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  • Help Identify Physical Therapy's 'Top 5' Unnecessary Procedures

    APTA is asking its members to choose wisely in order to help consumers do the same.

    This week, all APTA members were invited by e-mail to participate in a survey that will help the association identify the "top 5 things physical therapists (PTs) and patients should question," for consideration to be included in the American Board of Internal Medicine Foundation's "Choosing Wisely" campaign. This high-profile effort aims to educate consumers on health care procedures that tend to be done frequently, yet whose usefulness is called into question by evidence. The survey is now available online.

    APTA is among the first 3 nonphysician provider organizations to be invited to join this project, which is being promoted by Consumer Reports and has already garnered media attention.

    The association's work to create a physical therapy-related list began with a call for suggestions from members. A member expert panel reviewed over 170 suggestions and narrowed the list down to 9 candidates, basing its choices on Choosing Wisely requirements that the tests or procedures have been called into question through generally-accepted evidence, yet are frequently done.

    Members have until June 3 to complete the survey. The top 5 questioned procedures will go to the APTA Board of Directors before being submitted to the ABIM Foundation for final approval. Members who missed the initial e-mailed survey link are being advised to be on the lookout for a reminder e-mail coming soon. (Not receiving e-mails from APTA? Update your e-mail preferences or check your spam folder.)

    Choosing Wisely is a consumer-focused effort that is not intended to influence payment or coverage decisions. Instead, the initiative is designed to foster conversations between patients and health care providers about the care that is truly necessary for the individual health care consumer.

    Once approved by the APTA Board of Directors and accepted into the program, APTA's Choosing Wisely list will become a feature of its Integrity in Practice Initiative, a broad effort to eliminate fraud, abuse, and waste from health care and strengthen the good reputation of physical therapy. The effort was the subject of a feature article (members-only access) in the February issue of PT in Motion.


    • Electric stimulation

      Posted by Bill Curtis on 5/29/2014 10:37 PM

    • Did the email go out to members already? I have not recieved it and would love to contribute. Thank you

      Posted by Kate Campbell -> ?OSa@O on 5/29/2014 10:42 PM

    • Very, very bad idea! I strongly urge the APTA to reconsider this! Each clinician practices based on their education, experiences, and beliefs. To criticize one approach leads to my way is better than your way, and that is a very slippery slope! We could debate for hours "what works" and never get anywhere. For example, electrical stimulation WORKS yet one insurance company (biased) publishes an article stating it doesnt do they don't have to reimburse that code. The APTA should be focused on supporting ALL it's members and prioritize improving reimbursements and autonomous practice! Thank you!

      Posted by Andrew Reed on 5/29/2014 10:48 PM

    • Looking for the e-mail invite? Be sure to check your spam folders.

      Posted by APTA Staff on 5/30/2014 9:06 AM

    • I encourage members with concerns to visit the choosing wisely site and explore the lists generated by our colleagues in healthcare. They are not meant to stifle care but support clinicians using evidence based practice to confirm or inform them and their patients. The 2 examples below- we as therapists know to be best practice, however, we also know that internet savvy patients often want something that is expensive and unnecessary or in the case of overuse of antibiotics potentially harmful. These choosing wisely partner groups are simply informing within and outside their field the rationale behind clinical decisions they make. This is our opportunity to join that best practice initiative. Please check spam and junk folders for the link- once you go see what is actually up for vote- you will likely find many/most that you will embrace. This is our chance to show we provide informed practice and choose wisely. 1. Avoid computed tomography (CT) scans of the head in emergency department patients with minor head injury who are at low risk based on validated decision rules. http://www.choosingwisely.org/doctor-patient-lists/american-college-of-emergency-physicians/ 2. Don’t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement. http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-family-physicians/

      Posted by Tara Manal -> =GYaBF on 5/30/2014 9:29 AM

    • I think your time would be better spent on so much more. All this does is continues to arm insurance payors for denials. You guys want to put patients and professionals in boxes. We are just ants in a universe and are just scratching the surface of understanding the human body. Don't put yourselves in the same narrow boxes physicians have. I believe 7 minutes is what a primary care physician spends with a patient and that is all Evidence based care. Did it solve the patients problem? Probably not. That is the same road that you continue to take this profession.

      Posted by Jeff on 5/30/2014 9:18 PM

    • Estim means a lot. TENS vs NMES - the latter is supported for example. Anyway to some commenters: some interventions actually should NOT be used MOST OF THE TIME but not all based on evidence. E.g lumbar traction, mechanical in addition to manual cervical traction, craniosacral therapy to name a few... Time for us to think like the doctoring profession we are.

      Posted by John L on 5/31/2014 10:47 AM

    • "Time for us to think like the doctoring profession we are". Ok, that's fine, but does that mean we have to exclude all those so called passive manual methods that many PT's have no experience in (but some PT's do and get great results) yet evidence based PT's suggest that they should not be used. The human body is just too complex for a physical therapist to think that they have it all figured out by the evidence of today. The evidence today may in fact be crap in the future and in fact some of it is crap right now. At the end of the day, it is the patient that determines who's getting results and who is not. Lets just make it all cookie cutter like a cook book. That should solve the problem, and then we can be just like many primary care physicians and the model they use with the 7 minutes they spend. The APTA's view of a Doctoring Profession doesn't provide any security for PT's and nor do many of the State Associations opinions. I know that the CPTA threw PT's under the bus last year so frankly these associations are very hard to trust what they think along with the weak membership numbers that exist relative to the numbers of PT's in each State and in the Nation. Leave well enough alone in my opinion and let therapist's be innovative to discover new things. Why to they call a PT Practice, practice? Because a PT is learning ALL the time, discovering new things some evidence based and some not. So long as it does no harm, the sky should be the limit so long as it stays within the scope of practice in each State.

      Posted by Jeff on 5/31/2014 6:20 PM

    • I am all for evidence in practice. However, how does one add new procedures and practices? If it is not in the "cookbook" will insurance companies decide not to pay. I use a great deal of non-traditional procedures, basically they are classified as NMRE, will those procedures be denied? I see many people who have failed more traditional PT and have excellent results. Not sure how people who treat the most challenging conditions will fit into the "mold".

      Posted by Bonnie on 6/6/2014 1:34 AM

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