A Robot Physical Therapist Helps Kids with Cerebral Palsy

A young girl in Atlanta manages the symptoms of cerebral palsy with regular physical therapy, which normally means a visit to a doctor’s office, or hours of boring, repetitive actions on her own. Recently though, she began taking instructions, at home, from a pint-sized robot physical therapist called Darwin.

Researchers at Georgia Institute of Technology are using robots to help children and adults meet their physical therapy goals. And they’ve found that combining a simple game with words of encouragement and physical cues from the robots provides a noticeable boost to patients’ efforts, compared to asking them to go through the work on their own.

Full story of the PT robot at MIT Technology Review

Analysis of Hospital System’s LE Joint Replacement Bundling Programs Reveals Significant Drop in Expenditures

In brief:

  • Analysis of Medicare payments related to 3,942 LE joint replacements in a 5-hospital network participating in voluntary bundling programs between 2008 and 2015.
  • During study period, average expenditures on replacements without complications dropped by 20.8%; expenditures on replacements with complications dropped by 13.8%.
  • Treatment population, severity of illness, and outcomes remained stable during study period; volume rose steadily.
  • Just over half (50.2%) of the savings were related to reduced in-hospital costs—predominantly due to a 30% reduction in the cost of implants. The remaining 48.8% of savings were related to a decreased use of IRFs and SNFs.
  • Use of home health care (including physical therapy in that setting) increased by 9% during study period.

It may be too soon to judge the cost-effectiveness of Center for Medicare and Medicaid Services’ (CMS) mandatory hip and knee replacement bundling programs, but if the experience of 1 hospital system that participated in earlier voluntary programs is any indication, facilities have reason to expect overall Medicare expenditures to drop, say authors of a new study. Their analysis of nearly 4,000 patients who participated in bundling programs between 2008 and 2015 revealed an average 20.8% reduction in expenditures for joint replacements without complications, with the bulk of those savings due to reduced implant prices and the decreased use of institutional postacute care.

Full story on the cost-effectiveness of hip and knee replacement bundling programs at APTA

Revised Physician Guidelines Shift to Non-Drug Approaches as First-Line Treatment for LBP

In brief:

  • In a revision of clinical guidelines, the American College of Physicians is recommending nonpharmacologic approaches over the use of medications as first-line treatment for acute, subacute, and chronic LBP.
  • Changes are based in part on new evidence showing that acetaminophen and antidepressants were no better than placebos.
  • Guidelines recommend that physicians advise patients that pain is likely to diminish through exercise and maintenance of as many daily activities as possible.

The latest advice on low back pain (LBP) from the American College of Physicians (ACP) makes it clear: patients with acute LBP will generally improve over time regardless of treatment, and that when treatments are necessary, nondrug approaches including exercise are preferred for all but the most stubbornly chronic manifestations of the condition. The new guidelines represent a shift from ACP’s previous position, which called for the use of medication as part of first-line treatment.

Full story on use of medication as first-line treatment for LBP at APTA

Lymphedema Treatment Legislation Returns to Congress

The possibility of Medicare paying for lymphedema treatment supplies, a longtime target of APTA advocacy efforts, is back on the table at the US House of Representatives with the reintroduction of a bill that would expand coverage.

Last week, Reps Dave Reichert (R-WA), Earl Blumenauer (D-OR), Leonard Lance (R-NJ), and Jan Schakowsky (D-IL) introduced the Lymphedema Treatment Act (HR 930), legislation that would expand the range of compression supplies covered by Medicare for lymphedema treatment. A companion bill is expected to be filed in the Senate in the coming weeks.

Full story of lymphedema treatment legislation at APTA

Lower Extremity Stiffness Changes after Concussion in Collegiate Football Players

Recent research indicates that a concussion increases the risk of musculoskeletal injury. Neuromuscular changes after concussion might contribute to the increased risk of injury. Many studies have examined gait postconcussion, but few studies have examined more demanding tasks. This study compared changes in stiffness across the lower extremity, a measure of neuromuscular function, during a jump-landing task in athletes with a concussion (CONC) to uninjured athletes (UNINJ).

Full story of extremity stiffness change after concussions at Physiospot

Legal Dispute Continues Over Medicare Coverage Of Physical Therapy

Four years after Medicare officials agreed in a landmark court settlement that seniors can’t be denied coverage for physical therapy and other skilled care simply because their condition isn’t improving, patients are still being turned away.

As a result, federal officials and Medicare advocates have renewed their federal court battle, acknowledging that they cannot agree on a way to fix the problem. Earlier this month, each submitted ideas to the judge, who will decide — possibly within the next few months — what measures should be taken.

Several organizations report that the government’s initial education campaign following the settlement has failed. Many seniors have only been able to get coverage once their condition worsened. But once it improved, treatment would stop — until the people got worse and were eligible again for coverage.

Full story of legal disputes over Medicare coverage of PT at NPR

Judge Lays Out What CMS Must Do to Correct Jimmo Education Failings

The 2013 settlement agreement reached in the Jimmo v Sibelius case was supposed to have debunked the “improvement standard” myth once and for all—provided, of course, that the Centers for Medicare and Medicaid Services (CMS) did the debunking and educated Medicare contractors and others on the importance of stopping inappropriate coverage denials. Last year, a federal judge ruled that CMS fell short on those efforts. Now that same judge has spelled out just what CMS must do to make things right—and by when.

In a ruling released February 2, US District Court Judge Christina Reiss told the Secretary of Health and Human Services that CMS has until September 4 to complete a series of steps that would make it clear to Medicare contractors, Medicare Advantage plan administrators, and others that the so-called “improvement standard”—the idea that Medicare coverage can only be extended if that care will actually improve the patient’s condition—is a fallacy.

Full story of CMS and Jimmo Education failings at APTA

Stay on Top of Medicare Changes With Latest APTA Fact Sheets

New, proposed, and revised rules from the Centers for Medicare and Medicaid Services (CMS) can come in waves, and when they do, it’s easy to feel awash in a sea of new regulations. Fortunately, APTA has resources to help you navigate your way to safe harbor: fact sheets that provide members with context and details on many of the final and proposed rule changes from CMS.

Here’s a quick rundown of some recent additions. Note: the links will take you to a general webpage on a particular topic—to access the members-only fact sheet, scroll down to the “APTA Fact Sheets and Summaries” header.

Home Health Conditions of Participation Final Rule
CMS brought its home health participation rule out of the 1990s by issuing its first revision to the rule in more than 20 years. The new rule establishes minimum standards for home health agencies that want to serve Medicare and Medicaid beneficiaries.

Full story on the top Medicare changes at APTA

NIH: Treatment Using Patients’ Own Stem Cells Shows Promise for Knocking MS Into Remission

Through a process that the National Institutes of Health (NIH) likens to a “resetting” of the immune system, some individuals with multiple sclerosis (MS) are experiencing long-term remission of the disease symptoms with no additional brain lesions. The technique, which depletes a patient’s immune system before rebuilding it through transplants of the individual’s own stem cells, has proven effective at keeping nearly 70% of participants with MS symptom-free for 5 years—all without the use of any additional medications.

The treatment, known as high-dose immunosuppressive therapy and autologous hematopoietic cell transplant (HDIT/HCT), was applied to 24 participants with relapsing-remitting MS, the most common form of the disease. The patients ranged in age from 26 to 52 years, and all were experiencing active inflammation, severe relapses, and worsening disability despite taking medications.

Full story of stem cell treatment for knocking MS into remission at APTA

Welcome Back: Therapy Cap Repeal Is Reintroduced in Congress

After falling short by the narrowest of margins in 2015, an APTA-supported bill to end the Medicare therapy cap has been reintroduced in both houses of Congress. And now it’s time for the physical therapy community to make its voice heard.

The bill, named the Medicare Access to Rehabilitation Services Act (HR 807, S 253) would repeal the therapy cap once and for all, ending a battle that has taken place almost every year since the adoption of the 1997 Balance Budget Act. Representatives Erik Paulsen (R-MN), Ron Kind (D-WI), Marsha Blackburn (R-TN), and Doris Matsui (D-CA) introduced the legislation in the US House of Representatives. In the Senate, the bill was introduced by Sens Ben Cardin (D-MD), Susan Collins (R-ME), Dean Heller (R-NV), and Bob Casey (D-PA).

Full story of therapy cap repeal at APTA