It isn’t news that the number of total knee and total hip replacements is rising across the country. But what may be news is that efforts to reduce hospital readmissions associated with the surgeries may be working, albeit in different ways for different age groups.
A study released by the American Association of Retired Persons (AARP) looked at over 142,000 insurance claims from individuals 50 and older enrolled with a “large insurance carrier” to calculate the prevalence of the replacement surgeries—and rates of 30-day readmissions—from 2009 to 2013. What they found was that while both total hip arthroplasty (THA) and total knee arthroplasty (TKA) numbers rose dramatically, readmission rates fell nearly as dramatically, particularly among the 65- to 84-year-old age group.
Overall, THA rates jumped by 73% between 2009 and 2013, with TKA rates rising by 46% during the same period. THA rates for the 65-84 age group increased by 113%, while the 50-64 group saw a 58% rise. For TKA procedures, the older group once again outpaced the younger group, with the 65-84 group registering an 80% increase in procedures, compared with the 50-64 group’s 23% increase.
Women who want to protect themselves against cognitive decline as they age could get a leg up through legwork, according to a new study that found “a striking protective relationship” between aging women’s leg power and cognitive changes over 12 years.
Researchers in England reached this conclusion after analyzing leg muscle power and cognitive performance among 324 healthy female twins at baseline (average age, 55; range 43-73) and then 12 years later. After controlling for health and demographic variables, they found that the women who had increased leg power at baseline scored better on tests of brain processing speed and visual memory 12 years later than the women with lower leg power at baseline. Overall differences were modest but consistent, with a 40-watt leg explosive power (LEP) increase correlated with an average 3.3 years’ lower cognitive age.
Authors of the study assert that the use of twins further strengthens their conclusions, because they were able to compare 10-year differences among “discordant” twins—twins with similar genetic traits and childhood environmental influences, but whose leg power was different at baseline. As with entire group comparisons, researchers found that the twin with the greater leg power tended to demonstrate slower cognitive decline than her sister. The strongest differences were noted in dizygotic (fraternal) twins; less so in monozygotic (identical) twins.
When it comes to rehabilitation, many physical therapists (PTs) and physical therapist assistants (PTAs) don’t play around.
But maybe they should.
The “gamification” of physical therapy may not be anything new, but it’s been receiving attention from the media lately. Here’s a quick roundup of some of the highlights published recently.
The New Yorker looks at “a radical new approach to treating stroke patients”
This feature-length article in the November 23 issue of the magazine looks at “Bandit Shark Showdown,” a rehabilitative video game designed by a team of neuroscientists and game developers in the Brain, Learning, Animation, Movement (BLAM!) lab at Johns Hopkins University. Writer Karen Russell explores the game’s development and BLAM! leader John Krakauer’s thoughts on the relationship between the brain and the motor system.
If you recently received a Physician Quality Reporting System (PQRS)-related penalty notice from the Centers for Medicare and Medicaid Services, you’re not alone. But you need to take action before a November 23 deadline.
APTA is aware that some members have received letters related to PQRS performance during 2014. If you believe you have received a penalty notice letter in error, be sure to submit an informal review request through the CMS “QualityNet” website by Monday, November 23.
CMS has informed APTA that providers have been experiencing problems in reaching QualityNet over the past several days, and says that it’s attempting to fix the problem. APTA is also working with CMS to ensure that physical therapists are not unduly penalized for 2014 PQRS performance.
The Centers for Medicare and Medicaid Services’ (CMS) plan to implement a mandatory bundled care system for total hip and knee replacements in 2016 is not quite as extensive as originally planned and won’t start on January 1—but it’s still a big change, and it hasn’t been delayed for that long.
The basic idea is that in 67 metropolitan statistical areas, CMS will impose a bundled payment system—called the Comprehensive Care for Joint Replacement (CJR) model—for total knee and total hip replacements, comparing what hospitals spend in total on care, from admission to 90 days postdischarge, with what Medicare thinks they should be spending. If the total spending is less than the Medicare target, the hospitals may be eligible to receive additional payment from Medicare—but if they spend more than the Medicare target, they could be required to pay back Medicare for some portion of the difference.
There was a point in Scott Aldridge’s life when he wondered if he was about to lose the ability to walk. He was 50 years old, 520 pounds, and dealing with chronic venous wounds on his legs.
He wasn’t particularly hopeful that he could get better. But his physical therapist,Stephanie Fournier, PT, DPT, WCS, CLT-LANA, had other ideas.
Three years, more than 300 pounds, lots of physical activity later, Aldridge has an uplifting story worth sharing—and APTA is helping that story find a wider audience.
Aldridge’s transformational story is now part of the Patient Stories section of APTA’s official consumer information website, MoveForwardPT.com. Publication of the story will be followed by a podcast in which Aldridge describes his incredible improvement and Fournier’s role in inspiring that change.
OA: Do’s, Don’ts, and a Free Webinar With More Details
Physical therapists (PTs) and physical therapist assistants (PTAs) understand the importance of physical activity (PA) for their patients with knee osteoarthritis (OA), and they know just what a patient should do to maintain healthy activity and exercise levels. The challenge, of course, is getting patients to actually follow through.
Maura Daly Iversen, PT, DPT, SD, MPH, FNAP, FAPTA, knows the challenge well. Iversen, who serves as chair of Northeastern University’s Department of Physical Therapy, Movement, and Rehabilitation in the Bouve´ College of Health Sciences in Boston, has made nonpharmacologic approaches to rheumatology treatment a particular area of focus during her career, and will share her expertise during a free “lunch and learn” webinar sponsored by the Osteoarthritis Action Alliance (OAAA). APTA is an OAAA member.
Titled “Techniques to Enhance Adherence to Physical Activity and Exercise Recommendations: From Theory to Practice,” the prerecorded 30-minute session, set for Wednesday, November 18, at 12:00 pm ET, will address ways to motivate patients with OA – and keep them motivated.
The role of education and advice in the treatment of low back pain (LBP) may be important, but it’s probably not as effective as coupling that advice with physical therapy that’s been “individualized” to the particular kind of LBP a patient is experiencing, according to a new study from Australia.
Researchers focused on 300 patients, aged 18-65 (average age, 44.2) who had experienced LBP for between 6 weeks and 6 months. They split participants into 2 groups: 1 group received 2 30-minute education and advice sessions provided by a physical therapist (PT), plus 10 30-minute physical therapy sessions over 10 weeks; the other group received the education and advice sessions only. Results were e-published ahead of print in the British Journal of Sports Medicine.
A lawsuit challenging the North Carolina Acupuncture Licensing Board’s efforts to prevent physical therapists (PTs) from engaging in dry needling is being supported by the North Carolina Physical Therapy Association. Titled Henry v North Carolina Acupuncture Licensing Board, the challenge is an antitrust lawsuit filed in the US District Court for the Middle District of North Carolina, arguing that the North Carolina Acupuncture Licensing Board (NCALB) is violating antitrust law and due process rights in its actions to prevent PTs from practicing the skilled intervention.
NCALB’s efforts to shut down dry needling began after the state’s Board of Physical Therapy Examiners (NCBPTE) determined that dry needling is within the legal scope of practice of physical therapy in North Carolina, and issued a position statement providing guidance to its licensees. After that determination, NCALB engaged in various actions to prevent PTs from performing dry needling, including the issuing of “cease and desist” letters to PTs and clinics across the state claiming that the PTs practicing dry needling were illegally engaged in the practice of acupuncture, a Class 1 misdemeanor.
The final 2016 rules recently released by the Centers for Medicare and Medicaid Services (CMS) have been analyzed by APTA regulatory affairs staff, and the following summaries are now available:
Physician Fee Schedule
The final rule for the 2016 physician fee schedule includes a slight overall payment increase, the expansion of several quality measures, and continued examination of potentially “misvalued” current procedural terminology (CPT) codes, including 10 related to physical therapy.
Full APTA summary of final rule; PT in Motion News article with highlights.
Home Health Prospective Payment System
The final home health rule includes an estimated overall 1.4% payment reduction that’s smaller than the reduction originally proposed, and the introduction of a new value-based model that will be used in 9 states.
Full APTA summary of final rule; PT in Motion News article with highlights.