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  • SGR Patch Now In Place – Congress Gives Itself 12 Months To Develop Permanent Repeal

    With a vote taken just in time to avoid a March 31 deadline that would have triggered a 24% cut in payment via the flawed sustainable growth rate (SGR) formula, the US Senate has passed House-drafted legislation that will provide a 12-month temporary fix. In addition to the patch, the final bill still includes a delay on Medicare's implementation of the ICD-10 codes that had been set for an October 1 launch.

    The final bill replaces the cut with a .5% provider payment update through the end of the year and no update from January 1 to April 1 in 2015. In addition to the SGR fix, the legislation also continues extender provisions, including the therapy cap exceptions process and Geographic Pricing Cost Index (GPCI), until March 31, 2015.

    Congress had given itself until March 31, 2014, to finalize details of a proposal to repeal the SGR, but hit political road bumps that prevented the chambers from agreeing on the final shape of that legislation and how it would be paid for. As the deadline loomed, the Centers for Medicare and Medicaid Services (CMS) announced that it was prepared to put a temporary hold on claims processing to avoid implementing the SGR reductions while lawmakers scrambled to approve a patch. With that patch now in place before the deadline, CMS can drop the hold.

    The approximate $20 billion cost of the bill will be paid for through a combination of cuts and programmatic changes that include reductions to clinical labs, radiology services, a delay on oral-only drugs for end-stage renal disease bundles, the establishment of a new value-based purchasing program for skilled nursing facilities based on performance around hospital readmissions, and a tightening up of code valuation under the fee schedule. Additional funds are identified through the use of SGR "transitional fund" money and an extension of Medicare sequester provisions.

    The legislation also contains a provision that delays the implementation of the International Classification of Diseases, 10th revision (ICD-10) for all HIPAA-covered entities.

    APTA continues to work with legislators toward a permanent end to the SGR and therapy cap and will keep member advocates updated through PTeam alerts.

    New Tool Demystifies Security Risk Assessments

    Physical therapists (PTs) and other health professionals looking for help on how to conduct HIPAA security risk assessments have a new free tool to make the process more understandable.

    The US Office of the National Coordinator for Health Information Technology (ONC) is now offering a downloadable Security Risk Assessment (SRA) Tool that it says "lets you take a self-directed tour of HIPAA standards and helps you conduct a risk assessment at your own pace." The tool was developed in collaboration with the US Department of Health and Human Services' Office for Civil Rights and the Office for the General Counsel.

    Under HIPAA, PTs who are considered covered entities or business associates are required to conduct risk and vulnerability assessments of electronic personal health information (PHI) to evaluate the potential for the confidentiality, integrity, and availability of that information to be compromised.

    The tool is designed to lead users through each HIPAA requirement through a series of yes or no questions. In addition to providing space for documentation, the tool offers other features including "context sections" that explain threats and vulnerabilities, examples of safeguards, a glossary, and report charts that display the user's risk levels. The report can also be exported as a Microsoft Excel file or PDF document. The tool is available for both Microsoft and iOS (iPad only).

    Recent costly settlements for violations of HIPAA PHI requirements have made headlines, and underscore the importance of understanding the rules and assessing security risks. APTA offers multiple resources on health information technology, HIPAA requirements, and electronic health records.

    Capt. Mark Kelly To Speak At NEXT; Discounted Registration Ends April 2

    APTA members need to act by April 2 if they want to get in on early registration discounts for the inaugural NEXT Exposition and Conference featuring Captain Mark Kelly. A space shuttle commander and husband of former US Representative Gabrielle Giffords, Kelly will deliver the opening keynote address for the event June 11-14 in Charlotte, North Carolina.

    Kelly is an American astronaut, retired US Navy captain, bestselling author, prostate cancer survivor, and experienced naval aviator who flew combat missions during the Gulf War. He has served as his wife's partner and most ardent supporter during her continuing recovery from a traumatic brain injury. Kelly's presentation will also include a special video message from Giffords.

    NEXT evolved from the meeting formerly known as the Annual Conference and Exhibition. Though the focus and tone of NEXT will be on what's ahead for the profession, the event will also feature many of the popular elements of past annual conferences including the McMillan and Maley lectures and the Oxford Debate. As with past annual conferences, NEXT will occur immediately after APTA's House of Delegates.

    Registration and housing information can be found on the NEXT webpage along with a schedule of presentations and preconference sessions.

    Anticipating Patch Legislation, CMS Puts Hold On Claims Processing

    While a proposed "patch" to scheduled reductions in the 2014 Medicare Physician Fee Schedule (MPFS) may be imminent, the Centers for Medicare and Medicaid Services (CMS) is implementing a 10-business-day claims-processing hold just in case Congress doesn't take action to prevent the reductions before a March 31 deadline.

    In an e-mail alert sent to various groups, CMS states that it is "hopeful that there will be congressional action to prevent the negative update from taking effect on April 1, 2014. CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (ie, through April 14, 2014)."

    The hold would only affect MPFS claims with dates of service of April 1, 2014, and later. CMS believes that the hold will have minimal impact on provider cash flow, because under current law, clean electronic claims are not paid any sooner than 14 calendar days after the date of receipt. All claims for services delivered on or before March 31, 2014, will be processed and paid under normal procedures, regardless of any congressional actions.

    LPGA’s Natalie Gulbis Calls PTs ‘Huge Part to Our Success’

    Now in her 12th season on the LPGA Tour, golfer Natalie Gulbis believes that daily in-season treatment by physical therapists (PTs) played a major role in her ability to stay in the game for so long. “I don’t know how long my career would have been" without physical therapy, Gulbis told Move Forward Radio this week. “I don’t want to think about it.”

    Gulbis credited laser surgery on her back for saving her career in 2010, but she cited treatment by PTs as a key component in battling the ongoing physical demands of the LPGA Tour.

    In the Move Forward Radio interview, Gulbis described the transformations she has witnessed as golfers unsure of their ability to play in a tournament receive physical therapy that allows them to participate and even thrive. "I’ve seen them win," Gulbis said. "I’ve seen them play well. And here they were earlier in the week not sure if they could even swing a golf club. So [physical therapists] are a huge part to our success.”

    Gulbis was joined on Move Forward Radio by Al Casini, PT, who has treated Gulbis and other professional golfers.

    Gulbis called her relationship with Casini “a great partnership” and made it clear that her interest in fitness and health goes far beyond golf. “I do a lot of different active sports,” Gulbis said. “I want to make sure that I keep my back strong because I only get one back for my life, so I want to keep it healthy.”

    Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as a podcast via iTunes.

    APTA members are encouraged to share this episode via social media and to alert their patients to the Move Forward Radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be e-mailed to consumer@apta.org.

    New CPG Requirements Will 'Raise the Bar' at Federal Clearinghouse

    The federal government's official clearinghouse for practice guidelines will adopt more stringent standards for acceptance in the coming months. The new standards, adopted from the Institute of Medicine (IOM), include requirements for content, authorship, methodology, format, accessibility, and currency.

    The Agency for Healthcare Research and Quality's National Guideline Clearinghouse (NGC) will implement the new standards beginning June 1. The changes result from a 2008 directive from the federal government for IOM to identify best practice for developing clinical practice guidelines (CPGs). A full report, titled Clinical Practice Guidelines We Can Trust, is available at the IOM website.

    According to a recent article in JAMA, the journal of the American Medical Association, "The major changes from the older criteria are that documentation must be provided showing that a guideline is based on a systematic review of the evidence and an assessment of the benefits and harms of the recommended and alternative care options." The JAMA article described the change as one that is "raising the bar" for CPGs at the NGC.

    Need more information on practice guidelines and other evidence-based practice resources? Check out APTA's new Resources for the Development of Evidence-Based Documents webpage designed to help you find current guidelines and research and learn how to contribute to the growing pool of evidence-based physical therapy research.

    Autism Rates Show a 30% Rise in 2 Years

    In a report that could inform how physical therapists (PTs) and physical therapist assistants (PTAs) approach their work with children, the US Centers for Disease Control and Prevention (CDC) has cited a nearly 30% rise in autism spectrum disorder (ASD) rates in the US since 2008. Current CDC estimates raise the prevalence of ASD from 1 in 88 children to 1 in 68 children, with a growing number of children diagnosed with ASD who have average or above-average intellect.

    The CDC findings were widely reported in major media outlets including the Washington Post,New York Times, Los Angeles Times, and the Associated Press, each highlighting different features of the report, which pointed out variations in prevalence among ethnicities, sex, and geographic location.

    While the new rate "exceeds that of all previous surveillance years," authors of the CDC report said the "most notable change" was the prevalence rates among children with average or above-average intelligence—from 38% of all ASD diagnoses in 2006 to 46% in 2010, the year the study was conducted. The rise was accompanied by a decline in the number of children with co-occurring intellectual disabilities, from 41% to 31%.

    The CDC report called for more standardized measures to document ASD severity and functional limitations, improved recognition and documentation of symptoms of ASD, and lowering the age at which children are first assessed.

    For more information on ASD and its relationship to physical therapist services, check out a 2014 Physical Therapy article on Physical Activity and Exercise Recommendations for Children and Adolescents With ASD, as well as a 2011 article on Motor Functioning in Infants, Children, and Adults with ASD. Additionally, the association offers a 2-part continuing education primer (part 1; part 2) on ASD available through the APTA Learning Center.

    12-Month SGR Patch Approved in House While Congress Examines Permanent Repeal

    Recent advances made on a repeal of Medicare's flawed sustainable growth rate (SGR) and therapy cap may help chances of a permanent solution in 2015, but for this year at least, it appears Congress is opting for another temporary fix days before a March 31 deadline. The House bill that includes the 12 month patch also contains an unexpected provision—a delay on Medicare's implementation of the ICD-10 codes that had been set for an October 1 launch.

    With a looming March deadline that is set to trigger a 24% SGR cut, the House hurriedly voted on a bill that will replace the cut with a .5% provider payment update through the end of the year, and no update from January 1 to April 1 in 2015. The Senate is expected to vote on the patch by Monday, while the House passed the legislation on March 27 via an unusual voice vote that angered some Representatives on both sides of the aisle.

    In addition to the SGR fix, the legislation also continues extender provisions, including the therapy cap exceptions process and Geographic Pricing Cost Index (GPCI), until March 31, 2015.

    Somewhat surprisingly, the bill also contains a provision that delays the implementation of the International Classification of Diseases, 10th revision (ICD-10) for all HIPAA-covered entities. Prior to the action in Congress, the Centers for Medicare and Medicaid Services (CMS) made very public statements about its commitment to an October 1, 2014 rollout. Some observers speculate that the delay was included in the bill to make it more attractive to physician groups such as the American Medical Association (AMA), which opposed the fix in favor of hammering out a permanent repeal of SGR.

    Although members of both the House and Senate have recognized the need for permanent repeal and drafted bills to do just that, progress stalled when legislators were unable to agree on how the repeal would be paid for. House versions of the permanent repeal focused only on the SGR, while a Senate proposal would end both the SGR and the therapy cap. In press reports, both Speaker of the House John Boehner and Senate Majority Leader Harry Reid say they favor some form of permanent repeal, but that Congress once again ran out of time to work out the details.

    The approximate $20 billion cost of the temporary fix approved in the House will be paid for through a combination of cuts and programmatic changes that include reductions to clinical labs, radiology services, a delay on oral-only drugs for end-stage renal disease bundles, the establishment of a new value-based purchasing program for skilled nursing facilities based on performance around hospital readmissions, and a tightening up of code valuation under the fee schedule. Additional funds are identified through the use of SGR "transitional fund" money and an extension of Medicare sequester provisions.

    APTA continues to work with legislators toward a permanent end to the SGR and therapy cap, and will keep member advocates updated through PTeam alerts.

    Almost 60% of Patient Harm In SNFs Preventable, Says HHS IG Report

    A US Department of Health and Human Services (HHS) Inspector General's report says that nearly 60% of harm incidents experienced by patients in skilled nursing home facilities (SNF) are preventable, and that this gap in prevention resulted in hospitalizations that cost Medicare an estimated $2.8 billion in 2011. Among the preventable "adverse events" were falls, which the report related to both medication and resident care.

    The March 3 report (.pdf) from the HHS Office of the Inspector General (OIG) states that "Because many of the events that we identified were preventable, our study confirms the need and opportunity for SNFs to significantly reduce the incidence of resident harm events," and recommends that, among other things, the Centers for Medicare and Medicaid Services (CMS) direct its state facility surveyors "to review facility practices for identifying and reducing adverse events."

    The report focused on an analysis of 653 patients under Medicare who stayed in SNFs during the month of August, 2011, who began their SNF stay within 1 day after discharge, and whose stays in the SNF was 35 days or fewer. According to the report, 70% of the patients arrived at the SNF after hospitalization for nonsurgical treatment (most often septicemia or urinary tract infections), with the remaining 30% arriving after receiving surgery, usually hip or knee replacement.

    The study defined an adverse event as harm that resulted in "prolonged SNF stay or transfer to a hospital, permanent harm, life-sustaining intervention, or death." Events were classified by a panel of physicians after initial records screening by a panel of nurses led by a nurse practitioner. If evidence of an adverse event was identified by the nurse panel, the records were then reviewed by the physicians, who made a determination of whether the event was preventable. Researchers also analyzed "temporary harm events" that required medical intervention but did not cause lasting harm.

    According to the report, about 1 in 5 Medicare beneficiaries receiving post-acute care in SNF in August 2011 experienced an adverse event, and an additional 11% experienced a temporary harm event. Of those combined events, physician reviewers estimated that 59% were "clearly or likely preventable," and due to "substandard treatment, inadequate resident monitoring, and failure or delay of necessary care." The 59% preventable rate is an average of a 69% preventable rate for adverse events, and 46% preventable rate for temporary harm events.

    Among the IOG findings:

    • Of the preventable adverse events, 79% resulted in prolonged stay, transfer, or hospitalization; 14% required intervention to sustain life; and 6% resulted in or contributed to death
    • Harm related to medication was cited as a cause for 37% of the preventable events, with falls accounting for 4% of events in this category; harm related to resident care accounted for another 37% of preventable events, with falls making up 6% of that category; and 26% of preventable events were categorized as infection-related
    • Of the estimated $208 million spent by Medicare in August 2011 on all hospitalizations because of adverse events, $136 million was spent on hospitalizations associated with preventable events

    The report includes 2 major recommendations, both of which have been endorsed to greater and lesser degrees by CMS and the Agency on Healthcare Research and Quality (AHRQ). The bulk of the OIG recommendations focus on the development of lists of preventable events "to broaden and improve [SNF] staff understanding," the inclusion of preventable events in Quality Assurance and Program Improvement (QAPI) systems, and encouragement to SNFs to report adverse events to patient safety organizations (the only recommendation that received qualified agreement from CMS).

    The second major recommendation from the OIG was that CMS instruct state survey agencies "to include an assessment of adverse event identification and reduction in their evaluations of QAPI and [Quality Assessment and Assurance] compliance, and link related deficiencies specifically to resident safety practices." According to the report, CMS stated that activities under way to establish QAPI requirements for nursing homes "will include guidance for surveyors on how to evaluate nursing home efforts to identify and reduce adverse events."

    APTA provides physical therapists (PTs) and their patients and clients with education on exercise prescriptions for balance and falls prevention, a pocket guide on falls risk reduction (.pdf) and an online community where members can share information about falls prevention. In addition, APTA offers its members evidence-based resources on falls through PTNow as well as through PTNow ArticleSearch, its tool for access to current research works.The association's webpage on safe patient handling also includes information on how to patient and provider injury risk.

    Compression Hosiery as Effective—and Cheaper—Than Bandages for Venous Leg Ulcers, But Patient Compliance An Issue

    Layered compression bandages may be the "gold standard" in treatment of venous leg ulcers, but according to a new study, 2-layer hosiery is just as effective—and less costly. Rates of adherence, however, may mean that the approach is "not suitable" for all patients, according to researchers.

    The study, which appears in the March 8 edition of The Lancet (abstract only available for free, but see note at the bottom of this story for additional access information), analyzed treatment results among 453 patients with venous leg ulcers at 34 facilities in England and Northern Ireland. The patients were divided evenly into 2 groups—1 receiving 4-layer compression bandage treatment that authors said is regarded as the "gold standard," and the other receiving 2-layer hosiery (understocking and overstocking). Each group was monitored to assess healing rates and proportions.

    The results showed nearly identical rates of healing, with a 99-day median healing time in the bandage group and a 98-day median time in the hosiery group. Likewise, the overall proportion of patients whose ulcers healed through compression treatment was nearly the same for each cohort, at 70.4% for the bandage group and 70.9% for the hosiery group. "Our results indicate that 2-layer hosiery is as effective as 4-layer bandage for healing of venous leg ulcers," the authors write. The study also found a decreased chance of recurrence among the hosiery group.

    The authors also looked at overall cost-effectiveness for each approach and found that at least for patients in the UK's National Health System, average mean costs were about $485 less per year for the hosiery participants, a savings realized mostly because of fewer nurse consultations.

    After making additional adjustments for ulcer area and duration, participant mobility, and participating facilities, researchers also concluded that the hosiery group had "slightly more" quality adjusted life-years than the bandage group. "These findings suggest that hosiery is a dominant treatment—that is, on average it results in higher quality-adjusted life-years and lower costs than do bandages," the authors write.

    Though outcomes were good for the hosiery group, researchers were surprised at compliance rates. Authors expected that because of the ease of application and greater mobility provided, the hosiery treatment would enjoy strong compliance. Instead, they noted, 38% of hosiery participants changed to a nontrial treatment before their ulcers had healed, compared with 28% of the bandage group (combined rate: 33%). "Our results suggest that participants had more complaints about discomfort with hosiery, which led many participants in this group to change to another treatment," they wrote.

    The complete article will be available free to members in approximately 3 months via APTA's PTNow ArticleSearch, the association's research access tool. Check out ArticleSearch regularly, or e-mail APTA library staff to be notified when this article becomes available. For synthesized information on the management of venous leg ulcers, members can visit PTNow to access full-text clinical practice guidelines and 4 full-text Cochrane Reviews.

    USPSTF: More Research Needed on Routine Cognitive Impairment Screenings

    Though US Preventive Services Task Force (USPSTF) acknowledges that there may be "important reasons" to screen for cognitive impairment for adults over 65 with no recognized signs or symptoms of impairment, 10 years after its last investigation of the issue the group continues to say that more research is needed before it can reach a recommendation about the benefits and risks of the assessments.

    The recent USPSTF report does not recommend against the screenings and even asserts that some screening tools are better supported by performance data than they were during the group's 2003 review of the issue. However, the overarching message from the report is clear: "the overall evidence is insufficient" for the USPSTF to advise for or against.

    Within that general position, the task force did arrive at a few related conclusions. Among them:

    • Some drug therapies "have a small effect" on short-term outcome measures for patients with mild to moderate dementia.
    • Caregiver interventions have a "small effect" on caregiver burden and depression.
    • Exercise interventions "are not associated with serious adverse effects."
    • Acetylcholinesterase inhibitors (AChEls) can produce adverse effects, some serious.

    APTA responded to the USPSTF report during a comment period in late November 2013. In a letter based on expert member input, the association noted that a physical therapist's (PT's) screening for cognitive function can "significantly affect how [PT] interventions are communicated and delivered to the patient." While the comment letter did acknowledge that there was insufficient evidence to recommend routine screening for the public, APTA input pointed out that a patient's cognitive status "can have profound implications" on treatment approaches and outcomes in settings that involve PTs.

    Additionally, APTA suggested changes to the report, many of which were incorporated into the final document. One such change: including exercise among the nonpharmacological interventions for adults with cognitive impairment.

    HIPAA Violation Leads To $4.1 Million Judgment Based On State Law

    A protected health information (PHI) breach that violated HIPAA may now result in the same facility paying out an additional $4.1 million for violations of state privacy laws.

    According to a recent article inHealthcare IT News, a Los Angeles County Superior Court judge has approved the class action settlement that asserts Stanford Hospital and Clinics violated California's Confidentiality of Medical Information Act. The settlement stems from a 2010 breach that involved the posting the PHI of nearly 20,000 patients to a student website. The information remained on the public website for almost 1 year, and contained patient names and diagnoses.

    The Healthcare IT article reports that this was the fifth in a string of HIPAA breaches connected with the facility that affected the PHI of more than 92,000 patients. Of the 5 breaches, 4 involved the theft of unencrypted company laptops.

    HIPAA rules can be complex, but the consequences of not understanding them can be serious. APTA provides resources on compliance on APTA's HIPAA webpage.

    APTA Member Input Brought to CMS Meeting on FLR; CMS Provides Information on Claims Processing

    APTA members' willingness to share their experiences of claims processing errors and payment delays related to functional limitation reporting (FLR) enriched the information that APTA staff provided to representatives of the Centers for Medicare and Medicaid Services (CMS) during a recent meeting. During that same meeting CMS provided information on how claims on "1500" forms are processed that APTA believes may help physical therapists (PTs) avoid split claims in the future.

    Over the past 2 months, APTA received numerous complaints from members about FLR, which in turn helped association staff pinpoint specific systems problems in claims processing. The systems issues were brought to CMS as part of a discussion around changes that could be made to the program.

    As part of that discussion CMS explained that its current system can accommodate no more than 13 line items on a 1500 claim form. Given this information, APTA believes that PTs may experience more efficient processing and find their claims less likely to be split if they submit claims with no more than 12 line items.

    The FLR program was implemented in October 2013 after being delayed from its original July 1 launch. System difficulties were prevalent enough that APTA developed an FLR webpage that provides guidance to PTs experiencing problems with the system. That resource includes a complaint form (members only) that allows members to share examples of their problems. APTA encourages members to continue to provide feedback on FLR processing so that the association can continue its collaborative work with CMS to correct system issues.

    New APTA Webpage Offers Evidence-Based Document Resources

    Whether you’re first exploring evidence-based care issues, looking for information on how to create clinical practice guidelines, or trying to learn about ways to conduct guideline appraisals, a new APTA webpage can make the work a little less daunting.

    The association's new Resources for the Development of Evidence-Based Documents webpage brings together offerings that not only help physical therapists (PTs) access current guidelines and research, but provide PTs with materials that will help them learn how to contribute to the growing pool of evidence-based physical therapy research. The page includes links to APTA's PTNow research resource, the Agency for Healthcare Research and Quality (AHRQ) Systematic Review Data Repository, and the PEDro Physiotherapy Evidence Database, as well as information on how to conduct critical appraisals and develop recommendations.

    The new page is part of APTA's strategic objective to better enable physical therapists to consistently use best practice to improve the quality of life of their patients and clients.

    Health Professions Regulation Conference Will Look at High-Risk Industry Examples

    What do pilots, deep sea oil rig workers, and physical therapists have in common? More than you might think, particularly when it comes to regulation.

    The World Health Professions Regulation Conference in May will include a keynote address by Professor Rhona Flin, a director of a UK-based industrial psychology research center, who will explore the connection between health care and high-risk industries by showing how failures in communication and decision-making can trigger adverse results. The address is part of the conference, titled "Health Professional Regulation—Facing Challenges to Act in the Public Interest" and set for May 17-18 in Geneva, Switzerland.

    The conference will bring together health professionals and regulators from around the world to explore approaches to regulation including competency-based models. The meeting is being hosted by the World Health Professions Alliance (WHPA) and will take place immediately before the World Health Organization’s World Health Assembly in Geneva.

    More information and registration materials can be accessed through the conference website. WHPA is an alliance of global organizations representing more than 26 million of the world’s physical therapists, physicians, dentists, nurses, and pharmacists, in more than 130 countries. APTA is a member of the World Confederation for Physical Therapy, which is a part of WHPA.

    PT-Generated Lists of Unnecessary Procedures Coming In; Deadline April 4

    APTA's effort to get member opinions on potentially unnecessary physical therapy tests and procedures is off to a strong start, but the association is looking for as much input as possible as it considers joining a national campaign to educate consumers on making informed health care choices. Physical therapists (PTs) have until April 4 to forward suggestions via an online form.

    As part of its Integrity in Practice initiative, APTA is exploring the possibility of participating in the "Choosing Wisely" program, a national American Board of Internal Medicine (ABIM) Foundation-sponsored project that provides the public with lists of health care tests and procedures that may be unnecessary under certain circumstances. Consumer Reports is partnering with ABIM to promote the campaign and helped to create a video describing the effort, which was also featured in the March 2014 edition of the American Association of Retired Persons (AARP) newsletter.

    The association is on the lookout for any PT-controlled procedure that tends to be done frequently or carry a significant cost, yet whose usefulness is called into question by evidence. APTA will convene an expert panel to review and rate all member submissions and create a list of approximately 10 potential items that will be narrowed down to 5 by way of an all-member survey. The top 5 questioned procedures will then go to the APTA Board of Directors for final approval. Nearly 60 suggestions have been received so far.

    If approved for use by the ABIM Foundation, APTA's "5 Things Physical Therapists and Patients Should Question" would join similar lists (.pdf) provided by organizations including the American Geriatrics Society, the North American Spine Society, the American Academy of Family Physicians, and the American College of Occupational and Environmental Medicine. Procedures called into question by these and other organizations include routine imaging of certain patients with inflammatory arthritis, recommending more than 48 hours of bed rest for patients with low back pain, and screening of adolescents for scoliosis.

    APTA’s version of "5 Things" would become a component in the association's large-scale initiative to highlight physical therapy's role in eliminating fraud and abuse in health care. The effort is the subject of a feature article (members-only access) in the February issue of PT in Motion.

    APTA Contributes to FTC Discussion on Consumer Access

    A March 20 and 21 meeting of the Federal Trade Commission (FTC) examined activities and trends related to cost, quality, access, and care coordination that may affect competition in the US health care industry. APTA representatives attended the event and provided pre-workshop comments (.pdf) that pressed for greater patient access to physical therapists (PTs), the elimination of physician self-referral, and expanded health care networks under the Affordable Care Act (ACA), among other issues.

    The meeting, "Examining Health Care Competition (.pdf)," was attended by APTA staff and included panel discussions and presentations on the professional regulation of health care providers, measuring the quality of health care, and the interplay between quality and price transparency, among other topics.

    In the pre-workshop comments submitted to the FTC, APTA President Paul A. Rockar Jr, PT, DPT, MS, wrote that even though some form of direct access to PTs is allowed in 48 states, certain state restrictions enacted for political reasons are an obstacle to effective treatment. These restrictions, which include visit caps, time limits, or rules about the number of days a PT can treat before referring a patient to a physician, "are not based on evidence, clinical need, patient safety, or the best interest of the patient," Rockar wrote.

    Rockar also described to the FTC how physician-owned physical therapy services restrict trade and limit “the consumer's right to choose his/her physical therapist," a limitation that the consumer might not even perceive, "as no other option is offered." Other portions of the letter urged the FTC to work toward expansion of health care provider networks to include nonphysician providers, and to carefully review new models of service delivery such as accountable care organizations (ACOs) to ensure that the new systems do not disenfranchise patients by limiting choice.

    The association will also submit follow-up comments after the workshop.

    FTC's meeting follows the release of a policy paper (.pdf) that questions regulatory frameworks that it feels limit consumers' ability to seek treatment from Advance Practice Registered Nurses, particularly by way of restrictions on independent practice. In that paper, agency analysts propose that limited practice scopes and burdensome requirements for physician supervision or approval effectively dampen competition and leave consumers with fewer choices, a situation that "can have serious health and safety consequences."

    Time’s Running Out to Win an iPad Mini

    If you're in need of inspiration to read The Successful Physical Therapist, you could look up a motivational quote on your iPad mini—if you had one, that is.

    If you don't, well, get reading.

    APTA members who read The Successful Physical Therapist (.pdf) , learn the 4 key brand behaviors that build consumer trust, and take the post-quiz by March 28 will be entered to win the trendily useful (or usefully trendy) device. It's that simple. But time's almost up.

    Why are you still reading this when you could be reading The Successful Physical Therapist? Download the guide today—and get lots of other useful information on the brand at www.APTA.org/BrandBeat.

    2014 APTA Honors and Awards Program Recipients Announced

    APTA's national awards program has announced the full list of recipients (.pdf) of recognition for their outstanding contributions to the physical therapy profession.

    The honorees include newly named Catherine Worthingham Fellows as well as recipients of the Mary McMillan Lecture Award, John H.P. Maley Lecture Award, and Lucy Blair Service Award. APTA also announced award recipients for excellence in education, practice, service, publications, research, and academia.

    Recipients will be recognized at the Honors and Awards Ceremony on Thursday, June 12, 5:30 pm–6:30 pm, during the 2014 NEXT Conference and Exposition in Charlotte, North Carolina, with a reception to follow. Family, friends, colleagues, and conference attendees are encouraged to attend this important event to support and honor these members’ achievements and contributions to the profession.

    Nominations for the 2015 Honors and Awards Program will open September 2014.

    Exercise During Chemotherapy: Limited Research Finds Possible Positive Outcomes

    The sample size was small and the results not definitive, but authors of a new study on the effects of exercise on women undergoing chemotherapy for breast cancer assert that the findings were strong enough to support the need for further clinical trials.

    The Canadian study (abstract only available for free), published ahead of print in Medicine & Science In Sports & Exercise, found increased disease-free survival rates (DFS) among women who had participated in exercise training that began 1-2 weeks after starting chemotherapy. Among 242 breast cancer patients, the 8-year DFS rate for the exercise group was 82.7%, while the control group rate was 75.6%. Authors wrote that the trial "provides the first randomized data to suggest that adding exercise to standard chemotherapy may improve breast cancer outcomes."

    The women studied were part of the START Trial, a multicenter study aimed at analyzing differences between aerobic and resistance exercise and their effects on patient-reported outcomes for patients with breast cancer receiving chemotherapy. As part of that trial, participants were divided into 3 groups—an aerobic exercise training (AET) group, a resistance exercise training (RET) group, and a control group that was not required to exercise.

    The AET group exercised 3 times a week on a cycle, treadmill, or elliptical ergometer, beginning with 15-minute duration and working up to 45-minute sessions by week 18. RET group participants began by performing 8-12 repetitions of 9 exercises at 60% to 70% of their 1-repetition maximum, increased by 10% each time they completed more than 12 repetitions.

    When researchers looked at survival differences among the exercise and nonexercise groups, they found effects that "appear to be meaningful," including combined survival differences between 7% and 9%, with the strongest effects in women who were overweight or obese, had stage II/III cancers, had ER or HER2 positive tumors, or received taxane-based chemotherapies. Authors did not explore the degree of difference between the 2 exercise approaches due to small sample sizes.

    Authors cited 3 possible reasons for the positive effects: the possibility that exercise improves the rate of chemotherapy completion, the possibility that it assists in "drug distribution" through changes to metabolism, or that exercise "provides an additive benefit beyond current chemotherapy drugs mediated by mechanisms unrelated to interaction effects."

    Although encouraged by the study, authors described the sample size as "clearly underpowered for any definitive conclusions" and pointed out that confidence intervals were wide enough to not preclude the possibility that exercise could produce adverse effects on cancer outcomes. Arriving at "definitive efficacy information" was not the goal of the study, they write, which was meant to "identify promising experimental regimens that have a high likelihood of success" in a subsequent research phase.

    Claims of Dramatic Obesity Drop Called Into Question

    Recent media reports that preschool obesity rates have dropped 43% in 10 years may have been based on a faulty conclusion given the data in the study. Some experts now say that it's possible that contrary to reports from the US Centers for Disease Control and Prevention (CDC) and various news outlets, obesity rates for this group, like almost all demographic groups in the study, remain unchanged from previous levels.

    According to an article on the Reuter's news service, CDC press releases and other information that described a dramatic drop in obesity rates of children aged 2–5 is being called into question by experts largely because the study the agency cited was based on small sample sizes that generated wide margins of error. The report, published in the February 26 issue of JAMA, the Journal of the American Medical Association, caught the attention of most major news organizations.

    The report examined obesity rates reported in 2003–2004 and compared them with rates reported in 2011–2012. While CDC pinned the preschool obesity rates at 13.9% in 2003–2004 and 8.4% in 2011–2012, the margins of error of both rates were wide enough that the actual rates could in fact overlap. Authors of the study stated that the '03–'04 rates could range from 10.8% to 17.6%, and the '11–'12 rates could be anywhere between 5.9% to 11.6%. Though the authors did include the margins of error in the article, the abstract referenced the more dramatic drop, and CDC issued public statements that cited a 43% decline.

    If the actual rates do overlap or are closer, they would mirror the results of nearly all other age groups analyzed, in which "no significant changes" were observed. The only remaining exception, if data holds, would be that obesity rates for women aged 60 and above have actually increased.

    Virtual Career Fair Could Power Up Your Job Search

    Physical therapists (PTs), physical therapist assistants (PTAs), and physical therapy students will have an opportunity to jump start their job searches without leaving their laptops, thanks to APTA's upcoming Virtual Career Fair set for April 1 from 1:00 to 4:00 pm.

    The free event will allow attendees to chat online with recruiters from small and large physical therapy providers. Participants will be able to see opportunities available from each employer and then engage in 1-on-1 chats with recruiters.

    More information and registration instructions are available at the Virtual Career Fair webpage. Employers interested in participating should contact Meredith Turner for more information.

    Grassroots Support Needed for Senate Bill to End SGR, Therapy Cap

    Though a House-approved bill to end the flawed sustainable growth rate (SGR) is almost certain to be a nonstarter in the Senate, a Senate bill that would end both the SGR and the therapy cap is now gaining momentum and is the focus of renewed grassroots advocacy efforts from APTA and other organizations. Physical therapists (PTs), physical therapist assistants (PTAs), physical therapy students, and supporters are being urged to contact legislators to push for passage.

    On March 14, the House voted 238-181 to approve a bill that would pay for the cost of SGR repeal by delaying enforcement of the individual mandate in the Affordable Care Act (ACA). The political implications of the bill are widely viewed as unacceptable to the Democratic-controlled Senate, which so far has refused to take up the bill. The White House has threatened a veto of the bill if it should pass both houses.

    As the House bill was being announced, Senate insiders described a new effort to draft a bill that would end not just the SGR, but the therapy cap as well—something not addressed in the House bill. The bill, S. 2110, is scheduled to go to the floor of the Senate during the week of March 24.

    The coming days will be crucial ones for supporters of an end to the SGR and therapy cap, and APTA's advocacy team has issued e-mail alerts highlighting the need for grassroots shows of support for the bill. Additionally, supporters are being asked to contact House members to reemphasize the importance of repeal. Current exceptions to the SGR and therapy cap will expire on March 31.

    A permanent end to the therapy cap and SGR could be closer than ever. Now is the time for action to help legislators understand the importance of repeal for providers and their patients. APTA members can take action via the Legislative Action Center and nonmembers and the public can take action via the Patient Action Center. APTA members, nonmembers, and patients can also take action using the APTA Action app. Members interested in joining APTA's advocacy efforts can also sign up for PTeam.

    Volunteers Wanted for ICD-10 Testing – Sign Up by March 24

    The Centers for Medicare and Medicaid Services (CMS) is looking for volunteers to test systems (.pdf) built around the International Classifications of Diseases – 10th revision (ICD-10) codes that will be implemented throughout the Medicare and Medicaid systems in October. Practices that participate in the end-to-end testing this summer could find the experience to be a good way of assessing their own readiness for the transition.

    The tests, set for July 21–25, will involve a select group of providers working with Medicare Administrative Contractors (MACs), and the Common Electronic Data Interchange (CEDI) contractor. The testing will include submission of test claims to CMS with ICD-10 codes and the provider’s receipt of a Remittance Advice (RA) document that explains the adjudication of the claims. CMS wants to verify that:

    • Providers or submitters are able to successfully submit claims containing ICD-10 codes to the Medicare fee-for-service claims systems;
    • CMS software changes made to support ICD-10 result in appropriately adjudicated claims (based on the pricing data used for testing purposes); and
    • Accurate RAs are produced.

    The sample will be selected from providers, suppliers, and other submitters who volunteer to participate. CMS intends to create a broad nationwide sample that represents a mix of provider, claims, and submitter types. Providers interested in volunteering can sign up by filling out an interest form at the appropriate MAC website. Deadline for submission is March 24.

    Need more information on what the change to ICD-10 means for your practice? Visit the APTA ICD-10 webpage, which includes background, resources, and a pre-recorded webinar, "Are You Ready to Move from ICD-9 to ICD-10?"

    Free CDC Presentation on Knee OA and Physical Activity March 19

    Health care providers can get the latest Centers for Disease Control and Prevention (CDC) perspectives on knee osteoarthritis (OA) and physical activity in a free 30-minute webinar on March 19 at noon ET.

    The Osteoarthritis Action Alliance (OAAA) "Lunch and Learn" program will feature CDC epidemiologist Kamil Barbour, PhD, MPH, MS, in a presentation focusing on the public health implications related to knee OA and research findings that establish the link between the right amount and kinds of physical activity and positive outcomes.

    The program will be held as a conference call with accompanying presentation slides available for download in advance. Attendees can access the event by calling 866/487-9450 and entering conference code 5670233526.

    The March 19 presentation is part of a series of "lunch and learn" programs. APTA is an OAAA member.

    New ACA Rules Could Increase Provider Networks in Exchanges

    New proposed rules (.pdf) released on Friday, March 14, include changes to provider network requirements that could help increase the number and variety of facilities and specialists offered by policies in the federally managed exchanges.

    The changes are part of a package of significant proposed rules that affect consumer access to quality information about the Marketplace plans, rules on Navigators, reinsurance, and medical loss ratio in 2015 and beyond. According to an article in the Washington Post, President Barack Obama described the changes to "reasonable access" standards as a response to insurance company efforts to keep costs down by narrowing provider networks.

    Under the proposed rule, the Centers for Medicare and Medicaid Services (CMS) would review plans offered on the federal exchanges to see whether they have enough facilities and specialists in several fields, such as hospitals, primary care, mental health, and oncology providers. At this point, physical therapy is not included in the list. APTA and other provider groups have been concerned about the narrow provider networks in health insurance plans sold on the exchanges.

    If the rules are adopted as proposed, beginning in 2015 plans would also be required to include 30% of an area’s "essential community providers," which the Post article describes as "usually health centers and other hospitals serving mostly low-income patients." The current requirement is for 20% inclusion.

    The rule, a final letter to insurance issuers (.pdf), and a related bulletin (.pdf) are available online. The comment period for the rule will extend for 30 days from the date of publication in the Federal Register.

    APTA continually monitors changes to the Affordable Care Act and health care reform in general, and offers an extensive list of resources on its health care reform webpage.

    PT in Motion: Physical Therapy Vision Far From Blurry

    APTA's vision of "Transforming society by optimizing movement to improve the human experience" is certainly broad, definitely ambitious, possibly a little daunting—and very much about the realities of physical therapy, according to an article in the current issue of PT in Motion.

    In the March issue of the APTA member magazine, author Chris Hayhurst dives into the implications of the vision statement adopted by the association in 2013 and shares perspectives on what it will take for physical therapists (PTs) to truly transform society. Hayhurst's interviews with PTs who innovate, educate, and help to lead both private businesses and the professional association show how the vision strikes a chord with PTs.

    The PTs interviewed for the article don't see the APTA vision as yet another nebulous statement from yet another professional organization: instead, they provide solid examples of how the idea can be—and in some cases, already is—put into practice. Daniel Dade, PT, DPT, and APTA 2013 House of Delegates representative from Georgia who was interviewed for the article, thinks that making those practical connections to the vision isn't difficult. "This is what physical therapy is all about," he said of the statement.

    The PT in Motion article on APTA's vision appears in the March issue of the magazine. Hardcopy versions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.

    For more on the APTA vision, visit the Vision webpage and view the livestreamed House of Delegates deliberations (June 25, part 2, and June 26, part 2).

    Editorial Suggests Physician Screening Tool, PT Referral for LBP

    A British screening approach for physicians with patients complaining of low back pain (LBP) could help in creating a US approach that more frequently involves physical therapists (PTs) early on and lowers the financial burden of the condition, according to an editorial appearing in the April issue of The Annals of Family Medicine.

    In their editorial, "Physical Therapy for Low Back Pain: What Is It, and When Do We Offer It to Patients," authors Timothy S. Carey, MD, MPH, and Janet Freburger, PT, PhD, comment on a new study of PT management of patients with LBP, saying the results represent an "important incremental step" in validating approaches that involve PTs early on and reduce patient work time lost. The approach described in the study involves physician use of a British screening tool known as the STarT, which can help a physician assess LBP. Once that key assessment is made, a medium or high-risk patient can be referred to a PT for effective treatment.

    The editorial answers the question "Should we try to adopt such an approach in the United States" with "a qualified yes." Authors point to logistical and regulatory wrinkles that would need to be worked out, but they say that similar screening approaches—such as those used for alcohol use or depression—were implemented fairly easily. "These advances don't solve our problems with the large disability burden and high cost of low back pain," the editorial states, "but they represent a promising start."

    APTA offers synthesized evidence-based information on LBP through PTNow, including clinical practice guidelines developed by APTA's Orthopaedic Section. Other LBP guidelines can be accessed at PTNow's practice guidelines webpage.

    APTA Members Asked to Identify Unnecessary Procedures

    APTA's efforts to make physical therapy a leader in fraud and abuse prevention could soon include a public education campaign to encourage informed care decisions based on member input on physical therapy tests and procedures that are unnecessary.

    As part of its Integrity in Practice initiative, APTA is exploring the possibility of participating in the "Choosing Wisely" program, a national American Board of Internal Medicine (ABIM) Foundation-sponsored project that provides the public with lists of health care tests and procedures that may be unnecessary under certain circumstances. APTA would join over 50 medical specialty societies that each contributed a list of "5 Things a Patient Should Question."

    The first step in the process for APTA, according to a recent all-member email, is to hear from as many PTs as possible about commonly used physical therapy procedures "whose necessity should be questioned and discussed." The association is on the lookout for any PT-controlled procedure that tends to be done frequently or carry a significant cost, yet whose usefulness is called into question by evidence. APTA will convene an expert panel to review and rate all member submissions and create a list of approximately 10 potential items that will be narrowed down to 5 by way of an all-member survey. The top 5 questioned procedures will then go to the APTA Board of Directors for final approval.

    If approved for use by the ABIM Foundation, APTA's "5 Things Physical Therapists and Patients Should Question" would join similar lists (.pdf) provided by organizations including the American Geriatrics Society, the North American Spine Society, the American Academy of Family Physicians, and the American College of Occupational and Environmental Medicine. Procedures called into question by these and other organizations include routine imaging of certain patients with inflammatory arthritis, recommending more than 48 hours of bed rest for patients with low back pain, and screening of adolescents for scoliosis.

    PTs can submit their recommendations online. The deadline for submissions is April 4.

    APTA’s version of "5 Things" would become a component in the association's large-scale initiative to highlight physical therapy's role in eliminating fraud and abuse in health care. The effort is the subject of a feature article (members-only access) in the February issue of PT in Motion magazine and will be the focus of future association education efforts.

    SGR Reform, Therapy Cap Repeal Hit Political Road Bumps

    Although permanent solutions are still on the table, the flawed sustainable growth rate (SGR) formula—and the current therapy cap system—may be around for most of 2014, now that the House of Representatives will hold a vote to offset the costs of SGR repeal by delaying implementation of parts of the Affordable Care Act (ACA).

    The bad news: because the proposal is a non-starter in the Senate, the inaction would likely result in another temporary fix to both the SGR and the therapy cap. The good news: a new bill that would end both the SGR and the therapy cap has been introduced in the Senate, though action on the bill may not happen in time to meet a March 31 deadline.

    According to Roll Call, House Republicans will be calling for a delay in implementation of the ACA's individual mandate, using the projected $9 billion in savings per year to offset the anticipated $130 billion cost of ending the SGR. In the Roll Call story, House Ways and Means Ranking Member Sander M. Levin (D-Michigan) described the proposal as a "road to nowhere" and said that the Senate would not take up a vote on whether to delay the individual mandate.

    Instead, on March 12 the Senate introduced an alternate bill similar to an earlier Senate plan to end both the SGR and the therapy cap, a proposal that has support among many legislators. Supporters of SGR and cap repeal view this as a positive step—particularly because of the return of a therapy cap repeal, an element that is missing from the bill now in the House.

    Both the House and Senate bills would eliminate a flawed system that requires a "fix" every year in order to avoid significant cuts to provider payments. Late last year, while lawmakers were hammering out the details of new legislation and looking for offsets to pay for the changes, temporary exceptions to the SGR and therapy cap were extended through March 31, 2014. With that deadline looming passage of a permanent fix before the end of March now seems unlikely.

    In light of the inaction, Congress could agree to extend the exceptions for several more months—possibly until after the November elections—before once again taking up a bill.

    APTA and other organizations have advocated that any Medicare modernization bill include language to end the therapy cap, a position that has support among some legislators. APTA's advocacy team continues to work with members of Congress on passage of a bill that would include repeals of both the SGR and therapy cap, and has been emphasizing the importance of grassroots efforts to make sure legislators hear from supporters of ending both flawed policies. APTA members can take action via the Legislative Action Center and nonmembers and the public can take action via the Patient Action Center.

    APTA will continue to work the members of Congress to ensure the final reform package includes policies that reflect the interests of physical therapists and the patients and clients we serve. Members interested in joining APTA's advocacy efforts to reform SGR and repeal the therapy cap can sign up for PTeam.

    Clinical Practice Guideline Proposals Due Soon

    APTA sections have less than a week left to submit proposals for clinical practice guidelines (CPGs) and clinical practice appraisals (CPAs) for possible financial support from the association. Proposals for the current review cycle are due March 17.

    Proposals for CPG or CPA development must be supported and submitted by an APTA section, and must focus on clinical practice areas that are important and relevant to the practice of physical therapy. Each proposal will be considered individually and will be awarded in part or in full depending on the strength of the proposal and the priorities of the association.

    For more information or a copy of the proposal submission document, e-mail Anita Bemis-Dougherty, director, Practice Department, or call 800/999-2782, ext 3176.

    CMS Looking For 'Practice Transformation' Input

    Physical therapists (PTs) who have insights on transforming clinical practices now can share those insights with the Centers for Medicare and Medicaid Services (CMS). The agency hopes to shape future policy by reviewing what health care providers have done to meet the aims of "better care and better health at lower costs."

    Health care providers who have participated in practice transformation are encouraged to respond to the CMS request for information (RFI) by April 8. CMS states that it may use the information "to test new payment and service delivery models."

    CMS defines practice transformation as "a process that results in observable and measureable changes to practice behavior" around core competencies that include:

    • Engaged leadership and quality improvement
    • Empanelment and improved patient health outcomes
    • Business and financial acumen
    • Continuous and team-based healing relationships that incorporate culture, values, and beliefs
    • Organized, evidence-based care
    • Patient-centered interactions
    • Enhanced access
    • Progression toward population-based care management
    • State-of-the-art, results-linked care
    • Intentional approach of practices to maximize the systematic engagement of patients and families
    • Systematic efforts to reduce unnecessary diagnostic testing and procedures

    Physical Therapy As Effective As Surgery for Rotator Cuff Tears

    A recent study from Finland asserts that when it comes to treatment of nontraumatic rotator cuff tears, physical therapy alone produces results equal to those produced by arthroscopic surgery and open surgical repair. According to the study's authors, follow-ups of 167 shoulders treated show that "conservative treatment should be considered as the primary treatment for this condition."

    The research, published in the January issue of Bone and Joint Journal (abstract only available for free), was built around treatment of 173 patients aged 55 and older (mean age 65) with supraspinatus tendon tears. Patients were assigned to 3 groups: the first group received physical therapy only; the second group received acromioplasty and physical therapy; and the third group was treated with rotator cuff repair, acromioplasty, and physical therapy. Each group contained similar age ranges and equal distribution by sex. After exclusions and drop-outs, 167 shoulders were available for assessment.

    Components of the physical therapy treatment remained the same across groups: patients were given guidance and information on home exercise that focused on glenohumeral motion and active scapular retraction for the first 6 weeks, with increases during the next 6 weeks, followed up by increased strength and resistance training for up to 6 months. Participants were also referred for 10 physical therapy sessions in an outpatient clinic.

    When patients were assessed using the Constant score at 3 months, 6 months, and 1 year, researchers found substantial similarity in rates of improvement. "Contrary to our hypothesis, surgical repair of a supraspinatus tear does not improve the Constant score when compared with acromioplasty only or conservative treatment," the authors write. Additionally, the patients' subjective satisfaction ratings were the same for all 3 approaches.

    The findings even seemed to contradict the placebo effect often associated with surgery. Authors noted that participants were aware of the treatment path assigned to them, yet the surgery group did not report markedly different perceptions of improvement. The results led authors to speculate that the similar Constant scores among groups "may simply be due to the similar physiotherapy [regimens]."

    Humana Seeking to Amend Provider Contract Terms

    If you've received a letter from Humana or Health Value Management notifying you of reductions in payments in connection to sequestration, consider consulting a healthcare attorney: the letter could contain information on amendments to your contract and deadlines for review and objection.

    Humana and Health Value Management, Inc. doing business as ChoiceCare Network (ChoiceCare) recently distributed the letters, which mention sequestration reductions imposed by the Center for Medicare and Medicaid Services (CMS). APTA strongly encourages you to review the letter, including possible changes to your individual network participation and the time period for objections, and carefully analyze your individual contract terms. You may find it helpful to seek legal advice on whether and how to respond.

    Though APTA provides many resources on its private insurance webpage—including a managed care contracting toolkit—the association cannot provide legal advice or guidance to individual members.

    For further information regarding your contract, you may also contact your payer representative.

    APTA Part of TBI Events on Capitol Hill

    Members of the US Congress and their staff will have a chance to get the physical therapist (PT) perspective on traumatic brain injury (TBI), as APTA staff participate in the Brain Injury Awareness Fair taking place March 12 on Capitol Hill. APTA was invited to join in the event as part of Brain Injury Awareness Day and will use the opportunity to advocate for 2 bills on concussion and TBI.

    In addition to sharing APTA's consumer-oriented information on TBI and highlighting the association's participation in the Joining Forces initiative, APTA will promote passage of 2 pieces of legislation: the TBI Reauthorization Act (H.R. 1098), and the Protecting Student Athletes From Concussions Act (H.R. 3532) (.pdf). The TBI Reauthorization Act would continue support for research and data collection on TBI by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH); the Protecting Student Athletes From Concussions Act would ensure school districts have concussion management plans that educate students, parents, and school personnel about how to recognize and respond to concussions, among other programs.

    APTA's advocacy work at the event is part of a much larger strategy to educate legislators and the broader public on concussion and TBI. The association provides extensive resources to its members on the role of physical therapy in brain injury treatment and recovery, and offers a TBI webpage that includes continuing education courses and links to other interest groups.

    AHRQ Names Falls Prevention Policy Kit a 'Quality Tool'

    A resource for advancing falls prevention at the state policy level has been designated a "quality tool" by the federal Agency for Health Care Research and Quality (AHRQ) and included among offerings on the AHRQ website. The toolkit is a product of the National Council on Aging's (NCOA) Falls Free Coalition, whose members include APTA.

    The toolkit outlines 8 policy goals that will help advocates establish innovative falls prevention policies and practices in states, communities, and organizations. Each goal is accompanied by suggested policy changes, and includes examples of advances that are possible through education and engagement of key stakeholders.

    APTA is a member of the Falls Free Coalition responsible for creating the toolkit, and APTA member Bonita L. Beattie, PT, was instrumental in the development of the resource.

    An earlier version of the toolkit (.pdf) focused on falls and Medicare, along with many other resources on falls and falls prevention, can be accessed at APTA's Balance and Falls webpage.

    Innovation 2.0 Projects Selected For May Workshop

    A total of 21 projects will be part of APTA's Innovation 2.0 program aimed at bolstering the impact of physical therapy in innovative and emerging models of health care. The selected projects were the highest-rated among 59 proposals submitted to a review team of physical therapist clinicians, researchers, administrators, and educators.

    The projects will move on to the next phase of the Innovation 2.0 process—a 2-day workshop in May that will connect project leaders with researchers, clinicians and other experts to help refine the proposals and ready them for submission to a final round of review. During that final round, reviewers will select recipients for funding and in-kind services that could include environmental scans, policy analyses, collaboration with other researchers, statistical support and analysis, and consultation.

    For a complete listing of the proposals selected, visit the Innovation 2.0 web page.

    Medicare Spending Differences Still a Mystery

    Just about everyone knows that Medicare spending varies depending on geography. Just about no one knows why.

    A recent Health AffairsHealth Policy Brief reviewed current theories on why, for example, Medicare spent an average of $15,957 per beneficiary in Miami, Florida, and $6,569 per beneficiary in Grand Junction, Colorado, and found most explanations lacking. "Even after multiple factors are considered, some geographic differences remain unexplained," the report states. In 2012, Medicare spent a national average of $9,503 per beneficiary.

    The policy brief reviewed research around possible explanations for the disparities, including the amount Medicare pays for services, the health status of beneficiaries, and variations in use. Authors couldn't point to a consistent explanation, nor were they able to discount a 2013 Institute of Medicine report that asserted that higher costs were not always related to better outcomes.

    Further complicating matters, according to the report, is the idea that the geographic differences seem to be specific to Medicare. "When researchers look at health care spending for different populations, such as people with private insurance or those covered by Medicaid, they do not find the same patterns seen in Medicare spending," the authors write.

    Telehealth Assessments of LBP: Ready for Prime Time?

    The need is there, the opportunities are there, and the technology is, well, almost there, but when it comes to assessment of low back pain (LBP), the current reality of telerehabilitation (TR) is that more work is needed before a remote approach becomes a fully reliable substitute for in-person interaction. That's the conclusion reached by Australian researchers who compared face-to-face and remote LBP assessments and found that while "important components" of the assessments can be valid when obtained through TR, "some areas of the assessment require further testing and development."

    The study, published in the February 2014 edition of Telemedicine and e-Health (abstract only available for free) focuses on LBP assessments conducted on 26 adult residents of a rural area in Queensland, Australia. The participants reported experiencing LBP currently or within the past 2 years, but not at severe levels nor accompanied by severe neurological symptoms. All participants could mobilize independently, were capable of participating in a safe physical examination, and possessed adequate communication and cognitive function.

    Researchers divided the participants into 2 groups, assigning half to undergo a face-to-face LBP assessment followed by a TR assessment, and half to go through the process in reverse order. Outcome measures were then compared relative to disability, pain, posture, active movement, and the straight leg raise (SLR) test. Participants also filled out a questionnaire about their own satisfaction with the TR approach.

    Before the study could be conducted, however, researchers needed to create a viable TR system capable of facilitating a LBP assessment—and under realistic conditions. They set up the study in a rural hospital, to be conducted "by rural clinicians, with a group of local participants who have experience with limited access to health services." The technology selected reflected a similar real-world approach, using a 640x480-pixel digital camera that could record moving and still images, a 300mm calibration index, a plinth, and an audio hookup. "The TR assessment was pragmatically designed to require the minimum amount of equipment and setup at the remote end," the authors wrote. Clinicians used "features" of eHAB, a medical videoconferencing system developed by the Telerehabilitation Research Unit at the University of Queensland.

    As for the actual conduct of the assessments, participants were instructed to stand on a reference line on the floor of the TR room and move according to the physical therapist's (PT) instructions. Participants were also told to bring a friend with them to the TR room to help with the SLR test. In cases where the participants didn't bring a friend, researchers recruited an "untrained nonclinical assistant" from the hospital staff.

    At the end of the study, researchers found strong correlation between face-to-face and TR assessments when it came to some but not all measures.

    "We found high levels of agreement with establishing if a lumbar spine movement was painful, detecting pain, eliciting symptoms, and sensitizing the SLR," the authors wrote. "Moderate agreement was found in identifying the limitation to an active lumbar spine movement, identifying the worst lumbar spine movement direction, SLR range of motion, and active lumbar spine range of motion. Poor agreement was found in all elements of the postural analysis."

    Researchers believe the problems with the postural analyses were partly technical and partly related to individual participants. According to the study, the keystoning effect of the wide-angle lens "made it difficult to analyze coronal posture," while the resolution of the images obtained was "insufficient to discriminate physical landmarks and hence allow postural assessment." Adding to the difficulties, researchers reported that 4 participants were unwilling to disrobe for the postural analysis—"not an unusual occurrence in this physiotherapy clinic," and something that happened in both the TR and face-to-face sessions.

    The study shows how—at least for now—these kinds of difficulties can tip the balance away from telehealth solutions, according to Alan Chong W. Lee, PT, PhD, DPT, CSW, GCS, associate professor at the Mount St Mary's College (California) doctor of physical therapy program. In the US, HIPAA regulations require legally compliant technologies, but even beyond a technological baseline, "patient and provider relationship and patient preference trumps any ability to provide best practice with value," he said. "For example, if the patient doesn't want to disrobe for a posture assessment because of privacy issues, it limits examination and evaluation." Lee agreed with the study's finding that image distortion can affect the assessment, saying that "the image projected on the frontal plane can be larger on the top versus the bottom."

    Lee also believes that the study's target participants—patients with no mobility issues or neurological symptoms—says something about the current status of telehealth assessments when it comes to LBP. "Patient selection is key," he said. "Minors, patients with mobility and safety issues, and patients with severe irritability with LBP were excluded from this study."

    "This is another example of how clinical decision making plays such a crucial role," said Matt Elrod, PT, DPT, MEd, NCS, senior practice associate at the American Physical Therapy Association (APTA). Elrod pointed out that APTA supports telehealth models, but only "when provided in ways consistent with APTA positions, guidelines, policies, standards of practice, ethical principles, and the Guide to Physical Therapist Practice."

    "As physical therapists, we must use our professional judgment to identify when this technology is safe and appropriate by using the best available evidence, understanding the patients' wants and needs, and applying the physical therapist skills," Elrod said.

    As for the patients themselves, the study found moderate-to-high satisfaction with the TR assessment, save for 1 area: whether they believed the remote approach was as good as a traditional face-to-face assessment. Authors write that satisfaction "was similar to ratings taken during earlier urban studies."

    The key to moving forward with a telehealth assessment program, according to the study, is the development of a "clinically robust" TR assessment for LBP, and the investigation of multidisciplinary treatment.

    Lee agrees, and believes that the "multidisciplinary" label needs to be applied to approaches within the practice of physical therapy. "Access to timely care and use of appropriate clinical and nonclinical staff can be best determined by musculoskeletal specialists in telehealth as well as usual care," he said.

    Meet Trevor Russell, one of the lead authors of this study, at this year's APTA NEXT conference and exposition, June 11–14 in Charlotte, North Carolina.

    Humana Completing MPPR Refunds, Delays Policy Implementation

    The Humana health insurance corporation has nearly completed processing refunds owed to practitioners who were incorrectly billed during an "overpayment recovery" process last year. The overpayments were part of Humana's attempt to implement the multiple procedure payment reduction (MPPR) policy retroactively, and the problems have contributed to a Humana decision to hold off on full MPPR implementation until the system can run more smoothly.

    Last summer, APTA raised questions about the accuracy of the overpayment calculations and concerns about the administrative burden of the overpayment recovery process on physical therapist (PT) practices, among other issues. As a result of those efforts, Humana temporarily ceased application of the MPPR policy in December 2013 to focus on correcting their payment logic and refunding inappropriate overpayment recoveries.

    Humana will delay MPPR implementation until the policy can be applied accurately and timely during initial claims processing. Humana representatives acknowledged that application of the MPPR policy is complex, and the overpayment recovery application of the policy caused unnecessary burden for PTs. The company is testing application of the MPPR policy and anticipates making an announcement about startup of the MPPR policy on initial claims in the near future.

    Humana will notify APTA in advance of the implementation date, and APTA will update members in a future News Now story.

    Feedback Needed on Draft Manual for Residency and Fellowship Education

    APTA members have an opportunity to provide input on a new resource for physical therapist residency and fellowship education.

    The American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) is seeking feedback on a just-released draft of the Mentoring Resource Manual, an 18-page document that defines mentoring, discusses aspects of effective mentoring, and addresses use of technology. The manual and feedback survey can be accessed online. Comments must be submitted by March 30, 2014.

    Note: Cookies must be enabled, and if survey participants don’t finish commenting in 1 session they must use the same browser on the same computer to resume where they left off; otherwise, clicking on the link will start a new survey.

    '2 Midnight' Rule on Hold Until September 30

    The Centers for Medicare and Medicaid Services (CMS) is once again delaying implementation of the "2 midnight" rule for hospital admissions of patients in Medicare. In the face of criticism from physicians and hospitals, CMS now says recovery auditors cannot use the rule until after September 30. The rule was originally set to go into effect on March 31.

    Intended to reduce costly admissions in cases better suited to outpatient treatment, the rule stipulates that auditors can assume that an admission is reasonable and necessary if the patient spent 2 days as an inpatient, defined as spending 2 midnights in a hospital bed.

    According to a recent report in Modern Healthcare (access requires free registration), the rule was created to respond to "widespread complaints that Medicare's rules are too vague about when a moderately sick patient should be admitted for expensive inpatient care instead of outpatient observation." The report states that hospitals have been unhappy with the assumption that they provided "medically unneeded" care if the 2-day care definitions aren't met.

    Foundation Service Award Recipients Announced

    This year's recipients of the Foundation for Physical Therapy's Service Awards have advanced the cause of physical therapy research in a variety of ways, from providing funds to fundraising, and from partnering with the Foundation to leading its work.

    This year's awards and winners are:

    • Spirit of Philanthropy Award: Magistro Family Foundation
    • Charles M. Magistro Distinguished Service Award: Alan M. Jette, PT, PhD, FAPTA
    • Premier Partner in Research Award: Private Practice Section of APTA (PPS)
    • Innovation in Fundraising Award: Illinois Physical Therapy Association's Student Special Interest Group

    "The leadership, generosity, and creativity of this year's awardees have been instrumental to the continued success of the foundation." Foundation Board of Trustees President William G. Boissonnault, PT, DPT, DHSc, FAPTA, FAAOMPT, said in a press release (.pdf) announcing the winners. This year’s recipients will be recognized during the foundation’s 35th Anniversary Gala on June 12, 2014, during the NEXT conference in Charlotte, North Carolina.

    OA Model of Care Advances

    Much work remains to be done, but a multidisciplinary panel of health care providers, researchers, and patients has made significant progress toward establishing a model of osteoarthritis (OA) care that acknowledges the importance of early diagnosis and recognizes the powerful impact that OA can have on successful treatment of comorbidities. The group's efforts have been released in a report (.pdf) published by the US Bone and Joint Initiative (USBJI).

    The Chronic Osteoarthritis Management Initiative (COAMI) report lays out the challenge in no uncertain terms. "Instead of routine screening that provides early alerts … about the possible presence of osteoarthritis (OA), followed by a systematic exploration of strategies to reduce pain and preserve or increase function, patients and providers often have their first conversations about joint pain when the joint is damaged enough to require surgical replacement," the report states. Slow detection and uncoordinated treatment not only results in more severe joint damage, but can allow OA to significantly impact how well a patient responds to treatment of concurrent conditions such as respiratory problems and diabetes.

    The COAMI report calls for improvements and better coordination in self-management support, delivery system and design, decision support, and clinical information systems, with the aim of creating an OA model of care "that is far closer to the coordinated, proactive ideal than what is currently in place." With such a model, the report states, it may be possible "to overcome the view of patients, the public, and many health care professionals that OA is inevitable and that joint pain and related disability should be tolerated." The panel decided on specific action items that will be addressed by designated groups of participants.

    APTA is a founding member of USBJI and serves on its board of directors.

    Obama Budget Would Eliminate Medicare Physician Self-Referral Loophole for Physical Therapy

    President Obama's federal budget proposal would close the loophole that allows physician self-referrals for physical therapy services—a change long supported by APTA that would improve quality of care and lower Medicare costs.

    If adopted by Congress, the FY 2015 budget would eliminate exceptions that now apply to physical therapy, radiation therapy, anatomic pathology, and advanced imaging. The Office of Management and Budget estimates that closing the loophole for these services would provide a savings of just over $6 billion over 10 years.

    APTA has held that in addition to fostering costly overuse, the exceptions compromise patient care and choice. In a press release, APTA President Paul A. Rockar Jr, PT, DPT, MS, said that APTA "fought long and hard" for the elimination of the exceptions. Rockar added that the Obama proposal "would save the country billions in unnecessary Medicare expenses and, more important, protect patients from being used as pawns for profit."

    APTA Private Practice Section President Tom DiAngelis, PT, DPT, was quoted in the same press release saying that self referral has an "abusive financial impact," and that "as health care providers we work and interact with patients every day. When physicians self-refer, patients feel as though they aren’t in the driver’s seat when it comes to their own care.”

    The specific exceptions would be eliminated from the Stark self-referral law, a policy that was intended to prevent physicians from making referrals for certain health services payable by Medicare to an entity with which he or she, or an immediate family member, has a financial relationship. The exceptions to the law were carved out for in-office ancillary services (IOAS) that could be quickly administered for patient convenience, such as routine lab tests or x-rays. The problem, according to APTA and other groups, is that the exceptions have been broadly applied and now include self-referral for physical therapy services well beyond original intent.

    APTA has advocated for the elimination of physical therapy from the exceptions for years and is a founding member of the Alliance for Integrity in Medicare (AIM), a consortium of organizations focused on eliminating the IOAS loophole. In addition to APTA, the consortium includes laboratory, radiation oncology, and medical imaging groups.

    APTA strongly urges Congress to follow the recommendations laid out in the Administration's budget and pass legislation to remove physical therapy, advanced diagnostic imaging, anatomic pathology, and radiation therapy from the IOAS exception. Find out more about this issue at APTA's self-referral webpage, and take action now by asking your legislators to close the self-referral loophole. Contact the APTA advocacy staff for more information.

    Register Now for the North American Caribbean Region CE Conference Coming Up in April

    Physical therapists (PTs) from the Caribbean, United States, Canada, and South America will gather this spring to take part in the North American Caribbean Region (NACR) continuing education conference in Miami, April 25–27, hosted by APTA. The NACR is a regional body of the World Confederation of Physical Therapy (WCPT), of which APTA is a member organization.

    This year's conference theme is "baby boomers and women's health," and presentations highlight collaboration across borders and disciplines. Speakers include Marilyn Moffatt, PT, DPT, Phd, GCS, CSCS, CEEAA, FAPTA, Jack Miller, PT, DipMT, MCISc, DPT, FCAMPT, Chris Showalter, PT, COMPT, OCS, FAAOMPT, Timothy Flynn, PT, PhD, Pamela Downey, PT, DPT, WCS, and Alejandro Badia, MD, FACS. A list of courses and continuing education units awarded is available at the APTA Learning Center. Discounted rates apply for attendees who register by April 2.

    Questions? Need more information? Contact René Malone.

    PT Discusses Sandbag Weights in WSJ Article

    A recent Wall Street Journal article highlights the rise in popularity of sandbag workouts—and the importance of sound advice from a physical therapist (PT) before taking on any new exercise regimen.

    In a short article published March 3, WSJ reporter Laura Johannes describes how special sand-filled bags are replacing standard weights in workouts. The sand in the bags shifts with motion, something that supporters say works out a wider range of muscles.

    While the article includes information on the effectiveness of the new approach, it also touches on potential dangers. Robert Gillanders, PT, DPT, OCS, points out that care needs to be taken when engaging new muscle groups with unpredictable loads. In the article, Gillanders advises that people who are not in shape or new to weightlifting should build strength with machines or free weights before attempting to move on to sandbags.

    Latest Advances in Regenerative Rehab Topic of Upcoming Symposium

    Physical therapists (PTs) have the opportunity to connect with scientists, researchers, and other clinicians to discuss how tissue engineering and cellular-level therapies can impact rehabilitation at the 3rd annual Symposium on Regenerative Rehabilitation set for April 10–11 in San Francisco.

    The conference will be held at the Mission Bay Conference Center at the University of California – San Francisco and will feature session topics that include advances in the biology of tissue regeneration, mechanotransduction, rehabilitation engineering and regenerative medicine, and the importance of mechanical stimulation in cellular therapeutics. Presenters include a wide range of physicians, PTs, and scientists, including APTA 2002 Mary McMillan lecturer Steven Wolf, PT, PhD, FAPTA.

    Registration for the conference is now open. APTA is cosponsoring the event and offers resources on this emerging field at the association's regenerative rehabilitation webpage.