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  • Your Help Needed to Guide Movement System Integration

    APTA is leading the way in advancing the integration of the movement system as the core of physical therapist (PT) practice, education, and research. Now the association needs input from you to take an important next step: making the crucial leap from the conceptual to the practical through the development of a movement system diagnosis framework and movement screen.

    Draft diagnosis and screening templates have been created by the Movement System task force and work groups, and APTA would like you to take them for a test drive and provide your comments by the June 1, 2019, deadline.

    "We're at an exciting point in the evolution of the movement system concept and now need the widest possible stakeholder input," said Sue Whitney, PT, PhD, APTA Board of Directors member and chair of the Movement System Task Force. "Many PTs have been incorporating movement system concepts into their practice and teaching for some time now, but the development of these diagnosis and screening resources has the potential to accelerate the adoption of these concepts across the profession. That's why participation in the review and comment process is so critical—with the development of a repository of movement system diagnoses and the development of the screening templates, we hope to move the bar and create excitement about using the movement system in daily practice."

    Evaluation of each template involves a 2-step process. For the diagnosis template, reviewers are asked to submit an example of a movement system diagnosis using a specially developed online form, and then provide feedback about the template itself. The movement screen—a tool that helps PTs identify patient movement impairments observed during functional tasks and activities so that they can pinpoint which additional tests and measures should be brought into play—doesn't need to be filled out, just reviewed and evaluated through an accompanying survey. Click here to view the templates and provide your feedback.

    Work toward the development of the movement system concept in the physical therapy profession began in 2013, when APTA adopted a new vision statement with guiding principles that characterized the system as "the foundation of optimizing movement to improve the health of society." The association produced a white paper on the movement system in 2015 and held a Movement System Summit in 2016 that brought together 100 thought leaders to discuss how best to integrate the system throughout all facets of the profession. Since then, members of APTA’s Movement System Task Force have been developing resources to make widespread integration a reality.

    Want to learn more about the movement system? Visit APTA's Movement System webpage for a history of the association's work.

    APTA Working for You: Practice-Related Updates, February 2019

    APTA brings the profession's insights and expertise to bear in a variety of settings. Here's a quick rundown of some of the latest news and APTA activities.

    Professional Issues

    • APTA helps the National Institutes of Health's (NIH’s) "Go4Life" exercise campaign spread the word about the benefits of exercise: APTA was featured on the Go4Life website for the strong ties between APTA and NIH's National Institute on Aging (NIOA). APTA Senior Staff Specialist Hadiya Green Guerrero, PT, DPT, a certified sports physical therapy specialist, is working with NIOA on consumer fact sheets about physical activity for people with musculoskeletal conditions.
    • Understanding of the APTA Physical Therapy Outcomes Registry continues to grow: APTA is working with US Department of Health and Human Services Office of the National Coordinator for Health Information (ONC) and professional societies toward standardization of elements of practice, a key concept for the Registry. APTA staff also are collaborating with professional organizations on getting electronic health records to understand certain standard data elements.
    • APTA is helping staff at the Medstar National Rehabilitation Hospital (NRH) better understand the elements of culturally competent practice: APTA Practice Department staff will emphasize APTA’s mission, vision, and strategic plan at an upcoming NRH event, and explain how being a culturally competent practitioner can improve outcomes and patient satisfaction.
    • A list of consumer questions on pain management is now part of the #ChoosePT online toolkit: APTA practice staff helped to create a set of questions on pain and pain management for patients to ask their providers. Those questions are now featured within the #ChoosePT toolkit.
    • Could primary care become the next APTA board-certified specialty? An APTA House of Delegates charge to explore the role of physical therapists on the primary care team is being pursued. Led by member John Heick, PT, DPT, PhD, board-certified clinical specialist in 3 different areas--orthopaedics, neurology, and sports—APTA is petitioning for primary care to be recognized as a board-certified clinical specialty area of practice by the American Board of Physical Therapy Specialties (ABPTS). Signatures are being collected now for the ABPTS petition.

    APTA at the Table

    • National Coalition for Promoting Physical Activity
      APTA representatives attended the National Coalition for Promoting Physical Activity’s congressional briefing promoting the release of the latest edition of the Physical Activity Guidelines for Americans. Hadiya Green Guerrero has been named to the coalition's board of directors.
    • National Institutes of Health
      Staff from APTA took part in a strategic planning session for NIH's National Institute of Arthritis and Musculoskeletal and Skin Diseases.
    • Movement is Life National Caucus
      APTA Director of Minority Affairs Johnette Meadows, PT MS, who serves on the Movement is Life national caucus steering committee, provided leadership on understanding health disparities at the group's most recent gathering.
    • Osteoarthritis Action Alliance (OAAA)
      APTA continues its participation in OAAA and is helping the alliance to promote the Arthritis Foundation's evidence-based self-directed "Walk With Ease" program guidebook on creating a community-based walking program for individuals with OA.

    Clinical Practice Guidelines: Updates

    • Adults With Neurologic Conditions
      The APTA Academy of Neurologic Physical Therapy (ANPT) has published an APTA-funded clinical practice guideline titled "A Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation." APTA is working with the ANPT now on implementing the CPG and sharing resources that have been developed by the section.
    • Total Knee Replacement
      The American Academy of Orthopedic Surgeons (AAOS) is working with APTA practice staff to finalize action steps related to a clinical practice guideline on total knee replacement.The CPG will appear in an upcoming issue of PTJ (Physical Therapy) in 2019.

    Clinical Practice Guidelines: Resources

    APTA offers a wide range of resources for learning more about practice-related topics and staying connected. PTNow is a central source for evidence-based practice information including CPGs; other online resources include APTA's Annual Checkup by a Physical Therapist and Cultural Competence webpages. Members can stay connected by joining 1 or more APTA practice-related councils—the Council of Health Systems Physical Therapy, the Council on Prevention, Health Promotion, and Wellness, and Frontiers in Rehabilitation, Science, and Technology (FiRST) Council—and keep up with the latest practice-related news by subscribing to the Professional Issues and Evidence and Care editions of APTA's Friday Focus newsletter series to receive monthly compilations of practice-related news and resources. Questions? Email Practice-Dept@apta.org.

    New Medicare SNF Payment System Explained in Upcoming Q-and-A Sessions

    PTs and other providers in skilled nursing facilities (SNFs) will face an entirely new payment methodology beginning in October. APTA can help you get up to speed.

    Similar to an earlier-announced educational series on the upcoming home health payment system change, APTA will host 2 live Q-and-A sessions with staff and member experts on the new SNF payment system, known as the Patient-Driven Payment Model (PDPM). Presenters for the hour-long sessions—offered on March 12, 1:00 pm-2:00 pm ET, and March 14, 7:00 pm-8:00 pm ET—will answer questions from registered participants who've reviewed a prerecorded webinar that will be available after February 22. The recorded webinar and live sessions are free to APTA members

    Interested? Start by registering now for 1 of the Q-and-A sessions, then check back in on the SNF Patient-Driven Payment Model Webinars page on or after February 22 to download and review the recorded webinar. Have your questions ready for the hosts, including APTA Director of Regulatory Affairs Kara Gainer, JD; APTA Senior Payment Specialist Alice Bell, PT, DPT, board-certified geriatric clinical specialist; Jon Anderson, PT; Robert Latz, PT, DPT; and Ellen Strunk, PT, MS, board-certified geriatric clinical specialist.

    Clinicians in home health care will face a similar change in payment methodology beginning January 1, 2020, with implementation of the Patient-Driven Groupings Model (PDGM). APTA will host 2 Q-and-A sessions on the PDGM March 5 and 6.

    [Editor's note: Even more information on both the new SNF and new home health payment models is available on a specially created APTA webpage that includes resources from APTA and the US Centers for Medicare and Medicaid Services.]

    New APTA Policy Priorities Push for a More Wellness-Oriented, Value-Based, and Accessible Health Care System

    APTA's newest advocacy roadmap puts the current state of health care in the United States in stark terms—and commits the association to working for change.

    Describing the United States as being "at a crossroads," the association's 2019-2020 Public Policy Priorities document characterizes the country's health care system as one that favors treating illness over investing in prevention and wellness. It's an approach that APTA believes leaves too many Americans underserved, including people with disabilities, chronic conditions, and opioid addiction.

    The association's response? "This must change."

    The need for systemic change throughout the health care system is the common thread running throughout APTA's new resource, a high-level exploration of the areas that will be the focus of the association's advocacy efforts for the next 2 years. Much like the association's recently adopted strategic plan, the priorities point to an association that will fuel change at the societal level.

    The guide lays out 4 broad areas of emphasis for 2019 and 2020: population health; patient choice and access; value-based care and practice; and research and innovation. Within each area, the association lists multiple advocacy opportunities. Some, such as working for increased funding for the Individuals with Disabilities Education Act, are targeted at specific existing programs. Many others, however, such as a continued press for increased direct access to physical therapists (PTs) and decreased administrative burden, are more open-ended.

    The mix of general and specific was purposeful, according to Katy Neas, APTA's executive vice president of public affairs.

    "Over the course of 2018, the APTA Public Policy and Advocacy Committee [PPAC] developed policy recommendations that enhance the role of the profession as integral to an effective and efficient health care system that ensures better health outcomes for our patients," Neas said. "This guide advances the APTA Board of Directors' approval of the PPAC recommendations in ways that clearly reflect our commitment to true change in the health care system, and position APTA to partner with other stakeholders in innovative ways."

    Part of the reason the priorities take a more expansive approach is that an earlier advocacy goal—ending a hard stop on therapy services under Medicare part B, known as the "therapy cap"—was achieved in early 2018. With the nearly 2-decade battle over, the association found itself with an opportunity to survey an even wider advocacy landscape.

    Next: turning that plan into action, something that's already happening in many advocacy areas, according to Justin Elliott, APTA's vice president of government affairs.

    "Advocacy never stops for APTA and its members," Elliott said. "The new policy agenda includes many APTA existing priorities, such as our work to finalize the coverage of physical therapist assistants in the Department of Defense TRICARE program, but also creates opportunities to act as new legislation and policy possibilities arise."

    The new advocacy opportunities available to the profession will be a major focus of the upcoming APTA Federal Advocacy Forum in Washington, DC, a 3-day conference that provides the latest on regulatory and legislative issues affecting the profession, and ends with a chance for attendees to apply what they've learned by making in-person visits to Senate and House offices. The event is set for March 31 – April 1; registrations are open until March 18.

    APTA, ACSM Partnership Agreement Formalizes Long-Time Collaboration

    A longstanding collaborative relationship is now official: APTA and the American College of Sports Medicine (ACSM) have entered into a formal partnership that the organizations believe will strengthen their work toward improving health through movement.

    ACSM is now a participant in the APTA Partnerships Program, an initiative aimed at enhancing relationships between the association and other organizations that share common goals. ACSM joins Special Olympics, Move Together, the American Academy of Orthopaedic Manual Physical Therapists, the Federation of State Boards of Physical Therapy, and the US Department of Veterans Affairs in the program.

    ACSM and APTA aren't strangers to each other. The organizations have worked together before, and they hope to build on their relationship to bolster advocacy efforts as well as expand participation in each group's events and initiatives.

    "I am so pleased we were able to formalize our already productive and positive relationship with ACSM," said APTA CEO Justin Moore, PT, DPT, in an APTA news release. "Both organizations are founded in helping individuals live their best lives, and this partnership will help better achieve our goals."

    ACSM EVP and CEO Jim Whitehead also sees promise in the new partnership.

    "The American Physical Therapy Association is a recognized leader in promoting recovery, health, and wellness," said Whitehead. "Our 2 organization have a shared vision to improve lives through exercise and healthy lifestyles, so this partnership will open the door to tremendous opportunities that wouldn't be possible otherwise. We can't wait to get moving."

    ACSM's members number more than 50,000 and include physicians, scientists, researchers, educators, exercise professionals, and others in the field of sports medicine and exercise science. The mission of the college is to advance and integrate scientific research to provide educational and practical applications of exercise science and sports medicine.

    New Medicare Home Health Payment System Explained in Upcoming Q-and-A Sessions

    Private practice physical therapists (PTs) aren't the only ones facing major changes in the way Medicare provides reimbursement: PTs and other providers in the home health setting will face an entirely new payment methodology beginning next year. APTA can help you get up to speed.

    Coming in early March: 2 live Q-and-A sessions with APTA experts on the coming payment system, known as the Patient-Driven Groupings Model (PDGM). Presenters for the hour-long sessions—offered on March 5, 2:00 pm-3:00 pm ET, and March 6, 7:00 pm-8:00 pm ET—will answer questions from registered participants who've reviewed a prerecorded webinar that will be available February 20. The recorded webinar and live sessions are free to APTA members.

    Interested? Start by registering now for 1 of the Q-and-A sessions, then check back in on the Home Health Patient-Driven Groupings Model Webinars page on or after February 20 to download and review the recorded webinar. Have your questions ready for the hosts, including APTA Director of Regulatory Affairs Kara Gainer, JD; Bud Langham, PT, MBA; Carol Zehnacker, PT, DPT; and Ellen Strunk, PT, MS, a board-certified geriatric clinical specialist.

    Providers in skilled nursing facilities will face a similar change in payment methodology beginning in October, with implementation of the Patient-Driven Payment Model (PDPM). APTA will host 2 Q-and-A sessions on the PDPM March 12 and 14.

    [Editor's note: Even more information on both the new home health and skilled nursing facility payment models is available on a specially created APTA webpage that includes resources from APTA and the US Centers for Medicare and Medicaid Services.]

    New APTA Strategic Plan: Leading the Profession and Association Into the Next Century

    Take a look at the new APTA strategic plan covering the next 3 years, and almost immediately something becomes abundantly clear: the association has no intention of kicking back and cruising into its centennial in 2021. Dig deeper, and you're likely to find that the goals to be reached between now and the beginning of APTA's next century are as ambitious as anything the association has ever attempted.

    The plan, now available on the APTA website, is the result of an 18-month-long Board of Directors effort that included input from nearly 4,000 stakeholders to identify where APTA needs to go to realize its vision of transforming society by optimizing movement to improve the human experience. The end result: a roadmap built around 4 outward-facing goals, with measurable objectives that don't shy away from some ambitious targets.

    In an APTA Media Center interview conducted during APTA's 2019 Combined Sections Meeting, President Sharon Dunn, PT, PhD, characterized the plan as a new phase in the association's evolution.

    Dunn said that APTA's previous 5-year strategic plan served as a "pivot" away from work that supported the earlier "Vision 2020" statement and toward the association's current vision, adopted in 2013. During 2017 and 2018, and especially after listening to stakeholders and evaluating the association's opportunities, it became clear to the Board that the pivot was complete.

    "We were ready to make some bold moves toward actually transforming society," Dunn said.

    The 4 main goals in the new plan are centered on increasing member value and engagement, fostering the long-term sustainability of the physical therapy profession, elevating the quality of care provided by physical therapists (PTs) and physical therapist assistants (PTAs), and maximizing stakeholder awareness of the value of physical therapy.

    Each goal contains 2—and in 1 case, 3—objectives that lay out specific activities that APTA will pursue. The goal aimed at stakeholder awareness of the value of physical therapy, for example, sets APTA on course to advocate for payment policies that increase patient access to physical therapy, to leverage the #ChoosePT campaign and MoveForwardPT.com as public information platforms, and to "embody the APTA mission and vision through an integrated brand strategy." The sustainability goal directs the association to "champion student and early-career issues including debt burden and career-earning potential," and to "make APTA an inclusive organization that reflects the diversity of the society the profession serves."

    The plan isn't designed to be all-inclusive. Many ongoing activities central to APTA—including federal and state advocacy—will continue to be integral parts of the association's operations. Rather than covering every area in which the association will be working, Dunn said, the new plan "looks at what is absolutely necessary to take us into our next century."

    According to Dunn, one of those elements—the long-term sustainability of the physical therapy profession—is a goal that reflects a pervasive sentiment among the stakeholders providing input on the strategic plan's development and, in the case of student debt and early-career earning potential, "one of the things that keep's [APTA] leadership up at night."

    Dunn explained that APTA's efforts in this area must include not only providing program faculty with resources and tools to help keep a lid on education costs but also a wider effort to make the profession itself as diverse and inclusive as possible—something Dunn believes is key to the profession's long-term sustainability.

    "We need to make the path [to becoming a PT or PTA] easy, make it affordable, and engage and mentor along the way," she said.

    All of the goals and objectives in the plan are equally ambitious and equally capable of having a strong impact on the profession and society, according to Dunn. Here's what she had to say about other elements of the plan:

    • On translating the latest research into tools and resources for practice: "There's a lag time to translating evidence into practice. The environment doesn't allow for that lag time anymore."
    • On supporting the growth of the APTA Physical Therapy Outcomes Registry: "Payers have our data, and we need to have our data and use it to advocate for the benefits of physical therapy."
    • On advocating for PTs on the primary care team: "Putting a physical therapist on the front end of anything—pain, chronic disease—rather than the back end, [results in] a lot of quality and cost savings."
    • On expanding the #ChoosePT campaign beyond the opioid epidemic: "[#ChoosePT] will evolve into other opportunities for the physical therapy profession to meet societal need."

    What's next? With the goals and objectives in place, APTA leadership is now developing metrics to not only measure progress but to help keep the association on course as it attempts to achieve results that, as Dunn said, "meet the needs of not only our society but our members as we treat our patients."

     

    2019 Federal Advocacy Forum Coming March 31; Registration Open Through March 18

    When it comes to federal advocacy for the physical therapy profession, the watchword is "new"—new priorities after the end of the hard cap on therapy services under Medicare last year, new challenges that have surfaced in the wake of rulemaking and other changes, and a new Congress that needs to be well-acquainted with the profession's message of patient-centered, transformative care. APTA's 2019 Federal Advocacy Forum, set for March 31-April 2, promises to help attendees navigate all those new twists and more.

    Registration is now open for the annual event, which brings together physical therapists (PTs), physical therapist assistants (PTAs) and students together in Washington, DC, for a 3-day conference that provides the latest on regulatory and legislative issues affecting the profession, and ends with an opportunity for attendees to apply what they've learned by making in-person visits to Senate and House offices. Registration deadline is March 18.

    Other activities at the Forum include an evening reception, awards presentations, and breakout sessions on state and federal advocacy, regulatory affairs, and student action.

    "While 2018 was a year of real accomplishment, much more needs to be done with the new Congress that started this month," said Michael Matlack, APTA director of congressional affairs. "There are now almost 100 new members of Congress who need to learn about the essential role that physical therapy plays in the nation’s health care system—and in the lives of their constituents."

    [Editor's note: Want to get a feel for what the Federal Advocacy Forum is all about? Check out the video recap of the 2018 Forum on the Federal Advocacy Forum webpage.]

    From Move Forward Radio: Retreat Helps Veterans With Amputation—and Their Families

    Adjusting to life after an amputation can affect a veteran’s entire family, not just the individual. That reality wasn't lost on the Travis Mills Foundation, which offers a retreat program that aims to help veterans and their families bond with one another and participate in traditional activities that are adapted to teach new skills and strategies to ensure participation for everyone.

    Now available from APTA's Move Forward Radio: a conversation with APTA member Kelly Roseberry, PT, DPT. Roseberry is program director of the Travis Mills Foundation, which was founded by a veteran who had a quadruple amputation. Roseberry describes what this unique program means to veterans, families, and to her personally. "To be able to see a service member do something they never thought they would do again, or to see how happy their family is to watch them get to do that and to share in those moments together is…priceless," Roseberry says.

    Since 2017, selected veterans who have been injured in active duty or as a result of their service have come to Maine in the summer, along with their families, for an all-expenses-paid vacation. They participate in activities such as swimming, biking, kayaking, and a ropes course.

    “We take a great deal of pride in being able to serve the whole family," Roseberry tells Move Forward Radio. "We recognize that rehab is a lifetime process, and when someone is injured or goes through some sort of trauma, not only is the service member injured, but the injury affects the entire family. They may not think they can get on the floor with their kids or take them for a bike ride. We want to be able to not only encourage them but give them the tools to reach outside their comfort zone and do things with their family, because at the end of the day their family is their support system.”

    Move Forward Radio is hosted at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online or downloaded as a podcast via iTunes, Google Play, or Spotify.

    Other recent Move Forward Radio episodes include:

    Maintaining an Active Lifestyle and Avoiding Pain
    Surfing legend and fitness and nutrition expert Laird Hamilton applied lessons he learned through his surfing injuries to his preparation for—and recovery from—hip replacement surgery. In the podcast, he describes how he avoided pain medicine of any kind during the process, and how he surprised his health care team with one of the fastest recoveries they had ever seen.

    A Primer on Sciatica and Physical Therapy
    As many as 40% of people will experience sciatica in their lifetime. APTA member Mark Bishop, PT, DPT, PhD, breaks down sciatica’s symptoms and causes for consumers, and explains how physical therapy can help relieve pain.

    Navigating the Health Care System With Chronic Pain
    APTA member Jen Bambrough, SPT, was in car accident at age 19 but seemed to sustain no initial apparent injuries. Over time, though, a physical toll revealed itself as chronic pain, limiting her activities and compromising her quality of life. Because the root of her pain couldn’t be readily detected, however, she faced skepticism in the medical community and experienced misdiagnoses. Bambrough, now a third-year DPT student, discusses how she became a strong self-advocate and how physical therapy is an important piece of the pain management puzzle.

    A PT With Breast Cancer Turns to Her Peers to Make Life-Saving Decisions
    When APTA member Gwen Simons, PT, felt what she thought might be a lump in her left breast in 2010, it set in motion a series of decisions and scans that led to surgery. Simons shares her story of unexpected mammogram results, a strategically timed lecture, consultations with colleagues in the physical therapy profession, and a decision by Simons that may have saved her life.

    Cancer-Related Falls
    Cancer survivors have a higher prevalence of falls than do people who haven’t been treated for the disease. Even worse, various significant health consequences of falls may be more likely and extensive in cancer survivors. APTA member Elizabeth Hile, PT, PhD, discusses the reasons for increased falls susceptibility in cancer survivors, red flags to heed, and how physical therapy and certain types of community resources can help.

    Using Physical Therapy to Treat Pain in Addiction Treatment Centers
    America is in the grips of an opioid addiction crisis. APTA members Ahmed Rashwan, PT, DPT, and Eric Chaconas, PT, PhD, discuss the treatment for addiction to opioid pain medication. They are working with addiction treatment centers to help medically stabilized patients learn more about their pain and show them how they can use physical therapy to participate in managing it, making relapse less likely.

    APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be emailed to consumer@apta.org.

    APTA Outcomes Registry Earns Key QCDR Designation for Use With MIPS

    APTA's Physical Therapy Outcomes Registry (Registry) has been approved again by the US Centers for Medicare and Medicaid Services (CMS) as a qualified clinical data registry (QCDR). The designation for 2019 means that physical therapists (PTs) who participate in the Merit-based Incentive Payment System (MIPS) can submit their measures data directly from the Registry—including new measures supported by APTA that now position the Registry as the leading physical therapy registry in terms of the number of QCDR measures offered.

    The approval comes as many PTs are facing a new reporting and payment world, the result of a CMS decision to include physical therapy in its Quality Payment Program (QPP) beginning in 2019. That program, with MIPS as its centerpiece, puts a heavy emphasis on outcomes reporting and ties that reporting to potential payment adjustments.

    That's where the number of measures offered through the Registry comes into play. Basically, more measures mean more data points to report, and more data points mean more opportunities for PTs to meet CMS requirements—and possibly receive payment increases in the future. The Physical Therapy Outcomes Registry now offers more QCDR-related measures than any other physical therapy-only option.

    According to Heather Smith, PT, MPH, APTA's director of quality, while the Registry's role in helping PTs comply with MIPS is important, it's far from the only benefit of the resource.

    "With the Physical Therapy Outcomes Registry, APTA is looking forward, beyond MIPS data submission," Smith stated in an APTA news release. "Because the Registry gives users continual feedback on performance throughout the year, physical therapists can better understand their treatment patterns, interventions, and outcomes for specific patient populations, and apply that information to improve their practice. Ultimately, this will benefit the profession as a whole."

    Headed to the APTA Combined Sections Meeting this month? Check out the Registry booth at the APTA Pavilion. For a detailed look at MIPS and QPP, be sure to attend " Emerging Issues in Medicare: Quality Programs and Alternative Payment Models," on Friday, January 25 at 11:00 am. CMS representatives will be on hand to discuss the programs.