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  • Innovation 2.0 Series of Learning Labs Continues With Transitions in Care

    A program that teams an academic physical therapist program with a primary care provider of postacute care services to patients after hip and knee surgery shares its insights and experiences at APTA’s second of 4 Innovation 2.0 Learning Labs, now available in the APTA Learning Center. This free webinar includes the recorded session, including the presenters’ slide deck, and a downloadable guide to replicating the program in other facilities.

    The July online Learning Lab in APTA’s Innovation 2.0 series focuses on a partnership between a contract provider of physical therapist services to local skilled nursing facilities, and the University of Utah physical therapy program. The project has developed evidence-based care pathways for patients with hip fracture, total hip arthroplasty, and total knee arthroplasty. In this model, physical therapists are working collaboratively within the health care system to improve value-driven outcomes.

    The Innovation 2.0 series is designed to promote the participation of physical therapy in innovative models of care delivery by replicating successful models throughout the country. Free access to the course and materials is available through the APTA Learning Center.

    Look for other Innovation 2.0 Learning Labs; topics include pay for performance in treating patients with low back pain (available now), PTs as part of an accountable care organization (later this year), and a patient-centered medical home model that addresses childhood obesity (later this year).

    From PT in Motion: The Questions You Should Ask Suppliers

    Suppliers to physical therapists (PTs) and physical therapist assistants (PTAs) may believe their products are the answer to PT and PTA needs, but dig deeper: before accepting the product or service as an answer, see if it stands up to a few critical questions suggested by the suppliers themselves.

    This month in PT in Motion magazine: "Before You Buy: 26 Key Questions to Ask Suppliers," a list of tips on what a good supplier should be able to tell you about their company and product, accompanied by commentary from PTs, PTAs, and the suppliers.

    The list includes the straightforward ("Can you provide me with 3 references?" "How long have you been in business?"), the strategic ("Does your product contain tools for measuring client outcomes and tracking PT productivity?" "Can you respond quickly to changing market conditions?"), and the practical ("Can patients afford this?" "How long does it take to set up the equipment?"). Along the way, contributors offer up comments that help to put the questions in context—for instance, in support of the question about setup time, Jeff Leatherman, PT, writes that "If it takes longer than 2-3 minutes out of our treatment time, it had better be special."

    Suppliers Aretech, Bioodex Medical Systems, Fabrication Enterprises, KLM Laboratories, MW Therapy, and ReDoc provide industry perspective, encouraging PTs and PTAs to ask questions about a supplier's ability to respond to regulatory trends, the product's safety certifications, and any history of enhancements, among other topics.

    "Before You Buy: 26 Key Questions to Ask Suppliers" is featured in the August 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. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.

    EMG Lab Accreditation Process Recognizes Role of PTs

    Thanks to the collaborative work of several groups committed to making the case for physical therapists (PTs) as qualified providers of electrodiagnostic studies, the landscape for lab accreditation has changed in ways that create opportunities for PTs, all while following standards more rigorous than previously existing systems.

    The new lab accreditation is an effort of the Federation of Electrodiagnostic Laboratory Accreditation (FELA). But as the name implies, FELA is a group effort, created when members of the American Academy of Clinical Electrodiagnosis (AACE), the American Congress of Electroneuromyography (ACE), and APTA's Academy of Clinical Electrophysiology and Wound Management (ACEWM) came together around a shared goal—creating a program that allows PT-run labs to achieve accreditation.

    According to Greg Ernst, PT, PhD, member of AACE, the idea began 4 years ago. "There was already a lab accreditation process developed by the American Association of Neuromuscular and Electrodiagnostic Medicine [AANEM]," he said. "However, the AANEM accreditation requires that each lab, and all satellite labs, have a physician that performs electrodiagnostic studies—PTs could only function as technicians."

    So Ernst, ACE President Elaine Armantrout, PT, DSc, and Rick McKibben, PT, DSc, chair of ACEWM's clinical electrophysiology practice group, set out to create an accreditation program that would not only acknowledge the PT's ability to oversee electrodiagnostic labs, but would be based on standards that exceeded those created by AANEM. Joining the effort were Robert Sellin, PT, DSc, David Greathouse, PT, PhD, and John Palazzo, PT, DSc. Ernst, Armantrout, McKibben, Sellin, Greathouse, and Palazzo are all board-certified specialists in clinical electrophysiologic physical therapy. Greathouse, additionally, is a Catherine Worthingham Fellow of the American Physical Therapy Association.

    "We all agreed that FELA should be as inclusive and open as possible while maintaining strict adherence to what is needed to represent quality and integrity in an accreditation process," Armantrout explained. "FELA applicants can be from any discipline as long as their state licensure allows, which sets us apart from AANEM's accreditation, to which only neurologists and physiatrists can apply. We think that by restricting the accreditation in that way, the public and payers are misled, and it implies that there aren't other qualified providers, such as PTs."

    Besides the more open qualifications for accreditation, Ernst points to 3 other areas that make FELA distinct from the AANEM path:

    • A higher bar for "exemplary accreditation." While both FELA and AANEM offer 2 levels of accreditation—"regular" and "exemplary"—the requirements to achieve exemplary status through FELA are tougher than the ones used by AANEM, Ernst said
    • Emphasis on waste, fraud, and abuse training. Ernst said that FELA requires evidence of Centers for Medicare and Medicaid Services training on avoiding waste, fraud, and abuse. The AANEM program doesn't.
    • Cost. "The FELA lab accreditation process is less than half the cost of the AANEM accreditation," Ernst said.

    "The accreditation program is completely optional at this stage," Ernst added. "We developed FELA to help show third-party payers and the public that PTs and the labs [where they practice] can provide safe and quality care in the field of electrodiagnostics."

    Anti-Identity Theft Changes to Medicare Cards Coming

    How might changes to Medicare card numbers affect your practice? The Centers for Medicare and Medicaid Services (CMS) has some thoughts, but would like your input, too.

    On Wednesday, July 27, CMS will host a "listening session" to discuss its social security number removal initiative (SSNRI), a plan to end Medicare card numbers that are based on a beneficiary's social security number. The change is mandated under the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) as a way to reduce opportunities for identity theft.

    The session will run from 1:00 pm to 4:00 pm, ET, and will include a presentation on the SSNRI by CMS staff as well as a question-and-answer period. Registrants will be sent the CMS presentation in advance.

    Participants can register online, and are advised to call in 15 minutes before the session starts. CMS will also be accepting written comments on the SSNRI through August 3.

    PTA Advanced Proficiency Program is the Focus of Upcoming Webinar

    Physical therapist assistants (PTAs) and students interested in learning more about APTA's PTA Advanced Proficiency Pathways (APP) program are invited to join a free webinar coming up July 21.

    Now the association's sole postgraduation proficiency recognition program for PTAs, 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 self-select content-specific courses for the particular program pathway, followed by experiences with a qualified mentor of the participant's choosing. A dedicated program mentor designated by APTA makes sure that participants stay on the pathway and arrive at advanced proficiency as efficiently as possible.

    To help potentially interested PTAs get better acquainted with APP, the association will conduct a free webinar hosted by APTA Director of Postprofessional Credentialing Derek Stepp on July 21 from 12:00 pm to 1:00 pm, ET. Stepp will provide an overview of the program, as well as details on the steps needed to fulfill the requirements for completing it.

    No reservations are required. To sign up for the webinar, simply visit the APP webpage near the July 21 start time and click the "join the webinar" link. For more information on the webinar or the program in general contact Derek Stepp.

    A recorded copy of the webinar will be posted at the APP webpage as it becomes available.

    New APTA Series Gets at the Gaps

    APTA's #PTTransforms blog is now host to a new series that explores the divide between evidence and practice behaviors in the clinic.

    Titled "Narrow the Gap," the series features member and staff-authored posts that touch on the gaps that can exist among any of the components of evidence-based practice. Coming-soon topics include the pros and cons of research with small subject numbers, the ways implicit bias can affect practice (and what to do about it), and a decidedly "non-techie" physical therapist's encounters with the digitized research world.

    Perspectives are fresh, voices are diverse, and dialogue is welcomed. Visit the #PTTransforms blog page regularly to keep up with the series and check out other posts along the way.

    New at PTNow: THA Summary, Pain Resources, Clinical Case Studies, More

    From nonopioid pain treatment approaches to finding the most effective way to integrate into bundled payment systems, physical therapists (PTs) and physical therapist assistants (PTAs) have a lot to juggle. The latest additions to APTA's PTNow website make that juggling just a little easier.

    The association's flagship site for evidence-based practice resources continues to expand in ways that help PTs and PTAs easily find the information they need. If you haven't visited the site lately, check it out soon. New resources include:

    Total hip arthroplasty (THA) clinical summary with "quick take" feature
    A timely addition now that Medicare's Comprehensive Care for Joint Replacement bundled payment model is up and running in metropolitan areas across the country, the summary provides information on PT management of patients undergoing THA, including tests and measures, functional outcomes, exercise and gait training measures, associated conditions such as deep venous thrombosis and infection, and more. A quick take feature allows users to easily access just those sections they need at the moment, and additional links on the page connect the summary with other APTA resources, including consumer-focused materials available at MoveForwardPT.com.

    Pain management resources that include #ChoosePT, CDC, and multiple clinical practice guidelines (CPGs)
    The new PTNow pain management area is an impressive 1-stop shop for an area of health care that is increasingly turning to physical therapy for answers. Offerings on the page include everything from links to the #ChoosePT public education campaign to more than 25 CPGs and 40 Cochrane systematic reviews, plus tests and measures related to osteoarthritis, low back pain, and fibromyalgia.

    New clinical case studies on spinal cord injury (SCI) and both early and late Huntington disease
    The new SCI case tracks a 55-year-old male outpatient with an incomplete C5 SCI and limited insurance coverage. Readers can follow the initial examination and results, functional outcome measures, interventions, and outcomes at conclusion of care. The Huntington disease case studies track care in 2 distinct scenarios—early and late stages of the condition.

    New pediatric and balance tests and measures
    Tests and measures recently added include resources on assessing balance, measuring children's participation in and attitudes about leisure and recreational physical activities, and conducting a pediatric evaluation of disability inventory.

    PTNow is available for free only to APTA members.

    News From NEXT: Diversity's Goal Is Improved Decision Making, Not Consensus

    Increasing diversity in the boardroom and other groups results in better decisions. That was the take-home message from the NEXT 2016 session "Beyond Women in the Boardroom: Cognitive Diversity in Private Practice." Session panelists were Heidi Jannenga, PT, DPT, ATC/L, John Childs, PT, PhD, MBA, FAPTA, Julie Fritz, PT, PhD, FAPTA, and Claire Coonan, LCSW.

    "To make better—and wiser—decisions, we need to embrace cognitive diversity and collective intelligence," Coonan said. She listed 3 barriers to collective intelligence:

    • Self-silencing behaviors. Team members can tend to be reluctant to speak up. Factors such as gender, ethnicity, educational achievement, and financial status all can affect a person's willingness to speak.
    • Social punishment. Team members can tend to criticize views by other team members. Team diversity can reduce the likelihood of such criticism, as can validation of opposing views.
    • Cascading effects, also known as "group think." Team members can tend to agree with a viewpoint expressed early in discussion.

    "The job of a leader is to get other people to contribute, to draw them out," Coonan said.

    Bluntly, she said, "Ignoring collective intelligence can lead to collective stupidity." Research suggests that factors correlating with increased group intelligence include equal participation by group members, the ability to read the emotional states of others, and the presence of more women in the group. She added, "The goal is to create an environment that encourages diverse thought. Consensus is not the goal. Access to all relevant information is the goal."

    Fritz addressed 4 patterns of gender bias that exist in the workplace:

    • Prove it again. Women repeatedly have to prove their competence.
    • The tightrope. Women must walk a tight rope between being perceived as either too weak or too aggressive.
    • Maternal wall. Women are expected to change their commitment to work once they become mothers.
    • Tug-of-war. Women often are harder on other women than they are on men.

    Childs discussed cognitive diversity, defined as "the extent to which the group reflects differences in knowledge, including beliefs, preferences, and perspectives." He said that research shows that socially diverse groups are more innovative than homogeneous groups. But he acknowledged, "It's hard to surround yourself with people with opinions different from yours. Getting to consensus won't be easy. You have to become comfortable being uncomfortable."

    Returning to the definition of diversity, Jannenga said, "It's not specifically race, ethnicity, general, or sexual orientation. It's about bringing together multiple individuals with different ideas, perspectives, and creative influences." Specifically addressing physical therapy settings, she said, "It's not just about diversity among physical therapists. It's your front office and back office. It's physical therapist assistants. And it's the community, and their understanding of physical therapy."

    The panelists also discussed how the concept of diversity varies among generations. Childs said, "We Gen-Xers had diversity rammed down our throats. Millennials see it more as a business approach, to optimize the outcome. Previously, diversity was tied to social justice, not business outcomes." Fritz agreed, saying, "Millennials frame diversity as a means to a business outcome."

    Jannenga described how her company promotes diversity in the hiring process. "We hire for culture first. We ask hiring questions that are experiential. We have interviews not just with the hiring manager but also with the team that person will be working with. We see it as peeling back the layers of the onion to better understand the individual."

    Responding to a question from the audience on what the ideal board would look like, Jannenga answered, "We would have a representative from each relevant stakeholder. Ideally, we would have at least 2 of each [to minimize self-silencing behaviors and social punishment traits]. But I wouldn't assign a percentage to each. Actually, you already may have more diverse group than you think. You just may not be pulling out their views."

    Want more news from APTA's 2016 NEXT Conference and Exposition? Visit www.apta.org/NEXT/News/.

    Paper on PTs and Imaging Makes the Case for Expanded Privileges Nationwide

    If the relationship between diagnostic and procedural imaging and physical therapist (PT) practice were a Facebook status, it'd probably be "it's complicated." Now a new resource captures that relationship—where it's been, where it could and should be going, and the opportunities and obstacles along the way.

    The APTA Orthopaedic Section's Imaging Special Interest Group has released a white paper on PTs and imaging that serves as not only a history of the issue, but as a roadmap for advocating on behalf of expanded imaging privileges for PTs.

    The 41-page document also includes information on PT education and training around imaging, practice standards related to imaging, and the current state of payment for imaging ordered by PTs. Taken as a whole, the paper makes a compelling argument for expanded imaging privileges for PTs as a benefit to both individual consumers and society as a whole.

    "There is a strong evidence-based foundation and need to support widespread adoption of imaging in PT practice," authors write. "This document outlines historical perspective, proposes greater incorporation of imaging by PTs in systematically improving patient management and cost containment, and presents evidence in support of that proposal."

    New Online Rehab Reference Center Provides Point-of-Care Information

    It's not so much like getting a new tool as getting a fully-stocked 5-drawer, 2-cabinet toolchest: that's the impact of a new offering at PTNow that gives physical therapists (PTs) and physical therapist assistants (PTAs) quick access to point-of-care resources.

    The Rehabilitation Reference Center (RRC), now available for free to members, is an easy-to-use system that connects PTs and PTAs with information on diseases and conditions, drug information, patient education materials, exercise images, and practice resources. Designed as a resource that could be used quickly during a PT's workday, the RRC is updated daily and even contains breaking health care news from HealthDay News.

    "The RRC rounds out the offerings at PTNow by giving members quick access to extensive information," said Anne Reicherter, PT, DPT, PhD, OCS, CHES, APTA senior practice specialist. "It's a tool that can provide a lot of information very quickly—for example, just before a PT meets with a patient who has a condition that the PT wants to learn more about."

    The ever-expanding database already contains nearly 800 clinical reviews of diseases and conditions (including ICD-10 codes), information on 11,700 drugs, more than 9,800 exercise images in handout format, 1,500 patient education handouts, and reference information for more than 150 research instruments.

    "The RRC is a powerful system, yet it's very easy to use," said Gini Blodgett, MSLS, lead information resources specialist at APTA. "Navigation is intuitive, and as a user gets more experienced, more possibilities open up for refined searches, with the option for users to register with the RRC to create and save in-app files that can customize the experience even more." APTA has also posted a video tutorial that describes how the database works.

    Reicherter explained that the RRC is intended to complement other resources available at PTNow.

    "ArticleSearch, clinical practice guidelines, Cochrane Reviews and the member-authored clinical summaries and test summaries will still continue to grow as usual to provide members with rich resources for evidence-based practice," she said. "The RRC helps by augmenting the here-and-now information available on PTNow that PTs and PTAs need to better serve their patients and provide better treatment outcomes."

    The system is powered by EBSCOhost, a global information company that provides resources used by academic institutions, public and corporate libraries, hospitals, state institutions, national associations, and more.

    Want to see the RRC in action? Stop by the APTA pavilion in the exhibit hall during the upcoming NEXT Conference and Exposition, June 8-11 in Nashville.