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  • PTJ Perspective: PT Education on Medical Marijuana Highly Recommended

    Medical marijuana is no longer a novelty: In fact, physical therapists (PTs) in half the United States may be treating patients who use the drug, says Charles D. Ciccone, PT, PhD, FAPTA, in a recent "Perspective" column published in Physical Therapy (PTJ), APTA's science journal.

    The growing prevalence of medical marijuana means that PTs should be aware of the marijuana options available to their patients, potential benefits for certain conditions, and possible adverse effects on “cognition, coordination, balance, and cardiovascular and pulmonary function,” Ciccone writes.

    The "Perspectives" article outlines methods of consumption (each has "benefits and drawbacks," Ciccone writes), the differences between THC and cannabidiol, the drug's positive effects on certain conditions, and links to possible negative effects, such as increased risk of stroke, myocardial infarction, and falls. Ciccone writes that it would be “unwise” for a PT to advise a patient on the use of marijuana; patients should always be referred to their physician for a consultation. But, he notes, “Patients and their caregivers may approach physical therapists with questions about medical marijuana,” so PTs should educate themselves about its potential effects on patient function.

    Ciccone also writes about current barriers to research that could make a stronger case for or against the use of medical marijuana for particular conditions, not the least of which are federal regulations that aren't always sympatico with state laws. While some states may allow access to it, marijuana’s legal classification (in plant form) as a class I controlled substance (highest abuse potential) clouds the issue, making it difficult to conduct well-designed randomized controlled trials on its potential benefits, Ciccone observes. And despite pleas from the medical community, the FDA refuses to reclassify it—even though synthetic compounds are classified at a lower risk.

    While still controversial, “medical marijuana continues to gain acceptance” for treating a variety of disorders, Ciccone concludes. While more research clearly needs to conducted, “clinicians must be aware of the potential side effects of medical marijuana” and “should be able to educate their patients about the current status of medical marijuana” and refer them to their physicians for more information.

    Note: the PTJ article access process has changed. To view a PTJ article:

    • Go to https://academic.oup.com/ptj
    • Click on Sign In (righthand top of page)
    • Click on “Sign in via society site” (do NOT use Oxford Academic account)
    • Enter your APTA username and password
    • Click on “Click here to continue” to return to PTJ’s main page
    • Use the search, or navigate to desired article

    If you already are logged in at apta.org and want to go to PTJ, you can click on “PTJ” under the News and Publications tab, but you will still need to login again at the PTJ website to access articles.

    From PT in Motion: Ethics Under Pressure

    Making 100% ethical decisions with 0% internal conflicts would be easy if it weren't for … well, just about everything.

    This month's "Ethics in Practice" column in PT in Motion magazine uses a fairly uncommon setting to get at a fairly common issue: namely, the ways in which external pressures can cloud the ability of a physical therapist (PT) or physical therapist assistant (PTA) to stay true to professional ethics.

    The scenario involves a PT for a pro football team—not exactly a common gig—but the larger issues will be all-too-familiar to readers, who, for example, may receive pressure from parents of a pediatric patient, or feel conflicted over a working patient who believes he or she must return to the job as soon as possible.

    The PT in Motion column presents a PT for a pro team who is charged with overseeing rehab for a high-value player after meniscal surgery. The player is progressing in a fairly normal way, but as a big playoff game looms, the PT starts experiencing pressure to hurry things along and make a positive return-to-play decision.

    Some of the pressure is overt, coming from the team's coach and even the player in question. But some of that pressure comes from within the PT. The work with the team is rewarding, both personally and financially, and the PT feels the pull to make everyone—maybe even himself included—happy with a process that will get the star player on the field in time for the crucial game.

    While the particulars involve a setting most PTs will never experience, the conflicts are familiar. Column author Nancy Kirsch, PT, DPT, PhD, and guest coauthor Bruce Greenfield, PT, PhD, ask readers, "Have you faced similar situations, in which you have questioned your own clinical judgments and motives? What did you do about it? How did you subsequently feel about your action—or lack of action—as the case might be?"

    " A Game-Time Decision " is featured in the March 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.

    Also open for public access: " Beyond Rest: Physical Therapists and Concussion Management ." Check it out!



    Webinar, Q-and-A Session Help PTs and PTAs Make the Case for Physical Therapist-Led Workplace Programs

    If physical therapists (PTs) and physical therapist assistants (PTAs) are to be truly successful in taking a leadership role in prevention and wellness efforts, they'll need to take that message to a group that has the potential to make a difference: employers. A new free webinar from APTA provides insight on the whys, hows, and what-nexts for PTs and PTAs ready to take on population health initiatives in the workplace, and a follow-up Q-and-A session will explore questions from webinar viewers.

    "Direct-to-Employer Physical Therapy: Building Supply and Demand" is rooted in the idea that employers are motivated to lower health care costs and maintain a healthy and productive workforce, and are increasingly creating employer-based population health programs that attempt to do just that. This trend creates an opportunity for PTs and PTAs to step up and make the case directly to employers for the effectiveness of physical therapist-led efforts to meet those employer needs.

    The program essentially is a 2-part presentation: attendees are asked to listen to a prerecorded webinar that provides the compelling reasons that PTs and PTAs are so valuable in population health efforts as well as the potential challenges and pitfalls of establishing employer-based programs. Then, attendees are invited to participate in a live webinar on March 9 2:00 pm-3:00 pm ET, when experts will answer questions sent in by viewers of the introductory presentation.

    The presentation was developed through an APTA employer initiative work group that is creating additional resources on the topic.

    Presenters for the recorded session are Mike Eisenhart, PT; Todd Davenport, PT, DPT, MPH; Heidi Ojha, PT, DPT; and Holly Johnson, PT, DPT. Others on the employer initiative work group are Mark Amir, PT, DPT, MPH; Joe Shine, PT, DPT; and Zach Jones, PT, DPT, will join the live webinar.

    Cracking the Code: 6 Resources to Help You Navigate the 2017 CPT Code Changes

    When it comes to the new CPT evaluation coding system set to start on January 1, 2017, 2 things are inarguable: 1, this is actually happening; and 2, navigating and even thriving in the new system will require physical therapists (PTs) to stay engaged, learn as much as they can, and actively participate in shaping the future of the codes and how they're applied.

    With that in mind, here are 6 worthwhile resources that can help you understand and prepare for the big change in coding.

    1. Cut to the chase with APTA's quick guide to the codes.
    Want the basics? Check out the easy-to-read guide available online (it was also shipped with the December-January issue of PT in Motion magazine). This is the bare-bones, bottom-line content you need to know right now, accompanied by a set of definitions that help clarify what the Centers for Medicare and Medicaid Services mean by terms such as "activity limitations" and "body systems."

    2. Dig deeper with a free 60-minute webinar.

    This recording of a September 22 webinar covers the basics and then some. APTA staff are joined by Kathleen Picard, PT, and Helene Fearon, PT, in an in-depth review of the new coding system, including a brief history of how the system came to be, and case vignettes that show the codes in action.

    3. Get another perspective—in just 30 minutes.

    APTA has partnered with CEU provider MedBridge to deliver an online course that explores the elements of an evaluation and what conditions must be met for each level of complexity, accompanied by practical, interactive examples to help you practice documentation and proper code selection.

    4. Learn on your schedule with this self-paced course.

    One of the newest offerings from APTA, this free slide deck with accompanying notes explains the basics, and then puts heavy emphasis on seeing the codes in action through case scenarios focused on cardiovascular and pulmonary, neurology, pediatrics, orthpedics, and geriatrics.

    5. Join the conversation on payment.

    APTA has launched an online community on the Hub focused solely on payment reform. Ask questions, exchange thoughts with other PTs, and get a better sense of how your peers across the country are responding to the changes—not just in CPT codes, but other areas.

    6. Mark your calendars for more learning coming early in 2017.
    The opportunities to get up-to-speed don't end in 2016. Viewers of the APTA webinar from September 22 (see #2 above) are invited to participate in a live Q-and-A session set for January 19, 1:00 pm–2:00 pm, ET. Fearon and Picard will once again join the APTA staff team to provide updates on the codes, and then answer participants’ questions (deadline is January 12 to submit questions).

    Also in the near future: PT in Motion magazine articles in 2017 on the new system. While PT in Motion did cover the CPT codes in a 2016 article, both the February and March “Compliance Matters” columns will include even more information.

    The CPT codes aren't the only moving part in the evolving payment scene. Make it easy on yourself to keep up with all the news related to payment for physical therapist services: sign up for the Payment edition of APTA's Friday Focus series, a monthly collection of the top payment-related stories from PT in Motion News, the latest APTA resources, and more learning opportunities.

    From PT in Motion Magazine: Removing Roadblocks to Adherence

    Many physical therapists (PTs) know the pattern all too well: a patient makes significant improvement over an episode of care, only to lose ground when the PT's recommendations for posttreatment care aren't followed. So what can be done to increase adherence and stop "the revolving door" of physical therapy?

    This month in PT in Motion magazine: an exploration of what PTs can do to extend adherence after the conclusion of care. Associate Editor Eric Ries reports on several PTs who share different ways to recognize and remove the roadblocks that can get in the way of patients doing what needs to be done to stay healthy.

    While the PTs interviewed acknowledge that there is no single surefire way to guarantee adherence, they do describe some techniques that can at least help the PT get a better handle on the factors and attitudes that can be barriers. Some of the techniques, such as motivational interviewing and reflective listening, are comprehensive approaches to treatment; others, such as helping patients to understand and describe home exercise instructions in their own terms, are simple tweaks.

    The article also includes sidebars featuring the connection between adherence and technology, as well as a list of additional resources on increasing adherence.

    "Extending Adherence" is featured in the December-January 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.

    Free Learning Lab on Partnering With ACOs Recorded and Ready

    Are you in a private practice or rehab agency trying to figure out how to partner with physicians or hospitals in an accountable care organization (ACO)? Or a hospital working on innovative approaches to improved patient access within your facility? Do you want to hear from your colleagues about their work in ACOs and learn from their experiences?

    APTA’s series of Learning Labs now offers the third of 4 opportunities for you to hear firsthand from the physical therapist innovators who were selected to pursue new, creative models of care through APTA's Innovation 2.0 program. This third online lab, recorded in November, is now available in the APTA Learning Center and focuses on how physical therapists can facilitate access and provide value as integral participants in ACOs. This free webinar includes the recorded session, with the presenters’ slide deck and a downloadable guide to replicating the program in other facilities.

    This project was conducted with private physical therapy practices in Northern Colorado participating in the Medicare Shared Savings Program through the Mountain and Plains Division of Central US Accountable Care Organizations and led by Tim Flynn, PT, PhD. It evaluates the role of early access to physical therapist services for patients with musculoskeletal complaints, specifically lower back pain. In this model, physical therapists are working collaboratively with ACO primary care physicians to optimize management of low back pain in the outpatient setting.

    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.

    Other Innovation 2.0 Learning Labs topics include pay for performance in treating patients with low back pain (available now), adding value to a postacute care setting (available now), and a patient-centered medical home model that addresses childhood obesity (later this year).

    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 also were featured in a September 2015 article in PT in Motion magazine.

    LEAP: Bringing Cochrane to the Clinic

    You're probably familiar with Cochrane systematic reviews, those studies-of-studies that are intended to provide the most reliable take on conditions and treatments. Cochrane reviews provide invaluable information—but how do you put that information into practice?

    Enter "Linking Evidence and Practice" (LEAP), a learning program sponsored by Physical Therapy (PTJ), APTA's scientific journal, that aims to help clinicians get the most out of Cochrane reviews for the benefit of their patients and clients. Each LEAP article is written by an author team that generally includes at least 1 "in the trenches" physical therapist (PT), and includes "at a glance" tables as well as the bottom-line information you need to know to apply the review's findings.

    Here are some of the latest courses based on LEAP articles, available through the APTA Learning Center:

    The LEAP articles also include a case section to show how a review's results inform clinical decisions for a specific patients. Authors answer questions such as "How did the results of the Cochrane systematic review apply to [the patient]?" "How well do the outcomes of the intervention provided to the patient match those suggested by the systematic review?" "Can you apply the results of this systematic review to your own patients?" and "What can be advised based on the results of this systematic review?"

    Don't Slip on Appeal: Tips and Resources to Help You Navigate Payers and Insurance Commissioners

    Everyone knows the old saying about death and taxes being the only certainties in life. Physical therapists (PTs) and physical therapist assistants (PTAs) can probably add 1 more to that list: appeals to insurance company payment decisions.

    Here are a few tips and resources from APTA, to help you get it right.

    The tips

    Appeals are important …
    Yes, the appeals process adds yet another administrative burden to your plate, but don't forgo the process when you feel that medically necessary services have been denied or partially approved. You have a responsibility to protect the patient if payment for appropriate care is denied. And, remember, you won't be able to pursue an appeal at a higher level—the insurance commissioner's office—unless you have done your due diligence and exhausted all other means of reconsideration.

    …but be discerning.
    Appeals are time-consuming for you, but they also time-consuming and costly for the payer. Payers do track the number of appeals filed by providers, and they see a high rate as an unfavorable utilization management vendor statistic.

    Patient voices carry a lot of weight …
    The experiences of patients do matter, and a mass outcry by the consumer will get the ear of the payer, employer (particularly the self-insured), and the insurance commissioner. Delays in authorization approval, visits approved in small increments with waits in between, or denial of medically necessary services are all examples of access issues. The insurance commissioner’s job is to protect consumers, and that office is particularly interested in hearing about access issues.

    … so make sure patients have the necessary resources available.
    Yes, patients should be encouraged to report access issues to the payer, employer, benefit manager, human resources, and office of the insurance commissioner, or whatever the appropriate body may be in the state, in writing or by phone. But they need to know who to contact. Provide consumers with the contact information they need to facilitate timely reporting.

    Know what the insurance commissioner is and isn't interested in …
    You may experience increased burdens and reduced payment as the result of a payer's use of a third-party administrator or utilization management (UM) vendor, but those issues are not in the domain of the insurance commissioner. Instead, be ready to measurably demonstrate through data collection how a UM vendor's policies are adversely affecting patient access to medically necessary services.

    … and work, sometimes collectively, to supply the data that matter.
    Work with your state chapter to collect the data that will demonstrate the issues you and your patients are experiencing—or at the very least, get your clinic to collect clinic-wide data.

    The resources

    Celebrate 20 Years of HIPAA by Giving Yourself the Gift of Compliance

    How time flies. The Health Insurance Portability and Accountability Act—HIPAA—turned 20 in August. In honor of this milestone, APTA PT in Motion News asked staff practice experts to share their top 6 tips to protect patient information. These are easy-to-follow, and, even more important, they encourage good habits that will help you stay in compliance with a law that carries some very serious penalties.

    The top 6 tips are:

    1. Secure all patient information with physical locks and in private areas where access is limited to trusted personnel. Remember that non-business associates—for example, the crew that cleans your office or clinic—can be unintentionally exposed to this information. Take the time to put this information away. And lock it up. (But keep the key!)
    2. Implement safeguards for electronic information, including encrypted communications, and password-protected computer systems. Think the Department of Health and Human Services (HHS) doesn't take this seriously? Look no further than the sixth highest HIPAA fine of all time, a $2.7 million violation by the Oregon Health & Science University incurred when a physician's unencrypted laptop was stolen, followed by a second breach caused by residents storing patient information in an unprotected Google-based cloud system.
    3. Use common sense protections, such as cover sheets for copies and faxes, and discreet patient sign-in sheets to maintain privacy. What is meant by "discreet patient sign-in sheets?" These are sign-in sheets that require the minimal amount of information for "customary and essential" communication—basically, whatever it takes to announce to the patient that he or she is ready to be seen. Anything more—particularly reason for the visit—is treading into dangerous territory.
    4. Make sure patients understand their rights under HIPAA with easy-to-understand disclaimers and materials. HHS offers model privacy notices for patients, as well as details on notice requirements.
    5. Never share patient information over the phone, without a patient's permission, and only after multi-layered identity verification. And remember that patients have the right to request that communication be through certain channels only. Patients can also request that your practice restrict certain disclosures to family members or others about the individual's general condition, location, or death.
    6. Report any known or suspected disclosures immediately to affected patients and the government. Reporting is important, but so is understanding the type of reporting you need to do, depending on whether the breach affects 500 or more individuals. You can find details on who to notify, and when, at the HHS Breach Notification Rule webpage.

    Want to brush up on your understanding of HIPAA, particularly as it relates to electronic health records? Check out the HHS free online guide to the law (.pdf), and get physical therapist-specific details at APTA's HIPAA webpage.

    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).