Carole B. Lewis, PT, DPT, GTC, PhD, has focused throughout her career on the continuous improvement of clinical care provided to older adults. Dr Lewis is an adjunct professor at the George Washington University Medical Center Department of Health Care Services and continues to work in private practice. She serves as president of Great Seminars and Books and Great Seminars Online and for 33 years has been editor-in-chief of Topics in Geriatric Rehabilitation, which won the Association of American Publishers’ Award for the Most Outstanding Issue of a Scientific Journal. She earned a DPT from MGH Institute of Health Professions, a PhD in health education from the University of Maryland, an MS in gerontology from the University of Southern California Leonard Davis School, an MPA in health care management from the University of Southern California, and a BS in physical therapy from The Ohio State University.
Dr Lewis has held 24 consultation positions in clinics and workplaces and with third-party payers. One of the first researchers to determine that older adults are able to exercise safely and can realize major improvements in outcomes when prescribed appropriate exercise, Dr Lewis has published extensively in the field of aging, with research published in journals such as Archives of Physical Medicine and Rehabilitation and the New England Journal of Medicine. She is author of more than 20 textbooks on aging, including what may be the first text on aging and rehabilitation and one of the first on functional assessment (Aging: Health Care’s Challenge: Interdisciplinary Assessment and Treatment of the Geriatric Patient, now in its fourth edition; Geriatric Clinical Strategies; Geriatric Physical Therapy; Orthopedic Assessment and Treatment of the Geriatric Patient; The Geriatric Exercise Kit; The Functional Toolbox I & II; The Balance Book and Osteoporosis Exercise Book; The Prevention and Wellness Toolbox; The Orthopedic Outcome Toolbox; Health Promotion and Exercise for Older Adults; and Improving Mobility in Older Persons: A Manual for Geriatric Specialists). She also coauthored a book for the lay public titled Age-Defying Fitness.
As rates of obesity rise, so do the challenges associated with providing care. And nursing homes are feeling the strain.
A recent article by Kaiser Health News (KHN) and The New York Times (NYT)looks at how care facilities are struggling to accommodate an ever-increasing number of residents who require special care and equipment related to their weight.
“Obesity is redrawing the common imagery of old age: the slight nursing home resident is giving way to the obese senior, hampered by diabetes, disability, and other weight-related ailments,” reporter Sarah Varney writes. “Facilities that have long cared for older adults are increasingly overwhelmed—and unprepared—to care for this new group of morbidly heavy patients.”
Everyone’s entitled to his or her beliefs, so they say. But what happens when those beliefs get in the way of getting better?
This month’s issue of PT in Motion magazine takes on the subject of how physical therapists (PTs) and physical therapist assistants (PTAs) can help their patients and clients overcome misbeliefs that can interfere with achieving optimal outcomes. The feature-length article includes plenty of real-life examples of patients attached to ideas that were barriers to their understanding of their condition and how physical therapy can help—everything from believing that exercising makes multiple sclerosis worse, to a theory that wearing wet jeans causes arthritis.
Keeping in mind that patient values and beliefs are a factor in evidence-based practice, how should a PT or PTA handle off-target patient beliefs? According to the article, there simply isn’t a single best way—it’s all about nuance, about understanding the kind and source of the misinformation the patient holds, and about approaching the issue with genuine sensitivity to the patient’s belief system, culture, personality, and learning style.
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.
In what authors call a “distortion” of a Medicare prospective payment system (PPS) adopted 12 years ago, a new study says that long-term care hospitals (LTCHs) are basing discharge decisions less on patient status and more on capitalizing on a schedule that maximizes their reimbursements.
For their study, researchers looked at LTCH discharges for 55,840 patients 65 and older who were admitted for a respiratory symptom diagnosis that required prolonged ventilation—a sample that authors write “is persistently the most common and highest-reimbursed [diagnosis related group].” Authors reviewed records from 444 LTCHs of varying sizes across the country, looking to see if they could discern a pattern of discharges clustered around day 29, the end of the “short stay threshold,” after which reimbursements peak for this particular diagnosis group.
What they found didn’t really require much discernment.
The newest round of extensive Medicare part B payment data released by the US Department of Health and Human Services (HHS) is already making headlines for the “vast trove” of payment data on more than 950,000 providers, including just over 39,000 physical therapists (PTs).
On June 1, CMS released the second set of data, this one from 2013, on providers who received $90 billion in Medicare payments. The report also includes data on the 100 most common Medicare hospital stays.
Again this year, data on PTs included only services and procedures provided by or under the supervision of individuals enrolled in the Medicare Part B program as PTs in private practice. Not included were PTs providing services in hospitals, skilled nursing facilities, or rehabilitation agencies. In cases in which a PT in private practice billed Medicare for the services of physical therapist assistants (PTAs), those costs were attributed to the supervising PT.
The transformative power of physical therapy to treat diverse conditions is at the heart of recent Move Forward Radio episodes.
A twice-monthly podcast, available for free download from iTunes or at MoveForwardPT.com, Move Forward Radio is a terrific resource to share with your patients. Recent episodes include:
Pregnant and postpartum exercise
During pregnancy and childbirth a woman’s body goes through profound changes in a relatively brief period of time. For women who exercise during or after pregnancy, failure to respect those changes has the potential to lead to problems. Christy Martin, PT, DPT, SCS, who specializes in sports physical therapy, and Vicki Lukert, PT, PRPC, who specializes in pelvic health, outline how pregnant and postpartum women can exercise safely and how to spot warning signs for problems that might require medical attention.
Legislation that would include physical therapists (PTs) among the professions included in a federal program to provide greater patient access to health care in underserved areas was introduced in both the US House of Representatives and Senate, just in time to be included in the grassroots advocacy efforts taking place during PT Day on Capitol Hill June 3-4.
The Physical Therapist Workforce and Patient Access Act (H.R. 2342/S. 1426) was reintroduced late last week and, if passed, would allow PTs to participate in the National Health Service Corps (NHSC) loan repayment program, an initiative that repays up to $50,000 in outstanding student loans to certain health care professionals who agree to work for at least 2 years in a designated Health Professional Shortage Area (HPSA).
The bill was introduced in the House by John Shimkus (R-IL) and Diana DeGette (D-CO), and in the US Senate by John Tester (D-MT) and Roger Wicker (R-MS). The timing of the reintroduction couldn’t be better, as an estimated 1,000 PTs, physical therapist assistants (PTAs), and students from PT and PTA programs descend on Washington, DC, to join in PT Day on Capitol Hill on June 4. Events will begin with a rally before participants fan out across the halls of Congress to advocate for increased patient access to PTs, loan forgiveness, the Medicare therapy cap, and other issues.
A recent article in Modern Healthcare says that with increasing frequency skilled nursing facilities (SNFs) are being forced to compete for a coveted place on a hospital’s list of “preferred facilities” that will receive the bulk of the hospital’s referrals. According to the article, the results seem to be paying off—both in terms of improved patient outcomes and lower costs.
Reporter Melanie Evans tracks trend by focusing on several hospitals that have adopted an “aggressive new strategy” of creating a shortlist of SNFs that will be recommended to patients after discharge. These preferred facilities are accepted based on a host of outcome data from state health reports and Medicare quality measures, including length of stay and readmission rates, in addition to questionnaires and interviews from the hospital.