for a special e-mail today from APTA that includes important information about
sequestration and other time-sensitive issues that have a significant impact on
physical therapists (PTs). Included in the e-mail is a new video featuring APTA
President Paul A. Rockar Jr, PT, DPT, MS, outlining 2013 policy implementation
dates that PTs need to know and how they can support APTA's advocacy efforts.
more information, go to APTA's recently updated 2013 Medicare Changes webpage,
which includes the video, a new graphic and Heard on the Hill podcast, and
other resources to help members comply with the latest policy
Federal Communications Commission (FCC) recently released a final rule reforming its
universal service support program for health care. Specifically, the rule transitions
FCC's existing Internet Access and Rural Health Care Pilot programs into a new
Healthcare Connect Fund. This fund will expand health care provider access to
broadband, especially in rural areas, and encourage the creation of state and
regional broadband health care networks.
the rule, FCC notes that "Whether it is used for transmitting electronic
health records, sending X-rays, MRIs, and CAT scans to specialists at a distant
hospital, or for video conferencing for telemedicine or training, access to
broadband for medical providers saves lives while lowering health care costs
and improving patient experiences." In particular, FCC acknowledges the
role of telemedicine in helping patients with stroke avoid lasting damage.
final rule also includes examples of how telehealth applications save health
care providers money. For example, a South Carolina provider consortium funded
by the Commission's Rural Health Care Pilot Program saved $18 million in
Medicaid costs through telepsychiatry provided at hospital emergency rooms.
Another pilot project in the Midwest saved $1.2 million in patient transport
costs after establishing an electronic intensive care unit program, known as
will post a summary of the rule in the near future to www.apta.org.
Four physical therapists (PTs) from the Michigan Chapter presented posters at the
Clinical Trial Awareness Day held at the state capitol on January 30. This
inaugural event, sponsored by state Rep Gail Haines (43rd District), chair of
the House Health Policy Committee, aimed to educate citizens about the clinical
trials taking place in Michigan and encourage lawmakers to create a
research-friendly environment. More than 20 research participants represented
the state's major universities and hospitals. The PTs spoke with many state
representatives and senators on the importance of medical research and how
physical therapy contributes to the advancement of patient care.
her opening remarks,
Hines noted that there are more than 3,400 clinical trials under way in
(Left to right) Cathy Larson, PT, PhD, University of Michigan Flint; Susan Talley,
PT, DPT, C/NDT, Wayne State University; Michael Shoemaker, PT, DPT, PhD, GCS,
Grand Valley State University; and Lucinda Pfalzer, PT, PhD, FAPTA, University
of Michigan Flint.
new systematic review provides evidence that, in the short term, energy
conservation management (ECM) treatment can be more effective than no treatment
in reducing the impact of fatigue and improving quality of life in patients
with multiple sclerosis-related fatigue.
this review, the authors searched PubMed, CINAHL, EMBASE, and Web of Knowledge
to identify relevant randomized controlled trials (RCTs) and controlled
clinical trials. To select potential studies, 2 reviewers independently applied
the inclusion criteria. Two reviewers independently extracted data and assessed
the methodological quality of the studies included. If meta-analysis was not
possible, qualitative best-evidence synthesis was used to summarize the
searches identified 532 studies, 6 of which were included. The studies compared
the short-term effects of ECM treatment and control treatment on fatigue and quality
of life (QoL); 1 study reported short- and mid-term effects on participation
but found no evidence for effectiveness. Meta-analyses (2 RCTs, N=350) showed
that ECM treatment was more effective than no treatment in improving subscale
scores of the: (1) Fatigue Impact Scale: cognitive, physical, and psychosocial;
and (2) SF-36: role physical, social function, and mental health. Limited or no
evidence was found for the effectiveness of ECM treatment on the other outcomes
in the short- or mid-term. None of the studies reported long-term results.
is published online in Archives of
Physical Medicine and Rehabilitation.
Public Policy and Advocacy Committee is seeking members to provide strategic advice,
counsel, and options to the Board of Directors regarding: (1) how APTA can be
responsive to and advocate for society’s needs provided by physical therapists
and physical therapist assistants; (2) current and emerging public policy
issues impacting the provision of physical therapy, rehabilitation, and
health care services; and (3) how to advance the profession within public
policy arenas. Interested members should respond to the call by completing a
volunteer interest profile found on the Volunteer Interest Pool webpage. The
first step is creating a "profile" for service. After developing a
profile, to be considered for this committee members must then access the
"current opportunities for service page" and respond to the question
specific to this committee. The deadline to respond to this call is March 7.
For more information on this task force, click on the link above or contact Justin Moore, PT, DPT, vice
president, public policy, practice, and professional affairs.
sent a letter to the editor
of The New York Times regarding its February 20 article "No Consensus on a Common Cause of Foot Pain" by Gretchen Reynolds. APTA clarified the
physical therapist's role in treating plantar fasciitis and explained PT
education and how consumers may use direct access.
Americans reported having employer-based health insurance in 2012 than did in
2008, 2009, and 2010, but at 44.5% it is unchanged from 2011, says a new Gallup poll. At the same
time, more Americans continue to report having a government-based health
plan—Medicare, Medicaid, or military or veterans' benefits—with the 25.6% who
did so in 2012 up from 23.4% in 2008.
The percentage of Americans (11.9%) who say they get their coverage through
"something else," which could mean they buy it for themselves, has
been relatively unchanged over the years. While more Americans remain uninsured
than in the past, the percentage who are uninsured decreased slightly in 2012
(16.9%), after having risen each year previously going back to 2009.
High unemployment is partly to blame for the decrease in employer-based
health insurance from 2008-2010. The decline also may caused by fewer employers
offering insurance or by employees opting to not take their employers' plan due
to rising health insurance costs for employees, reports Gallup.
The decline in employer-based coverage from earlier years is apparent for
workers employed full time for an employer or for themselves. However, the
percentage of part-time workers who have employer-based insurance rose in 2012.
This group leans toward younger workers, who are likely to be insured since enactment
of the health care law provision allowing those up to age 26 to stay on their
The Department of Health and Human
Services (HHS) issued a final rule
last week implementing several consumer protections under the Affordable Care
Act (ACA) to
prevent insurance companies from discriminating against people with preexisting
conditions and protect consumers from insurance company abuses.
Under these reforms, all individuals
and employers have the right to purchase health insurance coverage regardless
of health status. In addition, insurers are prevented from charging
discriminatory rates to individuals and small employers based on factors such
as health status or gender, and young adults have additional affordable coverage
options under catastrophic plans.
These 5 key provisions
are applicable to nongrandfathered health plans:
In preparation for the health insurance
marketplaces and to streamline data collection
for insurers and states, the final rule amends certain provisions of the rate
review program. HHS has increased the transparency by directing insurance
companies in every state to report on all rate increase requests. A new
report has found that the law's transparency provisions have already resulted
in a decline in double-digit premium increases filed, from 75% in 2010 to,
according to preliminary data, 14% in 2013.
on previous studies that show many factors beyond medical care affect people's
health, the Institute of Medicine (IOM) recently established the Roundtable on Population Health Improvement to explore the interactions of these
influences. The new roundtable will provide opportunities for experts on
education, urban planning, medicine, public health, social sciences, and other
fields to interact and share their knowledge and perspectives with the goal of
catalyzing joint action.
a recent study by the National Research Council and IOM documented, Americans
experience worse health and shorter lives than people in other rich,
industrialized nations despite spending more on medical care than any other
nation. Several IOM studies have described the
effects of social and environmental factors that can lead to poor health
even when people have access to good health care. The nation's lagging
health burdens businesses, communities, and families, these reports note.
will engage roundtable members and outside experts, practitioners, and
stakeholders on 3 core issues:
hosts more than a dozen roundtables and forums, providing a neutral setting for
diverse groups of individuals to discuss issues of mutual interest and concern
and gain fresh insights and new understanding. A list of individuals who
serve on the roundtable can be found on IOM's website.
The US Preventive Services Task Force (USPSTF) recently released its updated 2012 Guide to Clinical Preventive Services—an authoritative source that can help primary care clinicians and patients decide together what preventive services are right for a patient's needs. This edition of the guide includes the USPSTF’s evidence-based recommendations on clinical preventive services from 2002 through March 2012, topics in development, and at-a-glance clinical summary tables.
Go to USPSTF's A-Z Topic Guide to access recommendation statements on interventions to prevent low back pain, falls in older adults, and osteoporosis. USPSTF also makes recommendations on screening for and management of obesity in adults and children.
The 2012 guide can be found on the Agency for Healthcare Research and Quality's website.
the Centers for Medicare and Medicaid Services (CMS) issued interim guidance on how the manual
medical review process will be implemented in 2013 for outpatient therapy
claims that exceed $3,700.
October 1, 2012, through December 31, 2012, CMS used a prior approval process
at $3,700 under which providers would submit a request to their Medicare
Administrative Contractors (MAC) for approval of up to 20 visits. With the
request, providers would include information from the patients' medical record
(eg, progress reports, daily notes, plan of care) to support the need for the
2013, CMS has replaced the prior approval process with prepayment review, at
least for the interim. Under prepayment review, when the patient reaches $3,700
in outpatient therapy services, the MAC will send the provider an additional
development request (ADR) asking him or her to submit documentation so that the
MAC can determine whether the services are medically necessary. Typically under
Medicare, MACs have 60 days to make a determination. However, CMS has requested that with regard to the therapy cap manual medical review process, MACs decide within 10 days of receipt of the documentation whether the services exceeding
$3,700 will be paid.
currently is working on a long-term strategy for the manual medical review
therapists should consult their MACs' websites for specific information about
submitting documentation in response to an ADR.
Royal Dutch Society for Physical Therapy (KNGF) has made PTJ its official journal. KNGF members will have access to PTJ
Online as one of its member benefits. Editor in Chief Rebecca Craik, PT, PhD,
FAPTA, notes in her February editorial, "I am delighted to be entering
into this relationship with our Dutch colleagues, [who have] made significant
contributions to our understanding of the use of measurement tools to examine
clinical effectiveness …, advanced our understanding of clinical practice
guideline development and clinician adherence to guidelines, as well as our
understanding of professional issues such as direct access, continuing
education, and physical therapist consultation in primary care." Philip
Van der Wees, PT, PhD, who is affiliated with the Scientific Institute for
Quality of Healthcare at Radboud University Nijmegen Medical Center and with
Maastricht University, was nominated by the Royal Dutch Society and appointed
by Craik to serve on PTJ's Editorial
Board; he will share his expertise in clinical practice guideline development
and in examining clinician adherence to practice guidelines. Read more at http://ptjournal.apta.org/content/93/2/126.full.
newly established Scope of Practice Task Force is seeking members to develop
recommendations to the Board of Directors on the appropriate role and authority
of APTA in decisions on scope of practice in physical therapy and recommend a
consistent process and criteria to establish current and future physical
therapist scope of practice. Those who are interested should respond to the
call by completing a volunteer interest profile found on the Volunteer Interest Pool webpage. The first step is
creating a "profile" for service. After developing a profile, to be
considered for this task force members must then access the "current
opportunities for service page" and respond to the questions specific to
this task force. The deadline to respond to this call is March 7. For more
information on this task force, click on the link above or contact Karen Jost, PT, MS, senior payment specialist, payment and practice management.
Yesterday, the Department of Health and Human Services (HHS) finalized provisions in the Affordable Care Act ensuring that health plans offered in the individual and
small group markets, both inside and outside of health insurance marketplaces (also called "exchanges") offer a core package of items and services, known as essential health benefits (EHB).
Beginning in 2014, all nongrandfathered health insurance coverage in the individual and small group markets, Medicaid benchmark and benchmark-equivalent plans, and basic health programs (if applicable) will cover EHB, which include items and services in 10 statutory benefit categories, including rehabilitation and habilitation services and devices. These benefits will be equal in scope to a typical employer health plan.
The final rule defines EHB based on a state-specific benchmark plan. States can select a benchmark plan from among several options, including the largest small group private health insurance plan by enrollment in the state. The final rule provides that all plans subject to EHB offer benefits substantially equal to the benefits offered by the benchmark plan.
The final rule also includes standards to protect consumers against discrimination and ensure that benchmark plans offer a full array of EHB benefits and services.
Substitution within EHB categories is still permissible to provide greater choice to consumers and promote plan innovation through coverage and design options. The requirement that any substitution must be actuarially equivalent is retained in the final rule. It is up to each state to set criteria for substitution.
HHS does not provide a federal definition of habilitative services in this final rule. If habilitative services are not yetcovered by the EHB-benchmark plan, then states have the first opportunity to determine which habilitative benefits must be covered by their benchmark plan. States may choose either the
definition used by the National Association of Insurance Commissioners or Medicaid. If states have not chosen to define habilitative benefits, the health plan issuers' will
determine the benefit. This is a transitional policy, and HHS intends to monitor available data regarding coverage of habilitative services.
HHS also finalizes actuarial values (AVs), also called "metal levels," to assist consumers in comparing and selecting health plans by allowing a potential enrollee to compare the relative payment generosity of available plans. Nongrandfathered health insurance plans must meet 1 of 4 specific AVs: 60% for a bronze plan, 70% for a silver plan, 80% for a gold plan, and 90% for a platinum plan.
APTA was highly involved in the processes that determined how EHBs should be defined. The association submitted comments to HHS in response to a December 2011 guidance bulletin, the Center for Consumer Information and Insurance Oversight's January 2012 bulletin, and the Institute of Medicine's report Essential Health Benefits: Balancing Coverage and Cost. APTA also took part in all public stakeholder meetings. Throughout the development of EHB, APTA urged HHS' secretary not to overly define the categories so that practitioners have the flexibility to provide both the type and frequency of care that is medically necessary for each individual.
APTA will post a comprehensive summary on the final rule shortly.
PT, DPT, PhD, FAPTA, a clinician and educator for 38 years who held numerous
national and state positions within APTA, died February 17. She had acute pneumonia that activated
interstitial lung disease, a condition she was diagnosed with 7 years ago.
Melzer served on
APTA's Board of Directors as director (1987-1992) and secretary (1992-1995), and on
the Executive Committee (1991-1995). She also was a member of the Nominating
Committee (2003-2006), serving as chair for 1 year (2005-2006). Most recently,
she was member of APTA's House of Delegates (2007-present).
A member of the
Education Section since 1976, Melzer served in numerous roles, including vice
president (2000-2004). She was a coeditor of A Normative Model of Physical Therapist Professional Education, Version 2000. In 2003, Melzer was named
a Catherine Worthingham Fellow, APTA's highest honor.
She also held
many positions at the state level. She served as president of the Texas Chapter
(1983-1984) and as chief delegate (2000-2003). She was a member of a variety of
chapter committees, including conference planning, bylaws, and educational
was professor at Texas State University and director of clinical education. She
represented the School of Health Professions on the Faculty Senate and was a
multiple winner of the Texas State University Presidential Award for
the incredible span of her service and lengthy list of accomplishments, she has
impacted the profession in ways no words can accurately capture," Eric
Robertson, PT, DPT, OCS, FAAOMPT, wrote in a tribute to Melzer.
President Paul A. Rockar Jr, PT, DPT, MS, recently participated in Healthy,
Wealthy, and Smart, an internet radio show hosted by Karen Litzy, PT, MS, to
discuss the future of the physical therapy profession. During the 1-hour
segment, Rockar answered questions and spoke on a variety of topics affecting
our profession, including health care reform and how it will affect physical
therapy, the "triple aim" of health care and how physical therapy
fits into the overall health care system, and issues related to direct access,
among others. The show, which originally aired on Monday, February 18, can be
heard anytime online at http://www.talkingalternative.com/monday-shows/healthy-wealthy-smart.
patients with radiculopathy due to cervical disc disease, anterior cervical
decompression and fusion (ACDF) followed by physical therapy did not result in
additional improvements in neck active range of motion, neck muscle endurance,
or hand-related function compared with a structured physical therapy program
alone, say authors of an article published this
month in Spine. They suggest that a
structured physical therapy program should precede a decision for ACDF
intervention in patients with radiculopathy to reduce the need for surgery.
this prospective randomized study, 63 patients with radiculopathy and magnetic
resonance imaging-verified nerve root compression received either ACDF in
combination with physical therapy or physical therapy alone. Outcomes,
including active range of neck motion, neck muscle endurance, and hand-related
functioning, were measured in 49 of these patients by an independent examiner
before treatment and at 3-, 6-, 12-, and 24-month follow-ups.
were no significant differences between the 2 treatment alternatives in any of
the measurements performed. Both groups showed improvements over time in neck
muscle endurance, manual dexterity, and right-handgrip strength.
Bruce Braley (D-IA) recently reintroduced legislation to ensure that
communities have access to a wide array of comprehensive health care services,
including physical therapy. HR 702 amends the Public Health Service Act to
establish a Frontline Providers Loan Repayment Program that would allow states
the flexibility to bring health care providers to specific areas of need and
incentivizes the transition to an interdisciplinary approach to health care.
bill was referred to the House Committee on Energy and Commerce on February
About a quarter of recreational
skiers who tear their anterior cruciate ligament (ACL) on the slopes can be
successfully treated without surgery, according researchers at Hospital for Special Surgery in New York City. Their article
appears online ahead of print in the journal Knee Surgery, Sports
The study found that at 6 to 12
weeks post-ACL tear, results from 2 tests that involve only the physical
manipulation of a knee can identify skiers with a torn ACL who will recover
The researchers examined records of
patients treated between 2003 and 2008 to identify recreational alpine skiers
who were seen within 6 weeks of a first-time ACL tear. To be included, skiers
had to have ACL rupture documented on an MRI after the injury and a minimum of
2 years follow-up. Patients were excluded if they had injured ligaments in both
knees. They identified 63 acute, first-time skiing ACL tears; 29 of these
patients did not undergo an ACL operation.
The researchers then separated the
29 patients into 2 groups, those that had low-grade Lachman scores and negative
pivot shift tests, indicating a potentially healed ACL, and those that had
Lachman scores of 2+ and a positive pivot shift test indicating a damaged ACL.
Six to 12 weeks after injury, 17 of
the 29 skiers who did not have surgery had a Lachman score of 0 to 1 and a
negative pivot shift test. Six of these patients were lost to follow-up, but 11
returned for a study-specific follow-up evaluation at more than 2 years
post-injury. These patients completed questionnaires that gauged how well the
knee was functioning and how their ski accident had occurred. They also
underwent Lachman and pivot shift tests and a KT-1000 test to measure motions
of the shin bone relative to the thigh bone.
Skiers described injuring their ACL
in tumbles where the ski had rotated too far. Physical exams revealed that 10
of the 11 patients still had Lachman scores of 0-1 and negative pivot shifts
tests, and only 1 patient's scores had deteriorated to a Lachman Grade 2+. None
of the patients, however, complained about knee instability. Eight had returned
to skiing without the use of a brace; 3 no longer skied. KT-1000 test results also
APTA member Greg Fives, PT, coauthored the article.
The federal government will be
running new health insurance marketplaces, also known as exchanges, in at
least 26 states, says an article by
Kaiser Health News. These states include the major population centers of
Texas, Florida, and Pennsylvania.
The Obama administration has given
"conditional approval" to 17 states and the District of Columbia to
run their own marketplaces. About 12 million people are expected to buy
coverage through the Internet sites next year, with the number increasing to 29
million by 2021, according to consulting firm PriceWaterHouseCoopers.
For consumers, it should make little
difference whether the new Internet sites are run from state capitals or
Washington, DC. But federal regulators hoped states would shoulder some of the
work and that stakeholder groups such as hospitals and insurers wanted states
to help, too. The exchanges become effective October 1.
Governors from Arkansas,
Delaware, Illinois, Iowa, Michigan, New Hampshire, and West Virginia have
sought approval for the third option— a partnership with the federal
government. Three of those states—Arkansas, Delaware, and Illinois—have
received conditional approval, says the article.
In a partnership, states would
approve which plans can participate on the marketplace and handle consumer
assistance duties, such as setting up call centers to handle inquiries. The
federal government would handle the more complex duties of running the website,
marketing the site, and determining the eligibility of millions
of people for government subsidies that will make prices more affordable.
The Foundation for Physical
Therapy recently appointed 2 new board members, Ruthann "Randy"
Roesch, PT, DPT, MBA, and Helene Fearon, PT, FAPTA.
Roesch is the owner of Business
Solutions and has been a strong supporter of the Foundation for many years.
Roesch previously served on the Foundation's Board of Trustees (1998-2004) and
most recently served on the Foundation’s audit committee. She also has served
on the Florida Chapter Board of Directors, Private Practice Section (PPS) Board
of Directors, and APTA Board of Directors as secretary and vice president.
Roesch currently is chair of the PPS Task Force on Clinical Internship.
Fearon is a founding partner of
Fearon & Levine, a national consulting firm focusing on practice management
and payment policy in the outpatient rehabilitation setting. For the past 27
years, she has been a partner in Fearon Physical Therapy, a private practice in
Phoenix. Fearon, similar to Roesch, is involved in APTA at both the state and
national levels, and has served on the PPS Board of Directors. She is an active
member of the Arizona Chapter, and is a member of its payer relations
committee. Fearon was a governor appointee to the Arizona State Board of
Physical Therapy from 1999-2007 and served as its president from 2003-2007.
Read more in the Foundation's press release.
you're not receiving the Foundation for Physical Therapy's monthly News
& Events e-newsletter, sign up today and stay current with the latest
information on research supported by the Foundation, funding and awards, and
events. The newsletter also provides quick links to information about the
Foundation's Trustees and staff; scholarships, fellowships, and grants; and how
to make a donation.
APTA invites members to participate
in the 2013 photography contest.
Each photo submitted should reflect physical therapy practice, education, or
research. Winning entries should:
Winners will be selected by a
distinguished panel of judges. Winning entries will be displayed at APTA
headquarters. They also may appear in APTA's online or print publications and
on the APTA.org or MoveForwardPT.com websites.
The first-place winner will receive
$500. The second and third place winners will receive $250 each. No cash prizes
will be awarded for honorable mentions. Winners will be announced in a future
issue of PT in Motion: News Now.
Merritt, senior coordinator, academic services,
at 800/999-2782, ext 3208, with questions or concerns. All entries must be
submitted to Courtney Merritt
by Friday, August 30. Winners
will be notified by Friday, January 10, 2014.
Don't miss out on this outstanding
opportunity to help identify and preserve the best in contemporary physical
therapy practice, education, and research through your own creativity and
See the photos that were honored
from the 2012 contest.
The World Confederation for Physical Therapy (WCPT) is
the largest international gathering of physical therapists, bringing together
clinicians, educators, researchers, managers, and policymakers.
The 2015 congress, which will be held in Singapore May
1-4, promises a high-quality program along with a major international trade
exhibition and plenty of opportunities for networking. More than 5,000 physical
therapists participated in the 2011 congress held in Amsterdam.
Are you involved in research, or is there a new project
that is due to start this year? Don't forget that your current research and
innovation projects may provide an opportunity for you to present in 2015.
Stay tuned for more information in the upcoming months.
Contact René Malone with questions.
members of Congress reintroduced identical bills in the House and Senate that
would permanently repeal the cap on outpatient physical therapy services. Sens
Ben Cardin (D-MD) and Susan Collins (R-ME) introduced the Senate's measure. The
House legislation is sponsored by Reps Jim Gerlach (R-PA) and Xavier Becerra
discussion on permanent reform of the sustainable growth rate (SGR) ramping up,
Congress also must address long-term repeal of the therapy cap, an arbitrary
limit on services that often are medically necessary for patients. Both flawed
policies were created in 1997 as part of the Balanced Budget Act and should be
repealed this year. Given the opportunity to act on both SGR and the therapy
cap, this should be the last time cap repeal legislation should need to be
introduced, says APTA.
to physical therapist services has long enjoyed broad bipartisan support, with
approximately 200 members of Congress supporting therapy cap repeal legislation
every congressional session.
Congress does not act on legislation by December 31, the 2-tier exceptions
process that was extended through 2013 by the American Taxpayer Relief Act of
2012 (HR 8), will expire.
comments from the bills' sponsors in APTA's press release.
APTA's Section on Research hosted a fly-in February 12-13 in
Washington, DC, to advocate on behalf of rehabilitation research and to push
for a delay in potential sequestration cuts to programs within the National
Institutes of Health (NIH).
Eleven researchers from 9 states spent the day meeting with staff
of the Senate and House appropriations committees and their individual members
of Congress to discuss the value and impact of innovative multidisciplinary
research to the overall US economy and its ability to remain globally
competitive in the future. The researchers strongly urged Congress to continue
funding agencies that support rehabilitation research within NIH, in light of
5%-7% sequestration cuts set to take effect on March 1.
In addition, the researchers informed members and their staff
about the key findings of the Blue Ribbon Panel Report on Medical Rehabilitation. The researchers received positive feedback from
Appropriations Committee members on the panel's recommendation to enhance the
role and exposure of the National Center for Medical Rehabilitation Research
(NCMRR) within NIH.
Rep Rodney Alexander (R-LA), far left, with members of APTA's
Section on Research. Alexander spoke at a breakfast held for the fly-in participants.
"It was an honor and a
privilege," Mike Klonowski, PT, DPT, PCS, said Wednesday morning
reflecting on his attendance at the State of the Union (SOTU) address Tuesday
Klonowski attended the SOTU address
as an invited guest of Sen Mark Kirk (R-IL). He was the senator's primary
physical therapist at the Rehabilitation Institute of Chicago following a
stroke in January 2012 that paralyzed the left side of Kirk's body.
Being among so many of the nation's
leaders—those on the floor of the House of Representatives and in the House
gallery—was a "unique experience," Klonowski said.
Certain parts of the address were
well received by all attendees. In particular, the audience came together to
cheer the president's call for advancements in education, particularly in
science and math. "We have seen how clinical research can improve care and
patient outcomes on RIC’s new recovery unit and AbilityLab, where Sen Kirk was
treated. Embracing science and innovation is how we lead the world into
the future," said Klonowski.
Before the address, Klonowski
visited with Kirk in his office. "He's not shying away from his stroke
recovery," said Klonowski, noting the odds the senator has overcome and
how his spirit and drive have allowed him to return to a high level of
function. "He's more and more like himself."
"All the hard work Mark did in
rehab is paying off," Klonowski said. "He returned to work better
prepared [to take on his role in the Senate]."
Long-stay home care clients who receive rehabilitation have improved
outcomes and lower utilization of costly health services, say authors of an article published
online in Archives of Physical Medicine
and Rehabilitation. The findings suggest that investment in physical
therapy and occupational therapy services for relatively short periods may
provide savings to the health care system over the longer term, they add.
This observational study conducted
in home care programs in Ontario, Canada, included 99,764 home care clients
with musculoskeletal disorders who received a baseline screening using the
Resident AssessmentInstrument for Home Care, 1 follow-up
assessment, and had discharge or death records between 2003 and 2008.
The effects of physical therapy and
occupational therapy services on transitions in function state, discharge from
home care with service plans complete, institutionalization, and death were
assessed using multistate Markov models.
Home care clients with deficiencies
in instrumental activities of daily living (IADL) and/or activities of daily
living at baseline and who received home-based rehabilitation had significantly
increased odds of showing functional improvements by their next assessment (for
a state 3 → 2 transition OR = 1.17; for a state 2 → 1 transition OR = 1.36).
Receipt of physical therapy or occupational therapy also significantly reduced
the odds of mortality and institutionalization in this group.
With increasing numbers of older
adults with chronic conditions and limited funding for health care services, it
is essential to provide the right services at the right time in a
cost-effective manner, the authors add.
APTA member Donald Jackson, PT, was elected the 16th president of Hastings College on February 4. Located in Hastings, Nebraska, the college was founded in 1882
and has been named a "best" college by numerous publications.
Jackson joined the college administration in the
fall of 2012 after serving more than 21 years as the chief operating officer of
Easter Seals. Previously, he founded and directed the expansion of
Rehabilitation Systems Inc, a multistate health care company focused on
physical therapy services. In addition to having served as vice chair of the
Hastings College Board of Trustees, he served as vice chair of the Hastings
College Foundation Board of Directors.
Jackson is a 1970 Hastings
graduate. He holds a master of
science degree in rehabilitation services administration from DePaul University
and a certificate in physical therapy from Northwestern University.
APTA believes that Jackson is the first
physical therapist to be elected president of a college or university in a
comments on his new position, and a Q&A with reporters, in this video press conference.
Physical Therapy Outcomes Registry Task Force is seeking members to serve on this
newly formed task force. Those wishing to provide input into the development
and implementation of the registry should respond to the call by completing a
volunteer interest profile found on the Volunteer Interest Pool webpage. The
first step is creating a "profile" for service. After developing a
profile, in order to be considered for this task force, members must then
access the "current opportunities for service page" and respond to
the questions specific to this task force. The deadline to respond to this call
is February 20. For more information on this task force, click on the link
above or contact Marc
Goldstein, EdD, senior advisor, Clinical Practice and Research.
APTA member Mike Klonowski, PT, DPT, PCS, will attend the State of the Union
address as an invited guest of Sen Mark Kirk (R-IL).
Klonowski was the senator's primary physical therapist at the Rehabilitation
Institute of Chicago following a stroke in January 2012 that paralyzed the left
side of Kirk's body. Last month, Klonowski watched Kirk climb the steps to the Capitol on the first day of the 113th
for Klonowski's comments on tonight's event in an upcoming article in News Now.
APTA's issue brief on the final
settlement in the class action "Improvement Standard" lawsuit (Jimmo
vs Kathleen Sebelius), which upheld the right of patients to continue to
receive reasonable and necessary care to maintain their condition and prevent
or slow decline, contains key points for physical therapists regarding
compliance with this Medicare regulation.
In the brief, APTA notes that there is "clear and convincing evidence embedded within the
provisions of the current Medicare regulations that providers may use to
justify the current practice of providing skilled therapy to patients to
maintain their current level of function or to prevent decline or
deterioration." Thus, the final settlement seeks to clarify the
regulations; it does not expand the Medicare benefit.
"Therefore, we expect that only patients who were unfairly denied services
based on this arbitrary standard will now have access to care," says the
members can access the issue brief on the Medicare Coverage Issues webpage under the
subtitle Improvement Standard.
An article* published this
month in JAMA reports that in
patients with unilateral lateral epicondylalgia, corticosteroid injections were
associated with poorer long-term outcomes and higher recurrence rates than
other interventions 1 year after receiving the injection. Patients in the same
study who participated in 8 weeks of multimodal
physical therapy did not achieve long-term outcomes. However, physical therapy
was beneficial in the short term in the absence of corticosteroid injection. In
addition, significantly fewer patients receiving physical therapy consumed an
analgesic or anti-inflammatory medication.
randomized, injection-blinded, placebo-controlled
trial was conducted in Australia at a single university research center and 16
primary care settings. A total of 165 patients aged 18 years or older with
unilateral lateral epicondylalgia of longer than 6 weeks' duration were
enrolled between July 2008 and May 2010; 1-year follow-up was completed in May
Of the 165 patients, 43 received corticosteroid injection,
41 received placebo injection, 40 received corticosteroid injection plus
physical therapy, and 41 received placebo injection plus physical therapy. The
physical therapy intervention was standardized, based on current evidence, and
primarily included manual therapy and exercise. The exercise program included
twice daily sensorimotor retraining of gripping and concentric and eccentric
exercise to progressively load the wrist extensors using resistive elastic
latex bands. The patients' home program and exercise diaries were monitored to
facilitate program adherence.
The 2 primary
outcomes were 1-year global rating of change scores for complete recovery or
"much improvement" and 1-year recurrence (defined as complete
recovery or much improvement at 4 or 8 weeks but not later) analyzed on an
intention-to-treat basis. Secondary outcomes included complete recovery or much
improvement at 4 and 26 weeks.
At 1 year,
corticosteroid injection demonstrated lower complete recovery or much
improvement and greater recurrence compared with placebo injection. There were
no differences between physical therapy and no physical therapy for complete
recovery or much improvement or recurrence.
their analysis of secondary outcomes, the authors found that at 4 weeks there
was a significant interaction between corticosteroid injection and physical
therapy for complete recovery or much improvement. In particular, patients who
received the placebo injection plus physical therapy had greater complete
recovery or much improvement compared with patients who did not receive
physical therapy, and medium-sized benefits for worst pain, resting pain, and
pain and disability.
their finding that physical therapy did not provide a statistically significant
long-term effect on complete recovery compared with the other groups, the
authors say that physical therapy "should not be dismissed altogether,"
because in the absence of corticosteroid it provided short-term benefit across
all outcomes and had the highest percentage of participants reporting a
complete recovery or improvement at 1 year.
results of this study were widely reported in the mainstream media, including
articles by USA Today, The New York Times, ABC News, NPR, and CBS News.
full text of this study is available by subscription or purchase only.
Copyright protections prohibit APTA from disseminating the information. For
suggestions about obtaining literature, visit APTA's Finding Information in Physical Therapy Literature webpage.
APTA's photographer take a great photo of you or your colleagues at the
Combined Sections Meeting (CSM) last month in San Diego? You now can view and
purchase CSM 2013 photos. To order images and downloads, go to www.davidbraun.photoreflect.com and click on
Enter password "ribcage,"
click the "GO" button, select any day or event gallery link, and
click on thumbnails to view larger images. Use the drop-down menu on the upper
right to change between daily galleries. Prices for prints appear on the right
when viewing an image. To order file downloads, click on the "Digital
Products" link below the print prices.
peer-reviewed, competency-based learning modules for interprofessional health
education now are available through a new innovative online portal launched by the
Interprofessional Education Collaborative (IPEC). Based on Core Competencies for Interprofessional Collaborative Practice, these
materials are designed to provide tools to prepare tomorrow's health
professions work force for interprofessional, team-based, patient-centered, and
community- and population-oriented care.
support was provided by the Josiah Macy Jr Foundation and IPEC, a national
organization connecting health professions for better care. IPEC's founding
members are the American Association of Colleges of Nursing, the American
Association of Colleges of Osteopathic Medicine, the American Association of
Colleges of Pharmacy, the American Dental Education Association, the
Association of American Medical Colleges, and the Association of Schools of
served on the Advisory Committee for the IPE PORTAL, representing both the association and the Interprofessional Professionalism Collaborative (IPC), for the development of this new interprofessional
IPE PORTAL collection is open for submissions. Inquiries should be
directed to email@example.com.
Register today for CARF
International's 2-day training session to gain valuable insight into the
accreditation process, and learn how to avoid the pitfalls some organizations
may experience on their accreditation survey.
This comprehensive and interactive training session
provides an appropriate forum to assimilate the ASPIRE to Excellence® quality
framework. In addition, the session will highlight practical examples of
demonstrating conformance to the standards and effective business management
and service delivery practice. All areas in the 2013 Medical Rehabilitation
Standards Manual will be covered.
Session topics include:
This session is recommended for
first-time organizations preparing for the accreditation survey process,
organizational contacts new to the CARF accreditation process, or those who
need a quick update and refresher course.
APTA is a member of CARF's International
is pleased with the decision of the federal court to approve the final
settlement in the class action 'Improvement Standard' lawsuit (Jimmo vs Kathleen Sebelius), which
upheld the right of patients to continue to receive reasonable and necessary
care to maintain their medical conditions and prevent or slow decline,"
President Paul A. Rockar Jr, PT, DPT, MS, in a statement issued today. "We look
forward to working with the Centers for Medicare and Medicaid Services (CMS)
and its contractors to ensure the appropriate and equitable application of
patient care as outlined in the settlement. We believe this final settlement
reinforces the fundamental right established in the Medicare statute that
affords patients the right to receive the services necessary to treat their
diagnoses or illnesses."
final settlement directs CMS to revise its Medicare Benefits Policy Manual to
set a maintenance coverage standard and launch a national educational campaign
to explain the clarified benefit to its contractors, providers, and
beneficiaries. "APTA is eager to serve as an active partner as the agency
begins this work. Over the next several months, we will provide clinical and
professional expertise to CMS to define appropriate treatment in accordance
with our professional standards," Rockar says.
CMS works to publicize changes and new resources, APTA will actively educate
members on how to give appropriate care as defined by this final settlement.
The candidate webpage now is
available. Learn about your candidates for the 2013 elections to national
office by browsing the candidates' biographical information and reading their
written statements. Contact Angela Boyd
with any questions.
The Indian Health Service (IHS) is
accepting applications for its Loan Repayment Program (LRP). This program
offers health care professionals, including physical therapists, the
opportunity to pay off qualified student loans to meet the staffing needs of
Indian health programs. There is an estimated $20 million available for
awards during Fiscal Year 2013. The LRP awards up to $20,000 per year in
exchange for a minimum 2-year service obligation, plus 20% of federal income
tax on the award (see payments and examples).
Applications are accepted and
evaluated monthly until funds are exhausted. February 15 is the first award
cycle deadline. August 16 is the last award cycle deadline. Visit the LRP website for more
and to apply.
The February issue of Health Affairs
explores the burgeoning field of activating and engaging patients in their
health and health care. Studies show that more informed and empowered patients
have better health outcomes, and there is some evidence that they also have
lower health care costs.
One study featured this month
found that patients with the lowest level of "activation"—that is,
those most lacking in the skills and confidence to be actively engaged in their
health care—had average costs that were 8 %-21% higher compared with patients
with the highest level of activation.
Another article reports on how offering online health care for patients with
simple conditions saved money for a prominent Minnesota health plan. Launched
in 2010, "virtuwell" provides 24-hour online access, diagnosis, and
treatment (including prescriptions) by nurse practitioners for about 40 simple
conditions, such as sinus infections, urinary tract infections, and pink eye.
Private and public sector leaders also weigh in with their perspectives on
strategies to lower health care costs, improve quality, engage patients, and
enhance outcomes research.
to popular demand, the deadline for the Innovation Summit: Collaborative Care Models has been extended to March 6. Don't miss out on the opportunity to
participate in this groundbreaking virtual event that will bring together
physical therapists, physicians, large health systems, and policy makers to
discuss the current and future role of physical therapy in integrated models of
out the programming,
the speakers and panelists who will provide you with the information needed to
get involved in accountable care organizations, patient-centered medical homes,
bundled payment models, and private payer and employer-sponsored initiatives.
in attending a viewing party in your area? APTA will soon list viewing parties
and their locations at www.apta.org/InnovationSummit/ViewingParties/.
newly created Leadership Development Committee (LDC) is seeking members to
serve in this capacity. If you or someone you know is interested in developing
the organizational structure for an APTA leadership development program, you may wish to add
your name in the pool for consideration. There are 7 committee member openings
for 1- or 2-year terms starting in April. Contact Elizabeth Grotos with questions
about the LDC.
answer the call for these opportunities, members must first complete a
volunteer interest profile found on the Volunteer Interest Pool webpage. Once your profile is created, you may review the
current opportunities and answer the questions specific to each committee. The deadline to respond to this call is
training regimen to adjust the body's motor reflexes may help improve mobility
for some people with incomplete spinal cord injuries, according to a study
supported by the National Institutes of Health.
The study involved 13 people who
were still able to walk after incomplete spinal cord injuries that had occurred
from 8 months to 50 years prior to the study. All had spasticity and an
impaired ability to walk. The goal was to determine if these individuals could
gain mobility by learning to suppress a spinal H-reflex, which is elicited by
electrical stimulation rather than by a tendon stretch.
Participants in the study received
electrical stimulation to the soleus of their weaker leg while standing with
support. The first 2 weeks of the study involved baseline measurements of the
resulting reflex. During the next 10 weeks, 9 participants underwent 3 training
sessions per week, during which they viewed the size of their reflexes on a
monitor and were encouraged to suppress it. A control group of 4 participants
received the stimulation but no feedback about their reflexes. Before and after
these sessions, the researchers measured the participants' walking speed over a
distance of 10 meters and monitored their gait symmetry with electronic shoe
Six of the 9 participants in the
training group were able to suppress their reflexes. Their walking speed
increased 59% on average, and their gait became more symmetrical. These
improvements in speed and symmetry were not seen in 3 participants who were
unable to suppress their reflexes, or in the control group. Many participants
also spontaneously told the researchers they were noticing improvements in
daily living activities. About 85% of these comments came from people who were
able to control their reflexes after several weeks of training.
author Jonathan Wolpaw, MD, said he
views reflex conditioning as a complement to current rehabilitation practices.
The technique could be tailored to focus on specific reflexes that affect
different muscle groups and, in some cases, to increase reflexes instead of
decrease them. In its 2006 study, his group found that enhancing soleus
H-reflex was beneficial for rats that had spinal cord injuries predominantly
characterized by weakness without spasticity.
Thompson, PhD, who also authored the article, said she plans to study how durable the effects of training are, but
such research presents a design challenge. "Once people noticed their
mobility had improved, they started exercising more and getting involved with
other types of therapy. Those activities are likely to have additional benefits
and will be difficult to separate from the long-term effects of our reflex
conditioning protocol," she said.
issued a letter to
the producers of the Dr. Oz Show to express its dissatisfaction with the
show's recent segment on "Cutting-Edge Solutions for Back Pain." In
the letter, APTA President Paul A. Rockar, Jr, PT, DPT, MS, points out that, "While
modalities may be used by physical therapists as part of an overall treatment
plan, the focus of physical therapy treatment for back pain is on
evidence-based exercises to improve strength and flexibility, manual therapy to
improve the mobility of joints and soft tissues, and patient education on ways
to enhance recovery, prevent and relieve pain, and avoid recurrence."
am so excited by the December issue and these 10 articles that I'm really
considering changing my path and going out to see if I can help develop acute
care specialization and become a practicing clinician again," says PTJ Editor in Chief Rebecca Craik, PT, PhD, FAPTA, at the conclusion of the latest Craikcast.
Craik this month in discussing the articles that complete the 2-part PTJ Special Series on Rehabilitation for
People With Critical Illness are coeditors Patricia
Ohtake, PT, PhD, Dale Needham, MD, and Dale Strasser, MD. The group also
discusses quality improvement research, a key topic of the articles in the
February edition of the critical care special series. The first part of the
series was published in the December 2012 issue.
part of APTA's strategic plan, one of the goals for 2013 is to better enable
physical therapists to consistently use best practice to improve the quality of
life of their patients and clients. To achieve this goal, APTA is supporting
the development of clinical practice evidence-based documents. This initiative
aims to provide structure, process, and resources for the development of
Clinical Practice Guidelines (CPG) and Clinical Practice Appraisals (CPA) that
enable the translation of research into physical therapist practice. In order
to facilitate the development of clinical practice documents and other high
quality evidence summaries, APTA is offering financial and training support to sections
for this purpose.
for CPG/CPA development must focus on clinical practice areas that are
important and relevant to the practice of physical therapy. The proposal must
be supported and submitted by an APTA section. Each proposal will be considered
individually and will be awarded in part or in full depending on the priorities
of the association and the strength of the proposal.
for the current review cycle are due on March 18. For more information or for a
copy of the proposal submission document, contact Anita Bemis-Dougherty, director,
Practice Department, at firstname.lastname@example.org or 800/999-2782,
In a retrospective cohort obtained
from electronic medical records and insurance claims data, initial physical
therapy management following a new primary care low back pain (LBP)
consultation was not associated with increased health care costs or utilization
of specific services. The authors of this article, which appears
online in Archives of Physical Medicine
and Rehabilitation, write that additional research is needed to examine the
cost consequences of initial management decisions made following a new
consultation for LBP.
Records and data were examined on 2,184 patients aged 18 and older with a
new consultation for LBP from 2004-2008 in single health care delivery system
in the United States. Patients were categorized as receiving initial physical
therapy management if care occurred within 14 days after consultation.
Total health care costs for all LBP-related care received in the year
following consultation were calculated from claims data. Predictors of
utilization of emergency care, advanced imaging, epidural injections,
specialist visits, and surgery were identified using multivariate logistic
regression. Generalized linear model was used to compare LBP-related costs
based on physical therapy utilization and identify other cost determinants.
Initial physical therapy was received by 286 of 2,184 patients (13.1%) and
was not a determinant of LBP-related health care costs or utilization of
specific services in the year following consultation. Older age, mental health
or neck pain comorbidity and initial management with opioids were determinants
of cost and several utilization outcomes.
member Julie M. Fritz, PT, PhD, ATC,
is the article's lead author. APTA members Gerard
P. Brennan, PT, PhD, Stephen J.
Hunter, PT, DPT, OCS, and John S.
Magel, PT, DSc, OCS, FAAOMPT, are coauthors.
February 11, is the deadline to submit nominations for the Federal Government Affairs Leadership Award and the APTA Public Service Award.
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.
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.
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. Submit nominations by February 11 to Stephanie Sadowski.
APTA's summary of a recently released HIPAA final rule
includes important information for physical therapists related to modifications
of the Privacy, Security, and Enforcement Rules embedded in the HITECH
Act, changes to the HIPAA Enforcement Rule to incorporate the increased
and tiered civil money penalty structure, the adoption of breach notification
requirements for unsecured data, and adjustments to the HIPAA Privacy Rule as
required by the Genetic Information Nondiscrimination Act to increase privacy
protections for genetic information.
members can access the document on the Health Information Technology webpage under
"APTA Summaries" and the HIPAA webpage.
a meeting with APTA yesterday, the Centers for Medicare and Medicaid Services
(CMS) clarified the impact of the therapy cap on patients who receive
outpatient therapy services in critical access hospitals (CAHs). CMS stated
that for 2013, when a patient receives outpatient therapy services from a
critical access hospital, the services will count toward dollars accrued toward
the therapy cap. For example, if a patient receives $2,000 of outpatient
therapy services in a CAH and upon discharge goes to a private practice to
continue therapy services, the private practice would need to obtain an
exception (in this case use the KX modifier).
CMS clarified that for 2013 the therapy cap does not apply to outpatient
therapy services provided within CAHs themselves. This means that if the
patient continued treatment in the critical access hospital, after exceeding
$1,900 in therapy services, there would be no need to seek an exception through
the automatic process. That is, the CAH would not need to submit the claim with
a KX modifier. Also, if the patient exceeds $3,700 and continues care in CAH,
the hospital would not need to obtain an exception through the manual medical
had been seeking clarification on this issue from CMS since the January 1
passage of the American Taxpayer Relief Act of 2012 (HR 8), which extended the
current 2-tier therapy cap exceptions process through 2013. The agency advised
APTA last month that it was working with its general counsel for interpretation
of the legislative language.
APTA's comments to the Senate
Finance Committee's May 2012 request for input from health care stakeholders on
3 areas critical to Medicare and Medicaid reforms—program integrity, payments, and enforcement—have
been included in the committee's recently released report
titled "Opportunities to Curb Waste, Fraud and Abuse in Medicare and
the Senate Finance Committee writes about eliminating self referral in 2
sections of the report. Under the Beneficiary Protection section, the committee
notes "concern that over-broad application of the Stark law exception for
physician in-office ancillary services compromises patient care by
incentivizing overutilization." The committee references "increasing
enforcement of existing laws, such as the Stark law" under the area titled
than 160 stakeholders in the health care community submitted comments to the
Senate Finance Committee's request. During the 113th Congress, 6 Senators plan to work
with key committees of jurisdiction, the Government Accountability Office, the
Department of Health and Human Services Office of the Inspector General, and
interested stakeholders to develop a more detailed list of administrative
recommendations and potential legislative actions.
comments can be found on the association's Self Referral webpage.
than 530 physical therapists, physical therapist assistants, and physical
therapy students from Indiana gathered at the statehouse on January 30 to show
their support for HB 1034, which would provide direct access to physical
therapists. Over 50 legislators joined the members of the physical therapy
profession for lunch and to discuss the bill.
Sen Pat Miller and state Reps Dave Frizzell and Matt Ubelhor spoke to the crowd
and confirmed their commitment to passing direct access legislation. Indiana is
1 of only 3 states with no form of direct access to physical therapy treatment,
and the only state without direct access to a physical therapy evaluation. Many
Indiana Chapter members held signs with the messages: "49 states allow you
to see your PT directly … not Indiana" and "Hoosiers deserve direct
access to physical therapists."
House Public Health Committee hearing for HB 1034 will be held February 6. The
chapter is coordinating a team of chapter members to speak in support of the
bill. If it is approved by the committee, the bill would then go to the full
House of Representatives for consideration.
of the January 30 event are available here.
More than 500 organizations will
begin participating in the Centers for Medicare and Medicaid Services' (CMS) bundled payments for care improvement initiative, made possible by the Affordable Care Act. Through this
initiative CMS will test how bundling payments for episodes of care can result
in more coordinated care for beneficiaries and lower costs for Medicare.
The bundled payment initiative
includes 4 models of bundling payments, varying by the types of health care
providers involved and the services included in the bundle. Depending on
the model type, CMS will bundle payments for services that beneficiaries receive
during an episode of care, encouraging hospitals, physicians, postacute
facilities, and other providers as applicable to work together to improve
health outcomes and lower costs. Organizations of providers participating in
the initiative will agree to provide CMS a discount from expected payments for
the episode of care, and then the provider partners will work together to
reduce readmissions, duplicative care, and complications to lower costs through
Last week's announcement includes
the selection of 32 awardees in model 1, who will begin testing bundled
payments for acute care hospital stays as early as April. In the coming weeks,
CMS also will announce a second opportunity for providers to participate in model
1, with an anticipated start date of early 2014.
CMS' announcement also marks the
start of phase 1 of models 2, 3, and 4. In phase 1 (January-July 2013), more
than 100 participants partnering with over 400 provider organizations will
receive new data from CMS on care patterns and engage in shared learning in how
to improve care. Phase 1 participants are generally expected to become
participants in phase 2, in which approved participants opt to take on
financial risk for episodes of care starting in July 2013, pending contract
finalization and completion of CMS' standard program integrity reviews.
list of the model 1 awardees and participants for phase 1 of models 2, 3, and 4
is available on the Center for Medicare and Medicaid Innovation's website.
how physical therapists are getting involved in bundled payment initiatives by
Innovation Summit: Collaborative Care Models. This groundbreaking virtual event will bring
together physical therapists, physicians, large health systems, and policy
makers to discuss the current and future role of physical therapy in integrated
models of care. A panel of experts, moderated by a physical therapist who is
highly involved in bundling initiatives, will provide you with perspectives on
bundling from large health systems, a physical therapy private practice, and
Registration for the Summit
closes Friday, February 8. Interested in attending a viewing party in your
area? APTA will soon list viewing parties and their locations at www.apta.org/InnovationSummit/ViewingParties/.
A proposed rule issued Wednesday
includes vital provisions regarding minimum essential coverage as mandated by
the Affordable Care Act.
the ACA, nonexempt individuals are required to maintain minimum essential
coverage or make a shared responsibility payment. This provision is known as
the individual mandate. The ACA
specifies the categories of individuals who are eligible to receive exemptions
from the shared responsibility payment under section 5000A of the Internal
Revenue Code, which provides nonexempt individuals with a choice: maintain
minimum essential coverage for themselves and any nonexempt family members or
include an additional payment with their federal income tax return.
proposed rule sets forth standards and processes under which the health
insurance exchanges will conduct eligibility determinations for and grant
certificates of exemption from the shared responsibility payment.
proposal also provides standards for determining whether certain other types of
health insurance coverage constitute minimum essential coverage and procedures
for sponsors to follow for a plan to be identified as minimum essential
coverage under section 5000A.
it proposes to designate certain types of existing health coverage as minimum
essential coverage. Sponsors of a health plan that seek to have such coverage
recognized as minimum essential coverage would have to submit information,
including the essential health benefits
covered, to the Department of Health and Human Services (HHS). Among the
essential health benefits required in the ACA are rehabilitation and
habilitation services and devices.
proposed rule, which complements a proposed rule issued the same day by the
Internal Revenue Service, is published in today's Federal Register.
on the rule are due March 18. APTA will analyze the proposed rule to determine
if it is necessary for the association to submit comments.
provides a comprehensive summary of a recently proposed rule that has
significant importance to the new Medicaid expansion population who must be offered
essential health benefits beginning in 2014. In the proposed rule, the Centers
for Medicare and Medicaid Services recommends that states define the
habilitative services category under Medicaid and requests comments on whether
the habilitative services should be offered in parity with rehabilitative
benefits, as contemplated in previously released guidance to states on
essential health benefits. In addition, the summary outlines proposals related
to eligibility and enrollment, cost sharing, and eligibility appeals.
summary is available on APTA's Medicaid webpage.
Kick off American Heart Month by
attending the third Annual State of Women's Heart Health webinar February 5,
4:00 pm ET. This informative discussion with some of the nation's health
leaders, including Department of Health and Human Services Secretary Kathleen
Sebelius, Food and Drug Administration Commissioner Margaret Hamburg, and
Million Hearts initiative Director Janet Wright, MD, will highlight advances in
women's heart health, actions to reduce risk factors, and ways to help raise
awareness about heart disease in women.
For more information and to
register, visit the American Heart
Association's You're the Cure website.