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
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.
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
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:
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
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."
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
In contrast, unthinking expansion of preventive medicine is the wrong
prescription, the article says.
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.
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.
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
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
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
"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 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.
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.
in the series are reports on APTA's "Beyond Vision 2020" open forum,
PT-PAC's 40th 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.
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.
and back pain rank among the most common conditions for visits to health care
providers, according to a new Mayo Clinic Proceedings
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
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.
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.
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).
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
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.
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
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.
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."
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.
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.
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.
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
"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
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
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.
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."
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.
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.
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
more about the COE at www.apta.org/.
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).
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.
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.
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.
offers member information and links to learn about compliance with HIPAA
regulations at www.apta.org/HIPAA/.
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
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.
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,
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.
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
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.
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
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.
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
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.
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:
Information on the 2013 photo contest will be
available February 1 on APTA's website.
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.
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.
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.
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.
Magistro Family Foundation recently bestowed a gift of $500,000 to support the
Magistro Family Foundation Endowment Fund.
was created in 1998 to support relevant clinical research that evaluates the
effectiveness of interventions most commonly delivered by physical therapists.
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.
this donation, the Magistro Family Foundation Endowment Fund now exceeds $2
million and will continue to provide vital grant funding well into the future.
view the news release, click here.
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."
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.
Rockar's full statement on APTA's website.
has created a tribute page for members of
the physical therapy community and others to share their memories about
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.
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).
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.
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.
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.
will comment on the proposed rule. Comments are due February 13.
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
"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.
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.
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.
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.
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
The registry also would help define
normative values of aerobic fitness across strata of physical activity levels.
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
upcoming Board of Directors meeting will be broadcast online for APTA members
when the Board convenes January 20 in San Diego.
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.
is the second time that the Board meeting has been livestreamed, following a similar broadcast
in November and December of last year.
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.
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
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/.
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.
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
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
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.
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.
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.
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.
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:
Select 1 course from the recorded audio conference options.
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.
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.
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
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,
Please submit your nominations by
Monday, February 11, to Stephanie Sadowski at firstname.lastname@example.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.
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
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.
member Brian Noehren, PT, is the
article's lead author. APTA member Irene
Davis, PT, PhD, FAPTA, is coauthor.
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.
of programs scheduled for review is available in this document. Information about how to
provide comments is available on CAPTE's website.
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
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.
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
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.
roadmap draws upon lessons learned from RWJF's Finding Answers' 33
grantee projects and 11 systematic reviews of the disparities-reduction
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.
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
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
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
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
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
The major points of clarification include:
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
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
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
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
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
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
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
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
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
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
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.
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.
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
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.
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