366:511-519.)

    Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson disease, with additional benefits of improved functional capacity and reduced falls, say authors of an article published this month in NEJM 

    For this trial, researchers randomly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale (which ranges from 1 to 5, with higher stages indicating more severe disease) to 1 of 3 groups: tai chi, resistance training, or stretching. The patients participated in 60-minute exercise sessions twice weekly for 24 weeks. The primary outcomes were changes from baseline in the limits-of-stability test (maximum excursion and directional control; range, 0 to 100%). Secondary outcomes included measures of gait and strength, scores on functional-reach and timed up-and-go tests, motor scores on the Unified Parkinson Disease Rating Scale, and number of falls.

    The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion (between-group difference in the change from baseline were 5.55 percentage points and 11.98 percentage points, respectively) and in directional control (10.45 percentage points and 11.38 percentage points, respectively). The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach. Tai chi lowered the incidence of falls more than stretching did, but not more than resistance training did. The effects of tai chi training were maintained at 3 months after the intervention. No serious adverse events were observed.

    APTA member Johnny Galver, PT, coauthored the article.

    Delitto, Paris Appointed to Foundation's Board of Trustees

    The Foundation for Physical Therapy recently appointed Anthony Delitto, PT, PhD, FAPTA, and Stanley Paris, PT, PhD, FAPTA, FAAOMPT, to its Board of Trustees. The Board of Trustees plays an important role in the growth and development of the organization and its mission of funding physical therapy research. Board members provide leadership in developing official policies, direct all business and financial affairs for the Foundation, and actively promote its fundraising activities. Read brief bios on Delitto and Paris in this Foundation press release. 

    Conference Committee Reaches Deal on SGR Update

    Late last night, the Congressional Conference Committee reached a deal on a 10-month measure that would prevent a 27.4% cut, due to the flawed Sustainable Growth Rate (SGR) portion of the fee schedule, to Medicare providers scheduled for March 1. Sources on Capitol Hill have indicated to APTA that the deal also would extend the therapy cap exceptions process for the remainder of 2012. 

    National Journal is reporting that the 10-month extension, which costs nearly $20 billion, could be paid for by pulling money from a fund earmarked for preventive medicine in the Affordable Care Act (ACA) and cutting Medicare "bad debt" payments to hospitals when beneficiaries fail to pay their copays. Significant pressure from the prevention community to defeat this legislation is expected, due to the defunding of prevention dollars included in ACA. 

    The House and Senate still must pass the measure by February 29 to avoid the return of the therapy cap without exceptions and the 27.4% payment cut for Part B outpatient physical therapy services.

    Upon its release, APTA will analyze the legislative text to see if it contains language that the association advocated for in the fall to set a path toward payment reform in therapy services.   

    Advocating on behalf of hundreds of thousands of Medicare beneficiaries who receive outpatient rehabilitation services every year, APTA, as part of the Therapy Cap Coalition, yesterday urged members of the Congressional Conference Committee to provide the longest possible exceptions extension for Medicare Part B therapy services in the committee's final agreement.

    Tri-Alliance Issues Joint Guidelines for Therapy Cotreatment Under Medicare

    APTA, the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association(ASHA) have issued guidelines to help therapists recognize appropriate opportunities for cotreatment. Cotreatment may be appropriate when practitioners from different professional disciplines can effectively address their treatment goals while the patient is engaged in a single therapy session. For example, a patient may address cognitive goals for sequencing as part of a speech-language pathology treatment session while the physical therapist (PT) is training the patient to use a wheelchair. Or, a patient may address activities of daily living goals for increasing independence as part of an occupational therapist treatment session while the PT addresses balance retraining with the patient to increase independence with mobility. 

    The guidelines contain information on proper documentation for cotreatment sessions and 3 clinical examples of 2 disciplines providing interventions during 1 treatment session. APTA has provided the document to the Centers for Medicare and Medicaid Services, as the agency had requested guidance on cotreatment therapy sessions from the 3 associations.  

    APTA will continue to work with CMS to develop additional resources for therapists, specifically in the skilled nursing facility setting, to ensure a thorough understanding of therapy coverage requirements.

    CMS Proposes Timeline for Providers to Return Overpayments

    The Centers for Medicare and Medicaid Services (CMS) yesterday proposed that providers and suppliers must report and return self-identified overpayments either within 60 days of the incorrect payment being identified or on the date when a corresponding cost report is due—whichever is later.

    The announcement is 1 in a series of steps Medicare is taking to protect taxpayer dollars, including efforts to prevent overpayments from occurring. These efforts include allowing private auditors working on behalf of Medicare to catch wasteful spending before it happens by expanding the use of Recovery Audit Contractors, testing changes to outdated hospital billing systems to help prevent overbilling, and changing processes for approving payments for medical equipment with high error rates.

    A Medicare overpayment refers to any funds that a person receives or retains under Medicare to which the person is not entitled. Examples of overpayments in Medicare include the following:

    • duplicate submission of the same service or claim
    • payment to the incorrect payee
    • payment for excluded or medically unnecessary services
    • payment for non-covered services

    Any failure to report and return the overpayment within the applicable time frame could be a violation of the False Claims Act. Providers also could be subject to civil monetary penalties or excluded from participating in federal health care programs for failure to report and return an overpayment.

    Before the Affordable Care Act (ACA) providers did not face an explicit deadline for returning overpayments. CMS has received approximately $5 million in overpayment refunds under ACA. Contractors also have received a substantial number of overpayment refunds.

    APTA is analyzing CMS' proposal and will post a summary on www.apta.org shortly.

    Also yesterday, the Obama Administration announced that the Health Care Fraud and Abuse Control Program had recovered $4.1 billion in Fiscal Year 2011 from anti-fraud efforts, while the Department of Justice opened 1,110 new criminal health care fraud investigations involving 2,561 potential defendants.

    Access the following links for APTA resources on fraud and abuse, the False Claims Act, and other compliance-related topics.  

    More Health Care Professionals Recommending Physical Activity

    In 2010, about 1 in 3 adults who had seen a physician or other health care professional in the past year had been advised to begin to exercise or continue with their physical activity program, says a February 8 National Center for Health Statistics data brief. Furthermore, the percentage of adults who had been advised to exercise increased from 22.6% in 2000 to 32.4% in 2010. 

    Younger people were told to exercise more often than older adults in 2010. However, adults aged 18-24 had the smallest increase over the decade 2000-2010 in the percentage receiving a recommendation to exercise (from 10.4% in 2000 to 16.1% in 2010), while adults aged 85 and over had the largest percentage point increase (from 15.3% in 2000 to 28.9% in 2010). In addition, Hispanic adults had the largest percentage point increase over the decade 2000-2010 in receiving a recommendation to exercise.

    Receiving advice to exercise varied with having selected chronic health conditions. Between 2000 and 2010, receipt of advice from a physician to exercise or engage in physical activity increased for adults with hypertension, cardiovascular disease, cancer, and diabetes. Adults with diabetes were more likely than those with hypertension, cardiovascular disease, or cancer to have been advised to exercise. In 2010, more than one-half of adults with diabetes were advised to exercise, compared with just over one-third of adults with cancer.

    Adults who were obese were about twice as likely as healthy weight adults to have been advised by a physician or other health care professional to exercise. The percentage of adults who had been advised to exercise increased in each body mass index category (underweight, healthy weight, overweight, obese) between 2000 and 2010, although the percentage point increase was largest for adults who were obese.

    New NIH Committee to Coordinate Pain Research Activities

    A new committee appointed yesterday by the National Institutes of Health (NIH) will coordinate pain research activities across the federal government with the goals of stimulating pain research collaboration, fully leveraging the government resources dedicated to supporting pain research, and providing an important avenue for public involvement.

    The Interagency Pain Research Coordinating Committee members include leading federal officials, including an individual from the Rehabilitation Research and Development Service at the Department of Veterans Affairs, Office of Research and Development; 6 nonfederal scientists; physicians; other health professionals; and 6 members of the general public who are representatives of leading research, advocacy, and service organizations. Appointees include organizations that advocate for people with fibromyalgia, chronic vulvar pain and related pain disorders, and peripheral neuropathies.   

    Created through the Affordable Care Act, the committee also will explore public-private partnerships to broaden collaborative, cross-cutting research, and consider best practices in disseminating information about pain to public and professional audiences.

    NIH Launches Resources to Promote Clinical Research

    Only through clinical research can the health care profession gain insights and answers about advancing prevention, treatments, and cures for disease and disability. To that end, the National Institutes of Health has compiled resources to raise awareness of the importance of clinical research and get the public to think about participating in clinical trials, including those involving physical therapy. Information for physical therapists and other health care providers includes opportunities for education and awareness; promotional posters, flyers, and slides; and guidance for talking with patients about, and referring them to, clinical trials.

    USBJI Defines Value in Musculoskeletal Care, Proposes Road Map for Future Actions

    A new report summarizes key issues and recommendations discussed at the Summit on The Value in Musculoskeletal Care, sponsored by the United States Bone and Joint Initiative (USBJI). The summit, held in Washington, DC, October 12-13, 2011, was attended by 127 invited representatives of the musculoskeletal community, including APTA staff and members, patients, health care professionals, payers, industry, and government. 

    Specifically, the report provides a definition of the value in musculoskeletal care, addresses the need for accurate and reliable measurements to assess quality and value of musculoskeletal care, outlines advocacy strategies, and makes recommendations on health organizations' roles in efforts to increase the value of musculoskeletal care. 

    According to USBJI, the report's proposals should meet several important goals to:

    • Redirect resources to control costs in the short and long term;
    • Fund innovative clinical, basic science, and translational research to an extent commensurate with the health care burden of musculoskeletal disease;
    • Develop and implement more effective multidisciplinary programs for prevention, treatment, and rehabilitation to decrease current and future costs;
    • Improve outcomes and reduce costs through integrated systems of care; and
    • Improve quality of life by enhancing the general health of all people.

    APTA is a founding member of USBJI. Member organizations are encouraged to consider strategic plans for collaborative implementation of the recommendations, in concert with USBJI and other groups.

    CSM Daily News Recaps Lectures and Sessions

    Read summaries of the Pauline Cerasoli and Linda Crane lectures and learn about the implications of cardiac comorbidities in outpatient settings, use of red flags when assessing low back pain, benefits of aquatic physical therapy as a complement to land-based therapy, and more in the February 11 issue of CSM 2012 Daily News. The February 9 and February 10 issues also are available on the Combined Sections Meeting (CSM) Web page , and a final, digital "wrap-up" issue will be e-mailed to all members in the next 2 weeks. 

    New Rules Require Insurers to Provide Clear and Concise Summaries for Policyholders

    Yesterday, the Departments of Health and Human Services, Labor, and Treasury, jointly published new rules requiring health insurers and group health plans to provide concise and comprehensible information about health plan benefits and coverage to the millions of Americans with private health care coverage. 

    Specifically, the rules will ensure that consumers have access to 2 key documents to help them understand and evaluate their health insurance choices:

    All health plans and insurers will provide an SBC to shoppers and enrollees at important points in the enrollment process, such as upon application and at renewal. A key feature of the SBC is a new, standardized plan comparison tool called "coverage examples," similar to the Nutrition Facts label required for packaged foods. The coverage examples will illustrate sample medical situations, such as such as giving birth (normal delivery) or managing type 2 diabetes (routine maintenance, well controlled), and describe how much coverage the plan would provide so consumers can directly compare one plan to another.

    These final regulations apply to disclosures for participants and beneficiaries who enroll or re-enroll in group health coverage through an open enrollment period (including re-enrollees and late enrollees) beginning on the first day of the first open enrollment period that begins on or after September 23.

    Daily News Brings CSM to You

    Couldn't make it to Chicago? Read what's been happening at the Combined Sections Meeting (CSM) in the February 9 and February 10 issues of CSM 2012 Daily News.

    Application Deadline Approaches for Vision Task Force

    Time is running out to submit your application and CV to serve on a new Board-appointed task force.

    At its June 2011 meeting, the House of Delegates adopted a motion charging the association to review and revise its current APTA Vision Sentence for Physical Therapy 2020 and APTA Vision Statement for Physical Therapy 2020 (HOD P06-00-24-35) to reflect the vision of the profession of physical therapy and its commitment to society beyond 2020. To fulfill this charge and facilitate the Board of Directors ability to create and implement a strategic plan to achieve the House-adopted vision, a Board-appointed Vision Task Force is being created. APTA members interesting in serving on this task force should complete and submit the volunteer application and CV by 11:59 PM ET February 15. Applications should be submitted via e-mail or by fax to 703/706-8519.

    E-mail APTA's Governance Department with questions regarding this task force or call 800/999-2782, ext 3256, for assistance.

    Cardiovascular and Stroke Research: Physical Activity Has 'Significant Value'

    Lifestyle factors, including physical activity, make a difference in improving and controlling cardiovascular risks, according to a list of the top advances in cardiovascular and stroke research in 2011 by the American Heart Association (AHA)/American Stroke Association (ASA). 

    "Multiple new studies this past year supported the importance of lifestyle factors such as diet and physical activity in improving and controlling cardiovascular risks," says AHA/ASA. "These findings are especially important given that 39% of Americans believe they are in ideal cardiovascular health when in reality less than 1% are."

    Since 1996, AHA/ASA has compiled an annual list of the major advances in heart disease and stroke. Other 2011 advances include congenital heart disease, genetics/personalized medicine, new drugs and treatment for atrial fibrillation, and improved systems of care to deliver faster care for heart attack and stroke.

    Federal Government Affairs Leadership Award, Public Service Award Applications Due February 27

    The Federal Government Affairs Leadership Award is presented annually to an active APTA member who has made significant individual contributions to APTA's Federal Government Affairs efforts and has shown exemplary leadership in furthering the association's objectives in the federal arena. The Public Service Award is presented annually to 1 or more individuals who have demonstrated unique support for the physical therapy profession at a national level. Individuals from the following categories are eligible for nomination: members of Congress/Congressional staff members; members of a state legislature; federal agency officials; health/legislative association staff; and celebrities or other public figures. APTA's Board of Directors will choose award recipients in March. Award presentations will be held at the Federal Government Affairs Forum in Washington, DC. This year's Federal Advocacy Forum will be held in conjunction with a larger event, APTA's Leadership Forum, which integrates APTA's Board of Directors meeting, the Leadership Symposium for New Component President and Executive Teams, and the Federal Advocacy Forum. Participation at other events is not required to attend the Federal Advocacy Forum. Submit nominations by February 27 to Angela Boyd or fax to 703/706-8519. If you need a nomination form or have questions, call Angela Boyd at 800/999-2782, ext 3256.

    Call for Applications: Health Care Reform Champions of Change

    The White House Champions of Change program highlights the stories and examples of citizens across the country that represent projects and initiatives that move their communities forward. In celebration of the Affordable Care Act (ACA), passed nearly 2 years ago, the program is seeking recommendations of individuals and organizations that are educating others about the new health care law to raise awareness about the benefits of ACA.

    If you know a "health care reform champion" who is educating the community about the new health care law and helping people take advantage of the benefits from the law, nominate him or her to the program by midnight February 16.

    World Physical Therapy 2011 Sessions Available Online

    If you couldn't attend World Physical Therapy 2011 or didn't get to all the presentations, you now can watch and listen to key sessions from the congress. As part of its continued efforts to facilitate information exchange across the profession, the World Confederation for Physical Therapy (WCPT) is offering 4 discussion panels and 8 focused symposia free of charge. Discussion panels include a video recording of the session with an option to download PowerPoint presentations. Focused symposia include a full audio recording with accompanying PowerPoint slides.

    New in the Literature: Subacute Neck Pain (Ann Intern Med. 2012;156(1 Pt 1):1-10.)

    For people with acute and subacute neck pain, spinal manipulation therapy (SMT) was more effective than medication in both the short and long term, say authors of an article published in Annals of Internal Medicine. However, a few instructional sessions of home exercise with advice (HEA) resulted in similar outcomes at most time points.

    This randomized, controlled trial was conducted at 1 university research center and 1 pain management clinic in Minnesota. Participants included 272 people aged 18-65 years who had nonspecific neck pain for 2-12 weeks. Participants received 12 weeks of SMT, medication, or HEA. The primary outcome was participant-rated pain, measured at 2, 4, 8, 12, 26, and 52 weeks after randomization. Secondary measures were self-reported disability, global improvement, medication use, satisfaction, general health status (Short Form-36 Health Survey physical and mental health scales), and adverse events. Blinded evaluation of neck motion was performed at 4 and 12 weeks.

    For pain, SMT had a statistically significant advantage over medication after 8, 12, 26, and 52 weeks. HEA was superior to medication at 26 weeks. No important differences in pain were found between SMT and HEA at any time point. Results for most of the secondary outcomes were similar to those of the primary outcome.

    New Podcast: Bringing the PT Perspective to the Innovation Center

    In a new APTA podcast, association member Pamela Duncan, PT, PhD, FAPTA, discusses how new models of care developed through the Center for Medicare and Medicaid Innovation (Innovation Center) will help meet the 3-part aim of improving health, improving care, and lowering costs through continuous improvement.

    Last month, Duncan was appointed to the Innovation Center's advisors program. Of 920 applicants, 73 individuals were selected from 27 states and the District of Columbia to serve on the program. In addition to supporting the Innovation Center in testing new models of care delivery, the advisors will work with other local organizations or groups in driving delivery system reform and build durable skill in system improvement throughout their area or region.

    APTA Launches Guide to Electronic Health Records

    APTA's new Guide to Understanding and Adopting Electronic Health Records (EHR) aims to help physical therapists (PTs) and physical therapist assistants (PTAs) assess and implement EHRs.

    Although PTs are not yet required or incentivized to adopt EHR systems for such initiatives as Medicare's Meaningful Use Program, which in 2015 will penalize eligible providers who do not meet the requirements for "meaningful use," physicians and facilities that are included in the program will expect PTs and PTAs with whom they share patients to use compatible EHR systems.

    The guide takes users through 4 steps:   

    • Part 1 – Decision: This section provides background information on why there is a push to adopt EHR and a brief introduction to the federal issues that impact physical therapist practice.
    • Part 2 – Preparation: This section provides basic information on what PTs and PTAs will need to understand for successful adoption of an EHR system, including what constitutes an EHR and provides suggestions to help consider your current environment and workflow.
    • Part 3 – Selection: This section will expand the user's knowledge about the available types of EHR software and hardware, and also provides considerations for choosing the right partner.
    • Part 4 – Implementation: This section shows how successful implementation makes a smooth transition when adopting an EHR. An organized approach and clear communication with all members of a facility's staff is described and suggestions for implementation are provided.

    Kaiser Updates Online Database of Medicaid Benefits in the 50 States

    The Kaiser Family Foundation's Commission on Medicaid and the Uninsured has updated its Medicaid Benefits Online Database to include 2010 state-level data about which benefits are covered by Medicaid programs in the 50 states, the District of Columbia and United States territories. The online tool contains Medicaid benefits data for adults covered under fee-for-service, with information about benefits covered, limits, copayments, and reimbursement methodologies. Other years for which data are available include 2003, 2004, 2006 and 2008. The tool allows users to access detailed profiles of which benefits are covered in a given state's Medicaid program, and also to see how a particular benefit is covered across all states.

    Categories of acute care benefits tracked in the database include institutional and clinic services, practitioner services, prescription drugs, physical therapy, transportation services, and more. In long-term care, the database tracks community-based care and institutional care.

    Users should note that this is 2010 data, and in the current fiscal environment states are evaluating and revising Medicaid benefits on an ongoing basis.  States' Medicaid agency portals will provide the most current information on Medicaid benefits, so be sure to also check your state Medicaid Web site.

    Registration Open for Health Care Reform Audio Conference

    A March 22 audio conference will examine the monumental challenges and opportunities that health care reform will bring in 2012. Join Justin Moore, PT, DPT, vice president of APTA Public Policy, Practice and Professional Affairs, and discover how clinicians, business owners, rehabilitation managers, and patients can prepare to successfully navigate the rapid changes, and get a bird's eye view of policy provisions specific to rehabilitation—including reforming payments, health care delivery, and the workforce.

    In addition to examining how health reform initiatives address fee schedule updates, therapy caps, bundled payments for post-acute care, integrated delivery systems, prevention and wellness, and insurance reforms, Moore will focus on contemporary issues surrounding the upcoming Supreme Court decision on the constitutionality of the law, the pressures on states to implement key provisions, and efforts in Congress to repeal, revise, and redirect funding related to the Affordable Care Act.

    The audio conference will be held 2 pm-3:30 EST March 22. Online registration closes 11:00 pm ET March 19, or as soon as all available spaces are filled. 

    APTA Names Performance Health, Bioness Inc Strategic Business Partners

    APTA recently added 2 companies to its Strategic Business Partner 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.

    Performance Health, based in Akron, Ohio, is the maker of Thera-Band®, Biofreeze®, and Pedigenix™ products. As a Charter partner the company is entitled to varied promotional opportunities that give APTA added visibility to Performance Health customers.

    As part of the strategic partnership, Performance Health is offering free membership for APTA members in the company's newly upgraded Thera-Band® Academy Web site. More information on this offer is available in APTA's press release.

    Bioness Inc, is a manufacturer and marketer of innovative neuromodulation products that help individuals with central nervous system disorders regain movement in affected limbs. Its NESS L300® Foot Drop System, NESS H200® Hand Rehabilitation System, and NESS L300® Plus System, cleared for use by the Food and Drug Administration, are designed to help patients achieve new levels of physical independence and productivity.

    Call to Action: Congressional Action Needed on Cap and Cuts

    The 2-month fix extending the Medicare cap exceptions process that Congress passed December 23, 2011, will expire February 29. If Congress does not pass legislation before February 29 the therapy cap will go into effect without an exceptions process, and a scheduled 27.4% cut to provider payments under the Medicare physician fee schedule will be implemented March 1.

    APTA is working with Congress to protect the physical therapy profession and its patients from these impending cuts. Help strengthen the association's efforts by contacting your legislators today to express your support for full repeal of the sustainable growth rate and the therapy cap. Urge your legislators to—at the very least—pass a 2-year extension of the therapy cap exceptions process as proposed in the original House bill, which saves money and creates a path to reform the therapy benefit in the long term.

    CMS Modifies Prepayment Review and Prior Authorization of PMD Demonstration

    In response to comments from APTA and other stakeholders, the Centers for Medicare and Medicaid Services (CMS) has removed the 100% pre-payment review phase (formerly Phase 1) from the Prepayment Review and Prior Authorization for Power Mobility Devices demonstration. All modifications that had previously been made to Phase 1 are no longer necessary or applicable as a result of the removal this phase.

    Also based on stakeholder feedback, CMS will allow suppliers to perform the administrative function of submitting the prior authorization request on behalf of the physician/treating practitioner.

    The Prepayment Review and Prior Authorization for Power Mobility Devices and the    Recovery Audit Prepayment Review demonstrations, which were delayed from their initial January 1 start date, are expected to move forward on or after June 1.

    Additional information on these demonstrations can be found on CMS' Web site.

    Indian Health Service Student Loan Repayment: Call for Applications

    The Indian Health Service (IHS) currently is accepting applications for its Loan Repayment Program (LRP). This program offers health care professionals, including physical therapists, the opportunity to pay off qualified student loans to meet the staffing needs of Indian health programs. The awards are based on the needs of IHS and the available funding. There is an estimated $20 million available for the program during Fiscal Year 2012 to be awarded to more than 450 individuals. 

    Applications will be accepted and evaluated monthly beginning February 17 until funds are exhausted. For more information or to apply visit the LRP Web site

    APTA continues its public policy priority to include physical therapists in additional student loan repayment initiatives.

    February Craikcast: A Variety of Content

    With 13 articles and topics ranging from telerehabilitation to posttraumatic stress disorder, this month's PTJ has something for everyone. In the February Craikcast, PTJ Editor in Chief Rebecca Craik, PT, PhD, FAPTA, provides a snapshot of each article, discusses the importance of sample size in 2 particular studies, and puts study limitations in context for clinicians.  

    Candidate Web Page Posted

    The Candidate Web page now is available. Learn about your candidates for the 2012 elections to national office by browsing the candidates' biographical information and reading their written statements on issues important to you. Contact Peyton Zeek with any questions.

    APTA Members Key Authors of Circulation Science Advisory

    A new science advisory from the American Heart Association calls on inpatient and home health care teams (physicians, physician assistants, nurse practitioners, nurses, physical therapists, clinical exercise physiologists, registered dieticians, and CR team members) to implement a coordinated effort to promote outpatient cardiac rehabilitation (CR) to eligible patients and to facilitate referral and enrollment.

    APTA member Ross Arena, PT, PhD, FAHA, is lead author of this scientific advisory. Coauthors include APTA members Lawrence P. Cahalin, PT, PhD, CCS, and Reed Humphrey, PT, PhD. 

    "Despite the well-documented benefits, outpatient CR referral and participation rates remain disappointingly low," write the authors. Therefore, a primary goal of the science advisory aims to better define the role of key health care professionals in both the inpatient and home health settings to ultimately improve participation in CR.

    Published online January 30 in Circulation, the advisory includes key recommendations to:

    • formulate a multidisciplinary inpatient CR program;
    • initiate an automatic referral to appropriate inpatient health professional(s) to assess the readiness of all patients with a cardiac event for discharge home and for participation in an outpatient CR program; and
    • develop and examine evidence-based multidisciplinary models of discharge planning.

    The authors also propose 8 "future directions" to address the lack of referral to outpatient CR.

    AHRQ Releases Hospital Quality Indicators Toolkit

    A new toolkit from the Agency for Healthcare Research and Quality (AHRQ ) is designed to help hospital staff understand AHRQ's quality indicators (QIs) and support them in using QIs to successfully improve quality and patient safety in the hospital setting. The toolkit is a general guide to using improvement methods, with a particular focus on QIs. It focuses on 17 patient safety indicators and 28 inpatient quality indicators.

    Tools are organized in 7 sections following a complete improvement process that includes setting priorities and planning for performance improvements on QIs, implementing improvement strategies, and sustaining improvements achieved. The toolkit has undergone a field test, evaluation, and revisions in response to feedback from 6 hospitals.

    New in the Literature: UE Neurodynamic Tests (Physiother Theory Pract. 2011 Dec 27. [Epub ahead of print])

    A study to determine whether within-subject differences exist between limbs in the upper extremity (UE) component of neurodynamic tests of the median, radial, and ulnar nerves found that between-limb values have low correlation and that it may be normal for an individual to have range of motion differences between limbs with neurodynamic tests.

    Researchers examined 61 healthy participants. Difference between limbs for the median nerve-biased test was significant. There was no significant difference between limbs for the radial or ulnar nerve-biased tests. Correlation between limbs was poor for all tests (median r(2) = 0.14; radial r(2) = 0.20; ulnar r(2) = 0.13). Lower-bound scores were calculated to determine the amount of difference needed to consider asymmetry beyond measurement error. The scores for each neurodynamic test were median 27°, radial 20°, and ulnar 21°.

    APTA member Laura G. Covill, PT, DPT, OCS, is the lead author of this article, which is published in Physiotherapy Theory and Practice. APTA member Shannon M. Petersen, PT, DScPT, OCS, is coauthor.

    APTA and FSBPT: Collaborating on Common Challenges

    As organizations that represent aspects of the physical therapy profession, APTA and the Federation of State Boards of Physical Therapy (FSBPT) have identified numerous collaboration opportunities on a variety of issues of joint concern. As the principle membership organization representing physical therapy, APTA works to serve its members and help them to best serve their patients. FSBPT's primary aim is to protect the public through licensure and regulation of the physical therapist and physical therapist assistant.

    It is just as important that chapters are aware of, and involved in, communicating with their state licensing boards to identify collaboration opportunities to develop solutions to address ongoing issues in the states involving licensure and regulation.

    In order to identify solutions to common challenges, APTA and FSBPT Board and staff representatives have been meeting regularly to coordinate efforts and share information. On January 19, a group of APTA Board members and staff met with FSBPT Board and staff to discuss several issues, including continuing competence, the physical therapy workforce, fixed-date exam testing, and the outcomes registry. A productive discussion was held on the topic of coordination of education, regulation and licensure. The group explored the current environment in these 3 areas, what is on the horizon for each area, and how APTA and FSBPT can collaborate to ensure that future developments in these areas are consistent and in the best interest of the profession. APTA will continue to keep members informed of progress in these areas. Contact Janet Bezner with any questions.

    New PQRS Discussion Forum Launched

    APTA recently launched a new Physician Quality Reporting System (PQRS) discussion forum for members in APTA Communities. Members can find answers to frequently asked questions, post new questions, and share their experiences including best practices for reporting successes in this program.

    The new discussion board is part of APTA's efforts to increase member resources for this program in anticipation of the upcoming payment adjustments in 2015. The decision by the Centers for Medicare and Medicaid Services to use data from the calendar year 2013 reporting period to inform the 2015 payment adjustment for PQRS has prompted many physical therapists who have previously not participated in the program to begin reporting this year. 

    To access the community, go to APTA Communities and click PQRS in the lefthand menu or use the direct link available on the PQRS page.

    APTA Seeks Volunteers for Vision Task Force

    At its June 2011 meeting, the House of Delegates adopted a motion charging the association to review and revise its current APTA Vision Sentence for Physical Therapy 2020 and APTA Vision Statement for Physical Therapy 2020 (HOD P06-00-24-35) to reflect the vision of the profession of physical therapy and its commitment to society beyond 2020. To fulfill this charge and facilitate the Board of Directors ability to create and implement a strategic plan to achieve the House-adopted vision, a Board-appointed Vision Task Force is being created. APTA members interesting in serving on this task force should complete and submit the volunteer application and CV by 11:59 PM ET February 15. Applications should be submitted via e-mail or by fax to 703/706-8519.

    E-mail APTA's Governance Department with questions regarding this task force or call 800/999-2782, ext 3256, for assistance.

    Board of Directors Meeting Agenda Posted

    APTA's Board of Directors will meet February 7 prior to the start of the Combined Sections Meeting. The meeting will take place in the Hilton Chicago, Continental A meeting room. The agenda is available online. To ensure that you are notified of any changes that might occur to the schedule, including a closed session that could affect the start of the meeting, RSVP to Kathy Cunningham by 12 pm ET February 3.