of a report published March 22 in the Morbidity
and Mortality Weekly Report say that just over 11% of US adults with
prediabetes were told during 2009-2010 that they have the condition. The report
also indicates awareness of prediabetes was low (<14%) across all population
subgroups and different levels of health care access or use and other factors.
report is based on the
National Health and Nutrition Examination Survey (NHANES), an ongoing,
stratified, multistage probability sample of the noninstitutionalized US
civilian population. This analysis was conducted using data from 3 sampling
cycles of NHANES, with examination response rates of approximately 77% for 2005-2006,
75% for 2007-2008, and 77% for 2009-2010.
During 2005-2010, the percentage of
persons aged ≥20 years with prediabetes who were aware of their prediabetes
remained low but was slightly higher during 2009-2010 (11.1%) than during 2005-2006
(7.7) During 2005-2010, prevalence of prediabetes awareness was lower among those
aged 20-44 years (5.1%) compared with
persons aged 45-64 years (10.0%) and those aged ≥65 years (11.95). Age-adjusted
prevalence of prediabetes awareness was lower among persons with less than a
high school education (4.9%) compared with those with greater than a high
school education (8.7%). Prevalence was higher among overweight (7.9%) and
obese (9.9%) individuals compared with those of normal weight (4.3%). Also, it
was higher among those with a family history of diabetes compared with those
without (10.4% vs 6.2%).
the vast majority of people with prediabetes are unaware of their condition,
identification and improved awareness of prediabetes are critical first steps
to encourage them to make healthy lifestyle changes or to enroll in
evidence-based, lifestyle-change programs aimed at preventing type 2 diabetes,
say the authors.
his 2012 McMillan Lecture, Alan Jette, PT, PhD, challenged physical therapy
professionals to ‘Face Into the Storm’ and boldly tackle the challenges of the
new century. These challenges include a health care system that is increasingly
data driven, and where reimbursement is tied to coordination of care and
performance. To meet these challenges, physical therapists must develop
critical systems skills to collect and examine clinical data to determine what
works for which conditions, for which patients and in different settings in
order to improve clinical practice and meet reimbursement requirements.
A 1-day conference on June 7 in
Boston, cosponsored by APTA and Boston University’s Health & Disability
Research Institute, focuses on the need to develop systems skills as a critical
component of physical therapy practice. The conference agenda includes a
combination of key didactic presentations, case examples of innovative
programs, and opportunities for discussion among attendees.
target audience for the conference includes innovators seeking to advance the
development of systems skills in physical therapy practice.
Register today to attend
"Face Into the Storm: Gaining the System Skills Needed to Succeed in the
Changing Healthcare Environment." If you are unable to travel to Boston, register for the virtual
The Otago Exercise Program: Training for Physical Therapists is an online course that aims to train physical therapists
to integrate the Otago Exercise Program as part of their practice. It is
intended to be used in combination with the Otago Exercise Program Manual
available as an attachment in this course.
The Centers for Disease Control and
Prevention was a key stakeholder whose efforts led to the development of the
program manual and this online training format. APTA member Terry Shea, PT, GCS, NCS, has led the effort to translate Otago for use in the United
States. She was instrumental in providing content and expertise for creating
this online manual and training.
"Fall Risk in Community-Dwelling Elders," a clinical summary in PTNow authored by APTA
member Tiffany Shubert, PT, PhD, cites the Otago Exercise Program and links to
the program's manual. APTA members also can find a reference to the Otago
Exercise Program in PTNow's clinical case on a 70-year-old
woman who was referred to a physical therapist for her knee pain and expresses
concern about falling. PTNow, APTA's clinician website portal developed in
collaboration with sections, moved out of beta in January.
course is approximately 3 hours and can be started and stopped at the user's
convenience. The cost is $25. Completers get 3 contact hours.
Don't miss out on the
opportunity to meet with large, small, regional, and national employers at APTA's live,
online Virtual Career Fair, to be held April 9, 1:00 pm-4:00 pm ET. This
first-ever online event is a great way for you to engage directly with
employers about their current and future physical therapy career opportunities.
Participate in the Virtual Career Fair
for as long as you wish, chatting 1-on-1 with recruiters to discuss your
background and experience, and their current and future needs for physical
Space is limited for this event, so register today.
physical therapists still may not be aware of the payment cuts that go into
effect April 1. In a recent blog post, APTA President
Paul A. Rockar Jr, PT, DPT, MS, urges physical therapists to review information
at APTA.org and share it with colleagues to prepare for these reductions.
APTA's 2013 Medicare Changes webpage
provides the information that physical therapists need to know about the
increase in the multiple procedure payment reduction (MPPR), and independent of
the MPPR, the Medicare sequestration cuts.
is conducting a workshop to support
sections in the development of evidence-based documents such as clinical
practice guidelines (CPGs) and clinical practice appraisals (CPAs). Sections are asked to nominate members who are
interested in working to develop CPGs/CPAs in their area of clinical practice.
Individual members who are interested in attending the workshop should ask
their section leadership to nominate them. The workshop will be held July
24-26, 2013, at APTA headquarters. Nominations must be received by noon,
Friday, April 26, 2013. Contact Sarah Miller at firstname.lastname@example.org if you have
The 2013 County Health Rankings
allow counties to see what medical and social conditions and behaviors are
making its residents sick or healthy, and how they compare to other counties in
the same state. This is the fourth year of the Rankings, published online by the Robert Wood Johnson
Foundation and the University of Wisconsin Population Health Institute. The
rankings data help to lay the groundwork for health improvement efforts of
governors, mayors, business leaders, and citizens across the country.
The County Health Rankings examines 25 factors that influence health,
including rates of childhood poverty, rates of smoking, obesity levels, teen
birth rates, access to physicians and dentists, rates of high school graduation
and college attendance, access to healthy foods, levels of physical inactivity,
and percentages of children living in single parent households.
Although the rankings only allow for county-to-county comparisons within
a state, this year’s rankings show significant new national trends:
the National Council on Aging's (NCOA) free webinar on April 11 to
learn how you can have an impact on falls prevention by changing policy in your
state or community. Discover policy goals, discuss strategies for making them a
reality, get resources, and listen as select states share their successes.
access NCOA's State Policy Toolkit for Advancing Fall Prevention, and other
patient care resources, go to APTA's Balance and Falls webpage.
reported last week in News Now, 2 APTA members recently participated
in the Patient-Centered Outcomes Research Institute's (PCORI) Preventing
Injuries From Falls in the Elderly work group meeting held in Washington, DC.
More information and presentation slides from the meeting can be found on PCORI's website.
progressive resistance strength training (HIPRST) improves lower limb strength
more than lesser training intensities in older adults, although it may not be
required to improve functional performance, say authors of a systematic review published this
month in Archives of Physical Medicine
and Rehabilitation. They note that training volume also is an important
variable, and HIPRST appears to be a safe mode of exercise in this population.
this systematic review, the authors searched online databases from their
inception to July 2012. Randomized controlled trials of HIPRST of the lower
limb compared with other intensities of PRST in older people (mean age ≥ 65
years) were identified. Two reviewers independently completed quality
assessment using the PEDro Scale and data extraction using a prepared
authors included 21 trials. Study quality was fair to moderate (PEDro Scale
range 3 to 7). Studies had small sample sizes (18 to 84) and participants were
generally healthy. Meta-analyses revealed HIPRST improved lower limb strength
greater than moderate- and low-intensity PRST, SMD 0.79 and 0.83, respectively.
Studies where groups performed equivalent training volumes resulted in similar
improvements in leg strength, regardless of training intensity. Similar
improvements were found across intensities for functional performance and disability.
The effect of intensity of PRST on mood was inconsistent across studies.
Adverse events were poorly reported; however, no correlation was found between
training intensity and severity of adverse event.
authors call for further research into HIPRST's effects in older people with
chronic health conditions across the care continuum.
you currently primarily see patients with arthritis in your practice and would
like to be included in a formative research project, contact Anita Bemis-Dougherty, PT, DPT, MAS, APTA department
of clinical practice, by Monday, April 1. You will be asked to complete a 20-minute
phone interview with Westat, a research company, to understand physical
therapists' (PTs) current knowledge, attitudes, and recommendation practices
related to arthritis community-based physical activity/self-management
education (PA/SME) programs, and to
explore communication preferences for learning about these programs.
is working with the National Association of Chronic Disease Directors (NACDD)
and the Centers for Disease Control and Prevention (CDC) to inform a strategy
to increase PT recommendations to PA/SME interventions for patients with
arthritis. To do this, NACDD is working with Westat to develop a marketing
strategy and arthritis educational materials to assist PTs in recommending
evidence-based community arthritis PA/SME interventions to their patients with
arthritis when indicated.
will conduct the primary research with the following objectives: (1) assess PTs'
awareness of and attitudes toward community-based interventions, (2) identify
messages that motivate PTs to recommend interventions to their patients, (3)
identify preferences about the form of the communications and additional
resources needed, (4) identify how to disseminate messages to PTs, and (5)
develop recommendations for marketing strategy and materials.
you have any questions, contact email@example.com.
of an article
published this month in Annals of
Internal Medicine report that many subspecialists are unable to accommodate
patients who use wheelchairs.
enrolled 256 subspecialty medical practices in 5 large US cities (Atlanta;
Dallas; Houston; Portland, Oregon; and Boston) in the study. The practices were
assigned to 1 of 2 groups: those where transfer from a wheelchair to an
examination table is required for adequate care (endocrinology, gynecology,
orthopedic surgery, rheumatology, and urology) and those where transfer might
not be necessary (otolaryngology, ophthalmology, and psychiatry).
researchers called practices and tried to make an appointment for a fictional
patient who was obese (99 kg) and was partially paralyzed on 1 side of the
body. The patient used a wheelchair and was unable to self-transfer from the
chair to an examination table. The patient could not bring a family member to
assist with transfer.
of the practices that would have to transfer the patient to provide adequate care
were accessible than those that might not have to transfer the patient to
provide adequate care (95% vs 74%). In all, 56 practices (22%) could not
accommodate the patient. Nine of these practices said that their buildings were
inaccessible, and 47 said that they could not transfer the patient to an
examination table. The practices gave different reasons for inability to
transfer the patient, including a lack of staff who could perform the transfer
(37 practices), a concern about liability (5 practices), and that the "patient
was too heavy" (5 practices).
the 160 practices in the group that required transfer for adequate care, 22
(9%) reported using special equipment for transfer, such as height-adjustable
examination tables and mechanical lifts. Another 88 (55%) planned to transfer
the patient from the wheelchair to a high table that was not height-adjustable
without using a lift. Gynecology had the highest rate of inaccessible practices
authors call for improved awareness about the Americans
with Disabilities Act requirements and the standards of care for patients with
Voting for APTA's "Fit After 50 Member Challenge" winner is in full swing! The top 10 featured
finalists were nominated for their commitment to being fit, active, and mobile
at age 50+. Read their stories and vote for
the member who you feel is most active and fit and who inspires others
to be the same. The winner should also have served the 50+ community and
promoted the role of the physical therapist. Encourage your friends, family,
community, and colleagues also to vote. Voting is open until April 5. The
top 3 winners will receive prizes from APTA and recognition at the APTA
Conference and Exposition in June.
should look for an e-mail from APTA today explaining 2 critical changes that
will affect the physical therapy profession on April 1. APTA has been
developing resources to help you prepare for the policies that will be
implemented on April 1, so it's imperative that you read the message and review the online information available from the links.
US Food and Drug Administration recently issued a proposed order
aimed at helping manufacturers improve the quality and reliability of automated
external defibrillators (AEDs). The proposed order, if finalized, will require
manufacturers of AEDs to submit premarket approval (PMA) applications that contain clinical data to support the product's
these devices have saved lives over the years, the FDA has received
approximately 45,000 adverse event reports between 2005 and 2012 associated
with the failure of AEDs. Manufacturers also have conducted dozens of recalls.
FDA says the problems it is seeing are "preventable and correctable."
The most common issues involve the design and manufacture of the devices and
inadequate control of components purchased from other suppliers.
addition to the clinical safety and effectiveness data, a PMA must also include
a review of a manufacturer's quality systems information and an inspection of
its manufacturing facilities. After approval, manufacturers must submit to the
FDA any significant manufacturing changes made to the devices and annual
reports of the device’s performance.
For information on APTA's position on
cardiopulmonary resuscitation certification and use of AEDs, and acquiring an
AED for a physical therapy practice, click here.
International Organisation of Physical Therapists in Paediatrics (IOPTP) has
posted information on clinical and administrative guidelines at the World
Confederation for Physical Therapy's (WCPT) website at www.wcpt.org/ioptp/resources.
began collecting information from its member organizations following round
table sessions held at WCPT's 2011 congress in which attendees requested that
IOPTP provide information about guidelines (practice and administrative) and
fact sheets for health care professionals and consumers. IOPTP will add new
information as additional guidelines and fact sheets are identified by its
other WCPT news, physical therapists from around the
world heard about the impact that WCPT education policies are having on the
development of the profession at the European Physiotherapy Education Congress,
held in Vienna, Austria, in November.
The congress attracted 587 delegates from 48 countries. The theme, "Advancing
the Professional Profile," focused on continuing professional development
as a means of promoting evidence based physical therapy. Speakers examined
innovative ways in which to continue professional development throughout a
career in physical therapy.
CMS announced last evening that as of April 1, recovery audit contractors (RACs) will conduct manual medical review (MMR) of outpatient therapy services, including physical therapy, for outpatient therapy claims that exceed $3,700.
In the additional guidance on MMR released last night, CMS said that RACS will complete 2 types of review for claims processed on or after April 1, 2013—prepayment review for states within the Recovery Audit Prepayment Review Demonstration, and immediate postpayment review for the remaining states.
APTA is gathering additional information regarding this MMR policy to further inform members. In addition, APTA will meet with CMS officials and Congress to address concerns about the challenges this process will present for both providers and patients. For continued updates on this and other changes to Medicare policy occurring this year, visit APTA's 2013 Medicare Changes website.
The New England Journal of Medicine (NEJM) study showing that physical therapy is just as effective as surgery in patients with meniscal tears and osteoarthritis (OA) of the knee "should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis," APTA President Paul A. Rockar Jr, PT, DPT, MS, said in response to the study. "Surgery may not always be the best first course of action," Rockar stated. "A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery."
An APTA press release quotes APTA member Clare Safran-Norton, PT, PhD, OCS, lead physical therapist in the study, who said their findings "suggest that a course of physical therapy in this patient population may be a good first choice … These findings should help surgeons, physicians, physical therapists, and patients in decision-making regarding their treatment options."
The Meniscal Tear in Osteoarthritis Research (METEOR) trial, widely publicized after appearing in NEJM this week, showed no significant differences in functional improvement after 6-12 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone.
APTA applauds the passage of new legislation on March 14 that has made Arkansas the third US state to limit patient copays and other forms of cost sharing for services provided by physical therapists. Senate Bill 277, which was heavily promoted by the Arkansas Physical Therapy Association (ArPTA), APTA's chapter in that state, was signed into law by Gov Mike Beebe. As a result, patients will now pay less out of their own pockets when they visit a physical therapist, resulting in improved access to vital health care.
Legislation introduced this week in Congress would authorize physical therapists to participate in the National Health Service Corps (NHSC) Loan Repayment Program and add for the first time to the Corps a component to provide for rehabilitative care. The Physical Therapist Workforce and Patient Access Act of 2013 was introduced as HR 1252 by Reps John Shimkus (R-IL) and Diana DeGette (D-CO); S602 was introduced by Sens Jon Tester (D-MT) and Roger Wicker (R-MS). NHSC serves as a lifeline to millions of patients living in rural and underserved communities, and inclusion of physical therapists in the loan repayment program is one of APTA's public policy priorities.
Physical therapists who submit Medicare Part B claims without proper functional limitation data, for services provided on or after January 1, 2013, soon will get feedback from the Centers for Medicare and Medicaid Services (CMS) reminding them of the new functional limitation reporting requirements. For claims processed April 1 through June 30, 2013, CMS will send Remittance Advice messages to providers whose claims lack the required data, alerting them to include the applicable G-codes and appropriate severity/complexity modifier on future specified claims.
Providers who bill certain CPT evaluation/reevaluation codes (the affected codes are: 92506, 92597, 92607, 92608, 92610, 92611, 92612, 92614, 92616, 96105, 96125, 97001, 97002, 97003, and 97004) and fail to submit functional limitation data will receive a remittance advice code of N566. Providers who bill the affected CPT codes and submit functional limitation codes (G8978-G8999, G9158-G9176, and G9186) without a severity modifier (CH-CN) will receive a remittance advice code of N565.
CMS published this information in transmittal RT1196OTN and in a Medicare Learning Network article.
CMS was mandated to collect information on claim forms regarding beneficiaries' function and condition, therapy services furnished, and outcomes achieved on patient function by the Middle Class Tax Relief Act of 2012. As of January 1, 2013, all practice settings that provide outpatient therapy services must include the functional limitation data on the claim form. To ensure a smooth transition, CMS set forth a testing period January 1 to July 1. After July 1, claims submitted without the appropriate G-codes and modifiers will be returned unpaid.
APTA has additional details and resources on these new requirements under its Medicare webpage.
In recognition of World Down Syndrome Day, today MoveForwardPT.com, APTA's official consumer information website, hosted an online radio show about the role of physical therapy in the development of people with Down syndrome.
In the episode, which was a Blog Talk Radio "Staff Pick" for March 21, APTA member Venita Lovelace-Chandler, PT, PhD, PCS, discusses how physical therapists help children with Down syndrome develop gross motor skills to achieve important physical developmental milestones that also benefit the child's social and cognitive maturation. She also provides tips for parents.
APTA issued a press release about the show and also promoted MoveForwardPT.com's Physical Therapist's Guide to Down Syndrome via social media.
Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com and can be streamed online via Blog Talk Radio or downloaded as a podcast via iTunes.
Previous episodes have covered conditions ranging from concussion to osteoporosis and explored settings ranging from aquatic physical therapy to physical therapy in the performing arts.
APTA members are encouraged to alert their patients to this series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be e-mailed to firstname.lastname@example.org.
Attend APTA's first-ever online Virtual Career Fair on Tuesday, April 9, 1:00 pm-4:00 pm, ET. This live, online event is a great way for you to engage directly with employers about their current and future physical therapy opportunities.
Participate in the Virtual Career Fair for as long as you wish, chatting 1-on-1 with recruiters to discuss your background and experience, and their current and future career opportunities.
Space is limited, so register now.
APTA's public policy priorities for 2013-2014 were posted this week on APTA's website for members and public audiences, representing issues to which APTA will direct its efforts in the 113th Congress and federal agencies. Initially adopted by the Board of Directors in November 2012, the priority list has been adjusted to reflect implications of the fiscal cliff legislation and sequestration, such as the multiple procedural payment reduction (MPPR) and a Blue-Ribbon Commission report on the future of rehabilitation research at the National Institutes of Health.
Every 2 years, APTA, through its Public Policy and Advocacy Committee, develops public policy priorities by gathering extensive member feedback on the issues that matter to your practice and patients. The committee will continue to update and revise the priorities as challenges and opportunities emerge over the next 2 years.
This list does not include all issues for which the association is advocating to advance physical therapy practice, education, and research; however, these issues were identified as priorities by members, confirmed by APTA leaders, and implemented by APTA staff. As these issues become active in Congress or federal agencies, APTA will communicate with and activate its membership to ensure physical therapy is best represented. To stay informed, join APTA's grassroots network, PTeam.
Also consider coming to Washington, DC, to educate and lobby your member of Congress on these priorities, including the immediate challenges facing physical therapist payment under Medicare, such as the therapy caps, MPPR, and impact of the sequester cuts. Join your engaged colleagues at the annual Federal Advocacy Forum, April 14-16. Learn more and register.
For the second time in 6 months, Medicare has erred in calculating hospital readmission penalties for more than 1,000 of the nation's hospitals, says a Kaiser Health News article.
As a result, Medicare has slightly lessened its readmissions penalties for 1,246 hospitals as part of its Hospital Readmissions Reduction Program. The penalty imposed on St Claire Regional Medical Center in Morehead, Kentucky, will drop the most, from 0.93% to 0.72% of every payment Medicare makes for a patient during the fiscal year that ends in September.
Medicare also modestly increased the penalties for 226 hospitals. LaSalle General Hospital in Jena, Louisiana, will see its penalty grow by the greatest percentage. LaSalle will lose 0.84% of each Medicare payment per patient, instead of the 0.65% reduction Medicare previously announced.
The payment changes for most hospitals were small, averaging .03% of each reimbursement. Overall, hospitals will pay $10 million less in penalties than previously calculated, for a total of $280 million this year. The changes are retroactive to October 2012, when the program began.
The readmission program, created by the Afforadable Care Act, is looking at the number of patients with heart attack, heart failure, and pneumonia who return to the hospital within 30 days of discharge. Hospitals with more readmissions than Medicare expected given their mix of patients are penalized by losing up to 1% of their regular payments. The maximum penalty ramps up to 2% starting this October and grows to 3% in 2014.
Medicare originally released the penalties last August, but then revised them at the end of September after determining that it had left some patients out of its calculations. That change increased penalties for 1,422 hospitals and decreased them for 55 others.
This second correction brings many hospitals closer to where they originally were, says Kaiser. More than 320 hospitals that had their penalties altered in September now will have their initial penalties restored.
Physical therapists can help serve an important role in patient care transitions and care coordination and can help reduce readmissions by providing recommendations for the most appropriate level of care to the health care team prior to and during care transitions. For more information and to find clinical practice and patient education resources to reduce readmissions, visit APTA's Hospital Readmissions webpage.
There were no significant differences in functional improvement after 6 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone, say authors of an article published in the New England Journal of Medicine.
The multicenter, randomized, controlled trial involved 351 symptomatic patients aged 45 years or older with a meniscal tear and evidence of mild-to-moderate osteoarthritis. Subjects randomly were assigned either to surgery and postoperative physical therapy or to a standardized physical therapy regimen (with the option to cross over to surgery at the discretion of the patient and surgeon). Patients were evaluated at 6 and 12 months, primarily using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical-function score (ranging from 0 to 100, with higher scores indicating more severe symptoms) 6 months after randomization.
In the intention-to-treat analysis, the mean improvement in the WOMAC score after 6 months was 20.9 points (95% confidence interval [CI], 17.9 to 23.9) in the surgical group and 18.5% (95% CI, 15.6 to 21.5) in the physical therapy group (mean difference 2.4 points, 95% CI, -1.8 to 6.5). At 6 months, 51 active participants in the physical therapy alone group (30%) had crossed over to undergo surgery, and 9 patients in the surgery group (6%) had not undergone surgery. The results at 12 months were similar to those at 6 months, say the authors, and the frequency of adverse events did not differ significantly between the groups.
The authors say their findings suggest that both options are "likely to result in considerable improvement … over a 6-12 month period." However, they continue that "these data provide considerable reassurance regarding an initial nonoperative strategy."
As states work to implement the Affordable Care Act (ACA) and improve Medicaid and CHIP for current beneficiaries, the Medicaid and CHIP Payment and Access Commission (MACPAC) made 2 recommendations Friday to Congress on eligibility policy.
MACPAC's March 2013 Report to the Congress on Medicaid and CHIP reflects the key priorities facing program administrators: implementing Medicaid eligibility provisions; managing the policy and operational interactions among Medicaid, CHIP, and coverage through new health insurance exchanges; and pursuing delivery system and payment innovations for individuals dually enrolled in Medicare and Medicaid, who are among the highest need and highest cost enrollees in both programs.
In its report, the commission recommends that Congress create a statutory option for states to implement 12-month continuous eligibility for children enrolled in CHIP and adults enrolled in Medicaid, as is now the case for children in Medicaid. This recommendation is designed to reduce frequent enrolling and disenrolling from different health plans in a short period and decrease the administrative burden of the eligibility determination process. It would enable states to enroll eligible individuals for a full year, regardless of changes in income. The commission is making the recommendation to ensure that the option, which would otherwise be removed under new income-counting eligibility standards, remains available to states.
The second recommendation calls for Congress to permanently fund transitional medical assistance (TMA), which provides additional months of Medicaid coverage to millions of families who might otherwise become ineligible and uninsured due to an increase in earnings. MACPAC's recommendation would allow states that expand Medicaid to the new adult group to opt out of TMA. If the recommendation were implemented, it would provide certainty that funding will be available for states that choose not to expand eligibility, and it would reduce administrative burden for states that do expand.
The report also continues the commission's work on people who are dually eligible for Medicare and Medicaid. This group is of great interest to Congress because of the complexity and cost of the health care needs of "dual eligibles."
An executive summary of the report is available at this link.
Take advantage of the March Madness Spring Sale Event going on in the APTA Marketplace. Choose from a wide variety of logo apparel and specialty items for a fraction of the price! Shop now for the best selection of colors and sizes at www.apta.org/Marketplace.
Healthy People 2020 will hold a webinar on Thursday, March 21, noon ET, highlighting the success of 1 community-wide partnership in reducing childhood obesity through community outreach, advocacy, education, policy development, and environmental change. US Department of Health and Human Services Assistant Secretary for Health, Howard Koh, MD, MPH, will lead the 45-minute webinar, which will include a roundtable discussion on the impact of this critical leading health indicator topic.
Register here for this event.
Last week, 2 APTA members participated in the Patient-Centered Outcomes Research Institute's (PCORI) Preventing Injuries From Falls in the Elderly work group meeting held in Washington, DC. Bonita (Lynn) Beattie, PT, MPT, MHA, vice president of injury prevention, National Council on Aging, and Steven Wolf, PT, PhD, FAPTA, FAHA, professor, departments of rehab medicine and medicine, Emory University School of Medicine, are part of a 14-member diverse work group that includes perspectives of researchers, patients, and other stakeholders.
Beattie presented in a session on patient and stakeholder perspectives on information gaps. Wolf spoke during the researcher presentations. The work group also discussed proposed research topics, refinement of research questions to be addressed, and next steps.
More information and presentation slides from the meeting can be found on PCORI's website. PCORI is accepting comments and questions through March 26, and the group will consider input as it develops targeted funding announcements to address falls prevention.
PCORI aims to help people make informed health care decisions and improve health care delivery and outcomes by producing and promoting high-integrity, evidence-based information that comes from research guided by patients, caregivers, and the broader health care community.
new message from APTA President Paul A. Rockar Jr, PT, DPT, MS, and Steve
Levine, PT, DPT, MSHA, chair of the Alternative Payment System Task Force,
provides an update on the alternative payment system
(APS), now known as the physical therapy classification and payment system
(PTCPS), for outpatient physical therapy services. In their message, Rockar and
Levine outline the progression of the proposed payment model and the need for a
comprehensive plan "to maximize the opportunity for successful transition
to a physical therapy classification and payment system."
addition to the message, APTA members can access an executive summary and a
full report of the survey results that were used to refine the first APS
developmental draft, which was sent in spring 2012 to association members for
comment. The second developmental draft of the APS/PTCPS will be available to
expects to transition to a new outpatient therapy payment system by January 1, 2015.
Jump start your spring job search
by attending APTA's first-ever Virtual Career Fair on Tuesday, April 9, 1:00
pm-4:00 pm ET. This live, online event is a great way for you to engage
directly with employers about their current and future physical therapy
Participate in the Virtual Career
Fair for as long as you wish, chatting 1-on-1 with recruiters to discuss your
background and experience, and their current and future career opportunities.
Looking for employment in northern
Virginia? Representatives from Inova Health System will be ready to answer your questions. If you want to go
further south, talk to recruiters from Drayer Physical Therapy Institute about openings in Georgia and Alabama. Check out last week's News Now article highlighting
national employers and those with sites in the Northwest.
Space is limited, so register today.
APTA has commissioned a survey to a
random sampling of members, asking for feedback on the association's member
communications. The simple, 10-minute survey, sent from Stratton Publishing,
will help APTA as it continues to develop and refine communication vehicles of
the greatest value to you.
If you received the survey or the
follow-up reminder, please take a few moments to respond, and you will be
included in a drawing for an iPad Mini!
Contact Lois Douthitt with any questions about
inaugural Innovation Summit on March 8—a groundbreaking event that brought together
physical therapists, other health care providers, large health systems, and
policy makers to discuss the current and future role of physical therapy in
integrated models of care—was viewed by more than 1,000 virtual attendees. The
virtual attendees participated in the event via a web portal with a virtual
lobby and exhibit hall; innovative panels and speakers were livestreamed in a
virtual auditorium. More than 40 viewing parties, held primarily at
universities and health care facilities, watched the event. Further, the
Innovation Summit generated significant social media buzz, with 1,099 tweets
posted using the #PTSummit hashtag.
attendance was by invitation only. The 150 onsite attendees included 17 APTA
physical therapist innovators who were nominated by APTA chapters and sections
to attend the event.
Summit: Collaborative Care Models was APTA's first interactive virtual event.
With strong attendance, engagement from both the onsite and virtual audiences,
and robust discussions from the summit panels, APTA believes the summit will
further the role of physical therapy in innovative models appearing across the
of the summit are available at www.apta.org/InnovationSummit/.
Foundation's annual Gala will take place on Thursday, June 27, at the Hilton
Salt Lake City Center during APTA's Conference & Exposition. The program will include recognition of the Foundation's
2013 service award recipients and a special tribute to past trustees of the
Foundation's Board of Directors. The evening also will include a special
celebration of the 25th anniversary of the Marquette Challenge.
Tickets now are available
at the following prices: individual tickets ($150), student tickets ($100).
Table sponsorships are available for $2,000 each and include 10 individual Gala
tickets. Tables can be purchased through J. Spargo or by
contacting Erica Sadiq for additional
total costs of diagnosed diabetes have risen to $245 billion in 2012 from $174
billion in 2007, when the cost was last examined, says the American Diabetes Association.
This figure represents a 41% increase over a 5-year period.
study, Economic Costs of Diabetes in the US in 2012, includes direct medical costs of $176 billion, which
reflects costs for hospital and emergency care, office visits, and medications;
and indirect medical costs totaling $69 billion. Indirect costs include
absenteeism, reduced productivity, unemployment caused by diabetes-related
disability, and lost productivity due to early mortality.
In addition, the study found that:
The research also examined costs along gender, racial and
ethnic lines, and included state-by-state data. Key findings include:
study will be published in the upcoming April issue of Diabetes Care.
In 2011 and 2012, a CSM Review Work Group evaluated roles,
responsibilities, and decision-making authority for the development of the
Combined Sections Meeting (CSM). Out of that work emerged a recommendation for
a CSM Steering Group to provide high-level oversight and guide innovation of
the meeting. A 13-member CSM Steering Group has been established, with the
initial 10 members selected from the original work group. This call is to
identify 3 at-large members to complete the new CSM Steering Group. For more
information on the CSM Steering Group, contact Dena Kilgore.
The deadline for this call is April 1.
Interested APTA 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 submitting the
profile, to be considered for current volunteer opportunities, members must
then access the "current opportunities for service page," select "CSM
Steering Group," and respond to the questions specific to the group.
month's PTJ includesarticles on a broad variety of topics
that have immediate clinical relevance, such as "People With Stroke Who
Fail an Obstacle Crossing Task Have a Higher Incidence of Falls and Utilize
Different Gait Patterns Compared With People Who Pass the Task" and
"The STarT Back Screening Tool and Individual Psychological Measures:
Evaluation of Prognostic Capabilities for Low Back Pain Clinical Outcomes in
Outpatient Physical Therapy Settings." Hear Editor in Chief Rebecca Craik,
PT, PhD, FAPTA, summarize these and other articles in the March Craikcast.
APTA participated in the Brain Injury Awareness Fair as part of the 12th annual
Brain Injury Awareness Day on Capitol Hill. These events aim to educate members
of Congress and their staff on the full range of effects of traumatic brain
injury (TBI), the challenges and recoveries of people living with brain injury,
and the services and supports that are available to them.
Bill Pascrell Jr (D-NJ) and Thomas J. Rooney (R-FL), cochairs of the
Congressional Brain Injury Task Force, held a press conference to announce
legislation advancing the treatment and prevention of TBIs.
afternoon panel discussion titled "Promoting Brain Injury Awareness
through Public/Private Partnerships" featured COL Jamie B.Grimes,
MD, MC, national director, Defense and Veterans Brain Injury Center;
Sara Patterson, associate director of policy, Centers for Disease Control and
Prevention; Katie Clarke Adamson, director of health
partnerships and policy, YMCA of America; Jeff Miller, chief security
officer, National Football League;
Roland Gerritsen van der Hoop, chief medical officer, BHR Pharma,
and Ralph Ibson, national policy
director, Wounded Warrior Project.
Check out APTA's TBI webpage for advocacy and education resources on TBI and
a 2-step trial conducted in the United Kingdom, providing active management
consultation for patients with acute whiplash injury in emergency departments
(ED) did not show additional benefit compared with usual care consultations,
say authors of an article published in
February in The Lancet. Physical
therapy resulted in a modest acceleration to early recovery of persisting
symptoms but was not cost effective from the National Health Service's (NHS)
perspective. Usual consultations in EDs and a single physical therapy advice
session for persistent symptoms are recommended, the authors add.
1 was a pragmatic, cluster randomized trial of 12 NHS Trust hospitals including
15 EDs that treated patients with acute whiplash associated disorder of grades
I-III. The hospitals were randomized by clusters to either active management or
usual care consultations. In step 2, the researchers used a nested individually
randomized trial. Patients were randomly assigned to receive either a package
of up to 6 physical therapy sessions or a single physical therapy advice
session. Randomization in Step 2 was stratified by the center. Investigator-masked
outcomes were obtained at 4, 8, and 12 months. The primary outcome was the Neck
Disability Index (NDI). Analysis was intention to treat, and included an
step 1, 12 NHS Trusts were randomized, and 3,851 of 6,952 eligible patients
agreed to participate (1,598 patients were assigned to usual care and 2,253
patients were assigned to active management). Of the 3,851 eligible patients,
2,704 (70%) provided data at 12 months. NDI score did not differ between active
management and usual care consultations (difference at 12 months 0.5).
step 2, 599 patients were randomly assigned to receive either a single physical
therapy advice session (299 patients) or 6 physical therapy sessions (300
patients); 479 (80%) patients provided data at 12 months. At 4 months, patients
who received physical therapy showed a modest benefit compared with advice (NDI
difference -3.7, -6.1 to -1.3), but not at 8 or 12 months. Active management
consultations and physical therapy were more expensive than usual care and a
single advice session. No treatment-related serious adverse events or deaths
new carbapenem-resistant Enterobacteriaceae (CRE) webpage contains news,
updates, and links to a variety of resources on these drug-resistant bacteria.
reported earlier this week in News Now, physical therapists and physical
therapist assistants play an important role in protecting patients from CRE.
CRE have high mortality rates, killing 1 in 2 patients who get bloodstream
infections from them. Additionally, CRE easily transfer their antibiotic resistance
to other bacteria. CRE are usually transmitted person-to-person, often on the
hands of health care workers. Currently, almost all CRE infections occur in
people receiving significant medical care. However, their ability to
spread and their resistance raises the concern that potentially untreatable
infections could appear in otherwise healthy people, including health care
Jacquelin Perry, MD, a physical therapist who trained at Walter Reed Army Hospital (1940-1941) and practiced in the US Army for 5 years, died at her home in Downey, California, on Monday at age 94.
Perry graduated from the University of California, San Francisco, in 1950 as a physician and became board certified as an orthopedic surgeon in 1958. At Ranchos Los Amigos, she was chief of the Pathokinesiology Service for 30 years.
She published hundreds of articles and received APTA's Golden Pen Award and the Helen
J. Hislop Award for Outstanding Contributions to Professional Literature. She was an honorary
lifetime member of APTA. She also received the Orthopaedic Section's Steven J. Rose Excellence in Research Award.
Throughout her career Perry advocated for the profession of physical therapy and worked closely with numerous physical therapists.
"The name Perry and the word movement are almost synonymous—we hear 'Perry,' and we think analysis of normal and abnormal movement of the trunk, upper extremity, and lower extremity and the restoration of movement through surgery, bracing, electrical stimulation, and exercise," Rebecca L. Craik, PT, PhD, FAPTA, wrote in a 2010 PTJ editorial.
The Centers for Medicare and
Medicaid Services (CMS) recently reported that
physical therapists and other providers who bill Medicare for outpatient
therapy services may have recently noticed an increase in the frequency of
Health Insurance Portability and Accountability Act rejection codes on their
provider notification letters. Medicare routinely mails these letters to
providers when various identified claims cannot be successfully crossed over to
their patient’s supplemental insurance companies.
The codes are:
you see "_____" directly above, the value [for example, G8978;
modifier CH; or CARC 246] was reported, when applicable, on the outbound
provider notification letter that billing offices would have received.)
CMS states that the new functional
G-codes, new severity/complexity modifiers, and new Claim Adjustment Reason
Code (CARC) 246 for the January 2013 Healthcare Common Procedure Coding System
(HCPCS) and CARC updates were inadvertently not loaded. As a result, a
moderate number of Part B outpatient therapy claims (claims for physical
therapy, speech-language pathology services, and occupational therapy) were
rejected in error. The newly added severity/complexity modifiers were as
follows: CH, CI, CJ, CK, CL, CM, and CN. The new functional G-codes
fall within the following ranges:
To remedy this issue, the
Coordination of Benefits Contractor (COBC) HIPAA validation vendor added the
new G-codes to its HCPCS table as of January 28. The vendor then added the
new severity/complexity modifiers to its HCPCS table as of February
11. Lastly, the vendor added the new CARC 246 to its table as of February
25. Thus, Medicare participating therapists, physicians, and nonphysician
providers should now see a drastic
decrease in the incidence of error codes H51000, H51061-H51064, and
H51108 reflected on their provider notification letters.
If your billing office received a
provider notification letter from Medicare indicating that claims could notbe crossed over due to one of the H-series error messages described
above, there unfortunately is not
a way for Medicare to retransmit the affected claims to your patients’
supplemental insurers. Therefore, you will need to bill your patients'
supplemental insurers directly.
To help mitigate this kind of problem
in the future, CMS will implement a fail-safe strategy in advance of the
scheduled installation of new HCPCS or other code updates. This will
ensure that any incorrectly rejected Medicare crossover claims will be repaired
by all A/B Medicare Administrative Contractors, thus minimizing the impact to
the provider community.
notice, titled CMS Reports Problem Impacting Crossover of Medicare Part B
Outpatient Therapy Claims, can be found in the March 7 issue of Provider e-News.
has added a new resource to its Balance and Falls webpage to help
physical therapists reduce falls that occur
during a patient's hospital stay. "Preventing Falls in Hospitals: A
Toolkit for Improving Quality of Care" addresses hospital readiness,
program management, fall prevention practices, implementation, measurement, and
sustainability. Developed by the Agency for Healthcare Research and Quality,
the toolkit is designed for
multiple uses. The core document is an implementation guide organized under 6 major
questions intended to be used primarily by the implementation team charged with
leading the effort to put the new prevention strategies into practice. The
full guide also includes links to tools
and resources found in the Tools and Resources section of the toolkit,
on the Web, or in the literature. The tools and resources are designed to be
used by different audiences and for different purposes, as indicated in the
On Friday, the Department of Health
and Human Services (HHS) released a new report identifying interventions that can help increase physical activity
in youth aged 3-17 years across a variety of settings. The primary audiences
for the report are policymakers, health care providers, and public health
professionals. APTA submitted comments in December 2012 on the draft report.
Physical Activity Guidelines for
Americans Midcourse Report: Strategies to Increase Physical Activity Among
Youth summarizes intervention strategies based on the evidence from
literature reviews and is organized into 5 settings where youth live, learn,
and play: school, preschool and childcare, community, family and home, and
primary health care.
Key findings of the report suggest that:
Other materials released by HHS include an infographic
highlighting opportunities to increase physical activity throughout the day and
a youth fact sheet summarizing the report's
recommendations for youth aged 6-17 years. More information can be found at www.health.gov/paguidelines/midcourse/.
APTA has long supported HHS' efforts to increase awareness about the
benefits of physical activity. It provided input on the 2008
Physical Activity Guidelines for Americansrelated to the importance of considering physical activity needs
and barriers for people with disabilities. It also served on the Physical
Activity Guidelines Reaction Group. The association also contributes to the Be Active Your Way Blog.
therapists (PTs) and physical therapist assistants (PTAs), especially those who
have patients with wounds, are encouraged to take steps to protect their most
vulnerable patients from carbapenem-resistant Enterobacteriaceae (CRE), a
family of germs that have become difficult to treat because they have high
levels of resistance to antibiotics. In addition to patients at high risks, PTs
and PTAs should take all necessary precautions to prevent the spread of CRE to
According to the Centers for Disease Control and Prevention
(CDC), CRE are resistant to all, or nearly all, antibiotics—even the most
powerful drugs of last-resort. CRE also have high mortality rates, killing 1 in
2 patients who get bloodstream infections from them. Additionally, CRE easily
transfer their antibiotic resistance to other bacteria. For example,
carbapenem-resistant klebsiella can spread its drug-destroying properties to a
normal E. coli bacteria, which makes the E.coli resistant to
antibiotics also. "That could create a nightmare scenario since E. coli
is the most common cause of urinary tract infections in healthy people,"
CRE are usually transmitted
person-to-person, often on the hands of health care workers. Currently,
almost all CRE infections occur in people receiving significant medical
care. However, their ability to spread and their resistance raises the
concern that potentially untreatable infections could appear in otherwise
healthy people, including health care providers.
includes resources for patients, providers, and
facilities. The agency's CRE prevention toolkit has in-depth recommendations to
control CRE transmission in hospitals, long-term acute care facilities, and
is in the process of updating its Infectious Disease Control webpage to ensure that
PTs and PTAs have the information they need to understand their critical role
in helping to halt the spread of CRE. Look for a follow-up article in News
Now when the webpage is launched.
has selected 9 association members to serve on the PTA Education Feasibility
Study Work Group: Wendy Bircher, PT, EdD (NM), Derek Brandes (WA), Barbara
Carter, PTA (WI), Martha Hinman, PT, EdD (TX), Mary Lou Romanello, PT, PhD, ATC
(MD), Steven Skinner, PT, EdD (NY), Lisa Stejskal, PTA, MAEd (IL), Jennifer
Whitney, PT, DPT, KEMG (CA), and Geneva Johnson, PT, PhD, FAPTA (LA). The work group is addressing the motion Feasibility Study
for Transitioning to an Entry-Level Baccalaureate Physical Therapist Assistant
Degree (RC 20-12) from the 2012 House of Delegates. The work group will address
the first phase of the study, finalizing the study plan and identifying
relevant data sources for exploring the feasibility of transitioning the
entry-level degree for the PTA to a bachelor's degree.
APTA supporting staff members
are Janet Crosier, PT, DPT, MEd, lead PTA services specialist; Janet Bezner,
PT, PhD, vice president of education and governance and administration; Doug
Clarke, accreditation PTA programs manager; and Libby Ross, director of
than 200 individuals volunteered to serve on the work group by submitting their
names to the Volunteer Interest Pool (VIP). APTA expects to engage additional
members in the data collection process.
walking tests are valid measurements to predict community walking in patients
with Parkinson disease, say authors of an article published
online in Journal of Rehabilitation
Medicine. However, evaluation of community walking also should include an
assessment of fear of falling, they add.
this investigation, researchers used data from baseline assessments in a randomized
clinical trial. A total of 153 patients with Parkinson disease were included.
Community walking was evaluated using the mobility domain of the Nottingham
Extended Activities of Daily Living Index. Patients who scored 3 points on item
1 ("Did you walk around outside?") and item 5 ("Did you cross
roads?") were considered community walkers. Gait speed was measured with
the 6-meter or 10-meter timed walking test. Age, gender, marital status,
disease duration, disease severity, motor impairment, balance, freezing of
gait, fear of falling, previous falls, cognitive function, executive function,
fatigue, anxiety, and depression were investigated for their contribution to
the multivariate model.
patients (46%) were classified as community walkers. A gait speed of 0.88 meter
per second correctly predicted 70% of patients as community walkers. The
multivariate model, including gait speed and fear of falling, correctly
predicted 78% of patients as community walkers.
has created 4 additional case scenarios to help physical therapists comply with
functional limitation reporting requirements under Medicare. Each scenario includes a description of
the patient and data and documentation requirements that physical therapists
must meet at the initial evaluation, 10th visit, and discharge. Examples of
charge forms for the 3 visits and a summary of reporting also are available for
scenarios are: multiple sclerosis, establishing a maintenance plan/no function
change; diabetic foot ulcer, functional limitations; diabetic foot ulcer, no
limitation; and neck pain.
scenarios will be posted in the near future.
limitation reporting on claim forms began January 1. A testing period is in
effect until July 1. After July 1, claims submitted without the appropriate
G-codes and modifiers will be returned unpaid.
is featured in an article titled "Work Out the Kinks in Functional
Limitations Reporting Now" that appears in this month's Eli's Rehab Report. Heather Smith, PT,
MPH, APTA program director of quality, provides examples of 2 exceptions
outlined in transmittal 2622 that require physical therapists to submit
additional G-codes to comply with Medicare's functional limitation reporting requirements.
your practical knowledge and cutting-edge ideas at the 2014 APTA Conference and
Exposition, June 11-14, 2014, in Charlotte, North Carolina. APTA is seeking
submissions focused on effectiveness of care; patient- and client-centered care
across the lifespan; professional growth and development, including
interprofessional collaboration; and value and accountability.
submission site opens March 15. The deadline for proposal submissions is July
15. Submissions are encouraged for 90-minute educational sessions and 1-day
preconference courses. APTA is especially interested in topics related to:
further information, visit www.apta.org/Conference/Submissions. For questions or
to discuss specifics about programming, contact Mary Lynn Billitteri, APTA professional
Voting has begun for APTA’s "Fit After 50 Member Challenge" winner. The top 10
finalists featured on APTA's Move Forward consumer website were nominated for
their commitment to being fit, active, and mobile at age 50+. Read their
stories and vote for 1 physical
therapist who you feel best exemplifies the following characteristics:
your friends, family, community, and colleagues also to vote. Voting is open
until April 5. The top 3 winners will receive prizes from APTA and recognition
at the APTA Conference and Exposition this June.
live, online Virtual Career Fair, to be held April 9, 1:00 pm-4:00 pm ET, is a great way for you to engage
directly with employers about their current and future physical therapy
Physical therapists will find a variety of
employment models at this first-ever virtual career event. Looking for a local
employment site? Chat 1-on-1 with recruiters from Scott & White Healthcare in Central
Texas. If you're interested in multiple regional
sites, look for representatives from ATI Physical Therapy (Eastern region) and Providence Health & Services (Western region). National companies,
including Life Care Centers, Concentra, and HCR Manor Care, will be available to discuss your background and
experience, and their career opportunities.
is limited for this event, so register today.
The Foundation for Physical Therapy recently
presented its 2013 Service Awards to 5 individuals and 2 organizations that
have demonstrated a strong commitment to supporting the Foundation and
advancing its mission to fund physical therapy research.
This year's recipients are:
more about the awards and the recipients in the Foundation's press release.
United States Bone and Joint Initiative's (USBJI) next summit, Best Practices
in Patient-Centered Musculoskeletal Care, will be held November 18-19 in
Washington, DC. This meeting will build on the
previous summit held in 2011 on The Value in Musculoskeletal Care.
a Q&A, cochairs David Pisetsky, MD, PhD, and Gregory Worsowicz, MD, MBA,
reflect on the upcoming meeting's agenda and
key goals. When asked how summit participants might prepare for the event,
Worsowicz, responded, "Do your
homework. Come with an open mind and be ready to listen and engage in vigorous,
change-making dialogue." As for summit take-away messages, Pisetsky said,
"We're striving for real-world solutions. As an example, we hope one
take-away will be insight on how to build an interdisciplinary process—one that
will work in your setting and, perhaps with modifications, can work for
colleagues in other settings or travel with you to a new environment."
APTA is a founding member of USBJI.
Robert Wood Johnson Foundation's (RWJF) "promising practices"
library includes interventions and how-to guides for improving care and
addressing major issues in health care quality and equality. Topics include
reducing readmissions, improving patient satisfaction and engagement, enhancing
patient safety, managing emergency department crowding, and reducing
Workplace wellness programs may not
save companies money in the short term, says an article
by the Associated Press based on a
2-year study at a major St Louis hospital system.
The new study provides an in-depth look at the experience of BJC HealthCare, a
hospital system that in 2005 started a comprehensive program linked to
insurance discounts. BJC employs 28,000 people and provides health insurance
for about 40,000, including family members. The overwhelming majority
participated in the wellness program.
The program focused on 6 lifestyle-influenced conditions: high blood
pressure, diabetes, heart disease, chronic lung problems, serious respiratory
infections, and stroke. Employees had to join the program in order to get the
hospital's most generous level of health insurance, called the Gold Plan. For
family coverage, for example, the hospital paid nearly $1,650 more of costs in
the Gold Plan.
Employees in the wellness program had to complete a health risk assessment
that included height, weight, blood pressure, cholesterol, blood sugar, and
other measurements. They also signed a pledge to maintain a healthy diet and
exercise regularly. Smokers had to get help to quit. Spouses also were required
to sign the health pledge and, if they smoked, get help.
The study tallied up BJC's medical costs before the wellness program and for
2 years after. It also compared those costs with expenses of 2 other big local
employers that did not have wellness programs.
Hospitalizations for employees and family members dropped dramatically, by
41% overall for the 6 major conditions. But increased outpatient costs erased
those savings. When those costs were added to the cost of the wellness
initiative itself, "it is unlikely that the program saved money," the
Steven Noeldner, an expert with the Mercer benefits consulting firm says
well-designed programs generally show a positive return of about 2% by the
third year, the article says.
BJC President Steven Lipstein said he doesn't dispute the conclusion, but he
remains committed to the wellness program and would invite the researchers to
take another look now.
He added that encouraging employees to make healthy lifestyle decisions and
rewarding those who do reflects corporate values, not just the bottom line.
Gautam Gowrisankaran, lead author of the study, notes that there could be other
benefits not directly measured in the study, such as reduced employee absenteeism
and higher productivity.
Friday, the US Office of Personnel Management (OPM) published a final rule establishing
standards for the Multi-State Plan Program (MSPP) to promote competition in the
new health insurance marketplace, also known as the "exchanges,"
and ensure that consumers have more
high-quality, affordable insurance choices.
the MSPP, OPM will enter into contracts with private health insurance issuers
to provide at least 2 Multi-State Plans (MSPs) in each state's exchange. MSPs
will be established in at least 31 exchanges this year, with coverage to be
extended to the exchanges/marketplaces in every state and the District of Columbia by
2017. At least 1 of these issuers must be a nonprofit entity. All state and
federal laws that apply to Qualified Health Plans (QHPs) also will apply to
to physical therapists is the rule's clarification that MSPs must offer essential health benefits
(EHBs), and MSPP issuers must comply with state standards relating to
substitution of state benchmark benefits or standard benefit designs. As
reported in News Now on February 21, a final rule
on EHBs gives states authority to impose more stringent requirements on EHBs
substitution than the federal regulation, meaning that states can prohibit
substitution within EHB categories altogether. Additionally, MSPP plan issuers
are directed to follow state definitions of habilitative services and devices
where they exist. If a state has not defined the benefits, OPM will
determine them during negotiations with the MSPP issuer. To ensure network
adequacy (adequate number of provider and facility types), the rule
adopts an approach in which the MSPP will establish a uniform standard for
network adequacy using time and distance standards similar to the Centers for
Medicare and Medicaid Services' standards for Medicare Advantage plans and
Medicare Part D.
final rule also:
initial open enrollment period for MSPs, as with QHPs, begins October 1 for
coverage beginning January 1, 2014. Individuals and small businesses wishing to
enroll in MSPs will then be able to enroll through the marketplace in their
state. However, an MSP may not be available in every state until 2017.
addition to the Multi-State Plan Program final rule issued Friday, the federal
government released other rules implementing portions of the Affordable Care
Act to encourage cost-sharing, stabilize health insurance premiums, and prevent
providers from denying coverage.
Notice of Benefit and Payment Parameters final rule expands upon the standards
set forth in earlier rules and provides further information on the permanent
risk adjustment, transitional reinsurance and temporary risk corridors
programs, advance payments of the premium tax credit, cost-sharing reductions,
medical loss ratio, and the Small Business Health Options Program (SHOP).
policies in this rule:
proposed rule seeks to amend
existing regulations to implement the SHOP effective January 1, 2015.
interim final regulation
will adjust risk corridors
would align the calculations with
the single risk pool provision. It also sets standards permitting issuers of QHPs the option of using an alternate methodology for calculating the value of cost-sharing reductions
provided for the purpose of reconciliation of advance payments of cost-sharing
Centers for Medicare and Medicaid Services (CMS) recently updated its therapy question-and-answer document that clarifies several provisions
regarding the therapy functional reassessment requirement under the Medicare
Home Health Part A benefit. Medicare pays only for visits in which the therapy
reassessment is done in compliance with the Medicare regulations. Noncovered
therapy visits are not to be included in the counting of therapy visits for the
purpose of determining when certain required therapy reassessment visits need
the Q&A, CMS clarifies that home health agencies and therapists should not
change the number of therapy visits a patient receives based on whether prior
visits were covered by Medicare, and patients should receive only the number of
therapy visits delineated in the plan of care. The Q&A also provides
detailed examples of when the therapy reassessment is missed or is not
compliant and its subsequent effect on the counting of Medicare-covered therapy
visits in single and multiple therapy cases.
requires that the patient's function must be initially assessed and
periodically reassessed by a qualified therapist of the corresponding
discipline for the type of therapy being provided (ie, physical therapy,
occupational therapy, or speech-language pathology services). When more than 1
therapy discipline is being provided, the corresponding qualified therapist
would perform the reassessment during the regularly scheduled visit associated
with that discipline that is scheduled to occur closest to the 13th and 19th
visit, but no later than the 13th and 19th visit.
APTA's first-ever online Virtual Career Fair on Tuesday, April 9, 1:00 pm-4:00
pm ET. This live, online event is a great way for you to engage directly with
top employers about their current and future physical therapy opportunities.
in the Virtual Career Fair for as long as you wish, chatting 1-on-1 with
recruiters to discuss your background and experience, and their current and
future career opportunities.
is limited, so register now at www.brazenconnect.com/event/apta_virtual_career_fair.
members have just a few days to register for the Innovation Summit:
Collaborative Care Models. Don't miss the opportunity to be a part of this
groundbreaking virtual event that will bring together physical therapists, other
health care providers, large health systems, and policy makers to discuss the
current and future role of physical therapy in integrated models of care.
in attending the summit with your colleagues? Eight APTA chapters and 26
members are hosting viewing parties. Go to www.apta.org/InnovationSummit/ViewingParties/ to find out if
there's one near you.
more information and to register, visit the Innovation Summit webpage.
a part of this important time in the history of your profession and join us
April 14-16 for the 2013 Federal Advocacy Forum. At the event, you will hear
from decision makers on Capitol Hill, learn to effectively communicate with
your elected officials, receive an update on the legislative and regulatory
issues affecting the physical therapy profession, and lobby your members of
Congress on behalf of your profession. Registration closes on March 22, so register
online today and bring your voice to
Capitol Hill on behalf of your profession.
The programming for the 2013 Federal Advocacy Forum will begin on Sunday,
April 14, with an evening reception. Monday, April 15, will be dedicated to
advocacy programming and preparation for your hill visits. The event will
conclude with the opportunity for you to take your message directly to your
members of Congress on April 16.
The number of CEUs earned for this event is pending. To claim CEU credit,
you 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.
For a full agenda and more information, visit www.apta.org/FederalForum. APTA
encourages you to get the word out to your friends and colleagues and bring
someone with you to the event.
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