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  • APTA Special Communication: Sequestration and Time-sensitive PT Issues

    Look for a special e-mail today from APTA that includes important information about sequestration and other time-sensitive issues that have a significant impact on physical therapists (PTs). Included in the e-mail is a new video featuring APTA President Paul A. Rockar Jr, PT, DPT, MS, outlining 2013 policy implementation dates that PTs need to know and how they can support APTA's advocacy efforts.

    For more information, go to APTA's recently updated 2013 Medicare Changes webpage, which includes the video, a new graphic and Heard on the Hill podcast, and other resources to help members comply with the latest policy requirements.

    Reform Expands Health Information Exchange, Telehealth Capabilities to Rural Areas; Has Potential to Reduce Medicaid Costs

    The Federal Communications Commission (FCC) recently released a final rule reforming its universal service support program for health care. Specifically, the rule transitions FCC's existing Internet Access and Rural Health Care Pilot programs into a new Healthcare Connect Fund. This fund will expand health care provider access to broadband, especially in rural areas, and encourage the creation of state and regional broadband health care networks.

    In the rule, FCC notes that "Whether it is used for transmitting electronic health records, sending X-rays, MRIs, and CAT scans to specialists at a distant hospital, or for video conferencing for telemedicine or training, access to broadband for medical providers saves lives while lowering health care costs and improving patient experiences." In particular, FCC acknowledges the role of telemedicine in helping patients with stroke avoid lasting damage.

    The final rule also includes examples of how telehealth applications save health care providers money. For example, a South Carolina provider consortium funded by the Commission's Rural Health Care Pilot Program saved $18 million in Medicaid costs through telepsychiatry provided at hospital emergency rooms. Another pilot project in the Midwest saved $1.2 million in patient transport costs after establishing an electronic intensive care unit program, known as "e-ICU."

    APTA will post a summary of the rule in the near future to www.apta.org.

    Michigan PTs Participate in Clinical Trial Awareness Day

    Four physical therapists (PTs) from the Michigan Chapter presented posters at the Clinical Trial Awareness Day held at the state capitol on January 30. This inaugural event, sponsored by state Rep Gail Haines (43rd District), chair of the House Health Policy Committee, aimed to educate citizens about the clinical trials taking place in Michigan and encourage lawmakers to create a research-friendly environment. More than 20 research participants represented the state's major universities and hospitals. The PTs spoke with many state representatives and senators on the importance of medical research and how physical therapy contributes to the advancement of patient care. 

    In her opening remarks, Hines noted that there are more than 3,400 clinical trials under way in Michigan.

    February 28, 2013 - MNPTA

    (Left to right) Cathy Larson, PT, PhD, University of Michigan Flint; Susan Talley, PT, DPT, C/NDT, Wayne State University; Michael Shoemaker, PT, DPT, PhD, GCS, Grand Valley State University; and Lucinda Pfalzer, PT, PhD, FAPTA, University of Michigan Flint.  

    New in the Literature: Reducing Multiple Sclerosis-related Fatigue (Arch Phys Med Rehabil. 2013 Feb 8 [Epub ahead of print])

    A new systematic review provides evidence that, in the short term, energy conservation management (ECM) treatment can be more effective than no treatment in reducing the impact of fatigue and improving quality of life in patients with multiple sclerosis-related fatigue.

    For this review, the authors searched PubMed, CINAHL, EMBASE, and Web of Knowledge to identify relevant randomized controlled trials (RCTs) and controlled clinical trials. To select potential studies, 2 reviewers independently applied the inclusion criteria. Two reviewers independently extracted data and assessed the methodological quality of the studies included. If meta-analysis was not possible, qualitative best-evidence synthesis was used to summarize the results.

    The searches identified 532 studies, 6 of which were included. The studies compared the short-term effects of ECM treatment and control treatment on fatigue and quality of life (QoL); 1 study reported short- and mid-term effects on participation but found no evidence for effectiveness. Meta-analyses (2 RCTs, N=350) showed that ECM treatment was more effective than no treatment in improving subscale scores of the: (1) Fatigue Impact Scale: cognitive, physical, and psychosocial; and (2) SF-36: role physical, social function, and mental health. Limited or no evidence was found for the effectiveness of ECM treatment on the other outcomes in the short- or mid-term. None of the studies reported long-term results.

    This systematic review is published online in Archives of Physical Medicine and Rehabilitation

    Member Opportunity to Serve on Public Policy and Advocacy Committee

    APTA's Public Policy and Advocacy Committee is seeking members to provide strategic advice, counsel, and options to the Board of Directors regarding: (1) how APTA can be responsive to and advocate for society’s needs provided by physical therapists and physical therapist assistants; (2) current and emerging public policy issues impacting the provision of physical therapy, rehabilitation, and  health care services; and (3) how to advance the profession within public policy arenas. Interested members should respond to the call by completing a volunteer interest profile found on the Volunteer Interest Pool webpage. The first step is creating a "profile" for service. After developing a profile, to be considered for this committee members must then access the "current opportunities for service page" and respond to the question specific to this committee. The deadline to respond to this call is March 7. For more information on this task force, click on the link above or contact Justin Moore, PT, DPT, vice president, public policy, practice, and professional affairs.

    APTA Letter to Editor Clarifies PT's Role in Treating Plantar Fasciitis

    APTA sent a letter to the editor of The New York Times regarding its February 20 article "No Consensus on a Common Cause of Foot Pain" by Gretchen Reynolds. APTA clarified the physical therapist's role in treating plantar fasciitis and explained PT education and how consumers may use direct access. 

    Percentage of Americans Covered by Employer-based Insurance Holds Steady in 2012

    Fewer Americans reported having employer-based health insurance in 2012 than did in 2008, 2009, and 2010, but at 44.5% it is unchanged from 2011, says a new Gallup poll. At the same time, more Americans continue to report having a government-based health plan—Medicare, Medicaid, or military or veterans' benefits—with the 25.6% who did so in 2012 up from 23.4% in 2008.

    The percentage of Americans (11.9%) who say they get their coverage through "something else," which could mean they buy it for themselves, has been relatively unchanged over the years. While more Americans remain uninsured than in the past, the percentage who are uninsured decreased slightly in 2012 (16.9%), after having risen each year previously going back to 2009.

    High unemployment is partly to blame for the decrease in employer-based health insurance from 2008-2010. The decline also may caused by fewer employers offering insurance or by employees opting to not take their employers' plan due to rising health insurance costs for employees, reports Gallup.

    The decline in employer-based coverage from earlier years is apparent for workers employed full time for an employer or for themselves. However, the percentage of part-time workers who have employer-based insurance rose in 2012. This group leans toward younger workers, who are likely to be insured since enactment of the health care law provision allowing those up to age 26 to stay on their parents' plans.

    Rule Finalizes Consumer Protections Under ACA

    The Department of Health and Human Services (HHS) issued a final rule last week implementing several consumer protections under the Affordable Care Act (ACA) to prevent insurance companies from discriminating against people with preexisting conditions and protect consumers from insurance company abuses.

    Under these reforms, all individuals and employers have the right to purchase health insurance coverage regardless of health status. In addition, insurers are prevented from charging discriminatory rates to individuals and small employers based on factors such as health status or gender, and young adults have additional affordable coverage options under catastrophic plans.

    These 5 key provisions are applicable to nongrandfathered health plans:

    • Guaranteed Availability—Nearly all health insurance companies offering coverage to individuals and employers will be required to sell health insurance policies to all consumers. No one can be denied health insurance because they have or had an illness.
    • Fair Health Insurance Premiums—Health insurance companies offering coverage to individuals and small employers will be allowed to vary premiums based only on age, tobacco use, family size, and geography.  Basing premiums on other factors will be illegal. The factors that are no longer permitted in 2014 include health status, past insurance claims, gender, occupation, how long an individual has held a policy, or size of the small employer.
    • Guaranteed Renewability—Health insurance companies will no longer be permitted to refuse to renew coverage because an individual or an employee has become sick. Consumers may renew coverage at their option.
    • Single Risk Pool—Health insurance companies will no longer be able to charge higher premiums to higher-cost enrollees by moving them into separate risk pools. Insurers are required to maintain a single statewide risk pool for the individual market and single statewide risk pool for the small group market.
    • Catastrophic Plans—Young adults and people for whom coverage would otherwise be unaffordable will have access to a catastrophic plan in the individual market. Catastrophic plans generally will have lower premiums, protect against high out-of-pocket costs, and cover recommended preventive services without cost sharing.

    In preparation for the health insurance marketplaces and to streamline data collection for insurers and states, the final rule amends certain provisions of the rate review program. HHS has increased the transparency by directing insurance companies in every state to report on all rate increase requests. A new report has found that the law's transparency provisions have already resulted in a decline in double-digit premium increases filed, from 75% in 2010 to, according to preliminary data, 14% in 2013.

    IOM Roundtable to Focus Attention on Nonmedical Factors That Influence Health

    Building on previous studies that show many factors beyond medical care affect people's health, the Institute of Medicine (IOM) recently established the Roundtable on Population Health Improvement to explore the interactions of these influences. The new roundtable will provide opportunities for experts on education, urban planning, medicine, public health, social sciences, and other fields to interact and share their knowledge and perspectives with the goal of catalyzing joint action. 

    As a recent study by the National Research Council and IOM documented, Americans experience worse health and shorter lives than people in other rich, industrialized nations despite spending more on medical care than any other nation. Several IOM studies have described the effects of social and environmental factors that can lead to poor health even when people have access to good health care. The nation's lagging health burdens businesses, communities, and families, these reports note.

    The roundtable will engage roundtable members and outside experts, practitioners, and stakeholders on 3 core issues:

    1. supporting fruitful interaction between primary care and public health
    2. strengthening governmental public health
    3. exploring community action in transforming the conditions that influence the public's health

    IOM hosts more than a dozen roundtables and forums, providing a neutral setting for diverse groups of individuals to discuss issues of mutual interest and concern and gain fresh insights and new understanding. A list of individuals who serve on the roundtable can be found on IOM's website

    USPSTF Releases Comprehensive Guide of Preventive Services

    The US Preventive Services Task Force (USPSTF) recently released its updated 2012 Guide to Clinical Preventive Services—an authoritative source that can help primary care clinicians and patients decide together what preventive services are right for a patient's needs. This edition of the guide includes the USPSTF’s evidence-based recommendations on clinical preventive services from 2002 through March 2012, topics in development, and at-a-glance clinical summary tables.

    Go to USPSTF's A-Z Topic Guide to access recommendation statements on interventions to prevent low back pain, falls in older adults, and osteoporosis. USPSTF also makes recommendations on screening for and management of obesity in adults and children.

    The 2012 guide can be found on the Agency for Healthcare Research and Quality's website.

    CMS Issues Interim Instructions for Manual Medical Review Process for 2013

    Yesterday, the Centers for Medicare and Medicaid Services (CMS) issued interim guidance on how the manual medical review process will be implemented in 2013 for outpatient therapy claims that exceed $3,700.     

    From October 1, 2012, through December 31, 2012, CMS used a prior approval process at $3,700 under which providers would submit a request to their Medicare Administrative Contractors (MAC) for approval of up to 20 visits. With the request, providers would include information from the patients' medical record (eg, progress reports, daily notes, plan of care) to support the need for the additional visits.      

    For 2013, CMS has replaced the prior approval process with prepayment review, at least for the interim. Under prepayment review, when the patient reaches $3,700 in outpatient therapy services, the MAC will send the provider an additional development request (ADR) asking him or her to submit documentation so that the MAC can determine whether the services are medically necessary. Typically under Medicare, MACs have 60 days to make a determination. However, CMS has requested that with regard to the therapy cap manual medical review process, MACs decide within 10 days of receipt of the documentation whether the services exceeding $3,700 will be paid.

    CMS currently is working on a long-term strategy for the manual medical review process. 

    Physical therapists should consult their MACs' websites for specific information about submitting documentation in response to an ADR.  

    PTJ Named Official Journal of Royal Dutch Society for Physical Therapy

    The Royal Dutch Society for Physical Therapy (KNGF) has made PTJ its official journal. KNGF members will have access to PTJ Online as one of its member benefits. Editor in Chief Rebecca Craik, PT, PhD, FAPTA, notes in her February editorial, "I am delighted to be entering into this relationship with our Dutch colleagues, [who have] made significant contributions to our understanding of the use of measurement tools to examine clinical effectiveness …, advanced our understanding of clinical practice guideline development and clinician adherence to guidelines, as well as our understanding of professional issues such as direct access, continuing education, and physical therapist consultation in primary care." Philip Van der Wees, PT, PhD, who is affiliated with the Scientific Institute for Quality of Healthcare at Radboud University Nijmegen Medical Center and with Maastricht University, was nominated by the Royal Dutch Society and appointed by Craik to serve on PTJ's Editorial Board; he will share his expertise in clinical practice guideline development and in examining clinician adherence to practice guidelines. Read more at http://ptjournal.apta.org/content/93/2/126.full.

    Member Opportunity to Serve on Scope of Practice Task Force

    APTA's newly established Scope of Practice Task Force is seeking members to develop recommendations to the Board of Directors on the appropriate role and authority of APTA in decisions on scope of practice in physical therapy and recommend a consistent process and criteria to establish current and future physical therapist scope of practice. Those who are interested should respond to the call by completing a volunteer interest profile found on the Volunteer Interest Pool webpage. The first step is creating a "profile" for service. After developing a profile, to be considered for this task force members must then access the "current opportunities for service page" and respond to the questions specific to this task force. The deadline to respond to this call is March 7. For more information on this task force, click on the link above or contact Karen Jost, PT, MS, senior payment specialist, payment and practice management.

    HHS Finalizes Essential Health Benefits Provisions

    Yesterday, the Department of Health and Human Services (HHS) finalized provisions in the Affordable Care Act ensuring that health plans offered in the individual and small group markets, both inside and outside of health insurance marketplaces (also called "exchanges") offer a core package of items and services, known as essential health benefits (EHB).

    Beginning in 2014, all nongrandfathered health insurance coverage in the individual and small group markets, Medicaid benchmark and benchmark-equivalent plans, and basic health programs (if applicable) will cover EHB, which include items and services in 10 statutory benefit categories, including rehabilitation and habilitation services and devices. These benefits will be equal in scope to a typical employer health plan.

    The final rule defines EHB based on a state-specific benchmark plan. States can select a benchmark plan from among several options, including the largest small group private health insurance plan by enrollment in the state. The final rule provides that all plans subject to EHB offer benefits substantially equal to the benefits offered by the benchmark plan.

    The final rule also includes standards to protect consumers against discrimination and ensure that benchmark plans offer a full array of EHB benefits and services.

    Substitution within EHB categories is still permissible to provide greater choice to consumers and promote plan innovation through coverage and design options. The requirement that any substitution must be actuarially equivalent is retained in the final rule. It is up to each state to set criteria for substitution.

    HHS does not provide a federal definition of habilitative services in this final rule. If habilitative services are not yetcovered by the EHB-benchmark plan, then states have the first opportunity to determine which habilitative benefits must be covered by their benchmark plan. States may choose either the definition used by the National Association of Insurance Commissioners or Medicaid. If states have not chosen to define habilitative benefits, the health plan issuers' will determine the benefit. This is a transitional policy, and HHS intends to monitor available data regarding coverage of habilitative services. 

    HHS also finalizes actuarial values (AVs), also called "metal levels," to assist consumers in comparing and selecting health plans by allowing a potential enrollee to compare the relative payment generosity of available plans. Nongrandfathered health insurance plans must meet 1 of 4 specific AVs: 60% for a bronze plan, 70% for a silver plan, 80% for a gold plan, and 90% for a platinum plan.

    APTA was highly involved in the processes that determined how EHBs should be defined. The association submitted comments to HHS in response to a December 2011 guidance bulletin, the Center for Consumer Information and Insurance Oversight's January 2012 bulletin, and the Institute of Medicine's report Essential Health Benefits: Balancing Coverage and Cost. APTA also took part in all public stakeholder meetings. Throughout the development of EHB, APTA urged HHS' secretary not to overly define the categories so that practitioners have the flexibility to provide both the type and frequency of care that is medically necessary for each individual.

    APTA will post a comprehensive summary on the final rule shortly.

    Former APTA Board Member Barbara Melzer Dies

    Barbara Melzer, PT, DPT, PhD, FAPTA, a clinician and educator for 38 years who held numerous national and state positions within APTA, died February 17. She had acute pneumonia that activated interstitial lung disease, a condition she was diagnosed with 7 years ago.

    Melzer served on APTA's Board of Directors as director (1987-1992) and secretary (1992-1995), and on the Executive Committee (1991-1995). She also was a member of the Nominating Committee (2003-2006), serving as chair for 1 year (2005-2006). Most recently, she was member of APTA's House of Delegates (2007-present).

    A member of the Education Section since 1976, Melzer served in numerous roles, including vice president (2000-2004). She was a coeditor of A Normative Model of Physical Therapist Professional Education, Version 2000. In 2003, Melzer was named a Catherine Worthingham Fellow, APTA's highest honor.

    She also held many positions at the state level. She served as president of the Texas Chapter (1983-1984) and as chief delegate (2000-2003). She was a member of a variety of chapter committees, including conference planning, bylaws, and educational affairs.  

    Melzer was professor at Texas State University and director of clinical education. She represented the School of Health Professions on the Faculty Senate and was a multiple winner of the Texas State University Presidential Award for Service.

    "Through the incredible span of her service and lengthy list of accomplishments, she has impacted the profession in ways no words can accurately capture," Eric Robertson, PT, DPT, OCS, FAAOMPT, wrote in a tribute to Melzer.  

    APTA President Discusses the Future of Physical Therapy on Internet Radio Show

    APTA President Paul A. Rockar Jr, PT, DPT, MS, recently participated in Healthy, Wealthy, and Smart, an internet radio show hosted by Karen Litzy, PT, MS, to discuss the future of the physical therapy profession. During the 1-hour segment, Rockar answered questions and spoke on a variety of topics affecting our profession, including health care reform and how it will affect physical therapy, the "triple aim" of health care and how physical therapy fits into the overall health care system, and issues related to direct access, among others. The show, which originally aired on Monday, February 18, can be heard anytime online at http://www.talkingalternative.com/monday-shows/healthy-wealthy-smart.

    New in the Literature: Physical Therapy for Cervical Disc Disease (Spine [Phila Pa 1976]. 2013;38(4):300-307.)

    In patients with radiculopathy due to cervical disc disease, anterior cervical decompression and fusion (ACDF) followed by physical therapy did not result in additional improvements in neck active range of motion, neck muscle endurance, or hand-related function compared with a structured physical therapy program alone, say authors of an article published this month in Spine. They suggest that a structured physical therapy program should precede a decision for ACDF intervention in patients with radiculopathy to reduce the need for surgery.  

    In this prospective randomized study, 63 patients with radiculopathy and magnetic resonance imaging-verified nerve root compression received either ACDF in combination with physical therapy or physical therapy alone. Outcomes, including active range of neck motion, neck muscle endurance, and hand-related functioning, were measured in 49 of these patients by an independent examiner before treatment and at 3-, 6-, 12-, and 24-month follow-ups.

    There were no significant differences between the 2 treatment alternatives in any of the measurements performed. Both groups showed improvements over time in neck muscle endurance, manual dexterity, and right-handgrip strength.

    House Bill Encourages Access to Providers in Underserved Areas

    Rep Bruce Braley (D-IA) recently reintroduced legislation to ensure that communities have access to a wide array of comprehensive health care services, including physical therapy. HR 702 amends the Public Health Service Act to establish a Frontline Providers Loan Repayment Program that would allow states the flexibility to bring health care providers to specific areas of need and incentivizes the transition to an interdisciplinary approach to health care.

    The bill was referred to the House Committee on Energy and Commerce on February 14. 

    Some Skiers Can Avoid Surgery for ACL Tears

    About a quarter of recreational skiers who tear their anterior cruciate ligament (ACL) on the slopes can be successfully treated without surgery, according researchers at Hospital for Special Surgery in New York City. Their article appears online ahead of print in the journal Knee Surgery, Sports Traumatology, Arthroscopy.

    The study found that at 6 to 12 weeks post-ACL tear, results from 2 tests that involve only the physical manipulation of a knee can identify skiers with a torn ACL who will recover without surgery.

    The researchers examined records of patients treated between 2003 and 2008 to identify recreational alpine skiers who were seen within 6 weeks of a first-time ACL tear. To be included, skiers had to have ACL rupture documented on an MRI after the injury and a minimum of 2 years follow-up. Patients were excluded if they had injured ligaments in both knees. They identified 63 acute, first-time skiing ACL tears; 29 of these patients did not undergo an ACL operation.

    The researchers then separated the 29 patients into 2 groups, those that had low-grade Lachman scores and negative pivot shift tests, indicating a potentially healed ACL, and those that had Lachman scores of 2+ and a positive pivot shift test indicating a damaged ACL.

    Six to 12 weeks after injury, 17 of the 29 skiers who did not have surgery had a Lachman score of 0 to 1 and a negative pivot shift test. Six of these patients were lost to follow-up, but 11 returned for a study-specific follow-up evaluation at more than 2 years post-injury. These patients completed questionnaires that gauged how well the knee was functioning and how their ski accident had occurred. They also underwent Lachman and pivot shift tests and a KT-1000 test to measure motions of the shin bone relative to the thigh bone.

    Skiers described injuring their ACL in tumbles where the ski had rotated too far. Physical exams revealed that 10 of the 11 patients still had Lachman scores of 0-1 and negative pivot shifts tests, and only 1 patient's scores had deteriorated to a Lachman Grade 2+. None of the patients, however, complained about knee instability. Eight had returned to skiing without the use of a brace; 3 no longer skied. KT-1000 test results also were positive.

    APTA member Greg Fives, PT, coauthored the article.

    Majority of States Opt for Federal Exchange

    The federal government will be running new health insurance marketplaces, also known as exchanges, in at least 26 states, says an article by Kaiser Health News. These states include the major population centers of Texas, Florida, and Pennsylvania.

    The Obama administration has given "conditional approval" to 17 states and the District of Columbia to run their own marketplaces. About 12 million people are expected to buy coverage through the Internet sites next year, with the number increasing to 29 million by 2021, according to consulting firm PriceWaterHouseCoopers.

    For consumers, it should make little difference whether the new Internet sites are run from state capitals or Washington, DC. But federal regulators hoped states would shoulder some of the work and that stakeholder groups such as hospitals and insurers wanted states to help, too. The exchanges become effective October 1. 

    Governors from Arkansas, Delaware, Illinois, Iowa, Michigan, New Hampshire, and West Virginia have sought approval for the third option— a partnership with the federal government. Three of those states—Arkansas, Delaware, and Illinois—have received conditional approval, says the article. 

    In a partnership, states would approve which plans can participate on the marketplace and handle consumer assistance duties, such as setting up call centers to handle inquiries. The federal government would handle the more complex duties of running the website, marketing the site, and determining the eligibility of millions of people for government subsidies that will make prices more affordable.

    Foundation Appoints 2 New Board Members

    The Foundation for Physical Therapy recently appointed 2 new board members, Ruthann "Randy" Roesch, PT, DPT, MBA, and Helene Fearon, PT, FAPTA.

    Roesch is the owner of Business Solutions and has been a strong supporter of the Foundation for many years. Roesch previously served on the Foundation's Board of Trustees (1998-2004) and most recently served on the Foundation’s audit committee. She also has served on the Florida Chapter Board of Directors, Private Practice Section (PPS) Board of Directors, and APTA Board of Directors as secretary and vice president. Roesch currently is chair of the PPS Task Force on Clinical Internship.

    Fearon is a founding partner of Fearon & Levine, a national consulting firm focusing on practice management and payment policy in the outpatient rehabilitation setting. For the past 27 years, she has been a partner in Fearon Physical Therapy, a private practice in Phoenix. Fearon, similar to Roesch, is involved in APTA at both the state and national levels, and has served on the PPS Board of Directors. She is an active member of the Arizona Chapter, and is a member of its payer relations committee. Fearon was a governor appointee to the Arizona State Board of Physical Therapy from 1999-2007 and served as its president from 2003-2007.

    Read more in the Foundation's press release

    If you're not receiving the Foundation for Physical Therapy's monthly News & Events  e-newsletter, sign up today and stay current with the latest information on research supported by the Foundation, funding and awards, and events. The newsletter also provides quick links to information about the Foundation's Trustees and staff; scholarships, fellowships, and grants; and how to make a donation.

    2013 Photo Contest Now Open

    APTA invites members to participate in the 2013 photography contest. Each photo submitted should reflect physical therapy practice, education, or research. Winning entries should:

    • Reflect the full scope of practice and depict the strides that contemporary physical therapy practice, education, or research has helped to achieve
    • Depict models of excellence in a variety of settings
    • Portray a diverse population of physical therapists, physical therapist assistants, patients, researchers, faculty, or students
    • Reflect high quality in terms of aesthetics, composition, and technical standards

    Winners will be selected by a distinguished panel of judges. Winning entries will be displayed at APTA headquarters. They also may appear in APTA's online or print publications and on the APTA.org or MoveForwardPT.com websites.

    The first-place winner will receive $500. The second and third place winners will receive $250 each. No cash prizes will be awarded for honorable mentions. Winners will be announced in a future issue of PT in Motion: News Now.

    Contact Courtney Merritt, senior coordinator, academic services, at 800/999-2782, ext 3208, with questions or concerns. All entries must be submitted to Courtney Merritt by Friday, August 30. Winners will be notified by Friday, January 10, 2014.

    Don't miss out on this outstanding opportunity to help identify and preserve the best in contemporary physical therapy practice, education, and research through your own creativity and initiative.

    See the photos that were honored from the 2012 contest.

    Save the Date: 2015 WCPT Congress to Meet May 1-4 in Singapore

    The World Confederation for Physical Therapy (WCPT) is the largest international gathering of physical therapists, bringing together clinicians, educators, researchers, managers, and policymakers.

    The 2015 congress, which will be held in Singapore May 1-4, promises a high-quality program along with a major international trade exhibition and plenty of opportunities for networking. More than 5,000 physical therapists participated in the 2011 congress held in Amsterdam.

    Are you involved in research, or is there a new project that is due to start this year? Don't forget that your current research and innovation projects may provide an opportunity for you to present in 2015.

    Stay tuned for more information in the upcoming months. Contact René Malone with questions.

    Therapy Cap Repeal Legislation Introduced in House and Senate

    Today, members of Congress reintroduced identical bills in the House and Senate that would permanently repeal the cap on outpatient physical therapy services. Sens Ben Cardin (D-MD) and Susan Collins (R-ME) introduced the Senate's measure. The House legislation is sponsored by Reps Jim Gerlach (R-PA) and Xavier Becerra (D-CA). 

    With discussion on permanent reform of the sustainable growth rate (SGR) ramping up, Congress also must address long-term repeal of the therapy cap, an arbitrary limit on services that often are medically necessary for patients. Both flawed policies were created in 1997 as part of the Balanced Budget Act and should be repealed this year. Given the opportunity to act on both SGR and the therapy cap, this should be the last time cap repeal legislation should need to be introduced, says APTA.  

    Access to physical therapist services has long enjoyed broad bipartisan support, with approximately 200 members of Congress supporting therapy cap repeal legislation every congressional session.

    If Congress does not act on legislation by December 31, the 2-tier exceptions process that was extended through 2013 by the American Taxpayer Relief Act of 2012 (HR 8), will expire.

    Read comments from the bills' sponsors in APTA's press release

    Rehabilitation Researchers Advocate on Capitol Hill

    APTA's Section on Research hosted a fly-in February 12-13 in Washington, DC, to advocate on behalf of rehabilitation research and to push for a delay in potential sequestration cuts to programs within the National Institutes of Health (NIH).

    Eleven researchers from 9 states spent the day meeting with staff of the Senate and House appropriations committees and their individual members of Congress to discuss the value and impact of innovative multidisciplinary research to the overall US economy and its ability to remain globally competitive in the future. The researchers strongly urged Congress to continue funding agencies that support rehabilitation research within NIH, in light of 5%-7% sequestration cuts set to take effect on March 1.  

    In addition, the researchers informed members and their staff about the key findings of the Blue Ribbon Panel Report on Medical Rehabilitation. The researchers received positive feedback from Appropriations Committee members on the panel's recommendation to enhance the role and exposure of the National Center for Medical Rehabilitation Research (NCMRR) within NIH.

     February 14, 2013 News Now Article 
    Rep Rodney Alexander (R-LA), far left, with members of APTA's Section on Research. Alexander spoke at a breakfast held for the fly-in participants.  

    Klonowski Calls SOTU a 'Unique Experience'

    "It was an honor and a privilege," Mike Klonowski, PT, DPT, PCS, said Wednesday morning reflecting on his attendance at the State of the Union (SOTU) address Tuesday night.  

    Klonowski attended the SOTU address as an invited guest of Sen Mark Kirk (R-IL). He was the senator's primary physical therapist at the Rehabilitation Institute of Chicago following a stroke in January 2012 that paralyzed the left side of Kirk's body.  

    Being among so many of the nation's leaders—those on the floor of the House of Representatives and in the House gallery—was a "unique experience," Klonowski said.  

    Certain parts of the address were well received by all attendees. In particular, the audience came together to cheer the president's call for advancements in education, particularly in science and math. "We have seen how clinical research can improve care and patient outcomes on RIC’s new recovery unit and AbilityLab, where Sen Kirk was treated. Embracing science and innovation is how we lead the world into the future," said Klonowski.     

    Before the address, Klonowski visited with Kirk in his office. "He's not shying away from his stroke recovery," said Klonowski, noting the odds the senator has overcome and how his spirit and drive have allowed him to return to a high level of function. "He's more and more like himself."

    "All the hard work Mark did in rehab is paying off," Klonowski said. "He returned to work better prepared [to take on his role in the Senate]." 

    New in the Literature: Rehabilitation in Home Care (Arch Phys Med Rehabil. 2013 Feb 2. [Epub ahead of print])

    Long-stay home care clients who receive rehabilitation have improved outcomes and lower utilization of costly health services, say authors of an article published online in Archives of Physical Medicine and Rehabilitation. The findings suggest that investment in physical therapy and occupational therapy services for relatively short periods may provide savings to the health care system over the longer term, they add.

    This observational study conducted in home care programs in Ontario, Canada, included 99,764 home care clients with musculoskeletal disorders who received a baseline screening using the Resident AssessmentInstrument for Home Care, 1 follow-up assessment, and had discharge or death records between 2003 and 2008.

    The effects of physical therapy and occupational therapy services on transitions in function state, discharge from home care with service plans complete, institutionalization, and death were assessed using multistate Markov models.

    Home care clients with deficiencies in instrumental activities of daily living (IADL) and/or activities of daily living at baseline and who received home-based rehabilitation had significantly increased odds of showing functional improvements by their next assessment (for a state 3 → 2 transition OR = 1.17; for a state 2 → 1 transition OR = 1.36). Receipt of physical therapy or occupational therapy also significantly reduced the odds of mortality and institutionalization in this group.

    With increasing numbers of older adults with chronic conditions and limited funding for health care services, it is essential to provide the right services at the right time in a cost-effective manner, the authors add. 

    Donald Jackson, PT, Elected President of Hastings College

    APTA member Donald Jackson, PT, was elected the 16th president of Hastings College on February 4. Located in Hastings, Nebraska, the college was founded in 1882 and has been named a "best" college by numerous publications.

    Jackson joined the college administration in the fall of 2012 after serving more than 21 years as the chief operating officer of Easter Seals. Previously, he founded and directed the expansion of Rehabilitation Systems Inc, a multistate health care company focused on physical therapy services. In addition to having served as vice chair of the Hastings College Board of Trustees, he served as vice chair of the Hastings College Foundation Board of Directors.

    Jackson is a 1970 Hastings graduate. He holds a master of science degree in rehabilitation services administration from DePaul University and a certificate in physical therapy from Northwestern University.

    APTA believes that Jackson is the first physical therapist to be elected president of a college or university in a permanent capacity.  

    Hear Jackson's comments on his new position, and a Q&A with reporters, in this video press conference

    Member Opportunity to Serve on Physical Therapy Outcomes Registry Task Force

    APTA's Physical Therapy Outcomes Registry Task Force is seeking members to serve on this newly formed task force. Those wishing to provide input into the development and implementation of the registry should respond to the call by completing a volunteer interest profile found on the Volunteer Interest Pool webpage. The first step is creating a "profile" for service. After developing a profile, in order to be considered for this task force, members must then access the "current opportunities for service page" and respond to the questions specific to this task force. The deadline to respond to this call is February 20. For more information on this task force, click on the link above or contact Marc Goldstein, EdD, senior advisor, Clinical Practice and Research.

    PT to Attend State of the Union Address

    Tonight, APTA member Mike Klonowski, PT, DPT, PCS, will attend the State of the Union address as an invited guest of Sen Mark Kirk (R-IL). Klonowski was the senator's primary physical therapist at the Rehabilitation Institute of Chicago following a stroke in January 2012 that paralyzed the left side of Kirk's body. Last month, Klonowski watched Kirk climb the steps to the Capitol on the first day of the 113th Congress.

    Look for Klonowski's comments on tonight's event in an upcoming article in News Now.    

    APTA Clarifies Key Points of Medicare 'Improvement Standard'

    APTA's issue brief on the final settlement in the class action "Improvement Standard" lawsuit (Jimmo vs Kathleen Sebelius), which upheld the right of patients to continue to receive reasonable and necessary care to maintain their condition and prevent or slow decline, contains key points for physical therapists regarding compliance with this Medicare regulation.    

    In the brief, APTA notes that there is "clear and convincing evidence embedded within the provisions of the current Medicare regulations that providers may use to justify the current practice of providing skilled therapy to patients to maintain their current level of function or to prevent decline or deterioration." Thus, the final settlement seeks to clarify the regulations; it does not expand the Medicare benefit. "Therefore, we expect that only patients who were unfairly denied services based on this arbitrary standard will now have access to care," says the brief. 

    APTA members can access the issue brief on the Medicare Coverage Issues webpage under the subtitle Improvement Standard. 

    Physical Therapy Provides Short-term Benefits for Unilateral Lateral Epicondylalgia

    An article* published this month in JAMA reports that in patients with unilateral lateral epicondylalgia, corticosteroid injections were associated with poorer long-term outcomes and higher recurrence rates than other interventions 1 year after receiving the injection. Patients in the same study who participated in 8 weeks of multimodal physical therapy did not achieve long-term outcomes. However, physical therapy was beneficial in the short term in the absence of corticosteroid injection. In addition, significantly fewer patients receiving physical therapy consumed an analgesic or anti-inflammatory medication.

    This randomized, injection-blinded, placebo-controlled trial was conducted in Australia at a single university research center and 16 primary care settings. A total of 165 patients aged 18 years or older with unilateral lateral epicondylalgia of longer than 6 weeks' duration were enrolled between July 2008 and May 2010; 1-year follow-up was completed in May 2011.

    Of the 165 patients, 43 received corticosteroid injection, 41 received placebo injection, 40 received corticosteroid injection plus physical therapy, and 41 received placebo injection plus physical therapy. The physical therapy intervention was standardized, based on current evidence, and primarily included manual therapy and exercise. The exercise program included twice daily sensorimotor retraining of gripping and concentric and eccentric exercise to progressively load the wrist extensors using resistive elastic latex bands. The patients' home program and exercise diaries were monitored to facilitate program adherence.

    The 2 primary outcomes were 1-year global rating of change scores for complete recovery or "much improvement" and 1-year recurrence (defined as complete recovery or much improvement at 4 or 8 weeks but not later) analyzed on an intention-to-treat basis. Secondary outcomes included complete recovery or much improvement at 4 and 26 weeks.

    At 1 year, corticosteroid injection demonstrated lower complete recovery or much improvement and greater recurrence compared with placebo injection. There were no differences between physical therapy and no physical therapy for complete recovery or much improvement or recurrence. 

    In their analysis of secondary outcomes, the authors found that at 4 weeks there was a significant interaction between corticosteroid injection and physical therapy for complete recovery or much improvement. In particular, patients who received the placebo injection plus physical therapy had greater complete recovery or much improvement compared with patients who did not receive physical therapy, and medium-sized benefits for worst pain, resting pain, and pain and disability. 

    Despite their finding that physical therapy did not provide a statistically significant long-term effect on complete recovery compared with the other groups, the authors say that physical therapy "should not be dismissed altogether," because in the absence of corticosteroid it provided short-term benefit across all outcomes and had the highest percentage of participants reporting a complete recovery or improvement at 1 year.

    The results of this study were widely reported in the mainstream media, including articles by USA Today, The New York Times, ABC News, NPR, and CBS News

    * The full text of this study is available by subscription or purchase only. Copyright protections prohibit APTA from disseminating the information. For suggestions about obtaining literature, visit APTA's Finding Information in Physical Therapy Literature webpage.     

    CSM 2013 Photos Available Online

    Did APTA's photographer take a great photo of you or your colleagues at the Combined Sections Meeting (CSM) last month in San Diego? You now can view and purchase CSM 2013 photos. To order images and downloads, go to www.davidbraun.photoreflect.com and click on "APTA-CSM 2013."  Enter password "ribcage," 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. 

    IPE PORTAL Advances Interprofessional Collaborative Practice Education

    High-quality, peer-reviewed, competency-based learning modules for interprofessional health education now are available through a new innovative online portal launched by the Interprofessional Education Collaborative (IPEC). Based on Core Competencies for Interprofessional Collaborative Practice, these materials are designed to provide tools to prepare tomorrow's health professions work force for interprofessional, team-based, patient-centered, and community- and population-oriented care.

    Funding support was provided by the Josiah Macy Jr Foundation and IPEC, a national organization connecting health professions for better care. IPEC's founding members are the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Dental Education Association, the Association of American Medical Colleges, and the Association of Schools of Public Health.

    APTA served on the Advisory Committee for the IPE PORTAL, representing both the association and the Interprofessional Professionalism Collaborative (IPC), for the development of this new interprofessional education portal.   

    The IPE PORTAL collection is open for submissions. Inquiries should be directed to mededportal@aamc.org.

    Preparing for Successful Accreditation in Medical Rehabilitation

    Register today for CARF International's 2-day training session to gain valuable insight into the accreditation process, and learn how to avoid the pitfalls some organizations may experience on their accreditation survey.

    This comprehensive and interactive training session provides an appropriate forum to assimilate the ASPIRE to Excellence® quality framework. In addition, the session will highlight practical examples of demonstrating conformance to the standards and effective business management and service delivery practice. All areas in the 2013 Medical Rehabilitation Standards Manual will be covered.

    Session topics include:

    • the CARF accreditation process and what happens during a survey
    • helpful tips in preparing for your CARF survey
    • a review of the 2013 standards, including the ASPIRE to Excellence quality framework, designed to provide a logical, action-oriented approach to quality improvement
    • a review of program standards for medical rehabilitation programs
    • frequently cited standards

    This session is recommended for first-time organizations preparing for the accreditation survey process, organizational contacts new to the CARF accreditation process, or those who need a quick update and refresher course.

    APTA is a member of CARF's International Advisory Council.  

    APTA Issues Statement on 'Improvement Standard' Final Settlement

    "APTA is pleased with the decision of the federal court to approve the final settlement in the class action 'Improvement Standard' lawsuit (Jimmo vs Kathleen Sebelius), which upheld the right of patients to continue to receive reasonable and necessary care to maintain their medical conditions and prevent or slow decline," says APTA President Paul A. Rockar Jr, PT, DPT, MS, in a statement issued today. "We look forward to working with the Centers for Medicare and Medicaid Services (CMS) and its contractors to ensure the appropriate and equitable application of patient care as outlined in the settlement. We believe this final settlement reinforces the fundamental right established in the Medicare statute that affords patients the right to receive the services necessary to treat their diagnoses or illnesses."

    The final settlement directs CMS to revise its Medicare Benefits Policy Manual to set a maintenance coverage standard and launch a national educational campaign to explain the clarified benefit to its contractors, providers, and beneficiaries. "APTA is eager to serve as an active partner as the agency begins this work. Over the next several months, we will provide clinical and professional expertise to CMS to define appropriate treatment in accordance with our professional standards," Rockar says.

    While CMS works to publicize changes and new resources, APTA will actively educate members on how to give appropriate care as defined by this final settlement.

    2013 Candidate Webpage Posted

    The candidate webpage now is available. Learn about your candidates for the 2013 elections to national office by browsing the candidates' biographical information and reading their written statements. Contact Angela Boyd with any questions.

    IHS Loan Repayment Program Accepting Applications

    The Indian Health Service (IHS) 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. There is an estimated $20 million available for awards during Fiscal Year 2013. The LRP awards up to $20,000 per year in exchange for a minimum 2-year service obligation, plus 20% of federal income tax on the award (see payments and examples). 

    Applications are accepted and evaluated monthly until funds are exhausted. February 15 is the first award cycle deadline. August 16 is the last award cycle deadline. Visit the LRP website for more information, eligibility requirements, and to apply.

    Research Focuses on Engaging Patients in Health Care

    The February issue of Health Affairs explores the burgeoning field of activating and engaging patients in their health and health care. Studies show that more informed and empowered patients have better health outcomes, and there is some evidence that they also have lower health care costs.

    One study featured this month found that patients with the lowest level of "activation"—that is, those most lacking in the skills and confidence to be actively engaged in their health care—had average costs that were 8 %-21% higher compared with patients with the highest level of activation.

    Another article reports on how offering online health care for patients with simple conditions saved money for a prominent Minnesota health plan. Launched in 2010, "virtuwell" provides 24-hour online access, diagnosis, and treatment (including prescriptions) by nurse practitioners for about 40 simple conditions, such as sinus infections, urinary tract infections, and pink eye.

    Private and public sector leaders also weigh in with their perspectives on strategies to lower health care costs, improve quality, engage patients, and enhance outcomes research.  

    Deadline Extended to Register for Innovation Summit

    Due to popular demand, the deadline for the Innovation Summit: Collaborative Care Models has been extended to March 6. Don't miss out on the opportunity to participate in this groundbreaking virtual event that will bring together physical therapists, physicians, large health systems, and policy makers to discuss the current and future role of physical therapy in integrated models of care.

    Check out the programming, including the speakers and panelists who will provide you with the information needed to get involved in accountable care organizations, patient-centered medical homes, bundled payment models, and private payer and employer-sponsored initiatives.

    Interested in attending a viewing party in your area? APTA will soon list viewing parties and their locations at www.apta.org/InnovationSummit/ViewingParties/.

    Member Opportunity to Serve on New Leadership Development Committee

    APTA's newly created Leadership Development Committee (LDC) is seeking members to serve in this capacity. If you or someone you know is interested in developing the organizational structure for an APTA leadership development program, you may wish to add your name in the pool for consideration. There are 7 committee member openings for 1- or 2-year terms starting in April. Contact Elizabeth Grotos with questions about the LDC.

    To answer the call for these opportunities, members must first complete a volunteer interest profile found on the Volunteer Interest Pool webpage. Once your profile is created, you may review the current opportunities and answer the questions specific to each committee.  The deadline to respond to this call is February 20.

    Reflex Control Linked With Improved Gait in Patients With Incomplete Spinal Injuries

    A training regimen to adjust the body's motor reflexes may help improve mobility for some people with incomplete spinal cord injuries, according to a study supported by the National Institutes of Health.

    The study involved 13 people who were still able to walk after incomplete spinal cord injuries that had occurred from 8 months to 50 years prior to the study. All had spasticity and an impaired ability to walk. The goal was to determine if these individuals could gain mobility by learning to suppress a spinal H-reflex, which is elicited by electrical stimulation rather than by a tendon stretch.

    Participants in the study received electrical stimulation to the soleus of their weaker leg while standing with support. The first 2 weeks of the study involved baseline measurements of the resulting reflex. During the next 10 weeks, 9 participants underwent 3 training sessions per week, during which they viewed the size of their reflexes on a monitor and were encouraged to suppress it. A control group of 4 participants received the stimulation but no feedback about their reflexes. Before and after these sessions, the researchers measured the participants' walking speed over a distance of 10 meters and monitored their gait symmetry with electronic shoe implants.

    Six of the 9 participants in the training group were able to suppress their reflexes. Their walking speed increased 59% on average, and their gait became more symmetrical. These improvements in speed and symmetry were not seen in 3 participants who were unable to suppress their reflexes, or in the control group. Many participants also spontaneously told the researchers they were noticing improvements in daily living activities. About 85% of these comments came from people who were able to control their reflexes after several weeks of training.

    Study author Jonathan Wolpaw, MD, said he views reflex conditioning as a complement to current rehabilitation practices. The technique could be tailored to focus on specific reflexes that affect different muscle groups and, in some cases, to increase reflexes instead of decrease them. In its 2006 study, his group found that enhancing soleus H-reflex was beneficial for rats that had spinal cord injuries predominantly characterized by weakness without spasticity.

    Aiko Thompson, PhD, who also authored the article, said she plans to study how durable the effects of training are, but such research presents a design challenge. "Once people noticed their mobility had improved, they started exercising more and getting involved with other types of therapy. Those activities are likely to have additional benefits and will be difficult to separate from the long-term effects of our reflex conditioning protocol," she said.

    APTA Expresses Dissatisfaction With Dr. Oz Show

    APTA issued a letter to the producers of the Dr. Oz Show to express its dissatisfaction with the show's recent segment on "Cutting-Edge Solutions for Back Pain." In the letter, APTA President Paul A. Rockar, Jr, PT, DPT, MS, points out that, "While modalities may be used by physical therapists as part of an overall treatment plan, the focus of physical therapy treatment for back pain is on evidence-based exercises to improve strength and flexibility, manual therapy to improve the mobility of joints and soft tissues, and patient education on ways to enhance recovery, prevent and relieve pain, and avoid recurrence."

    PTJ Special Series Inspires Editor in Chief to Consider Returning to Clinical Practice

    "I am so excited by the December issue and these 10 articles that I'm really considering changing my path and going out to see if I can help develop acute care specialization and become a practicing clinician again," says PTJ Editor in Chief Rebecca Craik, PT, PhD, FAPTA, at the conclusion of the latest Craikcast. 

    Joining Craik this month in discussing the articles that complete the 2-part PTJ Special Series on Rehabilitation for People With Critical Illness are coeditors Patricia Ohtake, PT, PhD, Dale Needham, MD, and Dale Strasser, MD. The group also discusses quality improvement research, a key topic of the articles in the February edition of the critical care special series. The first part of the series was published in the December 2012 issue.    

    Call for Proposals: CPG/CPA Development

    As part of APTA's strategic plan, one of the goals for 2013 is to better enable physical therapists to consistently use best practice to improve the quality of life of their patients and clients. To achieve this goal, APTA is supporting the development of clinical practice evidence-based documents. This initiative aims to provide structure, process, and resources for the development of Clinical Practice Guidelines (CPG) and Clinical Practice Appraisals (CPA) that enable the translation of research into physical therapist practice. In order to facilitate the development of clinical practice documents and other high quality evidence summaries, APTA is offering financial and training support to sections for this purpose.

    Proposals for CPG/CPA development must focus on clinical practice areas that are important and relevant to the practice of physical therapy. The proposal must be supported and submitted by an APTA section. Each proposal will be considered individually and will be awarded in part or in full depending on the priorities of the association and the strength of the proposal.  

    Proposals for the current review cycle are due on March 18. For more information or for a copy of the proposal submission document, contact Anita Bemis-Dougherty, director, Practice Department, at anitabemis-dougherty@apta.org or 800/999-2782, ext 3176.

    New in the Literature: Management Decisions Following New Consultation for LBP (Arch Phys Med Rehabil. 2013 Jan 18. [Epub ahead of print])

    In a retrospective cohort obtained from electronic medical records and insurance claims data, initial physical therapy management following a new primary care low back pain (LBP) consultation was not associated with increased health care costs or utilization of specific services. The authors of this article, which appears online in Archives of Physical Medicine and Rehabilitation, write that additional research is needed to examine the cost consequences of initial management decisions made following a new consultation for LBP.

    Records and data were examined on 2,184 patients aged 18 and older with a new consultation for LBP from 2004-2008 in single health care delivery system in the United States. Patients were categorized as receiving initial physical therapy management if care occurred within 14 days after consultation.

    Total health care costs for all LBP-related care received in the year following consultation were calculated from claims data. Predictors of utilization of emergency care, advanced imaging, epidural injections, specialist visits, and surgery were identified using multivariate logistic regression. Generalized linear model was used to compare LBP-related costs based on physical therapy utilization and identify other cost determinants.

    Initial physical therapy was received by 286 of 2,184 patients (13.1%) and was not a determinant of LBP-related health care costs or utilization of specific services in the year following consultation. Older age, mental health or neck pain comorbidity and initial management with opioids were determinants of cost and several utilization outcomes.

    APTA member Julie M. Fritz, PT, PhD, ATC, is the article's lead author. APTA members Gerard P. Brennan, PT, PhD, Stephen J. Hunter, PT, DPT, OCS, and John S. Magel, PT, DSc, OCS, FAAOMPT, are coauthors.

    Last Call for Federal Government Affairs Leadership Award and APTA Public Service Award Nominations

    Monday, February 11, is the deadline to submit nominations for the Federal Government Affairs Leadership Award and the APTA Public Service Award.

    The Federal Government Affairs Leadership Award is presented annually to an active APTA member who has made significant contributions to APTA's federal government affairs efforts, and has shown exemplary leadership in furthering the association's objectives in the federal arena.

    The APTA Public Service Award is presented annually to individuals who have demonstrated distinctive support for the physical therapy profession at a national level. Individuals from the following categories are eligible for nomination of this award: members of Congress, congressional staff members, members of a state legislature, federal agency officials, health and legislative association staff, and celebrities or other public figures.

    APTA's Board of Directors will select award recipients during its March 2013 conference call. Awards will be presented at the Federal Advocacy Forum to be held April 14-16 in Washington, DC. Submit nominations by February 11 to Stephanie Sadowski.

    Summary of HIPAA Final Rule Now Available

    APTA's summary of a recently released HIPAA final rule includes important information for physical therapists related to modifications of the Privacy, Security, and Enforcement Rules embedded in the HITECH Act, changes to the HIPAA Enforcement Rule to incorporate the increased and tiered civil money penalty structure, the adoption of breach notification requirements for unsecured data, and adjustments to the HIPAA Privacy Rule as required by the Genetic Information Nondiscrimination Act to increase privacy protections for genetic information. 

    Association members can access the document on the Health Information Technology webpage under "APTA Summaries" and the HIPAA webpage.

    CMS Clarifies Therapy Cap Exceptions for Critical Access Hospital Patients

    In a meeting with APTA yesterday, the Centers for Medicare and Medicaid Services (CMS) clarified the impact of the therapy cap on patients who receive outpatient therapy services in critical access hospitals (CAHs). CMS stated that for 2013, when a patient receives outpatient therapy services from a critical access hospital, the services will count toward dollars accrued toward the therapy cap. For example, if a  patient receives $2,000 of outpatient therapy services in a CAH and upon discharge goes to a private practice to continue therapy services, the private practice would need to obtain an exception (in this case use the KX modifier).

    However, CMS clarified that for 2013 the therapy cap does not apply to outpatient therapy services provided within CAHs themselves. This means that if the patient continued treatment in the critical access hospital, after exceeding $1,900 in therapy services, there would be no need to seek an exception through the automatic process. That is, the CAH would not need to submit the claim with a KX modifier. Also, if the patient exceeds $3,700 and continues care in CAH, the hospital would not need to obtain an exception through the manual medical review process.

    APTA had been seeking clarification on this issue from CMS since the January 1 passage of the American Taxpayer Relief Act of 2012 (HR 8), which extended the current 2-tier therapy cap exceptions process through 2013. The agency advised APTA last month that it was working with its general counsel for interpretation of the legislative language.   

    Senate Report Includes APTA Comments on Self Referral

    APTA's comments to the Senate Finance Committee's May 2012 request for input from health care stakeholders on 3 areas critical to Medicare and Medicaid reforms—program integrity, payments, and enforcement—have been included in the committee's recently released report titled "Opportunities to Curb Waste, Fraud and Abuse in Medicare and Medicaid."

    Specifically, the Senate Finance Committee writes about eliminating self referral in 2 sections of the report. Under the Beneficiary Protection section, the committee notes "concern that over-broad application of the Stark law exception for physician in-office ancillary services compromises patient care by incentivizing overutilization." The committee references "increasing enforcement of existing laws, such as the Stark law" under the area titled Enforcement.  

    More than 160 stakeholders in the health care community submitted comments to the Senate Finance Committee's request. During the 113th Congress, 6 Senators plan to work with key committees of jurisdiction, the Government Accountability Office, the Department of Health and Human Services Office of the Inspector General, and interested stakeholders to develop a more detailed list of administrative recommendations and potential legislative actions.  

    APTA's comments can be found on the association's Self Referral webpage.

    Indiana PT Day Focuses on Direct Access

    More than 530 physical therapists, physical therapist assistants, and physical therapy students from Indiana gathered at the statehouse on January 30 to show their support for HB 1034, which would provide direct access to physical therapists. Over 50 legislators joined the members of the physical therapy profession for lunch and to discuss the bill. 

    State Sen Pat Miller and state Reps Dave Frizzell and Matt Ubelhor spoke to the crowd and confirmed their commitment to passing direct access legislation. Indiana is 1 of only 3 states with no form of direct access to physical therapy treatment, and the only state without direct access to a physical therapy evaluation. Many Indiana Chapter members held signs with the messages: "49 states allow you to see your PT directly … not Indiana" and "Hoosiers deserve direct access to physical therapists."

    The House Public Health Committee hearing for HB 1034 will be held February 6. The chapter is coordinating a team of chapter members to speak in support of the bill. If it is approved by the committee, the bill would then go to the full House of Representatives for consideration.

    Photos of the January 30 event are available here.

    CMS Bundled Payment Initiative to Begin Testing in April

    More than 500 organizations will begin participating in the Centers for Medicare and Medicaid Services' (CMS) bundled payments for care improvement initiative, made possible by the Affordable Care Act. Through this initiative CMS will test how bundling payments for episodes of care can result in more coordinated care for beneficiaries and lower costs for Medicare.

    The bundled payment initiative includes 4 models of bundling payments, varying by the types of health care providers involved and the services included in the bundle. Depending on the model type, CMS will bundle payments for services that beneficiaries receive during an episode of care, encouraging hospitals, physicians, postacute facilities, and other providers as applicable to work together to improve health outcomes and lower costs. Organizations of providers participating in the initiative will agree to provide CMS a discount from expected payments for the episode of care, and then the provider partners will work together to reduce readmissions, duplicative care, and complications to lower costs through improvement.

    Last week's announcement includes the selection of 32 awardees in model 1, who will begin testing bundled payments for acute care hospital stays as early as April. In the coming weeks, CMS also will announce a second opportunity for providers to participate in model 1, with an anticipated start date of early 2014.  

    CMS' announcement also marks the start of phase 1 of models 2, 3, and 4. In phase 1 (January-July 2013), more than 100 participants partnering with over 400 provider organizations will receive new data from CMS on care patterns and engage in shared learning in how to improve care. Phase 1 participants are generally expected to become participants in phase 2, in which approved participants opt to take on financial risk for episodes of care starting in July 2013, pending contract finalization and completion of CMS' standard program integrity reviews. 

    A list of the model 1 awardees and participants for phase 1 of models 2, 3, and 4 is available on the Center for Medicare and Medicaid Innovation's website.

    Hear how physical therapists are getting involved in bundled payment initiatives by attending APTA's Innovation Summit: Collaborative Care Models. This groundbreaking virtual event will bring together physical therapists, physicians, large health systems, and policy makers to discuss the current and future role of physical therapy in integrated models of care. A panel of experts, moderated by a physical therapist who is highly involved in bundling initiatives, will provide you with perspectives on bundling from large health systems, a physical therapy private practice, and private payers.

    Registration for the Summit closes Friday, February 8. Interested in attending a viewing party in your area? APTA will soon list viewing parties and their locations at www.apta.org/InnovationSummit/ViewingParties/.  

    HHS Proposes Standards for Minimum Essential Coverage

    A proposed rule issued Wednesday includes vital provisions regarding minimum essential coverage as mandated by the Affordable Care Act.

    Under the ACA, nonexempt individuals are required to maintain minimum essential coverage or make a shared responsibility payment. This provision is known as the individual mandate. The ACA specifies the categories of individuals who are eligible to receive exemptions from the shared responsibility payment under section 5000A of the Internal Revenue Code, which provides nonexempt individuals with a choice: maintain minimum essential coverage for themselves and any nonexempt family members or include an additional payment with their federal income tax return.

    This proposed rule sets forth standards and processes under which the health insurance exchanges will conduct eligibility determinations for and grant certificates of exemption from the shared responsibility payment.

    The proposal also provides standards for determining whether certain other types of health insurance coverage constitute minimum essential coverage and procedures for sponsors to follow for a plan to be identified as minimum essential coverage under section 5000A.

    Additionally, it proposes to designate certain types of existing health coverage as minimum essential coverage. Sponsors of a health plan that seek to have such coverage recognized as minimum essential coverage would have to submit information, including the essential health benefits covered, to the Department of Health and Human Services (HHS). Among the essential health benefits required in the ACA are rehabilitation and habilitation services and devices.

    This proposed rule, which complements a proposed rule issued the same day by the Internal Revenue Service, is published in today's Federal Register.

    Comments on the rule are due March 18. APTA will analyze the proposed rule to determine if it is necessary for the association to submit comments.  

    New Summary: Proposals Affecting Medicaid and CHIP Beneficiaries

    APTA provides a comprehensive summary of a recently proposed rule that has significant importance to the new Medicaid expansion population who must be offered essential health benefits beginning in 2014. In the proposed rule, the Centers for Medicare and Medicaid Services recommends that states define the habilitative services category under Medicaid and requests comments on whether the habilitative services should be offered in parity with rehabilitative benefits, as contemplated in previously released guidance to states on essential health benefits. In addition, the summary outlines proposals related to eligibility and enrollment, cost sharing, and eligibility appeals.

    The summary is available on APTA's Medicaid webpage.  

    Sign Up for February 5 Women's Heart Health Webinar

    Kick off American Heart Month by attending the third Annual State of Women's Heart Health webinar February 5, 4:00 pm ET. This informative discussion with some of the nation's health leaders, including Department of Health and Human Services Secretary Kathleen Sebelius, Food and Drug Administration Commissioner Margaret Hamburg, and Million Hearts initiative Director Janet Wright, MD, will highlight advances in women's heart health, actions to reduce risk factors, and ways to help raise awareness about heart disease in women. 

    For more information and to register, visit the American Heart Association's You're the Cure website.