• Monday, July 27, 2015RSS Feed

    Rapid—and Recent—Developments in Robot-Assisted Rehab Point to Burgeoning Industry

    We're not quite in Iron Man territory yet, but new developments in mobility assistance through robotics have been occurring at a fairly fast clip over the spring and summer of 2015, and financial forecasters expect the rehabilitation technology market to take off over the next 5 years.

    A few of the latest developments:

    A Lego-friendly prosthetic arm. Developers in Colombia have created a prototype prosthesis that can accommodate creations made from the popular interlocking plastic building system. The device reacts to movements from muscles at the arm stump and delivers signals to a motor that accepts standard prosthetic attachments and Lego-based creations. It's a project they hope will help break down barriers for children with disabilities. "The idea erases that line between disability and ability," says Carlos Torres, developer of the IKEO Prosthetic System.

    The first-ever US commercial insurance reimbursement for a ReWalk exoskeleton. The first company to receive US Food and Drug Administration approval for a robotic exoskeleton reached a milestone when an unnamed commercial insurance company approved reimbursement for the device, which has a retail price of $71,000.

    A lightweight walking assistance device from Honda. The Walk Assist system built by the car manufacturer is worn like a belt, with attachments that can be strapped on to the thighs of the wearer. Walk Assist weighs about 6 pounds and has a 60-minute battery life. Honda says the device is based on "the inverted pendulum model" and is intended to be used under the guidance of a physician or therapist. Leasing begins in Japan in November.

    A robotic assistant that senses small muscle contractions and interfaces with video games. The Luna rehabilitation robot uses electromyography to sense muscle movement at nearly undetectable levels, and then translates those into mechanically assisted arm movements that in turn interact with video games to make rehabilitation sessions more interactive and entertaining.

    An upper-body exoskeleton that feels "weightless" to wearers. Researchers at the University of Texas – Austin have developed HARMONY, an upper-body exoskeleton with extensive adjustment capabilities that works with the entire upper body, rather than a single arm at a time. "HARMONY’s shoulder mechanism assists in a range of motions that are very close to those required for daily activities, and the eventual incorporation of a screen or gaming environment to simulate such activities may lead to successful relearning," according to a UT-Austin news release.

    A rehabilitation robotics market poised to grow rapidly. A new financial analysis estimates that rehabilitation technology will grow from a $200 million global industry to a $1.1 billion one by 2021. According to a summary of the analysis from medGadget, "all the products that are now commercially viable are positioned to achieve significant staying power in the market long term, providing those companies that offer them with a possibility for long-term leadership position in the market."

    Check out APTA's resources on technology and patient care as well as an audio course on robotics and physical therapy.


    Monday, July 27, 2015RSS Feed

    PT Bainbridge Featured in ESPN Coverage of Special Olympics

    Many physical therapists (PTs) and physical therapist assistants (PTAs) have been involved with the Special Olympics over the years, but Donna Bainbridge, PT, EdD, ATC, has elevated that involvement in ways that stretch beyond the actual World Games now taking place in Los Angeles.

    As part of its coverage of the event, ESPN.com correspondent Stephania Bell, PT, OCS, CSCS, caught up with Bainbridge to find out more about FUNfitness, the screening program Bainbridge developed with APTA that is now a central part of the Special Olympics' Healthy Athletes Program.

    Bainbridge, former director of practice at APTA, explains how FUNfitness was developed and implemented at the 2001 games in Alaska, and how the program has grown from a 6-consultant program to a global operation that includes between 75 and 80 programs. This year, Bainbridge says in the interview, there could be as many as 200 volunteers at the games, working together to reach a goal of providing screenings to 60%-65% of all participating athletes.

    For Bainbridge, the benefits of the program stretch beyond the immediate needs of the athletes at the games, and reach physical therapists and their home communities.

    "I feel like we're changing the lives of the volunteers we train because even though all these physical therapists work with people with disabilities, this is not necessarily a group they would solicit," Bainbridge says. "I've heard many times that they go back much more aware and seek out working with these people in their practices and their communities."


    Friday, July 24, 2015RSS Feed

    Anthem's Acquisition of Cigna Continues Insurer Consolidation Trend

    Health insurer Anthem's recent announcement that it will acquire Cigna in a $54.2 billion deal is continuing a consolidation trend that could reduce the number of major insurance companies in the US from 5 to 3. And while the nuts and bolts of the deal are plain enough, when it comes to speculation on what it will mean for consumers and providers, there's less consensus.

    What's known is this: the multibillion dollar acquisition will make the Anthem-Cigna combination the country's largest private health insurer in terms of members, with an estimated 53 million people covered. Revenues for the new company are projected at $115 billion annually.

    Anthem's acquisition comes on the heels of a July 3 merger announcement from insurance giants Aetna and Humana, meaning that if federal regulators approve both deals, the country's 5 major private insurance companies will be reduced to 3, United Healthcare being the third. Pending regulatory approvals, the Anthem-Cigna deal will close in late 2016.

    Media coverage of the acquisition generally pointed to pressures applied to insurance companies from the Affordable Care Act (ACA), which put caps on profits that could be made by insurance companies, as the big motivator for the consolidations.

    Aside from that, reports on the deal highlighted different aspects of the acquisition and its possible effects. Here's a quick take on how the deal was reported in news media outlets:

    "The merger between Aetna and Humana was a major change for the Medicare Advantage marketplace, whereas the Cigna and Anthem merger will have the biggest ripple effects for the commercial insurance market." The Washington Post

    "Anthem's combination with Cigna will result in a company with a much broader base over which to spread costs and expenses, and it could make technology investments over the industry's biggest customer pool.." Associated Press

    "Health insurers are seeking to consolidate to gain greater scale to reduce costs and capitalize on growing opportunities in the government and individual markets." New York Times

    "Anthem said it expects the deal to close in the second half of 2016, indicating a long regulatory road ahead." Reuters

    "Bigger insurers with more clout could raise premiums and reduce the number of doctors and hospitals in network coverage plans. But health insurers have defended their position." CNN Money

    Visit APTA's webpage on private insurance to access information, tools, and resources that can help you navigate the physical therapist-insurance company relationship.


    Tuesday, July 21, 2015RSS Feed

    ADA Turns 25—Here's How You Can Help Celebrate

    Happy 25th anniversary to a law based on an idea that lies at the very heart of the physical therapy profession—that individuals should not face barriers of any kind based on disability.

    Signed into law on July 26, 1990, the Americans with Disabilities Act (ADA) altered everything from employment policies to building design, and from educational approaches to the ways information is made available to people across the US. Its legacy, including the ways in which it has been expanded and strengthened over the years, is one of transformation—not just toward accommodations in physical, employment, and educational environments, but toward a more inclusive society.

    In recognition of this important anniversary, APTA has signed the Proclamation to Recommit to Full Implementation of the ADA. This statement celebrates progress made through the law but acknowledges that "the full promise of the ADA will only be reached if we remain committed to continue our efforts to fully implement” it. Signing organizations can be viewed by state—look for APTA among the organizations from Virginia.

    APTA is urging its members to join in celebrating and recommitting to this important act by signing the ADA Pledge for Individuals and participating in other programs meant to draw attention to the positive change that has taken place since 1990. Here are some additional things you can do to help mark the ADA's anniversary:

    • Share your story. The ADA Legacy Project has established a repository for individual stories about how the ADA has impacted people’s lives. Take a few minutes to share what the law has done for you and your patients and clients.
    • Check out the DisabilityBlog. This series of moving blog posts by individuals whose lives have been changed by the ADA is a great reminder of why this anniversary is worth celebrating.
    • Follow the ADA on Twitter. #ADA25 will keep you connected.
    • Join the celebration! Many local recognition events already have taken place, but there are more to come—particularly between July 24 and 26, and especially in Washington, DC. Check out this list of events to see what's up in your area.

    Need to get up to speed on the ADA? Time for an ADA refresher? Check out APTA's Americans with Disabilities Act webpage, a resource that features guides for employers, rules on mobility access rights, notes on ADA amendments, and more.


    Monday, July 20, 2015RSS Feed

    Medicare Extends 5-Star Ratings to Home Health Agencies

    Home health agencies are now part of the Centers for Medicare and Medicaid Services (CMS) 5-star rating system, which incorporates evaluations of patient mobility in its assessment of an agency's overall effectiveness.

    Released through its Home Health Compare website, the star ratings are based on 9 of the 27 quality measures included in that program. The measures included are patient wait for a first visit, thoroughness of explanations of drugs to a patient or caretaker, administration of a flu shot, hospital stays, and improvements in walking, getting in and out of bed, breathing, and movement with less pain.

    Of the 9,359 agencies rated (out of 12,261 total agencies), only 239 received 5 stars, while 2,218 received 4 or 4.5 stars. Nearly half of all agencies—46%—landed in the middle of the pack, receiving 3 or 3.5 stars, with 28% receiving lower ratings of 1.5 to 2.5 stars. Of all agencies rated, 6 received a single star.

    The 2,902 agencies not included in the rating system either had low patient volume, did not provide enough data, or had recently opened for business.

    In a state-by-state analysis conducted by Kaiser Health News, Rhode Island and Florida reported the largest percentages of 4- to 5-star rated agencies—albeit based on markedly different volumes. While Rhode Island, with 46% of its agencies earning 4-5 stars, technically had the best rate, those numbers reflected 24 rated agencies. The 43% of facilities that earned 4 to 5 stars in Florida were identified from a pool of 949 rated agencies.

    States with the highest percentages of agencies with 2.5 stars or lower include Arkansas (45%), Wyoming (48%), Texas (52%), and Minnesota (52%). Other states and territories with high percentages in this category included the District of Columbia, Alaska, and the US Virgin Islands, but relative numbers of agencies rated were small.

    The ratings were drawn from data from fall 2013 through the end of 2014. Medicare will update the ratings quarterly.


    Monday, July 13, 2015RSS Feed

    ICD-10 Testing Rates Improve, CMS Offers Concession for Certain Coding Errors

    As the October 1 startup date for the ICD-10 coding system creeps closer and closer, the compliance picture seems to be brightening, just as the US Centers for Medicare and Medicaid Services (CMS) announces that it's taking a somewhat softer approach to how it will handle provider mistakes in the new system.

    Recently, CMS announced that during the last round of "end-to-end" testing of ICD-10 June 1-5, 90% of claims filed were accepted. This acceptance rate was up from the 88% mark achieved during the second testing phase, and from the 80% figure achieved during the first week of testing.

    As in the previous tests, according to a report from Healthcare Informatics, most rejections in the June tests "resulted from improperly developed test claims unrelated to ICD-10." The report cites CMS as stating that most rejections were due to "provider submission errors in the testing environment that would not occur when actual claims are submitted for processing."

    On the same day CMS announced the testing results, it also confirmed that after October 1, it will reimburse for incorrectly coded claims "as long as that erroneous code is in the same broad family as the right one," according to a story in Modern Healthcare. The policy will be in effect for 1 year. CMS has outlined its approach in an FAQ document (.pdf) released recently.

    A recent sold-out APTA webinar on successful ICD-10 implementation offered additional information to help providers prepare for the October 1 deadline:

    • CMS will set up a communication and collaboration center to resolve issues.
    • An ICD-10 ombudsman will help receive and triage provider issues.
    • If Part B Medicare contractors are unable to process claims, an advance payment may be available.

    A recording of the webinar will be released for download in the coming weeks and is part of a suite of APTA resources on ICD-10.


    Friday, July 10, 2015RSS Feed

    Medicare to Test Bundled Payments for Hip, Knee Replacements in Selected Cities

    Hip and knee replacement surgery—which is nearly always partnered with rehabilitation including physical therapy—is the target of a proposed Medicare test of a bundled payment model, which will hold acute-care hospitals in 75 areas around the US accountable for their costs and quality of care. It's yet another signal that health care reform is moving away from fee-for-service payment models and toward paying for value and outcomes.

    The chosen areas include Los Angeles and New York City as well as smaller markets, and would affect more than 800 acute-care hospitals. Unlike similar tests of the past, there's no voluntary sign-up; all facilities must participate.

    The 5-year test period would begin January 1, 2016, and end December 31, 2020. Participating hospitals would bear the financial risk of the episode of care, which would begin at admission to the hospital and end 90 days after discharge, to include all related care covered under Medicare Parts A and B—the procedure, inpatient stay, hospital care, postacute care, and provider services.

    During the 5-year test period, Medicare would continue to pay using the current fee-for-services system. But at the end of every year, separate payments related to each episode would be bundled to calculate the total "episode payment" and reconciled against an established target price. If the episode payment is lower than the target and the hospital meets quality-performance thresholds, Medicare would pay the hospital the difference. If the episode payment is higher than the target, the hospital would have to repay Medicare the difference. The repayment responsibility would be waived the first year, and other policies in the proposal would limit the financial risk a hospital would be responsible for during the entire test period.

    As a result of the program, the Centers for Medicare and Medicaid Services (CMS) said in a press release, "hospitals would have an incentive to work with physicians, home health agencies, and nursing facilities to make sure beneficiaries get the coordinated care they need, with the goal of reducing avoidable hospitalizations and complications."

    Which is where physical therapy comes in. "The value of physical therapy after total joint replacement is well documented as providing improved outcomes," said APTA's Anita Bemis-Dougherty, PT, DPT, MAS, vice president, Department of Practice. "There are positive associations between earlier progression and outpatient, clinic-based, physical therapy."

    Hip and knee surgeries were chosen because they are the most common inpatient surgery for Medicare patients, and they tend to be high-cost, high-utilization procedures with a wide variance in spending.

    The initiative comes from CMS's Center for Medicare and Medicaid Innovation, whose purpose is to test innovative payment and service delivery models in search of those that reduce expenses while preserving or enhancing quality of care by making providers more accountable for both costs and patient outcomes.

    Previous tests of payment models have been voluntary, but CMS implied in the proposed rule that participation hasn't been as high, or among as broad a cross-section of providers, as the agency felt it needed to evaluate the models, and so this program would be mandatory for hospitals within the chosen geographic areas, with limited exceptions.

    APTA will submit comments on the proposal (.pdf), which are due September 8.


    Friday, July 10, 2015RSS Feed

    Mystery Polio-Like Illness Linked to New Virus

    For a while, researchers studying a mysterious polio-like illness in Colorado last year felt like they were coming close to pinpointing the cause of the disease. Now they're not so sure.

    According to a report in livescience, new research has uncovered that while there may be a connection between enterovirus D68 (EV-D68) and cases of acute flaccid paralysis suffered by children in various parts of the United States, new studies have found the presence of another virus in at least 1 patient. That virus, called enterovirus C105, belongs to the same species as the polio virus.

    The patient—a 6-year-old girl—tested negative for EV-D68. Hers was the first report of enterovirus C105 in the US.

    The discovery further clouds speculation that the EV-D68 virus was at the root of the neurological impairments.

    "Although cases of flaccid paralysis associated with isolation of EV-D68 from spinal fluid have been reported, the role of EV-D68 in the current outbreak remains to be determined," authors write in a report to the US Centers for Disease Control and Prevention. "As the results from this case indicate, it is possible that other viral pathogens with neurovirulence may be contributing to the outbreak."


    Thursday, July 09, 2015RSS Feed

    Researchers Call Into Question Prevailing Model of How Neurons Control Movement

    Researchers from Stanford University think they may be on to a deeper understanding of how neurons work as a "dynamical system" that links activity to a "pre-movement" state. It's a new way of thinking about movement that they believe can lead to significant improvements in prosthetic devices that can better respond to human thought.

    "The prevailing view of motor cortex holds that motor cortical neural activity represents muscle or movement parameters," authors write in a study published online last month in eLife. "However, recent studies in non-human primates have shown that neural activity does not simply represent muscle or movement parameters; instead, its temporal structure is well-described by a dynamical system where activity during movement evolves lawfully from an initial pre-movement state."

    In the most recent study, researchers analyzed "neuronal ensemble activity" in the motor cortex of 2 clinical trial participants diagnosed with amyotrophic lateral sclerosis (ALS). Both participants had very limited movement—one with some movement in her fingers and wrist, and the other able to move his index finger slightly.

    After implanting electrode arrays in the motor cortex of the participants, researchers were able to track electrical activity from individual neurons as the participants moved or attempted to move their fingers or wrists. They found evidence of the same neural patterns, described as "rotations," that they observed in the animal studies.

    "The presence of these rotations calls into question the prevailing model of motor cortical activity (ie, that motor cortical firing patterns represent muscle or movement parameters) in favor of a dynamical systems perspective," authors write. The perspective envisions a system in which neurons "coordinate and cooperate with each other in a very particular way," according to Krishna Shenoy, PhD, one of the study's lead authors.

    The researchers believe that once these dynamics are understood, they can be incorporated into the algorithms that control so-called brain-machine interfaces (BMIs), which could more precisely respond to the thoughts of the user.


    Tuesday, July 07, 2015RSS Feed

    WHO Report: Food Energy Surplus Could Account for Much of the World's Weight Gain

    In the fight against worldwide obesity, overabundance may be an overwhelming force: according to a new study from the World Health Organization (WHO), the increase in the amount of per-capita food energy available to people in 56 countries has created excesses that alone can account for increases in average body weight. Making matters worse is that much of the excess calories available come in the form of "obesogenic ultra-processed foods" that do little but create excess weight gain.

    Researchers compared surveys of average adult body weight among 69 countries with food balance totals created by the United Nations Food and Agriculture Organization (FAO) for each country. Analysis was limited to surveys with comparable methodologies conducted between 1961 and 2010, with at least 4 years between surveys. Average female and male heights in the countries at survey time points were then factored into the analysis.

    Of the countries included in the study, 56 (81%) reported increases in both food supply and body weight; for 45 of the countries, the increase in food energy supply "was more than sufficient to explain the increase in average body weight," authors write.

    The pattern appeared in countries at all income levels, though there were a few outliers—countries with reduced food supply and increased weight, and vice-versa.

    Overall, however, researchers found a significant association between changes in food supply and average weight increases, with the strongest associations occurring in high-income countries. Adding to the problem for these high-income countries, they write, are decreasing levels of physical activity—a change that other researchers believe may be more strongly linked to growing rates of obesity and overweight than caloric intake, at least in the US.

    The WHO study comes on the heels of recent reports that more that 2 out of 3 Americans are overweight or obese, a rate that researchers believe will make this generation of Americans the first to have a shorter life expectancy than the previous generation.

    The report also echoes a July 2 article in The Washington Post that recounts the ways in which food portions have increased in the US over time, citing statistics that estimate the average restaurant meal of today as 4 times larger than it was in the 1950s.

    "Our findings suggest that there is an excess of energy available from an increasing national average food energy supply in countries of varying income levels," write the authors of the WHO study. "Therefore, policy efforts need to focus on reducing population energy intake through improving the healthiness of food systems and environments." They suggest policy actions that include restricting the marketing of unhealthy food to children, "front-of-pack" nutrition labelling, "food pricing strategies," and a reassessment of "the impact of trade and investment agreements and agricultural policies on domestic food environments."

    APTA has been a strong advocate in the battle against obesity, and offers multiple resources on the role physical therapists and physical therapist assistants play in addressing prevention and wellness. Additionally, the 2015 APTA House of Delegates approved a measure to create and strengthen partnerships between the association and other organizations committed to addressing obesity.


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