In The News

New Bill Seeks To Increase Physical Therapy's Role at Community Health Centers

The bipartisan legislation would ease billing and other restrictions to boost patient access to care, especially in rural areas. Patients who receive care through community health centers could find it easier to access physical therapy, if a new bill introduced into the U.S. House of Representatives makes its way into law.

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Beginning Oct. 1: Stop Using This ICD-10 Code for LBP

In a continuing press for codes that are more specific, a single, general LBP code has been replaced with several.

One of the most commonly billed codes in the rehab industry is about to disappear: Beginning Oct. 1, the International Classification of Diseases code for low back pain — M54.5 — will no longer exist in the ICD-10 listings. The more general code is being replaced by a series of codes related to LBP aimed at providing greater specificity around diagnosis.

The changes come as part of annual updates to the ICD-10 that are implemented every October.

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We Went to D.C. to Advocate for Our Profession. Here's What It Was Like

APTA wrapped up its centennial celebration with an in-person advocacy day in Washington, D.C., on Sept. 14. More than 450 PTs, PTAs, students, and supporters turned out for the event, which was preceded by a training session on Sept. 13.

So what happens during an APTA advocacy event? We asked Theresa Marko, PT, DPT, the New York Physical Therapy Association's; federal affairs liaison, to chronicle her experience. She was joined in the project by Sabrina Basile, SPT, a student at Daeman College and advocacy chair of the NYPTA student special interest group; and Zaryna Sanchez, SPT, from Mercy College.

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CMS Official: Don't expect a lot of fully risk-based payment models going forward

Fierce Healthcare
Don’t expect a lot more fully risk-based payment models from the Center for Medicare and Medicaid Innovation (CMMI), a top official said.
Centers for Medicare & Medicaid Services Chief Operating Officer Jon Blum detailed the agency’s vision for value-based care during the National Association of Accountable Care Organizations' fall conference Thursday.
“I don’t think that CMS will be promoting models that have more risk just for the sake of having more risk,” said Blum.
Although Blum said it is still important to have risk-based models, there are data that show downsides of full-risk payment models.
“We know that when we [incentivize] risk we see some downsides to that,” Blum said. “We see stronger incentives for more diagnosis code submissions, some of which might be appropriate, some of which not.”
Another concern is when you have “more transformation towards risk that tends to favor those who are better capitalized and can afford risk,” he added.
ACOs agree to take on a share of financial risk and meet spending and quality benchmarks. ACOs that don’t meet the benchmarks will have to repay Medicare but will get a share of savings if they do.
CMS has offered payment models that require providers to take on a high degree of risk. However, one of those models, the Next Generation ACO model, was sunset by the Biden administration.
Blum said that doesn't mean CMS won't adopt any high-risk models.

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Critical Time Window for Rehabilitation After a Stroke

National Institutes of Health

Every 40 seconds, an American has a stroke. About 750,000 new strokes occur in the United States each year.

Restoring brain function after a stroke remains a challenge. Functional recovery from brain damage requires networks of nerves to adapt and reorganize. This “neuroplasticity” naturally occurs during early development. But studies in rodents suggest that there is a brief period of similarly high neuroplasticity after a stroke. Intensive motor training provided to rodents during this window can lead to nearly full recovery. But no evidence for a similar recovery window in humans has previously been found.

To find out if such a window exists in people, a team led by Dr. Alexander Dromerick of Georgetown University Medical Center and MedStar National Rehabilitation Hospital conducted a randomized phase II clinical trial. NIH’s National Institute of Neurological Disorders and Stroke (NINDS), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and National Institute on Deafness and Other Communication Disorders (NIDCD) supported the study. Results appeared in the Proceedings of the National Academy of Sciences on September 20, 2021.

The researchers recruited 72 patients from a rehabilitation hospital in Washington, DC. They randomly assigned participants to one of four groups. All participants received standard stroke rehabilitation therapy. Those in three of the four groups received an extra 20 hours of intensive motor skills therapy. In the first group, the extra therapy began within 30 days of stroke onset. In the second group, extra therapy began 2-3 months after stroke onset. In the third, it began 6-7 months after stroke onset. Participants in the fourth (control) group received no extra therapy.

The researchers assessed arm and hand function at various points before and after treatment, up to 12 months after stroke onset. People in the 2–3 month therapy group showed the greatest improvement one year after their strokes. Participants in the 30-day group showed smaller but still significant improvement. By contrast, participants in the 6-7 month group showed no significant improvement over controls.

“Our results suggest that more intensive motor rehabilitation should be provided to stroke patients at 60 to 90 days after stroke onset,” co-author Dr. Elissa Newport says.

“Previous clinical trials have found few or very small improvements in motor function post-stroke, so our research could be an important breakthrough in finding ways we can make substantial improvements in arm and hand recovery,” Dromerick says.

The results strongly suggest that there is a critical time window for rehabilitation following a stroke. For this study, that window was 2-3 months after stroke onset. Larger clinical trials are needed to better pin down the timing and duration of this critical window. A larger trial could also determine what dose of therapy would achieve the best results during this window.

—by Brian Doctrow, Ph.D.

References: Critical Period After Stroke Study (CPASS): A phase II clinical trial testing an optimal time for motor recovery after stroke in humans. Dromerick AW, Geed S, Barth J, Brady K, Giannetti ML, Mitchell A, Edwardson MA, Tan MT, Zhou Y, Newport EL, Edwards DF. Proc Natl Acad Sci U S A. 2021 Sep 28;118(39):e2026676118. doi: 10.1073/pnas.2026676118. PMID: 34544853.

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