Health care utilization and cost data released in the name of "transparency" continue to make headlines, and physical therapists (PTs) need to have a solid grasp of what's already out there—and what's to come—in order to help patients, clients, and other stakeholders understand what all the information means in context. The September issue of APTA's members-only PT in Motion magazine provides a starting point for getting a handle on this fast-growing trend.
In this issue's "Compliance Matters" section, Gayle Lee, JD, APTA senior director of health finance and quality provides a quick history of the push for transparency and an analysis of one of the most dramatic data releases to date—2012 Medicare payment figures for some 880,000 health care professionals, including nearly 38,000 PTs, searchable by provider name and National Provider Identifier (NPI) number.
Lee asserts that "the dataset is insufficient to draw meaningful conclusions about the billing practices or quality of care of individual PTs," and provides a list of limitations that prevent the presentation of complete picture. The article also looks at PT payments in particular and includes a chart showing the top 10 procedures in physical medicine and rehabilitation services in 2012 by total payments.
"It is clear that consumer outcry for price transparency will not abate," Lee writes. "Not only will the federal government release more information in the future, but private insurers are expected to follow suit."
Hardcopy versions of PT in Motion are mailed to all members who have not opted out; digital versions are available online ahead of print to members.
A newly published meta-analysis of randomized controlled trials (RCTs) supports the use of constraint-induced movement therapy (CIMT) for children with cerebral palsy as an effective intervention for upper-limb function, albeit one whose effectiveness isn't necessarily a slam dunk over other dose-equivalent approaches.
The study, e-published ahead of print in Clinical Rehabilitation (abstract only available for free) looked at 27 RCTs between 2004 and 2014 that included 894 participants with cerebral palsy ranging in age from 2.4 to 10.7 years. The majority of studies focused on a 5 day per-week intervention over the course of 2 to 3 weeks, and restraints included slings, gloves, mittens, and casts.
Authors write that the studies showed a medium effect of CIMT on arm function—results that they describe as "similar to the effect of [CIMT] when used in adults with stroke." When they applied the International Classification of Functioning, Disability and Health (ICF) model to the results, they found that CIMT resulted in medium improvements to activity level immediately after the intervention and to participation level during follow-up.
Effectiveness was also affected by location of the intervention, according to the study, with home-based settings producing better results than clinic or camp-based settings. "The natural environment … offered less distress during [CIMT] practice for both children with cerebral palsy and their parents," authors write. "Further the training schedule can be tailored to fit into the family's daily routine."
The CIMT approach didn't fare as well when a longer follow-up time was used, authors write, "consistent with the logical assumption that the [CMIT] effect could not be maintained over time." Additionally, when compared to dose-equivalent groups, the groups receiving CIMT showed only "slightly better" results, as opposed to the "large effect" noted when compared to interventions that were not dose equivalent.
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
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