Members of the US Congress and their staff will have a chance to get the physical therapist (PT) perspective on traumatic brain injury (TBI), as APTA staff participate in the Brain Injury Awareness Fair taking place March 12 on Capitol Hill. APTA was invited to join in the event as part of Brain Injury Awareness Day and will use the opportunity to advocate for 2 bills on concussion and TBI.
In addition to sharing APTA's consumer-oriented information on TBI and highlighting the association's participation in the Joining Forces initiative, APTA will promote passage of 2 pieces of legislation: the TBI Reauthorization Act (H.R. 1098), and the Protecting Student Athletes From Concussions Act (H.R. 3532) (.pdf). The TBI Reauthorization Act would continue support for research and data collection on TBI by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH); the Protecting Student Athletes From Concussions Act would ensure school districts have concussion management plans that educate students, parents, and school personnel about how to recognize and respond to concussions, among other programs.
APTA's advocacy work at the event is part of a much larger strategy to educate legislators and the broader public on concussion and TBI. The association provides extensive resources to its members on the role of physical therapy in brain injury treatment and recovery, and offers a TBI webpage that includes continuing education courses and links to other interest groups.
A resource for advancing falls prevention at the state policy level has been designated a "quality tool" by the federal Agency for Health Care Research and Quality (AHRQ) and included among offerings on the AHRQ website. The toolkit is a product of the National Council on Aging's (NCOA) Falls Free Coalition, whose members include APTA.
The toolkit outlines 8 policy goals that will help advocates establish innovative falls prevention policies and practices in states, communities, and organizations. Each goal is accompanied by suggested policy changes, and includes examples of advances that are possible through education and engagement of key stakeholders.
APTA is a member of the Falls Free Coalition responsible for creating the toolkit, and APTA member Bonita L. Beattie, PT, was instrumental in the development of the resource.
An earlier version of the toolkit (.pdf) focused on falls and Medicare, along with many other resources on falls and falls prevention, can be accessed at APTA's Balance and Falls webpage.
A total of 21 projects will be part of APTA's Innovation 2.0 program aimed at bolstering the impact of physical therapy in innovative and emerging models of health care. The selected projects were the highest-rated among 59 proposals submitted to a review team of physical therapist clinicians, researchers, administrators, and educators.
The projects will move on to the next phase of the Innovation 2.0 process—a 2-day workshop in May that will connect project leaders with researchers, clinicians and other experts to help refine the proposals and ready them for submission to a final round of review. During that final round, reviewers will select recipients for funding and in-kind services that could include environmental scans, policy analyses, collaboration with other researchers, statistical support and analysis, and consultation.
For a complete listing of the proposals selected, visit the Innovation 2.0 web page.
Just about everyone knows that Medicare spending varies depending on geography. Just about no one knows why.
A recent Health AffairsHealth Policy Brief reviewed current theories on why, for example, Medicare spent an average of $15,957 per beneficiary in Miami, Florida, and $6,569 per beneficiary in Grand Junction, Colorado, and found most explanations lacking. "Even after multiple factors are considered, some geographic differences remain unexplained," the report states. In 2012, Medicare spent a national average of $9,503 per beneficiary.
The policy brief reviewed research around possible explanations for the disparities, including the amount Medicare pays for services, the health status of beneficiaries, and variations in use. Authors couldn't point to a consistent explanation, nor were they able to discount a 2013 Institute of Medicine report that asserted that higher costs were not always related to better outcomes.
Further complicating matters, according to the report, is the idea that the geographic differences seem to be specific to Medicare. "When researchers look at health care spending for different populations, such as people with private insurance or those covered by Medicaid, they do not find the same patterns seen in Medicare spending," the authors write.
The need is there, the opportunities are there, and the technology is, well, almost there, but when it comes to assessment of low back pain (LBP), the current reality of telerehabilitation (TR) is that more work is needed before a remote approach becomes a fully reliable substitute for in-person interaction. That's the conclusion reached by Australian researchers who compared face-to-face and remote LBP assessments and found that while "important components" of the assessments can be valid when obtained through TR, "some areas of the assessment require further testing and development."
The study, published in the February 2014 edition of Telemedicine and e-Health (abstract only available for free) focuses on LBP assessments conducted on 26 adult residents of a rural area in Queensland, Australia. The participants reported experiencing LBP currently or within the past 2 years, but not at severe levels nor accompanied by severe neurological symptoms. All participants could mobilize independently, were capable of participating in a safe physical examination, and possessed adequate communication and cognitive function.
Researchers divided the participants into 2 groups, assigning half to undergo a face-to-face LBP assessment followed by a TR assessment, and half to go through the process in reverse order. Outcome measures were then compared relative to disability, pain, posture, active movement, and the straight leg raise (SLR) test. Participants also filled out a questionnaire about their own satisfaction with the TR approach.
Before the study could be conducted, however, researchers needed to create a viable TR system capable of facilitating a LBP assessment—and under realistic conditions. They set up the study in a rural hospital, to be conducted "by rural clinicians, with a group of local participants who have experience with limited access to health services." The technology selected reflected a similar real-world approach, using a 640x480-pixel digital camera that could record moving and still images, a 300mm calibration index, a plinth, and an audio hookup. "The TR assessment was pragmatically designed to require the minimum amount of equipment and setup at the remote end," the authors wrote. Clinicians used "features" of eHAB, a medical videoconferencing system developed by the Telerehabilitation Research Unit at the University of Queensland.
As for the actual conduct of the assessments, participants were instructed to stand on a reference line on the floor of the TR room and move according to the physical therapist's (PT) instructions. Participants were also told to bring a friend with them to the TR room to help with the SLR test. In cases where the participants didn't bring a friend, researchers recruited an "untrained nonclinical assistant" from the hospital staff.
At the end of the study, researchers found strong correlation between face-to-face and TR assessments when it came to some but not all measures.
"We found high levels of agreement with establishing if a lumbar spine movement was painful, detecting pain, eliciting symptoms, and sensitizing the SLR," the authors wrote. "Moderate agreement was found in identifying the limitation to an active lumbar spine movement, identifying the worst lumbar spine movement direction, SLR range of motion, and active lumbar spine range of motion. Poor agreement was found in all elements of the postural analysis."
Researchers believe the problems with the postural analyses were partly technical and partly related to individual participants. According to the study, the keystoning effect of the wide-angle lens "made it difficult to analyze coronal posture," while the resolution of the images obtained was "insufficient to discriminate physical landmarks and hence allow postural assessment." Adding to the difficulties, researchers reported that 4 participants were unwilling to disrobe for the postural analysis—"not an unusual occurrence in this physiotherapy clinic," and something that happened in both the TR and face-to-face sessions.
The study shows how—at least for now—these kinds of difficulties can tip the balance away from telehealth solutions, according to Alan Chong W. Lee, PT, PhD, DPT, CSW, GCS, associate professor at the Mount St Mary's College (California) doctor of physical therapy program. In the US, HIPAA regulations require legally compliant technologies, but even beyond a technological baseline, "patient and provider relationship and patient preference trumps any ability to provide best practice with value," he said. "For example, if the patient doesn't want to disrobe for a posture assessment because of privacy issues, it limits examination and evaluation." Lee agreed with the study's finding that image distortion can affect the assessment, saying that "the image projected on the frontal plane can be larger on the top versus the bottom."
Lee also believes that the study's target participants—patients with no mobility issues or neurological symptoms—says something about the current status of telehealth assessments when it comes to LBP. "Patient selection is key," he said. "Minors, patients with mobility and safety issues, and patients with severe irritability with LBP were excluded from this study."
"This is another example of how clinical decision making plays such a crucial role," said Matt Elrod, PT, DPT, MEd, NCS, senior practice associate at the American Physical Therapy Association (APTA). Elrod pointed out that APTA supports telehealth models, but only "when provided in ways consistent with APTA positions, guidelines, policies, standards of practice, ethical principles, and the Guide to Physical Therapist Practice."
"As physical therapists, we must use our professional judgment to identify when this technology is safe and appropriate by using the best available evidence, understanding the patients' wants and needs, and applying the physical therapist skills," Elrod said.
As for the patients themselves, the study found moderate-to-high satisfaction with the TR assessment, save for 1 area: whether they believed the remote approach was as good as a traditional face-to-face assessment. Authors write that satisfaction "was similar to ratings taken during earlier urban studies."
The key to moving forward with a telehealth assessment program, according to the study, is the development of a "clinically robust" TR assessment for LBP, and the investigation of multidisciplinary treatment.
Lee agrees, and believes that the "multidisciplinary" label needs to be applied to approaches within the practice of physical therapy. "Access to timely care and use of appropriate clinical and nonclinical staff can be best determined by musculoskeletal specialists in telehealth as well as usual care," he said.
Meet Trevor Russell, one of the lead authors of this study, at this year's APTA NEXT conference and exposition, June 11–14 in Charlotte, North Carolina.
The Humana health insurance corporation has nearly completed processing refunds owed to practitioners who were incorrectly billed during an "overpayment recovery" process last year. The overpayments were part of Humana's attempt to implement the multiple procedure payment reduction (MPPR) policy retroactively, and the problems have contributed to a Humana decision to hold off on full MPPR implementation until the system can run more smoothly.
Last summer, APTA raised questions about the accuracy of the overpayment calculations and concerns about the administrative burden of the overpayment recovery process on physical therapist (PT) practices, among other issues. As a result of those efforts, Humana temporarily ceased application of the MPPR policy in December 2013 to focus on correcting their payment logic and refunding inappropriate overpayment recoveries.
Humana will delay MPPR implementation until the policy can be applied accurately and timely during initial claims processing. Humana representatives acknowledged that application of the MPPR policy is complex, and the overpayment recovery application of the policy caused unnecessary burden for PTs. The company is testing application of the MPPR policy and anticipates making an announcement about startup of the MPPR policy on initial claims in the near future.
Humana will notify APTA in advance of the implementation date, and APTA will update members in a future News Now story.
APTA members have an opportunity to provide input on a new resource for physical therapist residency and fellowship education.
The American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) is seeking feedback on a just-released draft of the Mentoring Resource Manual, an 18-page document that defines mentoring, discusses aspects of effective mentoring, and addresses use of technology. The manual and feedback survey can be accessed online. Comments must be submitted by March 30, 2014.
Note: Cookies must be enabled, and if survey participants don’t finish commenting in 1 session they must use the same browser on the same computer to resume where they left off; otherwise, clicking on the link will start a new survey.
The Centers for Medicare and Medicaid Services (CMS) is once again delaying implementation of the "2 midnight" rule for hospital admissions of patients in Medicare. In the face of criticism from physicians and hospitals, CMS now says recovery auditors cannot use the rule until after September 30. The rule was originally set to go into effect on March 31.
Intended to reduce costly admissions in cases better suited to outpatient treatment, the rule stipulates that auditors can assume that an admission is reasonable and necessary if the patient spent 2 days as an inpatient, defined as spending 2 midnights in a hospital bed.
According to a recent report in Modern Healthcare (access requires free registration), the rule was created to respond to "widespread complaints that Medicare's rules are too vague about when a moderately sick patient should be admitted for expensive inpatient care instead of outpatient observation." The report states that hospitals have been unhappy with the assumption that they provided "medically unneeded" care if the 2-day care definitions aren't met.
This year's recipients of the Foundation for Physical Therapy's Service Awards have advanced the cause of physical therapy research in a variety of ways, from providing funds to fundraising, and from partnering with the Foundation to leading its work.
This year's awards and winners are:
"The leadership, generosity, and creativity of this year's awardees have been instrumental to the continued success of the foundation." Foundation Board of Trustees President William G. Boissonnault, PT, DPT, DHSc, FAPTA, FAAOMPT, said in a press release (.pdf) announcing the winners. This year’s recipients will be recognized during the foundation’s 35th Anniversary Gala on June 12, 2014, during the NEXT conference in Charlotte, North Carolina.
Much work remains to be done, but a multidisciplinary panel of health care providers, researchers, and patients has made significant progress toward establishing a model of osteoarthritis (OA) care that acknowledges the importance of early diagnosis and recognizes the powerful impact that OA can have on successful treatment of comorbidities. The group's efforts have been released in a report (.pdf) published by the US Bone and Joint Initiative (USBJI).
The Chronic Osteoarthritis Management Initiative (COAMI) report lays out the challenge in no uncertain terms. "Instead of routine screening that provides early alerts … about the possible presence of osteoarthritis (OA), followed by a systematic exploration of strategies to reduce pain and preserve or increase function, patients and providers often have their first conversations about joint pain when the joint is damaged enough to require surgical replacement," the report states. Slow detection and uncoordinated treatment not only results in more severe joint damage, but can allow OA to significantly impact how well a patient responds to treatment of concurrent conditions such as respiratory problems and diabetes.
The COAMI report calls for improvements and better coordination in self-management support, delivery system and design, decision support, and clinical information systems, with the aim of creating an OA model of care "that is far closer to the coordinated, proactive ideal than what is currently in place." With such a model, the report states, it may be possible "to overcome the view of patients, the public, and many health care professionals that OA is inevitable and that joint pain and related disability should be tolerated." The panel decided on specific action items that will be addressed by designated groups of participants.
APTA is a founding member of USBJI and serves on its board of directors.
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