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  • Proposed Legislation Would Allow PTs to Bring In Another Licensed PT to Continue Care During Absences

    Physical therapists (PTs) in private practice may be able to provide Medicare patients the continuity of care they deserve if a recently introduced bill is successful. The federal Prevent Interruptions in Physical Therapy Act of 2013 (HR 3426) would make it possible for PTs to bring in other licensed physical therapists during absences to avoid gaps in care and costs to practice.

    The bill was introduced October 30 by Reps Ben Ray Lujan (D-NM) and Gus Billirakis (R-FL), and seeks to expand so-called locum tenens arrangements to include PTs. This arrangement would allow a physical therapist to bring in another licensed physical therapist to treat Medicare patients and bill Medicare through the practice provider number when he or she is temporarily absent due to illness, pregnancy, vacation, or continuing medical education. Current law only extends locum tenens to doctors of medicine, osteopathy, dental surgery, podiatric medicine, optometry, and chiropractic.

    Because locum tenens arrangements are not granted to PTs under current law, PTs in private practice are forced to risk gaps in patient care should they be absent, or must avoid such absences altogether. The need for locum tenens for PTs in rural areas is particularly great, where a small private practice may be the only source for physical therapy for miles. Should a PT in such a setting need to be absent, the entire practice could be forced to shut down temporarily, leaving Medicare patients with limited choices for nearby care.

    This legislation came from a collaborative effort between APTA and the Private Practice Section of the American Physical Therapy Association (PPS) to provide relief for private practitioners and continuity of service for Medicare beneficiaries. APTA President Paul Rockar Jr, PT, DPT, MS, sees HR 3426 as another example of what can be accomplished when PTs work together. "This legislative collaboration between APTA and PPS reconfirms our commitment to advocate for sensible solutions to challenges seen by physical therapists in private practice," said Rockar. "We look forward to working with PPS on the hill to move this bill forward."

    PPS President Tom DiAngelis, PT, DPT, describes the bill as legislation that "seeks to eliminate an unnecessary limitation on our ability to practice and provide excellent continuous care. We commend congressmen Lujan and Bilirakis for taking an important step to ensure a patient’s access to uninterrupted physical therapy."

    APTA has advocated for this issue to be linked to larger Medicare reforms that may be moving through Congress, particularly the efforts to find a solution to the flawed sustainable growth rate (SGR) formula (.pdf) that determines Medicare payment rates. Congress has until December 31 to act to avoid a 24.4% decrease in Medicare reimbursement, though it is possible it will continue to address these reforms in 2014.

    APTA will monitor the progress of the bill and will post updates to its locum tenens webpage. Resources on the website include a podcast on the importance of this legislation and information on how PTs can get involved in advocating for its passage.

    'Culture of Resistance' Complicates Concussion Reporting in Youth Sports

    As youth sports programs have grown, so has a "culture of resistance" around concussion reporting and treatment compliance, according to a major study released October 30 by the National Institute of Medicine and National Research Council. The report addresses this culture, as well as a wide range of topics including rates of concussion by sport, effectiveness of protective gear, and the lack of research around concussions in youth.

    The 340-page report, titled Sports-Related Concussions in Youth: Improving the Science, Changing the Culture is available for free download (1-time registration required) or online viewing, and contains several key findings. Among them:

    • Male high school and college athletes report the highest rates of concussions in football, ice hockey, lacrosse, wrestling, and soccer; for females, the highest rates occur in soccer, lacrosse, and basketball.
    • Researchers found "little evidence" that the latest helmet designs reduce the risk of concussions, even though they do reduce the risk of other injuries.
    • Recent sports program efforts to put limits on the number of head contact incidents for a given player are "fundamentally sound" but "without a scientific basis."

    The report acknowledges that while there has been an increase in awareness of the signs and risks of concussion in youth sports culture, "there are indications that the culture shift is not complete. Athletes profess that the game and the team are more important than their individual health and that they may play through a concussion in order to avoid letting down their teammates, coaches, schools, and parents."

    Physical therapists (PTs) and physical therapist assistants (PTAs) play an important role in the recognition and management of concussions, and the findings in the federal study echo the work APTA has done over several years to promote greater awareness of the dangers of concussions in youth sports and the need for policy changes and guidelines on the state and federal level. Along with legislative efforts, APTA has worked with the Centers for Disease Control and Prevention (CDC) on the issue of concussions and two APTA members have been appointed to the CDC Pediatric Traumatic Brain Injury Guideline Workgroup. APTA online concussion resources include a series of podcasts, and a PT's guide to concussions.

    Contact Your Legislators on November 4 to Stop the Therapy Cap

    Congress is approaching the 60-day mark for its opportunity to finally end the Medicare therapy cap and sustainable growth rate formula, and now is the time to amplify a grassroots effort to make the needed changes.

    Physical therapists (PTs), physical therapist assistants (PTAs), students, faculty, patients, and all other supporters are being urged to e-mail their legislators on November 4 to call for a full repeal of the therapy cap in the sustainable growth rate (SGR) reform package, or at the very least to approve an extension of the exceptions process before the December 31 deadline. Many supporters of the repeal have already signed on to participate in a Thunderclap program that will harness the power of social media to get the word out—now it's time to add to that momentum.

    APTA has several tools that make it easy to contact legislators. Members can take action on their computers using the Legislative Action Center and can even sign up for an e-mail reminder alert by joining the PTeam. Patients and nonmembers can e-mail their legislators using the Patient Action Center.

    The Senate Finance and House Ways and Means Committees are working on legislation to permanently fix the SGR. It is essential to remind lawmakers of the importance of repeal and to urge them to address the Medicare therapy cap in this legislative package.

    For more information about the Medicare therapy cap and APTA’s grassroots campaign to stop it visit the Advocacy webpage or e-mail advocacy@apta.org.

    Falls Prevention Exercises May Lessen Severity of Fall Injuries

    Prevention exercises can help the elderly avoid falls, but can they also reduce injuries when a fall occurs? A recently-published meta-analysis indicates just such a possibility.

    In the study, published October 29 in the British Medical Journal, researchers reviewed results of 17 trials involving 4,305 patients aged 60 and older living in community dwellings. Each of the studies compared patients who received falls prevention exercises with those who did not, and contained data on subsequent falls and the extent of injury sustained. Authors of the meta-analysis then grouped the injuries according to standardized classifications and reviewed seriousness of injuries across the studies.

    The research revealed that in addition to lessening the rate of falls, prevention exercises also reduced the severity of injury when falls do occur, with estimated reductions of 37% for all injurious falls, 43% for severe injurious falls, and 61% for falls that produced fractures. Authors of the study write that "it is…thought that exercise prevents injurious falls not only by improving balance and decreasing the risk of falling, but also by improving cognitive functioning, and the speed and effectiveness of protective reflexes (such as quickly extending an arm or grabbing nearby objects) or the energy absorbing capacity of soft tissues (such as muscles), thereby diminishing the force of impact on the body."

    APTA provides education on exercise prescriptions for balance and falls prevention, and offers resources for physical therapists on balance and falls prevention, how to develop consumer events on balance, falls and exercise, and information on evidence based falls programs. Members can also access an APTA pocket guide on falls risk reduction (.pdf) as well as take part in an online community where members can share information about falls prevention.

    Walking Can Decrease Joint Pain in Breast Cancer Survivors

    Older women who take aromatase inhibitor (AI) therapy as part of their breast cancer treatment may be able to walk their way to decreased joint pain, according to a recent study from the University of North Carolina at Chapel Hill. Results of the study were announced in a press release issued in conjunction with the annual meeting of the American College of Rheumatology.

    The study focused on 30 women aged 65-87 whose treatment included the use of an AI. AI treatment often produces joint pain or stiffness-a side-effect that results in a 20%-32% discontinuation rate. In the study, the women were placed on the Arthritis Foundation's 6-week Walk With Ease physical activity program and interviewed before and after implementation.

    Researchers found that in addition to increasing walk frequency and duration, the women reported a 19% drop in fatigue, a 10% decrease in pain, and a 32% reduction in joint stiffness. Of the group, 90% reported increased motivation to increase physical activity and expressed confidence that they would continue to walk.

    The findings echo APTA's understanding of the important role that activity should play in the lives of cancer survivors. The association offers continuing education on physical therapy for cancer survivors, and visitors to APTA's website can view a video on collaborative care and breast cancer rehabilitation. Additionally, the role of the physical therapist in cancer survivorship was the focus of an article in the July 2013 edition of PT in Motion magazine.

    Tell Your Story of a Mid-Career Shift to Physical Therapy

    APTA has been contacted by a freelance journalist for BBC Capital looking to profile an APTA member who switched careers to become a physical therapist.

    The journalist would like to focus on a physical therapist who went to school in his or her 30s and is now practicing. Interviews need to be scheduled by November 1. If you or someone you know fits the description and is willing to be interviewed, e-mail APTA's Media Relations Staff.

    Recovery Room Mobilization Can Make a Difference in Length of Hospital Stay

    A new study has reinforced the idea that for total hip and knee replacement patients, rehabilitation that begins in the recovery room can reduce the length of hospital stays. Researchers in the study found that 70% of rapid rehabilitation patients spent less time in the hospital than patients whose first rehabilitation session occurred the day after surgery.

    The study (.pdf), published in a recent issue of the Bulletin of the Hospital for Joint Disease, reviewed 900 hip and knee replacement patients divided into 1 group of rapid rehabilitation patients (331) and 1 group of standard rehabilitation patients (569). The 2 groups were comparable for sex, age, ASA class, anesthesia type, comorbidity groups, and time of physical therapy, although procedure length and estimated blood loss did vary somewhat between the groups, with the rapid rehabilitation group recording less of both.

    The therapy program for both groups was the same, with the only difference being when and where it began: the rapid rehabilitation patients were mobilized in the recovery room, while the standard rehabilitation patients were mobilized on the morning of postoperative day 1.The results showed that hip replacement patients averaged a 3.9-day stay in the rapid rehabilitation group and a 4.6-day stay in the standard rehabilitation group. Knee replacement patients saw a less dramatic difference, with the rapid rehabilitation group averaging a 3.6-day stay and the standard rehabilitation group recording a 4.1-day average.

    Researchers called the differences significant and cited benefits of shorter stays that included decreased patient needs for services such as blood transfusion, reduced risk of postoperative complications, and increased cost savings.

    APTA is a strong supporter of rehabilitation research, and APTA members were part of the Blue Ribbon Panel on Medical Rehabilitation Research at the National Institutes of Health (NIH). The panel's findings, which included recommendations for the development of a research plan and elevation of the National Center for Rehabilitation Research within the NIH structure, were recognized in a statement issued by APTA in January 2013.

    'Washington Post' Story Questions Effectiveness of Spinal Fusion Surgery

    The Washington Post recently looked at the rise in spinal fusion surgeries and uncovered more questions than answers when it comes to the procedure's effectiveness over therapy.

    Post reporters Peter Whoriskey and Dan Keating examined spinal fusion surgeries as an example of how the debate over what is considered medically necessary can be colored by politics and business. According to the article, spinal fusion surgeries have increased sixfold over the past 20 years in the United States, whose citizens undergo more such procedures than any other country.

    The Post report states that "more than 465,000 spinal fusions were performed in the United States in 2011, according to government data, and some experts say that a portion of them — perhaps as many as half — were performed without good reason." The lengthy article includes summaries of the debate over the procedure's efficacy and the ways in which Medicare has approached the issue of payment. A recent APTA News Now story reported on research that found physical therapy to be as effective as fusion surgery for treatment of degenerative disc disease.

    The APTA patient-focused Move Forward website offers a host of low back pain resources for physical therapists (PTs) and their patients, including audio presentations and an e-book on low back pain and how PTs can help. Treatment of low back pain was the subject of a 2-day series of presentations at the 2013 APTA Conference in Salt Lake City in June, as well as the focus of several CEU courses in APTA's Learning Center.

    NY, CT Medicare Contractor Makes Official Announcement of Documentation Rule Changes

    Physical therapists (PTs) in New York and Connecticut have received official word that 2 burdensome requirements have been lifted. The changes reduce reporting and documentation rules that were in conflict with national Medicare policy.

    National Government Services, the Medicare administrative contractor (MAC) for the 2 states, released a statement on October 24 announcing that PTs are no longer required to submit progress reports every 5 days after services exceeded the therapy cap, and that requirements for documentation of a physician reexamination for services that exceeded either 90 days or the therapy cap have been removed. The changes are effective for dates of service on or after August 1, 2013.

    APTA and chapters in New York and Connecticut advocated for changes to the NGS requirements, which directly conflicted with national Medicare policy. NGS posted detailed information about the changes to Outpatient Physical and Occupational Therapy Services (L26884) Local Coverage Determination (LCD) on its website.

    Let Everyone See How You Celebrated National Physical Therapy Month

    How did you celebrate National Physical Therapy Month (NPTM)? Tell APTA—and the rest of the world.

    APTA is calling on physical therapists (PTs), physical therapist assistants (PTAs), students, and faculty to share stories and photos of their October activities to bring attention to the value of physical therapy. An ever-growing collection of photos and statements has been posted to a special APTA NPTM celebration page, and now's your chance to add your highlights to the chronicle of celebrations across the country.

    Help APTA and your fellow PTs and PTAs show how physical therapy can help restore and improve motion in people’s lives. E-mail a brief description and at least 1 photo (300 dpi) to the APTA public relations staff, then sit back and watch as you become the next worldwide internet sensation.

    Okay, maybe not, but you'll at least get the thrill of seeing your own post on APTA's website, and the satisfaction of knowing you've helped to promote physical therapy. And then, who knows?

    APTA Private Insurance Page Adds Expanded MPPR Resources

    The increased use of the multiple procedure payment reduction (MPPR) by private and workers' compensation payers is already affecting physical therapists (PTs), and it's now among the elements of the changing insurance landscape addressed in an expanded APTA private insurance website.

    APTA online resources now include targeted MPPR information related to the move made by private insurers to adopt policies first developed by the federal Centers for Medicare and Medicaid Services (CMS). The shift toward MPPR poses a risk to PTs, who need to carefully review contracts with insurers to evaluate impact. The APTA website includes tips on contract review that can help PTs determine if the policy is appropriately applied under the contract and payment guidelines to help PTs verify the accuracy of any overpayment amount claimed by the insurer.

    Several insurers, including Blue Cross and Blue Shield (BCBS) of Kansas City, BCBS of Missouri, Wellmark, Aetna, and UnitedHealthcare have implemented MPPR over the past 2 years, and are paying claims using an MPPR methodology.

    A recent example of the trend toward MPPR use surfaced earlier this year, when Humana announced that it would be applying MPPR policies, an approach that it had initially adopted in 2011 but quickly reversed. Not long after the reversal, Humana announced that it would be reviewing the MPPR payment methodology and stated that it may make changes to payments. When those changes were implemented, Humana made providers aware of its shift to MPPR by sending notifications of overpayments on claims as far back as 2012 for contracted providers. Noncontracted providers were told that they were responsible for overpayments dating back to 2011.

    In light of Humana's reversal on MPPR, APTA sent a formal letter (.pdf) to Humana's CEO addressing several areas that it views as problematic for PTs. APTA expressed particular concern over the lack of prior warning of Humana’s intention to adopt the policy, the administrative burdens associated with overpayment recovery, the appropriateness of MPPR's application to medical procedure codes, the suitability of application to all contracts, and apparent inaccuracies in calculations that result in incorrect overpayment amounts.

    Global Stroke Burden Increasing

    In what its authors describe as the first study of its kind, the burden of stroke was found to be a growing global issue, with a 25% increase in the number of strokes suffered by adults aged 20-64 around the world, and disparities among higher and lower-income countries.

    The study, published in The Lancet (free one-time registration required) this month, states that the rise in strokes among younger populations will put increased burdens on countries throughout the world, albeit at rates that more heavily impact lower-income countries. The increases need to be addressed through greater awareness of risk factors and preventive measures, according to the authors, and further study is needed to examine the causes for disparities in stroke burden among countries with varying levels of income.

    The researchers included 119 studies (58 from high-income countries and 61 from low- and middle-income countries), published between 1990 and 2010. They applied the analytical technique from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 to calculate estimates of stroke incidence, prevalence, mortality, and disability-adjusted life-years lost by age group and country income level.

    The authors also write that the numbers point to a "need for health-care services … to pay more attention to provision of stroke chronic care (including prevention of secondary stroke)" and the incorporation of "community rehabilitation, including self-managed rehabilitation strategies." APTA offers resources to physical therapists (PTs), including a podcast, around care of patients with limitations in functioning after a stroke, and has created a PT's "guide to stroke" and pocket guide to physical fitness for survivors of stroke at its Move Forward website.

    CMS to Issue Rules On Outpatient and Home Health Payments, Physician Fees in Late November

    Although the federal Centers for Medicare and Medicaid Services (CMS) is still assessing the impact of the recent government shutdown on its work schedule, physical therapists (PTs) can count on seeing final rules for calendar year 2014 on at least 3 issues relevant to PTs by the end of November.

    A recent memo from CMS stated that the agency will issue final rules on regulations that include:

    • Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B Final Rule With Comment Period (CMS-1600-FC (.pdf)). Excluding the 24.4% projected sustainable growth rate payment cut, the rule’s aggregate impact on payment is a positive 1% for outpatient physical therapy services. Additional proposed policies that will impact physical therapists include updates to the Physician Quality Reporting System (PQRS), application of the therapy cap to critical access hospitals, and changes to the calculation of geographic practice cost indices. APTA issued comments on the proposal (.pdf) in September.
    • Changes to the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (CMS-1601-FC). APTA published a summary of the proposed rule when the rule was published (see "Outpatient Care" at the APTA "Medicare Payment and Policies for Hospital Settings" site), and issued comments on the proposal in September (.pdf).
    • Home Health Prospective Payment System Final Rule (CMS-1450-F). The rule affects services provided by home health agencies under Medicare Part A beginning January 1, 2014. The proposed national, standardized 60-day episode payment for 2014 is $2,860.20. CMS projects that as a result Medicare payments to home health agencies in 2014 will be reduced by 3.5%, based on the proposed policies. APTA issued comments on the proposal (.pdf) in August.

    Typically, rules are issued by November 1 of each year, but CMS says that this year they could be finalized as late as November 27. All rules generally will go into effect on January 1, 2014.

    NIH to Fund Research on Robotic Ankle Exoskeletons for Patients Recovering From Stroke

    The National Institutes of Health (NIH) National Institute of Biomedical Imaging and Bioengineering has announced a $2.4 million funding program focused on the development of robotic technologies, including a project to help researchers evaluate designs for ankle "exoskeletons" for patients recovering from stroke.

    Titled "Novel Platform for Rapid Exploration of Robotic Ankle Exoskeleton Control," the research will attempt to establish a way to consistently test controls and designs used in powered braces and other devices. The design research was 1 of 3 areas to be funded; NIH will also back research on the development of a "co-robotic cane" for people with visual impairments, and the creation of a robotic catheter that could adjust for heart movement and blood flow when patients are undergoing procedures to treat atrial fibrillation.

    The awards mark the second year of NIH's participation in the National Robotics Initiative (NRI), a commitment among multiple federal agencies to support the development of a new generation of robots that work cooperatively with people, known as co-robots. NRI has issued an announcement for research applications in 2014, and NIH says it is interested particularly in proposals that support the development of assistive robotic technology to achieve functional independence in humans, improve quality of life, assist with behavioral therapy and personalized care, and promote wellness/health.

    APTA offers information on the use of technology in patient care, and has produced podcasts on robotics in physical therapy.

    Rise in Observation Status Could Be Costly for Patients and PTs

    A recent article in the Wall Street Journal reports that hospitals, wary of regulatory penalties, are increasingly holding patients for observation rather than formal admission. The practice triggers outpatient therapy caps and requires physical therapists (PTs) to submit functional limitation reporting data to the Centers for Medicare and Medicaid Services (CMS) for physical therapy services provided while the patient is on “observation status.”

    The WSJ article draws data from the Medicare Payment Advisory Commission, which released a report showing a 34% rise in observation services related to Medicare beneficiaries between 2004 and 2011. During the same period, inpatient admissions declined by 7.8%. According to the report, the overall rise in beneficiaries over that same time period—13%—does not account for the increase in observation status.

    The use of observation status in hospitals can be problematic for PTs, whose services can be subject to therapy caps should a patient's hospital stay be classified as outpatient, according to an APTA advocacy letter (.pdf). Additionally, beginning this year, CMS requires that PTs must submit functional limitation data (G-codes) for observation patients in order to receive payment. PTs can also find themselves challenged to create discharge plans for patients whose observation status disqualifies them from the 3-night inpatient stay required to receive Medicare payments for skilled nursing facilities.

    APTA has taken positions that advocate for the elimination of functional limitation reporting for observation patients and is engaged in a grassroots effort to end the therapy cap. The association also provides a functional limitation reporting website that offers resources on the reporting requirement, including a podcast on G-codes and observation patients.

    Newest WCPT Networks Connect PTs Around the World

    APTA members interested in physical therapy education or amputee rehabilitation now have an opportunity to interact with like-minded physical therapists (PTs) from around the world via new networks developed by the World Confederation for Physical Therapy (WCPT).

    The WCPT Network for Amputee Rehabilitation and the Network for Physical Therapist Educators are available free to members of APTA. Both networks offer LinkedIn groups as a way to facilitate international discussion of issues. If you are interested in joining, send an e-mail with your name, country, WCPT member organization, professional background, and field of expertise to louise.tisdale@nhs.net. APTA is a member organization of WCPT.

    The latest WCPT additions join a growing list of interest networks and subgroups hosted by the confederation. These include groups focused on international work and study, aquatic therapy, health promotion, intellectual and developmental disability, neurology, pediatrics, and women's health.

    PTs, PTAs, Patients, Supporters Needed to Add Thunder To Therapy Cap

    Ending the hard cap in Medicare outpatient physical therapy services will take unified voices, personal effort—and more than a little help from technology. APTA is hoping to do just that when it launches a new grassroots campaign that will allow physical therapists (PTs) and others to combine their individual social media reach to create a wave of highly coordinated messaging.

    APTA has worked with the Therapy Cap Coalition to create an opportunity for PTs, physical therapist assistants (PTAs), patients, and others to participate in a "thunderclap," a service in which participants donate their Facebook, Twitter, and Tumblr presences to allow a 1-time coordinated message to be sent to their friends and followers. To participate in the therapy cap thunderclap, supporters simply sign up and choose which social media outlets they would like to temporarily donate. At noon on November 4, thunderclap will automatically send out the same messages through all participants’ social media outlets. The thunderclap is free and limited to a single message. Deadline for sign up is November 3.

    The Therapy Cap Coalition's thunderclap is aimed at drawing national attention to the Medicare therapy cap and preventing a hard cap from being implemented in 2014. The cap puts arbitrary limits on therapy services under Medicare and negatively impacts a PT's ability to provide the highest quality care to often-vulnerable populations. While APTA representatives have been meeting with legislators over the past year, coalition organizers believe that grassroots efforts to stop the cap need to intensify now that Congress has little more than 60 days to address the issue.

    The coalition must meet its goal number for thunderclap participants to send the message, but participants need not be limited to the affected health care providers. APTA is urging its members to encourage colleagues, patients, family members, and friends to join in the thunderclap to make the reach as broad as possible. More information about thunderclap and APTA's therapy cap efforts can be found at APTA's therapy cap advocacy site, and questions about the program or how to get involved can be sent to APTA's advocacy staff e-mail. Specific information on thunderclaps can be found at Thunderclap's website.

    Select NSC 2013 Events to Be Livestreamed

    Physical therapy students unable to attend National Student Conclave (NSC), October 24-26, in Louisville, Kentucky, will be able to watch select events live online.

    The first livestreamed session, "What It Means to Your Career to Be Connected," features current and former members of APTA's Board of Directors APTA President Paul A. Rockar Jr, PT, DPT, MS; APTA Vice President Sharon Dunn, PT, PhD, OCS; APTA Director Kathy Mairella, PT, DPT, MA; and former APTA Director and Treasurer Connie Hauser, PT, DPT, ATC. Using the "TED-talk" style of conversation and inspired by the life and friendship of the late Dave Pariser, PT, PhD, who was a board director, they will each discuss the importance of involvement with APTA. The 90-minute session is scheduled for Thursday, October 24, with an approximate start time of 5:30 pm, ET.

    Also livestreamed will be the Friday, October 25, keynote address, "Transcending Limitation on Disability," by Aaron Scheidies, PT, DPT, who hasn't let a hereditary eye condition stop him from practicing physical therapy or from competing in triathlons and earning 8 paratriathlon national championships. The address is scheduled to begin at 1:00 pm, ET.

    Each event will be streamed live, and an archive of the sessions will be available for an additional month. A broadcast schedule and session descriptions can be found on the NSC livestream page.

    PT Named to Institute of Medicine

    APTA member Alan M. Jette, PT, MPH, PhD, FAPTA, was included in the 70 professionals named to the Institute of Medicine (IOM), one of the world's most prestigious health care advisory organizations. Election to the IOM is considered among the highest honors given to health care professionals.

    Jette serves as professor of health policy and management at Boston University's School of Public Health. He is also active in APTA, serving on the association's PT Outcomes Registry Task Force and as chair of the Foundation for Physical Therapy's Scientific Advisory Committee.

    A news release from IOM describes its membership as professionals "who have made major contributions to the advancement of the medical sciences, health care, and public health." The organization is among the 4 US National Academies along with the national academies of science and engineering and the National Research Council, and has provided analysis and recommendations on issues ranging from postdeployment needs of Iraq and Afghanistan veterans to the benefits of physical activity programs in schools.

    Slower Population Growth, Lowered Predictions for Insured Impact Future Demand for PTs

    What might the future hold when it comes to demand for physical therapists (PTs)? According to the latest models developed by APTA, that depends on several factors, including the rate at which PTs leave the profession over the next 7 years.

    The association has just released the results of its latest adjustments to predictions of supply and demand for PTs through 2020, and while 2 of 3 possible scenarios show a healthy growth in demand, changes to demographics, health insurance use, and projected supply of PTs may make that growth less dramatic than earlier reports suggested. A third scenario contemplates the possibility that by 2020 there may actually be a slight surplus of PTs—about 1,500 over demand.

    The APTA Workforce Task Force makes adjustments to projections each year. According to the report, the differences between the 2012 and 2013 projections are mostly due to 3 factors: a lower rate of US population increase than projected in 2012, a lower percentage of insured people than projected last year, and an anticipated increase in the supply of PTs. The lower demand numbers mean that if PT attrition rates are 1.5% or lower, supply could meet or even slightly exceed demand by 2020.

    Most projections show physical therapy as a growing profession, with projected unmet demand ranging from 13,638 to 27,822, depending on the attrition rate of PTs over time. The APTA Workforce Task Force now uses 3 projected attrition rates—3.5%, 2.5%, and 1.5%. When balanced against PT workforce rates that include a projected 4% growth in graduates, a 1% increase in candidates who pass the licensure examination, and a steady flow of international PTs who pass the exam, the number of licensed PTs is projected to rise from about 176,000 to between 203,000 and 232,000 by 2020. The supply and demand data are part of a suite of resources on the physical therapy workforce available on APTA's website.

    2013 PQRS Interim Feedback Dashboard Data Now Available

    Eligible professionals, including physical therapists (PTs), who reported at least 1 2013 Physician Quality Reporting System (PQRS) quality-data code through claims can now access an online dashboard to review data on their submissions. PTs in private practice who do not participate in PQRS in 2013 face a 1.5% penalty that will be imposed in 2015.

    PTs who reported measures can view data organized by taxpayer identification number or individual national provider identifier. The dashboard is available through the Center for Medicare and Medicaid Services (CMS) Physician and Other Health Care Professionals Quality Reporting Portal and can help PTs monitor whether or not they will avoid the 2015 payment adjustment and possibly earn a 2013 PQRS incentive payment. The site includes a User Guide for additional information on the types of data available.

    APTA offers a site dedicated to explaining PQRS and helping PTs understand their reporting responsibilities. The penalties can be avoided if PTs meet the PQRS measurement specifications, an approach that allows the PT to earn a 2013 incentive payment of .5% of covered Medicare part B charges. PTs can also avoid the 2015 penalty (but miss out on the incentive payment) by submitting 1 valid measure through claims, participating registry, or through a qualified electronic health record, or by reporting at least 1 valid measure in a measures group through claims or a participating registry.

    PQRS also offers a help desk accessible by phone at 866/288-8912 (TTY 877/715-6222) or e-mail. Assistance is available Monday through Friday 7:00 am-7:00 pm, CT.

    Heart Association Calls for Physical Activity Assessments to be Considered a Vital Health Measure

    An American Heart Association (AHA) scientific statement released in October 2013 urges clinicians and researchers to include physical activity assessments as a vital patient health measure equal to other cardiovascular risk factors like obesity, smoking, diabetes, and hypertension.

    The statement, released online this month and scheduled for print publication in November, points out the well-established connection between physical activity and overall health. Despite this connection, most adults in the United States fail to achieve the recommended 150 minutes per week of moderate physical activity or 75 minutes per week of vigorous activity, though the degree to which these adults are falling short tends to vary among studies.

    According to the AHA statement, this variation is part of what begs the need for "consistent assessment of physical activity in research and clinical settings to improve risk factor identification, minimize physical inactivity, and further advance our understanding of health-related impact." But the heart of the matter, so to speak, is the fact that a clear risk factor and "vital health measure" are often overlooked.

    The statement provides an overview of assessment approaches that range from questionnaires and logs to more objective techniques such as indirect calorimetry, heart rate monitoring, and accelerometer use. The authors also include a "decision matrix guide" to the selection of a physical activity monitoring instrument that offers options related to what needs to be described, burden on the patient, personnel available, and other factors. The idea behind the matrix and other information in the statement is "to provide a guide to allow professionals to make a goal-specific selection of a meaningful physical activity method."

    The importance of physical activity has been a central focus of APTA and is the foundation of the APTA "Fit After 50" campaign. The campaign recently reached millions of Americans through APTA's publication of the "Top 10 Fittest Baby Boomer Cities in America," in partnership with the Huffington Post. APTA has long supported the promotion of physical activity and the value of physical fitness, and currently has representatives on the practice committee of Exercise is Medicine and the board of the National Physical Activity Plan Alliance.

    Weight Loss Apps Light on Behavioral Content

    Though extremely popular, weight loss apps may not really deliver the kinds of help proven to be most effective in shedding pounds and keeping them off. This was the conclusion of a study published in the October, 2013 issues of the American Journal of Preventive Medicine.

    The study evaluated 30 weight loss apps listed in the top 100 downloaded apps in both iPhone and Android platforms by rating each app in terms of the number of behavioral weight-loss strategies offered. The behavioral strategies were drawn from the Diabetes Prevention Program (DPP), which the study's authors describe as "evidence-based lifestyle interventions." These interventions include behavioral strategies ranging from the establishment of a weight loss goal to stress reduction, overcoming negative thinking, identification of problem social cues, and time management.

    The results? No app made the cut in terms of including a wide range of behavioral strategies. Although most apps included weight and dietary goal-setting, self-monitoring, and calorie balance, authors found that all of the apps were completely lacking in 7 strategies: stress reduction, relapse prevention, social cues, negative thinking, regulating eating patterns, time management, and instruction on reading nutritional labels. The study also concluded that paid apps were no more likely to include behavioral strategies than free ones.

    The conclusions reached in the study are consistent with approaches to weight loss taken by physical therapists (PTs), which emphasize focusing on building a healthy lifestyle over a fixation on pounds lost. APTA's Move Forward website offers tips for families on how to encourage changes that will contribute to long-term health.

    ED Visits for Falls Will Rise as Population Ages

    Injuries—particularly injuries suffered in falls—will become an increasingly prevalent reason for emergency department (ED) visits as the US population continues to age, according to the Centers for Disease Control and Prevention (CDC).

    A recently released data brief from the CDC reports that between 2009 and 2010, 19 million ED visits were made by people 65 and older, a number that represents about 1 out of every 20 older Americans. The rates increased with age.

    Particularly significant for physical therapists (PTs) and physical therapist assistants (PTAs), the CDC brief states that of the 19 million ED visits in this age group, nearly 30% were injury-related, with falls accounting for 13.5% of the visits. The likelihood of fall-related visits increased markedly with age.

    Older Americans can recover from falls and other injuries with the help of a physical therapist (PT) both in EDs and as part of the recovery process. APTA offers resources for physical therapy practice in EDs as well as information related to balance and falls. Research on risk factors for community dwelling elders is also available on the PTNow website.

    The CDC brief predicts that by 2030, 20% of the US population will be 65 or over with a proportionate rise in ED visits, many of which will be for falls.

    Budget on the Table Provides Support for Reform of Caps and SGR

    Reform of the caps on outpatient therapy and repeal of the Medicare sustainable growth rate (SGR) payment formula will be part of the 2014 federal budget discussions in a conference committee seeking compromise after disagreements led to a 16-day government shutdown. Amendments to a congressional budget resolution support the authority to "reform or replace" both provisions.

    The conference committee has until December 13 to send a compromise budget to both chambers of Congress—failure to do so will leave unresolved many of the issues that sparked the October 1 shutdown. The shutdown was rooted in largely partisan disagreements over federal spending, disagreements that budget conferees hope to resolve before the December deadline.

    Conference committee members will discuss a budget proposal that allows for substantive changes to be made to limitations on Medicare Part B payments. The legislative language in the budget resolution lends support to SGR and therapy cap reform efforts being reviewed by both the House and Senate. These discussions include finding a permanent path to repeal the Medicare therapy caps and the SGR.

    APTA has been a strong advocate for changes that would end hard caps and put a permanent end to the SGR—an outdated formula that has been temporarily altered by Congress every year in so-called "Doc Fix" legislation. Grassroots efforts to make these changes are now under way and will become a central focus of APTA's advocacy agenda through the end of the year.

    Personal Physical Therapy Success Stories Featured On Move Forward Radio

    Physical therapists (PTs), physical therapist assistants (PTAs), and their patients can tell plenty of stories about the power of physical therapy. Throughout October, in honor of National Physical Therapy Month, APTA is using Move Forward Radio to bring those inspiring stories to a wider audience.

    In today's episode, Linda Conklin, a personal trainer and recreational marathoner from Illinois, and her physical therapist, Patrick Chapman, PT, MS, discuss her incredible recovery from a water skiing accident that broke 2 bones in her left leg and nearly led to the amputation of her foot.

    Last week's episode featured Pam Pelton, a school worker from Kentucky, who after a single dry needling treatment by her physical therapist, Chad Garvey, PT, DPT, OCS, FAAOMPT, CSCS, noticed immediate changes to the range of motion of her surgically repaired shoulder and to her ability to sleep through the night.

    Additional success stories are slated for the coming weeks.

    These Move Forward Radio episodes, which can be streamed online or downloaded as a podcast via iTunes, provide great resources for PTs and PTAs to share with friends and family to create awareness about the benefits of physical therapy.

    Ideas for future episodes can be e-mailed to consumer@apta.org.

    iPods—The Next Tool in Parkinson Disease Treatment?

    A new approach that uses music may improve freezing of gait among patients with Parkinson disease (PD) and can be used as part of an assessment tool to give physical therapists (PTs) and other health care professionals a better understating of symptom severity. Discussion of the new system took place at the 3rd World Parkinson Congress and was reported in Medscape Medical News.

    The system is called Ambulosono, and it uses an app called Gait Reminder in conjunction with motion sensing technology in an iPod Touch. The iPod is strapped to an arm or leg, and the app controls music, which plays or stops based on the quality and synchronization of the patient's stride length, arm swing, and other factors. The system was featured in a YouTube video posted by the University of Calgary in May.

    The app-assisted exercise focuses on areas of the brain that respond to reward-based learning, and patients tend to find that walking exercises become more pleasurable, according to Amulosono developer Bin Hu, MD, PhD. A University of Calgary pilot study of the system cites marked improvement in average daily walking time (from 6.3. minutes to 20.4 minutes) and 10% -30% improvements in stride length and walking speed. The study involved 46 patients who used the system for 320 days.

    PTs also can use the system to assess PD patients, which may be particularly useful in incorporating coordination evaluations with evaluations of gait and freezing. The system is under study at 4 trial sites in Canada.

    PTs and physical therapist assistants (PTAs) are on the front lines of care of patients with PD. APTA has highlighted the PT's role in PD and created a guide at its Move Forward website. An APTA video released in spring of 2013 highlights the ways in which PTs can help patients with PD improve their symptoms.

    '10 Essential IT Tools' for Medical Homes Emphasize Connection

    Innovative, collaborative care models such as the patient-centered medical home depend on making connections not just within the practice but throughout the health care system and broader communities. The 10 "essential" tools for making these connections have been identified in a recent publication from the Patient-Centered Primary Care Collaborative (PCPCC). An announcement of the report was featured in ModernHealthcare.com.

    According to the PCPCC, while medical homes offer the possibility for a coordinated and patient-focused continuum of care, in order to be truly effective, these models need to pay careful attention to making "population health connections." These connections touch on technologies that assist the system's health care professionals, patients, and the community at large. The PCPCC report identified 10 "essential" population health IT tools: Electronic health records, patient registries, a health information exchange, risk stratification systems, automated outreach, referral tracking, patient portals, telehealth/telemedicine capabilities, remote patient monitoring, and advanced population analytics.

    The patient-centered medical home concept has been an area of focus at APTA for some time. APTA has engaged in advocacy to ensure that physical therapists (PTs) have a voice in the development of medical home models, and has supported the development of the Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services. In addition, APTA offers a series of videos on collaborative care models, including a presentation on the PT's role in the medical home.

    APTA Nominations for National Office Due November 1

    Now's the time to reach out to colleagues you think will continue to provide APTA with strong, creative, and engaged leadership.

    The APTA Nominating Committee is seeking recommendations for the 2014 slate of candidates for the following positions: treasurer of the Board of Directors, speaker of the House of Delegates, 3 Board directors, and 2 Nominating Committee members.

    Use the online nomination form (NC1) to submit names of members who are ready and willing to be considered for the 2014 election cycle. Deadline is November 1.

    Wall Street Journal Article Quotes PTs on Postpartum Health

    Physical therapists (PTs) can play a key role in postpartum health for mothers for a range of issues beyond weight loss, according to a recently published article in the Wall Street Journal (WSJ). The article quoted APTA members in its examination of the musculoskeletal changes that can occur in women after birth, particularly among women who have more closely spaced babies later in life.

    In the article, APTA members Jessica McKinney, PT, MS, Debra Goodman, PT, and Marianne Ryan, PT, OCS, explained the changes that can take place in a woman's abdominal and pelvic muscles, as well as in the general shape of the spine, and described how scarring or the wrong exercise intensity levels can create problems for women who have not established stable core strength. Secili Destefano, PT, DPT, OCS, director of research for APTA's Section on Women's Health, described how age and hormonal changes can impact recovery.

    While women face many postpartum challenges, physical therapy can strengthen the key muscles that help to counter incontinence, pelvic organ prolapse, and other issues. The problem, according to WSJ reporter Sarah Nassauer, is that women are exposed to a huge amount of health information both prenatal and postpartum, and unless obstetricians take particular care, important elements—such as clear instruction on the proper way to do Kegel exercises—can be missed along the way.

    APTA's consumer website, www.MoveForwardPT.com, offers extensive women's health resources for patients, some of which are directly related to the musculoskeletal issues associated with postpartum recovery.

    Muscle Loss a Significant Contributor to Fractures in Older Men

    A recent Medscape article draws attention to research showing that the loss of skeletal muscle mass in men with osteopenia or osteoporosis increases risk of fracture by roughly 3 times over men who have these conditions but less muscle loss. Researchers believe the results point to the importance of focusing not just on bones but on muscle function as well.

    Age-related loss of muscle, called sarcopenia, was found to be an independent risk factor for nonspine fractures, with normal men showing a risk of about 10 per 1,000, and men with sarcopenia showing a risk of about 15.7 per 1,000. Among men with both sarcopenia and osteopenia/osteoporosis, risk rose to 30.5 per 1,000.

    Sarcopenia can be managed effectively through resistance exercises and dietary changes. APTA offers a consumer guide to sarcopenia and frailty at MoveForwardPT.com and features courses on frailty and mobility in the APTA Leaning Center (search "frailty" and "mobility").

    International Physical Therapy Organization Seeks Members for Scientific Committee

    APTA members have a unique opportunity to lend their scientific expertise to physical therapy research on an international scale by applying for appointment to the Education Congress Scientific Committee of the European Region of the World Confederation for Physical Therapy (ER-WCPT). The committee will oversee the development of the program of the 4th European Congress on Physiotherapy Education, set for November 11-12, 2016, in Liverpool, UK.

    Appointments will be made with attention to a balance of talents, but ER-WCPT is particularly interested in physical therapists with strengths in research/education, research/clinical practice, scientific program planning, publication/presentation, and e-learning. Committee appointments run from 2014 through spring of 2017, and during that time members can expect to attend 1 or 2 quarterly meetings (videoconferencing available) and other duties as assigned. Expenses for meeting attendance will be reimbursed.

    APTA members interested in serving on the committee should submit a CV, letter of support from APTA, and statement (500-word maximum) that addresses previous experience, the ways in which the applicant's expertise will benefit the committee, and ability to devote the necessary time to the project. Deadline for application is November 15, 2013, but APTA members should contact Rene Malone at renemalone@apta.org no later than November 6 to arrange for the required APTA letter of support.

    Appointment decisions will be made by the end of January 2014. Applications and additional questions can be sent to enquiries@csp.org.

    Physical Therapy Just as Effective as Surgery for Degenerative Disc Disease

    Physical therapy and other nonoperative treatments are just as effective at reducing pain and disability as surgical spinal fusion for patients suffering from degenerative disc disease (DDD), according to a recently published study conducted at Thomas Jefferson University Hospital in Philadelphia.

    Results of the study, which were published ahead of print in World Neurosurgery, show that among 96 patients treated for DDD, there were no significant differences in outcomes between the 53 who were treated with lumbar fusion and the 43 who chose to pursue nonoperative treatment. Measured outcomes included pain, health status, disability, and overall satisfaction. All patients were cared for by the same physiatrist.

    All of the subjects in the study received a diagnostic lumbar discography procedure between 2003 and 2009, and were offered fusion surgery based on the discogram and magnetic resonance imaging (MRI) results. Researchers found that while all patients reported significantly lower pain scores, data for the 2 groups "do not demonstrate a significant difference for standardized outcomes measures of pain, generalized health status, satisfaction, or disability."

    Results from an APTA survey found that 61% of Americans experience low back pain, but only 4 in 10 seek relief through movement. The APTA patient-focused Move Forward website offers a host of low back pain resources for physical therapists (PTs) and their patients, including audio presentations and an e-book on low back pain and how PTs can help. Treatment of low back pain was the subject of a 2-day series of presentations at the 2013 APTA Conference in Salt Lake City in June, as well as the focus of several CEU courses in APTA's Learning Center.

    Signing of AB 1000 Concludes Busy Legislative Year for California Chapter

    California residents will have improved access to physical therapist services due to a bill that was signed into law by Gov Jerry Brown on October 7. The signing of the bill, known as Assembly Bill 1000, marks the end of a challenging legislative journey for physical therapists in the state in 2013.

    Under the previous law, patients could only be seen for an evaluation, fitness and wellness services, and treatment for a condition that had been the subject of a medical diagnosis. AB 1000, which goes into effect on January 1, 2014, expands patient access to physical therapist services for immediate treatment for up to 45 days or 12 visits, whichever comes first.

    "With the ability to evaluate and provide interventions to the direct access patient immediately, physical therapists in California can quickly address the needs of their patients," stated APTA President Paul A. Rockar Jr, PT, DPT, MS.

    While the end result of AB 1000 helps California physical therapists achieve the longstanding goal of direct access, the final version also includes language that allows physical therapists to be employed by medical professional corporations. This aspect of the bill was not without controversy, and created debate among some California chapter members, given that the legislation combined two significant and unrelated public policy issues. The provision of the law allowing medical professional corporations to employ physical therapists stipulates that a physician, surgeon, podiatrist, or other referring practitioner must inform patients that they may seek physical therapy treatment services by a practitioner of their own choice, and that the practitioner does not have to be employed by the medical corporation. The legislation also authorizes the organization of physical therapy professional corporations with majority ownership by physical therapists that, as well, may employ other health professionals.

    In addition to CPTA's work with AB 1000, the chapter successfully advocated against 2 other bills earlier this year: SB 381, which would prohibit physical therapists from performing manipulations; and AB 864, which would have licensed athletic trainers. Both SB 381 and AB 864 were defeated.

    2013 APTA State Awards Recipients Announced at State Policy & Payment Forum

    APTA state chapter leaders from Indiana, North Carolina, Kansas, Michigan, and Nebraska were honored for their efforts to ensure that physical therapists and physical therapist assistants have a strong voice in the legislative process. The awards were part of the activities of the most recent APTA State Policy & Payment Forum, held September 15-17, 2013, in Omaha, Nebraska.

    In recognition of their individual leadership on legislation advancing or defending Vision 2020 in the state arena, the APTA Board of Directors awarded the 2013 State Legislative Leadership Award to Pauline Flesch, PT, MPS, of the Indiana Chapter; Dean McCall, PT, DPT, OCS, of the North Carolina Chapter; and Pam Palmer, PT, of the Kansas Chapter. State Legislative Commitment Awards were presented to Jake Jakubiak Kovacek, PT, of the Michigan Chapter and Kirk Peck, PT, PhD, CSCS, CCRT, of the Nebraska Chapter in recognition of their long-term commitment to their chapters' state advocacy activities. Future advocacy efforts will seek to advance the Vision Statement for the Physical Therapy Profession, adopted by the APTA House of Delegates in 2013.

    More than 200 physical therapists, physical therapist assistants, and physical therapy student advocates from across the country attended the forum, cohosted by APTA and the Nebraska Chapter. The event featured a variety of informational and strategy sessions on topics including the implementation of health care reform at the state level, fair physical therapy copay legislation, telehealth, emerging scope of practice issues, strategies for negotiating with insurance companies, and infringement challenges. Highlights from this year's event and awards reception can be found on the APTA website.

    Quality of Care Differs Among Insurance Types

    The quality of care patients receive may depend on the type of insurance they have, even when variations in facility-level factors like geography and ownership are accounted for. The findings, released in the October 2013 issue of Health Affairs, suggest that after data are adjusted for risk, privately insured patients have lower mortality rates than their Medicare-enrolled counterparts, even when these patients were treated in the same hospital.

    The findings are based on an analysis of State Inpatient Database records of hospital discharges in Arizona, California, Florida, Iowa, Maryland, Massachusetts, New Jersey, New York, North Carolina, Washington, and Wisconsin—a diverse sample that represents nearly 39% of the country's acute care discharges. Records from 1,434 hospitals were reviewed in the study, which focused on 8 surgical procedures and 7 medical conditions.

    Researchers found that privately insured patients had lower mortality rates than Medicare patients in 12 of the 15 selected procedures or conditions. For instance, Medicare patients had a 104% higher mortality rate than the privately insured for hip replacement and a 22% higher rate of mortality for hip fractures. Medicare patients showed lower mortality rates in stroke, congestive heart failure, and pneumonia, but the differences were smaller.

    The study cites no clearcut reason for why Medicare patients would have higher mortality rates than patients with private insurance, but the authors suggest that some of the inequality may have to do with the ways attending physicians are assigned, the availability of referral networks, unequal access to newer technologies, and possible overcoding of premorbidities for private insurance patients. The report recommends that "to help reduce care disparities, public payers and hospitals should measure care quality for different insurance groups and monitor differences in treatment practices within hospitals." A report on the findings appeared in Medscape on October 8.

    Resistance Training for Kids Can Be Safe and Beneficial When Well-Supervised

    Children may benefit from resistance training—but only if the program is professionally supervised and customized to the individual child's age, motor skill level, emotional maturity, and other factors. That's the bottom line of a position statement recently published in the British Journal of Sports Medicine and endorsed by the American Academy of Pediatrics, the North American Society for Pediatric Exercise Medicine, the National Athletic Trainers' Association, and several other organizations.

    The "Position statement on youth resistance training: The 2014 International Consensus" states that "there is now a compelling body of scientific evidence that supports regular participation in youth resistance training" as a way to combat inactivity, reduce sports-related injury, and instill lifelong fitness habits.

    That doesn't mean, however, that kids should start pumping as much iron as they can lift for as many reps as they can endure, according to the statement. Professionals must carefully evaluate a constellation of factors, and then develop a supervised program that responds to the physical, emotional, and intellectual realities of the child—an approach at the heart of the work done by physical therapists and physical therapist assistants. APTA has a history of advocacy for the importance of physical conditioning and wellness instruction for children, and offers resources on family exercise at its consumer-focused Move Forward site.

    The statement asserts that the real focus of a safe program should be on "developing the technical skill and competency [of the child] to perform a variety of resistance training exercises at the appropriate intensity and volume, while providing youth with an opportunity to participate in programmes that are safe, effective and enjoyable." The statement's release was first reported in a Reuters Healtharticle.

    Wal-Mart, Lowe's Will Pay for Employees' Hip and Knee Procedures in Select Facilities

    Hip and knee replacement procedures will be covered with no cost-sharing for employees of Wal-Mart and Lowe's—but only if those procedures take place in select facilities that have met specific evidence-based quality goals, according to a recent story from ModernHealthcare.com.

    The program, which will be offered by several companies besides the retail and home improvement giants, would still allow employees to receive care at a provider of their choice with regular cost-sharing in place. However, if the employee chooses to undergo the procedure at 1 of 4 participating hospitals, all costs for consultation, care, travel, lodging, and living expenses for the patient and a caregiver will be fully covered. The 4 so-called "designated center of excellence health care organizations" are Johns Hopkins Bayview Medical Center in Baltimore, Orange County-Irvine Medical Center in California, Mercy Hospital Springfield in Missouri, and the Virginia Mason Medical Center in Seattle.

    The article reports that the hospitals were selected by way of quality criteria developed by the Negotiating Alliance of The Pacific Business Group on Health. In a press release from Wal-Mart, the retailer's senior vice president of global benefits is quoted as saying that "each of these providers has a proven record of practicing evidence-based medicine with above-average positive patient outcomes in knee and hip replacement procedures." Selection decisions were made with an eye toward hospitals that produced consistent outcomes, and reported low rates of complications and repeat operations.

    APTA advocates for the important role physical therapists play in effective care for knee and hip replacement patients, and, through its patient-focused Move Forward website, offers a range of resources designed to help patients better understand the procedures and the ways a physical therapist can speed recovery.

    Calling All Residency Experts

    Members of APTA have an opportunity to help develop the clinical performance evaluation instrument for residency education by participating in a work group looking for volunteers with a range of backgrounds in residency programs.

    The American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) is in search of volunteers interested in reviewing the current landscape of residency evaluation used in physical therapy and other professions and building a valid, reliable evaluation instrument. Experts are being recommended in the categories of residency program director (academic and clinic-based residency models), residency clinical educator, residency mentor, active resident, and residency graduate. ABPTRFE is also seeking an external member with expertise in measurement and evaluation.

    Work will begin in May 2014, and will include 2 2-day meetings per year, held at APTA headquarters in Alexandria, Virginia, as well as a 1-day meeting during APTA’s Combined Sections Meeting. Additional teleconference meetings will be held as needed.

    To apply for this important project, visit the ABPTRFE website, where you can also review the complete charge for the work group. Deadline for application is November 30, with appointments made on February 3. If you have additional questions, contact Kendra Harrington, APTA manager of residency/fellowship at kendraharrington@apta.org.

    Updated Policies, Standing Rules, and Bylaws Posted

    Newly adopted or amended House of Delegates (House) policies, standing rules, and bylaws have been posted to the Policies and Bylaws area of the APTA website. APTA's standing rules have been reordered by theme and, where possible, by related association bylaw.

    Minutes of the 2013 House of Delegates (House) have been posted on the House webpage. An archived livestream broadcast of the entire 2013 House is available for viewing by APTA members.

    Physical Therapist Will Join Key AMA Performance Measures Group

    APTA member Dianne Jewell, PT, PhD, CCS, FAACVPR, has been appointed to one of the nation's leading advisory groups guiding the development of evidence-based performance measures in health care. The appointment will make Jewell the first physical therapist to serve on the Measure Advisory Committee (MAC) for the American Medical Association's Physician Consortium for Performance Improvement (AMA-PCPI).

    Jewell, a former member of the APTA Board of Directors, is founder and CEO of The Rehab Intel Network consulting company and former assistant professor in the Department of Physical Therapy at Virginia Commonwealth University in Richmond. She has more than 25 years of experience as a physical therapist practicing in a variety of settings, and is program director for the Health Policy Certificate Program at Arcadia University in Philadelphia.

    The MAC functions as the advisory body to the AMA-PCPI Executive Committee on issues related to current and future performance measures and methodologies. The AMA-PCPI performance measures are used in a wide range of national quality improvement programs.

    21% of Health Care Dollars Spent on 1% of Patients

    Although efforts to create more coordinated care systems may be making a small impact, as late as 2010 expenditures on health care in the United States were skewed toward the "super utilizer" patients—the 1% of patients who consume 21% of money spent on health care.

    According to a recent story from the Kaiser Health Network, the lopsided expenditure rates are related to the prevalence of emergency room use by patients, often with multiple problems, who are unable to steer through a complex and often fragmented health care delivery system. Conditions that could be effectively treated in outpatient settings are often addressed in hospitals, and follow-up compliance can be hit-or-miss, the story indicates.

    The problem has been well-documented, most recently in a report from the federal Agency for Healthcare Research and Quality, and is addressed to some extent by provisions in the Affordable Care Act (ACA) that penalize hospitals that readmit certain Medicare recipients in fewer than 30 days. Attempts to create more coordinated systems that use case managers to help individual patients understand their care are making an impact, according to Kaiser, but the scope of these efforts are limited.

    Physical therapists (PTs)—particularly those who work in emergency departments--often have the opportunity to collaborate on the coordination of care for patients with conditions that affect neuromusculoskeletal, cardiovascular/pulmonary and integumentary systems, as well as provide follow-up care. Information about this expanding area of practice is available at APTA's Physical Therapist Practice in the Emergency Department webpage, which includes a toolkit designed to help PTs incorporate PT practice in an emergency department.

    PTs Are Effective Primary Care Providers in Military Settings

    Physical therapists (PTs) who function as musculoskeletal primary care providers (PCP) may provide a better route to recovery than family practice physicians, according to a new study that focused on use of PTs in the military. Decreased use of radiology and medication, and a higher return-to-duty ratio for patients whose PCP was a physical therapist were cited as indicators that PTs are effective "musculoskeletal gatekeepers."

    In the study, which appears in the October issue of Military Medicine, data were collected on treatment approaches and outcomes among PTs and family practice physicians serving as the PCP for members of the military with musculoskeletal complaints. The results showed that PTs used radiology in 11% of cases while family practitioners had an 82% usage rate. Similarly, medication use for PTs was 24%--family practitioners used medication at a 90% rate. The return-to-duty rate was 50% higher for patients whose PCP was a physical therapist.

    Author Lt Col Troy McGill, PT, MPT, USAF, BSC, writes that these results mirror similar efficiencies realized with direct access in the civilian world. In the face of attention to cost containment, and an ever-dwindling supply of internists and family practitioners, he writes that "PT direct access can help fill this void and give patients the safe and effective care they need in a reasonable time."

    APTA provides a wealth of resources in support of direct access and continues to work with policymakers to strengthen the ability of PTs to provide the most efficient and effective care possible. Members of APTA can access the full text of McGill's article through Open Door.

    Basic Resident Education Could Help Reduce Falls

    A fairly simple educational program may help family practice residents recognize and assess potential for falls among elderly patients, according to a recent article in Medscape.

    Scripps Mercy Chula Vista Family Medicine Residency Associate Program Director Michael Rosenblatt, DO, MPH, worked with a team to develop a short computer-based learning module that they administered to second- and third-year residents. Residents also watched a DVD from the Assessing Care of Vulnerable Elders (ACOVE) project before they conducted patient assessments and created care plans.

    The results? Fall assessment scores from second-year residents increased from 42% to 78%, and from 55% to 85% for the third-year residents. Designers of the program hope that better education on falls assessment will result in fewer incidents. One-third of elderly Americans experience a fall each year, with 20%-30 % resulting in serious injury.

    Physical therapists can help educate their patients on falls, and help them understand how to stay safe by using information provided on APTA's "Move Forward" site.

    Help Improve the Contents of PTNow—And Your Wallet

    Members can help shape an important PT web portal—and earn $50 doing it.

    APTA is in search of physical therapists willing to participate in a 1-hour phone interview that will help us improve PTNow, the clinician web portal that provides physical therapists with evidence-based resources for day-to-day practice. The interviews will inform a survey now in development and will be conducted by a research firm working with APTA.

    Interested APTA members need to complete a 5-minute survey that will determine eligibility to participate in the phone interviews. Qualified participants will receive $50 for their participation. Share your insights to refine PTNow and help make an impact on practice!

    The deadline for completing the online survey is October 10.

    PT and PTA Students Take up the Marquette Challenge

    Physical therapy students across the country are getting ready to take part in an annual grassroots fundraising event that has gathered more than $2.5 million for the Foundation for Physical Therapy and helped to reinforce the strong connection that already exists between physical therapy programs and physical therapy research.

    The Foundation is inviting all physical therapist (PT) and physical therapist assistant (PTA) students to take part in the Miami – Marquette Challenge beginning later this month and continuing through April 2014. The program encourages students to develop creative ways to raise funds locally and awards prizes to the top earners. All participating schools will be recognized in several national publications, and the winning school gets the honor of cohosting next year's challenge. The program has become the foundation’s largest fundraising event.

    Here's the best part: it’s easy to get involved, even if it’s your first time. The foundation has created a "Get on the List" initiative to encourage new participants and maintains a site dedicated to details about how to get your school’s team up and running.

    Unpreparedness Can Be Disastrous for PTs

    Physical therapists don't need much more than a news broadcast to understand that disaster strikes nearly every day. It can be less easy to grasp the idea that the next flood, fire, or weather event could hit their own practices, and downright overwhelming to think about how to prepare. The latest issue of APTA's PT in Motion magazine can help.

    In her article "Before Disaster Strikes," APTA Senior Regulatory Affairs Specialist Deborah Crandall, JD, makes the compelling case that when it comes to disaster planning, there's no time like the present. To get PTs started, she offers advice and tips that range far beyond the typical "back up your data" admonitions.

    In addition to ideas on how to create and implement a preparedness plan, the article also includes advice on what to do after a disaster—a time when it can be difficult to be calm and pragmatic. Tips in this area touch on making insurance contacts, tracking losses, salvaging equipment, and maintaining communication with staff and patients/clients.

    The complete article can be found in print and online, and is available free to APTA members.

    Get 'Insider Intel' On Hot Topics in Medicare, Insurance Exchanges, Reporting, and More

    Functional limitation reporting, post-acute care setting changes, Medicare Part A to Part B rebilling, health insurance exchanges, and the implementation of multiple procedure payment reduction by Medicare Advantage plans will take center stage for APTA's next "Insider Intel" program on October 8.

    The 30-minute call-in program will begin at 2:00 pm, ET. To register for a spot in the session, e-mail advocacy@apta.org with "October 8 Call" in the subject line.

    "Insider Intel" Q&A call-ins dedicated to specific hot topics in policy and payment are held on the second Tuesday of every month, 2:00 pm–3:00 pm, ET, free to APTA members. If you're unable to participate live, recordings of the calls will be available on the APTA website afterwards.

    Physical therapists and physical therapist assistants work in a fast-paced and changing policy and payment environment. APTA's "Insider Intel" gives you the latest critical information you need to know to keep on top of the changes.

    PT Programs Boost Foundation Funds

    A total of 61 teams from physical therapist and physical therapist assistant programs across the country raised nearly $37,000 for the Foundation for Physical Therapy in a fundraiser that tracked swimming, running, and biking activities. Combined, the participants logged more than 336,000 miles for the foundation as part of the event, dubbed "Log 'N Blog."

    The Log 'N Blog event was created by students from the University of Pittsburgh. Winning teams, individual leaders, and more details are available from the foundation.

    Give Your Patients a (Clean) Hand

    If you find yourself being asked to wash your hands by your next patient, don’t take it personally: patients are increasingly becoming more assertive about seeing to it that health care providers have washed their hands before beginning treatment. You might even say the trend is contagious.

    According to a recent story in the Wall Street Journal, studies show that despite broad understanding of the importance of hand-washing, health care providers manage to wash their hands only about half of the time necessary to control infection. Now patients, encouraged by the Centers for Disease Control and Prevention (CDC) and the Association for Professional in Infection Control and Epidemiology (APICE), are taking matters into their own hands, so to speak.

    CDC has created a video for patients, "Hand Hygiene Saves Lives," that urges patients to not be shy about requesting that a health care provider wash his or her hands in the patient's presence. Patients who watched the video became less hesitant to make the request. This month, APICE is launching a public education effort on the importance of hand-washing by health care providers.

    This kind of patient empowerment still may have a long way to go. According to a recent study in Infection Control and Hospital Epidemiology, nearly one-third of patients reported that their providers failed to wash their hands. Of the patients who saw the lapse, nearly two-thirds stayed silent.

    Hand washing is crucial in all patient care settings, and APTA offers resources on hygiene from the CDC, including guidelines on infection control for all health care professionals.

    Get Ready to Respond to Health Care Reform Questions

    Physical therapists are likely to find themselves responding to patient questions about how the Affordable Care Act will affect their health care. Are you prepared to help point them to the answers they need?

    Despite the government shutdown that began October 1, the Affordable Care Act (ACA) remains unaffected. But as the ACA continues to rollout major features—most recently, the marketplace system—the public remains largely uninformed.

    A September 28 tracking poll from the Henry J. Kaiser Family Foundation found that as late as last month, 51% of all Americans felt that they lacked adequate information on the ACA. Most feel that current news coverage on health reform focuses more on political wrangling than on providing information, and more often than not, respondents stated that they don't know where to turn for accurate, unbiased information on the changes.

    Many public uncertainties remain, according to the poll. These include worries about cost (19%), confusion about where to find an easy-to-understand, unbiased summary of the ACA (18%), a need to know how the ACA will make things better (7%%), impacts on specific groups (6%), personal/family impacts (5%), questions about insurance marketplace plans (5%), and questions about the impact on currently-held insurance (4%).

    You may not need to know all the answers to these questions, but helping a patient find resources is important. The federal government has published a series of fact sheets on the ACA, and on October 1 the Kaiser Foundation released a series of consumer resources that aim to answer the most common questions.

    Of course, physical therapists have plenty of questions about how ACA will affect their work. Answers can be found in APTA's "10 Things You Need to Know on October 1" guide on the Expansion of Coverage webpage.

    ER Visits for Child Traumatic Brain Injuries Up 92% in 10 Years

    A recently released study cites a dramatic rise in the number of children being treated for traumatic brain injuries (TBI) in emergency rooms, but the cause for the increase may be harder to pin down. Increased public awareness of concussion symptoms and treatment, however, may be one important reason behind the rise.

    The study, available in the October issue of Pediatrics, found that while visits for TBI rose by 92% between 2002 and 2011, the rate of hospitalization remained relatively unchanged—about 10%. Researchers involved in the study point to a variety of possible reasons for the rise, including wider involvement in sports activities and an increased intensity of those activities by children who are generally bigger and faster than previous generations. Researchers found that skateboarding, inline skating, skiing, and sledding were the activities with the highest admission rates.

    The findings also contained some good news. Because the study also showed that injury severity actually decreased as visits increased, authors theorize that the biggest reason for the rise may be due to a better-educated public, able to recognize the potential signs of concussion and aware of the need for quick treatment.

    Physical therapists can access a range of information on concussion, including the advocacy work being taken on by APTA, by visiting the APTA website.

    Federal Government Shutdown Begins Today

    The federal government began a shutdown today that will affect daily operations of most federal agencies. At the time of writing, congress has yet to reach an agreement on a federal budget, leaving both duration of the shutdown and the final outcome of the budget for the next fiscal year uncertain.

    Payment for services provided to Medicare beneficiaries should not be impacted in the near term, according to the Centers for Medicare and Medicaid Services, which stated that Medicare Administrative Contractors will continue to perform all functions related to Medicare fee-for-services claims processing and payment during the shutdown. Additionally any ongoing Medicare provider enrollment applications, revalidations or changes to enrollment will also continue to be processed.

    Members of APTA who are employed by the federal government should check with their agencies to find out about individual impacts. The Washington Post has published a helpful interactive guide on agency responses to the shutdown.

    Staff at APTA will continue to update members regarding congressional negotiations to resolve the budget impasse.

    Study: PTs' Unique Skills Help Dancers Recover From Injury

    Physical therapists (PTs) can be particularly effective at helping dancers recover from injury thanks to the unique matrix of evaluation, intervention, and communication skills they bring to their approaches, according to a recent study in the Journal of Dance Medicine & Science.

    The study, conducted by Megin Sabo, PT, DPT, LMT, OCS, describes the challenge of treating an injured dancer, whose rehearsal and training time is extensive, and who typically wants to return to full function as soon as possible with a minimum of missed practice. Treatment that fails to recognize these elements will tend to be less successful than approaches that are based in an understanding of the dancer's world, a willingness to incorporate modified dance techniques to encourage adherence to "relative rest," and sensitivity to the importance of communicating in ways relevant to the performer.

    Sabo's qualitative study incorporated interviews from PTs who had provided care to dancers and dancers who had received rehabilitation after a dance-related injury. Dancers were asked to recount their experiences and share the positives and negatives of their rehabilitation, while the PTs were surveyed on the range of approaches used.

    The results showed a high level of agreement among PTs and dancers that the most successful interventions involved in-depth reviews of technique—not just to correct potentially damaging habits but to identify ways for the dancer to incorporate periods of relative rest while minimizing missed rehearsal. Equally important, according to the study, is the PT's ability to understand dance vocabulary and to communicate with dancers in ways that demonstrate this understanding.

    APTA members can find the full text of this article in Open Door—choose Open Door's OneSearch Feature, go to Advanced Search, change Keyword to Title in the first field, and type in the article title, "Physical therapy rehabilitation strategies for dancers: a qualitative study."

    Facts, Fast: 10 Things You Need to Know for October 1

    Some of the biggest parts of health care reform launch today. Are you ready?

    Get up to speed fast with 10 Things You Need to Know for October 1, an APTA resource document that highlights some of the main issues affecting physical therapists in practice. The guide provides relevant information on how reform elements such as Health Insurance Marketplaces and Medicaid expansion may impact you.

    "10 Things You Need to Know for October 1" is the first in a series of many new resources that will be posted on our Health Reform: Expansion of Coverage page. Coming soon: A feedback form that will allow you to share how health reform implementation is working in your area and the challenges you are facing in this changed landscape. Until the form is posted, please e-mail your questions and concerns to advocacy@apta.org.