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  • 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.

    From PT in Motion: Going 'Fixer Upper' on Your Clinic

    You have the right team, the right tools, and the right training to serve your patients. But is the clinical space you're offering making the most of those assets?

    This month's issue of PT in Motion magazine includes a feature article on how physical therapists (PTs) are rethinking the design of their clinics, from a University-sponsored overhaul of a 10,000-square-foot facility to an individual PT (and his brother) rehabbing an old tire store into a state-of-the-art space.

    "Physical Therapy By Design" explores the ways PTs have created patient-centered layouts that combine functionality with aesthetics to make their clinics welcoming and efficient. Sometimes working in partnership with architects, sometimes working alone, the PTs interviewed for the article have at least 1 thing in common: a willingness to question old assumptions about how a physical therapy clinic should look.

    The article includes examples of design changes both big and small—from moving walls to adding PT equipment baskets containing scissors, tape, goniometers, and the like at every bed. A second piece provides basic tips on what to think about when you begin considering a redesign.

    "Physical Therapy by Design" is featured in the October issue of PT in Motion 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.

    Registry to Collect Torticollis Data Through Collaboration With Academy of Pediatric Physical Therapy

    APTA's Physical Therapy Outcomes Registry (Registry) has taken another step in the development of resources that will provide "a continuous feedback loop" for the physical therapy profession—this time, by way of a clinical "module" focused on torticollis.

    Recently the association signed an agreement with the Academy of Pediatric Physical Therapy to collaborate on the creation and integration of a congenital muscular torticollis module within the Registry. The module will be based on the academy’s clinical practice guideline on the topic.

    In Registry terminology, a “module” is a set of data elements that describe and risk-adjust process-of-care and clinical outcomes for a defined patient population. These condition- or disease-specific data elements are based on evidence-based clinical practice guidelines and will help refine the way outcomes data is analyzed and interpreted for specific populations. Modules will build on the current functions of the Registry, which collects a core set of patient and outcomes data from an electronic health record.

    The torticollis module will include more granular information, such as description of the type of cranial deformity, right side or left side of the head, and torticollis severity, among other factors. Analyzing a large amount of this data will help describe typical physical therapist practice patterns, variations in care, and the effectiveness of physical therapy interventions in different types of patients—all key elements in the Registry's mission to amass outcomes data to inform practice and enhance research.

    “This is the Registry’s first module agreement with an APTA section, and we look forward to more such collaborations in the future,” said James Irrgang, PT, PhD, ATC, FAPTA, scientific director of the Registry’s Scientific Advisory Panel. “The process of care and clinical outcomes data from modules will provide a continuous feedback loop not only for physical therapists but for guideline developers.”

    APTA is working with other sections to develop guideline-based modules in other areas, such as shoulder pain and neck pain.

    For more information about participating in the Physical Therapy Outcomes Registry and how sections can play an integral role in module development, visit www.ptoutcomes.com.

    You Down With QPP? Watch and See (And Take the Quiz)

    Medicare payment is poised to change in big ways for physical therapists (PTs) in private practice. Are you ready?

    APTA can help. Since late 2015, the association has been rolling out new resources to help members prepare for what's coming down the pike as the US Centers for Medicare and Medicaid Services (CMS) implements its Quality Payment Program (QPP). The program already is significantly changing how some health care providers report to Medicare, and those changes likely will be required of PTs in the near future.

    The association's latest offering: a 4-minute video featuring Heather Smith, PT, MPH, APTA's director of quality, on reporting through MIPS and APMs, 2 of the biggest changes to how CMS will be doing business.

    Don't miss the video. But before you do, take this quick PT in Motion News quiz to find out just how much you know about what's happening. Consider it a kind of warm-up exercise—answers are at the bottom of this quiz. Also check out another quick questionnaire that looks at your readiness for payment reform in general.

    1. What does MIPS stand for?
    A. Meta-Inquiry on Performance Statistics
    B. Medicare-Implemented Payment Scale
    C. Madness-Inducing Participation Structure
    D. Merit-Based Incentive Payment System

    2. Successful participation in Advanced Alternative Payment Models (APMs) could result in a lump sum additional payment each year of how much?
    A. An amount equal to 2% of the previous year's fee-for-service payments
    B. An amount equal to 3% of the previous year's fee-for-service payments
    C. An amount equal to 5% of the previous year's fee-for-service payments
    D. An amount equal to 7% of the previous year's fee-for-service payments

    3. How soon can PTs expect to be required to participate in QPP?
    A. 2018
    B. 2019
    C. 2020
    D. They are required to participate this year

    4. Which MIPS performance category will include measures that were reported under the Physician Quality Reporting System?
    A. Advancing care information
    B. Improvement activities
    C. Cost
    D. Quality

    5. How high will MIPS noncompliance payment penalties be by 2022?
    A. 5%
    B. 7%
    C. 9%
    D. 12%

    6. True or false: clinicians participating in an advanced APM must continue to participate in MIPS.

    7. True or false: the Comprehensive Care for Joint Replacement model is considered an APM.

    8. To qualify as an approved APM, a program must require at least 50% of eligible clinicians to use certified electronic health record technology during the first year. What percentage is required in the second year?
    A. 50%
    B. 64%
    C. 70%
    D. 75%

    9. How can the APTA Physical Therapy Outcomes Registry help PTs participate in QPP?
    A. Participation in the Registry earns PTs points toward MIPS improvement activities.
    B. The Registry can package data for submission to MIPS.
    C. PTs are able to receive real-time feedback on their performance throughout the year.
    D. All of the above.

    10. True or false: QPP changes will be limited to only Medicare Part B for the forseeable future.

     

    ANSWERS:

    1. Answer: D. It's the Merit-based Incentive Payment System, and although the change might spark the fear of madness among PTs, things may not be as dire as all that: PTs who report to PQRS already know how to do much of the quality reporting required by MIPS, and PTs can voluntarily participate in MIPS risk-free this year so they can hit the ground running when QPP participation becomes a requirement.

    2. Answer: C. When APMs succeed in reducing providers’ spending, they may receive a payment equal to 5% of the previous year's payments. The payments will be made 2 years after the performance period being evaluated.

    3. Answer: B. While not certain, there is a strong likelihood that PTs will be required to participate beginning in 2019.

    4. Answer: D. Data previously reported under PQRS will be included in the Quality category. The Cost category will contain new measures still being worked out by CMS; Improvement Activities will include elements such as practice access, population management, care coordination, and beneficiary engagement; and Advancing Care Information encompasses the former electronic health records (EHR) "meaningful use" program under PQRS. Although PTs weren't required to participate in the meaningful use under PQRS, they will be required to do so under MIPS—meaning if you haven't established a relationship with an EHR program, now would be a good time to start.

    5. Answer: C. CMS is not playing around. Penalties for noncompliance could be as steep as 9% by 2022.

    6. Answer: False. Clinicians can choose to participate in QPP either through MIPS or through participation in an APM—they don't have to do both; in fact, they have to choose 1 or the other.

    7. Answer: True – for the most part. One of the CJR tracks is an APM, along with several others listed on the CMS Centers for Medicare and Medicaid Innovation webpage.

    8. Answer: D. At least 75% of eligible clinicians must use certified EHR technology by the second year of operation.

    9. Answer: D. APTA's Physical Therapy Outcomes Registry is a storehouse, a data packaging service, and an ongoing feedback loop all in 1.

    10. Answer: False. Look for QPP provisions to spread to private payers—and probably sooner than you think.