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  • '2 Midnight' Rule on Hold Until September 30

    The Centers for Medicare and Medicaid Services (CMS) is once again delaying implementation of the "2 midnight" rule for hospital admissions of patients in Medicare. In the face of criticism from physicians and hospitals, CMS now says recovery auditors cannot use the rule until after September 30. The rule was originally set to go into effect on March 31.

    Intended to reduce costly admissions in cases better suited to outpatient treatment, the rule stipulates that auditors can assume that an admission is reasonable and necessary if the patient spent 2 days as an inpatient, defined as spending 2 midnights in a hospital bed.

    According to a recent report in Modern Healthcare (access requires free registration), the rule was created to respond to "widespread complaints that Medicare's rules are too vague about when a moderately sick patient should be admitted for expensive inpatient care instead of outpatient observation." The report states that hospitals have been unhappy with the assumption that they provided "medically unneeded" care if the 2-day care definitions aren't met.

    Foundation Service Award Recipients Announced

    This year's recipients of the Foundation for Physical Therapy's Service Awards have advanced the cause of physical therapy research in a variety of ways, from providing funds to fundraising, and from partnering with the Foundation to leading its work.

    This year's awards and winners are:

    • Spirit of Philanthropy Award: Magistro Family Foundation
    • Charles M. Magistro Distinguished Service Award: Alan M. Jette, PT, PhD, FAPTA
    • Premier Partner in Research Award: Private Practice Section of APTA (PPS)
    • Innovation in Fundraising Award: Illinois Physical Therapy Association's Student Special Interest Group

    "The leadership, generosity, and creativity of this year's awardees have been instrumental to the continued success of the foundation." Foundation Board of Trustees President William G. Boissonnault, PT, DPT, DHSc, FAPTA, FAAOMPT, said in a press release (.pdf) announcing the winners. This year’s recipients will be recognized during the foundation’s 35th Anniversary Gala on June 12, 2014, during the NEXT conference in Charlotte, North Carolina.

    OA Model of Care Advances

    Much work remains to be done, but a multidisciplinary panel of health care providers, researchers, and patients has made significant progress toward establishing a model of osteoarthritis (OA) care that acknowledges the importance of early diagnosis and recognizes the powerful impact that OA can have on successful treatment of comorbidities. The group's efforts have been released in a report (.pdf) published by the US Bone and Joint Initiative (USBJI).

    The Chronic Osteoarthritis Management Initiative (COAMI) report lays out the challenge in no uncertain terms. "Instead of routine screening that provides early alerts … about the possible presence of osteoarthritis (OA), followed by a systematic exploration of strategies to reduce pain and preserve or increase function, patients and providers often have their first conversations about joint pain when the joint is damaged enough to require surgical replacement," the report states. Slow detection and uncoordinated treatment not only results in more severe joint damage, but can allow OA to significantly impact how well a patient responds to treatment of concurrent conditions such as respiratory problems and diabetes.

    The COAMI report calls for improvements and better coordination in self-management support, delivery system and design, decision support, and clinical information systems, with the aim of creating an OA model of care "that is far closer to the coordinated, proactive ideal than what is currently in place." With such a model, the report states, it may be possible "to overcome the view of patients, the public, and many health care professionals that OA is inevitable and that joint pain and related disability should be tolerated." The panel decided on specific action items that will be addressed by designated groups of participants.

    APTA is a founding member of USBJI and serves on its board of directors.