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  • APTA Attends RNC; Gears Up for DNC

    APTA attended the Republican Nation Convention (RNC) this week in Tampa, Florida. Next week, the association heads to Charlotte, North Carolina, for the Democratic National Convention (DNC). 

    The conventions provide an opportunity for APTA to represent the interests of the physical therapy profession through meetings with key congressional leaders from both parties and participation in various briefings and events. This week at the RNC, APTA had a presence at key health care policy briefings and interacted with several members of Congress who serve on committees important to APTA’s public policy priorities. APTA has had a long-standing presence at both conventions.  

    In a convention highlight on Wednesday, Ann Romney spoke about her experiences with physical therapy. See related article titled "Ann Romney Expresses Support for Physical Therapy."  

    You can follow APTA at the RNC and DNC on Twitter.

    Ann Romney Expresses Support for Physical Therapy

    At a ribbon cutting ceremony for a therapeutic playground at All Children's Hospital, in St Petersburg, Florida, Ann Romney spoke about how physical therapy helped her after her multiple sclerosis diagnosis at age 49. At that time, Romney had lost the use of her right side.    

    The ceremony followed her appearance Tuesday night at the Tampa Bay Times Forum.

    Help Celebrate Extraordinary PTs and PTAs

    Do you know an extraordinary physical therapist (PT) or physical therapist assistant (PTA) who deserves recognition for outstanding personal and professional achievement? By nominating the person or people you feel are most deserving of an APTA Honor or Award for 2013, you can help APTA celebrate their many contributions to the physical therapy profession. 

    APTA now is accepting Honors and Awards nominations. Your participation in the nominating process is extremely important. It's quick, easy—and in keeping with APTA's green initiative, all APTA national Honors and Awards applications are available for electronic submission.    

    Go to www.apta.org/honorsawards and submit your nominations online. All submissions must be received by December 1.  

    E-mail questions to honorsandawards@apta.org or call 800/999-2782, ext 3233, for more information.

    In California, a Rough Ride for Senate Bill 924

    California physical therapists (PTs) have been infuriated by the legislatively wrangling that California SB 924 has been subject to during the past 2 weeks, made all the more frustrating because the bill is stalled in the Assembly Rules Committee during this last week of the California legislative session. 

    The legislation, a compromise bill brokered by California Senate President Darrell Steinberg and sponsored by state Sen Curren Price, was intended to end a long and bitter battle in the state legislature between the California Chapter and the California Medical Association (CMA) over the issues of direct access to physical therapist services, and whether PTs may be employed by, or be shareholders of, medical corporations, and alternatively whether physicians may be employed by or shareholders of PT corporations. While the chapter supported the direct access elements of SB 924, it was not in favor of the corporation aspect of the bill. Conversely, CMA supported the corporation language in the bill and remained adamantly opposed to allowing direct access.

    For the most part, the legislation had been moving without major incident through the California legislature; SB 924 passed the Senate unanimously on January 30, and passed the Assembly Business & Professions Committee on June 26. 

    The flare-up started on Thursday, August 16, when SB 924 passed unanimously out of the Assembly Appropriations Committee, but not before the committee made hostile amendments to the direct access aspects of the bill behind closed doors, without input from the California Chapter or the bill’s chief sponsor, Sen Price. Under the prior compromise version of SB 924, a signed plan of care from a physician or podiatrist was required to continue treatment after the initial 30 business days or 12 visits provided via direct access; the physical therapist also needed to provide written disclosure to the patient explaining the provisions tied to the direct access law. As amended by the Assembly Appropriations Committee, a diagnosis from a physician or podiatrist must be obtained after the initial 30 business days or 12 visits via direct access in order to continue treatment. The disclosure language the PT must provide to the patient also was amended to add language stating the private insurance may not pay for the services without a physician referral. The amendments made by the Appropriation Committee were held from the public for 5 days before being released, causing an uproar.

    The bill took another turn on Friday, August 24, when the amendments that were placed into SB 924 during the Assembly Appropriations Committee hearing were removed on the Assembly floor, while new unwelcome amendments were added. But shortly thereafter Assembly Speaker John A. Pérez referred SB 924 to the Assembly Rules Committee, a procedural stall tactic, where SB 924 may stay until the end of the legislative session. If SB 924 is not moved from the Assembly Rules Committee and sent to the Assembly floor for a full vote by midnight Friday, August 31, SB 924 will die. The California Chapter is urging its members to contact their Assembly member to ask for an up–or-down vote on SB 924 by the full Assembly before the midnight deadline this Friday. The full text of the current version of SB 924 is available here.

    Governance Proposal Town Halls Scheduled

    To provide members opportunities for conversation related to the governance proposal and garner feedback about the elements that members support, are uncertain about, or do not support, a series of virtual town hall discussions centered on House of Delegates processes have been scheduled. The first town hall will be held on September 18. To offer members on both coasts ample opportunity to take part in the conversation, APTA has scheduled 2 town halls for that evening, 6 pm-7:30 pm Eastern Time and 10 pm-11:30 pm Eastern Time. Contact Amber Neil if you are interested in attending. Additional town halls will be held on September 20 and 27 at the times indicated above.

    Minutes of the 2012 House Posted

    Minutes of the 2012 House of Delegates (House) now are available. The minutes provide information on how the House revised and voted on all motions and bylaw amendments brought forward this year. The document is housed in the House of Delegates community's archive folder. In addition, the Policies and Bylaws page on APTA's website also has been updated to reflect policies that were adopted or amended at the 2012 House.

    Aetna Clarifies 97001/97002 Not Included in Policy Change

    In communication with New York Chapter leaders, Aetna has clarified that 97001 and 97002 are not included in a policy change published on page 2 in its September 2012 OfficeLink Updates™.

    The publication includes an updated policy for evaluation and management codes billed by certain nonphysician provider types, which becomes effective December 1. The policy states that evaluation and management codes will not be allowed for physical therapists, occupational therapists, speech therapists, audiologists, dieticians, and nutritionists. Aetna representatives have confirmed that the policy applies to codes in the 992xx series, and will not be billable by physical therapists. However, physical therapists will continue to be able to report 97001 and 97002 for evaluation and reevaluation.

    New Podcast: Introduction to the Therapy Cap Manual Medical Review Process

    A new APTA podcast and transcript provide an overview of the manual medical review process for Medicare claims for beneficiaries who reach $3,700 in outpatient therapy expenditures in a calendar year.

    Under the new therapy cap exceptions process, outpatient therapy patients will still be eligible for an automatic exception at the 2012 therapy cap level of $1,880. Therapists will follow the same process of applying the KX modifier on the claim form when a patient exceeds the cap amount. Claims for patients who then meet or exceed $3,700 in therapy expenditures will be subject to a manual medical review process that will be implemented in 3 distinct phases beginning October 1, November 1, and December 1. (See last week's News Now  article for more information about provider assignment to the phases.)

    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. Next week, APTA will record a webinar that will address the therapy cap and the manual medical review process. News Now will provide a link to the recording, which will be free to members, when it is available.

    APTA Joins Initiative to Develop National Safe Patient Handling Standards

    Earlier this summer, APTA served on an expert panel as part of the American Nurses Association's (ANA) broad-based effort to develop national standards to guide hospitals and other health care facilities in their implementation of policies and equipment to safely lift and move patients.

    Ken Harwood, PT, PhD, CIE, represented APTA on the panel that included 26 specialists with expertise in nursing, physical therapy, occupational therapy, ergonomics, architecture, health care systems, and other disciplines to create overarching standards for implementing safe patient handling programs and detailed guidelines for making them work effectively in practice. The Safe Patient Handling National Standards Working Group plans to distribute the standards and guidelines to their professional memberships for comment in October, with publication and release set for March 2013.

    The panel is seeking to build a consensus of evidence-based best practices in safe patient handling that will apply to multiple health care professions and settings. The panel's goal is to develop language that can be incorporated nationwide into practices, policies, procedures, and regulations and become the basis for resource toolkits and certifications.

    Currently, there are no broadly recognized government or private industry national standards for safe patient handling. Health care facility programs lack consistency, as do regulations in 10 states that have enacted safe patient handling laws. In the meantime, health care professionals continue getting injured, and musculoskeletal injury remains a top concern, says ANA.

    New in the Literature: Back Care in Children and Adolescents (BMC Musculoskelet Disord. 2012. August 21. [Epub ahead of print])

    Physical therapy interventions for back care in children and adolescents are successful in significantly increasing healthy behaviors and knowledge acquired both in the posttest and in the follow-up, say authors of a meta-analysis published in BMC Musculoskeletal Disorders. The combined treatment of postural hygiene with physical therapy exercise exhibits the best results. The small number of studies limits the generalizability of the results, they add.

    The authors located studies from the Cochrane Library, Medline, PEDro, Web of Science and IME, and other sources. The search period extended to May 2012. To be included in the meta-analysis, studies had to use physical therapy methodologies of preventive treatment on children and adolescents and compare a treatment and a control group. Treatment, participant, methodological, and extrinsic characteristics of the studies were coded. Two researchers independently coded all of the studies. As effect size indices, standardized mean differences were calculated for measures of behaviors and knowledge, both in the posttest and in the follow-up. The random and mixed-effects models were used for the statistical analyses. Sensitivity analyses were carried out to check the robustness of the meta-analytic results.

    A total of 19 papers fulfilled the selection criteria, producing 23 independent studies. On average, the treatments reached a statistically significant effectiveness in the behaviors acquired, both in the posttest and in the follow-up (d+ = 1.33 and d+ = 1.80, respectively), as well as in measures of knowledge (posttest: d+ = 1.29; follow-up: d+ = 0.76). Depending on the outcome measure, the effect sizes were affected by different moderator variables, such as the type of treatment, the type of postural hygiene, the teaching method, or the use of paraprofessionals as cotherapists.

    APTA Launches First Fall Legislative Cosponsor Drive

    APTA is launching its first annual Fall Cosponsor Drive and needs your help. Building upon the success of the Federal Advocacy Forum, held April 22-24, APTA wants to reach 200 cosponsors for Medicare therapy cap repeal legislation (HR 1546) and 150 cosponsors for student loan repayment legislation (HR 1426) by December 31. Currently, the bills have 170 and 117 cosponsors, respectively. APTA has been working diligently to educate members of Congress on Capitol Hill about these issues and now needs association members to echo these messages at the local level. Several congressional representatives have requested that PTs, PTAs, and PT students contact their district offices and express their support for these bills. This is your opportunity to contact your representative and ask him or her to cosponsor HR 1546 and HR 1426.

    APTA has several resources to help you educate your legislator on these issues. You can identify if your representative is currently a cosponsor, view position papers and background information, and track the progress of the Cosponsor Drive on the Medicare Therapy Cap and Student Loan Repayment Cosponsor Drive webpages. You also can e-mail your representative and ask him or her to repeal the therapy cap and support legislation allowing physical therapy students to participate in loan forgiveness programs.

    If you have questions about the Cosponsor Drive, contact APTA's Grassroots and Political Affairs Department at 800/999-2782, ext 3170, or advocacy@apta.org.

    Midlife Fitness Keeps Chronic Disease at Bay

    Being physically during midlife not only helps extend lifespan, but it also increases the chances of aging healthily, free from chronic illness, investigators at the University of Texas Southwestern Medical Center and The Cooper Institute have found.

    The association between cardiorespiratory fitness and mortality is well described, say the study's authors. However, it previously had been unknown just how much fitness might affect the burden of chronic disease in the most senior years—a concept known as morbidity compression.

    Researchers examined the patient data of 18,670 participants in the Cooper Center Longitudinal Study, research that contains more than 250,000 medical records maintained over a 40-year span. These data were linked with the patients' Medicare claims filed later in life from ages 70 to 85. Analyses during the latest study showed that when patients increased fitness levels by 20% in their 30s, 40s, and 50s, they decreased their chances of developing chronic diseases—congestive heart failure, Alzheimer disease, and colon cancer—decades later by 20%.

    "What sets this study apart is that it focuses on the relationship between midlife fitness and quality of life in later years," said Benjamin Willis, MD, MPH, lead author of the study. "Fitter individuals aged well with fewer chronic illnesses to impact their quality of life."

    This positive effect continued until the end of life, with more-fit individuals living their final 5 years of life with fewer chronic diseases. The effects were the same in both men and women.

    The study was published online August 27 in Archives of Internal Medicine.  

    Mobile App Helps Women Learn About Health in 52 Weeks

    A new app from the National Institutes of Health (NIH) offers women access to a year's worth of practical health information, highlighted week by week.

    The app can help women identify health risks for themselves and their families, and can help them create and maintain healthy lifestyles throughout their lives. Questions to ask health care providers, a glossary of health terms, and health screening information and links to additional information from NIH institutes and centers expand the mobile app's offerings.

    Key features of the app are:

    •a personal health section for recording medications, medical conditions, and disabilities

    •a journal feature

    •a personal goal-setting section for health and lifestyle details

    The app is based on the Primer for Women's Health: Learn about Your Body in 52 Weeks, published by NIH's Office of Research on Women's Health.

    Content also is accessible without the use of a handheld device, at http://52weeks4women.nih.gov/. In the near future, NIH will launch an app for men's health with similar features.

    HHS Seeks Comments on New Digital Strategy

    To help "cut loose content, work better, and put people first," the US Department of Health and Human Services (HHS) is seeking comments on how it provides public health information on the web.   

     HHS' initiative is part of the federal government's new digital strategy, which aims to shift the way government information is accessed and consumed. Instead of focusing on simply producing a final product, which has been common practice for years, the government's strategy now will be to make content more accurate, available, and secure. This strategy aims to "open doors for communication and give everyone the opportunity to use government information in a more meaningful way." 

    Visitors to HHS' digital strategy webpage can post their thoughts and suggestions for next steps under 4 areas that can be accessed by the tabs located at the top of the page—people first, mobile, open data, and working better. Specific to "open data," HHS is interested in the types of datasets that should be added to healthdata.gov.

    HHS will explain how the collective comments, along with the metrics it collects on user experience, influence the agency's work. 

    Mergers Help Companies 'Cope' With Smaller Profits, Compliance Costs

    Two mergers announced last week suggest that the health care industry is "increasingly turning to consolidation as a way to cope with smaller profit margins and higher compliance costs that many anticipate" when reforms under the Affordable Care Act take effect, says a Washington Post article.     

    Both acquisitions will affect the Washington, DC, area. On August 20, Aetna announced it will buy Maryland-based Coventry Health Care, which provides Medicare and Medicaid services, for $5.7 billion. Two days later, Health Care REIT announced an $845 million deal to acquire Sunrise Senior Living, which is based in McLean, Virginia. Sunrise manages 300 senior living facilities in the United States, Canada, and the United Kingdom, including 25 in the Washington region. 

    The Coventry deal will add 5 million members to Aetna's existing pool of 36.7 million enrollees. The merger will help Aetna reduce overhead costs and boost Coventry's ability to market to more consumers on state-run health insurance exchanges, the article says.

    Aetna's planned purchase of Coventry follows similar announcements of large acquisitions. In October 2011, Cigna reached an agreement to acquire HealthSpring. Last month, WellPoint announced plans to acquire Amerigroup.

    Because a real estate investment trust such as Health Care REIT cannot both own and operate its real estate, Sunrise will likely continue to be run independently.

    Still, many health care experts predict nursing homes, senior communities, and other long-term care facilities will follow a similar path of consolidation because small and mid-size operators will struggle to afford compliance costs, the Post says. 

    Final Rule Postpones ICD-10 Implementation Until 2014

    In a rule issued today, the Department of Health and Human Services (HHS) made final a 1-year proposed delay—from October 1, 2013, to October 1, 2014—in the compliance date for use of ICD-10 codes.

    The rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013—a delay of 2 years from the compliance date initially specified in the 2008 proposed rule. In February, HHS announced it would postpone the 2013 deadline in an effort to address the provider community's concerns about administrative burdens. In April, HHS proposed the transition be delayed until October 2014.  

    Today's final rule also establishes the standard for a national unique health plan identifier and a data element that will serve as an "other entity" identifier. This is an identifier for entities that are not health plans, health care providers, or individuals, but that need to be identified in standard transactions. The rule also specifies the circumstances under which an organization-covered health care provider, such as a hospital, must require certain noncovered individual health care providers who are prescribers to obtain and disclose a National Provider Identifier.

    APTA's ICD-10 webpage has resources to help physical therapists understand the transition to the new code set.

    Final Rules on EHR Meaningful Use Incentive Program and HIT Standards Released

    Yesterday the Department of Health and Human Services released final rules related to electronic health records (EHR) and health information technology (HIT). While at this time physical therapists are not directly affected by the rules related to meaningful use under Medicare and Medicaid, they should remain aware of issues relating to HIT technology, particularly in this dynamic health care delivery environment.

    The final rule on Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 2 specifies the necessary criteria eligible professionals (EP) and eligible hospitals (including critical access hospitals) must meet to receive incentive payments for achieving Stage 2 meaningful use requirements with their certified EHR systems. The rule also specifies payment adjustments for entities and providers that do not meet meaningful use requirements and other program requirements. Physical therapists are not yet defined as eligible professionals for demonstrating meaningful use and, therefore, are not subject to these payment adjustments for failing to demonstrate meaningful use. Certain criteria previously specified in regulations have also been revised, including certain Stage 1 criteria, such as allowing "states the option for their providers to calculate total Medicaid encounters or total needy individual patient encounters in any representative, continuous 90-day period in the 12 months preceding the EP or eligible hospital's attestation" for those participants in the Medicaid Incentive Program.

    The second rule relating to EHR certification criteria identifies the implementation specifications and other technical standards that EPs' and hospitals' EHR systems must meet to be deemed certified for supporting meaningful use requirements. These systems must be capable of meeting these standards and specifications, at a minimum, by fiscal and calendar year 2014 to be able to support eligible entities in achieving their meaningful use requirements. Additionally, the rule revises the HIT permanent certification and changes the name to the ONC HIT Certification Program. This final rule is titled Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology.   

    APTA will post summaries of both rules on the APTA website at a later date.

    While physicians and hospitals are the beneficiaries of many of the federal government's initial efforts to encourage EHR system adoption, they will expect the other providers they work with, including physical therapists, to implement it as well. Patients also may begin to expect their providers to use EHRs to manage their care. Visit APTA's HIT webpage for resources and updates on HIT program development and legislation, as well as APTA's related advocacy efforts.

    ABPTRFE Approves APTA Education Leadership Institute Fellowship Program

    The American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) recently approved the APTA Education Leadership Institute (ELI) Fellowship as the first nonclinical credentialed postprofessional fellowship program. Official commencement of this prestigious credential begins August 31and will continue for a period of 5 years. The 2012 inaugural graduating class from the Education Leadership Institute will receive the designation of Fellow of the APTA Education Leadership Institute. The Education Leadership Institute will be recognized by ABPTRFE as a credentialed fellowship at APTA's 2013 Combined Sections Meeting in San Diego.

    Applications for the class of 2013-2014 will be available on APTA's website on October 1, with the submission deadline on January 4, 2013, at 5 pm ET.

    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.

    Top Concerns of ACOs: Reducing Clinical Variation, Cost of Care

    Among hospitals that currently are participating in an accountable care organization (ACO), the top 3  challenges they encounter are reducing clinical care variation, reducing the cost of care, and developing and maintaining a common culture among the various ACO partners, says a new issue brief by the Commonwealth Fund. Increasing the size of the covered patient population, developing an information system infrastructure, and accessing capital to invest in the ACO model are the top concerns of hospitals preparing to partici­pate in an ACO.

    As of summer 2012, 154 groups are participating in ACO initiatives sponsored by the Centers for Medicare and Medicaid Services (CMS). Thirty-two organi­zations have signed contracts to become Pioneer ACOs, 116 organizations have enrolled in the CMS Shared Savings Program, and 6 have joined the Physician Group Practice Transition demonstration program. In all, more than 2.4 million Medicare ben­eficiaries are receiving care from providers participat­ing in these initiatives.

    Numerous other organizations have contracts with private payers that include many of the key features of the ACO model. A recent report identified 221 ACOs in 45 states as of May 2012. This number includes both CMS and private sec­tor ACOs.

    Nineteen percent of hospitals participating or preparing to participate in an ACO report using predictive tools to identify patients at high risk of poor health outcomes or high resource use, compared with 9% of those not exploring the ACO model. Further, 28.4% of those participating or preparing to participate in an ACO report managing high-volume, high-cost patients using experienced case managers, compared with 19.5% of those not exploring the ACO model.

    Only 50% of hospitals currently participating in an ACO track performance data; the other half plans to do so within the next 3 years.

    All hospitals—regardless of whether they are participating in ACOs, in planning phases, or not considering the model—expect an average 11% decrease in the percent of their revenue coming from fee-for-service payments in the next 3 years.

    Check out what your peers are saying about physical therapy and ACOs on APTA's collaborative care models communities discussion forum. Visit the collaborative care webpage for information and resources on ACOs, bundled payment models, and patient-centered medical homes.  

    CMS Launches Interactive Provider Compliance Group Map

    The Centers for Medicare and Medicaid Services (CMS) recently launched an interactive map to help providers determine state-specific organizations that provide Medicare auditing and compliance services. The map includes contact information, e-mail addresses, and websites for state organizations. It also features the CMS divisions responsible for contractors and definitions of contractors and their roles.

    New Podcasts Address Physical Therapy and the Role of Hospice and Palliative Care

    Two new APTA podcasts provide guidance to physical therapists (PTs) regarding the distinct approaches of hospice and palliative care services and the role that physical therapy plays in treating  individuals in those situations.      

    The first podcast clarifies the 2 terms "hospice" and "palliative" based on Medicare's conditions of participation guidance published June 5, 2008, in the Federal Register. It also highlights APTA's position The Role of Physical Therapy in Hospice and Palliative Care, which was adopted by the 2011 House of Delegates. 

    In the second podcast, Chris Wilson, PT, DPT, GCS, describes how patients in acute care can experience rapid changes in the ability to perform activities of daily living and why regular monitoring and intervention by PTs may be required. Wilson, who provides acute care physical therapy service in the Hospice and Oncology Unit and outpatient oncology services at Beaumont Health System near Detroit, Michigan, also explains the role PTs may play in determining when less-aggressive measures, such as hospice or palliative care, may be appropriate for patients. Additionally, he addresses the need for PTs to consider the big picture and respect a patient's autonomous decision to decide what care is best—particularly when a patient opts to come off hospice care in order to qualify for a nursing home stay or rehabilitate to improve his or her strength to be able to return home.

    Find more information on this topic on APTA's Hospice and Palliative Care webpage.

    New Resource Shows Value of Physical Therapy in the Emergency Department

    Several leading primary emergency department (ED) diagnoses have the potential for physical therapy triage and possible treatment, according to a new APTA resource that members can use with facility administrators or ED staff to illustrate the value of physical therapy in the ED. Developed by the member experts who created the Incorporating Physical Therapist Practice in the ED: A Toolkit for Practitioners, this new PowerPoint outlines recent ED trends, potential benefits of having physical therapists (PTs) in the ED, and how ED PTs can improve patient satisfaction and patient function and outcomes.   

    APTA members can download the PowerPoint and tailor it for their specific presentation needs.  Find the Value of Physical Therapy in the ED PowerPoint and other resources on APTA's Physical Therapist Practice in the Emergency Department webpage.

    Few Patients Seek Care at Retail Clinics for Chronic Conditions

    "Despite the controversy over the entry of retail clinics into chronic disease management," say authors of a new study published online in Health Affairs, less than 1% of visits through 2009 were for chronic disease care.

    The number of patient visits to retail clinics grew from 1.48 million in 2006 to 5.97 million in 2009. Preventive care—in particular, the influenza vaccine—was a larger component of care for patients at retail clinics in 2007-2009, compared with patients in 2000-2006 (47.5% versus 21.8%). Across all retail clinic visits, 44.4% of visits in 2007-2009 were on the weekend or during weekday hours when physician offices are typically closed.

    From 2000-2006 to 2007-2009, the proportion of retail visits made by children under age 18 decreased, from 26.8% to 22.2%, while the proportion of visits made by those 65 or older increased, from 7.5% to 14.7%. In both study periods, 30%-40% of the patients who visited a retail clinic paid for their care out of pocket and reported having a primary care physician.

    Acute care visits made up a smaller proportion of overall visits in 2007-2009 than in 2000-2006. The same 9 conditions accounted for the vast majority of acute care visits in both time periods. The distribution of acute and preventive care visits was similar for children and adults under age 65.

    The authors say that the "rapid growth of retail clinics makes it clear that they are meeting patients' needs." They believe that the chief drivers are convenience, after-hours accessibility, and cost effectiveness.  

    APTA Educates State Lawmakers on PT Issues at NCSL

    APTA was again a leading exhibitor at the National Conference of State Legislatures (NCSL) annual Legislative Summit, held August 6-9, in Chicago. APTA's sponsorship and participation in the seventh annual NCSL "Walk for Wellness" and the association's physical therapy information booth were prominent features at this year's event. State lawmakers and legislative staff participated in warm-up exercises, led by Patti Naylor, PT, MS, and Chris Egizio, PT, at the "Walk for Wellness," a 5K run/walk to raise awareness of conditions such as heart disease, diabetes, and obesity, while drawing attention to health disparities that exist in underserved communities.

    In addition, conference attendees took the "PT Challenge" at APTA's exhibit booth. Participants who correctly answered quiz questions on direct access, protection for the term "physical therapy," and the detrimental effect of high patient copays for PT services, were entered into a drawing for a Kindle Fire. This and other activities drew numerous state lawmakers from across the country to APTA's booth, where APTA State Government Affairs staff and Illinois Chapter volunteers educated them about direct access to physical therapist services, referral for profit (POPTS), infringement concerns, reimbursement challenges, and other issues important to the physical therapy profession at the state level.

    Blood Pressure Control Inadequate 1 Year After ICH, Particularly in Black Population

    Black people who survive strokes caused by an intracranial hemorrhage (ICH) are more likely than whites to have high blood pressure a year later—increasing their risk of another stroke, according to a study in the American Heart Association journal Stroke.

    The study was conducted at Georgetown University Medical Center, Washington, DC, and included 162 patients (average age 59, 77%, 53%).

    ICHs account for only 10% of all strokes but have a death rate of about 40% in the first month, much higher than other types of stroke. High blood pressure is the most important modifiable risk factor associated with bleeding stroke.

    However, more than half of patients in the study still had high blood pressure a year after the stroke, despite taking 1 or more antihypertensive medications. There were no significant racial differences 30 days after ICH. But a year later, 63% of blacks had hypertension, compared with 38% of whites, despite taking more blood pressure medications.

    The study was too small to identify which factors may explain the racial differences. However, the authors say that factors associated with lower blood pressure at follow-up in multivariable analysis were being married and living in a facility rather than a personal residence.   

    New York Times Publishes APTA Letter to Editor

    The New York Times August 14 issue included APTA's letter to the editor about how physical therapists can help women with vaginal pain. APTA submitted the letter, which also was published online, in response to an August 7 article titled "Persistence Is Key to Treating Sexual Pain."

    New Podcast Series to Focus on Telehealth in Physical Therapist Practice

    APTA has launched a new podcast series that will address physical therapists' practice in the realm of telehealth. The first podcast in the series provides an overview of telehealth and focuses on providing integumentary and wound management physical therapy rehabilitation services via telehealth. Harriett B. Loehne, PT, DPT, CWS, FACCWS, the recipient of the 2010 Georgia Partnership for TeleHealth Partner of the Year Award, shares her experiences with 2 telemedicine  systems—Real Time and Store-and-Forward—and how they have helped expand staff's advanced wound management knowledge in a manner that has been cost effective, timely, and efficient for patients and health care providers. 

    Alan Chong W. Lee, PT, DPT, PhD, CWS, GCS, associate professor of physical therapy at Mount St Mary's College, hosts the podcast. Loehne currently performs more consults via telemedicine than any other consultant in Georgia.  

    New in the Literature: Enhanced Medical Rehabilitation of Older Adults (J Am Med Dir Assoc. 2012 August 2. [Epub ahead of print])

    Higher intensity and patient engagement in the postacute rehabilitation setting is achievable, resulting in better functional outcomes for older adults, say authors of an article published online in Journal of the American Medical Directors Association.  

    Twenty-six older adults admitted from a hospital for postacute rehabilitation in a skilled nursing facility in St Louis, Missouri, participated in a randomized controlled trial of enhanced medical rehabilitation versus standard-of-care rehabilitation. Based on models of motivation and behavior change, enhanced medical rehabilitation is a set of behavioral skills for physical therapists and occupational therapists that increase patient engagement and intensity, with the goal of improving functional outcomes through a patient-directed, interactive approach; increased rehabilitation intensity; and frequent feedback to patients on their effort and progress.

    The authors assessed therapy intensity using the time that the patient was active in therapy sessions. Therapy engagement was assessed using the Rehabilitation Participation Scale. Functional and performance outcomes were measured using Barthel Index, gait speed, and 6-minute walk.

    Participants randomized to enhanced medical rehabilitation had higher intensity therapy and were more engaged in their rehabilitation sessions. They had more improvement in gait speed (improving from 0.08 to 0.38 m/s versus 0.08 to 0.22 m/s in standard of care) and 6-minute walk (from 73 to 266 feet versus 40 to 94 feet in standard of care), with a trend for better improvement of Barthel Index (+43 points versus +26 points in standard of care), compared with participants randomized to standard-of-care rehabilitation.

    APTA member Helen Host, PT, coauthored the article. 

    On-site Reviewers for PTA Programs Needed

    The Commission on Accreditation in Physical Therapy Education (CAPTE) is seeking nominations for physical therapist assistant (PTA) on-site reviewers to evaluate accredited programs. While CAPTE always seeks individuals committed to the accreditation and peer review process it embodies, it now is looking specifically for PTA on-site review team members who are APTA members and currently work as PTA clinicians and for higher education administrators (eg, president, provost, vice president of academics or instruction, department or division chair) who are involved with an accredited PTA program at their institution. Interested PTAs can find additional information and requirements in this Call for On-site CAPTE Reviewers.   

    HHS Releases Final Guidance for Exchanges

    Yesterday, the Department of Health and Human Services' (HHS) Center for Consumer Information and Insurance Oversight released the final Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges. Most qualified health plans offered in these exchanges must offer plans that included the 10 mandatory categories of essential health benefits as mandated by the Affordable Care Act, which include rehabilitative and habilitative services.

    The guidance sets out timelines and requirements for state exchange documents (ie, "blueprints") each state must file with HHS. The document explains what type of exchange the state will run and how it will comply with the requirements.

    A complete blueprint and declaration letter (specifying the chosen exchange model) must be submitted no later than November 16 for states seeking to operate a state-based or state partnership exchange for plan year 2016. Those states that submit letters more than 20 business days before the submission of their blueprints may request additional consultation and support from the Centers for Medicare and Medicaid Services to assist in blueprint preparation.

    States that intend to operate in a federally-facilitated exchange but retain control of their own reinsurance programs also must submit a declaration letter by November 16.

    HHS will begin plans to implement a fully federally-facilitated exchange in states that do not submit a blueprint and declaration letter before or by November 16.

    The final guidance was released in conjunction with the first of 4 regional implementation forums that HHS is holding this month in the District of Columbia, Atlanta, Chicago, and Denver.

    CDC: 12 States Report Obesity Prevalence of 30% or More in 2011

    In 2011, rates of adult obesity remained high, with state estimates ranging from 20.7% in Colorado to 34.9% in Mississippi, according to new data from the Centers for Disease Control and Prevention (CDC). Twelve 12 states reported a prevalence of 30% or more. The South had the highest prevalence of adult obesity (29.5%), followed by the Midwest (29%), the Northeast (25.3%), and the West (24.3%).

    In 2011, CDC made several changes to its Behavioral Risk Factor Surveillance System (BRFSS) that affect estimates of state-level adult obesity prevalence. First, there was an overall change in the BRFSS methodology, including the incorporation of cell phone-only households and a new weighting process. These changes in methodology were made to ensure that the sample better represents the population in each state. Second, to generate more accurate estimates of obesity prevalence, small changes were made to the criteria used to determine which respondents are included in the data analysis.

    Because of these changes in methodology, estimates of obesity prevalence from 2011 forward cannot be compared to estimates from previous years. Data collected in 2011 will provide a new baseline for obesity prevalence data collected in subsequent years.

    CMS Improves Internet-based PECOS

    Based on stakeholder feedback obtained over the last year, the Centers for Medicare and Medicaid Services (CMS) has made improvements to the Provider Enrollment, Chain, and Ownership System (PECOS), which allows most providers and suppliers to enroll in the Medicare program or make changes to their Medicare enrollment information via the Internet rather than through the paper form. The following upgrades aim to make PECOS more user-friendly:

    • Providers/suppliers now can submit their entire enrollment application including supporting documentation electronically with the new digital document feature. Hard copies of supporting documentation to the Medicare Administrative Contractors are no longer required. 
    • Individual providers who reassign benefits to individuals/organizations with multiple practice locations will be able to designate a primary and secondary practice location where services are rendered. Selecting a primary and secondary practice location does not restrict the provider from providing services at other practice locations associated with the individual/organization to which they are reassigning benefits. It is recommended that a primary and secondary practice location be specified, but it is not required.  
    • Providers/suppliers now can enter multiple contact persons in the contact information section and will have the ability to identify the contact's relationship to the provider/supplier. While Internet-based PECOS requires at least 1 contact person to be entered in this section, additional contacts and the relationship to the provider field are optional.
    • At least 1 managing employee now will be required when submitting a CMS 855A, CMS 855B, and CMS 855S enrollment application. Applications that do not include at least 1 managing employee will receive an error message in Internet-based PECOS under the error/warning check tab and will not be able to proceed with submitting the enrollment application. Internet-based PECOS also will recommend that at least 1 owner is entered for a CMS 855A, CMS 855B, and CMS 855S application. Applications that do not include at least 1 owner will receive a warning message under the error/warning check tab in Internet-based PECOS. This warning message will not prevent the user from submitting the enrollment application.
    • Providers/suppliers now will have the option to select "county" in the "geographic location" topic when identifying the geographic location where services are rendered for CMS 855A and CMS 855B enrollment applications. Prior to this feature the only available options were state, city, or zip code. When selected, Internet-based PECOS will populate the county field with all counties that exist within the enrollment state identified for the application.   
    • CMS has redesigned the CMS 855O paper application, which is used to enroll in Medicare solely to order and refer services, and those changes are reflected in Internet-based PECOS. Providers who are currently enrolled in Medicare and are of a specialty that is eligible to order and refer already have the ability to order and refer services. Therefore, they are not required to submit a separate CMS 855O enrollment application solely to order and refer services. 

    APTA members can find more information about the program on the association's PECOS webpage

    Functional-based Exercise Should Be Considered in Falls Prevention

    Functional-based exercise, such as such as ironing while standing on 1 leg, should be a focus for interventions to protect older, high-risk people from falling and to improve and maintain functional capacity, say authors of an article published August 7 in BMJ.  

    Researchers in Australia conducted a 3-arm randomized trial in which 317 residents of Sydney older than 70 years who had 2 or more falls or 1 injurious fall within the previous year were recruited and randomly assigned to 1 of the following interventions—a novel activity-integrated exercise program called Lifestyle integrated Functional Exercise (LiFE), a structured exercise program, or a gentle exercise control program.

    "In the LiFE approach, movements specifically prescribed to improve balance or increase strength are embedded within everyday activities, so that the movements can be done multiple times during the day… whenever the opportunity arises," write the authors. For example, a prescribed activity incorporating the balance strategy of "reducing base of support" might involve a tandem stand while working at a countertop, and over time could be upgraded to working while standing on 1 leg. A prescribed activity incorporating the strategy to increase strength by bending knees might involve squatting instead of bending at the waist to close a drawer, and could be upgraded to picking things up from the floor.

    The researchers performed follow-up at 6 months and 12 months after study participants started their programs. After 12 months of follow-up, the authors recorded 172 falls in the LiFE group, 193 in the structured exercise group, and 224 falls in the control group. The LiFE, structure exercise, and control groups had 21, 24, and 26 people who fell once, and 39, 41, and 45 who fell at least twice, respectively.

    "The LiFE program provides an alternative to traditional exercise to consider for fall prevention," say the authors. 

    Don't forget to sign up for the National Council on Aging's (NOCA) free webinar on August 28 and learn how you can participate in Falls Prevention Awareness Day, recognized September 22. Find patient care, consumer education, and NOCA resources, in addition to continuing education courses on balance and falls at www.apta.org/BalanceFalls/

    Hospitals Expected to Forfeit $280 Million in Medicare Payments Due to Readmissions

    More than 2,000 hospitals, including some nationally recognized ones, will be penalized starting in October under the Affordable Care Act's Hospital Readmissions Reduction Program, says a Kaiser Health News  article. Together, these hospitals will forfeit about $280 million in Medicare payments over the next year for excess readmissions for heart attack, heart failure, and pneumonia.

    The penalties will be the most severe in hospitals in New Jersey, New York, the District of Columbia, Arkansas, Kentucky, Mississippi, Illinois, and Massachusetts. Hospitals that treat the most low-income patients will be hit particularly hard.

    A total of 278 hospitals nationally will lose the maximum amount allowed under the health care law—1% of their base Medicare payments. Several of those are top-ranked institutions, including Hackensack University Medical Center in New Jersey; North Shore University Hospital in Manhasset, New York; and Beth Israel Deaconess Medical Center in Boston, the article says.

    The total number of hospitals receiving penalties is 2,211. According to Medicare records, 1,933 hospitals will receive penalties less than 1% percent. Massachusetts General Hospital in Boston, which has been rated as the best hospital in the country, will lose 0.5% of its Medicare payments because of its readmission rates.  

    Nearly 1 in 5 Medicare beneficiaries are readmitted within 30 days of discharge each year, costing Medicare 17.4 billion in additional hospital bills, according to a 2009 study on Medicare claims data from 2003-2004. The national average readmission rate has remained steady at slightly above 19%, even as many hospitals have worked to lower theirs, says Kaiser Health News

    Physical therapists can help serve an important role in patient care transitions and care coordination and can help reduce readmissions by providing recommendations for the most appropriate level of care to the health care team prior to and during care transitions. For more information and to find clinical practice and patient education resources to reduce readmissions, visit APTA's Hospital Readmissions webpage

    New Podcast: Improving Access to Care for Medicare Patients

    APTA member Danielle Haggerty, PT, explains how her practice has successfully provided direct access to Medicare beneficiaries in a new APTA podcast. Haggerty shares her office's protocol for obtaining a signed plan of care to ensure that patients have access to physical therapy services and payment is received, and discusses the importance of educating therapists and office staff on Medicare requirements. In addition, Haggerty explains why she opts to have physicians recertify the plan of care every 30 days and how this has turned into an "excellent marketing tool" that strengthens the practice's relationship with the physician community.          

    For more information about direct access and Medicare, go to www.apta.org/DirectAccess/Medicare/

    CMMI Seeks Reviewers for Bundling Payment Improvement Initiative

    Physical therapists are encouraged to apply to become review panelists for the Center for Medicare and Medicaid Innovation's (CMMI) Bundled Payments for Care Improvement Initiative. This initiative has 4 broadly defined models of care, 3 of which would involve a retrospective bundled payment arrangement, with a target price (target payment amount) for a defined episode of care and 1 of which would be paid prospectively. CMMI is ready to bring together expert panel members for the review of applications for models 2, 3, and 4. 

    Review panels will be held in Baltimore, Maryland, for 2 full days of meetings the week of September 19. Prior time commitment and travel to Baltimore will be required. Reimbursement of travel expenses and an honorarium will be offered.

    If you are interested in participating, e-mail Diane Graham by August 17. CMMI will evaluate the panel list, finalize the list of panel reviewers, and contact applicants by August 27.

    PPS Summaries for SNFs, IRFs Available From APTA

    APTA has posted summaries of recent notices from the Centers for Medicare and Medicaid Services (CMS) that update the payment rate used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) and for inpatient rehabilitation facilities (IRFs) for fiscal year 2013. The notices are effective October 1, 2012. Neither notice contains any substantive policy changes, and so there is no comment period for them.

    For the SNF PPS, the overall economic impact of the payment update is an estimated $670 million in increased payments to SNFs during fiscal year 2013. The market basket increase factor is 2.5%, which is reduced by a 0.7% multi-factor productivity adjustment. The result is a payment percentage update of 1.8% for the year. The SNF summary is available to APTA members on the Medicare Payment and Policies for Skilled Nursing Facilities webpage under the "APTA Summaries" heading.

    For the IRF PPS, the update provides a 1.9% net increase, resulting in an overall economic impact of $140 million during fiscal year 2013. The notice also includes the continued implementation of quality measures for IRF settings. The IRF summary is available to APTA members on the Medicare Payment and Policies for Hospitals webpage under the "Inpatient Rehabilitation/APTA Summaries" heading.

    Employers Increasing Incentives to Gain Participation in Wellness Programs

    With the cost of employer-provided health care benefits at large US employers expected to rise another 7% next year, employers are considering a variety of cost-control measures, including asking workers to pay a greater portion of premiums but also sharply boosting financial rewards to engage them in healthy lifestyles, according to a new survey by the National Business Group on Health, a nonprofit association of 342 large employers.

    Six in 10 employers plan to increase the percentage of the premium paid by employees in 2013, although the majority of those employers indicated that the increase would be by a small amount (less than 5%).

    While many employers continue to adopt cost-sharing provisions, survey respondents now consider consumer-directed health plans (CDHPs) and wellness initiatives to be more effective at stemming cost than shifting costs to employees. According to the survey, 43% cited a CDHP as the most effective cost-control tactic followed by wellness programs (19%). Less than 1 in 10 (9%) respondents reported increased employee cost-sharing as the most effective tactic. Last year, cost shifting was cited as the most effective measure.

    The survey found that employers continue to experiment with and perfect the best ways to incorporate financial incentives into wellness programs. While nearly half of respondents (48%) use incentives to encourage participation in programs, some employers are basing incentives on specific health outcomes. More than 4 in 10 (44%) provide an incentive based upon tobacco-use status while 29% base awards upon achievement of outcomes such as BMI or cholesterol levels. About 22% apply surcharges to employees who do not participate in certain programs.

    Additionally, employers plan to sharply increase the incentive amount for maintaining a healthy lifestyle or participating in a wellness program. Among employers that offer incentives, the median amount employees can earn will jump 50% from $300 this year to $450 next year. The median incentive amount that dependents can earn is expected to increase from $250 this year to $375 in 2013.

    The survey also found that employers are continuing to make adjustments to their benefit plans to comply with additional provisions of the health reform law. Half of all respondents (50%) indicated that they no longer have any annual benefit limits in place, while 32% reported that they did not make any changes to their annual limits this year. Among employers making changes for 2013, the most common benefits requiring adjustments to their annual limits were mental health and substance abuse (9%) and rehabilitative services and devices (9%).

    The survey, based on responses from 82 of the nation's largest corporations, was conducted in June 2012 prior to the Supreme Court's announcement to uphold the health care reform law.

    How to Encourage Walking at the Community Level

    Six in 10 adults now get physical activity by walking, according to the Centers for Disease Control and Prevention (CDC). To enhance walking spaces and help more people become physically active, physical therapists can work with their community leaders to:

    • Consider walking when creating long-range community plans.
    • Consider designing local streets and roadways that are safe for people who walk and other road users.
    • Create opportunities to let community residents use school tracks or gyms after school hours.
    • Maintain existing sidewalks and walking paths.
    • Promote walking paths with signs and route maps that are easy to read.

    For more ideas on promoting walking in your community, visit CDC's website.

    New in the Literature: Endurance Exercise Training and Small AAA (Arch Phys Med Rehabil. 2012 July 27 [Epub ahead of print])

    Despite a low recruitment rate, findings from an article published online last week in Archives of Physical Medicine and Rehabilitation suggest that moderate-intensity endurance exercise training is feasible in patients with small abdominal aortic aneurysm (AAA), and can evoke improvements in important health outcomes.

    For this study conducted in the United Kingdom, researchers randomized 28 patients with small AAA (age 72 ± 7 years; mean ± SD) to a 12-week program of moderate-intensity endurance exercise or standard care control (encouragement to exercise only). They assessed safety in terms of the frequency of adverse events and changes in maximum AAA diameter. Outcomes were assessed at baseline and 12 weeks, including cardiopulmonary fitness (ventilatory threshold), health-related quality of life (SF-36v2), and markers of vascular risk (blood pressure and High Sensitivity C-reactive Protein [hs-CRP]).

    Adherence to the exercise program was 94%. There were no paradoxical increases in AAA size or adverse clinical events. Ventilatory threshold increased in the exercise group, but not the control group (adjusted mean difference 2.5 mL/kg/min). Systolic blood pressure and hs-CRP decreased in the exercise group compared with the control group. There were no substantial changes in anthropometric variables or quality of life.

    Last Call: Photo Contest Deadline Approaches

    APTA members have until August 15 to submit their entries for this year's photo contest. Winners will be selected by a distinguished panel of judges. Winning entries will be displayed at APTA headquarters, may appear in APTA's online or print publications, and on the APTA.org or MoveForwardPT.com websites.

    The first-place winner will receive $500. The second and third place winners will receive $250 each. No cash prizes will be awarded for honorable mentions. Winners will be announced in a future issue of PT in Motion.

    Visit the 2012 Photo Contest webpage for descriptions of winning entries and to download the consent, release, and entry forms.

    Student Assembly Leaders Discuss the Brand and Interprofessional Professionalism

    APTA's Student Assembly leadership shared their views and personal experiences in a video-recorded panel discussion at PT 2012 about how the "Move Forward" brand provides a foundation for professionalism and interprofessional professionalism. Student Assembly President Colleen Sullivan, PT, DPT, Director Samantha Letizio, PT, DPT,  Nominating Committee member Chukuemeka Nwigwe, PT, DPT, Secretary Leiselle Pilgrim, PT, DPT, and Treasurer Ken Swantek, PT, DPT, composed the panel, which was moderated by APTA Lead Academic Affairs Specialist Jody Frost, PT, DPT, PhD. View the video on www.apta.org/BrandBeat.

    Preparing for Falls Prevention Awareness Day

    Learn how you can participate in Falls Prevention Awareness Day (FPAD), recognized September 22, by attending a free webinar on August 28 hosted by the National Council on Aging (NCOA). The webinar will explore:

    • the issue of older adult falls in the United States
    • effective strategies for bringing greater awareness to older adult falls prevention and how organizations can participate in FPAD
    • the Centers for Disease Control and Prevention's new STEADI (Stopping Elderly Accidents, Deaths, and Injuries) toolkit for health care providers to assess falls risks, create action plans to reduce risk, and link patients to community-based programs
    • funding options, including Medicare coverage for falls and Title IIID falls prevention community program funding 

    More than 40 states and numerous countries worldwide are coalescing to address this growing public health issue; many are working closely with physical therapists as key contributors to reducing falls. This year's theme, Standing Together to Prevent Falls, seeks to unite professionals, older adults, caregivers, and family members to play a part in raising awareness and preventing falls in the older adult population. Forty-six states will participate in FPAD this year, joining more than 70 national organizations, including APTA, professional associations and federal agencies that constitute the Falls Free© Initiative. Find ideas for observing FPAD and your State Falls Prevention Coalition on NCOA's website.

    Weight Training Associated With Lower Risk of Diabetes

    A new study published August 6 in Archives of Internal Medicine finds that weight training is associated with a significantly lower risk of type 2 diabetes, independent of aerobic exercise.

    Researchers conducted a prospective study of 32,002 men from the Health Professionals Follow-up Study observed from 1990 to 2008. They obtained the weekly time spent on weight training and aerobic exercise (including brisk walking, jogging, running, bicycling, swimming, tennis, squash, and calisthenics/rowing) through questionnaires at baseline and biennially during follow-up.  

    In the 18-year follow-up, the researchers documented 2,278 new cases of type 2 diabetes. In multivariable-adjusted models, they observed a dose-response relationship between an increasing amount of time spent on weight training or aerobic exercise and lower risk of the disease. Engaging in weight training or aerobic exercise for at least 150 minutes per week was independently associated with a lower risk of type 2 diabetes—34% and 52%, respectively. Men who engaged in aerobic exercise and weight training for at least 150 minutes per week had the greatest reduction in type 2 diabetes (59%).

    For people who have difficulty engaging in or adhering to aerobic exercise, the results suggest "that weight training, to a large extent, can serve as an alternative to aerobic exercise for type 2 diabetes prevention," lead researcher Anders Grøntved, MPH, MSc, told HealthDay News

    A separate study also published yesterday in the journal found that higher levels of physical activity were associated with lower mortality risk in people with diabetes. Even study participates who engaged in moderate amounts of activity were "at appreciably lower risk for early death compared with inactive persons," say the study's authors. 

    New Podcast: Ensuring Appropriate Payment by Using Modifiers

    A new APTA podcast addresses the appropriate use of billing modifiers, which provide additional information to payers in cases in which diagnosis and procedure codes alone are insufficient. The podcast and accompanying transcript explain the difference between the 2 types of modifiers typically used by physical therapists and the relationship between modifiers and the National Correct Coding Initiative. Additionally, the most frequently used modifiers are discussed, along with the type of detail that supporting documentation should provide.   

    New World Physical Therapy Day Materials Available From WCPT

    The World Confederation for Physical Therapy (WCPT) has developed new materials to help physical therapists organize activities and campaigns for World Physical Therapy Day 2012, celebrated September 8. As in previous years, WCPT's suggested theme is Movement for Health. This year's materials also include the message Fit for Life, encouraging physical therapists around the world to highlight the importance of physical activity throughout the lifespan.

    The following materials are available free for download from WCPT's website:

    • World Physical Therapy Day logo, including web ads and banners
    • posters and flyers/leaflets (aimed at patients and the public)
    • banners
    • clinical resources booklet for physical therapists with information and references about the profession's impact on noncommunicable diseases, which includes an article by WCPT President Marilyn Moffat, PT, DPT, PhD, FAPTA, in addition to general facts and figures about the profession
    • e-card to send with a personalized message to friends and colleagues to promote events
    • stickers to print on standard printer labels
    • ready-made tweets and Facebook postings
    • t-shirt design
    • press release template and guide to writing a press release 

    Access the materials and start planning today.

    CMS Issues Guidance on Manual Medical Review for Therapy Services Exceeding $3,700

    Yesterday, officials from the Centers for Medicare and Medicaid Services (CMS) held a call with therapy stakeholder groups to describe their plans to implement the manual medical review process for the therapy cap exceptions that exceed $3,700 effective October 1. CMS has provided a fact sheet and question-and-answer document regarding the process and will issue a transmittal in the coming days. The therapy cap is an annual per-beneficiary limitation on services that applies to all outpatient therapy settings except critical-access hospitals.

    Highlights regarding manual medical review include these:

    • KX modifier requirements still remain in place for therapy services that exceed $1,880.
    • For outpatient therapy services that exceed $3,700 an advanced approval process under which providers will be assigned to 1 of 3 distinct phases for manual medical review. CMS will notify providers by letter and contractor websites regarding which phase they are included in.
      * Phase I providers:  Subject to manual medical review October 1-December 31.
      * Phase II providers:  Subject to manual medical review November 1-December 31.
      * Phase III providers:  Subject to manual medical review December 1-December 31.
    • Criteria for medical review will be based on current medical review standards. CMS will provide guidance and additional training for providers and Medicare Administrative Contractors (MACs) in the coming weeks.
    • MACs will have 10 business days to decide whether or not they will approve services that exceed $3,700. If the MAC does not respond to a provider within 10 business days, claims beyond the $3,700 threshold will be approved.
    • Advanced approval will allow an additional 20 treatment days beyond the $3,700 amount. Advanced approval does not guarantee payment. Retrospective review may still be performed.
    • If a provider does not request advanced approval prior to providing services over $3,700, payment for the claims will stop, and a request for medical records will be sent to the provider. The provider will be subject to prepayment review for those claims, and the time frame for review will be approximately 60 days.
    • Beneficiaries who have received $1,700 or more of therapy services in 2012 will receive letters in September 2012 providing them information about their potential financial liability for services over the therapy cap amount. An advanced beneficiary notice to beneficiaries is not required but is recommended as a way for the provider to convey information about the patient's potential financial responsibility for services above the therapy cap amount.  

    A special open door forum (ODF) teleconference on the manual medical review of therapy claims will be held August 7, 2 pm-3:30 pm, ET. Special open door participation instructions are below:

    • Dial 800/603-1774, using conference ID: 16032541.
    • Participants may submit questions prior to the ODF to therapycapreview@cms.hhs.gov.
    • A transcript and audio recording of the ODF will be posted to the special ODF website and will be accessible for downloading.

    New in the Literature: Sitting Balance Scale (Clin Rehabil. 2012 July 26. [Epub ahead of print])

    The Sitting Balance Scale is comparable to the Trunk Impairment Scale for measuring sitting balance in older adults who are nonambulatory or have limited mobility, say authors of an article published in Clinical Rehabilitation.  

    The authors conducted this prospective study in acute care, inpatient rehabilitation, skilled nursing facility, and home health settings. Participants included 98 patients, with a mean age of 80.5 (SD 7.9) years, who received physical therapy (n = 20 acute care, n = 18 inpatient rehabilitation, n = 30 skilled nursing facility, n = 30 home setting). Nineteen patients were nonambulatory, and 79 had limited functional mobility with Timed Up and Go scores ≥20 seconds. The main measures were the Sitting Balance Scale, Trunk Impairment Scale, Timed Up and Go, length of stay, and setting-specific clinical measures of sitting balance (OASIS-C M1850; MDS G-3b).

    A moderate association between ambulatory status and sitting balance measures was found (Sitting Balance Scale r = 0.67, Trunk Impairment Scale r = 0.61). Moderate to strong relationships between Sitting Balance Scale, Trunk Impairment Scale, and clinical outcomes varied by setting. Multivariate analysis of variance results revealed differences between ambulators and nonambulators and among diagnostic categories for both instruments.

    APTA member Mary Thompson, PT, PhD, GCS, is lead author of the article. APTA members Ann Medley, PT, PhD, CEEAA, and Steve Teran, PT, are coauthors.      

    Johns Hopkins Conference to Focus on Creating New ICU Culture

    Interdisciplinary collaboration and coordination is vital to facilitate early mobility and rehabilitation in the intensive care unit (ICU) setting. A recent stakeholders' conference aimed at improving long-term outcomes for ICU survivors identified important silos among critical care and rehabilitation clinicians working in the ICU, with these silos acting as a barrier to collaboratively advancing the field and improving patient outcomes. While clinical trials support the benefits of early rehabilitation for mechanically ventilated patients, implementing these interventions requires creating a new ICU culture based on proactive rehabilitation and interdisciplinary collaboration between all critical care and rehabilitation clinicians.

    Critical Care Rehabilitation Conference 2012: Creating and Sustaining a Physical Rehabilitation Program in the ICU, hosted by Johns Hopkins University School of Medicine September 21-22, will bridge the interdisciplinary gap from research to clinical implementation at the bedside. 

    APTA members Jennifer Zanni, PT, Michelle Kho, PT, PhD, and Michael Friedman, PT, MBA, will participate in panel discussions and present several sessions at the conference.

    For course objectives and registration information, visit the conference's webpage.

    CMS to Release Follow-up Comparative Billing Report on August 6

    On Monday, the Centers for Medicare and Medicaid Services (CMS) will release a follow-up Comparative Billing Report (CBR) to the 5,000 independent physical therapy providers who received the report in 2010. The CBR shows KX modifier use for 5 codes commonly billed by physical therapists. The report will be the same format as the CBR released in 2010. However, this CBR will use 2011 billing data, intending to inform providers of any change in use since receiving the original CBR.

    The CBRs are produced by Safeguard Services under contract with CMS and contain data-driven tables and graphs with an explanation of findings that compare nationally and statewide physical therapist billing and payment patterns with the KX modifier. Safeguard Services has indicated to APTA that these reports are only educational rather than punitive, intending to prevent improper billing and use of the KX modifier.

    For more information regarding these Outpatient Physical Therapy Services CBRs, visit CBR Services' website or call the SafeGuard Services' provider help desk, CBR support team, at 530/896-7080.

    Power Mobility Device Demonstration Begins September 1

    The Centers for Medicare and Medicaid Services' (CMS) 3-year Medicare Prior Authorization for Power Mobility Device (PMD) demonstration begins September 1. The demonstration is designed to develop and demonstrate improved methods for the investigation and prosecution of fraud in the provision of care or services. CMS believes this demonstration will lead to reductions in improper payments for power mobility devices.

    CMS will implement a prior authorization process for scooters and power wheelchairs for people with fee-for-service Medicare who reside in 7 states with high populations of fraud- and error-prone providers (California, Illinois Michigan, New York, North Carolina, Florida, and Texas). Additionally, this demonstration will help ensure that a beneficiary's medical condition warrants his or her medical equipment under existing coverage guidelines and assist in preserving a Medicare beneficiary's ability to receive quality products from accredited suppliers.

    Based on comments from APTA and other stakeholders, CMS removed the 100% prepayment review phase (formerly Phase 1) from the demonstration earlier this year. Also based on stakeholder feedback, CMS will allow suppliers to perform the administrative function of submitting the prior authorization request on behalf of the physician/treating practitioner.

    Additional information is available on CMS' website.

    August Craikcast: Worldwide Contributions to Physical Therapy Practice

    This month's PTJ has a diversity of authorship—with articles by physical therapists, occupational therapists, engineers, basic scientists, and physicians from around the world. Hear Editor in Chief Rebecca Craik, PT, PhD, FAPTA, summarize the issue's 6 research reports and 2 "remarkably interesting" case reports and offer her comments on articles' contribution to the literature in the in the August Craikcast.     

    Start Planning Now for National Physical Therapy Month

    Plan now to make this your best National Physical Therapy Month (NPTM) event yet. Go to www.apta.org/NPTM for this year's tools and resources. Start with the 2012 NPTM Event Planning Guide for specific information about conducting a successful community event. Next, check out the links to tools and resources designed specifically for this year's celebration, such as a sample proclamation for your governor or mayor, sample press release, logos, and web buttons. New tools will be added in the coming weeks, such as an event flyer template and downloadable NPTM bookmarks to give to patients and members of your community. And, learn how you can participate in APTA's public relations initiative, "Fit After 50," kicking off during NPTM.