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  • 'Pathways' Program Takes Center Stage as Premier Advanced Proficiency Program for PTAs

    Physical Therapist Assistants (PTAs) now have a single program to help them demonstrate advanced proficiency in several different areas of care.

    APTA announced that the PTA Advanced Proficiency Pathways (APP) program has been elevated to the association's sole postgraduation proficiency recognition program, and that the PTA Recognition of Advanced Proficiency program will be discontinued.

    The APP program uses multiple approaches to help applicants gain and demonstrate proficiency in areas of interest that include acute care, cardiovascular and pulmonary, geriatrics, oncology, orthopedics, pediatrics, and wound management. Participants take online core courses common to all of the APPs as well as content-specific courses for the selected area of work, followed by experiences with a qualified mentor of the participant's choosing. A dedicated program mentor at APTA makes sure that participants stay on the pathway and arrive at advanced proficiency as efficiently as possible.

    The next APP program application cycle will open on May 1, 2016, with a submission deadline of August 1, 2016.

    The soon-to-be discontinued Recognition of Advanced Proficiency program will issue its last call for applications on February 1, 2016 with the recognition remaining valid through 2021. Recipients in this final cycle will be recognized during the 2016 NEXT Conference and Exposition. Questions about PTA Recognition of Advanced Proficiency can be directed to Lisa McLaughlin at lisamclaughlin@apta.org.

    For more information on APP, contact Derek Stepp at derekstepp@apta.org.

    PQRS Penalty Letters Require Quick Action From PTs

    Editor's note: This story has been modified to reflect a recent announcement by the Centers for Medicare and Medicaid Services (CMS) that it is extending the deadline to submit review requests until December 16, 2015. (This is an additional extension from that of an earlier CMS announcement, which initially extended the deadline to December 11.)

    If you recently received a Physician Quality Reporting System (PQRS)-related penalty notice from the Centers for Medicare and Medicaid Services (CMS), you're not alone. But you need to take action before December 16, a deadline moved back by CMS from its original November 23 date.

    APTA is aware that some members have received letters related to PQRS performance during 2014. If you believe you have received a penalty notice letter in error, be sure to submit an informal review request through the CMS "QualityNet" website by Friday, December 16.

    CMS has informed APTA that providers have been experiencing problems in reaching QualityNet over the past several days, and says that it's attempting to fix the problem. APTA is also working with CMS to ensure that physical therapists are not unduly penalized for 2014 PQRS performance.

    Questions? Problems with filing an informal review? Contact the APTA advocacy staff.

    Want more on PQRS? A recording of APTA's  recent webinar, "Physical Therapy and PQRS in 2016: How to Report Successfully," will be available in the coming weeks.

    Motivation and Behavior Changes for Patients With Knee OA: Do's, Don'ts, and a Free Webinar With More Details

    Physical therapists (PTs) and physical therapist assistants (PTAs) understand the importance of physical activity (PA) for their patients with knee osteoarthritis (OA), and they know just what a patient should do to maintain healthy activity and exercise levels. The challenge, of course, is getting patients to actually follow through.

    Maura Daly Iversen, PT, DPT, SD, MPH, FNAP, FAPTA, knows the challenge well. Iversen, who serves as chair of Northeastern University's Department of Physical Therapy, Movement, and Rehabilitation in the Bouve´ College of Health Sciences in Boston, has made nonpharmacologic approaches to rheumatology treatment a particular area of focus during her career, and will share her expertise during a free "lunch and learn" webinar sponsored by the Osteoarthritis Action Alliance (OAAA). APTA is an OAAA member.

    Titled "Techniques to Enhance Adherence to Physical Activity and Exercise Recommendations: From Theory to Practice," the prerecorded 30-minute session, set for Wednesday, November 18, at 12:00 pm ET, will address ways to motivate patients with OA - and keep them motivated.

    In the meantime, Iversen provided PT in Motion News with a quick take on some of the do's and don'ts she'll be covering during the program:


    • Don't assume all patients with OA are equally motivated by a particular strategy. "This requires a careful and sensitive approach from the PT, because 1 size doesn't fit all," Iversen said.
    • Don't try to change too many behaviors at once. "Overwhelming a patient with what seems like an impossible list of changes is a good way to really knock down motivation," according to Iversen.
    • Don't forget to reinforce patients’ positive comments about their past exercise and PA successes. "Most often, patients with knee OA feel better once they move," Iversen said. "Helping them remember that they were successful with exercise can go a long way in motivating behavior change."
    • Don't forget to assess where a patient is on the spectrum of behavior change. "Being aware of just where the patient is helps you to target your conversation and messaging," Iversen said.


    • Do target 1 behavior to change (or activities related to 1 behavior). "It's important for patients to experience a real success early on," Iversen explained. "Keeping your initial targets limited and well-defined increases the likelihood a goal will be reached, which serves as a motivator to tackle other goals."
    • Do incorporate strategies for self-monitoring. "Devices like Fitbits or other easy-to-use monitoring technology can give patients a way to see their accomplishments as they achieve them," Iversen said.
    • Do assess your patient's self-efficacy. "One simple question can be used to determine whether patients lie on the spectrum of 'confident' to 'lacking confidence' to engage in the behavior," Iversen said. "Ask that question, because it's important to uncover what the factors are that are personally impacting their behavior."
    • Do ask the patient what worked best for them in the past when they were physically active. "For example, some people are self-motivating, while others need social reinforcement like group exercise or a public gym," Iversen explained. "Knowing what worked in the past is great information, because the PT can work with the patient to design a program that maximizes the potential for success."

    Note: although the webinar is prerecorded, Iversen will be available by email to answer your questions from 1:45 pm-2:45 pm ET on the same day. More information on contacting her will be made available during the broadcast. Can't make the webinar? OAAA archives its webinars for viewing at a later time.

    MedPAC Releases Updated 'Payment Basics' Series

    Don't know your APC from a hole in the ground? Wouldn't recognize a CMG if it bit you? (Hint: they don't in fact bite.) Think OASIS is just the name of a 90s band?

    The Medicare Payment Advisory Commission (MedPAC) has a little something for you.

    Now available for free download: MedPAC's latest version of "Payment Basics," a series of informational sheets that describe the need-to-know elements of 19 different Medicare payment systems. Areas covered include outpatient therapy, skilled nursing facilities, home health services, hospital acute inpatient services, and more.

    Most information sheets provide background for how the system is organized and include flowcharts for a visual representation of how that particular payment system works.

    Quick facts from the MedPAC Payment Basics: According to the MedPAC report on outpatient therapy, in 2011 Medicare spent $5.7 billion on outpatient therapy services provided to 4.9 million beneficiaries. Physical therapy services accounted for 72% of all spending in this area.

    PTs Encouraged to Verify Their PQRS Data Before It Hits Physician Compare

    Did you participate in the Physician Quality Reporting System (PQRS) in 2014? If so, did you report measure #128, "Preventive Care: General Health, Body Mass Index (BMI) Screening and Followup"? That data, linked to your name, will soon be posted to the Physician Compare website, and you should verify its accuracy while you can.

    The Centers for Medicare and Medicaid Services (CMS) has opened the 30-day preview period for the 2014 quality measures that will be reported later this year to Physician Compare, the CMS website that provides the public with searchable information on health care providers, including physical therapists (PTs) who participated in PQRS in 2014.

    You can access the secured measures preview site now through the Provider Quality Information Portal (PQIP). To learn more about how to preview your measures, visit the Physician Compare Initiative page.

    At present, the only publicly reported data relevant to PTs is the BMI code--#128 for PTs who reported individually via claims data submission. CMS has produced flowcharts to explain the public reporting process.

    APTA, CDC Partner on Community-Based Resources for Arthritis

    APTA and the US Centers for Disease Control and Prevention (CDC) have partnered to offer physical therapists (PTs) and physical therapist assistants (PTAs) new resources to promote community-focused, evidence-based physical activity programs that help people manage arthritis outside a therapeutic setting.

    Information on the offerings have been made available on the APTA website, through the association's consumer-focused MoveForwardPT.com, and via a CDC webpage. Taught by trained, certified instructors, the programs extend the benefits of physical therapy through activities including walking, aquatics, and low-impact aerobics.

    Resources include:

    The evidence-based programs are designed to be effective for patients with arthritis and related conditions that limit mobility, and generally cost less than $50 per participant.

    Utah Grabs Top Spot in 'Best States for PT Practice' for Third Year in a Row

    It's beginning to look like a dynasty: for the third year in a row, Utah has been declared the best state in which to practice physical therapy, this year followed by Virginia and Nebraska. The rankings—and the explanations behind the rating system—appear in the October issue of PT in Motion, APTA's member magazine.

    The rankings were derived from an analysis of 8 factors: well-being and future livability, literacy and health literacy, employment and employment projections for physical therapy, business and practice friendliness, technology and innovation, compensation and cost of living, physical therapist/physical therapist assistant/student engagement with APTA, and—new this year—health and financial disparities.

    "What's the secret of Utah's success? It had consistently strong scores across the board, with a particularly high rating (third) in 'well-being and future livability' and coming in first for its lack of health and financial disparities," writes PT in Motion Editor Donald E. Tepper in the article.

    This year, both Virginia and Nebraska pushed out Colorado and Minnesota to take over the number 2 and 3 positions. Colorado dropped to fourth place, and Minnesota fell to fifth.

    As Tepper explains in the article, the overall scores gave equal weight to each of the 8 factors used in the analysis—an assumption that may not be the case for an individual physical therapist or physical therapist assistant, who might feel that some factors are more important than others. To provide as complete a picture as possible, the article provides each state's individual rankings on all 8 factors for the top 20 states.

    Rounding out the top 20 after Minnesota were North Dakota, South Dakota, Idaho, Iowa, Vermont, Washington, Alaska, Arizona, Wyoming, Oregon, Montana, Texas, Kansas, Wisconsin, and New Hampshire.

    "The Best States in Which to Practice" is this month's open-access article in the online version of PT in Motion, which makes it easy to share with nonmembers. (Also available to share this month is “Facing True North From the Louisiana South,” a profile of APTA’s new president, Sharon Dunn, PT, PhD, OCS.)

     Hardcopy versions of PT in Motion are mailed to all members who have not opted out and to subscribers; digital versions of the entire issue are available online ahead of print to members.

    CMS Offers Up Resources for Your ICD-10 Questions

    The US Centers for Medicare and Medicaid Services (CMS) says that it has "tested and retested our systems" designed to handle the ICD-10 codes that will begin on October 1, and wants health care providers to feel equally prepared for the transition.

    But if you still have questions, they're offering resources that may provide answers.

    A recent blog post from CMS ICD-10 Ombudsman Bill Rogers outlines 4 major areas of support that are available online. These include:

    In addition to the CMS resources, APTA offers an ICD-10 webpage that includes frequently-asked-questions, case scenarios, and a link to a popular (and free-to-members) recorded webinar on final steps toward implementation of the new system.

    Ready for October 1? APTA's Top 5 ICD-10 Tips

    Editor's note: this story was changed from its original version to clarify tip 4, which now emphasizes that if care started before October 1, new referrals or plans of care are not required.

     The long-awaited changeover to ICD-10 is finally happening on October 1. Are you ready? Here are 5 hot tips on the new system, plus 1 bonus piece of advice.

    1. Careful with those code extensions.
      Not every ICD-10-CM code requires a code extension (7th character) for injuries and external causes to identify the encounter as initial, subsequent, or sequela. Typically a 7th code is used for injury or trauma, and it's also used in the obstetrics, musculoskeletal, and external cause chapters.
    2. It's not just about national requirements.
      Make sure you're aware of state and payer mandates that may apply to you. For instance, although there is no national requirement to report the ICD-10 codes for “external causes for morbidity,” you may be required provide these codes if you are subject to a state-based external cause code reporting mandate or if a particular payer says you have to provide them.
    3. No code cocktails!
      Do not mix ICD-9 and ICD-10 codes on the same claim form.
    4. Did care start before October 1? You don't need a new referral or plan of care.
      A new referral or plan of care will not be required if an episode of care is initiated before October 1 and continued after October 1.
    5. X marks the spot.
      You will need to use an “X” to fill in empty characters when a code contains fewer than 6 characters and a 7th character is needed.

    This is really happening.
    ICD-10 coding will be required October 1. There will be no postponement, no exemptions, no dual-code period, or anything else that would mean physical therapists could avoid using the new codes, even temporarily. The changeover is a reality.

    If you're still feeling uncertain about the switch, give yourself an opportunity to get up to speed: get some guidance on the new system from a free APTA webinar, and then dive deeper into resources now available at the association's ICD-10 webpage.

    New ICD-10 Resources Added Just in Time for Oct 1 Transition

    Surprises are great for birthdays and anniversaries. When it comes to ICD-10—not so much.

    That's why APTA now provides additional resources that can help make the October 1 changeover to the new coding system as uneventful as possible.

    APTA's ICD-10 webpage now features an extensive collection of information that ranges from the big-picture stuff to the nitty gritty of how the coding works—including some case studies of how the codes would be used in physical therapy and links to additional guidance from the US Centers for Medicare and Medicaid Services (CMS).

    In addition to the case studies, other resources on the page include:

    • An extensive list of frequently-asked-questions and answers that delve into details you need to know, such as when to use the "7th character," the hows and whys of "X" as a placeholder, and an explanation of the "sequelae."
    • A list of the common codes used in physical therapy according to practice area
    • Links to CMS resources that include guidance for small-practice providers
    • Access to a recording of the highly popular APTA webinar on final steps for successful implementation of the -10 (free to APTA members)

    The assistance goes beyond the resources posted on apta.org: the association has also created a special online community devoted to ICD-10, where you can ask questions and share experiences with colleagues.