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  • CMS Assigns Providers to Phases for Manual Medical Review

    The Centers for Medicare and Medicaid Services (CMS) has posted a list on its website assigning providers to 1 of 3 phases for manual medical review when outpatient therapy services exceed $3,700. The list identifies phase I and phase II providers by their National Provider Identifier; those who do not appear on the list are included in phase III. The phases delineate the time frames during which the providers would be required to obtain advanced approval from their Medicare Administrative Contractor (MAC) in order to receive coverage for outpatient therapy services beyond $3,700.

    • Phase I providers:  Subject to manual medical review October 1-December 31, 2012.
    • Phase II providers:  Subject to manual medical review November 1-December 31, 2012
    • Phase III providers:  Subject to manual medical review December 1-December 31, 2012.

    Additional information regarding the therapy cap and the manual medical review process is available on APTA's website. CMS also provides a fact sheet and question-and-answer document regarding the process. MACs are expected to issue additional information about the process in the near future.

    Move Forward to Launch Concussion Series August 27

    MoveForwardPT.com, APTA's official consumer information website, will host a series on concussion in sports called "Head in the Game." The series will premiere on Move Forward Radio on August 27 and culminate with a live broadcast on August 29 at 3 pm ET. Experts will discuss the latest advances in evaluation and treatment of sports concussions, and a physical therapist's role on the concussion management team. Listeners also will hear from a former NFL player who was forced to retire after suffering multiple concussions.

    APTA will conduct targeted media outreach to local and national sports reporters at print, broadcast, and online outlets. For more information about the series and the guests, view the press release.

    The "Head in the Game" series lineup is as follows:

    • August 27, 10 am ET, prerecorded interview with Chris Miller, NFL quarterback, 1987-1995, 1999.
    • August 28, 10 am ET, prerecorded interview with APTA member Anne Mucha, PT, MS, NCS
    • August 29, 3 pm ET, live show with Kevin Guskiewicz, PhD, ATC, FACSM, and APTA member Mike Ryan, PT, ATC.

    New in the Literature: Preventing Work-related Musculoskeletal Disorders (Cochrane Database Syst Rev. 2012 August 15)

    The level of evidence supporting workplace ergonomic design or training interventions, or both, for the prevention of work-related upper limb and neck musculoskeletal disorders (MSDs) ranges from moderate to very low quality, according to authors of a meta-analysis published online in Cochrane Database of Systematic Reviews. However, given there were multiple comparisons made involving a number of interventions and outcomes, the authors say that high-quality evidence is needed to determine the effectiveness of these interventions clearly.

    The authors searched 13 databases for randomized controlled trials (RCTs) of ergonomic workplace interventions for preventing work-related upper limb and neck MSDs. They included only studies with a baseline prevalence of MSDs of the upper limb or neck, or both, of less than 25%.

    Two review authors independently extracted data and assessed risk of bias. They included studies with relevant data that they judged to be sufficiently homogeneous regarding the intervention and outcome in the meta-analysis. They assessed the overall quality of the evidence for each comparison using the GRADE approach.

    Thirteen RCTs (2,397 workers) were included in the analysis. Eleven studies were conducted in an office environment and 2 in a health care setting. The authors judged 1 study to have a low risk of bias. The 13 studies evaluated effectiveness of ergonomic equipment, supplementary breaks or reduced work hours, ergonomic training, a combination of ergonomic training and equipment, and patient lifting interventions for preventing work-related MSDs of the upper limb and neck in adults.

    Overall, there was moderate-quality evidence that arm support with an alternative mouse reduced the incidence of neck/shoulder disorders (risk ratio [RR] 0.52) but not the incidence of right upper limb MSDs (RR 0.73), and low-quality evidence that this intervention reduced neck/shoulder discomfort (standardized mean difference (SMD) -0.41) and right upper limb discomfort (SMD -0.34). There also was moderate-quality evidence that the incidence of neck/shoulder and right upper limb disorders were not reduced when comparing alternative mouse and conventional mouse (neck/shoulder RR 0.62; right upper limb RR 0.91), arm support and no arm support with conventional mouse (neck/shoulder RR 0.67; right upper limb RR 1.09), and alternative mouse with arm support and conventional mouse with arm support (neck/shoulder RR 0.58; right upper limb RR 0.92). There was low-quality evidence that using an alternative mouse with arm support compared with conventional mouse with arm support reduced neck/shoulder discomfort (SMD -0.39). There was low- to very low-quality evidence that other interventions were not effective in reducing work-related upper limb and neck MSDs in adults.

    Call for Chair and ISC Committee Members: WCPT Congress 2015

    The World Confederation for Physical Therapy (WCPT) is recruiting for its International Scientific Committee (ISC) for WCPT Congress 2015. Physical therapists who are APTA members are encouraged to submit applications to serve as a member of the ISC or ISC chair.

    Qualifications; responsibilities; essential and desired experience, knowledge and skills, and attributes; and terms of reference can be found in the call for applications for ISC chair and ISC members. 

    Applications must be supported by a WCPT member organization, region, or subgroup. To obtain a letter of support from APTA, PTs should send their CV and letter of application addressing the specifications outlined in the call to Rene Malone, APTA senior research coordinator, by 5 pm ET on September 5. 

    Despite Benefits, Few Pregnant Women Follow Exercise Guidelines

    Women who exercise 1-2 times a week are less likely to report low back pain and depression, say authors of a study that followed 3,482 pregnant women in Norway. Women exercising 3 or more times a week during pregnancy are less likely to report pelvic girdle pain and low back pain, although the result for low back pain was not found to be significant. Despite these benefits, few women follow current exercise prescriptions for exercise in mid-pregnancy, the authors add.    

    The authors collected data by questionnaire in pregnancy weeks 17-21, pregnancy week 32, and at birth. Only 14.6% of the respondents followed the current exercise prescription for exercise during pregnancy (3 or more times a week for at least 20 minutes at moderate intensity). One-third of the study sample exercised less than once a week at pregnancy weeks 17-21. Women who exercised at least once a week at mid-pregnancy were more often primiparous, higher-educated, and less likely to have a prepregnacy body mass index of greater than 30 kg/m2 than women exercising less than once a week.

    The study is published online in British Journal of Sports Medicine

    APTA's consumer e-book, Women's Health Across the Lifespan, and an APTA video explain how PTs can help pregnant women with low back pain. Share these and other women's health resources with your patients by linking to Move Forward from your website.     

    CBO Reduces Medicare Spending Forecast

    The Congressional Budget Office (CBO) reduced its spending forecasts yesterday from earlier this year for Medicare by $19 billion for 2012 and by $169 billion over the coming decade, projecting total spending at $7.7 trillion for the 10 years ending in 2022, according to Reuters

    The change reflects lower spending growth for physicians, hospitals, and prescription drugs since the US economy went into recession in 2007. CBO states the slower growth of Medicare is "consistent with slower growth in health care costs more generally in the economy." This is the third consecutive year that CBO has reduced its forecasts for Medicare spending, says the article.

    CBO also predicted that Medicaid would also spend less money--$375 billion or 7% less than expected over the coming decade. This projection changed largely as the result of the Supreme Court's decision allowing states to choose whether or not to expand eligibility for coverage under their Medicaid programs.