Physical therapists (PTs) in Washington, Oregon, Idaho, and Utah are in for some good news: Regence insurance company has announced that it is abandoning its tiered system for utilization management (UM) that divided PTs and chiropractors into 3 groups with different allowances for preapproved visits. The system will be suspended on July 1.
Instead of the tiered system, all providers will receive an initial authorization for 6 visits, with additional visits approved when providers demonstrate medical necessity. According to Regence, the change is based on Regence data supporting 6 as the number of visits that covers most episodes of care.
Regence plans to send letters to providers informing them about the change at the end of March.
Chapter representatives from the 4 affected states and APTA staff began regular discussions with Regence and CareCore (Regence's UM vendor) about problems with the program since its launch more than a year ago. The discussions were aided by feedback provided by individual PTs through an APTA initiative calling for provider accounts of problems with UM systems.
“We think there will be many fewer gaps in patient care with the elimination of tiering,” said Pete Rigby, PT, Washington Chapter payment chair. “We’ll continue to work with Regence regarding the ideal number of preapproved visits.”
Encountering difficulties with UM and utilization review (UR)? APTA is collecting your experiences to strengthen its advocacy efforts around third-party UM and UR administrators. Fill out the online feedback form, and staff will contact you for more information.
Whether in academic research journals, political advocacy reports, or the sports page, discussions about concussion and traumatic brain injury (TBI) weren't hard to find last week.
The common thread? Something APTA has been stressing for years: more attention needs to be paid to all aspects of brain injury diagnosis and management.
In a widely covered announcement, 24-year-old Chris Borland, a successful rookie linebacker for the San Francisco 49ers professional football team, announced that he is retiring from the sport after 1 season because of concerns about potential health risks associated with head trauma.
"From what I've researched and what I experienced, I don't think it's worth the risk," Borland said in an interview for ESPN's "Outside the Lines."
"I just want to live a long, healthy life, and I don't want to have any neurological diseases or die younger than I would otherwise," Borland told ESPN.
According to an article in the New York Times (NYT), Borland's announcement "stands out because of how explicit he was regarding his concerns about head injuries." The frankness comes as the National Football League "scramble[s] to find a response" to mounting evidence "linking blows sustained on the field with long-term cognitive disability," according to the NYT.
Response to head injury was also the focus of a recent article in the Journal of Pediatrics (.pdf) that looked at public school principals' knowledge of concussion management, specifically around "return to learn" (rather than return to play) decisions.
In a survey of 695 high school principals in Ohio, researchers found that among the 465 administrators who responded, approaches to—and knowledge of—concussion management varied widely.
While 37.2% of the principals reported having received "some form" of concussion training in the past year and were supportive of providing training to faculty, researchers found that issues such as school size, funding, and available staff contributed to inconsistencies.
One example: only 32% of respondents said that they provide a written concussion plan to families and health professionals, with only 24.3% stating that the plan includes potential academic adjustments and accommodations. In contrast, authors write, research from Michigan found that 62% of school coaches provide a plan to families about postconcussion protocols for student athletes.
Authors cite progress in the ways schools respond to concussion in youth sports, but write that the academic environment needs to make up ground. "Not all concussions are sports related, and not all students with concussions are athletes," authors write. "Schools and health professionals must be prepared to monitor and accommodate students with concussion, regardless of athlete status."
The need for broad understanding of youth concussion management—and, in fact, all mild brain injury as well as TBI—was what brought APTA advocates and staff to Washington, DC, last week to participate in congressional briefings and provide information to legislators and congressional staff during a "Brain Injury Awareness Fair" on Capitol Hill. APTA representatives also spoke with lawmakers about the importance of the SAFE PLAY Act, now in congress, that aims to improve concussion management in schools. The act includes physical therapists in the list of professionals qualified to make return-to-play decisions.
Find more resources on APTA's Traumatic Brain Injury webpage, read the clinical summary on concussion available for free to members on PTNow, and direct patients and clients to the Physical Therapist's Guide to Concussion on APTA's MoveForwardPT.com consumer website. Looking for continuing education on concussion management in today's environment? Check out the prerecorded webinar "Managing Concussions with an Interprofessional Team" available through the APTA Learning Center.
Michael Hurlbut, right, APTA senior congressional affairs specialist, gets the APTA word out during the Brain Injury Awareness Fair held on Capitol Hill last week.
The latest cyberattack on health insurance data is the second-largest on record, affecting around 11 million current and former customers of Washington-based Premera Blue Cross—and this time, hackers may have made off with bank account and clinical information.
According to Premera, the breach of its encrypted files began in May 2014 but was not detected until January 29, 2015. Potentially affected files include those of customers, employees, and others dating back to 2002.
In terms of number of people potentially affected, the Premera Blue Cross hack is the second-largest to date. In February, Anthem Blue Cross Blue Shield announced that a breach of its system resulted in information theft from approximately 80 million current and former customers.
One difference in the Premera theft: hackers are believed to have accessed customer financial information and clinical data, as well as Social Security numbers, addresses, and birthdates. Anthem maintains that no financial or clinical health information was accessed when their files were breached.
Premera Blue Cross, which operates in Washington and as Premera Blue Cross Blue Shield Alaska, has affiliates including Vivacity and Connexion Insurance Solutions. Employer clients include Microsoftand Starbucks, according to the Wall Street Journal.
Women may make up 64% of the physical therapist (PT) workforce, but in 2013, they earned about 88% of what male PTs made, according to the latest data from the US Census Bureau.
The report issued on March 16 tracks employment and earnings data across professions, and divides them in to major sectors. The PT pay disparities are smaller than the average for health care professions in general, which combined showed that women make about 70.3% of what is paid to men. Data on physical therapist assistants were not included as a distinct line item.
Among the data related specifically to PTs:
The disparity percentage in physical therapy was similar to that of occupational therapists, estimated at 88.7%.
The smallest disparity among health care professions was for dietitians and nutritionists, where women earn 97.4% of what their male counterparts earn. The greatest difference? Dentistry, where female dentists are estimated to earn only 67.8% of what male dentists earn.
More workforce resources, including supply and demand estimates for PTs, are available on APTA's physical therapy workforce data webpage.
A recently published Wall Street Journal article says that a growing number of adults in later life are taking up strength training, but advises readers to consult with experts beforehand.
The March 15 article asserts that "while old-school wisdom held that older adults were too frail to pump iron, a growing body of research is showing that strength training helps stave off age-related disability, preserve bone mass in women, and even boost brainpower."
The article relates the stories of 3 individuals who found relief through strength training: a 54-year-old man whose strength training regimen eased pain from a childhood back injury, a 75-year-old woman who participates in special exercise classes that have helped reduce arthritis pain, and a 75-year-old man who was able to regain his ability to walk without back pain after training for 6 months.
APTA has long supported strength training for older adults, and even included under-dosed strength training in its list of "5 Things Physical Therapists and Patients Should Question" released as part of the American Board of Internal Medicine Foundation's "Choosing Wisely" campaign. The APTA recommendation advises "Don’t prescribe under-dosed strength training programs for older adults. Instead, match the frequency, intensity, and duration of exercise to the individual’s abilities and goals."
Training experts and researchers interviewed for the story advised that individuals with preexisting injuries—a common condition for older adults—should consult with professionals who can monitor and adjust exercises.
The benefits go beyond the ways in which strength training can address pain and mobility, according to the article, which cites studies claiming that this type of exercise can serve as a complement to aerobic training to help keep brains sharp. Whereas cardio exercise can help strengthen the brain's ability in memory tasks, the article states, strength training has been found to help with higher-level brain functions that allow an individual to juggle multiple tasks.
Do you have patients or clients interested in starting a strength training program? Share MoveForwardPT.com's consumer-oriented information on strength training and how a PT can help.
Less than 24 hours after its debut, Apple's ResearchKit health research app connected Parkinson disease researchers with more than 5,500 consenting subjects, while a cardiac research project registered double that number—all amid a trickle of doubts and concerns about the quality of data that might be generated via the open-source software.
Articles in Bloomberg News, Modern Health Care, Engadget, and other sources report that organizers of the 5 research projects already created through ResearchKit were encouraged by the public's response to the new app, which turns iPhones into interactive monitoring devices and feeds data back to researchers.
Bloomberg News quoted Alan Yeung, medical director of Stanford Cardiovascular Health and member of one of the teams using ResearchKit as saying that "to get 10,000 people enrolled in a medical study normally, it would take a year and 50 medical centers across the country." In the case of the Stanford study on cardiac health, that number was reached overnight.
The excitement is not universal. Almost as soon as the product was unveiled, criticism began.
In addition to reporting on excitement over the participant numbers being generated, recent stories cite some research experts' concerns about how representative the data will be, given that iPhone owners do not represent an accurate cross section of the general population.
Other critics worry about how the app's inability to ask open-ended questions of participants could skew the results, and cite possible problems with participants allowing others to use their phones during the research.
In the Modern Health Care article, Michael E. DeBakey VA Medical Center researcher Hardeep Singh voiced concern about how the sheer scale of data can have an impact. "Ultimately, it's about data quality and reliability," he said. "You can lose control in this virtual environment of big data."
It may lack the glitz of the $10,000 gold-plated AppleWatch that debuted this week, but Apple's new foray into open-source medical research is turning its share of heads in health care.
As part of its "Spring Forward" launch program, Apple unveiled ResearchKit, an app that integrates with its HealthKit app to provide medical researchers with access to data from users who sign up and consent to participating in a particular study—also transformed by Apple into a simple online process.
The app is open-source, which will allow researchers to use ResearchKit in a wide variety of studies, and with non-Apple devices. According to an article in MobiHealth News, apps already created with ResearchKit focus on Parkinson disease, diabetes, cardiovascular disease, asthma, and breast cancer.
Participants in studies that employ ResearchKit will use their phones as a monitoring and data delivery system. The Parkinson app, for instance, can analyze the gait and balance of a participant by having the individual put the phone into a pants pocket, walk 20 steps, turn around, and return. Developers also report that the app can "detect symptoms in Parkinson patients just by having them say 'ahhhh' into the phone," according to the MobiHealth News article.
Apple claims it will never have access to the data shared between participants and researchers using the app. ResearchKit is set to launch in April.
Medical identity theft increased by 21% between 2013 and 2014, adding an estimated 500,000 Americans to the 2 million who have been victimized over the past 5 years, according to a new report from a research firm specializing in privacy management. And if that weren't bad enough, findings by the Ponemon Institute, which completed its study in November 2014, do not include statistics from the recently announced massive records breach of Anthem customers, which could affect as many as 80 million Americans.
In its fifth annual study of medical identity theft (.pdf), Ponemon analyzed surveys from 1,005 respondents across the United States who had experienced theft. The survey asked not just about the costs and circumstances around instances of theft 2013–2104, but about respondents' attitudes toward their health care providers' security practices. Among the findings:
While Ponemon acknowledges that medical identify theft can't be prevented completely, the report does recommend that health care and insurance providers "help consumers gain more control over their medical records" by making electronic health records more accessible to consumers. Given the large percentage of respondents who knowingly shared their medical identity records with others, the firm also asserts that "providers … have a responsibility to inform individuals of the negative consequences of sharing medical credentials with others."
To just about nobody's surprise, the future of working out is shaping up to be a lot like the future of most everything else: data-driven, networked, personalized, and maybe just a little creepy.
A recent article published on the Fast Company website polled leaders from their list of the most innovative companies in fitness on what they think fitness programs will look like 5 years from now. Their predictions? You'll still have to work up a sweat, but technology may help you to get more benefit from your efforts—and will likely be able to track your every movement. Literally.
Besides the increasing use of personal data to shape workouts, the contributors also predicted an increase in smaller, more individualized training centers, widespread use of virtual classes at gyms, a stepped-up focus on early intervention and getting children more involved in fitness programs, and a more holistic approach to fitness that recognizes how behaviors outside the gym can impact health.
Because so many of these changes are fueled by access to personal data, the experts interviewed believe that wearable monitoring systems will evolve beyond the wristband, to include smart clothing.
Like, really smart clothing.
"Behavioral data will be collected on all aspects of our life—and without us being aware of it," said one leader interviewed for the story. "This will provide a noninvasive and holistic view of our health with opportunities to upgrade our behaviors."
Experts interviewed were not clear on whether the personal behavior upgrades would be compatible with older operating systems.
Want to hear what's in store for fitness in the very near-future? Check out a recent APTA Move Forward Radio podcast on fitness trends for 2015.
Researchers in England are hoping a prototype robotic glove will help speed rehabilitation for individuals poststroke by way of video games that are fun and interesting enough to keep users playing without real-time monitoring by health care providers.
According to a story recently published in CNET, University at Hertfordshire researchers have developed 2 of the gloves, which are capable of sensing and recording a wide range of finger, hand, wrist, and elbow movements. The movements can be programmed to operate elements in specially designed video games—bending the wrist to open and close a clam that earns points by eating fish, for example; or using a variety of hand, wrist, and elbow movements to control an alligator swimming down a river.
The device is designed for home use, but the difficulty levels and types of movements required to play the video games can be controlled by the individual's health care provider, who is also able to monitor use and progress. The project is part of the Supervised Care and Rehabilitation Involving Personal Tele-robotics (SCRIPT) program.
Researchers reported that, on average, patients using the device and game chose to exercise by themselves for about 15 minutes a day for 6 weeks. "It has to be noted that this is without external motivation such as fixed appointments … for online remote supervision during exercise, which distinguishes the SCRIPT application from recent telerehabilitation approaches in stroke," authors write in an article on the glove (.pdf) published in the journal Robotica.
"The present research is the first exploration of independent arm/hand training at home using a physical hand/wrist orthosis combined with remote monitoring," authors write. Because the device is in its earliest stages of use, they add, more research is needed "to explore whether patients will actually use a telerehabilitation system provided to them and whether more use will actually result in larger clinical gains."
A video of the device and a closer look at the games developed for the glove are available at the SCRIPT YouTube channel.
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