AMA Issues Top 10 Least, Most Competitive States for Insurance

The American Medical Association’s (AMA) latest ratings of health insurance competitiveness across the United States finds that in 17 states, a single health insurer commands 50% or more of the market in each state, and that in 45 states 2 insurers have captured over half or more of each state’s share.

The AMA’s Competition in Health Insurance: A Comprehensive Study of US Markets uses commercial enrollment data from 2012 to create lists of the country’s most and least competitive states for insurance companies, and to assess competitiveness in 388 metropolitan areas.

The 10 least-competitive states are, in order, Alabama, Hawaii, Michigan, Delaware, Louisiana, South Carolina, Alaska, Illinois, Nebraska, and North Dakota. States that have the most competitive markets are, in order, Oregon, Wisconsin, Pennsylvania, New York, Colorado, Missouri, Washington, Ohio, California, and Florida.

Full story of competitive states for insurance at APTA

‘Severe’ Restriction on Compression Devices on Indefinite Hold

A planned change to Medicare coverage of pneumatic compression devices (PCDs) that would have severely restricted patient access to the devices at home has been put on indefinite hold, thanks in part to the efforts of an alliance that includes APTA.

Had it been implemented, the final local coverage determination (LCD) would have imposed restrictions for PCDs that would only allow their use after a 6-month period of “chronic and severe” lymphedema, and would have attached other requirements including the presence of lymphedema into the trunk or chest, the use of manual lymphatic drainage prior to PCDs, and the use of medications. Additionally, the new policy would have denied PCDs to patients who experience any kind of improvement through conservative therapy. The requirements were set to become effective on November 1.

Full story of restrictions on compression devices at APTA

Midterms and Beyond: Find Out What Could Happen on Capitol Hill

A recent APTA Google+ Roundtable now available on YouTube makes one point very clear: while there’s plenty of media attention on which party will control the US Senate after the coming midterm elections, that’s just 1 of several moving parts in Congress that could impact how the physical therapy profession’s legislative priorities are addressed on Capitol Hill.

In a 35-minute video session that covered everything from Senate races to the politics of lame duck sessions, APTA Director of Grassroots and Political Affairs Michael Matlack answered questions about the current political landscape in Washington, and how APTA and its members can continue to influence legislation on issues such as the therapy cap, locum tenens, and direct access.

Full story on physical therapy profession’s legislative priorities at APTA

New Urinary Prosthesis Could be Alternative to Catheterization for Some Women

The US Food and Drug Administration (FDA) has approved a replaceable urinary prosthesis that could free women with impaired detrusor contractility (IDC) from the mobility problems associated with catheters.

The in Flow Intraulrethal Valve Pump is a replaceable device consisting of a sterilized single-use urethral insert, an introducer, an activator, and a sizing shaft. According to a news release from the FDA, the device “draws urine out to empty the bladder and blocks urine flow when continence is desired.”

Patients with IDC are unable to spontaneously urinate, a condition that can result from stroke, spinal cord injury, diabetic neuropathy, or other neurologic disease or injury. Typically patients with IDC must use some type of catheter, and are unable to experience continence.

Full story of new urinary prosthesis at APTA

Exercise Regimen Significantly Decreases Disability in Individuals With RA of the Hand

Tailored hand exercise used as an adjunct to drug regimens can make a significant, cost-effective difference in function and quality of life for individuals with rheumatoid arthritis (RA) of the hand, according to a new randomized controlled trial from the United Kingdom (UK).

In the Strengthening and Stretching for Rheumatoid Arthritis of the Hand study (SARAH), 438 participants representing “the population of people with rheumatoid arthritis in the UK in terms of age and sex” were divided into 2 groups, 1 receiving usual care and the other receiving usual care plus special strengthening and stretching exercises overseen by a physiotherapist or occupational therapist. More than 90% of participants in both groups had been placed on a stable regimen of disease modifying drugs (DMARDs) for at least 3 months before the study, and all continued to take the drugs.

Full story of exercise regimen decreasing disability of RA at APTA

New System Delivers Sense of Touch From Prosthetic Hand

A new development in prosthetic hands is not only restoring a sense of touch to individuals with amputations, but seems to be making a significant impact in reducing phantom limb pain.

Researchers from Case Western Reserve University and the Louis Stokes Cleveland Veterans Affairs Medical Center have found a way to attach sensors to mechanized prosthetic hands that feed touch sensations to nerve bundles in the patient’s arm. The connection allows users to actually feel sensations of pressure and texture—video of the system shows a user picking up and holding a cherry delicately enough between finger and thumb to pluck off its stem without crushing the fruit. Another photo shows a user squeezing toothpaste out of a tube.

Full story of sense of touch with a prosthetic hand at APTA

Self-Reported Quality of Life Among Adolescents With Cerebral Palsy Similar to Peers Without Disability

In what authors describe as “some of the most reliable evidence on how adolescents with cerebral palsy feel about life,” a new study from Europe reports that in general, self-reported quality of life (QoL) among this population isn’t that much different from their peers without disability, but could be even better with greater attention paid to pain early on.

Researchers gathered responses to a survey (KIDSCREEN) issued to the same group of 355 individuals with cerebral palsy at 2 different points in their lives—as children aged 8 to 12 (average respondent age 10.4) and then later as adolescents aged 13 to 17 (average respondent age 15.1). The study compared the responses against results from adolescents without a disability and longitudinally within the respondents with cerebral palsy. An article describing the results was e-published ahead of print in the October 7 issue of The Lancet.

Full story of life with cerebral palsy among adolescents at APTA

Hospital Rates, Lengths of Stay Drop; Costs Continue ‘Steady’ 1.8% Rise

“Greater use of chronic disease management programs and emphasis on outpatient treatment” may be part of the explanation for an overall decrease in inpatient hospital stays from 2003 to 2012, according to a recent report that analyzed community hospital use over a 10 year period.

According to the study, hospitalization rates dropped by an average of .3% per year from 2003 to 2008, and an average of 1.8% per year from 2008 to 2012.

The report, issued by the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project, looked at rates, length, costs, and demographic variables related to hospitalization, and found that in addition to dropping rates, length of hospitalization also decreased by an average of .2% per year between 2003 and 2012.

Full story of hospital rates continuing to rise at APTA

IMPACT Act Standardizing Postacute Care Data Signed Into Law

Legislation that would standardize data used across postacute care (PAC) settings has been signed into law and will join a larger package of reforms. APTA worked to influence this legislation.

The Improving Medicare Post-Acute Care Transformation (IMPACT) Act signed by President Barack Obama on Monday directs the US Department of Health and Human Services (HHS) to standardize patient assessment data, quality, and resource use measures for PAC providers including home health agencies (HHAs), skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and long-term care hospitals (LTCHs).

The House and Senate passed the legislation in September.

Full story of the IMPACT Act at APTA

Acupuncture No Better Than Sham for Chronic Knee Pain in Adults 50+

Regardless of whether it’s delivered traditionally or through a more high-tech laser version, acupuncture doesn’t appear to have any benefit over sham procedures when it comes to reducing moderate-to-severe knee pain in adults 50 and over, according to a new study in the October 1 issue of the Journal of the American Medical Association(JAMA).

Researchers in Australia studied treatments of 282 patients who were 50 or older and had been experiencing moderate to severe knee pain on most days for a period of time longer than 3 months. The patients were divided into 4 groups: a needle acupuncture group, a laser acupuncture group, a sham laser acupuncture group, and a control group. Acupuncture treatments were conducted 1 to 2 times weekly for 12 weeks. Both acupuncturists and patients did not know if they were involved in the sham or actual laser treatment, but there was no sham treatment used in the needle-based acupuncture group.

Full story of acupuncture for chronic knee pain for over 50+ at APTA