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  • Help Aging Communities 'Go4Life' in September

    Physical therapists (PTs), physical therapist assistants (PTAs), students, and supporters of the profession shouldn't wait until National Physical Therapy Month in October to spread the word about the importance of mobility and physical activity—September is Go4Life month, a National Institutes of Health (NIH)-sponsored campaign that provides plenty of opportunities to educate the public on the ways older Americans can stay healthy through maintaining or increasing endurance, strength, balance, and flexibility.

    Strongly supported by APTA, Go4Life is an ongoing effort to connect the public and health care providers with information and resources related to healthy aging. In addition to information on how exercise improves health, the Go4Life website includes suggested exercises, workout videos, fitness tracking resources, and access to printed materials including infographics, posters, bookmarks, and postcards, all available for free. The program also offers a free "Speaker's Toolkit" to help providers develop presentations to target audiences—available by emailing Go4Life@mail.nih.gov.

    During September, the campaign offers special resources that include a weekly planning guide and a Facebook Live event set for Thursday, September 13, at 2:00 pm ET. The campaign is an effort from NIH's National Institute on Aging, and can be followed on Twitter through @NIAGo4Life.

    Aetna's Policy Clarifications Increase Access to PT Care

    Major commercial insurer Aetna recently provided some clarification on policies related to payment for physical therapy, and it's good news for physical theapists (PTs) and their patients.

    The clarifications help to answer questions related to the company's physical therapy policy, specifically around payment for evaluations and the ways direct access provisions can affect payment. Here's what Aetna said:

    Evaluations could be eligible for payments sooner than the 180-day wait period.
    Although Aetna’s policy reads that "physical therapy evaluations will be eligible for payment once every 180 days," Aetna representatives have informed APTA that evaluations performed within 180 days of the original evaluation may be allowed upon reconsideration or appeal, providing the evaluation is for a new or unrelated condition.

    State direct access provisions could allow for reimbursement from Aetna without a referral.
    Aetna’s policy reads that “Aetna considers physical therapy medically necessary when this care is prescribed by a chiropractor, DO, MD, nurse practitioner, podiatrist or other health professional qualified to prescribe physical therapy according to state law." Representatives from Aetna have clarified that in states with direct access provisions for PTs, a PT is considered an “other health professional qualified to prescribe physical therapy,” meaning that PT services will be reimbursed without an order or referral if all other requirements are met.

    "Aetna has been working with APTA to support access to PT services, and understands the importance of making providers aware of how specific policies are interpreted," said Alice Bell, PT, DPT, an APTA senior payment specialist. "We appreciate Aetna's efforts and look forward to continued cooperation on issues that may impact access to care."

    From PT in Motion Magazine: How to Defend Yourself Against Scams and Cyberattacks

    As technology and information sharing evolves at a rapid pace, it becomes harder to keep up with criminals and scammers—even if you are an experienced professional. Last year, a staggering 83% of physicians said they had experienced some form of cyberattack, according to an American Medical Association report. What kind of scams are out there? What should you be wary of? What new threats are emerging?

    A feature in this month's PT in Motion magazine describes common cybercrimes and scams, including data breaches, phishing, and ransomware. Author Katherine Malmo reports that cyberattacks happen to more organizations than we might think, since people don't want to share their experiences. Robert Latz, PT, DPT, told PT in Motion, "The question is less if there will be a breach and more what to do when the breach happens."

    The article examines other scams that take advantage not of security holes but human error, such as fraudulent job ads that require financial transactions or predatory scholarly journals that publish anything as long as you pay, which can damage your credibility. "What is most astounding," Chad Cook, PT, DPT, comments, "is that really talented people submit to these publications."

    "How to Defend Yourself Against Scams and Cyberattacks" 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 one 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.

    From PT in Motion: PTs Improving the Health of Communities

    Physical therapists (PTs) and physical therapist assistants (PTAs) have long understood the connection between mobility, physical activity, and the prevention of society's most serious health conditions. Some committed PTs say now's the time to start sharing that understanding at the community level.

    Featured in the May issue of PT in Motion magazine: "Reaching Beyond the Clinic," an exploration of how PTs are engaging in community health promotion in a variety of settings. And "variety" is a key word here: as explained in the article, "community health promotion" can be conceptualized in a number of ways, which can in turn create multiple opportunities for PTs and PTAs to make a difference.

    Among the PTs interviewed for the article are Rupal Patel, PT, PhD, who created a 12-week group-based lifestyle program to reduce diabetes risk among Asian Indians; Beth Black, PT, DSc, the co-instructor of a 6-week program for people who have multiple sclerosis; and Jessica Berglund, PT, DPT, chair of APTA's Council on Prevention, Health Promotion, and Wellness, and an employee of a home health company that offers a "7 elements of well-being" program to older adults. Accompanying articles include a list of relevant APTA resources and a report on a new clinical model that helps PTs overcome unease about asking people about their unhealthy habits.

    The article also addresses the question of whether PTs and PTAs should be involved in community health in the first place, and arrives at a definitive "yes." While education and training alone would seem to make the case for PTs stepping into this space—Berglund describes the PT's background as "ideal" for this kind of work—there's also a compelling ethical argument to be made for the profession becoming a leader in community health, according to longtime proponent Janet Bezner, PT, DPT, PhD, FAPTA. Bezner is on the steering committee for the APTA council mentioned above.

    "We can't ignore that [preventable diseases] are harming society and fueling skyrocketing health care costs," Bezner says in the article. "If we don't address them, we're complicit—frankly, we're contributing to the problem."

    "Reaching Beyond the Clinic" is featured in the May 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.

    Coming to NEXT in June? Don't miss "Utilizing Community Collaboration to Reduce Health Disparities," a session focused on the ways PTs have developed and implemented community-based programs.

    Payers Looking for More Coding Detail

    Physical therapists (PTs), take note: the 59 modifier is a potential red flag for the US Centers for Medicare and Medicaid Services (CMS) and commercial payers.

    The 59 modifier is the code under the health care common procedural code system (HCPCS) used to represent a service that is separate and distinct from another service it's paired with. In an effort to tease out precisely why the service is distinct, CMS is requiring that in certain cases, providers use different modifiers instead of the 59 modifier. The modifiers—XE, XP, XS, and XU—are intended to bypass a National Correct Coding Initiative edit by denoting a distinct encounter, anatomical structure, practitioner, or unusual service.

    When the X modifiers were introduced in 2015, PTs weren't required to use them. But movement toward the use of these modifiers—and greater scrutiny of claims using the 59 modifier—is happening.

    CMS recently issued detailed guidance on the use of the 59 and X modifiers, complete with examples of what it considers appropriate and inappropriate applications. Providers should carefully review the CMS guidance document, as well as check their commercial payer payment policies regarding the use of the 59 modifier versus the X modifiers.

    APTA will continue to monitor this issue and share news of any changes.

    From PT Pintcast: Now's the Time to Embrace Outcomes Registries

    Medical specialty societies and associations have a responsibility to help members define, measure, and report value—or someone else will do it for them. And registries such as APTA's Physical Therapy Outcomes Registry are important vehicles for staying ahead of the curve.

    This was 1 takeaway from a recent PT Pintcast podcast featuring Heather Smith, PT, MPH, APTA director of quality, and Nathan Glusenkamp, a registry expert who is director of registries at the American Academy of Orthopaedic Surgeons (AAOS).

    For Glusenkamp, associations are ideal for developing clinical registries because they bring "specialized experience" that can’t be matched. He is "a firm believer that if [medical specialty societies] are not engaged in defining value, reporting value, measuring value—that’s still going to happen, but it’s probably going to happen in a way [members] don’t like."

    Smith believes that association-run registries also serve another important function: helping providers get a handle on the seemingly inevitable move toward value-based health care.

    "I can’t stress enough, being prepared ahead of time and really getting involved as early as possible to start to think about the value that you bring," Smith says in the podcast. "Not just in the care that you deliver today, but think more broadly in new and different ways we may be able to bring value to the health care system. Being able to support payment for these services in new and emerging models is really exciting. So you’ve got to be involved to reap the benefits of the new frontier we’re moving into."

    Listen to the full podcast at www.ptpintcast.com. Learn more about the Physical Therapy Outcomes Registry at www.ptoutcomes.com.

    From PT in Motion: PTs Should Cultivate Their Knowledge of Medical Marijuana

    Despite a lingering social stigma attached to marijuana use, there is a growing interest in medical marijuana (MMJ) among patients, researchers, and health care providers, including some PTs and PTAs. Medical marijuana is a potential alternative to opiates, muscle relaxers, and anti-inflammatory drugs. But is it always safe?

    This month in PT in Motion magazine: "A Growing Interest in Medical Marijuana" explores the complicated legal landscape regarding MMJ and how a patient’s use of MMJ may influence physical therapy care.

    While state laws regarding marijuana use are inconsistent, there is a trend toward legalization and decriminalization. However, the United States Drug Enforcement Agency (DEA) is still trying to shut down domestic cultivation of marijuana. Mike Pascoe, PhD, a neurophysiologist and assistant professor in the physical therapy program at University of Colorado, says he meets many physical therapists (PTs), physical therapist assistants (PTAs), and students who are "uninformed about federal and state laws and the process for researching marijuana."

    Charles Ciccone, PT, PhD, FAPTA, told PT in Motion that "many patients are ahead of the curve" compared with clinicians. While no PT or PTA should ever advise use of any medication, Ciccone says clinicians should be able to educate patients on the "reported benefits of marijuana as regards chronic pain, spasticity, and chemotherapy-induced nausea and vomiting"—as well as potential adverse effects.

    Laura Borgelt, PharmD, a pharmacology professor at University of Colorado, educates PT students about how cannabis works in the human body, and how it can be helpful or harmful to certain body systems. Because it is often used to treat pain symptoms, she says, marijuana is "very relevant for a PT." She encourages PTs to be on the lookout for side effects such as cardiovascular issues while exercising, and changes in mood or memory.

    Vivian Eisenstadt, PT, MA, is among PTs who are "very much in favor of legalizing" marijuana. "Marijuana helps many people I treat," she says, comparing it to Vicodin or "any other medication a physician has prescribed for management of physical or mental pain." That said, she observes that sometimes marijuana use can affect a patient’s response time or focus. In such cases, she counsels the patient about "not taking the drug before sessions if it’s going to lower the quality" of the therapy session—just as she would for someone taking Vicodin or OxyContin. "As a PT," she explains, "it is my job to navigate the situation with compassion and professionalism."

    The variety of forms of marijuana consumption is a concern, as dosage is often inaccurately labeled, says Pascoe. Pharmaceutical-grade marijuana extracts and topical creams differ from commercial products such as baked goods or candy. In addition, the different cannabinoids found in marijuana have varying effects on the body.

    When researching medical marijuana’s effects, Ciccone urges PTs to consider the source of the information to be able to provide patients with balanced and valid information. Clinicians "should be vigilant for any problems that may arise if patients are using cannabinoids during physical rehabilitation."

    "A Growing Interest in Medical Marijuana" is featured in the February issue of PT in Motion magazine, and is open to all viewers—pass it along to nonmember colleagues to show them one 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.

    Move Forward Radio: Former NBA All-Star Grant Hill Discusses Pain Management and Alternatives to Opioids

    As a 19-year player in the National Basketball Association (NBA), Grant Hill was no stranger to injury, both major and minor. Experiencing "aches and pains, bumps and bruises is kind of par for the course," he says.

    Now available from APTA's Move Forward Radio: a conversation with Hill, who describes his experience with injury, managing pain, and what he would do differently today. "We all have pain in some fashion. The most important thing is to educate yourself…about pain—how do you handle postsurgery? What are your rights as a patient?" With regard to opioids, he explains, "You have options."

    The 7-time all-star retired in 2013 after numerous ankle injuries and surgeries—and painful recoveries—over the course of his career. Hill is a strong proponent of nonopioid alternatives to pain management and is a spokesperson for Plan Against Pain, a national campaign that educates the public on the availability of nondrug approaches to pain treatment postsurgery. As a player, he was prescribed opioids after surgery and for very painful injuries but says, "I didn’t like the way I felt." Hill tried to find alternative ways to treat his pain, including physical therapy. "Physical therapy has been an integral part of my career and my longevity" as a player, he says.

    He tells listeners: "Listen to your body. This is your body. This is your health. You don’t have to rely on opioids to deal with pain."

    Like Hill, APTA is raising public awareness about the risks of opioids and the benefits of physical therapy via its #ChoosePT campaign, which includes TV and radio public service announcements, national advertising, and free resources at MoveForwardPT.com/ChoosePT.

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

    Other recent Move Forward Radio episodes include:

    Recovery From Debilitating Abdominal Pain Inspires a New Career Path
    Michelle Griffith had severe abdominal pain that was undiagnosed—until she saw a PT, who discovered her nerve damage and guided her recovery. Now she is an aspiring PT student.

    Pain Does Not Discriminate, Even in Hollywood
    Karen Joubert, PT, DPT, shares some insights into the needs of her famous clients, how they benefit from physical therapy, and her universal, back-to-basics approach in treating all of her clients.

    Neonatal Abstinence Syndrome
    Bertie Gatlin, PT, DSc, Divya Rana, MD, and Kalyani Garde, OTR, discuss signs and symptoms, treatment in the hospital, and aftercare for infants born with neonatal abstinence syndrome (NAS), which occurs when an infant who was exposed to opiates through his or her mother experiences withdrawal after birth.

    Diastasis Recti Abdominis: The Likely Cause of "Mummy Tummy"
    Carrie Pagliano, PT, DPT, discusses diastasis recti abdominis during or after pregnancy, including misconceptions about the condition and her perspective on how women can work with PTs to correct the condition.

    Amplified Pain Syndromes: Treating a Pediatric Population
    Brandi Dorton, PT, DPT, and Misty Wilson, OTR/L, discuss the variety of tools and interventions they use to effectively treat individuals with increased sensitivity to pain, and help them improve and reclaim their lives.

    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.

    Innovation 2.0 Learning Lab to Focus on PTs as Key Players in PCMHs to Address Childhood Obesity

    Managing childhood obesity in a patient-centered medical home setting is the fourth and final installment of APTA’s online Learning Labs series based on the Innovation 2.0 initiative. Interested members are invited to register for the interactive session, scheduled for December 15, 1:00 pm–4:00 pm.

    Like the first 3 labs, the January 18 event will enable participating APTA members to hear firsthand from the physical therapist innovators who were selected to pursue new, creative models of care. This fourth lab is your chance to hear from your colleagues about working in a patient-centered medical home (PCMH).

    In this innovative health care model, the physical therapist (PT) plays a key role in measurements of obesity-related signs and symptoms that affect the human movement system, including aerobic fitness and strength deficit, lower extremity joint pain, gait dysfunction, and motor control deficit. The PT also evaluates and monitors children's physical activity and sedentary behaviors, and is trained in behavioral strategies to enhance physical activity and parental support. The model measures cost-effectiveness by tracking incidence of disease rates and hospitalization for obesity-related conditions.

    Referrals to specialists (such as PTs when a cluster of impairments appear that indicate a movement disorder associated with obesity) are coordinated so that appropriate care is received. Regular follow-ups document progress and help the young patients and their families with self-management. This model also could provide support for including PTs in PCMHs that target other chronic health conditions that affect movement.

    The Learning Lab is a free online event intended as an advanced experience for providers who are currently active in innovative programs or ready to explore them. Participants will be expected to actively engage in the lab session, and materials will be provided beforehand to help them do so. If that’s you, visit the Innovation 2.0 webpage and scroll to the "Learning Lab" section to register.

    APTA will post a recording of the event afterward, which also will include the prerecorded presentation and downloadable template—all free to APTA members.

    Visit the Innovation 2.0 webpage to register for the PTs as Key Players in a PCMH Program for Childhood Obesity Learning Lab. For details on all of the projects selected for development, as well as projects that received honorable recognition, go to Innovation 2.0 Background. Profiles of each project were also featured in a September 2015 article in PT in Motion magazine.

    Move Forward Radio: Pain Does Not Discriminate, Even in Hollywood

    Karen Joubert, PT, DPT, treats patients of all ages and levels of fitness and ability—those recovering from injury and those seeking to maintain healthy lifestyles. But with an office in Beverly Hills, California, her clientele also happens to include famous entertainers and big-name athletes.

    Whether it is maintaining peak athletic performance for tennis superstar Serena Williams or achieving top fitness and stamina for Cher, Joubert says her physical therapist (PT) services provide a “back-to-basics” approach for all of her clients, celebrities and noncelebrities alike. “You don’t need expensive machines,” insists Joubert.

    “Everyone is unique; everyone has different goals,” Joubert notes, but reaching them “takes focus; it takes discipline.”

    Now available from APTA's Move Forward Radio: a conversation with Joubert, who shared her insights on the implications of living longer and “pushing our bodies harder” and described what she learned from swimmer Diana Nyad, who, at age 64, swam from Cuba to Florida without a shark tank after physical therapy for a rotator cuff injury.

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

    Other recent Move Forward Radio episodes include:

    Neonatal Abstinence Syndrome
    Divya Rana, MD, Bertie Gatlin, PT, DSc, and Kalyani Garde, OTR, discuss signs and symptoms, treatment in the hospital, and aftercare for infants born with neonatal abstinence syndrome (NAS), which occurs when an infant who was exposed to opiates through his or her mother experiences withdrawal after birth.

    Diastasis Recti Abdominis: The Likely Cause of “Mummy Tummy”
    Carrie Pagliano, PT, DPT, discusses diastasis recti abdominis during or after pregnancy, misconceptions about the condition, and how women can work with PTs to correct the condition.

    Amplified Pain Syndromes: Treating a Pediatric Population
    Brandi Dorton, PT, DPT, and Misty Wilson, OTR/L, discuss the variety of tools and interventions they use to effectively treat individuals with increased sensitivity to pain, and help them improve and reclaim their lives.

    Five Domains of Sustainable Health
    Jennifer Gamboa PT, DPT, describes how her team of collaborative health care providers approaches sustainable health through 5 domains—because when it comes to total health, diet and exercise are just part of the equation.

    Living With Ehlers-Danlos Syndrome
    Victoria Graham, a beauty pageant champion, describes how she manages her constant pain, which has involvedphysical therapy, medication, and multiple surgeries.

    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.