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  • US Health Care Most Expensive, Least Effective Among Wealthy Nations

    The news is, there's no news: once again, the United States ranks first among industrialized nations in health care spending but lands near the bottom on most health care outcomes, and winds up in last place overall.

    The Commonwealth Fund has released its Mirror Mirror report on health care among 11 wealthy countries, and just as in 2010, 2007, 2006, and 2004, the US is found to have an expensive system that comes in dead last in efficiency, equity, and mortality/life expectancy—and near the bottom in most other measures.

    The report compared spending and outcomes among Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the US. The report estimates per-capita health expenditures in the US at just over $8500, almost $3,000 more than the next highest rate (Switzerland), and more than $5,000 above the UK, the country with the highest-rated health care system overall.

    Switzerland was ranked second to UK, with Sweden, Australia, and Germany next in line. Canada was ranked second-to-last. Although the US did do well in preventive care, waiting times, and specialist care, it lagged behind in access to services and the ability to receive prompt service from primary care physicians, according to the report.

    'Rock Doc' Gets 6 Years for Medicare Fraud Involving 'Physical Therapy'

    The so-called "Rock Doc" who pleaded guilty to defrauding Medicare of $2.6 million through bogus physical therapy services has been sentenced to 6 years in prison.

    In addition to the billing fraud, Christopher Gregory Wayne, 54, of Miami Beach, Florida, also admitted to illegally prescribing controlled substances and has been ordered to repay Medicare about $1.65 million. The sentencing, which occurred on June 13, was reported in the Wall Street Journal and Miami Herald, among other outlets.

    Wayne was the subject of a 2010 WSJ front-page article that tracked nearly $1.2 million in payments from Medicare, mostly for "physical therapy" that was not provided by licensed physical therapists—or not provided at all. The family physician earned his nickname thanks in part to his high-profile lifestyle and punk appearance, complete with spiked blond hair.

    According to the Herald article, Wayne told the judge at his sentencing hearing that the billing abuse "was not intentional or malicious." Instead, Wayne claimed that he was simply unaware of 2008 Medicare changes that required his employees to be licensed PTs.

    The headline-making nature of Wayne's crimes underscores the importance of maintaining a strong professional understanding of fraud, abuse, and waste. APTA's Integrity in Practice campaign supports physical therapy's high practice standards by helping PTs understand regulations and payment systems, and putting them in touch with tools and resources that promote evidence-based practice, ethics, and professionalism.

    Check out the latest addition to the Integrity in Practice webpage: Preventing Fraud, Abuse, and Waste: A Primer for Physical Therapists (.pdf) is a free guide that examines not only the laws around these issues but the ways in which PTs can avoid fraud, abuse, and waste with payers, referral sources, and patients.

    6K Steps a Day Linked to Better Function in Individuals With Knee OA

    Walking 6,000 steps a day can significantly reduce the risk of functional limitation among people with or at risk of knee osteoarthritis (OA), according to a new study. And it doesn't have to be by way of a structured exercise program—the steps taken in everyday activities can add up to better function in the long run.

    In the study, 1,788 participants with or at risk for knee OA were monitored with an ankle pedometer for 2 years. They were not instructed to engage in any formal activity program. Researchers noted at the follow-up that 70% of participants who averaged 6,000 or more steps per day reported no decrease in function, while 70% of those who walked less than 6,000 steps experienced limitations. The findings were published in Arthritis Care & Research (abstract only available for free).

    Though authors cited the 6,000-step mark as the point with the “best discriminating ability" relative to functional limitations, they noted that as few as 3,000 steps a day reduced problems, with every additional 1,000 steps lowering limitation risk by at least 16%. The effects were similar between individuals determined to have knee OA at baseline and those found to be at risk for knee OA.

    Although the study calls for more extensive studies to reinforce the findings, authors believe that the results point to a possible set of clinical recommendations. "Specifically, walking > 3,000 steps per day may be an initial minimum daily walking goal to recommend," the authors write. "Increasing this amount to walking > 6,000 steps per day may be an ideal amount on an ongoing basis as this threshold best discriminated those who developed functional limitation from those who did not."

    Daniel K. White, PT, ScD, MSc, assistant professor of physical therapy at Boston University, was primary author of the study.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.