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  • North Carolina Enacts Legislation Ensuring Patient Choice and Coverage of PT Services

    Patients in North Carolina soon will have the right to choose their physical therapist (PT) under their health benefits plan and ensure that PT services will be covered. SB 656, sponsored by State Sen Jim Davis (R) and advocated for by the North Carolina Chapter, was signed by North Carolina Gov Beverly Perdue (D) on June 29 and goes into effect October 1. SB 656 specifies that whenever an insurance policy provides for certification of disability that is within the scope of practice of a licensed PT, the policyholder, insured, or beneficiary will have the right to choose the provider of the services.

    According to Chapter President Dean McCall, PT, DPT, OCS, the chapter initiated the legislation after reports began surfacing that some patients were unnecessarily driving more than 90 miles and having to wait 3 to 4 weeks before being seen by other providers, when they could have been seen in their home town by their local physical therapist. In addition, SB 656 states that when any health benefit plan, subscriber contract, or policy of insurance issued by a health maintenance organization, hospital or medical service corporation, or insurer provides for coverage for, payment of, or reimbursement for physical therapist services, the insured or other persons entitled to benefits under the policy will be entitled to coverage or reimbursement for the services.

    CMS Announces 89 New ACOs

    As of July 1, 89 new accountable care organizations (ACOs) began serving 1.2 million people with Medicare in 40 states and Washington, DC. In total, 154 organizations now participate in Medicare shared savings initiatives, serving over 2.4 million Medicare patients across the country.

    Federal savings from the Medicare Shared Savings Program (MSSP), and other initiatives related to ACOs, could amount to $940 million over 4 years. All ACOs that succeed in reducing the rate of growth in the cost of care while providing high-quality care may share in the savings to Medicare. Five of the new ACOs applied for a version of the program that allows them to earn a higher share of any savings by also being held accountable for a share of any losses if the costs of care for the beneficiaries assigned to them increase.

    The selected ACOs, announced yesterday by the Centers for Medicare and Medicaid (CMS), operate in a wide range of areas of the country, and almost half are physician-driven organizations serving fewer than 10,000 beneficiaries, demonstrating that smaller organizations are interested in operating as ACOs. Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas that they are serving.  

    To ensure high quality of care, ACOs will report performance on 33 measures relating to care coordination and patient safety, use of appropriate preventive health services, improved care for at-risk populations, and patient and caregiver experience of care.

    Beginning this year, new ACO applications will be accepted annually. The application period for organizations that wish to participate in MSSP beginning in January 2013 is August 1 through September 6.

    Check out APTA's ACO webpage for resources such as FAQs, podcasts, assessment tools, and summaries on ACO regulations. APTA's video series on innovative models of care illustrates ways physical therapists can play an important role in ACOs and other integrated care models.

    Small Study Shows Wii Effective in Reducing Falls in Patients With Mild AD

    Regular Wii Fit workouts proved as effective as a robust walking routine in reducing the risk for falling in older people with mild Alzheimer disease (AD), says a Medscape Medical News  article based on a study published online June 13 in Journal of Aging Research.

    Researchers at the University of Arkansas for Medical Sciences assessed fall risk with 3 tests of balance and gait in 22 elderly people enrolled in 1 of 2 exercise interventions. Eleven participants were assigned to a supervised walking program, and 11 used the Wii Fit yoga, strength-training, and balance games. Each group exercised 5 times weekly for 30 minutes over 8 weeks.

    The participants were tested with the Berg Balance Scale (BBS), the Tinetti Test (TT), and Timed Up and Go (TUG) test before they began exercising, at the 4-week point, and after 8 weeks. Research participants lived in an assisted-living facility.

    Both groups showed improvements on all 3 tests, with no statistically significant difference between the groups. Both groups began with a BBS score of less than 45, indicating a high risk for falls, and significantly improved those scores over time. But group-by-time interactions failed to reach significance for any measure.

    In an intragroup analysis, at 8 weeks the Wii Fit group showed statistically significant improvements in BBS and TT scores. Wii Fit TUG scores did not reach significance.

    In the walking group, an intragroup analysis showed a significant improvement in TT scores. However, although BBS and TUG scores trended toward improvement, they failed to reach statistical significance.

    Robert P. Friedland, MD, chair and professor of neurology at the University of Louisville, Kentucky, who was not involved in the research, calls the study a "relatively limited observation." He added that the mean age of the participants—79.3 years for the Wii Fit group and 81.6 years for the walking group—rather than the disease probably led to their balance issues.