The annual review and revision of the association strategic plan conducted in late 2012 by the APTA Board of Directors has resulted in a revised plan for 2013. Members can access the plan and related materials on the website at this link. The strategic plan represents the highest priorities of the Board of Directors as it manages the work of the association and was informed by member and external stakeholder input.

In a follow-up of a randomized controlled trial, a strategy of rehabilitation plus early acute anterior cruciate ligament (ACL) reconstruction did not provide better results at 5 years than a strategy of initial rehabilitation with the option of having a later ACL reconstruction. Results did not differ between knees surgically reconstructed early or late and those treated with rehabilitation alone. These results should encourage clinicians and young active adult patients to consider rehabilitation as a primary treatment option after an acute ACL tear, say the authors in their article published this month in BMJ. 

This study included 121 young, active adults (mean age 26 years) with acute ACL injury to a previously uninjured knee. All patients received similar structured rehabilitation. In addition to rehabilitation, 62 patients were assigned to early ACL reconstruction and 59 were assigned to the option of having a delayed ACL reconstruction if needed. One patient was lost to 5-year follow-up.

The main outcome was the change from baseline to 5 years in the mean value of 4 of the 5 subscales of the knee injury and osteoarthritis outcome score (KOOS₄). Other outcomes included the absolute KOOS(4) score, all 5 KOOS subscale scores, SF-36, Tegner activity scale, meniscal surgery, and radiographic osteoarthritis at 5 years.

Thirty (51%) patients assigned to optional delayed ACL reconstruction had delayed ACL reconstruction (7 between 2 and 5 years). The mean change in KOOS₄ score from baseline to 5 years was 42.9 points for those assigned to rehabilitation plus early ACL reconstruction and 44.9 for those assigned to rehabilitation plus optional delayed reconstruction (between group difference 2.0 points after adjustment for baseline score). At 5 years, no significant between-group differences were seen in KOOS₄, any of the KOOS subscales, SF-36, Tegner activity scale, or incident radiographic osteoarthritis of the index knee. No between-group differences were seen in the number of knees having meniscus surgery or in a time-to-event analysis of the proportion of meniscuses operated on. The results were similar when analyzed by treatment actually received.

If you are interested in leadership development, collaborating with colleagues, and lending your expertise to APTA, then you need to join the Volunteer Interest Pool. Current opportunities include all awards subcommittees: Advocacy, Catherine Worthingham Fellows, Education, Lecture, Practice and Service, Publications, Research, and Scholarship. 

To answer the call for these opportunities, you must first complete a volunteer interest profile. Creating this profile allows you to include your preferred level of involvement, willingness to travel, current availability, and interest/experience in a variety of areas. You only need to create the volunteer profile once. It can be updated at any time. Once you have created a profile, you will need to review the current opportunities and answer the questions specific to each committee.

Deadlines will vary by group, so don't delay in checking out these opportunities! To learn more about the Volunteer Interest Pool, please contact Angela Boyd.

A new report that seeks to move the nation from "sick care" to "health care" encourages all employers, including federal, state, and local governments, to provide effective, evidence-based workplace wellness programs.

Trust for America's Health's (TFAH) A Healthier America 2013: Strategies to Move from Sick Care to Health Care in Four Years outlines top policy approaches to respond to studies that show that (1) more than half of Americans are living with 1 or more serious, chronic diseases, a majority of which could have been prevented; and (2) today's children could be on track to be the first in US history to live shorter, less healthy lives than their parents.

The Healthier America report stresses the importance of taking innovative approaches and building partnerships with a wide range of sectors in order to be effective. Some recommendations include:

• Advance the nation's public health system by adopting a set of foundational capabilities, restructuring federal public health programs, and ensuring sufficient funding to meet these defined foundational capabilities;
• Ensure insurance payment for effective prevention approaches both inside and outside the physician's office;
• Integrate community-based strategies into new health care models, such as by expanding accountable care organizations into accountable care communities; and
• Work with nonprofit hospitals to identify the most effective ways they can expand support for prevention through community benefit programs.

Healthier America features more than 15 case studies from across the country that show the report's recommendations in action. It also includes recommendations for a series of 10 key public health issues.

After the report's release, economic experts came out against TFAH's position on preventive care's role in reducing health care spending. (See related article posted in News Now titled "Experts Say Preventive Care Produces Limited Savings.")   

While some disease-prevention programs do produce net savings, such as childhood immunizations and counseling adults about using baby aspirin to prevent cardiovascular disease, most preventive care does not save money, says an article by Reuters News.

Following the release yesterday of a new report from Trust for America's Health (TFAH) that calls for putting more resources into preventive care, economic experts challenged TFAH's position on preventive care's role in reducing health care spending. (See related article posted in News Now tilted "TFAH Releases Strategies to Improve Nation's Health in 4 Years.")

"Preventive care is more about the right thing to do" because it spares people the misery of illness, economist Austin Frakt of Boston University told Reuters. "But it's not plausible to think you can cut health care spending through preventive care. This is widely misunderstood."

A 2010 study in Health Affairs, for instance, calculated that if 90% of the US population used proven preventive services, more than do now, it would save only 0.2% of health care spending.

One reason why preventive care does not save money, say health economists, is that some of the best-known forms don't actually improve someone's health. These low- or no-benefit measures include annual physicals for healthy adults.

The second reason preventive care brings so few cost savings is the large number of people who need to receive a particular preventive service in order to avert a single expensive illness.

A promising approach is to target preventive care at those most likely to develop a chronic disease, not at low-risk people. Such "smart" prevention increases the chances of preventing expensive diseases and saving money.

In contrast, unthinking expansion of preventive medicine is the wrong prescription, the article says.

The American Academy of Pediatrics (AAP) recently issued guidelines to provide evidence-based recommendations on managing type 2 diabetes in children aged 10 to 18. The guidelines are the first of their kind for this age group.   

The recommendations suggest integrating lifestyle modifications, including diet and exercise, in concert with medication rather than as an isolated initial treatment approach. Specifically, clinicians should encourage patients to engage in moderate-to-vigorous exercise for at least 60 minutes daily and to limit nonacademic “screen time” to less than 2 hours a day. "Physical activity is an integral part of weight management for prevention and treatment of T2DM," write the authors. They suggest that when prescribing physical exercise, clinicians should be sensitive to the needs of children, adolescents, and their families. Noting that routine, organized exercise may be beyond the family's logistical and/or financial means, it is "most helpful to recommend an individualized approach that can be incorporated into the daily routine, is tailored to the patients' physical abilities and preferences, and recognizes the families' circumstance."

The guidelines also call for additional research. In particular the authors recommend studies that delineate whether using lifestyle options without medication is a reliable first step in treating selected children with type 2 diabetes, explore the efficacy of school and clinic-based diet and physical activity interventions to prevent and manage pediatric type 2 diabetes, and investigate the association between increased "screen time" and reduced physical activity with respect to type 2 diabetes risk factors.

The guidelines were written in consultation with the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians, and the Academy of Nutrition and Dietetics.

Marilyn Mount, PT, a prolific member of the Ohio physical therapy community, who passed away last August, has left a bequest of $32,000 to the Foundation for Physical Therapy, which will be designated toward the Florence P. Kendall Doctoral Scholarship Fund.

Mount was the recipient of numerous awards and accolades for her lifelong service to the physical therapy profession, some of which include: from the Ohio Chapter, Physical Therapist of the Year (1997), Outstanding Service Award from the Northeast District (2003), and Meritorious Service Award (2008); the Viking Shield Award from Cleveland State University's Physical Therapy Program (2011); and the Crains Cleveland Business Health Care Heroes Award for Allied Health (2012).

Read more about Mount in the Foundation's press release.

Last week, the Department of Education's Office for Civil Rights issued guidance clarifying school districts' existing legal obligations to provide equal access to extracurricular athletic activities to students with disabilities. In addition to explaining those legal obligations, the guidance urges school districts to work with community organizations to increase athletic opportunities for students with disabilities, such as opportunities outside of the existing extracurricular athletic program.

Students with disabilities have the right, under Section 504 of the Rehabilitation Act, to equal opportunity to participate in their schools' extracurricular activities. A 2010 report by the US Government Accountability Office found that many students with disabilities are not afforded an equal opportunity to participate in athletics and therefore may not have equitable access to the health and social benefits of athletic participation.

"Sports can provide invaluable lessons in discipline, selflessness, passion, and courage, and this guidance will help schools ensure that students with disabilities have an equal opportunity to benefit from the life lessons they can learn on the playing field or on the court," said Education Secretary Arne Duncan.

The guidance letter provides examples of the types of reasonable modifications that schools may be required to make to existing policies, practices, or procedures for students with intellectual, developmental, physical, or any other type of disability. Examples of such modifications include:

• The allowance of a visual cue alongside a starter pistol to allow a student with a hearing impairment who is fast enough to qualify for the track team the opportunity to compete.
• The waiver of a rule requiring the "two-hand touch" finish in swim events so that a swimmer with 1 arm with the requisite ability can participate at swim meets.

The guidance also notes that the law does not require that a student with a disability be allowed to participate in any selective or competitive program offered by a school district, on the condition that the selection or competition criteria are not discriminatory.

Couldn't make it to the Combined Sections Meeting (CSM)? Get a sense of being there by watching APTA's collection of short video dispatches from San Diego.

Included in the series are reports on APTA's "Beyond Vision 2020" open forum, PT-PAC's 40^th anniversary celebration, the Foundation for Physical Therapy's Log 'N Blog campaign, the "Going Beyond Borders" session on international collaboration, the Student Caucus on physician-owned physical therapy services, and more.

It's impossible to capture everything that occurs at CSM, with 4 days of educational programming and countless networking events, but this series provides a glimpse of the wide range of opportunities.

Osteoarthritis/joint disorders and back pain rank among the most common conditions for visits to health care providers, according to a new Mayo Clinic Proceedings study.

The Mayo team used the Rochester Epidemiology Project, a unique, comprehensive medical records linkage system, to track more than 140,000 Olmsted County, Minnesota, residents who visited Mayo Clinic, Olmsted Medical Center, and other Olmsted County health care providers between January 1, 2005, and December 31, 2009. Researchers then systematically categorized patient diagnoses into disease groups. The top disease groups include:

• skin disorders
• osteoarthritis/joint disorders
• back problems
• cholesterol problems
• upper respiratory conditions (not including asthma)
• anxiety, depression and bipolar disorder
• chronic neurologic disorders
• high blood pressure
• headaches/migraine
• diabetes

"Surprisingly, the most prevalent nonacute conditions in our community were not chronic conditions related to aging, such as diabetes and heart disease, but rather conditions that affect both genders and all age groups," says Jennifer St Sauver, PhD, primary author of the study.

The authors say their finding of skin and back problems as major drivers of health care utilization affirms the importance of moving beyond the commonly recognized health care priorities such as diabetes, heart disease, or cancer. "Our findings highlight opportunities to improve health care and decrease costs related to common nonacute conditions as we move forward through the changing health care landscape," they write. 

The Department of Health and Human Services recently launched 2 websites to educate stakeholders and consumers about the health insurance exchanges, which now are referred to as the Health Insurance Marketplace (Marketplace).

The stakeholder website offers users a resources toolkit, talking points, an overview of consumer research, and survey results about low-income parents' experiences with their children's health insurance coverage and awareness of and attitudes toward Medicaid and CHIP programs. The consumer website offers basic information on the Marketplace, such as who is eligible, and links to websites that describe each state’s Marketplace efforts thus far. The consumer page will have more information about the states' health plans in October.

Pelvic floor muscle training (PFMT) is effective for treating stress urinary incontinence (SUI), say authors of an article published in International Urogynecology Journal. There is no apparent add-on effect of biofeedback (BF) training in short-term follow-up, they add.

Women with SUI were randomized to PFMT with BF (BF group, n = 23) or without BF (PFMT group, n = 23) for 12 weeks. As primary outcome measures, subjective symptoms and QOL were assessed by the King's Health Questionnaire (KHQ) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). A voiding diary, 1-h pad test, and measurement of PFM strength were secondary outcome measures. Changes in the primary and secondary outcomes were assessed before and after 12 weeks of exercise training.

Of the 9 domains of the KHQ, the scores of 5 significantly decreased in the PFMT group; the scores of 7 significantly decreased in the BF group. All ICIQ-SF items and the total score significantly decreased in both groups after therapy. The number of incontinence episodes significantly decreased in the PFMT group, and tended to decrease in the BF group, but this was not significant. The leakage volume in the 1-h pad test tended to decrease in both groups, but was not significant. Maximum vaginal squeeze pressure significantly increased in both groups. There were no significant inter-group differences in the changes in any of the parameters assessed.

In a new APTA podcast lead investigator Gail Jensen, PT, PhD, FAPTA, and coinvestigators Jan Gwyer, PT, PhD, FAPTA, and Terry Nordstrom, PT, EdD, describe the history and background of the study Physical Therapist Education for the 21st Century (PTE-21).      

The PTE-21 research team, which also includes Laurita M. Hack, PT, DPT, MBA, PhD, FAPTA, and Elizabeth Mostrom, PT, PhD, is in the process of conducting 4 site visits aimed at uncovering and examining the crucial dimensions of excellence in physical therapist education across academic and clinical settings.

The group will issue a final report on the first phase of the study in the fall of 2013. Also in 2013, Jensen and colleagues will begin fundraising for the second phase of the study that will include an additional 6 sites. 

Phase I of the study is funded by a 2-year APTA award of $50,000. The funding is the result of a request for proposal (RFP) for "Innovation and Excellence in Academic and Clinical Education Funding" developed by APTA and announced in November 2010. The RFP was targeted at stakeholder groups throughout the profession.  

Measuring patients' vital signs, wellness coaching for cancer survivors, genetics and stroke, and lean health care are just a few of the topics covered in today's CSM Daily News. Thursday's issue also summarizes the 16th annual Pauline Cerasoli Lecture.

Last week the Department of Health and Human Services (HHS) started referring to state health insurance exchanges as "marketplaces" in an attempt to rebrand the central component of the Affordable Care Act, says an article in The Hill.  

A press release issued January 17 by HHS announced new grants to support states building health insurance "marketplaces." The agency also revamped HealthCare.gov to reflect the name change. 

Opponents of the health care law say the name change shows the administration is "failing" at getting support for the state-run programs and won't make any difference.

According to The Hill, supporters of health care reform say the name change wasn't meant to assuage political opposition to the health care law. They say that "exchange" simply isn't a very good description. States have come up with their own names for their exchanges. Massachusetts', which predates the federal health care law, is called the "Connector." California named its exchange "Cover California."

Wednesday's CSM Daily News includes coverage of the ABPTS Opening Ceremony and Linda Crane Lecture, and articles on gait pattern, a "flipped" classroom model, fraud and abuse, "oxygen debt" in patients with chronic fatigue syndrome, and more.    

Authors of an article published online in Diabetes Care say that compared with younger adults, older adults receive equal glycemic benefit from participating in self-management interventions. Clinicians can safely recommend group diabetes interventions to community-dwelling older adults with poor glycemic control, they add.

For their study, the researchers randomized 71 community-dwelling older adults and 151 younger adults to attend a structured behavioral group, an attention control group, or 1-to-1 education. Half of the younger group and nearly a third of the older group had type 1 diabetes, and the rest had type 2. All group interventions were delivered separately to patients with type 1 diabetes and those with type 2 diabetes. The researchers measured A1C, self-care (3-day pedometer readings, blood glucose checks, and frequency of self-care), and psychosocial factors (quality of life, diabetes distress, frustration with self-care, depression, self-efficacy, and coping styles) at baseline and 3, 6, and 12 months postintervention.

Both older and younger adults had improved A1C equally over time. Older and younger adults in the group conditions improved more and maintained improvements at 12 months. Furthermore, the authors say, frequency of self-care, glucose checks, depressive symptoms, quality of life, distress, frustration with self-care, self-efficacy, and emotional coping improved in older and younger participants at follow-up.

"Many clinicians are reluctant to refer older patients to group education, feeling that older people may require individual attention in order to benefit," study coauthor Katie Weinger, EdD, told Medscape Medical News. She notes that the new study answers research questions posed in a recent consensus statement from the American Diabetes Association and the American Geriatrics Society regarding which education approaches work best for older people with diabetes. "Our paper addresses these issues by including both middle-aged and older adults," Weinger says.

Check out today's CSM Daily News for articles on scoliosis treatment and managing triathletes, a photo of outgoing component presidents, a list of exhibitors, product news, and more.   

Researchers at the National Institutes of Health (NIH) have identified proteins that allow muscle cells in mice to form from the fusion of the early stage cells that give rise to the muscle cells.

The findings have implications for understanding how to repair and rehabilitate muscle tissue and to understanding other processes involving cell fusion, such as when a sperm fertilizes an egg, when viruses infect cells, or when specialized cells called osteoclasts dissolve and assimilate bone tissue in order to repair and maintain bones.

The findings were published online January 7 in the Journal of Cell Biology.

"Through a process that starts with these progenitor cells, the body forms tissue that accounts for about one-third of its total weight," said the study's senior author, Leonid V. Chernomordik, PhD. "Our study provides the first look at the very early stages of this fusion process."

Muscle cells originate from precursor cells known as myoblasts. Myoblasts fuse to form a single long tubular cell called a myocyte (a muscle fiber). Muscle tissue is composed of large collections of these fibers. The fusion of myoblasts into muscle fibers takes place early in fetal development. With exercise and throughout a person's life, the process is repeated to form new muscle mass and repair old or damaged muscle.

It takes many hours for cells to prepare for fusion, but the fusion process itself is very rapid. To study myoblast fusion, the researchers first blocked the start of the fusion process with a chemical. Ordinarily, the mouse myoblasts the researchers worked with fuse at varied intervals. By blocking fusion, and then lifting the block, the researchers were able to synchronize fusion in a large number of cells, making the process easier to study.

The researchers identified the 2 distinct stages of cell fusion and the essential proteins that facilitate these stages.

In the first stage, 2 myoblasts meet, and proteins on cell surface membranes cause the membranes to meld. In the second stage, a pore opens between the cells and their contents merge. This second step is guided by proteins inside the cells. (See graphic provided by NIH.)

The work identifies 2 cell surface proteins that act at the start of myoblast fusion. These proteins belong to a large family of proteins called annexins. Annexins also are known to play a role in membrane repair and in inflammation.

The researchers identified the protein dynamin, found inside the cell, as essential to the second stage of the cell fusion process.

"Dynamin also has an unexplained link to certain rare and poorly understood myopathies—disorders characterized by underdeveloped muscles," said Chernomordik. "We hope that further examination of the role of dynamin in cell fusion will lead to a greater understanding of these conditions."

Lisa K. Saladin, PT, PhD, has been appointed by the APTA Board of Directors to fill the unexpired term of director David Pariser, PT, PhD, who died unexpectedly January 14. Saladin's term will begin immediately and run through June 2014.

"Today, we honor our friend and colleague Dave Pariser by continuing the important work of the association he loved so dearly in appointing Lisa Saladin to fill his unexpired term," said APTA President Paul A Rockar Jr, PT, DPT, MS. "Lisa's previous experience as a member of APTA's Board of Directors and her in-depth knowledge of the issues currently facing the association will help the Board retain continuity while moving the association forward, as Dave would certainly have wanted."

A member of APTA's Board from 2008-2011, Saladin, serves as professor and dean of the College of Health Professions at the Medical University of South Carolina, where she has been a full-time faculty member since 1990. She served on APTA's Government Affairs Committee for 3 years, including 1 year as chair, and as chief delegate and delegate from South Carolina for 8 years. She also has served as president of the South Carolina Chapter, where she was known as a strong advocate for student membership and active participation in professional service. In 2004, she received APTA's Dorothy Baethke-Eleanor J. Carlin Award for Excellence in Academic Teaching.

Saladin has been instrumental in advancing the body of knowledge in the areas of community-based service learning, health disparities, and neuropathology/neurological rehabilitation. In 2001, she was awarded the Neurology Section's Golden Synapse Award for best journal publication in recognition of her efforts in this area.

Saladin has been recognized by her peers and students with numerous teaching awards, including 3 University Teaching Excellence Awards and the South Carolina Governor's Distinguished Professor Award.

APTA has pledged $1 million to the Foundation for Physical Therapy to help create the Center of Excellence (COE) for Health Services/Health Policy Research. 

The COE will provide training for physical therapy researchers to conduct health services/health policy (HS/HP) research. HS/HP research will examine physical therapy resource utilization, costs, and quality, and will identify the most effective ways to deliver, organize, finance, and assess outcomes of health care services.

Academic institutions will compete for funds to start the nation's first training program to develop physical therapy investigators in HS/HP research. The selected institution must promote an intellectual environment that attracts members of the physical therapy profession to HS/HP research, provide research experience, mentorships, and opportunities for collaboration with scientists from other disciplines, and conduct pilot projects leading to future high-impact health services research studies.

Read more about the COE at www.apta.org/.

Yesterday, the Department of Health and Human Services (HHS) issued a final omnibus rule that  makes extensive modifications to the privacy, security, and enforcement rules established under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). 

The final rule expands many of the requirements to business associates of entities that receive protected health information, such as contractors and subcontractors. Penalties are increased for noncompliance based on the level of negligence with a maximum penalty of $1.5 million per violation.

The changes also strengthen the Health Information Technology for Economic and Clinical Health (HITECH) Breach Notification requirements by clarifying when breaches of unsecured health information must be reported to HHS. An interim final version has been in effect since September 2009. The new version clarifies requirements for when a breach must be reported to authorities.

The final rule will be effective March 26. However, covered entities and business associates have until September 23 to comply with the rule.

APTA will post a summary of the rule in the future.

APTA offers member information and links to learn about compliance with HIPAA regulations at www.apta.org/HIPAA/.

Prompted by the recent mass shootings across the country, the Department of Health and Human Services (HHS) this week released a letter to healthcare providers to emphasize that the Health Insurance Portability And Accountability Act (HIPAA) Privacy Rule does not prevent a provider from disclosing information about a patient "…to law enforcement, family members of the patient, or other persons [who may reasonably be able to prevent or lessen the risk of harm], when you believe the patient presents a serious danger to himself or other people."

Issued by HHS' Office of Civil Rights, the letter recommends that providers consult their state law, court decisions, and professional practice acts for any additional requirements related to disclosure of patient information to prevent or lessen the risk of harm.

APTA will upgrade critical systems the weekend of January 25. During this upgrade, website visitors will be able to access www.apta.org, log in to member-only content, work on an LMS course, use Find a PT, look up an individual in the Membership Directory, and use the fee calculator. However, they will not be able to pay membership dues, update their profile information, or register for an event. Please continue to use www.apta.org throughout the weekend. If, when you do, you see the image below, check back with us on Monday, January 28.

APTA's Vision Task Force is seeking feedback on the proposed vision statement that will be sent to the House of Delegates in June. In a Moving Forward  blog post, the task force describes several broad themes that guided its work in developing the proposed statement and explains why the proposed vision is intentionally broad and "lofty." Members and nonmembers are encouraged to leave their comments at Moving Forward. For individuals attending the Combined Sections Meeting in San Diego, the blog post includes information about a Beyond Vision 2020 Member Forum (also open to nonmembers) that will be held on Wednesday, January 23.  

APTA offers a multitude of ethics resources that can significantly inform practitioners. Resources include an online course, Information on APTA’s Revised Code of Ethics for the Physical Therapist and Standards of Ethical Conduct for the Physical Therapist Assistant, available through APTA’s Learning Center. The non-CEU version is free for members. In addition, ethics decision-making tools are available and include a PT in Motion Ethics in Practice article reflecting on its 6-year anniversary. These articles explore a variety of ethical scenarios on topics such as reimbursement, confidentiality, discharging patients, gifts, professional integrity, and professional behavior. The Ethics and Professionalism webpage includes the core ethics documents and resources on professionalism. Extensive information also is available on the Resolving Complaints or Disputes and Legal Topics of Interest to PTs and PTAs webpages. Use and review of these regularly updated ethics resources is strongly encouraged.

Manual physical therapy provided benefits over usual care that were sustained to 1 year for patients with osteoarthritis of the hip or knee, say authors of an article published online in Osteoarthritis and Cartilage. Exercise physical therapy also provided physical performance benefits over usual care. There was no added benefit from a combination of the 2 therapies. 

In this 2x2 factorial randomized controlled trial conducted in New Zealand, 206 adults (mean age 66 years) who met the American College of Rheumatology criteria for hip or knee osteoarthritis were allocated to receive manual physical therapy (n=54), multimodal exercise physical therapy (n=51), combined exercise and manual physical therapy (n=50), or no trial physical therapy (n=51). The primary outcome was change in the Western Ontario and McMaster osteoarthritis index (WOMAC) after 1 year. Secondary outcomes included physical performance tests. Outcome assessors were blinded to group allocation.

Of 206 participants recruited, 193 (93.2%) were retained at follow-up. Mean (SD) baseline WOMAC score was 100.8 (53.8) on a scale of 0 to 240. Intention-to-treat analysis showed adjusted reductions in WOMAC scores at 1 year compared with the usual care group of 28.5 for usual care plus manual therapy, 16.4 for usual care plus exercise therapy, and 14.5 for usual care plus combined exercise therapy and manual therapy. There was an antagonistic interaction between exercise therapy and manual therapy. Physical performance test outcomes favored the exercise therapy group.

As private and governmental payers continue to ramp up efforts to curb fraud and abuse, physical therapists are facing more audits of their services. APTA recently published FAQs on audits that identifies strategies to prepare for and respond to private insurance audits. The FAQ document also identifies additional resources available through APTA, including APTA's Medicare Claims Audits webpage, and external entities.

APTA has released a statement commending the final report of the Blue Ribbon Panel on Medical Rehabilitation Research at the National Institutes of Health (NIH). The association supports the panel's call for the development and implementation of a NIH rehabilitation research plan that is periodically updated, elevation of the role of the National Center for Rehabilitation Research within NIH's structure, and the elimination of "Medical" from the name of the center to better reflect the inclusive and multidisciplinary nature of rehabilitation, among other recommendations.

APTA members Rebecca Craik, PT, PhD, FAPTA, Anthony Delitto, PT, PhD, FAPTA, and Alan M. Jette, PT, PhD, FAPTA, served on the 13-member panel. The panel, formed in August 2011, was charged with assessing rehabilitation research across NIH while focusing on the National Center for Medical Rehabilitation Research. 

APTA congratulates the following association members for their winning entries to the 2012 photo contest: Jan Black, PT, MSPT, first place; Megan Herrman, PT, and Gayati Mathur, PT, second place; and Bob Wellmon, PT, PhD, NSC, third place. Black will receive $500. Herman and Mathur will receive a total of $250. Wellmon also will receive $250. 

Physical therapists, physical therapist assistants, and students submitted 73 entries to the contest. The 3 winning photos and 5 honorable mentions are available at www.apta.org/PhotoContest/. They also will be displayed at association headquarters and may appear in APTA's online or print publications.  

Submissions to the contest were judged on how well they:

• Reflected the full scope of practice and depict strides in contemporary physical therapy practice, education, or research
• Depicted models of excellence in a variety of settings
• Portrayed a diverse population of physical therapists, physical therapist assistants, patients, researchers, faculty, or students
• Reflected high quality in terms of aesthetics, composition, and technical standards  

Information on the 2013 photo contest will be available February 1 on APTA's website.

Be a part of this important time in the history of your profession and join us April 14-16 for the 2013 Federal Advocacy Forum. At the event, you will hear from decision makers on Capitol Hill, learn to effectively communicate with your elected officials, receive an update on the legislative and regulatory issues affecting the physical therapy profession, and lobby your members of Congress on behalf of your profession.

The programming for the 2013 Federal Advocacy Forum will begin on Sunday, April 14, with an evening reception. Monday, April 15, will be dedicated to advocacy programming and preparation for your hill visits. The event will conclude with the opportunity for you to take your message directly to your members of Congress on April 16.

The number of CEUs earned for this event is pending. To claim CEU credit, you must attend the live event and complete the online posttest with at least 70% accuracy. The online posttest will be available on APTA's Learning Center by April 16.

For a full agenda and more information, visit www.apta.org/FederalForum. APTA encourages you to get the word out to your friends and colleagues and bring someone with you to the event. Register now and bring your voice to Capitol Hill on behalf of your profession.

The Magistro Family Foundation recently bestowed a gift of $500,000 to support the Magistro Family Foundation Endowment Fund.

This fund was created in 1998 to support relevant clinical research that evaluates the effectiveness of interventions most commonly delivered by physical therapists.  

Going forward, the fund will support health policy research. This most recent gift to the Foundation for Physical Therapy includes support for the campaign to establish a Center of Excellence for Health Policy Research.

With this donation, the Magistro Family Foundation Endowment Fund now exceeds $2 million and will continue to provide vital grant funding well into the future.

To view the news release, click here. 

"It is with a heavy heart that I share the news of the sudden passing of our friend and colleague, APTA Board Member Dave Pariser, PT, PhD," says APTA President Paul A. Rockar Jr, PT, DPT, MS, in a statement released this morning. "Dave was an outstanding gentleman and professional whose friendship, devoted service, and leadership we will sorely miss."

A member of APTA since 1981, Pariser served in various capacities within APTA and the Kentucky and Louisiana chapters, including on APTA's Nominating Committee, as Louisiana Chapter president, and as chair of the legislative committees for both the Louisiana and Kentucky chapters. Most recently, he was elected in June 2011 by APTA's House of Delegates to serve on the Board of Directors. Pariser received numerous awards in recognition of his service, including the Dave Warner Award for Distinguished Service (Physical Therapist of the Year) from the Louisiana Chapter (2001) and induction into the chapter's “Hall of Fame” in 2006 for career achievement. 

Read Rockar's full statement on APTA's website.    

APTA has created a tribute page for members of the physical therapy community and others to share their memories about Pariser.   

The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule that has important implications for Medicaid beneficiaries who require rehabilitative and habilitative services and devices.

In the rule, CMS proposes changes to provide states more flexibility to coordinate Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices, appeals, and other related administrative procedures with similar procedures used by other health coverage programs authorized under the Affordable Care Act (ACA), such as coordination of benefits between Medicaid and health plans offered in the health insurance exchanges (Exchanges).    

Specifically, CMS is soliciting comments on whether the habilitative benefit should be offered in parity with the rehabilitative benefit under the Medicaid program (as they must be under the Exchanges). Additionally, CMS requests input on whether the state defined habilitative benefit definition for the Exchanges should apply to Medicaid or states should be allowed to separately define habilitative services for Medicaid. Habilitative and rehabilitative benefits are part of the mandatory essential health benefits (EHB) established by the ACA to ensure that certain health plans offered in Exchanges provide this baseline of coverage, benefits, and services to their enrollees.

In December 2012, CMS released guidance to help states align Alternative Benefit Plans under Medicaid programs with the EHB requirements. In that guidance, CMS stated that it intended for the provisions of the EHB proposed rule, released on November 20, generally to apply to Medicaid, but noted that it would address EHB in future rulemaking.

The newly released proposed rule also proposes to update and simplify the complex Medicaid premiums and cost-sharing requirements, to promote the most effective use of services, and to assist states in identifying cost-sharing flexibilities. 

APTA will comment on the proposed rule. Comments are due February 13. 

In a study evaluating the financial impact of providing early physical therapy for intensive care patients, researchers at Johns Hopkins found that the up-front costs are outweighed by the financial savings generated by earlier discharges from the intensive care unit (ICU) and shorter hospital stays overall.

"The evidence is growing that providing early physical and occupational therapy for intensive care patients—even when they are on life support—leads to better outcomes," says Dale M. Needham, MD, PhD, senior author of the study. "Patients are stronger and more able to care for themselves when they are discharged."

Hospital administrators' concerns about costs have been cited as barriers to implementing early rehab programs in the ICU. "However, our study shows that a relatively low investment up front can produce a significant overall reduction in the cost of hospital care for these patients," Needham says. "Such programs are an example of how we can save money and improve care at the same time."

For the study, the researchers developed a financial model based on actual experience at The Johns Hopkins Hospital's medical intensive care unit (MICU) and projections for hospitals of different sizes with variable lengths of stay.

The Johns Hopkins MICU admits about 900 patients each year. In 2008, the hospital created an early rehabilitation program with dedicated physical therapists and occupational therapists, which added about $358,000 to the cost of care annually. However, by 2009, the length of stay in the MICU had decreased an average of 23%, down from 6.5 days to 5 days, while the time spent by those same patients as they transitioned to less-intensive hospital units fell 18%. Using their financial model, the authors estimated a net cost saving for the hospital of about $818,000 per year, even after factoring in the up-front costs.   

The researchers then analyzed the potential impact of early rehabilitation services in 24 different scenarios, accounting for variations in the number of ICU admissions, cost savings per day and reductions in length of stay.

They found that in 20 out of the 24 scenarios, hospitals would have an overall cost savings by providing early rehabilitation to patients in the ICU, and in the 4 remaining scenarios, using the most conservative assumptions, there was a modest net cost increase of up to $88,000 per year.

APTA member Michael Friedman, PT, MBA, is a coauthor of the study.

APTA's innovative models of care video series includes an interview with a physical therapist who was instrumental in starting an early physical therapy program for patients in a Houston hospital's ICU.

A new policy statement by the American Heart Association (AHA) encourages clinicians to assess cardiorespiratory fitness with the hope that researchers can gather more information on aerobic fitness and its related variables to identify individuals who might be at risk for adverse clinical outcomes.

The AHA writing committee also advocates for the creation of a national registry that includes data on cardiorespiratory fitness that would allow researchers to track aerobic fitness over long periods of time, just as is being done with other variables such as cholesterol, blood pressure, physical activity levels, and body weight, among others. It also would provide more information on normative aerobic fitness levels in subsets of the population.

According to a Heartwire article, one of the goals of the national registry is to increase awareness about the importance of cardiorespiratory fitness. Many of the assessments are performed in exercise centers and research settings, but not as frequently in clinical practice.

While information is available in pockets of the country, including data from the Aerobics Center Longitudinal Study, the hope is more information would allow researchers to determine normative cardiorespiratory fitness levels, via direct measurements of VO₂, in groups stratified by age, gender, and body composition in large samples representative of the US population.

The registry also would help define normative values of aerobic fitness across strata of physical activity levels. Chair of the AHA policy statement, Leonard Kaminsky, PhD, told Heartwire that "physical activity is simply a behavior, and while both are inversely associated with the risk of cardiovascular disease, there are factors that contribute to aerobic fitness than other physical activity levels, including age and genetics. In addition, cardiorespiratory fitness is a more clinically meaningful measure than self-reported physical-activity levels, which are prone to considerable error."

APTA member Ross Arena, PT, PhD, is a coauthor of the statement, which was published online ahead of print January 7 in Circulation.   

A new APTA podcast that focuses on screening for physical inactivity distinguishes between physical activity and physical fitness, explains the use of physical activity to screen for issues of impaired physical fitness, and provides information on what to do with the results of the screen. It also gives examples illustrating various types of patients and the role that physical activity plays in their overall health. 

APTA's upcoming Board of Directors meeting will be broadcast online for APTA members when the Board convenes January 20 in San Diego.

All open sessions of the meeting will be livestreamed, and archived video will be available through February 10 at www.apta.org/Livestream. The agenda for the meeting, which includes a generative session on membership development initiatives and a fiduciary session, is posted on the same page.

This is the second time that the Board meeting has been livestreamed, following a similar broadcast in November and December of last year.

Physicians and health care providers have formed 106 new accountable care organizations (ACOs), bringing the nationwide number of Medicare beneficiaries included in ACOs to about 4 million.

According to the Department of Health and Human Services (HHS), the new ACOs include a diverse cross-section of physician practices across the country. Roughly half of all ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries. Approximately 20% of ACOs include community health centers, rural health centers, and critical access hospitals that serve low-income and rural communities.

The new group includes 15 advance payment model ACOs, physician-based or rural providers who would benefit from greater access to capital to invest in staff, electronic health record systems, or other infrastructure required to improve care coordination. Medicare will recoup advance payments over time through future shared savings. In addition to these ACOs, last year the Centers for Medicare and Medicaid Services (CMS) launched the Pioneer ACO Program for large provider groups able to take greater financial responsibility for the costs and care of their patients over time.

ACOs must meet quality standards to ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely. CMS has established 33 quality measures on care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care. Federal savings from this initiative are up to $940 million over 4 years.

For more information on ACOs, visit www.apta.org/ACO/.

Join your colleagues on March 8 for APTA's groundbreaking virtual event, Innovation Summit: Collaborative Care Models, which will focus on the current and future role of physical therapy in ACOs and other integrated models of care.

APTA has posted new instructions to help members use the multiple procedure payment reduction (MPPR) calculators to determine their payment for services in 2013 based on the MPPR only and compare 2012 payments with 2013 payments. The downloadable step-by-step instructions include screen captures and example scenarios to better illustrate the fields that users must complete to calculate and compare payment amounts.       

The American Taxpayer Relief Act of 2012 (HR 8) applies the MPPR to therapy services at 50%, up from 20% for office settings and 25% for facility settings, beginning April 1. APTA estimates the application of a 50% MPPR policy will reduce payments by approximately 6%-7%. This reduction will be partially offset by a 4% increase in the practice expense values that resulted from the Centers for Medicare and Medicaid Services' use of new survey data of practice expenses conducted by APTA. The impact of the MPPR reduction on individual practices and facilities will vary depending on the CPT codes billed and the typical duration of the therapy sessions.

APTA will advocate to stop the implementation of the MPPR provision.

For more information on the MPPR, other provisions included in HR 8, and new functional limitation reporting requirements that went into effect January 1, go to APTA's 2013 Medicare Changes webpage.

In response to an APTA House of Delegates resolution passed in June 2012, complimentary "read only" access to Hooked on Evidence now is available all health care practitioners and health care students worldwide in an effort to advance evidence-based practice by all physical therapists and physical therapist assistants.

Non-APTA members visiting Hooked on Evidence for the first time will be asked to create a username and password that they will use every time they visit Hooked on Evidence to search the database. APTA members and others who already have established a login to the APTA website can access the database by logging in.

If you have previously logged into either the Hooked on Evidence or APTA website and do not recall your login information, try using the "Forgot your Password" feature on the login page to request reset instructions. You may also contact APTA Member Services at 800/999-2782 for help.

During the month of January APTA members can enjoy a free recorded audio conference (up to a $99 value) on us!

To redeem your free recorded audio conference course: 

1.      Select 1 course from the recorded audio conference options.

2.      Click the Purchase Now link and complete the online store transaction (login required). At the View Shopping Chart phase, click Enter Vouchers. Enter promotion code: CEUMBR113. The member price for the program will be $0.

3.      Once you receive your order confirmation number, go to My Courses to launch the course.

This offer is nontransferable. Questions? E-mail Member Services, or call 800/999-2782, ext 3395, Monday to Friday, 8:30 am-6:00 pm ET.

Do you know of an APTA member who in 2012 went above and beyond to advocate on behalf of the physical therapy profession at the federal level? Is there a legislator, staffer, or public figure who championed physical therapy causes in 2012? Nominate them for the Federal Government Affairs Leadership Award or the APTA Public Service Award.

The Federal Government Affairs Leadership Award is presented annually to an active APTA member who has made significant contributions to APTA's federal government affairs efforts and has shown exemplary leadership in furthering the association's objectives in the federal arena.

The APTA Public Service Award is presented annually to individuals who have demonstrated distinctive support for the physical therapy profession at a national level. Individuals from the following categories are eligible for nomination of this award: members of Congress, congressional staff members, members of a state legislature, federal agency officials, health and legislative association staff, and celebrities or other public figures.

APTA's Board of Directors will select award recipients during its March 2013 conference call. Awards will be presented at the Federal Advocacy Forum to be held April 14-16, in Washington, DC.

Please submit your nominations by Monday, February 11, to Stephanie Sadowski at stephaniesadowski@apta.org or fax to 703/706–8536. If you have questions, call Stephanie Sadowski at 800/999-2782, ext 3127.

The Centers for Medicare and Medicaid Services (CMS) yesterday further clarified the regulations on the new functional limitation reporting requirements to include reporting on patients who have Medicare part B as a primary insurance and those who have Medicare part B as a secondary insurance.

CMS was mandated to collect information on claim forms regarding beneficiaries' function and condition, therapy services furnished, and outcomes achieved on patient function by the Middle Class Tax Relief Act of 2012. As of January 1, all practice settings that provide outpatient therapy services must include the functional limitation data on the claim form. To ensure a smooth transition, CMS sets forth a testing period January 1-July 1. After July 1, claims submitted without the appropriate G-codes and modifiers will be returned unpaid. For additional details and resources on these new requirements, see the FAQ under General Information on APTA's Functional Limitation Reporting Under Medicare webpage.  

Authors of an article published online in Medicine and Science in Sports and Exercise say their finding of greater hip adduction in female runners who develop patellofemoral pain (PFP) is in agreement with previous cross sectional studies. These results suggest that runners who develop PFP use a different proximal neuromuscular control strategy than those who remain healthy. Injury prevention and treatment strategies should consider addressing these altered hip mechanics, they add.  

For this investigation, the authors conducted an instrumented gait analysis on 400 healthy women runners and tracked them for any injuries that they may have developed over a 2-year period. Fifteen cases of PFP developed, which were confirmed by a medical professional. The participants' initial running mechanics were compared with an equal number of runners who remained uninjured.

According to the results, the runners who developed PFP exhibited significantly greater hip adduction. No statistically significant differences were found for the hip internal rotation angle or rearfoot eversion.

APTA member Brian Noehren, PT, is the article's lead author. APTA member Irene Davis, PT, PhD, FAPTA, is coauthor. 

The Commission on Accreditation in Physical Therapy Education (CAPTE) invites comments from the physical therapy community regarding the physical therapist and physical therapist assistant education programs scheduled for review at CAPTE's April 2013 meeting. Comments will be accepted until March 1.

A list of programs scheduled for review is available in this document. Information about how to provide comments is available on CAPTE's website.

Working-age adults with disabilities account for a disproportionately high amount of annual emergency department visits, reports a comparison study from National Institutes of Health (NIH) researchers.

The NIH study analyzed pooled data from the Medical Expenditure Panel Survey. Researchers found access to regular medical care, health profile complexity, and disability status contributed to people with disabilities' use of the emergency department.

Despite representing 17% of the working age US population, the study found that adults with disabilities accounted for 39.2% of total emergency department visits. Those with a severely limiting disability visited an urgent care department more often than their peers and were more likely to visit the emergency department more than 4 times per year.

Emergency visits also were associated with poor access to primary medical care, which was more prevalent among adults with disabilities.

"We want to understand what takes people to the emergency department to learn if their care could be better managed in other ways," said Elizabeth Rasch, PhD, chief of the Epidemiology and Biostatistics Section in the NIH Clinical Center's Rehabilitation Medicine Department. "While many of those visits may be necessary, it is likely that some could be avoided through better information sharing among all of the health care providers who see a particular individual."

The authors make recommendations for providers and policymakers to offset some of the need for emergency care by individuals with disabilities. Prevention and chronic condition management programs tailored for the functional limitations and service needs of people with disabilities may help avoid a crisis situation that would call for an urgent care visit, the report noted. The authors also endorsed wider adoption of coordinated care systems for people with disabilities that provide case management, integration of psychosocial care, and 24/7 access to medical assistance, among other services.

Free full text of the study is available online in Health Services Research.  

Physical therapists (PTs) are increasingly being asked to provide evaluation and management of patients in the emergency department. As part of the emergency department team, PTs have the opportunity to collaborate in the care of patients with a wide range of acute and chronic problems coming from the neuromusculoskeletal, cardiovascular/pulmonary and integumentary systems. PTs in this setting also serve a critical role in screening for appropriateness of care, consultation with other practitioners, and in the direct care of patients. For more information about this expanding area of practice, visit APTA's Physical Therapist Practice in the Emergency Department webpage, which includes a toolkit designed to help PTs initiate the development of a PT practice in an emergency department.   

A new infographic roadmap from the Robert Wood Johnson Foundation (RWJF) illustrates a 6-step framework that integrates reducing disparities into all health care quality improvement efforts. The framework is designed to be flexible: organizations can get on the road where appropriate. Its goal is to support a thoughtful and comprehensive approach to achieving equity, even though the causes of disparities may vary across regions or patient populations.

The roadmap draws upon lessons learned from RWJF's Finding Answers' 33 grantee projects and 11 systematic reviews of the disparities-reduction literature.

Copying and pasting old, potentially out-of-date information into patients' electronic health records (EHR) is common among physicians in the intensive care unit (ICU), according to a Reuters Health article based on a study that examined 2,068 electronic patient progress reports created by 62 residents and 11 attending physicians in a Cleveland hospital ICU.

Using plagiarism-detection software, the researchers analyzed 5 months' worth of progress notes for 135 patients. They found that 82% of residents' notes and 74% of attending physicians' notes included 20% or more copied and pasted material from the patients' records.

In their report, published in Critical Care Medicine, the authors did not examine what motivated physicians and residents to copy and paste, or whether the shortcut affected patient care, says Reuters.

Nothing about a patient—length of stay, sex, age, race or ethnicity, what brought them into the ICU or how severely ill they were—affected how often a physician copied information into the medical record.

Although residents' notes more often included copied material, attending physicians tended to copy more material between notes. They also tended to copy more of their own assessments from other notes.

Experts suggested that copying information signifies a shift in how physicians use notes—away from being a means of communication among fellow health care providers and toward being a barrage of data to document billing, the article says.

The Supreme Court will not hear a challenge to President Obama's policy of expanding government-funded research using embryonic stem cells that scientists say may offer hope for new treatments for spinal injuries and Parkinson disease, reports the Los Angeles Times. 

The court's action brings an end to a lawsuit that threatened to end all funding for such research. 

A federal judge in Washington in 2010 ordered the National Institutes of Health (NIH) to halt funding of the research, citing a long-standing congressional ban on spending for research in which "human embryos are destroyed."

But an appeals court overturned that order and ruled last year that the ban applied only to research that destroyed human embryos so as to obtain stem cells.

President George W. Bush in 2001 had allowed limited research on several stem cell lines that were already in existence. Upon taking office in 2009, President Obama went further and said NIH could conduct "scientifically worthy human stem cell research to the extent permitted by law." Under guidelines issued by NIH, researchers can used stem line cells derived from donated frozen embryos that are no longer needed for fertility treatments, says the article.

Two researchers who work with adult stem lines brought the lawsuit to the high court. They were represented by several groups, including the Law of Life Project, whose general counsel called human stem cell research "an ethical tragedy as well as a waste of the taxpayer's money," the Times says.

APTA has updated its Medicare Physician Fee Schedule FAQ to clarify the impact of the multiple procedure payment reduction (MPPR) on payment for therapy services.

Set to be implemented on April 1, the provision applies the MPPR to therapy services at 50%, up from 20% for office settings and 25% for facility settings. APTA estimates the application of a 50% MPPR policy will reduce payments by approximately 6-7% in aggregate for outpatient therapy services. This reduction will be partially offset by a 4% increase in practice expense that resulted from the Centers for Medicare and Medicaid Services' use of new survey data of practice expenses conducted by APTA. The impact of the MPPR reduction on individual practices and facilities will vary depending on the CPT codes billed and the typical duration of the therapy sessions. To determine the impact on your practice, refer to APTA’s MPPR calculator, which can be used to determine payment rates for 2012 and 2013.

APTA will advocate to fix this flawed policy. The association soon will call on APTA members to help in this effort.

The Centers for Medicare and Medicaid Services (CMS) has further clarified the regulations on the new functional limitation reporting requirements that were included in transmittal R2622CP and a new Medicare Learning Network resource. CMS was mandated to collect information on claim forms regarding beneficiaries' function and condition, therapy services furnished, and outcomes achieved on patient function by the Middle Class Tax Relief Act of 2012. All practice settings that provide outpatient therapy services must include this information on the claim form. These new functional limitation reporting requirements were implemented on January 1. To ensure a smooth transition, CMS sets forth a testing period January 1-July 1. After July 1, claims submitted without the appropriate G-codes and modifiers will be returned unpaid.

The major points of clarification include:

• Guidance on using the “Other PT/OT” functional limitation category
• Submission of functional limitation data for more than 1 therapy plan of care
• Reporting instructions for 1-time therapy visits
• Information regarding remittance advice codes to indicate successful submission of the functional reporting data

Additionally, CMS has released revisions to the Medicare Benefit Policy Manual that include the functional limitation reporting requirements (see related article titled "CMS Releases Updates to the Medicare Benefit Policy Manual"). 

APTA has posted links to these documents on its functional limitation reporting webpage. The association also has updated the FAQ posted on the webpage, which provides resources to help members meet this new reporting requirement.    

The Centers for Medicare and Medicaid Services (CMS) has revised the Medicare Benefit Policy Manual to include a change to the progress note requirement, which now is required at either a date chosen by the clinician or the 10th treatment day, whichever is shorter. Additionally, there is a new section dedicated the functional limitation reporting requirements that were implemented on January 1. Therapists are required to include functional limitation reporting information in their documentation. The functional impairments identified and expressed in the long-term treatment goals must be consistent with those used in the claims-based functional reporting using nonpayable G-codes and severity modifiers for services furnished on or after January 1. For more information, visit APTA's functional limitation reporting webpage.

On Thursday, Sen Mark Kirk (R-IL) returned to Capitol Hill for the first time since having a stroke in January 2012 that paralyzed the left side of his body. Kirk climbed the steps to the Capitol using a 4-prong cane and assisted by Vice President Joe Biden and Sen Joe Manchin (D-WV) while his colleagues in the 113th Congress cheered.

Kirk was scheduled to hold a press conference Thursday with physicians and researchers from the Rehabilitation Institute of Chicago and Northwestern Memorial Hospital to discuss the treatment he underwent.

APTA member Michael Klonowski, PT, DPT, PCS, who was Kirk's primary physical therapist in Chicago, told USA Today that he was "more emotional" than he thought he would be as he watched his former patient make the climb.

"Seeing what he's done is absolutely inspiring," Klonowski said. "I've seen him go up tons of stairs. ... It was really something to see him do what he did today."

In an interview published Wednesday in the Chicago Sun-Times  Kirk said that his experience with the health care system has given him a new perspective. He said that he plans to take a look at the Illinois Medicaid program, which he noted allows 11 rehab visits for patients with stroke.

"Had I been limited to that, I would have had no chance to recover like I did," Kirk said. "So unlike before suffering the stroke, I’m much more focused on Medicaid and what my fellow citizens face."

Watch this NBC video of Kirk's "45 monumental steps." To view photos of Kirk in rehabilitation, visit the Huffington Post.    

Adults diagnosed with diabetes are at significantly increased risk for fracture-related hospitalization, says a Medscape Medical News article based on the results from an analysis of data from a large, community-based study. 

More than 15,100 patients between 45 and 64 years old participated in the Atherosclerosis Risk in Communities (ARIC) study, a 4-community study that began in 1987. There were a total of 1,078 fracture-related hospitalizations during the 20-year follow-up period. (Only fractures that resulted in inpatient hospitalization were captured in ARIC.)

At baseline, 1,195 participants had been diagnosed with diabetes based on self-report, and 605 had undiagnosed diabetes according to their measured serum glucose values.

Compared with the 13,340 study participants without diabetes, the incidence of fracture-related hospitalization was significantly greater among the group with diagnosed diabetes (6.6 vs 3.9 per 1,000 person-years of follow-up).

The incidence of fracture hospitalization was higher among those with diagnosed diabetes compared with those without diabetes for all age groups. However, the fracture risk was not increased among those with undiagnosed diabetes compared with those without diabetes, the article says. 

After adjustment for the covariates, diagnosed diabetes still was associated with a significantly increased risk for fracture hospitalization, with a hazard ratio (HR) of 1.74.

However, also in the fully adjusted analysis, the fracture risk among those with undiagnosed diabetes was similar to that for those participants without diabetes (HR 1.12). 

There also was a significant relationship with glycemic control. After adjustment, participants with diagnosed diabetes who had hemoglobin A1c values of 8% or greater had a significantly greater risk for fracture hospitalization than did those with A1c values less than 8% (HR 1.63). After further adjustment for diabetes medication use that risk was reduced (HR 1.50).

The authors say further studies are needed to understand if exercise interventions or strategies to improve glycemic control while minimizing hypoglycemic episodes may prevent fractures among people with diabetes.

The study was published online December 17 in Diabetes Care.  

In response to a troublesome provision included in the fiscal cliff package passed by Congress on Tuesday, APTA is advising members to monitor APTA's website and the Legislative Action Center specifically for upcoming action alerts regarding efforts to avert the increased multiple procedure payment reduction (MPPR) included in the American Taxpayer Relief Act of 2012 (HR8).

Set to be implemented on April 1, the provision applies the MPPR to therapy services at 50%, up from 20% for office settings and 25% for facility settings. APTA estimates the application of a 50% MPPR policy will reduce payments by approximately 6%-7%. This reduction will be partially offset by a 4% increase that resulted from the Centers for Medicare and Medicaid Services' (CMS) use of new survey data of practice expenses conducted by APTA. Coupled together, APTA expects the net overall decrease for outpatient therapy services to be between 2%-3%, a lower cut than expected. Nevertheless, APTA will advocate to fix this flawed policy. The association soon will call on APTA members to make their voices heard on Capitol Hill.

The increase to a 50% MPPR was recently endorsed by the Medicare Payment Advisory Commission (MedPAC). Despite months of aggressive lobbying efforts to reject the provision, Congress ultimately included this and a number of other spending cuts in the fiscal cliff package to offset other health care related provisions, including the prevention of the 26.5% fee schedule cut and the extension of the therapy cap exceptions process.

Once policy options are assessed, APTA will issue additional alerts to PTeam. If you're not a member of PTeam, sign up today to receive the alerts. In the meantime, APTA members are encouraged to learn more about this and other important provisions included in the legislation through the resources provided on APTA's 2013 Medicare Changes: January 2013 webpage at www.apta.org/Payment/Medicare/2013/Changes/. These resources include a statement by APTA's president on HR8, a congressional summary, a 2013 Medicare therapy cap FAQ, and a 2013 Physician Fee Schedule and MPPR FAQ.

Additionally, APTA has updated the MPPR calculator to help association members determine their reimbursement for services based on the MPPR only. 

Safe patient handling (SPH) programs do not appear to inhibit patient recovery, say authors of a retrospective cohort study conducted in a rehabilitation unit in a hospital system. Fears among therapists that the use of equipment may lead to dependence may be unfounded, they add.

For this investigation, the authors enrolled consecutive patients (N=1,291) over a 1-year period without an SPH program in place (n=507) and consecutive patients over a 1-year period with an SPH program in place (n=784). The SPH program consisted of administrative policies and patient handling technologies. The policies limited manual patient handling by staff. Equipment included ceiling- and floor-based dependent lifts, sit-to-stand assists, ambulation aides, friction-reducing devices, motorized hospital beds and shower chairs, and multihandled gait belts. The main outcome measure was the mobility subscale of the FIM.

Patients who were rehabilitated in the group with SPH achieved similar outcomes to patients rehabilitated in the group without SPH. A significant difference between groups was noted for patients with initial mobility FIM scores of 15.1 and higher after controlling for initial mobility FIM score, age, length of stay, and diagnosis. Those patients performed better with SPH.

APTA member Marc Campo, PT, PhD, OCS, is the article's lead author. APTA member Heather Margulis, PT, is coauthor. The article is available in this month's Archives of Physical Medicine and Rehabilitation.

Two themes emerge in this month's PTJ, says Editor in Chief Rebecca Craik, PT, PhD, FAPTA, in her January Craikcast. The first theme, which reflects back on PTJ's December 2011 Special Issue on Advances in Disability Research, calls for physical therapists to go beyond measurements of impairments and consider other variables when evaluating outcomes following interventions. Craik notes that 4 papers in the current issue "certainly have gone beyond the impairment level in looking at outcome measures." The second theme, motor control and motor learning, can be found in articles on intermanual transfer in patients with upper-limb amputation, body-scaling, and mastering motivation in toddlers.      

Responding to a charge from the 2012 House of Delegates to revise Vision 2020 to "reflect the vision of the profession of physical therapy and its commitment to society beyond 2020," the Vision Task Force sent a revised vision to the APTA Board of Directors for consideration at its November 2012 meeting. The Board will forward the proposed vision to the 2013 House of Delegates for consideration. Information about the proposed vision has been posted and is available for members and delegates to review. Please direct your comments about the vision to your chapter or section delegates or directly to the members of the Vision Task Force.

The Foundation for Physical Therapy recently launched a new effort that enables students, faculty, and members of the community to collectively raise funds for physical therapy research. Built around the concept of training for a triathlon, physical therapy programs will form teams, and team members will log the number of miles they each swim, bike, and run on the Log 'N Blog website. Register today!

The relationship between health care spending and quality of care is "totally unclear," say researchers in a Reuters Health article about their meta-analysis of 61 studies that compared health care spending with outcomes on both small hospital-wide scales and broader state-wide levels.

Some of the studies looked at whether hospitals that spent more money per patient had fewer in-hospital deaths, or if their physicians and nurses better followed guidelines. Others compared states' Medicare spending with how well their older residents were treated for a range of conditions.

"The bottom line was that no matter how you drill down into the results, at every level the results are just all over the map," Peter S. Hussey, PhD, the study's lead investigator, told Reuters Health.

Twenty-one of the 61 studies showed higher spending was tied to better outcomes for patients, such as fewer deaths. However, 18 studies found a link between more spending and worse outcomes, and 22 showed no difference or an unclear association based on spending.

Many of the studies compared certain types of spending with potentially unrelated outcomes. Others didn't take into account how sick patients were initially when looking at how they fared in different situations, the article says.

Hussey and colleagues conclude that future studies should focus on what types of spending are most effective in improving quality and what types of spending represent waste.

The findings are published in the January 1 issue of Annals of Internal Medicine.

Yesterday, the House and Senate passed legislation to bring the nation back from the "fiscal cliff" that includes 5 important provisions for physical therapists. The bill has been sent to President Obama for his signature.

The American Taxpayer Relief Act of 2012 (HR 8) freezes the Medicare conversion factor for 2013 at the 2012 level, averting a 26.5% cut to physical therapists and other providers under the physician fee schedule, and continues the 1.0 GPCI work value floor through 2013. The legislation also extends the current 2-tier therapy cap exceptions process ($1,900 automatic KX modifier process, $3,700 manual medical review, and application of the therapy cap to hospital outpatient department) for 1 year. Additionally, in a provision that APTA has called "unjustified, capricious, and poor public policy," the bill applies the multiple procedure payment reduction (MPPR) to therapy services at 50%, up from 20% for office settings and 25% for facility settings, beginning April 1. APTA estimates the application of a 50% MPPR policy will reduce payments by approximately 6-7%. This reduction will be partially offset by a 4% increase that resulted from the Centers for Medicare and Medicaid Services' (CMS) use of new survey data of practice expenses conducted by APTA. Coupled together, APTA expects the net overall decrease for outpatient therapy services to be between 2%-3% beginning April 1. APTA will update the MPPR calculator on its website in the coming days. APTA will advocate to stop the implementation of the MPPR provision.

HR 8 also postpones sequestration cuts until March 1. Under these cuts Medicare providers would see a 2% reduction in payment. The National Institutes of Health and other federal agencies would see reductions of 7%-8%.  

Read this statement by APTA President Paul A. Rockar Jr, PT, DPT, MS, on HR 8. A summary of the legislative provisions and offsets (savings) to HR 8 is available on APTA's website.    

Several other policies of importance to physical therapists went into effect January 1. Under the functional limitations reporting requirement for Medicare Part B services, physical therapists must include nonpayable G-codes and modifiers on claim forms to capture data on the beneficiary's functional limitations at the outset of the therapy episode, at a minimum of every 10th visit, and at discharge. To ensure a smooth transition, the Centers for Medicare and Medicaid Services has set forth a testing period from January 1 until July 1. After July 1 claims submitted without the appropriate G-codes and modifiers will be returned unpaid.

In addition, physical therapists who successfully participate in the Physician Quality Reporting System in 2013 can obtain a 0.5% bonus payment in 2013 and 2014 and will avoid penalties of 1.5% in 2015. 

APTA will continue to provide updates and post resources to help members comply with 2013 Medicare policies.  

Early-career physical therapist investigators are encouraged to apply for the United States Bone and Joint Initiative (USBJI) Young Investigators Initiative Program. This distinctive and well-regarded career development and mentoring program pairs promising new musculoskeletal investigators with experienced researchers who offer counsel on securing funding and other survival skills required for pursuing an academic career.

This grant mentoring workshop series is open to promising junior faculty, senior fellows, or postdoctoral researchers nominated by their department or division chairs. It also is open to senior fellows or residents who are doing research and have a faculty appointment in place or confirmed and have a commitment to protected time for research. Basic and clinical investigators, with or without training awards (including K awards), are invited to apply.

Participants, who will be assigned mentors, attend 2 workshops, 12 to 18 months apart. The next workshop for new participants will take place April 26-28 in Chicago. Participants will receive a solid grounding in proposal writing and have a chance to watch as experienced researchers review grant proposals in a mock study section. They also will meet 1-on-1 with their mentors over the course of the workshop.

When the group reconvenes for the second workshop, participants are expected to have submitted a grant proposal for government, foundation, military, or industry funding. For the second workshop, participant-mentor activities are built around responding to summary statements and study section comments, and strategizing to address other issues relating to performing and funding research. Participants are encouraged to take advantage of ongoing consultation with mentors through the remainder of the application process, until funding is secured.

The deadline to apply for the April workshop is January 15. Visit USBJI's website for application information.

APTA is a founding member of USBJI.