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  • APTA, Women's Section Help Clear Up Misinformation in NPR 'Mummy Tummy' Report

    Despite what you may have heard, if the idea of a single, daily, 10-minute exercise being the solution to diastasis recti, aka "mummy tummy," seems too good to be true, that's because it probably is. APTA and its Section on Women's Health, attempted to set the record straight.

    During the August 7 broadcast of NPR's Morning Edition, correspondent Michaeleen Doucleff reported on her experiences with a daily 10-minute abdominal exercise whose proponent, Leah Keller, a personal trainer, claims will close separated abdominal muscles often associated with women postpartum. The text version of the story that appeared on NPR's website under the rosy headline: "Flattening The 'Mummy Tummy' With 1 Exercise, 10 Minutes a Day."

    According to the story, Michaeleen reduced the separation in her abdominal muscles from 1.2 inches to .6 inches over 6 weeks, and other women in her exercise group did the same or better through the exercise. NPR reported that the program was supported by a pilot study of 63 women who all saw their diastasis recti fixed after 12 weeks.

    Not so fast, said APTA and the Section on Women's Health (SOWH). After the story aired, SOWH Vice President Carrie J. Pagliano, PT, DPT, contacted APTA with a suggestion that the section and the association point out some of the misinformation in the story. Together, SOWH President Patricia Wolfe, PT, MS, and APTA President Sharon Dunn, PT, PhD, drafted a letter to NPR describing several elements of the story that were "misleading to women seeking out help for diastasis recti." Pagliano also holds clinical specialist certifications in both orthopaedics and women's health; Dunn is a board-certified specialist in orthopaedics.

    The letter explained that besides the idea that a single short-duration exercise could be the quick-fix solution to diastasis recti, the story also contained factual errors about the kinds of exercises women postpartum should and shouldn't do. In the story, Keller tells these women to "please don't ever again in your life do crossover crunches or bicycle crunches," claiming that "they splay your abs in so many ways."

    In reality, the opposite could be the case, according to Dunn and Wolfe: contracting the rectus abdominis with a curl-up exercise has been shown to decrease muscle separation, while the exercise described in the story—a contraction of just the transverse abdominal muscle—has been associated with increased muscle separation while potentially improving how well the abdominals handle load. "It's not as simple as the '1 muscle-1 exercise approach' proposed by Keller," they write.

    Further, the authors point out, the study on which the program is based has several flaws, including the fact that only 29 of the 63 women in the study were postpartum, no explanation was provided for how diastasis recti was measured initially, and no control group was used.

    "Diastasis recti is not well understood and more research, including standardization of assessment, etiology, and clinical practice guidelines, is required," write Dunn and Wolfe. "In the meantime, a women's health physical therapist trained in the assessment and treatment of patients concerned about diastasis recti can be beneficial both during and after pregnancy to guide participation in exercise."

    In a follow-up report aired August 20, NPR acknowledged that the story received a "huge" response and included quotes from the Dunn and Wolfe letter. In that story, NPR described the criticism it had received, provided more information on the exercise in question, and included descriptions of other exercises that could be helpful, as well as advice from Dunn and Wolfe that "if done properly, the crossover crunches and bicycle crunches would actually help a woman restore the strength to all of her abdominal muscles."

    CMS MAC Claims Review Process Will Move to More Targeted System

    The US Centers for Medicare and Medicaid Services (CMS) will move away from its current practice of randomly selecting claims for audit in favor of a more targeted approach that it hopes will streamline the process and result in fewer appeals.

    The program, dubbed Targeted Probe and Educate, directs Medicare administrative contractors (MACs) to select claims for items or services "that pose the greatest financial risk to the Medicare trust fund and/or those that have a high national error rate," focusing only on "providers/suppliers who have the highest claim error rates or billing practices that vary significantly out from their peers." The program was piloted in 1 MAC jurisdiction in 2016, and expanded to 3 more in July of this year. All MAC jurisdictions will be following the procedure "later in 2017," according to a CMS fact sheet.

    Once a claim and provider have been targeted, MACs will begin a multiphase process by probing 20-40 claims per provider. If the provider is found to be noncompliant, the provider must participate in education on meeting requirements. After the education phase, the MAC must wait 45 days or more before reviewing another batch of 20-40 claims. At that point, the MAC can either determine that the provider is in compliance or submit the provider to another round of education and later review. Should a third review round not make a difference in compliance, the provider will be referred to CMS for possible further action.

    The new process moves away from the "Probe and Educate" program, a less-targeted process that resulted in more reviews—and more appeals from providers. According to an article in Modern Healthcare, CMS has 667,000 pending appeals and expects that number to rise to 687,000 by the end of 2017, and more than 1 million by 2021.