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  • Donation to Expand Special Olympics Screenings

    The success of the Special Olympics Healthy Athletes program, which includes the physical therapy fitness screening FUNfitness, has led to a $12 million donation to expand Special Olympics' health-related services and launch a new Healthy Communities initiative. The donation, made by United States businessman and philanthropist Tom Golisano, was announced September 23 by former President Bill Clinton at the Clinton Global Initiative event in New York City. 

    Healthy Athletes has provided free health screenings and products to athletes for 15 years. In addition to physical therapy screenings the program offers podiatry, better health and well-being, audiology, sports, vision, and dental screenings. The donation will allow FUNfitness to expand its efforts to develop and promote fitness activities at the community level in a multitude of locations around the globe.

    Healthy Communities' goal is to achieve improved health outcomes for people with intellectual disabilities with the ultimate goal of ensuring that all are receiving health services and are able to reach their full potential. It will expand services to more athletes, increase partnerships with local organizations, expand the use of technology, and promote awareness of the health difficulties facing people with intellectual disabilities. The program will be launched in 7 countries (Mexico, Peru, Romania, Malawi, South Africa, Malaysia, and Thailand) and 6 states in the US (Arizona, Florida, Kansas, New Jersey, Wisconsin, and New York). It will build upon and broaden the scope of the current Healthy Athletes program.

    Several APTA members have been instrumental in the success of FUNfitness and the Healthy Athletes program. Donna Bainbridge, PT, EdD, ATC, is global clinical advisor for FUNfitness and Fitness Programming. Jim Gleason, PT, MS, serves as FUNfitness research and education coordinator. Vicki Tilley, PT, GCS, is FUNfitness coordinator of Clinical Services-North America.

    APTA developed FUNFitness, an assessment of flexibility, functional strength, and balance created for athletes participating in the Special Olympics, as an outgrowth of the North Carolina Chapter's successful flexibility screening program created for the 1999 Special Olympics.

    Help Shape APTA's Public Policy Priorities for the 113th Congress (2013-2014)

    For the past decade, APTA's Board of Directors (Board) has sought feedback to provide critical information on the public policy priorities and issues that are important to its members. This feedback is used by APTA's Public Policy and Advocacy Committee to draft the association's public policy priorities for consideration and refinement by the Board at its November meeting. Please fill out the survey, and send it to your colleagues to fill out.  

    Survey responses are due October 15.APTA will publish its public policy priorities for the 113th Congress on its website and share them with its components by January 1, 2013. Questions or requests for additional information should be directed to Justin Moore, PT, DPT, APTA vice president of public policy, practice, and professional affairs. Thank you for your participation in this effort.

    APTA Launches Therapy Cap Resources Webpage to Assist PTs With Implementation of New Exceptions Process

    On October 1 significant changes will occur regarding the Medicare therapy cap exceptions process that will impact physical therapists (PTs) and their patients. In order to help make the transition as smooth as possible, APTA has developed a Medicare Therapy Cap Resources webpage. This webpage compiles relevant information available from APTA and the Centers for Medicare and Medicaid Services (CMS) in 1 place. The resource page includes: 

    • a frequently-asked-questions sheet, a webinar that reviews the new exceptions process, and a podcast on the therapy cap
    • links to Medicare Administrative Contractor websites where information on manual medical review is posted
    • manual medical review complaint form
    • CMS resources, including a fact sheet, a frequently- asked-questions sheet, open door forum transcript and transmittals
    • information for Medicare beneficiaries
    • medical necessity and documentation resources
    • advocacy information

    Share this information and new resource with your colleagues and staff.

    E-mail questions to advocacy@apta.org. Questions regarding the therapy cap also can be e-mailed directly to CMS at therapycapreview@cms.hhs.gov.

    New in the Literature: Barefoot and Minimalist Shoe Running (US Army Med Dep J. 2012 Oct-Dec:25-30)

    Barefoot and minimalist shoe wearers reported a more anterior footstrike than traditionally shod runners, say authors of an article that will be published in the October-December issue of the US Army Medical Department Journal. Traditionally shod runners were more likely to report injuries of the lower extremities than runners who wear minimalist shoes.  

    For this retrospective descriptive epidemiology survey, the authors recruited 2,509 runners (1,254 male, 1,255 female) aged 18 to 50 to complete an anonymous online survey. The survey assessed running tendencies, footstrike patterns, shoe preferences, and injury history. Reported footstrike patterns were compared among 3 shoe groups: traditionally shod, minimalist shoes, and barefoot runners. Overall and specific anatomical injury incidence was compared between traditionally shod and minimalist shoe-wearing runners. They did not include 1,605 runners in the analyses due to incomplete data or recent changes in footstrike patterns and/or shoe selection.

    Shoe selection was significantly associated with reported footstrike (χ² (4df) =143.4). Barefoot and minimalist runners reported a more anterior footstrike than traditionally shod runners. Traditionally shod runners were 3.41 times more likely to report injuries than experienced minimalist shoe wearers (46.7% shod vs 13.7% minimalist, χ² (1df) =77.4, n=888). Minimalist shoe wearers also reported fewer injuries at the hip, knee, lower leg, ankle, and foot than traditionally shod runners.

    Additional longitudinal prospective research is required to examine injury incidence among various footstrike patterns and shoe preferences, the authors add.

    The article was written by APTA members Donald L. Goss, PT, DPT, PhD, OCS, ATC, and Michael T. Gross, PT, PhD, FAPTA.

    Presidential Youth Fitness Program to Assess Health Versus Athleticism

    The President's Council on Fitness, Sports, and Nutrition will phase out its Youth Fitness Test, which dates back to 1966, and replace it with the Presidential Youth Fitness Program. The comprehensive school-based program employs the latest science and promotes health and physical activity for America's youth. This voluntary program represents a significant change in how schools and parents approach kids' physical fitness. Instead of recognizing athletic performance, the new program assesses students' health-related fitness and helps them progress over time.

    The Presidential Youth Fitness Program minimizes comparisons between children and instead supports students as they pursue personal fitness goals for lifelong health. By adopting the program, schools gain access to a robust selection of resources to promote lifelong physical activity: web-based access to test protocol, standards for testing, calculators for aerobic capacity and body composition, promotion of PALA+, online training, school recognition programs, and more.

    Key to the success of the Presidential Youth Fitness Program is the expertise and resources provided by partnering organizations, which include:

    • The adoption of the Cooper Institute's fitness assessment, FITNESSGRAM®.
    • Professional development, such as monthly webinars, led by the American Alliance for Health, Physical Education, Recreation and Dance, a leading organization of professionals involved in physical education.
    • The Amateur Athletic Union's continued administration of the youth fitness recognition program.
    • The expertise of the US Centers for Disease Control and Prevention to lead the development of a plan to track and evaluate the Presidential Youth Fitness Program.

    Components: Nominate Your Innovators Today

    APTA's Innovation Summit 2013: Collaborative Care Models will bring together innovators and thought leaders from physical therapy, health policy, payment, and other health professions to explore the role of physical therapists in new models of health care delivery and payment. Participation in the summit will be available to all members through live web streaming. Attendance onsite will be limited to speakers, panelists, and invited attendees, including the member innovators selected through this nomination process.

    APTA sections, chapters, and the Student Assembly are each invited to nominate a member who is involved in an innovative model of care to attend and participate in the Summit, to be held March 7-8, 2013, in the Washington, DC area. A panel of member experts will select 20 member innovators to share their practice models as a part of the Summit. Those selected will receive free registration and a stipend for travel and lodging expenses. Chapters and sections whose nominees are selected will receive special recognition during the Summit.

    The deadline for nominations is Monday, October 22. More information about the Summit is available at www.apta.org/innovationsummit. Components can direct questions about the nomination process to innovationsummit2013@apta.org.

    Private Market Required to Provide Clear, Comparable Information on Health Plans

    Under the Affordable Care Act (ACA) insurance companies and employers now are required to provide consumers in the private health insurance market with a brief summary of what a health insurance policy or employer plan covers, called a Summary of Benefits and Coverage (SBC). Additionally, consumers will have access to a uniform glossary that defines insurance and medical terms in standard, consumer-friendly terms.

    These tools also will help employers find the best coverage for their business and employees.

    SBC includes a new comparison tool that helps consumers compare coverage options by showing a standardized sample of what each health plan will cover for 2 common medical situations. The comparison tool is modeled on the nutrition facts label required for packaged foods.

    SBC will include information about the covered health benefits, out-of-pocket costs, and the network of providers. The glossary defines terms commonly used in the health insurance market, such as "deductible" and "copay," using clear language.

    Starting this fall, consumers will receive SBC free of charge and in writing from their insurance companies or employers. This information can be requested at any time, but it will also be made available when shopping for, enrolling in, or renewing coverage. It also will be provided whenever information in SBC changes significantly.

    SBC now is available for consumers in the individual health insurance market. For enrollees in group health plans enrolling during an open enrollment period, it will be available during the next open enrollment period that started on or after September 23, 2012. For enrollees who enroll outside of an open enrollment period, it will be available at the start of the next plan year that began on or after September 23, 2012.

    The Center for Consumer Information and Insurance Oversight provides examples of SBC, an SBC template, and the uniform glossary

    Additional information for consumers is available at healthcare.gov

    Sign Up for Foundation's Monthly E-newsletter

    If you're not receiving the Foundation for Physical Therapy's monthly News & Events  e-newslettersign up today and stay current with the latest information on research supported by the Foundation, funding and awards, and events. The newsletter also provides quick links to information about the Foundation's Trustees and staff; scholarships, fellowships, and grants; and how to make a donation.

    Infographic: Visualizing Health Care Costs

    September's Visualizing Health Policy, a new monthly feature in JAMA, illustrates how health care costs in the United States have surged over the past 50 years. The infographic, created by the Kaiser Family Foundation (KFF), shows how health care spending is unevenly distributed within the US population, with only half the population accounting for more than 97% of health care costs; how health care costs are putting pressure on US families; how the United States spends more per person for health care than other countries; and how the cost of health insurance premiums has increased in the past decade for both workers and employers.

    Archived infographics are available on KFF's website

    New NIH Resource Teaches Kids About Sports Injuries

    A free booklet available in English and Spanish from the National Institutes of Health (NIH) aims to teach children and teens how to avoid sports injuries. Suitable for active kids, parents, and coaches, the story features teen soccer player Ana, who sprains her knee during a pick-up game at a family picnic. Ana and her family learn the best way to treat a sports injury promptly to avoid future complications. This new resource also offers specific tips on how to keep sports safe for kids and prevent injuries, such as warming up before exercise and staying hydrated.

    Ana's Story is NIH's second fotonovela, a comic-book style publication popular in the Hispanic/Latino culture that has been used effectively as an educational tool. Isabel's Story, also available in English and Spanish, teaches about osteoporosis and bone health. 

    Free copies of both Ana's Story and Isabel's Story are available to anyone upon request. To order, contact NIH's National Institute of Arthritis and Musculoskeletal and Skin Diseases' information clearinghouse at 877/ 226-4267 or http://catalog.niams.nih.gov/.

    Open Door Forum Tomorrow on Manual Medical Review of Therapy Claims

    Tomorrow the Centers for Medicare and Medicaid Services (CMS) will hold a special open door forum, ­­3:00 pm-4:00 pm ET (conference call only), on the manual medical review of therapy claims. Physical therapists are encouraged to participate in the call, which will provide an opportunity to ask questions about the mandated manual medical review of therapy services October 1-December 31, 2012, which was enacted by the Middle Class Tax Relief and Job Creation Act of 2012. 

    CMS will discuss therapy documentation requirements. The therapy cap applies to all Part B outpatient therapy settings and providers including:

    • private practices,
    • Part B skilled nursing facilities,
    • home health agencies (TOB 34X),
    • rehabilitation agencies (outpatient rehabilitation facilities), and
    • comprehensive outpatient rehabilitation facilities.

    Beginning this year, the therapy cap also will apply to therapy services furnished in hospital outpatient departments October 1-December 31, 2012. Before 2012, therapy provided in hospital outpatient departments did not count toward the therapy cap.

    Participants may submit questions prior to the special forum to therapycapreview@cms.hhs.gov.

    To participate, call 866/501-5502 and enter conference ID 34261274. (TTY Communications Relay Services are available for people with hearing impairments. For TTY services dial 7-1-1 or 800/855-2880. A relay communications assistant will help.)

    A downloadable transcript and audio recording of the forum will be posted to CMS' website.

    Visualize, Customize, and Share State-level Data From RWJF

    The Robert Wood Johnson Foundation's (RWJF) new Data Hub tracks state-level data and allows users to visualize, customize, and share facts and figures on key health care topics. Users select a category and an indicator to create a map or rankings report, and can modify reports as appropriate by payer, income, educational attainment, race/ethnicity, or timeframe. Data Hub is part of RWJF's commitment to providing timely, accessible information and evidence to inform health policies and practices. The online resource establishes a system of priority measures for monitoring state-level progress toward improving the nation's health and health care.

    Military Leaders Call for Less Junk Food in Schools, Fitter Youths

    Being overweight or obese is the leading medical reason that young adults cannot join the military, with 1 in 4 too overweight to enlist, says a report issued today by Mission:Readiness, a group of more than 300 retired generals and admirals.

    Schools are selling 400 billion calories of junk food every year—the equivalent of nearly 2 billion candy bars—says Still Too Fat to Fight, which calls for stronger standards for foods and beverages sold at schools.

    According to the report, the military spends over a billion dollars a year on weight-related diseases. "Because our country has failed to improve fitness and reduce obesity among our youth, the military has had to work much harder than in the past to recruit and retain enough qualified men and women who can effectively serve our country," the authors say.

    This month the Centers for Disease Control and Prevention (CDC) is highlighting the critical role that schools play in improving the physical activity and dietary and behaviors of children and adolescents. CDC has synthesized research and best practices related to promoting healthy eating and physical activity in schools, culminating in 9 guidelines.

    Each of the guidelines is accompanied by a set of implementation strategies developed to help schools work toward achieving each guideline. For example, strategies to achieve guideline 4, which calls for the implementation of a comprehensive physical activity program with high-quality physical education as the cornerstone, include requiringstudents in grades K-12 to participate in daily physical education that uses a planned and sequential curriculum and instructional practices that are consistent with national or state standards for physical education, providing a substantial percentage of each student's recommended daily amount of physical activity in physical education class, and using instructional strategies in physical education that enhance students' behavioral skills, confidence in their abilities, and desire to adopt and maintain a physically active lifestyle.

    Foundation Awards $300,000 to Investigate Physical Therapy Referral

    The Foundation for Physical Therapy recently awarded a $300,000 high-impact research grant to Jean Mitchell, PhD, to investigate the influence of physical therapy referral characteristics and practices on quality, cost effectiveness, and utilization.

    The purpose of Mitchell's project will be to investigate the effects of physician self-referral arrangements on the provision of physical therapy services. Data from multiple sources will be analyzed to determine whether the initiation of physical therapy differs for physicians who have established self-referral arrangements compared with those who do not self-refer, whether the composition of physical therapy treatments differs between these 2 groups, and whether there is a higher overall cost associated with physical therapy self-referral arrangements.

    Mitchell, a professor of public policy at Georgetown University, received her PhD in economics from Vanderbilt University. Her health policy research has been published in refereed journals such as Health Affairs, Journal of Health Politics, Policy and Law, and Medical Care, and her work has been funded by sources such as the National Institutes of Health National Institute on Aging.

    This high-impact study focusing on a profession-deemed, high-priority research area was made possible by funding from APTA and its Private Practice Section, Orthopaedic Section, and Florida Chapter; the Institute of Private Practice Physical Therapy; the American Academy of Orthopaedic Manual Physical Therapists; Evidence in Motion; and the Physical Therapy Business Alliance.

    APTA Highlights Falls Prevention on HHS Blog

    APTA's latest post on the Department of Health and Human Services' (HHS) Be Active Your Way blog explains the role of balance training and evidence-based balance exercise programs in helping to prevent falls. The post also discusses how successful partnerships between physical therapists and community agencies, such as senior centers, older adult housing, churches, fitness and wellness centers, and nutrition sites, can help reach populations at risk of falls and deliver the recommended type and amount of exercise. Written by APTA member experts and students, Promoting Exercise for Improved Balance and Falls Prevention recognizes National Falls Awareness Prevention Day, which was celebrated September 22, the first day of fall.

    House Proposal Town Hall Discussion Scheduled for September 27

    Thanks to the many members who have joined the virtual town halls to discuss the House governance proposals! The discussions have been rich and the input very informative. The next town hall is Thursday, September 27 (2 sessions: 6:00 pm-7:30 pm and 10:00 am-11:30 pm ET), and you will choose the topic. What would you like to discuss? What topic have we missed? Let us know. Suggest ideas via the AdditionalThoughts comment blog posted to www.apta.org/governancereview. Please contact Amber Neil if you are interested in attending. Can't join the Town Hall? Have your voice heard via the comment blogs on the following topics: House constituency, House activity, and Resolutions Committee.

    National Robotics Initiative Includes 3 Rehab Projects

    A collaboration among the National Institutes of Health (NIH) and 3 other federal agencies aims to accelerate the development of the next generation of robotics, called corobotics. These projects include robots that help engineers better design prosthetic legs for patients with amputation, miniature robot pills that help doctors diagnose and treat disease, and microrobots that help researchers make artificial tissues.

    Along with the National Science Foundation, the National Aeronautics and Space Administration, and the United States Department of Agriculture, NIH will find 6 projects over the next 4 years. The projects are expected to receive $4.4 million in funding.

    In addition to the below-knee prostheses project, 2 other projects have implications for the physical therapy profession. The goal of Control of Powered Segmented Legs for Humanoids and Rehabilitation Robotics is to uncover the principles behind the biomechanical design and neuromuscular control of human legs in a variety of gaits and to transfer these principles to the design and control of powered leg prostheses and robotic rehabilitation devices.

    Another proposal, titled Brain Machine Interface Control of a Therapeutic Exoskeleton, plans to combine a human-robot interface with a noninvasive brain-machine to allow the patient to use his or her thoughts to control the movement of the robot to better rehabilitate the upper limb affected by stroke.

    Six Million People Expected to Pay Mandate Penalty in 2016

    A new federal report estimates about 6 million people will pay a penalty because they are uninsured in 2016, a figure that includes uninsured dependents who have the penalty paid on their behalf. Total collections will be about $7 billion in 2016 and average about $8 billion per year over the 2017-2022 period.

    The penalty will be the greater of a flat dollar amount per person that rises from $95 in 2014 and  $325 in 2015 to $695 in 2016 and is indexed by inflation thereafter (the penalty for children will be half that amount and an overall cap will apply to family payments) or a percentage of the household's income that rises to 2.5% for 2016 and subsequent years (also subject to a cap).

    The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) estimate that about 30 million nonelderly residents will be uninsured in 2016, but the majority of them will not be subject to the penalty tax. Unauthorized immigrants, for example, who are prohibited from receiving almost all Medicaid benefits and all subsidies through the insurance exchanges, are exempted from the mandate to obtain health insurance. Others will be subject to the mandate but exempted from the penalty tax—for example, because they will have income low enough that they are not required to file an income tax return, because they are members of Indian tribes, or because the premium they would have to pay would exceed a specified share of their income (initially 8% in 2014 and indexed over time). CBO and JCT estimate that between 18 million and 19 million uninsured people in 2016 will qualify for 1 or more of those exemptions.

    Of the remaining 11 million to 12 million uninsured people, some individuals will be granted exemptions from the penalty because of hardship, and others will be exempted from the requirement on the basis of their religious beliefs.

    New in the Literature: Predictors of WBA After TKA (Gait Posture. 2012 September 11. [Epub ahead of print])

    Greater amounts of weight-bearing asymmetry (WBA) 1 month after total knee arthroplasty (TKA) are predicted by modifiable factors, including habitual movement pattern and asymmetry in quadriceps and hamstrings strength, say authors of an article published online in Gait & Posture

    Fifty-nine people were tested preoperatively and 1 month following unilateral TKA for WBA using average vertical ground reaction force under each foot during the Five Times Sit-to-Stand Test. Candidate variables tested in the regression analysis represented physical impairments (strength, muscle activation, pain, and motion), demographics, anthropometrics, and movement compensations.

    WBA, measured as the ratio of surgical/nonsurgical limb vertical ground reaction force, was 0.69 (0.18) (mean (SD) 1 month after TKA. Regression analysis identified preoperative WBA, quadriceps strength ratio, and hamstrings strength ratio as factors predictive of WBA 1 month after TKA (R(2)=0.30).

    APTA member Cory L. Christiansen, PT, PhD, is lead author of the article. APTA members Michael J. Bade, PT, and Jennifer E. Stevens-Lapsley, PT, PhD, are coauthors. 

    Countdown to Kickoff for APTA's 'Fit After 50' Campaign

    On October 1, in conjunction with National Physical Therapy Month, APTA will launch an extensive outreach initiative to our nation's Baby Boomers through its "FitAfter 50" campaign. The purpose of the campaign is to reach Boomers with the message that physical therapists play a vital role in helping people age 50 and older remain active, fit, and mobile as they age.

    The campaign will begin with "50 Days, 50 Ways," a daily series of 50 tips, provided through social media from APTA members, about preventing injury by staying active and fit. The public can view the tips on the moveforwardpt.com/fitafter50 webpage and via Twitter @MoveForwardPT, and Facebook.com/MoveForwardPT. Please participate by sharing these tips with your patients, family, and friends!

    In addition, we'll be launching the "Fit After 50 Member Challenge," an opportunity for APTA members to go online and nominate member colleagues ages 50 and older who are committed to being fit, active, and mobile as they age. Winners will be announced at the APTA Conference & Exposition in 2013.

    Watch for more information in next week's News Now about how you can be a part of this exciting campaign.

    KY Governor Appoints Physical Therapist to Health Exchange Board

    On September 18, Kentucky Governor Steve Beshear appointed Connie Hauser, PT, DPT, ATC, to the Kentucky Health Benefit Exchange Advisory Board. The 19-member Health Exchange Board will review program and policy issues and make recommendations for Kentucky’s new marketplace for health insurance mandated by the federal Affordable Care Act.

    "We need the insight and experience of a variety of Kentuckians to ensure that the Exchange not only meets the requirements of the law, but also meets the needs of Kentuckians who will be looking for affordable health insurance," said Beshear

    The Kentucky Chapter nominated Hauser to Governor Beshear because of her knowledge and understanding of health care and payment policy, and her experience as a clinician. Hauser, a private practice practitioner, previously served as Kentucky Chapter president, 2 terms on the APTA Board of Directors, and 1 term as APTA treasurer. Hauser also served as chair of APTA's Public Policy Committee (previously known as the Government Affairs Committee).

    The primary purpose of the state-based health exchanges is to enhance competition in the health insurance market, improve consumers’ choice of affordable health insurance, and give small businesses the same purchasing clout as large businesses. The Kentucky Health Exchange will facilitate the purchase and sale of health plans in the individual market, assist small employers in facilitating the enrollment of their employees in health plans, and provide 1-stop shopping by helping individuals enroll in health plans. The exchange also will enable individuals to receive premium tax credits and premium subsidies, and qualify small businesses for tax credits. For additional information on state health insurance exchanges, visit APTA's website.

    New Therapy Cap Resources Posted

    APTA has created 2 new resources to help members prepare for the October 1 implementation of the therapy cap to hospital outpatient settings and the start of the manual medical review process.

    • A prerecorded webinar and accompanying PowerPoint slides cover the changes to the therapy cap policy in detail.
    • A comprehensive document provides links to each Medicare Administrative Contractor's manual medical review information and preauthorization forms.

    These new resources and more can be found on APTA's Medicare therapy cap webpage.

    APTA Members Serve Important Roles in CDC-Funded Falls Prevention Project

    The Centers for Disease Control and Prevention (CDC) recently awarded $800,000 to Texas A&M Health Science Center School of Rural Public Health and the University of North Carolina for a 2-year Policies, Programs, and Partners for Fall Prevention (PPPFP) project. APTA member Tiffany E. Shubert, PT, PhD, is a principal investigator for the initiative

    The project addresses the urgent need to identify more effective public health strategies for reducing falls, fall-related injuries, and fall-related rates of emergency room visits among the growing population of seniors. It also will develop strategies and train community health workers in Texas and North Carolina to help raise awareness about falls prevention and refer older adults to evidence-based programs. This includes the evaluation of a training program for physical therapists to understand and implement evidence-based fall prevention and to integrate these efforts with state and national fall prevention policies

    An important partner in this effort is the National Council on Aging's Falls Free© Initiative, led by APTA member (Bonita) Lynn Beattie, PT, MPT. The national initiative—composed of 42 state coalitions—works collaboratively to increase awareness, bring education and training to providers, and increase investment in effective community interventions.

    The timing of the award is noteworthy; September 22 is National Falls Prevention Awareness Day. (See related News Now   article posted Monday.) 

    Shubert is a member of APTA's clinical practice guidelines (CPG) group that is developing CPGs for falls.

    Moffat and Students 'Blitz' Morning Shows

    Marilyn Moffat, PT, DPT, PhD, FAPTA, CSCS, and New York University physical therapy students appeared in the crowd on the "Today" show and "Good Morning America" yesterday to raise awareness about the Foundation for Physical Therapy. They were easily recognizable by banners promoting the Foundation and their bright green shirts that flanked the outdoor areas of NBC and ABC studios in midtown Manhattan. Moffat organizes the annual "media blitz" of morning shows to promote the Foundation.

    Good Morning America - 09/20/12
    Moffat and students outside the "Good Morning America" studio.

    APTA Educates Legislators on Benefits of Therapy for Veterans With TBI

    Yesterday, Rep Mike Michaud (D-ME), ranking member of the House Veterans Affairs Subcommittee on Health, hosted an APTA-cosponsored briefing on traumatic brain injury (TBI). The Capitol Hill event, held for legislators and their staff, addressed how physical therapy, occupational therapy, and speech-language pathology are helping wounded warriors and veterans recover and rehabilitate from TBI and reintegrate into society.

    Aaron Eaton, PT, DPT, and Heather Malecki, PT, DPT, served as panelists with Paul R. Rao, PhD, CCC-SLP, chief operating officer for inpatient services at the National Rehabilitation Hospital in Washington, DC, and Tracey Ellis OTR/L, MPH, CEO of International Diagnostic Solutions and Ellis Therapeutic Consultants.

    Eaton shared his experiences as a former employee of the National Naval Medical Center (now Walter Reed National Military Medical Center) and member of the team that was responsible for physical therapy services for soldiers with war-related injuries, namely those with polytrauma, who had arrived from Landstuhl, Germany. Many of these patients also had TBIs.

    Malecki, rehabilitation and polytrauma coordinator at the Washington, DC, VA Medical Center, also provided insight on the needs of soldiers with TBI. She highlighted the benefits of coordination and cooperation among physical therapy, occupational therapy, and speech-language pathology.

    The American Occupational Therapy Association and the American Speech-Language-Hearing Association cosponsored the briefing.

    Find out more about APTA's efforts with wounded warriors at www.apta.org/TBI/WoundedWarriors/.

    APTA Response to Article on Medicare Charges Published

    The Concord Monitor published an APTA letter to the editor in response to an article about the author's experiences with charges for Medicare services, including physical therapist services. The letter also acknowledged New England region chapter presidents who were cosigners.

    APTA Participates in 2012 Warrior-Family Symposium

    Caregivers, National Guard, reserve support, and sports are top Defense Department priorities for wounded warriors and their families, said top officials last week at the 2012 Warrior-Family Symposium. APTA has participated in each of the 6 annual Warrior-Family Symposiums. This year the association sponsored the event's breakfast.

    The September 12 symposium, titled Saluting Their Sacrifice: A Decade of Challenges and Triumphs for Our Wounded Heroes and Their Families, expanded on previous forums and efforts over the last 5 years to improve the physical, psychological, and well being of service members and their families. Programming focused on addressing the concerns and challenges facing wounded warriors and families/caregivers and helping those in attendance prepare to retire or transition to their new life, as veterans and citizens outside the military.

    Lunch keynote speaker VA Secretary Eric Shinseki spoke about issues facing returning service members, such as substance abuse, homelessness, and posttraumatic stress disorder, and explained what the VA is doing about these issues.

    Reception keynote speaker Lt Gen Patricia D. Horoho, USA, surgeon general and commanding general, US Army Medical Command, spoke about role of the command in meeting wounded warriors' needs.

    The day culminated in a Recognition-Transition Ceremony, honoring and celebrating the service and sacrifice of all service members wounded and disabled over the last decade.

    Senate Recognizes Injuries Caused by Falls, Costs to Health Care System

    On September 12 the Senate passed S Res 553, designating September 22, the first day of fall, as National Falls Prevention Awareness Day (FPAD). This year marks the 5th anniversary of the national effort to protect older adults from falls.

    FPAD is spearheaded by the National Council on Aging (NCOA). This year's theme, Standing Together to Prevent Falls, seeks to unite professionals, older adults, caregivers, and family members to play a part in raising awareness and preventing falls in the older adult population. Forty-six states will participate in FPAD this year, joining more than 70 national organizations, including APTA, professional associations, and federal agencies that make up the Falls Free© Initiative. Find ideas for observing FPAD and your State Falls Prevention Coalition on NCOA's website.

    Sen Herb Kohl (D-WI) led the effort to raise awareness and encourage the prevention of falls among older adults. Sens Barbara A. Mikulski (D-MD), Michael Enzi (R-WY), Richard Blumenthal (D-CN), Susan Collins (R-ME), Bernie Sanders (D-VT), and Bob Casey (D-PA) cosponsored the resolution.    

    Cigna Video Tips: Using Health Plans Effectively

    To help patients use their health plan most effectively for the rest of 2012, Cigna is urging policyholders to determine what they've spent on health care to date, prepare for future health care expenditures, and make a proactive plan to manage overall health care needs. The insurer has produced a video series featuring 2 Cigna executives discussing tips for consumers about how they can make good health care choices and best use their health plan benefits. Share the Health Plan Conversation with your patients by including links to the videos in your facility's newsletter or post them on your website.   

    New Certification Aims to Recognize Top Stroke Centers

    A new level of certification from the Joint Commission and the American Heart Association/American Stroke Association is designed to recognize the specific capabilities of hospitals that can treat the most complex stroke cases.

    The Advanced Certification Program for Comprehensive Stroke Centers aims to help health care organizations focus on the care processes that produce the best outcomes for complex stroke cases. The Joint Commission and the American Heart Association/American Stroke Association anticipate that, over time, municipalities and regions will develop a formal referral network so the most complicated stroke cases can be treated at the centers best equipped to provide the specialized care that can lead to the best possible outcomes for patients. The organizations anticipate that there may be more than 200 certified comprehensive stroke centers in the US within the next few years.

    State Exchanges Interactive Map

    Use this interactive map from the Kaiser Family Foundation to review the status of state action on state health insurance exchanges. Sixteen states and Washington, DC, have passed legislation or issued an executive order establishing a health insurance exchange. Choose the table or map function to determine the source of the exchange activity (governor's executive order or state law), the structure of the exchange (quasi-governmental, state-run, or nonprofit), and how it plans to contract with health plans.

    FDA Encourages Reporting of Burns Caused by OTC Topical Pain Relievers

    The US Food and Drug Administration (FDA) is encouraging health care providers to report adverse events involving over-the-counter (OTC) topical muscle and joint pain relievers to the FDA MedWatch program.  

    Last week, FDA alerted the public that certain OTC products that are applied to the skin for the relief of mild muscle and joint pain have been reported to cause rare cases of serious skin injuries, ranging from first- to third-degree chemical burns, where the products were applied. These OTC topical muscle and joint pain relievers are available as single- or combination-ingredient products that contain menthol, methyl salicylate, or capsaicin. Based on the reported cases, the majority of second- and third-degree burns occurred with the use of products containing menthol as the single active ingredient, and products containing both menthol and methyl salicylate in concentrations greater than 3% menthol and 10% methyl salicylate.

    The various formulations include creams, lotions, ointments, and patches. The products are marketed under various brand names, such as, Bengay, Capzasin, Flexall, Icy Hot, and Mentholatum.

    New Podcast: Advocating for Rural Providers and Patients

    Advocating for the continued use of the Geographic Practice Cost Index, monitoring Medicaid disproportionate share hospital payments that provide financial assistance to hospitals that serve a large number of low-income patients, and supporting the inclusion of physical therapy in programs that incentivize providers to practice in underserved areas are just a few of the ways that APTA attempts to protect and increase the rural physical therapy workforce and optimize care of the patients it serves. Find out more about these policies and the association's priorities in rural health care in this new APTA podcast and transcript.   

    Find Statistics on Hospital Use With New AHRQ Online Tool

    HCUPnet, a free, online query system based on data from the Healthcare Cost and Utilization Project (HCUP), provides access to health statistics and information on hospital inpatient and emergency department use. Users can access national and state statistics on specific diagnoses or procedures for a single year, statistics on all hospital stays, and trends. The system also allows users to rank diagnoses or procedures by key outcomes and measures—such as number of discharges and total charges. National and state statistics on hospital stays by payer also are available.

    This new tool is available from the Agency for Healthcare Research and Quality (AHRQ). To begin a search, go to the step-by-step description of the HCUPnet query process.  

    APTA Members Appointed to CDC Pediatric TBI Guideline Workgroup

    APTA members Anne Mucha, PT, DPT, MS, NCS, and John DeWitt PT, DPT, SCS, ATC, have been appointed to the Centers for Disease Control and Prevention's (CDC) newly created Pediatric Mild Traumatic Brain (TBI) Injury Guideline Workgroup. Mucha and Dewitt will represent the role of physical therapists in concussion management.

    The workgroup, housed in CDC's National Center for Injury Prevention and Control, was established as a component of the Concussion Treatment and Care Tools (ConTACT) Act, legislation that was not passed into law but was supported by APTA in past congressional sessions. Comprising leading experts in the field of TBI, the workgroup will create a clinical guideline for use in physician's offices and emergency departments. A general overview of the 18- 24-month timeline for completion and a list of workgroup members are available on CDC's website

    Mucha and DeWitt served on APTA's Concussion Workgroup established in 2010 to develop model language for APTA chapters to use in advocating for the involvement of physical therapists as part of the health care team responsible for management of concussion in student athletes. The workgroup also developed language for a House of Delegates position that was adopted in 2011 and updated in 2012.

    Last month, Mucha took part in APTA's "Head in the Game" podcast series on concussion in sports. The multiday series featured interviews with experts in the evaluation, treatment, and prevention of sports concussions. Mucha discussed some of the ways athletes are tested for concussions and rehabilitated, both to return to the playing field and for the benefit of long-term health.  

    Find out more about the association's policy efforts in concussion management on APTA's Concussion Management Legislation webpage and in this Heard on the Hill podcast.

    Scoville Receives Prestigious Federal Award

    APTA member Charles R. Scoville PT, DPT, has received a Samuel J. Heyman Service to America Medal—an award that pays tribute to America's dedicated federal workforce. Honorees are chosen based on their commitment and innovation, in addition to the effect of their work on addressing the needs of the nation.

    Scoville is the 2012 National Security and International Affairs Medal recipient. This medal recognizes a federal employee for a significant contribution to the nation in activities related to national security and international affairs (including defense, military affairs, diplomacy, foreign assistance, and trade). Scoville, who served in the US Army for 29 years, is chief at Amputee Patient Care at Walter Reed National Military Medical Center. Established in 2003, the program has helped service members with amputation lead active lives, with some returning to duty, through a novel approach that combines traditional medical and counseling services with a physically active regime. The program strives to give soldiers with amputation "back their lives, restore their sense of self-worth, and keep them physically active."

    "It's an interdisciplinary approach to patient care that looks at our patients as tactical athletes," says Scoville. "They do things they never did before and reach more high-level activities than in the past.”

    Read more about Scoville on the "Sammies" website, which includes a video of him describing his unique rehabilitation program.  

    See APTA's Management of Wounded Warriors and Joining Forces Initiative webpages for information on the association's efforts aimed at military members and their families.

    CMS Issues Cap Letter to Part A Beneficiaries; APTA Updates Patient FAQs

    The Home Health Section alerted APTA this week that the Centers for Medicare and Medicaid Services (CMS) began issuing its therapy cap letter to Medicare beneficiaries who are receiving home health under Part A, resulting in patients cancelling appointments. To address these beneficiaries' concerns, APTA has updated its patient FAQs to explicitly state that the cap does not apply to patients who receive skilled therapy at home under the Medicare home health benefit Part A, those who receive services under Part A in skilled nursing facilities, or those under a Part A inpatient hospital stay.           

    Innovation Summit 2013: Call for Nominations

    APTA's Innovation Summit 2013: Collaborative Care Models will bring together innovators and thought leaders from physical therapy, health policy, payment, and other health professions to explore the role of physical therapists in new models of health care delivery and payment. Participation in the summit will be available to all members through live web streaming. Attendance onsite will be limited to speakers, panelists, and invited attendees, including the member innovators selected through this nomination process. APTA sections, chapters, and the Student Assembly are each invited to nominate a member who is involved in an innovative model of care to attend and participate in the Summit, to be held March 7-8, 2013, in the Washington, DC area. A panel of member experts will select 20 member innovators to share their innovative practice models as a part of the Summit. Chapters and sections whose nominees are selected will receive special recognition during the Summit. Nomination forms must be submitted by October 22. Visit the Innovation Summit webpage for additional information, including Summit objectives, agenda, and collaborative care resources. Question can be sent to Innovation Summit.   

    Volunteer Interest Pool Open: Current Volunteer Call Closes September 28

    APTA's Volunteer Interest Pool (VIP) now is open. VIP provides a mechanism to match the right person with the right task at the right time. Click here to set up a profile (you must be an APTA member and log on to the APTA website first before accessing this link). The VIP profile asks you to indicate your preferred levels of involvement (ranging from 1 day tasks to multiyear commitment), willingness to travel, current availability, level of interest/experience in a variety of areas; and to submit a CV. Once you complete your profile, click on the "Current Volunteer Opportunities" button to browse the list of current opportunities. VIP is open for members to create profiles throughout the year. However, the deadline for the current call for volunteer groups is September 28. Contact Angela Boyd with questions.     

    CMS Revamps Medicaid RAC Website

    The Centers for Medicare and Medicaid Services (CMS) recently revamped its Medicaid Recovery Audit Contractor (RAC) website to promote transparency and incorporate feedback from states and industry stakeholders. The enhanced RACs At A Glance website includes state-reported information on each state's RAC program, the name of each RAC vendor and medical director, contact information for the state program integrity director, and user-friendly charts and data.

    CMS's role in the Medicaid RAC program focuses on providing guidance to states as they implement their Medicaid RAC programs, monitoring the progress of those programs, and encouraging states to make their Medicaid RAC programs as transparent as possible.

    New in the Literature: Anodal Transcranial Direct Current Stimulation (J Hand Ther. 2012. September 7. [Epub ahead of print])

    Eight randomized placebo-controlled trials provide further evidence that anodal transcranial direct current stimulation (a-tDCS) may benefit motor function of the paretic upper limb in patients with chronic stroke, say authors of a meta-analysis published online in Journal of Hand Therapy 

    Prior reviews on the effects of a-tDCS have shown the effectiveness of a-tDCS on corticomotor excitability and motor function in healthy individuals but nonsignificant effect in participants with stroke. To summarize and evaluate the evidence for the efficacy of a-tDCS in the treatment of upper limb motor impairment after stroke, the authors conducted a meta-analysis of randomized controlled trials that compared a-tDCS with placebo and change from baseline.

    A pooled analysis showed a significant increase in scores in favor of a-tDCS (standard mean difference [SMD]=0.40, compared with baseline). A similar effect was observed between a-tDCS and sham (SMD=0.49).

    APTA members Margaret Shuster, PT, Kevin Hurley, PT, and Karen E. Guilkey, PT, DPT, coauthored the article.  

    Building Blocks of Health Literacy

    Does your facility have the foundation of a health-literate organization? Check out this infographic based on the discussion paper Ten Attributes of Health Literate Health Care Organizations available on the Institute of Medicine's website. The interactive infographic includes a short description for each attribute; implementation strategies can be found in the discussion paper.

    Physical Therapist Receives International Pain Award

    PTJ Editorial Board member Steven Z. George, PT, PhD, recently was awarded the Ulf Lindblom Young Investigator Award for Clinical Science from the International Association for the Study of Pain (IASP). This award honors an IASP member who is younger than 40 years old and has achieved a level of independence as a scholar in the field of pain in clinical science.

    George is associate professor and assistant chair in the Department of Physical Therapy at the University of Florida. He has written more than 115 peer-reviewed articles and numerous guest editorials; letters to the editor, responses, and commentaries; and book chapters and monographs. He serves on the International Editorial Review Board for Journal of Orthopaedic & Sports Physical Therapy. In 2009 he received the University of Florida's Jack Wessel Excellence Award for Assistant Professors. He is a recipient of APTA's Eugene Michels New Investigator Award (2007) and the American Pain Society's John C. Liebeskind Early Career Scholar Award (2009).

    George's research has been supported by grants from the National Institutes of Health, the Department of Defense, the University of Florida, APTA's Orthopaedic Section, and the Foundation for Physical Therapy. His current research projects include: developing and testing behavioral interventions for patients with low back pain; investigating the interaction between pain-related genetic and psychological factors in the development of postoperative chronic shoulder pain; and investigating the mechanisms and efficacy of manual therapy techniques.

    George accepted the award earlier this month in Milan at IASP's 14th World Congress on Pain.

    Web-based Training Provides Users With Real Life Privacy Challenges

    A new web-based security training module from the Office of the National Coordinator (ONC) for Health Information Technology aims to help health care providers understand some of the common privacy and security issues related to health information technology. The innovative game-based system requires users to respond to privacy and security challenges often faced in a typical small medical practice. Users choosing the correct response earn points and see their virtual medical practices flourish, while wrong security decisions can hurt their virtual practices.

    CyberSecure: Your Medical Practice was developed with the assistance of the Regional Extension Center Program's Privacy and Security Community of Practice.

    Sign Up Today: House Town Halls Begin September 18

    Join the conversation! The first virtual town hall to discuss APTA governance review proposals related to the House of Delegates is September 18. This town hall will focus on House process, House constituency, and the Resolutions Committee and will allow members to help shape the final proposals by providing feedback about elements they support, are uncertain about, or do not support. To offer members on both coasts ample opportunity to take part in the conversation, APTA has scheduled 2 town halls for September 18 (both on the same topic), at 6:00 pm-7:30 pm ET and 10:00 pm-11:30 pm ET. Contact Amber Neil if you are interested in attending. Additional town halls will be held on September 20 and 27 at the times indicated above, with topics to be shared in advance.

    New Legal Resources Address Expert/Fact Witnesses and Other Legal Matters

    APTA recently developed additional general information for members who may act in the capacity of a fact or expert witness. Reviewing the witness resources may assist in being better prepared when faced with receiving a subpoena or a request to act as a witness. Myriad legal issues come into play and the resources serve to provide information on topics such as qualifications of an expert, compensation, and discovery. APTA also provides a general information page to house existing materials that address a variety of legal matters, such as contracts, informed consent, and advertising. 

    The expert/fact witness resources were developed in response to RC 22-12, a motion passed by the House of Delegates in June. 

    Hyperventilation Shows Benefits for Asthma; Evidence is Limited

    Authors of a comparative effectiveness review issued by the Agency for Healthcare Research and Quality conclude that hyperventilation reduction techniques "may be a useful tool in the larger asthma management toolbox, which also includes medication and other components as needed, such as environmental controls, symptom monitoring, and a plan for handling exacerbations." However, given that none of the studies included in the review were conducted in the United States, available evidence is limited in its strength and applicability to the US population, they add.     

    The authors searched MEDLINE; PsycInfo; Embase; Cumulative Index to Nursing and Allied Health Literature; Physiotherapy Evidence Database; Cochrane Central Register of Controlled Trials; AltHealthWatch; Allied and Complementary Medicine; Manual, Alternative and Natural Therapy Index System; and Indian Medical Journals from 1990 through December 2011. They supplemented searches with manual searching of reference lists and grey literature, including regulatory documents, conference abstracts, clinical trial registries, and websites of professional organizations.

    APTA member Anne Swisher, PT, PhD, CCS, served on the technical expert panel that provided input on the analytic framework, key questions, and review protocol. Two independent reviewers screened identified abstracts against predefined inclusion/exclusion criteria. Two investigators reviewed full-text articles and independently quality-rated those meeting inclusion criteria. Data from fair- and good-quality trials were abstracted into standardized forms and checked by another investigator. The authors summarized data qualitatively and, where possible, used random effects meta-analysis.

    The authors identified 4 types of interventions—hyperventilation reduction breathing techniques, yoga breathing techniques, inspiratory muscle training (IMT), and other nonhyperventilation reduction breathing techniques, which included physical therapy methods. They found the most robust body of evidence for hyperventilation reduction breathing techniques in adults, including the only large-scale trial (n=600, aged 14 and older). Hyperventilation reduction interventions (particularly those with 5 hours or more of patient contact) achieved medium to large improvements in asthma symptoms and reductions in reliever medication use of approximately 1.5 to 2.5 puffs per day, but did not improve pulmonary function. These trials also were more applicable, although still somewhat limited, to the United States than trials examining other interventions due to similarities in applicable treatment guidelines to US guidelines and similar levels of development in the countries in which these studies were conducted.

    Limited evidence suggested yoga breathing may improve pulmonary function in adults in addition to reducing asthma symptoms, but medication use was rarely reported and applicability to the United States was very low. Evidence for IMT and other breathing retraining techniques was limited to small, heterogeneous trials providing insufficient evidence to determine effectiveness. The only harms of breathing retraining techniques identified were minor annoyances associated with taping the participants' mouths. Almost all trials were limited entirely or primarily to adults.

    The authors include recommendations for future trials for hyperventilation reduction and other techniques in their review. 

    Rate of Private Insurance Remains Steady; Public Programs See Increases

    For the first time in the last 10 years, the rate of private health insurance coverage has not decreased, according to a report released today by the US Census Bureau.

    The percentage of people covered by private health insurance in 2011 was not statistically different from 2010, at 63.9%. The percentage covered by employment-based health insurance in 2011 was not statistically different from 2010, at 55.1%.

    The number of people with health insurance increased to 260.2 million in 2011 from 256.6 million in 2010, as did the percentage of people with health insurance (84.3% in 2011, 83.7 % in 2010).

    The percentage of people covered by government health insurance increased from 31.2% to 32.2%. The percentage covered by Medicaid increased from 15.8% in 2010 to 16.5% in 2011. The percentage covered by Medicare also rose over the period, from 14.6 % to 15.2%.

    In 2011, 9.7% of children under 19 (7.6 million) were without health insurance. Neither estimate is significantly different from the corresponding 2010 estimate. The uninsured rate for children in poverty (13.8%) was higher than the rate for all children (9.4%).

    The uninsured rate remained statistically unchanged for people aged 26 to 34 and 45 to 64. It declined, however, for those aged 19 to 25, 35 to 44, and 65 and older.

    In 2011, the uninsured rates decreased as household income increased from 25.4 % for those in households with annual income less than $25,000 to 7.8% in households with income of $75,000 or more.

    The findings are available in Income, Poverty, and Health Insurance Coverage in the United States: 2011. The results were compiled from information collected in the 2012 Current Population Survey Annual Social and Economic Supplement.

    COAMI Recommends Treating OA as a Chronic Disease

    Osteoarthritis (OA) should be considered—and treated—in a more multidisciplinary, coordinated, and prevention‐oriented way, similar to other chronic diseases, says a call to action recently issued by the Chronic Osteoarthritis Management Initiative (COAMI), a program of the United States Bone and Joint Initiative (USBJI).   

    The COAMI work group met in May to assess current practice in the management of osteoarthritis. Work group members included physical therapists; orthopedic nurses and surgeons; specialists in rheumatology, rehabilitation, and sports medicine; osteopathic physicians; and athletic trainers.

    Changing the paradigm of intervention for OA, especially among health care providers, was a primary focus of the meeting. OA should be "subject to screening for risk factors, prevention‐oriented interventions, ongoing monitoring, and comprehensive care models typical of other chronic diseases. Instead, many patients and health care providers tolerate and expect pain and disability as an inevitable trajectory of OA and aging," says COAMI.

    In addition, the work group identified 7 priority actions to undertake, with the help of partners in other organizations who share COAMI's goals for improved patient outcomes.

    The priority actions are:

    • developing a call to action geared specifically to health care professionals who treat patients with OA, as well as policymakers and the public;
    • convening a larger conference that leads to further recommendations that would build agreement across disciplines and specialties within the health care system, so that current inconsistencies in approach could be resolved, and models of care developed;
    • reaching out to other partners beyond the Work Group members (both existing and new) to include them in future COAMI work;
    • exploring standardized screening tools and indicators of OA to make early diagnosis both more consistent and more likely;
    • developing tools and prompts that promote patient engagement in learning about and managing OA (especially before symptoms become debilitating);
    • lending COAMI's support to existing advocacy and awareness efforts that are already underway; and
    • developing and supporting an OA-specific research agenda that would fill gaps in evidence and practice.

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

    Yearly Costs of Chronic Pain Exceed Those of Cancer, Heart Disease, and Diabetes

    The annual cost of chronic pain is as high as $635 billion a year, which is more than the yearly costs for cancer, heart disease, and diabetes, say health economists from Johns Hopkins University in this month's The Journal of Pain.

    The researchers estimated the annual economic costs of chronic pain in the United States by assessing incremental costs of health care due to pain and the indirect costs of pain from lower productivity. They compared the costs of health care for people with chronic pain with those who do not report chronic pain. The authors defined people with pain as those who have pain that limits their ability to work, are diagnosed with joint pain or arthritis, or have a disability that limits capacity for work.

    Data from the 2008 Medical Expenditure Panel Survey was used to gauge the economic burden of pain. The sample included 20,214 individuals 18 and older to represent 210.7 million US adults.

    Results showed that mean health care expenditures for adults were $4,475. Prevalence estimates for pain conditions were 10% for moderate pain, 11% for severe pain, 33% for joint pain, 25% for arthritis, and 12% for functional disability. Persons with moderate pain had health care expenditures $4,516 higher than someone with no pain, and individuals with severe pain had costs $3,210 higher than those with moderate pain. Similar differences were found for other pain conditions: $4,048 higher for joint pain, $5,838 for arthritis, and $9,680 for functional disabilities.

    Also, adults with pain reported missing more days from work than people without pain. Pain negatively impacted 3 components of productivity—work days missed, number of annual hours worked, and hourly wages.

    Based on their analysis of the data, the authors determined that that the total cost for pain in the United States ranged from $560 to $635 billion. Total incremental costs of health care due to pain ranged from $261 to $300 billion, and the value of lost productivity ranged from $299 to $334 billion. Compared with other major disease conditions, the per-person cost of pain is lower but the total cost is higher.

    The authors noted their conclusions are conservative because the analysis did not consider the costs of pain for institutionalized and noncivilian populations, for persons under 18, and for caregivers.

    APTA Develops Patient FAQs to Ease Concerns Over CMS Therapy Cap Letter

    APTA has learned that a letter issued by the Centers for Medicare and Medicaid Services (CMS) about the therapy cap has caused some beneficiaries to panic and cancel appointments. 

    CMS recently began issuing letters to Medicare beneficiaries who have received $1,700 or more in outpatient therapy services in calendar 2012. The letter informs beneficiaries that if services are furnished above the therapy cap of $1,880 in 2012, and the requirements for an exception are not met, then the beneficiary would be financially responsibility for these services.

    To help ease beneficiaries' concerns, APTA has developed a frequently-asked-questions (FAQs) document that physical therapists can download and distribute to patients. Additionally, the document can be accessed by patients directly from APTA's Move Forward consumer website. 

    CMS Issues Transmittals on Manual Medical Review Process

    The Centers for Medicare and Medicaid Services (CMS) has released 2 transmittals regarding the manual medical review process for outpatient therapy services that exceed $3,700. The manual medical review process, which approves or denies requests for therapy services in advance, goes into effect October 1.

    Transmittal 1117 provides a list of the documentation and information that physical therapists must submit to their Medicare Administrative Contractors (MACs) to get approval for therapy services when patients exceed $3,700. The transmittal also provides guidance on MACs responsibilities in the review process. Specifically, MACs must make a decision (number of days approved and/or denied) and inform the provider and beneficiary (by telephone, fax, or letter; if by letter the letter must be postmarked by the 10th day) within 10 business days of receipt of all requested documentation. Failure to make a decision within 10 business days will lead to an automatic approval of the request.

    If the request is denied, the contractor must provide a letter of denial to the provider and beneficiary. The provider letter must have detailed reasons (eg, not enough evidence of skilled care is not sufficient detail).

    CMS recently assigned providers to 1 of 3 phases for manual medical review:

    • Phase I Providers: Subject to manual medical review October 1 - December 31, 2012
    • Phase II Providers: Subject to manual medical review November 1 - December 31, 2012
    • Phase III Providers: Subject to manual medical review December 1 - December 31, 2012

    No automatic exceptions apply to claims above $3,700 for claims submitted by providers in their respective phase.

    A provider education article related to this instruction will be available on CMS' website shortly. 

    In addition to providing details on the automatic and manual medical review exception processes, Transmittal 2537 clarifies that therapy evaluations performed after the therapy caps are reached to determine if the patient needs continued services would be exempt from the cap. CPT Codes 97001 97002 are included in this exception for evaluation services. 

    APTA Urges CMS to Alter Data Collection Plan to Provide Meaningful Information, Ease Provider Burden

    In comments sent Tuesday to the Centers for Medicare and Medicaid Services (CMS) on the proposed 2013 Medicare physician fee schedule, APTA recommends multiple revisions to CMS' plan for collecting information on beneficiaries' functional limitations as part of payment reform. "While APTA strongly supports gathering information to develop an alternative to the current arbitrary payment limits (or "caps") on Medicare therapy services," the association says, "… CMS's proposal is overly complex and burdensome and may not result in the collection of meaningful and accurate patient information that could be used to develop an alternative payment system."   

    Following the July 6 release of the proposed rule, APTA immediately began communicating with various stakeholder groups, including the American Hospital Association, the American Occupational Therapy Association, the American Speech-Language-Hearing Association, American Stroke Association, and APTA components about CMS' intention to require therapists to report patients' functional limitations. In a meeting with CMS officials on August 27, APTA urged the agency to keep this particular provision as simple as possible to ensure that the requirements are not excessively onerous for physical therapists and do not cause delays in payment for therapy services.    

    Specifically, APTA recommends that therapy associations and organizations and CMS collaborate to develop core items in the future that could be used in any tool to standardize data collection. Instead of reporting on primary and secondary functional limitations as described in the rule, APTA recommends that therapists report the information regarding the patient's functional limitation using 1 of 4 specific categories and that CMS establish another G code that would be the "catch all" for functional limitations that do not fit into the 4 categories. Additionally, the association urges against the collection of goal data at this time, comments on the 12-level severity scale, and suggests changes to the proposed frequency of reporting. APTA also provides CMS with a detailed outline of how the agency could implement claims-based therapy data collection in 3 phases that would "decrease provider burden, while still providing CMS with some useful beneficiary information regarding functional limitations." 

    APTA also remarks on the proposed 27% percent reduction in the Medicare physician fee schedule conversion factor, prepayment review, and the therapy cap. The association comments extensively on the extension and implementation of the Physician Quality Reporting System (PQRS)—voicing its concern over the use of 2013 data to inform the 2015 payment adjustments given the continued low participation rates and overall lack of awareness of programmatic changes to PQRS. 

    APTA Comments on Medicare OPPS Rebilling Demo, IRF Quality Reporting

    This week APTA responded to 4 specific questions posed by the Centers for Medicare and Medicaid Services (CMS) in its proposed rule for Medicare hospital outpatient prospective and ambulatory surgical center payment systems (OPPS) for calendar year 2013.   

    The questions are in relation to implementation of the Medicare Part A to Part B Rebilling Demonstration. In this demonstration, participating hospitals are allowed to receive 90% of the allowable Part B payment for Part A short-stay claims that are denied on the basis that the inpatient admission was not reasonable and necessary. The hospitals can rebill denied Part A claims as Part B services and be paid additional reimbursement when an inpatient admission is found not reasonable and necessary. CMS' questions involve setting parameters regarding the amount of time a patient can remain on observation status, establishing specific clinical criteria for admission and payment, aligning hospital payment rates more closely with the resources used to provide outpatient care, and having case management and utilization review staff available in hospitals outside of regular business hours to improve the accuracy of admission decisions. 

    Additionally, APTA notes its support for 3 proposed changes to the IRF Quality Reporting Program. The changes seek to harmonize the processes for the maintenance of technical specifications and measure removal from the IRF quality program with other quality reporting programs such as those in inpatient hospital settings.

    New in the Literature: Knee Osteoarthritis (Arthritis Care Res [Hoboken]. 2012. August 29. [Epub ahead of print])

    Individuals with knee osteoarthritis, regardless of the involvement of 1 or both knees, perform and perceive their functional ability similarly, say authors of an article published online in Arthritis Care & Research. This suggests that clinicians need to consider other factors, such as how long the disease has been progressing or how functional abilities have changed, when treating patients with knee osteoarthritis, the authors add.  

    The functional abilities of patients with symptomatic and radiographic diagnosed unilateral (N=84) or bilateral (N=68) knee osteoarthritis were evaluated with self-reports and performance-based tests. Self reports included the Knee Outcome Survey, Global Rating Scale, and Physical Component of Short Form-36; functional tests included Timed Up-and-Go, Stair Climbing Test, and 6-Minute Walk. Separate MANOVAs were performed separately for men and women to determine if perception (self-reports) and performance (functional tests) were dependent on the number of involved knees.

    No significant main effects were observed in functional performance between groups for either sex. Similarly, the perception measures did not differ between groups. In general, individuals diagnosed with unilateral and bilateral knee osteoarthritis both performed functional tasks and perceived their functional ability similarly.

    APTA members Joseph A. Zeni, PT, PhD, and Lynn Snyder- Mackler, PT, ScD, SCS, FAPTA, coauthored the article.

    NFL Commits $30 Million to NIH to Support Medical Research

    The National Football League (NFL) will donate $30 million to the Foundation for the National Institutes of Health in support of research on serious medical conditions prominent in athletes and relevant to the general population.

    With this contribution, NFL becomes the founding donor to a new Sports and Health Research Program, which will be conducted in collaboration with institutes and centers at the National Institutes of Health (NIH). Specific plans for the research to be undertaken remain to be developed, but potential areas under discussion include concussion; chronic traumatic encephalopathy; the potential relationship between traumatic brain injury and late life neurodegenerative disorders, especially Alzheimer disease; chronic degenerative joint disease; the transition from acute to chronic pain; sudden cardiac arrest in young athletes; and heat and hydration-related illness and injury.

    The announcement of the philanthropic gift, the largest that NFL has given in the league's 92-year history, coincides with the release of a study that found that professional football players are more likely to die from neurological disorders than other men.

    The study, published online in Neurology, looked at death rates for more than 3,400 pros who played for at least 5 years from 1959 to 1988. For players in speed positions, such as quarterback, running back, and linebacker, death rates for Alzheimer disease and amyotrophic lateral sclerosis combined were 4 times higher than for men in the general population, says a HealthDay News  article. The researchers also looked at death rates for Parkinson disease but found no difference from the general population.

    While the study appears to support recent research showing an increase of diseases that damage brain cells among football players, it does not prove that playing pro ball is the cause. Other factors, including the football field surface and looser safety guidelines during the study period, may have played a role, experts say.

    Also, chronic traumatic encephalopathy, a relatively new diagnosis associated with concussions and repeated blows to the head, might have been the actual or partial cause of death for some, says the article. 

    APTA Recommends Interim Revisions to HH PPS; Calls for Alternative Payment System

    APTA illustrates several ways that the home health prospective payment system (HH PPS) can be revised to better reflect the role of physical therapists in home health, as well as bolster clinically appropriate practice patterns that improve quality of care and lower growth in expenditures, in comments submitted on September 4 to the Centers for Medicare and Medicaid Services (CMS). 

    APTA's remarks focus heavily on therapy coverage requirements. While calling on CMS to begin the work of developing an alternative payment system for therapy services under the Medicare home health benefit, the association makes specific interim recommendations to alleviate the burdens associated with missed reassessment visits and alter provisions regarding coverage of compliant therapy disciplines and visit ranges.

    In response to CMS' quality reporting proposal, APTA advocates for the alignment of HH measures with current measures under the inpatient prospective payment system. Specifically, the association asks that CMS apply consistent measures regarding emergency department use and readmissions.

    Recognizing CMS' commitment to ensuring that home health payments are accurate and are not unduly influenced by practices not associated with changes in the patient's condition, APTA recommends that the agency find alternative ways to account for these nominal case-mix changes that do not impose further cuts to HH PPS.

    Finally, APTA urges CMS to finalize its proposal to provide more flexibility in the physician face-to-face requirement. 

    VA to Provide Veterans With Mobility Impairments Assistance for Service Dogs

    The Department of Veterans Affairs (VA) has amended its regulations to provide veterans with mobility, visual, or hearing impairments benefits to support the use of a service dog as part of the management of these impairments. The benefits include assistance with veterinary care, travel benefits associated with obtaining and training a dog, and the provision, maintenance, and replacement of hardware required for the dog to perform the tasks necessary to assist the  veterans.

    APTA will provide a summary of the final rule on service dogs on its website shortly.

    Call for Participants: PTs Needed for Pain Study

    Researchers from McMaster University are seeking physical therapist (PT) participants for an 18-month study on Pain PLUS, a new free information service for evidence-based pain management. The purpose of this study is to compare 2 different methods of sharing pain research evidence, as well as the knowledge and decisions made by 4 different types of professionals—physicians, nurses, rehabilitation professionals, and psychologists—involved in pain management. One method of sharing will be sending e-mail alerts. The other method will be providing web-based resources. All participants will have access to both services for 9 months each.

    For more information on Pain PLUS and how you can participate in this study, contact Margaret Lomotan at lomotam@mcmaster.ca or 905/525-9140, ext 27328, or visit http://plus.mcmaster.ca/PainPLUS/.

    Patients With Cancer Not Discussing Exercise With Oncologists

    Despite evidence of the positive effect that exercise can have on cancer care and recovery, many patients with cancer are reluctant to exercise and few discuss it with their oncologists, according to a Mayo Clinic study published in the Journal of Pain and Symptom Management.

    The study is part of a series of investigations looking at exercise habits among patients with cancer. For this investigation, researchers qualitatively analyzed semistructured interviews with 20 adults (half male and half aged 65 years or older) with Stage IIIB or IV nonsmall cell lung cancer. Participants were questioned about their levels of activity, the influence of their symptoms on their activities, perceived barriers and facilitators for exercise, and exercise-related instructions received from their professional caregivers.

    "Participants overwhelmingly cited usual daily activities as their source of 'exercise,'" say the authors. Symptoms, particularly treatment-related, discouraged participation, with fear of harm being a significant concern only among younger women. Participants recognized exercise as important for physical and mental well being but seldom as a means to mitigate symptoms. Although respondents said they preferred to receive guidance from their oncologist, none reported receiving more than general encouragement to "stay active." Participants accepted a lack of direction as approval of their current activity levels. Additionally, participants appeared less receptive to guidance from ancillary health professionals, say the authors.

    HHS Amendment Excludes DACA Non-US Citizens From PCIP Coverage

    Non-US citizens under age 31 who have resided in the US and have been granted temporary relief under the Department of Homeland Security's June 15 Deferred Action for Childhood Arrivals (DACA) process will not be eligible for Pre-Existing Condition Insurance Plan (PCIP) coverage pending their removal determination.   

    Last week, the Department of Health and Human Services (HHS) released a clarifying amendment to the interim final rule on the PCIP program. This amendment, effective immediately, revises the definition of "lawfully present" that was codified in the interim final regulation  on PCIPs (published July 30, 2010) to exclude this group from PCIP participation. 

    The Affordable Care Act (ACA) prohibits non-grandfathered health insurance coverage issuers from denying health care coverage or inflating health insurance rates based on preexisting conditions. This section of the ACA takes effect in 2014, at which time coverage will be made available through the Affordable Health Insurance Exchanges. In the interim, ACA directs states or nonprofit entities to establish temporary high-risk health insurance pool programs to cover eligible US citizens with preexisting conditions.

    CMS to Hold Open Door Forum on Manual Medical Review September 5

    The Centers for Medicare and Medicaid Services (CMS) will hold a special open door forum on the manual medical review of therapy claims September 5, 2 pm-3:30 pm, ET. If you wish to participate, dial 877/251-0301 and enter conference ID 23782155. This announcement and full participation instructions are available on CMS' website.

    September Craikcast Now Available

    In the United States, September is associated with returning to school. This month's PTJ provides many opportunities for physical therapy educators to refer to outstanding research, says Editor in Chief Rebecca Craik, PT, PhD, FAPTA, in her monthly Craikcast podcast. Craik also urges faculty and students to listen to the 43rd Mary McMillan Lecture, "Face the Storm," presented by Alan Jette, PT, PhD, FAPTA, in June at APTA's annual conference. 

    Research topics in the September issue include predictors of chronic nonspecific low back pain, physical activity after total knee replacement, prevalence of McKenzie's classification categories among patients with extremity problems, walking activity in people poststroke compared with older adults without disability, and the use of electromagnetic fields used in stem-cell tissue engineering. Full text and a podcast of the 2012 APTA Presidential Address, delivered by R. Scott Ward, PT, PhD, also are available.   

    Army Awards Almost 1,000 Purple Hearts for Concussions

    Following an investigation and the issuance of new guidelines, the US Army has awarded nearly 1,000 Purple Hearts to soldiers who sustained concussive injuries in Iraq and Afghanistan, says an article by NPR.  

    In 2010, NPR reported that some Army commanders and physicians "belittled" concussions and commanders "refused to award the Purple Heart to many soldiers who got concussions in combat because they didn't consider these 'real' injuries."

    In August 2011, the US Army released a statement encouraging active-duty and reserve-component soldiers, as well as veterans, who were denied Purple Heart awards for concussive or mild traumatic brain injuries (MTBIs) to resubmit documentation for reconsideration of the medal. The statement says that since the Vietnam War, concussions and MTBIs as a direct result of an enemy action have warranted the award of the Purple Heart. "Nevertheless, field commanders have sometimes been unclear on what constituted concussion." With medical advances in the treatment and knowledge of concussion and MTBIs injuries, the Army says it now can "further identify the characteristics of the unseen wound and clarify guidance for entitlement to the Purple Heart."  

    The new guidelines are "dry and technical," says NPR. But the message is: If a soldier is diagnosed with a concussion from an enemy explosion and he or she received treatment, then he or she deserves the Purple Heart.

    However, with studies suggesting that tens of thousands of troops sustaining concussions in Iraq and Afghanistan, it looks like only a small portion of them have applied for Purple Hearts under the new guidelines. "Veterans advocates say that maybe most of those soldiers never got an official diagnosis, or maybe they don't know about the new guidelines. Or maybe they know about the guidelines, but they don't have the will to go through the red tape," says NPR.  

    For information on programs that work collaboratively to provide and improve traumatic brain injury care for active duty military, veterans, and their eligible beneficiaries, visit APTA's Management of Wounded Warriors webpage

    September Is National Childhood Obesity Awareness Month

    To help America's children develop healthy habits that can last a lifetime, health care providers, parents and caregivers, educators, and community leaders are encouraged to use the Department of Health and Human Services' (HHS) resources available through the President's Council on Fitness, Sports and Nutrition, Centers for Disease Control and Prevention, National Institutes of Health's We Can!! (Ways to Enhance Children’s Activity & Nutrition)® program, and Let's Move! initiative.

    In addition, several new public-private partnerships are being launched across the nation to ensure that all kids experience the positive health benefits of daily physical activity and healthy eating. For example, the Partnership for a Healthier America and Olympic Team USA's recently committed to provide 1.7 million kids the opportunity to participate in free and low cost physical activity programs offered by the United States Olympic Committee (USOC), USOC National Governing Bodies for sport, and others over the next year.

    Over the past 30 years, the childhood obesity rate in America has almost tripled. According to the CDC, in 2010, approximately 17% of children and adolescents aged 2-19 years were already obese.

    According to the 2008 Physical Activity Guidelines for Americans, children and adolescents aged 6-17 years should spend 60 minutes or more being physical active each day.