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  • APTA Educates Insurers, Policymakers About PT Services in Insurance Plans

    This week, APTA issued a press release to insurance companies, third-party payers, employer groups, benefit managers, human resource professionals, self-insurers, and policymakers on the association's recently adopted Physical Therapy Model Benefit Plan (MBP) Design.   

    APTA's MBP includes a description of the role and value of physical therapists (PT) in health care that emphasizes the use of evidence in reducing disability and clinical costs, guiding principles for access to physical therapists, the role of medical necessity in decision making, the coverage of physical therapy benefits, and appropriate cost-sharing provisions. Physical therapists can use MBP to advocate for appropriate access to and coverage of physical therapist services.

    An APTA podcast provides an overview and background information on MBP.

    APTA Honors Military PTs at Annual Ceremony

    Yesterday, APTA participated in a panel discussion for service members during Iron Majors week, an annual event to honor the best physical therapists (PTs), occupational therapists, physician assistants, and dietitians in the Army Medical Specialists Corps (AMSC). The honored members come to Washington, DC, every March for an awards presentation and a week of educational programming. This is the third consecutive year that APTA has participated in Iron Majors week, and the second year that it has been invited to participate in a panel. The panel of the 4 professions, which make up AMSC, discussed the work and strategies of their respective organizations, specifically how each organization advances issues of importance to their military membership. 

    A March 2 podcast outlines APTA's current efforts on behalf of veterans and members of the armed services as part of the Joining Forces Initiative. For additional background, a July 2011 podcast recaps the progress APTA made with Veterans Affairs in securing new qualification standards for PTs and collaborating with the physical therapy discipline lead position.

    Editor's Note: This article was updated at 2:30 pm to reflect the correct name of the Army Medical Specialists Corps.  

    APTA Summary on Exchange Rules Now Available

    APTA's summary on the rules governing the establishment of health insurance exchanges and qualified health plans (QHP) highlights provisions pertinent to physical therapists, such as the QHP network adequacy standards that require issuers to maintain sufficient amounts and types of providers to ensure that all services will be accessible without unreasonable delay. The summary covers provisions related to initial and annual open enrollment periods, the eligibility determination process for the Small Business Health Options Program, consumer assistance tools and programs, privacy and security of information, and more.    

    Several provisions in this final rule were published as interim final and are open for public comment until May 11.

    Association members can access the summary on APTA's Summaries of Health Care Reform Rules & Regulations Web page under the heading "Additional Summaries."

    New in the Literature: Electrical Stimulation and Pressure Ulcers (Ostomy Wound Manage. 2012;58:30-44.)

    High-voltage pulsed current (HVPC) improved the healing rate of recalcitrant Stage II and Stage III pressure ulcers in patients enrolled in a prospective, randomized controlled clinical study in Poland, according to an article published in Ostomy Wound Management. Research to compare the effectiveness of using cathodic and anodal stimulation combined or alone, and to determine the optimal duration of these 2 types of electrical stimulation, is warranted, say the article's authors.

    Patients admitted for care and eligible to participate in this study received standard supportive care and topical treatments covered with wet-to-moist dressings. Patients assigned to the treatment arm of the study also received HVPC (100 V; 100 μs; 100 Hz) continuously for 50 minutes once daily, 5 times per week. Over a 4-year period, researchers enrolled 26 patients in the treatment and 24 in the control group. Researchers followed patients until healing or for a maximum of 6 weeks. Wound tracings and measurements were obtained weekly.

    Ulcers had existed for an average of 3.17 and 2.83 months in the treatment and control groups, respectively. Most were classified as Stage II (17 in the treatment and 16 in the control group) with an average baseline size of 4.54 cm2 and 3.97 cm2, respectively. Wound areas and linear measurements decreased significantly in both groups, but increases in granulation tissue were significant in the treatment group only. Wound area, linear measurement, wound volume, and granulation tissue changes were statistically significantly greater in the treatment group than in the control group starting in the second week of treatment. Week 6 surface area change was 88.9% (SD 14) in the treatment group and 44.4% (SD 63.1) in the control group. Correlation coefficients between changes in wound surface area, longest length, and longest width were R = 0.96 and R = 0.98 in the treatment group and R = 0.94 and R = 0.89 in the control group.

    HHS Underscores Advances in Meeting Health Needs of LGBT Populations

    In recognition of LGBT Health Awareness Week, the US Department of Health and Human Services (HHS) is emphasizing its ongoing efforts to address the specific health concerns of lesbian, gay, bisexual, and transgender (LGBT) Americans, especially through implementation of the Affordable Care Act. Such efforts include incorporating data collection on LGBT populations into national health surveys, releasing rules requiring hospitals to allow same-sex partners the ability to visit each other in the hospital, and setting up an internal working group to ensure the agency is effectively coordinating policies to best address LGBT health needs.

    In addition, HHS outlines several recommendations for future action. For example, the agency is planning to add information to HealthCare.gov that is of specific relevance to LGBT populations. In particular, the Web site will allow LGBT consumers to identify health insurance policies available to them that include coverage of domestic partners. HHS also will conduct outreach to organizations that serve LGBT communities to make them aware of available funding opportunities and highlight programs that may particularly benefit LGBT populations.

    More information and resources on some of the health issues and inequities affecting LGBT communities can be found on the Centers for Disease Control and Prevention's Web site. Some of this information is designed for members of the general public. Other information has been developed for health care providers, public health professionals, and public health students.

    NIH Releases New Web Tool for Researchers

    A new Web-based interactive anthology will provide psychologists, economists, anthropologists, sociologists, and other scientists with the latest research methods and tools to address emerging challenges in public health, such as the obesity epidemic and the rise of chronic diseases. With contributions from international experts, the anthology provides authoritative answers to methodological questions and sets quality standards for the research community.

    The goal of the program is to demonstrate the potential of behavioral and social science research, focusing on applying research findings to public health activities and the potential to enhance biomedical research. It is also a useful training resource for biological scientists, providing them with a basic foundation for collaborations with behavioral and social scientists.

    The Office of Behavioral and Social Sciences Research at the National Institutes of Health (NIH) collaborated with New England Research Institutes to create e-Source.

    Supreme Court Hears First Two Rounds of Arguments

    Yesterday the Supreme Court heard oral arguments on whether it has to wait to hear challenges against the health care reform law until 2015 when the first penalties must be paid following the implementation of the individual mandate in 2014. Neither the government lawyers nor those representing the 26 states believe the court is barred from hearing the case under the Anti-Injunction Act, which prohibits a person from bringing a lawsuit claiming that a tax is unlawful until after the tax has been paid. So the High Court appointed an independent, private attorney to argue that the Court did not have jurisdiction to decide the matter. That attorney's argument hinged on the theory that the penalty assessed under the law on those who fail to obtain health insurance is the same as a tax, thus the court must wait to hear the case until after 2015. According to NPR, the justices "appeared not to be buying" that argument.

    Yesterday's arguments are available in audio files and a transcript.

    Today's arguments focused on the individual mandate and if such a regulation is permissible under the Commerce Clause that allows the federal government to regulate interstate activity. Challengers of the law believe that the decision not to buy health insurance is economic inactivity, rather than activity, and therefore not a behavior the federal government can regulate, says the Washington Post. Proponents argue that the decision to not purchase health insurance has an economic effect because taxpayers essentially pay for the uninsured.

    Tomorrow the justices will hear arguments on whether the law can stand if the individual mandate is struck down. Additionally, lawyers will argue the part of the law that expands Medicaid. 

    A ruling is expected in June. 

    Therapy Partners Inc Receives Innovation Award for Value-based Model

    HealthPartners, a nonprofit HMO, recently awarded Therapy Partners Inc a 2011 Excellence in Innovation award for its project Value-based Purchasing Model for Therapy Services.

    Therapy Partners' 6-member independent physical therapy practices collected outcomes information using a patient-reporting tool over the course of 1 year. That information helped HealthPartners develop a pay-for-performance model for therapy services that focuses payment on value rather than on volume of services.

    With health care reform's emphasis on developing new models of care that reduce costs and increase patient outcomes, it is important that physical therapists (PTs) begin to consider similar models for their practices. To help APTA members seek opportunities in the changing health care environment, APTA has created a series of videos that highlight various innovative clinical practice models. Each APTA member appearing in a video is part of a nontraditional, outside-the-box creative practice model. These videos can help PTs gain insight and inspiration as they look for ways to become involved in new models of care delivery.

    Glycemic Control: Daily Exercise No More Beneficial Than Every Other Day

    Exercising for an hour every 2 days lowered blood sugar as much as daily 30-minute workouts in a group of 30 men with type 2 diabetes, says a Reuters Health article based on a Dutch study published in Diabetes Care. 

    The men in the new study were 60 years old on average. About half of them required insulin injections to control their blood sugar. The rest managed their condition with diet and oral medication.

    The 30 men participated in 3 experiments that lasted 3 days each. In 1 of the 3 experiments, they cycled for 60 minutes on the first day and then rested the next day. In the other, they cycled for 30 minutes on 2 consecutive days. In the third, they didn't exercise at all. Throughout the experiments, they ate a standardized diet and were asked to continue with their daily level of activity.

    The researchers continuously monitored the men's blood sugar during exercise and for the next couple of days.

    When the men didn't exercise at all, they had high blood sugar 32% of the time. But when they biked, their blood sugar was in the high range only 24% of the time, no matter which schedule they followed, Reuters says.

    The 2 exercise schedules also did equally well in terms of lowering the men's average blood sugar levels.

    The authors suggest that women with type 2 diabetes are likely to reap the same benefits as the men in this study. However, the participants in the current study were relatively healthy. They didn't have heart disease and weren't extremely obese, so the results may not apply to all people with type 2 diabetes, says the article.

    New Podcast: Opportunities for PTs in ACOs

    In a recently recorded podcast, APTA member Jose Kottoor, PT, MS, provides his perspective of accountable care organizations (ACO) and their relevance to physical therapists. Kottoor addresses strategies to reduce costs by decreasing the length of stay in acute care hospitals, such as early mobility of patients, weekend therapy, evening shifts for therapies, and using telehealth. He also discusses improving outcomes and quality measures, and reducing readmissions. Kotoor wraps up his presentation by highlighting the various opportunities for physical therapists who participate in programs aimed at disease risk management, health promotion, prevention, and fitness, in addition to those that reduce repeat emergency department visits, hospital admissions and readmissions, the incidence of falls, and the need for surgery. 

    A PowerPoint presentation accompanies this podcast.

    Study Calls for Longer-term Estimates in Assessing Obesity Costs

    Cost estimates for legislative proposals to address obesity use a time period that is too short to capture the potential economic value of preventing related diseases such as diabetes and heart disease, concludes a study released Wednesday by the Campaign to End Obesity. This failure limits policymakers' ability to consider effective policies to address these costly conditions.

    The study, Assessing the Economics of Obesity and Obesity Interventions, addresses how policymakers measure the benefits of policies to address chronic diseases. The authors describe how Congressional Budget Office cost estimates, which generally cover a 10-year period, do not capture the costly complications of chronic diseases, including those associated with obesity. Because those complications often take more than 10 years to manifest themselves, the authors suggest that a 25-year budget window would be more appropriate and effective when there is strong and reliable disease modeling to inform longer-term estimates. In assessing how cost estimates are conducted, the study also examines the large and still-growing health care costs associated with obesity and catalogues an array of programs to prevent and treat it.

    Data included in the study indicate that past increases in obesity rates are responsible for $34.3 billion and $27.6 billion in additional spending in Medicare and Medicaid, respectively. Obesity also contributes to $74.6 billion in higher spending by private health insurers.

    The authors also conducted an extensive examination of peer-reviewed programs aimed at addressing or preventing obesity, including government, community, and workplace wellness programs. They found that certain interventions can be both clinically successful and cost effective. The authors say it is extremely important to use both clinical and cost-effectiveness data to inform future policy action.

    PT 2012, APTA's Annual Conference & Exposition, offers a variety of courses on wellness, including sessions on the PT's role in physical activity and fitness promotion; promoting positive behavioral change in patients and clients; and managing health, wellness, and disease reduction across a young adult to senior lifespan of their patients.

    New in the Literature: Effect of Postoperative Physical Therapy on LOS (J Arthroplasty. 2012 Mar 2. [Epub ahead of print])

    To study the isolated effect of physical therapy on total joint arthroplasty hospital length of stay (LOS), researchers from the University of Pittsburgh conducted a prospective cohort study on 136 patients with primary total joint arthroplasties (58 hips, 78 knees). LOS was determined by the operative start time until the time of discharge. On postoperative day (POD) 0, 60 patients remained in bed, 51 moved to a chair, and 25 received physical therapy (22 ambulated, 3 moved to a chair). LOS differed for patients receiving physical therapy on POD 0 (2.8 ± 0.8 days) compared with POD 1 (3.7 ± 1.8 days). There was no difference in physical therapy treatment based on nausea/vomiting, pain levels, or discharge location. Isolated physical therapy intervention on POD 0 shortened hospital LOS, regardless of the intervention performed.

    This article was published online March 2 in The Journal of Arthroplasty.

    DOD Contract Extends UnitedHealth to 'Every Part' of US Insurance Market

    The US Department of Defense (DoD) has awarded UnitedHealth, the nation’s biggest health insurer by revenue, its western military health contract valued at as much as $20.5 billion, says an article by Bloomberg. TriWest Healthcare Alliance Corp has held the contract since 2003.  

    UnitedHealth had $102 billion in revenue last year. In June 2011 it lost a separate challenge for a $23.5 billion contract for the south region, covered by Louisville, Kentucky-based Humana Inc.

    "It's a huge strategic win for them because they're not in the military space," said Ana Gupte, an analyst with Sanford C. Bernstein & Co in New York. "It just extends the reach of United into every part of health benefits in the United States."

    TriWest, Humana, and HealthNet Inc currently are the main managed care providers for Tricare, the military's health care program. The DoD contract replacing TriWest with UnitedHealth is effective April 1, 2013. The loss of the new contract essentially would erase much of TriWest's revenue stream, says Bloomberg

    The award comes after TriWest agreed to pay a $10 million fine in September to settle a federal whistleblower lawsuit. The suit, filed in US District Court in San Francisco by 4 former employees, accused the company of submitting claims to the government without including discounts negotiated with service providers.

    Registration, Abstract Submission Open for Falls Management Conference

    Registration is open for the 2012 Transforming Fall Management Practices Conference, to be held May 23‐24 in Clearwater Beach, Florida. Upon completion of this program, participants will be able to:

    • identify 3 best practices for safe patient mobility
    • evaluate technological solutions for safe patient mobility
    • successfully network with national, regional, and local experts across the settings of care
    • discuss special challenges associated with safe mobility in vulnerable populations
    • gain new insights in education, practice, administration and technology initiatives that can be transferred into current practice settings to improve patient safety

    Poster presentations for the meeting will be accepted until April 2. Abstracts should be 250 words or less and provide a brief, clear summary of the research/project/program. Content should include timely and relevant topics related to all aspects of patient safety (falls, wandering, and bed safety). Authors of selected abstracts will be notified by April 15. Submission information can be found on the Department of Veterans Affairs Web page

    APTA is a cosponsor of the conference. 

    Nominations Requested for Scientific Review Committee

    The Foundation for Physical Therapy is seeking individuals to serve on its Scientific Review Committee (SRC). Qualified physical therapist researchers will review doctoral, fellowship, and research grant applications received by the Foundation. To be considered, individuals must meet the criteria for SRC membership, posted on the Foundation's Web site. Self-nominations are welcome. E-mail your recommendations to info@foundation4pt.org.

    APTA Rehabilitation Researchers Advocate on Capitol Hill

    APTA's Section on Research hosted a fly-in March 19-20 in Washington, DC, to advocate on behalf of rehabilitation research and for increased funding for programs within the National Institutes of Health (NIH). Eleven researchers from 9 states met with staff of the Senate and House appropriations committees and their individual members of Congress. The researchers asked for funding increases for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which is the housing institute for the National Center for Medical Rehabilitation Research; the National Institute of Neurological Disorders and Stroke (NINDS); and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). In addition, they requested report language on the benefits of prioritizing rehabilitation research in the translational science research agenda. The researchers received positive feedback from committee members and individual members of Congress on the benefits of funding NIH programs.

    APTA Seeks Volunteers for MoveForwardPT.com Editorial Board

    In order to enhance the development of physical therapy-specific content for APTAs official consumer Web site, MoveForwardPT.com, APTA is seeking volunteers to participate in its new editorial board. 

    Members of the MoveForwardPT.com editorial board will help write, edit, and review content, such as the detailed symptoms and conditions guides, according to their area of expertise, and/or will help to facilitate content development and review with other physical therapist experts in the field.

    APTA is seeking applications for initial 2-year terms. Applicants must be APTA members with a PhD, DPT, or equivalent, a strong clinical background, proven writing skills, and a keen interest in developing evidence-based, consumer-friendly content.

    If interested, review the full position descriptions for editorial board members and/or the editorial board chair (position also available), and send a curriculum vitae, letter of intent, and appropriate writing samples to Katie Kissal, consumer portal specialist.

    The application deadline is April 20.

    IFOMPT Congress to Blend Evidence and Clinical Expertise

    The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) will hold its World Congress of Manual/Musculoskeletal Physiotherapy September 30-October 5 in Quebec City, Canada. Although the conference is geared toward the needs of manual physical therapists, the material that will be covered will be of interest to all physical therapists who have a special interest in orthopedics. The meeting will use the focus symposia formula. Some conference sessions will be longer and paired with workshop sessions to offer unique opportunities for the participants to share their knowledge with colleagues from other countries. Preconference and postconference courses also are available. The deadline for early bird registration is May 15. 

    Peer Mentoring Helps African American Veterans Improve Glucose Control

    Intervention by peer mentors has a statistically significant effect on improving glucose control in African American veterans with diabetes, says a Medical News Today article based on study by researchers at the University of Pennsylvania and the Philadelphia VA Center for Health Equity Research and Promotion.

    In the study, 118 African American veterans aged 50 to 70 years old with persistently poor diabetes control were randomly assigned to 3 groups—usual care, peer mentoring, and financial incentives. Patients receiving usual care were notified of their starting levels and recommended goals for HbA1c. Those in the mentor group were assigned mentors, matched by age and sex, who previously had poor glycemic control but now had good control. Mentors participated in hour-long 1-on-1 training, including motivational interviewing techniques, and were informed that they would receive $20 per month if the patient confirmed that they had spoken at least once a week. Patients in the financial incentive group were told they would earn $100 if their HbA1c dropped by 1 point and $200 if it dropped by 2 points or to a level of 6.5%.

    In the 6-month study, intervention by the peer mentors had a statistically significant effect in improving glucose control. On average, patients in the mentor group saw their HbA1c drop by approximately 1% (from 9.8 to 8.7). HbA1c levels in the financial incentive group dropped from 9.5 to 9.1, while the usual care group saw the smallest change (from 9.9 to 9.8), the article says.

    Free full text of the study is available in the March 20 issue of Annals of Internal Medicine.

    Final Rule Creates Programs to Help Avoid Adverse Selection in Exchanges

    A final rule issued Friday by the Department of Health and Human Services implements 3 programs under the Affordable Care Act to help ensure that insurance plans compete on the basis of quality and service and not on attracting the healthiest individuals.

    The new standards related to risk adjustment, reinsurance, and risk corridors will mitigate the impact of potential adverse selection and stabilize premiums in the individual and small group markets as insurance reforms and the Affordable Insurance Exchanges (Exchanges) are implemented, starting in 2014. The permanent state-based risk adjustment program provides payments to health insurance issuers that disproportionately attract high-risk populations (such as individuals with chronic conditions). The transitional state-based reinsurance program serves to reduce uncertainty by sharing risk in the individual market through making payments for high claims costs for enrollees. The temporary federally administered risk corridors program serves to protect against uncertainty in rate setting by qualified health plans sharing risk in losses and gains with the federal government. 

    Last week, HHS issued 2 other rules concerning Exchanges. A final rule issued March 12 establishes a framework to help states set up Exchanges. A final and interim rule issued March 16 sets eligibility standards for Medicaid and Children's Health Insurance Program beneficiaries within Exchanges. These rules have significant implications for patients and physical therapists regarding mandatory essential health benefits (EHB), which include the category of "rehabilitative/habilitative services," although the details of EHB will be addressed in future rule-making.

    WCPT Launches Disability and Rehabilitation Web Resource

    Check out the recently updated World Health Organization (WHO) Disability and Rehabilitation Web page on the World Confederation for Physical Therapy (WCPT) Web site. Included on the page are details and links to WHO's community-based rehabilitation guidelines, the World Report on Disability, and a joint position paper on the provision of mobility devices in less-resourced settings.

    Final and Interim Rule Ensures Access to Affordable Coverage Under Medicaid and CHIP

    A final and interim rule issued today by the Centers for Medicare and Medicaid Services (CMS) updates regulations to include the new Medicaid coverage groups created by the Affordable Care Act (ACA), simplifies eligibility policy for Medicaid and the Children's Health Insurance Program (CHIP), streamlines the eligibility and enrollment processes, and coordinates eligibility procedures with those of the Affordable Insurance Exchanges (Exchanges).

    Beginning in 2014 when Exchanges begin operation, Medicaid coverage will be extended to all individuals between ages 19 and 64 with incomes up to 133% of the federal poverty level, or $14,856 for an individual and $30,656 for a family of 4. This group is termed those "newly eligible" for Medicaid. Children will remain eligible for either Medicaid or CHIP at higher income levels based on the eligibility standards already in effect in their state. New federal matching rates will provide 100% federal funding for newly eligible individuals for 3 years (calendar years 2014-2016), gradually reduced to 90% in 2020, where it remains permanently.

    As outlined in a rule released earlier this week, Exchanges must offer essential health benefits (EHB), which include the category of "rehabilitative/habilitative services," to beneficiaries. The "newly eligible" group of Medicaid beneficiaries must receive benefits that include EHBs; however, details of this will be addressed in future rulemaking. 

    The rule provides 2 ways for Exchanges to perform Medicaid-eligibility evaluations: (1) the Exchange can determine Medicaid eligibility based on the state's Medicaid eligibility rules and also determine eligibility for advance payment of premium tax credits; or (2) the Exchange can make a preliminary Medicaid eligibility assessment and rely on the state Medicaid and CHIP agencies for a final eligibility determination.

    The rule also simplifies financial eligibility by relying on a single "Modified Adjusted Gross Income" (MAGI) standard for determining eligibility for most Medicaid and CHIP enrollees and by consolidating eligibility categories into 4 main groups—adults, children, parents, and pregnant women. People eligible under the new MAGI-based category will be promptly enrolled in Medicaid.

    In response to public comments, the rule clarifies that people with disabilities or in need of long term services and supports may enroll in an existing Medicaid eligibility category to ensure that they are quickly enrolled in coverage that best meets their needs.

    CMS issued several provision of this rule on an interim final basis and, therefore, is seeking stakeholder input on them. These include safeguarding information on applicants and beneficiaries, timeliness and performance standards for Medicaid, timeliness standards for CHIP, and coordinated eligibility and enrollment among insurance affordability programs. APTA will review this rule and post a summary to its Web site in the near future. The association also will submit comments on the interim rules as necessary.

    CMS Delays Enforcement of Version 5010 for Additional 3 Months

    The Centers for Medicare and Medicaid Services' (CMS) Office of E-Health Standards and Services (OESS) has delayed the enforcement of HIPAA Version 5010 through June 30 for covered entities that are required to comply with the updated transactions standards.

    The new standards went into effect January 1. However, in November 2011, OESS announced it would delay enforcement until the end of March to allow covered entities to complete outstanding implementation activities, including software installation, testing, and training. Although covered entities have been making steady progress, OESS has extended its enforcement discretion period for an additional 3 months.  

    During this additional delay, OESS is stepping up its existing outreach to include more technical assistance for covered entities. It also is partnering with industry groups and the Medicare fee-for-service (FFS) program and Medicaid to expand technical assistance opportunities and eliminate remaining barriers. 

    The Medicare FFS program will continue to host separate provider calls to address outstanding issues related to Medicare programs and systems. Medicare Administrative Contractors will continue to work closely with clearinghouses, billing vendors, or health care providers requiring assistance in submitting and receiving Version 5010 compliant transactions. 

    Last month, APTA launched a new Web page that 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 CMS.

    MedPAC Makes Recommendations to Increase Efficiency of Medicare

    Yesterday, the Medicare Payment Advisory Commission (MedPAC) made several payment recommendations that could affect physical therapists in private practices and those working in skilled nursing facilities (SNF) and for home health agencies (HHA).   

    In its March report, MedPAC calls on Congress to repeal the sustainable growth rate and replace it with a 10-year path of statutory fee-schedule updates. This path comprises a freeze in current payment levels for primary care and, for all other services, annual payment reductions of 5.9% for 3 years, followed by a freeze. Under the 10-year update, the Department of Health and Human Services (HHS) should increase the shared savings opportunity for physicians and other providers who join or lead 2-sided-risk accountable care organizations.

    The commission also recommends that HHS regularly collect data—including service volume and work time—from a cohort of efficient practices to establish more accurate work and practice expense values. The initial round of data collection should be completed within 3 years.

    Additionally, the report addresses the need to identify overpriced fee-schedule services and reduce their relative value units accordingly.

    In the SNF setting, MedPAC suggests that Congress eliminate the market basket update for 2013 and revise the prospective payment system (PPS). Specifically, MedPAC calls for raising SNF Medicare Part A payments for medically complex care and lowering SNF Medicare Part A payments for high-intensity therapy, with the goal of making payments more equitable across facilities. Rebasing payments should begin in 2014, with an initial reduction of 4% and subsequent reductions over an appropriate transition until Medicare's payments are better aligned with providers' costs.

    In addition, the commission proposes reducing payments to SNFs with relatively high risk-adjusted rates of rehospitalization during Medicare-covered stays to counter the financial incentive that SNFs and hospitals have to rehospitalize beneficiaries.

    To help address fraud and abuse in home health care, MedPAC calls on HHS and the Office of the Inspector General to conduct medical review activities in counties that have aberrant home health utilization. Additionally, the report urges HHS to suspend payment and the enrollment of new providers if they indicate significant fraud.

    Recommendations for HHA payment include a 2-year rebasing of home health rates in 2013 and eliminating the market basket update for 2012. Additionally, the home health case-mix system should be revised to rely on patient characteristics to set payment for therapy and nontherapy services and should no longer use the number of therapy visits as a payment factor. MedPAC also suggests establishing a per episode copay for home health episodes that are not preceded by hospitalization or post-acute care use.

    These recommendations will be considered by Congress and the Centers for Medicare and Medicaid Services for implementation into current Medicare policies. APTA will continue to work with MedPAC and the federal government to ensure that implementation is conducted in a manner that ensures access to high-quality physical therapy services and avoids undue administrative burden on providers.

    APTA Urges MedPAC to Include Stakeholders in Development of Congressional Report

    Following last week's discussion on the congressionally mandated report on outpatient therapy services at the Medicare Payment Advisory Commission (MedPAC) meeting, APTA submitted comments to the commission urging it to include APTA in the report's development to "ensure that a comprehensive and accurate assessment… is conducted that results in recommendations that ensure access to high quality therapy services for Medicare beneficiaries."

    APTA's comments also provide MedPAC with a broad description of the use of outpatient physical therapy services, noting that changes in policies often result in payment shifts from Medicare Part A to Medicare Part B and in patient shifts from one setting to another. In addition, the association comments on major systems reform, tighter coding, and improving the management of the outpatient physical therapy benefit. 

    2012 Leadership Forum: Advocate, Govern, Lead

    The first APTA Leadership Forum, which combines the APTA Board of Directors Meeting, the Leadership Symposium for New Component Presidents and Executives, and the Federal Advocacy Forum into 1 conference, offers a special opportunity to convene with APTA leadership in Washington, DC, April 20-24. This unique gathering of APTA members and leaders promises to be a closely connected 4 days of in-depth skills-building, issue updates, and grassroots advocacy. Spaces are limited and some events are by invitation only. For a complete list of activities see the Leadership Forum schedule. The Federal Advocacy Forum requires a separate registration. 

    CMS Issues Proposed Coverage Decision for TENS

    Yesterday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed decision memo on electrical nerve stimulation for chronic low back pain. APTA is analyzing the proposal and will post a summary of the memo on its Web site next week.   

    In October 2011, APTA submitted comments to CMS outlining the association's concerns with a national policy limiting local Medicare contractors' ability to assess the medical necessity of TENS. APTA included evidence in its comments to support TENS efficacy for chronic low back pain when used appropriately.

    Johnson Named to AHRQ Council

    APTA member Michael Johnson, PT, PhD, OCS, recently was named to the National Advisory Council for Healthcare Research and Quality. The Council provides advice and recommendations to the director of the Agency for Healthcare Research and Quality (AHRQ) and the secretary of the Department of Health and Human Services on priorities for a national health services research agenda. The 21-member panel comprises private-sector experts who contribute a varied perspective on the health care system and the most important questions that AHRQ's research should address in order to promote improvements in the quality, outcomes, and cost-effectiveness of clinical practice. Johnson is the only physical therapist on the panel.

    Johnson, regional director and chief clinical officer for the Home Health Practice at Bayada Home Health Care in Moorestown, New Jersey, has held numerous positions within APTA. He served as the Pennsylvania Chapter's chief delegate (2009-2011) and as a member of APTA's Government Affairs Committee (2005-2008). He is a member of the association's Workforce Consulting Group (2006-present) and PTJ's Special Feature Advisory Group (July 2009-present). He has been active in clinical and health policy-related research, resulting in the publication of multiple peer-reviewed abstracts and articles. In addition, Johnson has participated as a consultant on 2 expert work groups involved in developing quality measures for the Centers for Medicare and Medicaid Services for use under the Physician Quality Reporting System. He also is a member of the Steering Group for the Ambulatory Care Quality Alliance.

    New in the Literature: Glucocorticoid Therapy and Exercise Adherence (Support Care Cancer. 2011 Dec 28. [Epub ahead of print])

    The high acuity of patients receiving glucocorticoid (GC) therapy for acute graft vs host disease may limit their adherence to an exercise-based rehabilitation program, which can slow their recovery, say authors of an article published in Support Cancer Care.

    To test their hypothesis, researchers reviewed the medical records of 59 patients who received a hematopoietic stem cell transplant (HSCT) and who were receiving methylprednisolone (MP). They also measured patients' performance on the repeated sit-to-stand, 50-foot walk, and 6-minute walk tests before and after completing a 4-week progressive exercise rehabilitation program. Outcomes were compared by a paired t-test.

    Thirty-two patients (54%) finished a treatment plan (adherent group), completing 80% of the prescribed sessions, and were reevaluated. Twenty-seven patients (46%) did not complete the rehabilitation program (nonadherent group), primarily because of readmission to the hospital (18 patients, 62%). The adherent group did not significantly improve their physical performance. However, a subgroup of 40% of these patients did experience clinically significant improvements in their physical performance.

    Report Details Characteristics of Medical Homes

    Robust and lasting clinician-patient relationships are at the heart of every medical home, says a new report from the Commonwealth Fund that proposes 8 characteristics of the patient-centered medical home (PCMH). The report aims to provide general guidance for transforming a practice into this new model of care.  

    The broad "change concepts," as the report calls them are: engaged leadership; a quality improvement strategy; empanelment or linking patients with specific providers to ensure the continuity of the patient-provider relationship; continuous and team-based healing relationships; organized, evidence-based care; patient-centered interactions; enhanced patient access to clinical information after office hours; and care coordination.  

    For each of the 8 concepts, the authors suggested 2 to 6 specific practice modifications called key changes. For example, under organized, evidence-based care they propose that providers:

    • use planned care according to patient need
    • identify high-risk patients and ensure they receive appropriate care and case management services
    • use point-of-care reminders based on clinical guidelines
    • enable planned interactions with patients by making up-to-date information available to providers and the care team prior to the visit

    Within the descriptions of the 8 characteristics, the report illustrates how the care of patients would differ between a fully transformed PCMH and a more typical primary care practice as seen through the health care experiences of 2 fictitious sisters—Ms G and Ms H.

    PT 2012 Early Bird Registration Closes March 19

    Register by March 19 to get the best rates for PT 2012, APTA's Annual Conference & Exposition, June 6-9, in Tampa, Florida. The Annual Conference Web page has everything you need to preselect sessions, register, and book housing quickly and securely online. Belong, interact, and connect with your peers, recognized experts, and leaders for 3 days of valuable, relevant, invigorating professional development and networking.

    Summary on Collaborative Osteoarthritis Project Now Available

    State of the Science in the Prevention and Management of Osteoarthritis, the summary of a collaborative project on osteoarthritis (OA) that included experts in physical therapy, nursing, epidemiology, rheumatology, public policy, geriatrics, pharmacotherapy, and complementary modalities, is available in this month's American Journal of Nursing (AJN). 

    In July 2011, association members Carol Oatis, PT, PhD, and Maura Iversen, PT, DPT, MPH, ScD, and Anita Bemis-Dougherty, PT, DPT, MAS, of APTA's Department of Clinical Practice, represented the US Bone and Joint Initiative at a symposium hosted by AJN, the Hospital for Special Surgery, and the National Association of Orthopaedic Nurses to recommended ways in which nurses could take on greater leadership roles in research, policy, education, and clinical practice for the early diagnosis and management of OA.

    The objectives of the symposium were to:

    • Identify gaps in the science and barriers to the early identification of OA and the implementation of interventions that promote mobility, decrease pain, and slow progression.
    • Describe the state of the science of current interventions for preventing immobility and managing the effects of OA.
    • Achieve consensus on the priorities for developing the best nursing practices—in the clinical, educational, research, and policy arenas—in order to meet the needs of diverse populations with OA in a variety of settings. 
    • Disseminate the analysis and recommendations to clinicians, nurse leaders, educators, researchers, specialty nursing organizations, other health care professionals, policymakers, consumer advocacy groups, and the general public.

    Five main themes emerged from the symposium that address the burden of OA, the need for national initiatives to raise awareness of OA, assessment of  risk and progression of OA, interventions that relieve symptoms and minimize disease progression, and support for self-management as an aspect of OA treatment.  

    Final Rule Aims to Give States More Flexibility in Creating Exchanges

    Today, the US Department of Health and Human Services issued a final rule offering a framework to help states set up Affordable Insurance Exchanges (Exchanges) that meet their residents' needs by establishing standards for health insurance plans that participate in Exchanges, determinations of an individual's eligibility to enroll in Exchange health plans and in insurance affordability programs, and employer eligibility for and participation in the Small Business Health Options Program. 

    The rule also provides flexibility to states in determining how they will monitor Qualified Health Plan (QHP) networks for sufficient access to services and to ensure ongoing compliance. In the rule, the Centers for Medicare and Medicaid Services (CMS) encourages states to coordinate with state departments to identify tools and strategies to monitor QHP compliance with certification standards, including standards related to network adequacy. APTA commented extensively on this provision in the proposed rule, calling the standard "too broad" and recommending that CMS adopt 4 additional requirements to "ensure that enrollees have timely and geographically accessible care as well as access to sufficiently diverse provider types from diverse health care settings." However, in the final rule, CMS states that it is "… not prescribing specific oversight and enforcement strategies" to monitor QHPs. 

    Additionally, essential health benefits (EHB), which are mandatory and include the category of rehabilitative/habilitative services, must be offered in QHPs. This final rule provides states guidance and flexibility in implementing EHBs in the Exchanges. A separate proposed rule will be issued this year regarding EHBs.

    Today's rule combines policies from 2 Notices of Proposed Rulemaking (NPRMs) published last summer. One rule, published July 15, 2011, outlined a proposed framework to enable states to build Exchanges. A second NPRM, published August 17, 2011, outlined proposed standards for eligibility for enrollment in qualified health plans through the Exchange and insurance affordability programs, including premium tax credits.

    APTA will post a summary of the rule on its Web site shortly.

    Foundation Seeks RFAs to Examine Physical Therapy Referral

    The Foundation for Physical Therapy will soon accept applications for the special issue Request for Application (RFA) titled The Influence of Physical Therapy Referral Characteristics and Practices on Quality, Cost Effectiveness, and Utilization Patterns. Investigators with extensive experience and publication in health services research should e-mail Karen Chesbrough, MPH, scientific program administrator, to express interest in applying and request a copy of the RFA.

    MedPAC Weighs Options for Outpatient Therapy Reform

    Yesterday at the March meeting of the Medicare Payment Advisory Commission (MedPAC), APTA provided comments on the value of physical therapy, support for short- and long-term payment reform, and an update on the associations' work on the severity/intensity model.

    Among its agenda items, MedPAC discussed outpatient therapy services and the mandated report it is required to deliver to Congress by June 15, 2013, as authorized by the Middle Class Tax Relief and Job Creation Act of 2012. The law specifically charges MedPAC with creating recommendations on how to reform payment under Medicare Part B and to examine private sector initiatives as they relate to outpatient therapy services.

    In its discussion, MedPAC considered background on therapy services and providers under Medicare, current trends in spending for outpatient therapy services, and concerns about payment policies regarding therapy services—such as the variety of settings in which therapy is provided under Medicare Part B, the growth in volume of therapy services, and variances in spending by setting and region. Commissioners also voiced concern over using diagnosis as an indicator of therapy need.  

    MedPAC provided 4 options for the commissioners to consider: (1) major systems reform; (2) tighter coding (short-term reform); (3) improved management of the benefit; and (4) benefit refinement and improvement.

    APTA will work with MedPAC in the coming months as it examines ways to reform the Part B outpatient therapy benefit and prepares its recommendations to Congress.       

    Highmark Medicare Services Inc Becomes Novitas Solutions Inc

    Physical therapists in Delaware, New Jersey, Pennsylvania, Maryland, and the District of Columbia should be aware of a name change for the Part A and Part B Medicare Administrative Contractor (MAC) for Jurisdiction 12 (J12).

    In January, Diversified Service Options Inc, a wholly owned subsidiary of Blue Cross and Blue Shield of Florida Inc, acquired MAC Highmark Medicare Services (HMS) from its parent company, Highmark Inc. As a result, HMS changed its name to Novitas Solutions Inc.

    Effective March 10, Novitas Solutions will begin to migrate the current HMS Web site to the new Novitas Solutions Web site, www.novitas-solutions.com. Novitas is targeting completing the name change to all active Web page content by March 30. Although main headers throughout the Web site will be changed, some historical documents, such as Medicare reports issued under HMS, will not be changed to reflect the new name.

    For users who have bookmarked pages throughout the HMS Web site, an automatic redirect process will send page requests to the correct new Web page. The company recommends that users update the bookmark after being redirected to the new Web page. 

    2012 Federal Advocacy Forum Registration Deadline Is March 20

    Time is running out to register for APTA's 2012 Federal Advocacy Forum. Join your colleagues April 22-24 to hear from decision makers on Capitol Hill, learn to effectively communicate with elected officials, receive an update on the legislative and regulatory issues affecting the physical therapy profession, and lobby members of Congress on behalf of the profession.  

    Programming for the 2012 Federal Advocacy Forum will begin April 22. The following day will be dedicated to preparation for Capitol Hill visits. The event will conclude with participants meeting with members of Congress on April 24. 

    The number of CEUs earned for this event is pending. In order to claim CEU credit, participants must attend the live event and complete the online posttest with at least 70% accuracy. The online posttest will be available on APTA's Learning Center by April 24.

    For a full agenda and more information about this event, visit www.apta.org/FederalForum. APTA encourages members to get the word out to friends and colleagues and bring someone along to this important advocacy event.

    This year's Federal Advocacy Forum will be held in conjunction with a larger event, APTA's 2012 Leadership Forum: Advocate, Govern, Lead, 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. Contact advocacy@apta.org for questions regarding this event. 

    New in the Literature: CIMT and Cerebral Palsy (Pediatr Phys Ther. 2012;24(1):64-8.)

    In a pilot study of children with cerebral palsy, constraint-induced movement therapy (CIMT) was found to promote changes in 2 spatial temporal parameters of gait, but no changes were noted in the participants' measures on the Standardized Walking Obstacle Course (SWOC) and Pediatric Balance Scale (PBS).

    Sixteen children aged 4 to 12 years participated in a 3-week CIMT program. Participants were tested on the first and last day of the CIMT program using the SWOC, PBS, and the GAITRite Gold system (CIR Systems Inc Havertown, Pennsylvania).

    Wilcoxon signed rank tests were used on all pretests and posttests. Only the spatial temporal parameters of cadence and velocity differed significantly, with 12 children displaying a faster cadence and 10 displaying a faster velocity.

    APTA member Susan Winning, PT, coauthored this article.

    NIH Launches Genetic Testing Registry

    A new online tool from the National Institutes of Health (NIH), the Genetic Testing Registry (GTR), aims to help health care providers and researchers navigate the landscape of genetic tests.

    GTR provides a central location for voluntary submission of genetic test information by providers. In addition to basic facts, GTR offers detailed information on analytic validity, clinical validity, and how likely the test is to improve patient outcomes.

    NIH offers FAQs about the development of the registry and detailed instructions on how to use it.  

    CDC: Health Care-associated Infection Reaches All Time High

    The incidence, mortality, and medical care costs of Clostridium difficile (C. difficile), a common and sometimes fatal health care-associated infection, are all at historic highs, according to a report released yesterday by the Centers for Disease Control and Prevention (CDC). The report shows that C. difficile is not just a problem in hospitals—it is a patient safety issue in all types of medical facilities, including nursing homes, physician offices, and outpatient facilities.

    C. difficile causes diarrhea linked to 14,000 American deaths each year. Almost half of the infections occur in people younger than 65, but more than 90% of deaths occur in people 65 and older. About 25% of C. difficile infections first show symptoms in hospital patients; 75% first show in nursing home patients or in people recently cared for in physician offices and clinics.

    To help reduce the spread of C. difficile, CDC provides guidelines and tools to the health care community, including a podcast on 6 steps to prevention for clinicians, in addition to information for patients. CDC notes that hospitals that follow infection control recommendations have lowered C. difficile infection rates by 20% in less than 2 years.  

    Podcast Outlines APTA's Commitments to Joining Forces Initiative

    In January, APTA attended the launch of the Joining Forces Initiative (JFI), a national effort that partners the health care community with federal agencies to develop resources and educational materials to fully engage providers in meeting the needs of the nation's service members with traumatic brain injury, posttraumatic stress disorder, and postcombat depression. Once developed, practitioners across the country will be able to access the provider-specific information, publications, and toolkits from 1 central location. Eventually, every organization involved will seek to have its own member-specific site to disperse information that helps soldiers return to the battlefield or start their new lives.

    As part of its involvement, APTA has made 5 commitments to JFI related to educating members, including 1 commitment to partner with other therapy associations to share educational and training resources. Hear more about these commitments in this prerecorded podcast.   

    CSM 2013 to Move to San Diego, January 21-24, 2013

    In light of its unprecedented growth over the past few years, APTA's Combined Sections Meeting (CSM) will be held January 21-24, 2013, at the San Diego Convention Center. The meeting had been set for Gaylord Opryland Resort in Nashville.

    Last month's CSM in Chicago drew nearly 13,000 physical therapists, physical therapist assistants, students, and exhibitorsa more than 50% increase in attendance in the last 4 years. With record-breaking attendance year after year, it's clear that CSM is important to members. APTA has worked diligently to find a location that will allow the association to provide a positive experience for as many participants as possible. APTA is looking forward to a great CSM in San Diego for physical therapists, physical therapist assistants, students, and exhibitors.

    Watch for more details on CSM 2013 in upcoming issues of News Now.

    Longer Diabetes Duration Linked With Increased Risk of Stroke

    A new study shows that having diabetes for 10 years or more triples the risk of stroke, according to the American Heart Association. The findings emphasize the chronic nature of diabetes and the need to educate young people about the disease and how to prevent it.

    As part of the Northern Manhattan Study, researchers followed 3,298 people (average age 69) who had never had a stroke. Nearly 22% of participants had diabetes at the start of the study. After an average 9 years of follow-up, an additional 10% developed diabetes. Compared with participants without diabetes, those with the disease were at increased risk. Specifically, the authors found the risk increases 3% each year, and triples with diabetes at 10 years.

    Some of the reasons for increased stroke risk may include an association between longer diabetes duration and thicker plaque in neck arteries and the higher prevalence of hypertension, accelerated vascular complications, and clotting abnormalities in people with diabetes.

    The onset of diabetes may be 4 to 7 years earlier than diagnosis, the authors say. Among the nearly 26 million Americans with diabetes, more than half are younger than 65, and the age of diagnosis is "getting younger and younger because of the obesity problem among young people."

    "If how long a person has diabetes matters, young people with a long history of diabetes are more likely to develop complications earlier in life," says Mitchell S. V. Elkind, MD, MS, the study's senior author. "It's possible that people with diabetes may start having strokes at a younger age."

    Full text of the study is published online ahead of print in Stroke.

    APTA offers members physical fitness pocket guides for survivors of stroke and people with type 2 diabetes.

    Recognizing Brain Injury Awareness Month

    During March, in recognition of Brain Injury Awareness Month, the Centers for Disease Control and Prevention (CDC) is spreading the word and raising awareness about traumatic brain injury (TBI) prevention, recognition, and response. A new CDC Web page brings together a variety of TBI resources, including the "Heads Up" concussion initiative aimed at health care professionals, school professionals, sports coaches, parents, athletes, and others. 

    APTA's TBI resources, related to the management of mild TBI (mTBI) for wounded warriors, are valuable for physical therapists (PTs) in the Department of Defense, Department of Veterans Affairs, or in community-based practices treating wounded warriors who are returning home; family members/caregivers of wounded warriors with mTBI; and wounded warriors who have sustained mTBI.

    For information on federal and state legislation, and APTA's position on the role of physical therapists in concussion management, visit APTA's Concussion Web page. Also, PTs can direct patients to the Physical Therapist's Guide to Concussion, located on APTA's Move Forward consumer Web site. 

    March PTJ: An 'Outstanding Issue'

    This month's PTJ includes a study that will "create a lot controversy," a "really fun paper," and an article that will "make a lot of people pleased"—among many other thoughtful research reports. Find out more from PTJ Editor in Chief Rebecca Craik, PT, PhD, FAPTA, in the March Craikcast.   

    APTA Summary: Proposed Rule on Returning Overpayments

    APTA's summary of a proposed rule requiring physical therapists and other health care providers to report and return overpayments from Medicare and Medicaid within 60 days provides members with the proposal's definition of "overpayment," the process of reporting overpayments, and examples of what steps should be taken when an overpayment is identified. In addition, the summary addresses enforcement implications, which include liability under the False Claims Act, and the 10-year lookback period.

    Comments for this proposed rule are due before 5 pm April 16. APTA will submit comments on behalf of membership.

    Look for this document on APTA's Compliance Web page under Overpayments.