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  • Awareness of Prediabetes Remains Low

    Authors 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.

    The 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%).

    Because 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.

    Conference to Focus on Development of Systems in Physical Therapy Practice

    In 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.

    The 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 conference/webcast.

    Otago Exercise Program Now Available in Online Course

    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.  

    The 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.

    Registration Still Open for APTA Virtual Career Fair

    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 therapists. 

    Space is limited for this event, so register today.  

    Rockar Urges Physical Therapists to Prepare for April 1 Medicare Cuts

    Many 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. 

    Call for Section Nominations: Development of CPGs and CPAs Workshop

    APTA 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 sarahmiller@apta.org if you have questions.

    2013 County Health Rankings Show New National Trends

    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 counties where people don’t live as long and don't feel as well mentally or physically have the highest rates of smoking, teen births, and physical inactivity, and more preventable hospital stays.
    • Access to health care remains an important factor and this year, the rankings include residents' access to dentists and primary care physicians. Residents living in healthier counties are 1.4 times more likely to have access to a physician and dentist than those in the least healthy counties.

    NCOA Webinar: Policy Change to Advance Falls Prevention

    Join 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.

    To access NCOA's State Policy Toolkit for Advancing Fall Prevention, and other patient care resources, go to APTA's Balance and Falls webpage.

    As 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.

    New in the Literature: High-intensity PRST in Older Adults (Arch Phys Med Rehabil. 2013 Mar 6. [Epub ahead of print])

    High-intensity 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.  

    For 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 checklist.

    The 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.

    The authors call for further research into HIPRST's effects in older people with chronic health conditions across the care continuum.

    PTs Needed for Research Project on Patients With Arthritis

    If 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.

    APTA 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. 

    Westat 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.

    If you have any questions, contact anitabemis-dougherty@apta.org.

    Many Practices Cannot Accommodate Patients With Mobility Impairment

    Authors of an article published this month in Annals of Internal Medicine report that many subspecialists are unable to accommodate patients who use wheelchairs. 

    Researchers 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).

    The 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.

    More 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).

    Of 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 (44%).

    The authors call for improved awareness about the Americans with Disabilities Act requirements and the standards of care for patients with mobility impairment.

    Remember to Vote For Your Favorite 'Fit After 50' Member

    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. 

    Special Communication: MPPR and Sequestration Cuts Effective April 1

    Members 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.

    FDA Proposes to Improve Quality of AEDs

    The 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 approval.  

    Although 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.

    In 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 Pediatric Organization Posts Guidelines at WCPT Website

    The 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.

    IOPTP 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 member organizations.

    In 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.

    RACs to Conduct Manual Medical Review of Claims Subject to Therapy Cap

    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.

    Physical Therapy 'Good First Choice' for Meniscal Tear and Knee OA

    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.

    New Legislation Means Reduced Out-of-Pocket Expenses for Patients in Arkansas

    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 Would Boost Underserved Patients' Access to Physical Therapist Services

    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.

    CMS to Send Reminders on Functional Limitation Reporting

    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.

    Move Forward Radio Show Recognizes World Down Syndrome Day

    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 consumer@apta.org.

    APTA To Hold Virtual Career Fair April 9, 2013

    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.

    Public Policy Priorities Drive APTA Efforts in 2013-2014

    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.

    Medicare Adjusts Readmissions Penalties

    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.

    New in the Literature: No Significant Difference Between Surgery and Physical Therapy for Meniscal Tear and Knee Osteoarthritis (NEJM. 2013 Mar 19.)

    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."

    MACPAC Recommendations Aim to Improve Enrollment Stability, Align Medicaid With ACA

    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.

    Save 20% in APTA's Marketplace

    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 Webinar to Address Reducing Childhood Obesity

    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.

    APTA Experts Participate in National Work Group on Falls Prevention

    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.

    APTA Moves Forward With Development of an Alternative Payment System

    A 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."      

    In 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 members shortly.     

    APTA expects to transition to a new outpatient therapy payment system by January 1, 2015.

    APTA's Virtual Career Fair: A Great Way to Jump Start Your Job Search

    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 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.

    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 Is Seeking Member Feedback on Communications Efforts

    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 the survey.

    APTA's Innovation Summit Reaches 1,000 Virtual Attendees

    APTA's 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. 

    Onsite 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.  

    Innovation 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 country.

    Pictures of the summit are available at www.apta.org/InnovationSummit/.

    Foundation Gala: Honoring Past and Present Visionaries

    The 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 details

    Cost of Diabetes Increases 41% in 5 Years

    The 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.

    The 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:

    • Medical expenditures for people with diabetes are 2.3 times higher than for those without diabetes.
    • The primary driver of increased costs is the increasing prevalence of diabetes in the US population.
    • Despite the introduction of new classes of medication for the treatment of diabetes, antidiabetic agents and diabetes supplies continue to account for only 12% of medical expenditures in both 2007 and 2012.

    The research also examined costs along gender, racial and ethnic lines, and included state-by-state data. Key findings include:

    • Most of the cost for diabetes care in the US, 62.4%, is provided by government insurance. The rest is paid for by private insurance (34.4%) or by the uninsured (3.2%).
    • Total per-capita health expenditures are higher among women than men ($8,331 vs $7,458). Total per-capita health care expenditures are lower among Hispanics ($5,930) and higher among non-Hispanic blacks ($9,540) than among non-Hispanic whites ($8,101).
    • The per-capita cost of medical care attributed to diabetes was $6,649 in 2007 and $7,900 in 2012, a 19% increase. 
    • Among states, California has the largest population with diabetes and thus the highest costs, at $27.6 billion. Although Florida's total population is fourth among states behind California, Texas, and New York, it is second in costs at $18.9 billion.

    The study will be published in the upcoming April issue of Diabetes Care.

    Call for CSM Steering Group Members

    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.

    Find Articles With 'Immediate' Clinical Relevance in March PTJ

    This 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 Educates Members of Congress on Role of Physical Therapy in TBI

    Today, 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.

    Reps 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. 

    An 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 concussion. 

    New in the Literature: Physical Therapy for Acute Whiplash (Lancet. 2013;381(9866):546-556.)

    In 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. 

    Step 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 economic evaluation.

    In 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).

    In 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 were noted.

    APTA Launches CRE Webpage

    APTA's new carbapenem-resistant Enterobacteriaceae (CRE) webpage contains news, updates, and links to a variety of resources on these drug-resistant bacteria.

    As 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 providers.

    Jacquelin Perry, Renowned Physical Therapist and Physician, Dies

    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.

    CMS Reports 'Moderate' Number of Part B Outpatient Therapy Claims Rejected in Error

    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:

    • H51000: The Procedure Code ____ is not a valid CPT or HCPCS Code for this Date of Service
    • H51061: 'Procedure Modifier 1' ___ is not a valid CPT or HCPCS Modifier Code
    • H51062: 'Procedure Modifier 2'____ is not a valid CPT or HCPCS Modifier Code
    • H51063: 'Procedure Modifier 3' ____ is not a valid CPT or HCPCS Modifier Code
    • H51064: 'Procedure Modifier 4' ____ is not a valid CPT or HCPCS Modifier Code
    • H51108:  _______ is not a valid 'Line Level Adjustment Reason Code.'

    (Where 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:

    • G8978—G8999
    • G9158—G9176
    • G9186

    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.

    This 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.   

    New Toolkit Aims to Reduce Falls During Hospital Stays

    APTA 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 guide.

    Schools Provide Evidence-based Opportunity to Increase Physical Activity Among Youth

    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: 

    • School settings hold a realistic and evidence-based opportunity to increase physical activity among youth and should be a key part of a national strategy to increase physical activity.
    • Preschool and child care centers that serve young children are an important setting in which to enhance physical activity.
    • Changes involving the built environment and multiple sectors are promising.
    • To advance efforts to increase physical activity among youth, key research gaps should be addressed.

    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.    

    PTs and PTAs Play Important Role in Protecting Patients From Drug-resistant Bacteria

    Physical 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 healthy individuals.      

    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," says CDC.

    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.

    CDC's website 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 nursing homes.

    APTA 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.  

    PTA Education Feasibility Study Work Group Members Selected

    APTA 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 academic services.

    More 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.

    New in the Literature: Predictive Value of Gait Speed in Patients With Parkinson Disease (J Rehabil Med. 2013 Feb 28. [Epub ahead of print])

    Timed 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.

    For 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.

    Seventy 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.

    Additional Functional Limitation Reporting Case Scenarios Now Available

    APTA 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 each scenario.

    The new scenarios are: multiple sclerosis, establishing a maintenance plan/no function change; diabetic foot ulcer, functional limitations; diabetic foot ulcer, no limitation; and neck pain.

    More case scenarios will be posted in the near future.

    Functional 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.

    Rehab Report Quotes APTA in Functional Limitation Reporting Article

    APTA 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.    

    2014 APTA Conference and Exposition Call for Proposals: Submission Site Opens March 15

    Share 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.

    The 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:

    • Cardiovascular/pulmonary
    • chronic disease management
    • health and wellness
    • innovative collaborative care delivery models
    • innovative models of clinical education
    • innovative models of practice
    • needs of special populations
    • older athletes
    • orthopedics/manual therapy
    • pain management
    • rural health

    For further information, visit www.apta.org/Conference/Submissions. For questions or to discuss specifics about programming, contact Mary Lynn Billitteri, APTA professional development.

    Vote For Your Favorite 'Fit After 50' Member

    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:

    • Remains fit and active at 50+
    • Inspires others in the 50+ age group to do the same
    • Serves the 50+ community through activities that enhance function and quality of life
    • Promotes the role of the physical therapist to the 50+ community

    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 this June.

    Variety of Employers to Participate in APTA's Virtual Career Fair

    APTA's 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 opportunities.

    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.   

    Space is limited for this event, so register today.    

    Foundation Announces 2013 Service Award Recipients

    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:

    • APTA, Premier Partner in Research Award
    • Wisconsin Chapter, Innovation in Fundraising Award
    • Daniel Riddle, PT, PhD, FAPTA, Charles M. Magistro Distinguished Service Award
    • Jayne Snyder, PT, DPT, MA, FAPTA (posthumously), Spirit of Philanthropy Award
    • Patricia Traynor, PT, Robert C. Bartlett Trustee Recognition Service Award
    • Philip Vierling, MBA, Robert C. Bartlett Trustee Recognition Service Award
    • Charles T. Wetherington, Robert C. Bartlett Trustee Recognition Service Award

    Learn more about the awards and the recipients in the Foundation's press release.

    Save the Date for November Musculoskeletal Summit

    The 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.

    In 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.

    RWJF Library Offers How-to Guides for Improving Care

    The 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 disparities.

    Workplace Wellness Programs Not Netting Savings

    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 authors concluded.

    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.

    Economist 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.

    OPM Final Rule Clarifies That Multi-State Plans Must Offer EHBs

    On 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.  

    Under 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 MSPs. 

    Important 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.

    The final rule also:

    • Reflects OPM's commitment to collaborate with states to ensure that the MSPs are competitively neutral in the marketplaces.
    • Sets standards related to how OPM will coordinate with states and HHS to approve rates, standards for rating, medical loss ratios, and an MSPP issuer's participation in reinsurance, risk adjustment, and risk corridor programs.
    • Establishes how OPM will monitor contract performance for the MSPP, including ensuring quality assurance, preventing fraud and abuse, and possible contract compliance actions.
    • Creates a process and standards for handling appeals for enrollees that are denied claims for payment or service.

    The 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.

    Rules Aim to Implement Standards to Ensure Quality Insurance Choices for Americans

    In 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. 

    The 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).

    Key policies in this rule:

    • Reduce the incentives for health insurance issuers to avoid enrolling people with preexisting conditions.
    • Stabilize premiums in the individual market for health insurance.
    • Protect health insurance issuers against uncertainty in setting premium rates.
    • Help working Americans afford health insurance in the Exchanges.
    • Finalize a number of provisions to provide qualified health plan (QHP) options for the SHOP.
    • Amend the Medical Loss Ratio program, also known as the 80/20 rule.

    A proposed rule seeks to amend existing regulations to implement the SHOP effective January 1, 2015.

    An interim final regulation will adjust risk corridors calculations that 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 reductions.

    CMS Revises Home Health Therapy Q&As to Address Issues With Functional Reassessments

    The 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 to occur.

    In 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.

    CMS 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 to Hold Virtual Career Fair April 9

    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 top 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 at www.brazenconnect.com/event/apta_virtual_career_fair

    Last Call: Registration for Innovation Summit, Viewing Parties Closes March 6

    APTA 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.

    Interested 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.

    For more information and to register, visit the Innovation Summit webpage.

    Registration Deadline Nears for 2013 Federal Advocacy Forum

    Be 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.