request for a new place of service (POS) code to indicate that a physical therapist
(PT) delivered services at a patient’s worksite recently was granted by the
Centers for Medicare and Medicaid Services (CMS). Place of service codes are 2-digit
codes placed on health care claims to indicate the setting in which a service
was provided. The new code is available for use effective January 1, 2013, but
will not be effective for Medicare until May 1, 2013.
code, POS 18, is named "place of employment-worksite." Per the description, the code should be used when
physical therapy is delivered at "A location, not described by any other
POS code, owned or operated by a public or private entity where the patient is
employed, and where a health professional provides on-going or episodic
occupational medical, therapeutic or rehabilitative services to the individual."
delivering services that are appropriately reported using POS codes should
check with payers to determine if they are prepared to accept POS 18.
of situations in which POS 18 can be used include, but are not limited to:
PTs are likely to report POS 99, known as "other place of service,"
when delivering services at the worksite. The addition of POS 18 will enable
PTs, payers, and others using POS code data to more accurately identify where
services are delivered. Health plans can use this information to implement
payment differentials when providers are required to travel in order to deliver
services, and to study the costs and benefits of alternative service delivery
request to CMS for the new POS code, APTA noted that the provision of physical
therapy (and other medical) services at the place of work reduces lost
productivity, enhances the effectiveness of job-specific training, and improves
access to services where transportation and other barriers may exist. The
association also told the agency that workers are more likely to receive the
health care services they need in order to remain productive in the workforce
when services are easily accessible. Additionally, job-specific evaluation and
training services, including job and/or ergonomic analysis, must be performed
at the work site and therefore are not appropriately reported using other place
of service codes (except POS 99, which is nonspecific).
POS codes used throughout the health care industry. Additional information
about POS codes is available on CMS' website. CMS will publish a change
request in the near future to inform payers of the change. Meanwhile, the
updated list of codes is available here.
studies with modest methodologic quality and 1 direct comparison, the Canadian
C-spine rule appears to have better diagnostic accuracy than the National
Emergency X-Radiography Utilization Study (NEXUS) criteria when used to assess
the need for cervical spine imaging, say authors of a systematic review published in CMAJ.
Future studies need to follow rigorous methodologic procedures to ensure that
the findings are as free of bias as possible, they add.
For this review, the authors identified studies by an electronic search of
CINAHL, Embase, and MEDLINE. They included articles that reported on a cohort
of patients who experienced blunt trauma and for whom clinically important
cervical spine injury detectable by diagnostic imaging was the differential
diagnosis, evaluated the diagnostic accuracy of the Canadian C-spine rule or
NEXUS or both, and used an adequate reference standard. They assessed the
methodologic quality using the Quality Assessment of Diagnostic Accuracy
Studies criteria. They used the extracted data to calculate sensitivity,
specificity, likelihood ratios, and posttest probabilities.
Fifteen studies of modest methodologic quality were included in the review. For the Canadian
C-spine rule, sensitivity ranged from 0.90 to 1.00 and specificity ranged from
0.01 to 0.77. For NEXUS, sensitivity ranged from 0.83 to 1.00 and specificity
ranged from 0.02 to 0.46. One study directly compared the accuracy of these 2
rules using the same cohort and found that the Canadian C-spine rule had better
accuracy. For both rules, a negative test was more informative for reducing the
probability of a clinically important cervical spine injury.
physical activity is associated with longer life expectancy, even at relatively
low levels of activity and regardless of body weight, according to researchers at
the National Cancer Institute, part of the National
Institutes of Health (NIH).
to determine the number of years of life gained from leisure-time physical
activity in adulthood, researchers examined data on more than 650,000 adults,
mostly aged 40 and older, who took part in 1 of 6 population-based studies that
were designed to evaluate various aspects of cancer risk.
accounting for other factors that could affect life expectancy, the researchers
found that life expectancy was 3.4 years longer for people who reported they
got the recommend level of physical activity (2.5 hours at moderate
intensity/1.25 hours at vigorous intensity each week). People who reported
leisure-time physical activity at twice the recommended level gained 4.2 years
researchers even saw benefit at low levels of activity. For example, people who
said they got half of the recommended amount of physical activity still added
1.8 years to their life.
The researchers found that the association between physical activity and
life expectancy was similar between men and women, and blacks gained more years
of life expectancy than whites. The relationship between life expectancy and
physical activity was stronger among people with a history of cancer or heart
disease than among those with no history of cancer or heart disease.
The researchers also examined how life expectancy changed with the
combination of both activity and obesity. Obesity was associated with a shorter
life expectancy, but physical activity helped to mitigate some of the harm.
People who were obese and inactive had a life expectancy that was between 5 to 7
years shorter (depending on their level of obesity) than people who were normal
weight and moderately active.
study was published online November 6 in PLoS Medicine.
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