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  • APTA Launches New ‘Find a PT’ and ‘ChoosePT.com’ Website to Support Consumer Awareness

    Every day, people choose physical therapy for a multitude of reasons, from managing pain to building healthy lifestyle habits. Now APTA's consumer-focused website has a new name—and a new look—to support that reality and help connect patients with physical therapists (PTs) through an enhanced "Find a PT" feature.

    This week, APTA unveiled ChoosePT.com, a consumer website that replaces MoveForwardPT.com, now retired after 10 years. The new site is a best-of-both-worlds combination of 2 of the association's most high-profile and far-reaching initiatives—APTA's popular online source for consumer-oriented health information, now operating under a name that leverages the power of the association's award-winning opioid awareness campaign. The ChoosePT site is expected to receive more than 4 million visitors in 2019, with anticipated increases in the coming years.

    The transition to ChoosePT does not significantly change the content on the former MoveForwardPT site, which still includes information on symptoms and conditions, prevention, and pain management, as well as access to podcasts and videos that deliver powerful messages about the difference physical therapy can make in people’s lives.

    But not everything's the same: The changeover has allowed APTA to make improvements to the site's "Find a PT" directory, an APTA member benefit for physical therapists, that makes it easier for consumers and other providers to filter results by practice focus or specialization.

    The upgraded feature is an opportunity that members shouldn't miss, according to Jason Bellamy, APTA's executive vice president of strategic communications.

    “Millions of people will visit ChoosePT.com this year, and one of their most common destinations will be Find a PT," Bellamy said. "APTA members should ensure their information is up-to-date, and add a headshot to make their profile more appealing. Our message to members is, 'do everything you can to help consumers choose you.'"

    ChoosePT.com is also enhanced by geolocation technologies that, with a user's permission, create an online experience customized to the user's physical location. APTA state chapters that have an active geolocation page—49 to date—can add state-specific information to the ChoosePT site, providing visitors with an additional depth of relevant information.

    Bellamy believes the change to ChoosePT.com is the right move at the right time, with more exciting changes coming around the corner.

    “When we launched our opioid awareness campaign we knew our #ChoosePT message was dynamic enough to extend beyond the safe management of chronic pain,” Bellamy said. “With APTA’s centennial approaching in 2021, and the public awareness opportunities that will provide, this was the perfect time to make that our primary call to action.”

    Want t-shirts with the new ChoosePT logo? They're available here.

    New Rule Allows CMS to Deny Enrollment to Providers 'Affiliated' With Sanctioned Entities

    In this review: US Centers for Medicare & Medicaid Services (CMS) Medicare, Medicaid, and Children's Health Insurance programs; Program Integrity Enhancements to the Provider Process (final rule)
    Effective date: November 4, 2019
    CMS Press Release

    The big picture: a new level of authority for CMS
    CMS has released a final rule that gives it the power to revoke Medicare, Medicaid, and Children's Health Insurance Program (CHIP) enrollments of providers or suppliers who have an "affiliation" with previously sanctioned entities, even if those providers and suppliers aren't directly violating any existing rules themselves. CMS says the new authority will help to "stop fraud before it happens."

    While APTA supports efforts to reduce waste, fraud, and abuse in all areas of health care, we believe this rule may create more problems than it solves, particularly given an overly broad definition of what constitutes an "affiliation." The likely result: undue administrative burden for providers and suppliers who have been compliant from the start.

    The rule goes into effect November 4.

    Notable in the final rule

    • "Affiliations" authority. Under the new rule, all Medicare, Medicaid, and CHIP providers must disclose current or past affiliations with any organization that has uncollected debt, has had a payment suspension under a federal health care program, has been excluded from a federal health care program, or has had billing privileges denied or rescinded. If they don't disclose, CMS reserves the right to prevent them from participating in Medicare, Medicaid, and CHIP. These affiliations must be reported even if the other organization was not enrolled in Medicare, Medicaid, or CHIP at the time of the relationship.

    What's an "affiliation"? CMS provides 5 definitions:

    1. Direct or indirect ownership of 5% or more in another organization
    2. A general or limited partnership interest, regardless of the percentage
    3. An interest in which an individual or entity "exercises operational or managerial control over, or directly conducts" the daily operations of another organization, "either under direct contract or through some other arrangement"
    4. When an individual is acting as an officer or director of a corporation
    5. Any reassignment relationship
    • Expanded authority to revoke Medicare enrollment for other reasons. The final rule also gives CMS more power to revoke or deny Medicare participation for providers or suppliers who do any of the following:
    • Try to come back into the Medicare program under a different name.
    • Bill for services or items from noncompliant locations
    • "Exhibit a pattern or practice of abusive ordering or certifying of Medicare Part A or Part B items, services or drugs."
    • Owe CMS money from an overpayment referred to the US Treasury Department.

    Concerns
    When the rule was first proposed in 2016, we voiced our concerns in a comment letter that characterized the plan as an overly burdensome one that would prove costly for providers and, ultimately, decrease patient access to care as providers downscaled or ended their participation in Medicare. Not much has changed since then

    Between the extremely low 5% ownership threshold that triggers disclosure (APTA proposed a 25% bar), the requirements that providers disclose relationships with affiliates who weren't enrolled in Medicare at the time, and a poorly defined "lookback" requirement that puts a 5-year limit on how far back a provider must scour its records for bad-actor affiliates but no similar timeframe on how long ago that affiliate's violations may have occurred, the new rule is burdensome to say the least.

    Under the rule, we wrote, "providers and suppliers will be forced to become private investigators to determine whether an affiliate ever had its enrollment denied, revoked, or terminated. We believe this is simply not feasible and will divert time that physical therapists could spend on improving the quality of patient care rather than on regulatory requirements that will not make the Medicare program appreciably safer."

    Where things stand
    According to Kate Gilliard, APTA senior regulatory affairs specialist, now that the rule is final, the emphasis should be on monitoring for impacts and reporting problems to strengthen APTA's advocacy for changes in future versions.

    "It's clearly important for CMS and the physical therapy profession to make every reasonable effort to eliminate fraud in health care, and APTA will continue to work toward that goal," Gilliard said. "But this rule threatens to sacrifice patient access to care for the sake of a shotgun approach to the problem, adding further unnecessary burden to providers who already follow the rules. That's the message we will continue to bring to CMS."

    The new rule goes into effect November 4. APTA will provide information on how to comply with the new requirements as it becomes available.

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    Posture and Movement Coordination, Sensorimotor Integration May Affect Motor Skills in Children With Autism

    In this review: Postural Control and Interceptive Skills in Children With Autism Spectrum Disorder
    (PTJ, August 2019)

    The message

    In children with autism spectrum disorder (ASD), problems with sensorimotor integration and difficulty in coordinating posture and arm motions may result in impaired motor planning and control. These children also exhibited fewer anticipatory postural adjustments and demonstrated more corrective control during arm movements. Compared with typically developing peers, children with ASD were less likely to use visual cues to plan for motions required to catch an item, such as a ball.

    The study

    To examine the interplay of sensory cues, postural demands, and arm movement during ball-catching, researchers in Taiwan asked children with and without ASD to catch a ball rolling down a ramp toward them. Of the children, 15 had ASD and 15 were typically developing age- and sex-matched peers.

    During the task, each child was asked to catch a foam ball rolling down 3 stationary tubular ramps inclined at 4 degrees. The first ramp was placed directly in front of the child, while 2 others each were placed 35 degrees to the left and right. The first 59-centimeter section of each ramp was enclosed so that the child could not see the ball. A sensor within the tube activated a beep as the ball passed through, and, to test catching with and without visual cues, a second sensor lit up an arrow sign during half of the catching attempts.

    A real-time motion-capture system measured the children's arm movements while catching the ball. The authors measured center of pressure (COP) displacements using a computerized pressure plate and recorded ball-catching on video, both synchronized with the motion capture system.

    Findings

    • Children who were typically developing had a significantly higher success rate for all 3 ramps than did their peers with ASD.
    • Children with ASD were more successful in catching on the left side and right side ramps than they were in catching on the center ramp.
    • Visual pre-cues had no effect on rates of ball catching. However, children with ASD used visual information to plan their arm movements significantly less often than did their typically developing peers.
    • Overall, children adjusted their posture before moving their arms in nearly half of catching attempts. While children with ASD had a lower rate of postural adjustment for lateral ramps compared with their peers, all of the children were more likely to adjust their posture for lateral directions than they were for the middle ramp. Children with ASD made anticipatory postural adjustments later than did children who were typically developing, and all children adjusted their posture earlier when presented with visual pre-cues.
    • Amplitude of shoulder excursion was greater in children with ASD, and was higher overall when visual pre-cues occurred. In contrast, elbow displacements were larger when no visual pre-cues were present. Visual pre-cues were associated with slower arm movements for lateral catches. In general, children with ASD moved their arms faster than did their peers.
    • During lateral catches, both groups demonstrated larger COP displacements and greater COP velocity, but visual pre-cues resulted in slower COP velocity.
    • Children with ASD demonstrated more corrective control during arm movements than did their typically developing peers.

    Why it matters

    Physical therapist interventions for children with ASD, the researchers write, "could focus on the integration between perception and motor components as well as motor adaptability of the motor skills."

    Related APTA resources

    The association offers a Cochrane systematic review and several clinical practice guidelines through the PTNow resource area. Individuals who want to learn more about physical therapist treatment for autism spectrum disorder can visit APTA's consumer-friendly guide at MoveForwardPT.com, the American Physical Therapy Association's consumer website.

    Keep in mind…

    The study excluded children with intellectual disability and attention deficit and hyperactivity disorders, which might reduce generalizability to the entire ASD population. Also, the small sample size limited the authors' ability to analyze the effect of any comorbidities.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website, where's you'll also find a clinical summary on Autism Spectrum Disorder in Children.

    New Clinical Guidelines Find Strong Evidence Supporting Exercise Therapy for Knee Pain

    In this review: Patellofemoral Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association
    (The Journal of Orthopaedic and Sports Physical Therapy, September 2019)

    The message    
    It's all about movement: In its first-ever comprehensive clinical practice guideline (CPG) on patellofemoral pain (PFP), APTA's Academy of Orthopaedic Physical Therapy (Academy) lays out a set of recommendations that stress exercise therapy as the best approach to improve functional performance in the short, medium, and long term. But that's just 1 facet of the guidelines, which also include recommendations on diagnosis, classification, and examination.

    The study
    A panel of content experts from the Academy conducted an extensive review of scientific articles associated with PFP from 1960 to 2018, evaluating each for its evidence related to physical therapist (PT) clinical decision-making around the condition. From an initial field of 4,691 articles, reviewers winnowed the studies down to 271 that addressed diagnosis and classification (120), examination (56), and interventions (95). The panel then analyzed the overall strength of evidence, and shared a draft of its recommendations with members of the Academy and, later, with a panel of consumer representatives and other stakeholders that included claims reviewers, coding experts, researchers, and academic and clinical educators.

    Recommendations were assigned letters according to the strength of the evidence evaluated: A-"strong," B-"moderate," C-"weak," D-"conflicting," E-"theroretical/foundational," and F-"expert opinion."  

    Among the Recommendations
    Recommendations within the following CPG categories include:

    • Interventions. CPG authors found strong evidence supporting exercise therapy with combined hip- and knee-targeted exercises to reduce pain and improve outcomes, stressing that a combination of hip and knee exercises is better than a focus on knee exercises alone.
      The guidelines also find strong evidence that dry needling shouldn't be used for PFP, and moderate evidence that clinicians should stay away from the use of "biophysical agents" including ultrasound, cryotherapy, electrical stimulation, and laser treatments.
      Taping was supported by moderate-level evidence. The guidelines state that clinicians should combine physical therapist interventions such as foot orthoses, taping, mobilizations, and stretching when appropriate, but that "exercise therapy is the critical component and should be the focus in any combined intervention approach."
    • Diagnosis. Use of diagnostic tests that reproduce retropatellar or peripatellar pain during squatting received an A-level recommendation as a diagnostic tool, as did "performance or other function activities that load the patellofemoral joint in a flexed position, such as stair climbing or descent."
    • Examination. Strong evidence supports the Anterior Knee Pain Scale, the patellofemoral pain and osteoarthritis sub¬scale of the Knee Injury and Osteoarthritis Outcome Score (KOOS-PF), and the visual analog scale (VAS) for activity or the Eng and Pierrynowski Questionnaire (EPQ) as ways to measure pain and function. Moderate-level evidence supports the use of "clinical or field tests" that reproduce pain and allow for assessment of movement. Authors write that "these tests can assess a patient's baseline status relative to pain, function, and disability; global knee function; and changes in status throughout the course of treatment."
    • Classification. The guideline panel found no "previously established valid classification system" for PFP, so it developed one. The system is based on impairment and function-based categories that include overuse/overload, muscle performance deficits, movement coordination deficits, and mobility impairments.


    Why the CPG Matters
    PFP is estimated to affect 1 in 4 adults every year, with women reporting knee pain twice as often as men do. Authors of the CPG write that while the recommendations shouldn't be considered a standard of care that guarantees a successful outcome for every patient, they are a reflection of the best-available evidence around the condition. They add that "significant departures" from the CPG "should be documented in the patient's medical records."

    APTA's Role
    The association provided funding and technical support during development of the CPG. This support is part of an ongoing APTA initiative to work with its sections and academies to produce a range of guidelines that highlight the evidence base for physical therapy in treatment of a variety of conditions. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    3D Technology: All That's Fit to Print?

    When it comes to 3D printing and physical therapy, the future is now—well, almost now.

    In the September issue of PT in Motion magazine: "A New Dimension to Physical Therapy," a feature article that explores the current use of 3D as well as its challenges and possibilities, as seen through the eyes of physical therapists (PTs), a physical therapist assistant (PTA), and a professor of visual arts who heads the University of North Georgia's 3D printing efforts.

    The APTA members interviewed for the story say that in many ways 3D printing has arrived in physical therapy—and already is allowing for the creation of customized equipment and devices, many of which can be produced relatively quickly, and some at a fraction of the cost of their non-3D printed counterparts. The possibilities for orthotics and adaptive equipment for pediatric patients are just some of the reasons the interviewees are excited about the technology's future.

    "Future," however, is the key word: While 3D technology has improved dramatically since its debut in the 1990s, refinements still are needed. And the cost of the devices—particularly those capable of manufacturing with multiple materials—must come down before they become standard equipment in a physical therapy clinic.

    The challenges aren't just technological—a clinic has legal and regulatory considerations should it decide to go all-in on 3D printing now or in the future. Patient safety is an issue, of course, but so is the line between a clinic that produces the occasional customized orthotic and an equipment manufacturer, and the attendant regulatory oversight that entails.

    Still, those challenges shouldn't overshadow 3D printing's potential in physical therapy, and they certainly shouldn't cause physical therapy education programs to shy away from incorporating 3D printing concepts into their curricula.

    Robert Latz, PT, DPT, who was interviewed for the article, says there's good reason for practicing PTs and physical therapy students to keep up with the technology and not wait until it's perfected.

    "We need to learn the technology and apply the development process to this new technology," Latz says in the article. "If we do not do this, someone else will. I guarantee that the technology of 3D printing is only going to continue to improve and that the cost to create with this technology will continue to decrease."

    "A New Dimension to Physical Therapy" is featured in the September issue of PT in Motion magazine and is open to all viewers—pass it along to nonmember colleagues to show them 1 of the benefits of belonging to APTA. Also open to all: highlights from the 2019 APTA NEXT Conference and Exhibition.

    'Fundamentally Flawed': APTA's Comments on CMS' Plan Around PTAs, OTAs Target Potential Harms

    The big picture: a bad plan for determining when services are delivered by a PTA or OTA
    The US Centers for Medicare and Medicaid Services' (CMS) proposed physician fee schedule rule for 2020 includes provisions that would require providers to navigate a complex system intended to identify when outpatient therapy services are furnished by a physical therapist assistant (PTA) or occupational therapy assistant (OTA). If adopted, the plan would trigger a payment differential in 2022 based on how many minutes of services are provided by the PTA or OTA. (See this PT in Motion News story for a more detailed overview of the proposed rule.)

    CMS proposes to accomplish this by way of new PTA and OTA modifiers (CQ and CO, respectively) to be included on claims beginning January 1, 2020. The proposal also requires providers to add a statement in the treatment note that explains why the modifier was or wasn't used for each service furnished that day. In short, the system is rooted in total minutes of service, and would require the use of the applicable modifier that would indicate when a PTA or OTA provided outpatient therapy services for 10% or more of the total time spent furnishing the service.

    The proposal is more than just problematic—it's a threat to patient access to care, a vast overreach of CMS authority, and a documentation nightmare that flies in the face of CMS' "patients over paperwork" initiative to ease administrative burdens on providers. We laid out our concerns in a comment letter to CMS that describes the plan as "fundamentally flawed."

    Some of what's being proposed, CMS reasoning behind it—and what we have to say

    CMS: When the PTA participates in the service concurrently with the PT for a portion of total time, the modifier should be used when the minutes furnished by the therapy assistant are greater than 10% of the total minutes spent by the therapist furnishing the service, which means that the entire service would be subject to the 15% payment adjustment in 2022. This is being done to comply with Section 1834(v) of the Social Security Act.
    APTA: The intent of the therapist assistant provisions in the Social Security Act was to better align payments with the cost of delivering therapy services given that therapist assistant wages are typically lower than therapist wages. It was not meant to apply an adjustment to a PT's services furnished when the therapist assistant provides a “second set of hands” to the therapist for safety or effectiveness.

    The proposal completely ignores the efficacy of team-based care (CMS uses the term “concurrent“) and runs counter to the evolution—ostensibly supported by CMS—toward value-based care. "It is nonsensical to diminish reimbursement for services when safety precautions are implemented, and the overall value of the care is increased," we say in our letter. Bottom line: only services furnished in whole or in part independently by the assistant should count toward the 10% standard.

    CMS: If the PTA and the PT each separately furnish portions of the same service, the modifier would apply when the minutes furnished by the PTA are greater than 10% of the total minutes—the sum of the minutes spent by the therapist and therapy assistant—for that service.
    APTA: This proposal directly contradicts CMS' response to comments in the 2019 fee schedule final rule. In the rule, CMS explained how its claims processing system allows for the differentiation of the same procedure code when the same service or procedure is furnished separately by the therapist and assistant.

    In our letter, we write that “the agency clearly is contradicting itself now, several months later, in proposing to require that the CQ/CO modifier apply when the minutes furnished by the assistant are greater than 10% of the total minutes—the sum of the minutes spent by the therapist and therapist assistant for that service, thereby not allowing for the same procedure code to be reported on 2 different claim lines.”

    But that's just part of the problem. The system CMS is proposing for how providers arrive at this is anything but simple—in fact, we say that it's "outrageous that CMS expects therapy providers—particularly those who do not employ administrative staff and must perform all the coding and billing themselves in addition to delivering treatment to patients—to engage in division, addition, multiplication, and rounding merely to determine whether to affix a modifier to the claim."

    CMS: Beginning in 2022, if the PTA services exceed the 10% limit, reimbursements will be cut by 15%.
    APTA: The cuts pose a grave threat to the delivery of services, particularly in rural and underserved areas, especially when it's combined with the geographic indices that affect payment in these areas—on top of other potential reimbursement reductions in future years. We recommend that if CMS moves ahead with this proposal, it should exempt providers in rural and underserved areas from the requirements.

    CMS: In addition to the use of new modifiers, providers will need to provide a written statement explaining why the modifier was or wasn't used—and it has to be done for each service furnished that day.
    APTA: In our letter we call this plan "wholly unbelievable." Aside from the facts that the modifier proposal itself is extremely complicated and the extra documentation is not required by law, the addition of a statement requirement is clearly an undue administrative burden and a direct contradiction of the CMS "Patients Over Paperwork" initiative.

    We write that the plan "conveys a sense that CMS is being vindictive toward outpatient therapy providers, creating a divisive environment for therapy providers enrolled in the Medicare program." Our comment letter goes on to provide 6 additional reasons why the documentation requirement is a bad idea, including the ways in which it complicates 15-minute timed billing, exceeds requirements of Medicare administrative contractors, and applies a standard to PTs, OTs, PTAs, and OTAs that isn't applied to physicians, physician assistants, and nurse practitioners.

    What's next?
    This letter is the first of 2 comment letters on the fee schedule that APTA will be providing to CMS in the coming weeks. Deadline for comments is September 27, and the final rule will likely be issued by November 1. APTA and several other providers associations will be meeting with CMS officials in mid-September to share concerns and provide recommendations.

    You have an important role to play. Visit APTA's "Regulatory Take Action" webpage to access a customizable template letter on the PTA/OTA modifier, fill it in, and make your voice heard. It's easy—and crucial.

    Stay tuned for additional opportunities for comment on other elements of the proposed rule.

    4 Videos (and a Podcast) to Get You Ready for Pain Awareness Month

    September is National Pain Awareness Month—a perfect opportunity to spread the word about the important role physical therapists (PTs) and physical therapist assistants (PTAs) play in the management of pain, and the unique knowledge they bring to the table.

    Need a reminder of why patient access to physical therapy for pain is so crucial, or inspiration to get you thinking about your own activities during National Pain Awareness Month? Here are some standout videos—and a podcast—that do just that. All but 1 were produced by APTA.

    A Journey Out of Pain and Addiction, and a PT's Crucial Role
    What it's about: In his keynote address for the 2019 APTA NEXT Conference and Exhibition, US Army Master Sergeant (Retired) Justin Minyard recounted the injuries he received during rescue attempts first at the Pentagon during the 9-11 attacks and then while on a mission in Afghanistan. But the heart of Minyard's story is about what happened afterward: the multiple fusion and other surgeries, the intense pain, his slide into addiction, and his eventual freedom from opioids. He readily acknowledges that his recovery was thanks in large part to the work of an interprofessional team that included a dedicated physical therapist.

    Why you should listen: Minyard's brutal honesty and his ability to tell a story with both humor and pathos pull you in from the start. And the gratitude he has for his PT—he describes her as not just his physical therapist "but my psychologist, my sounding board, my marriage counselor, my educator of my options, and my kick in the ass"—will remind you of why you love the profession.

    Beyond Opioids: Transforming Pain Management to Improve Health
    What it's about: This video of a February 2018 Facebook Live panel discussion hosted by APTA provides a wide range of perspectives on physical therapy's role in pain management. Panelists include a patient advocate, a representative from the US Centers for Disease Control and Prevention, a member of the US House of Representatives, the President of the American Academy of Pain Medicine, and 2 PTs working on the front lines of pain management.

    Why you should watch: It's fascinating to watch the ways in which panelists' individual perspectives weave a unified message: that there's a need for increased and more open communication, better identification of risk factors for opioid abuse, greater use of multidisciplinary approaches to pain management, and more education delivered to patients, providers, employers, and entire communities.

    Congressional Briefing on Treating Pain
    What it's about: This video, a straightforward recording of an APTA-sponsored Congressional briefing held in May 2019, makes the case for better policy support for nonpharmacological approaches to pain management through the perspectives of 2 PTs and Cindy Whyde, a high school teacher whose son Elliot struggled with opioid addiction after receiving the drugs for a football injury.

    Why you should watch: Cindy Whyde's story is a heartbreaking (and frustrating) testimony to how far the health care system still has to go when it comes to patient education on and access to nondrug pain management approaches. Jen Bambrough, PT, DPT, and Sarah Wenger, PT, DPT (Wenger was also a panelist for the Facebook Live event), discuss how more thoughtful, collaborative, and patient-centered strategies can and do work.

    How Physical Therapy is Helping to Fight the Opioid Crisis
    What it's about: In September 2018, Prevention magazine editor Sarah Smith interviewed Sarah Wegner, PT, DPT, about the ways PTs and PTAs can help patients explore nonpharmacological management of pain.

    Why you should watch: It's a great interview aimed at a general audience, and Wenger is articulate and passionate about the profession. The half-hour program also explores the training, knowledge, and skills PTs must acquire, and why this combination is so well-suited to pain management. A great intro to physical therapy for the consumer—particularly the consumer struggling with pain.

    "You've Got No Bigger Fan Than the Surgeon General"
    What it's about: This APTA interview with US Surgeon General Jerome Adams, MD, MPH, took place just after he finished an address at the association's Component Leadership Meeting in January 2019. Adams' address at the meeting amounted to a resounding endorsement for physical therapy as a key player in the battle against pain and the opioid crisis. The video interview afterwards recaps his main points.

    Why you should watch: It never hurts to have friends in high places, and Adams is an enthusiastic supporter of physical therapy. His commitment to bringing the profession to the table, pressing for more multidisciplinary approaches to pain and addiction, and bringing the message of responsible opioid stewardship into communities comes through loud and clear.

    [Editor's note: stay tuned for more APTA activities during National Pain Month coming up in mid-September,]

    Physical Therapy Education Leader Rosemary Scully Dies

    Rosemary Scully

    Physical therapy thought leader Rosemary Scully, PT, EdD, FAPTA, whose tireless passion for learning left a lasting imprint on physical therapist clinical education, has died. She was 83 years old.

    Scully was born in West Virginia and earned her first degree—a baccalaureate in physical education—from West Virginia University. She later received a master's degree in physical therapy and a doctorate in education from Columbia University in New York. Along the way, Scully dedicated herself to applying what she had learned to improve the physical therapy profession, particularly related to education.

    Her work and educational efforts eventually took her to the University of Pittsburgh, where she led the university's physical therapy program until her retirement in the early 1990s. Scully's legacy lives on at Pitt through the Scully Scholar Lecture Series, an annual event that features some of the most prominent voices in the physical therapy profession.

    Scully authored several influential reports, studies, and books, including "Cooperative Planning for Clinical Experience in Clinical Therapy" and the comprehensive textbook, Physical Therapy, published in 1989. In addition, she was a coeditor of the Studies in the Health Related Professions series of publications, and within that series, a coauthor of several books focused on physical therapist and physical therapist assistant faculty characteristics.

    A member of APTA since 1958, Scully was vice speaker of the APTA House of Delegates from 1977 to 1983. In 1989, she received the association's Lucy Blair Service Award, and was named a Catherine Worthingham Fellow in 1992.

    Scully's love for the physical therapy profession—and particularly for the learning opportunities it presents—shone through in a recap of an oral history she provided to APTA in 1999. In that recap, published in the association's PT Magazine in 2000, Scully described what she viewed as one of the profession's greatest assets.

    "I was very fortunate to find physical therapy, a profession where I could, as an individual, do whatever it is that I wanted to do, while at the same time, other folks in the same field are doing entirely different kinds of things," Scully said. "I was always pleased with its diversity. Physical therapy is eclectic. It brings in all different kinds of people: wonderful folks who are pioneers and push the field forward."

    What a Difference a Day Makes: Researchers Say That for TKA, Post-Op Same-Day Physical Therapy Reduces Opioid Use and Shortens Length of Stay

    In this review: Same-Day Physical Therapy Following Total Knee Arthroplasty Leads to Improved Inpatient Physical Therapy Performance and Decreased Inpatient Opioid Consumption
    (The Journal of Arthroplasty, August 2019)

    The message
    Total knee arthroplasty (TKA) patients who received physical therapy on the same day as their surgeries were able to walk more while in the hospital and had lower rates of opioid consumption during their stay compared with patients who didn't receive physical therapy until the day after their surgeries. The same-day patients also tended to have shorter lengths of stay and higher rates of discharge to home.

    The study
    Researchers at the New York-based Columbia University Medical Center tracked 687 patients with knee osteoarthritis (OA) who received TKA at the facility between July 2016 and December 2017. A total of 295 "PT0" patients received postoperative physical therapy on the same day as their surgeries (POD0), consisting of a 30-minute session that included information, education, knee exercises, and activities-of-daily-life training. The remaining 392 "PT1" patients received the same session, but not until the day after surgery (POD1). Patients weren't randomized into the groups; instead the "PT0" and "PT1" groups fell into place, depending on whether factors such as patient motivation, fatigue, or pain during physical therapy prevented same-day physical therapy.

    All patients were asked to participate in 2 physical therapy sessions on postoperative day 1 if willing and able. Researchers evaluated ambulation distance, morphine equivalents consumed, pain levels, length of stay, and discharge disposition among the PT0 and PT1 groups. They also analyzed demographics, treatment details such as length of surgery, and preoperative function and outcome measures using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Knee Society Score (KSS).

    Findings

    • The PT0 group experienced an average 76% increase in "physical therapy performance" (number of steps taken) compared with the PT1 group. Authors of the study think the difference may be attributable to the idea that "early interaction with the physical therapist (PT) motivates and affirms patients that they can ambulate with full weight-bearing immediately postoperatively." That confidence-building, they write, paves the way for better progress in subsequent sessions.
    • While self-reported pain levels between the groups were similar, the PT0 group consumed about 25% less opioids than the PT1 group while in the hospital.
    • Average length of stay for the PT0 group was less than for the PT1 group—2.7 days compared with 3.2 days for the PT1 patients. The PT0 patients also tended to be discharged to home at a greater rate than the PT1 group, with 81.7% of the PT0 cohort sent home, compared with 54.8% of the PT1 patients.
    • Factors including gender, pain scores, preoperative KSS and KOOS, and age-influenced results, but did so similarly between the 2 groups. The groups showed no major differences in baseline characteristics.

    Why it matters
    TKA is an ever-increasing procedure predicted to rise to a rate of 1.3 million surgeries a year by 2030. Expenditures are high, with hospital length of stay and postacute care figuring heavily into costs—2 factors that seem to be positively affected by starting physical therapy the same day as surgery. Additionally, as authors point out, "any intervention that can demonstrate decreased opioid consumption is beneficial."

    Related APTA resources
    The association offers a TKA clinical summary, the Knee Outcome Survey-Activities of Daily Living test, and the Knee Injury and Osteoarthritis Outcomes Score for Joint Replacement through the PTNow resource area, and individuals considering TKA can find a consumer-friendly guide at MoveForwardPT.com, the American Physical Therapy Association’s official consumer website. APTA's highly successful #ChoosePT campaign is helping to spread the word about effective nonopioid approaches to pain management, while the association continues to work for increased patient access to physical therapy for pain through direct advocacy and publications, such as its white paper on physical therapy's role in pain management. And be on the lookout: APTA's own clinical practice guideline on TKA is coming soon.

    Keep in mind…
    The research didn't employ a formal randomization process.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    APTA's Comments on FCC Telehealth Proposal Stress Inclusion of PTs and Wider, More Innovative Use

    The big picture: a telehealth subsidy for providers?
    The Federal Communications Commission (FCC) has proposed a pilot project that aims to increase the delivery of telehealth to rural and low-income Americans by way of a $100 million, 3-year funding initiative. The program, known as the Connected Care Pilot, would subsidize a large portion of provider costs for broadband through the Universal Service Fund (USF) program.

    However, there are still plenty of details to be worked out, including which providers would qualify for the subsidies, whether the funding would be limited to telehealth services for a limited list of patient conditions, and how compliance with the program would be monitored.

    APTA provided FCC with its take on the proposal through a comment letter that emphasizes the inclusion of physical therapists (PTs) as qualified providers, and urges the FCC to think more expansively about the range of conditions that would be appropriate for telehealth services.

    Some of what's being proposed—and what we have to say about it

    FCC: Wants to establish a system that gives providers flexibility in determining which patients would be best suited to receive telehealth services.
    APTA: Agreed. "Providers are in the best position to determine which of their patients would benefit the most from access to telehealth services," our letter states, and adds that "it would be counterproductive to limit which patients providers can treat via telehealth."

    FCC: Believes the pilot program should be limited to care for conditions that tend to require several months of treatment, such as behavioral health, opioid dependency, chronic health conditions, and high-risk pregnancies.
    APTA: It's a good start, but the program should also prioritize conditions that require frequent visits with a provider, such as common orthopedic and neurological conditions, total knee arthroplasty, and stroke. These conditions can involve multiple visits per week, which can be burdensome for patients.

    FCC: Asks for feedback on whether participating patients should be required to contribute to the nonsubsidized share of the costs, with certain limits on what they'd be asked to pay.
    APTA: Bad idea. It could be a disincentive to some patients and will impede the wider adoption of telehealth in the long run. Besides, patients already have to pay for their own internet connection, and the FCC proposal doesn't cover costs of any other end-user devices.

    FCC: Wants to limit the program to certain nonprofit or public health care providers such as teaching hospitals, medical schools, community health and mental health centers, local health departments, nonprofit hospitals, rural health clinics, skilled nursing facilities, and a "consortia" of health care providers associated with these facilities.
    APTA: That's too narrow. The program should include providers who have not always been associated with telehealth—especially PTs, whose services are "well-suited to the medium," as stated in our letter. On top of that, the profession already is paving the way for its role in telehealth through the Physical Therapy Compact now enacted in 26 states.

    FCC: Asks for parameters around choosing which applications to accept, in addition to overall cost, and whether the applicant would serve program goals and has the capacity to operate and evaluate the outcomes of the program.
    APTA: The program also should factor in whether the proposed program is using telehealth in innovative ways. Our comments encourage FCC to push the boundaries of what telehealth has to offer.

    FCC: Thinks it may be a good idea to award additional points to projects that would serve areas or populations that have "well-documented health care disparities"—places such as tribal lands and rural areas, and populations such as military veterans. The agency also proposes that additional points be to awarded to projects that are "documented to benefit from connected care, such as opioid dependency, diabetes, heart disease, and high-risk pregnancy."
    APTA: We agree and disagree. While targeting areas and populations that are experiencing health disparities is an excellent idea, awarding extra points to only primary or mental health care is far too limiting. Our comments encourage FCC to be more inclusive in its consideration of provider types considered, "and score them on their ability to positively impact patients' lives, not on the specific discipline of medicine they practice."

    FCC: Wants to establish metrics for evaluating progress that could include reductions in emergency room or urgent care visits, decreases in hospital admissions or readmissions, changes in condition-specific outcomes, and patient satisfaction.
    APTA: Measurement is important, but don't reinvent the wheel; there are plenty of existing metrics. The US Centers for Medicare and Medicaid Services is a good place to start—the agency has developed a host of quality-reporting measures through its Quality Reporting Program.

    What's next?
    Once the FCC reviews the feedback it has received, it will issue a final rule outlining the details of the pilot including when and how to apply to participate. APTA’s Regulatory Affairs team will monitor any developments.

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