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  • PT in Motion Magazine Looks at PTs in Primary Care

    Think the idea of the physical therapist (PT) as a primary care provider is some kind of far-off, pie-in-the-sky concept? Don't tell that to Tony Bare, PT, DPT, ATC; or Rebecca Byerley, PT, DPT; or Kaiser Permanente of Northern California, for that matter. They're already doing it—and doing it successfully.

    This month in PT in Motion magazine: Associate Editor Eric Ries takes an in-depth look at PTs in the primary care space, where they assume roles that range from a "roving PT" member of a multidisciplinary primary care team (the Kaiser approach), to a clinician in private practice who is often a patient's first point of contact with the health care system. Bare and Byerley are examples of the latter, both of whom have thriving practices in very different settings.

    The article features various PTs' perspectives on what it takes to provide primary care and outlines what APTA is doing to promote the concept. Ries also covers the longstanding use of PTs as primary care providers in the military and interviews PTs for their perspectives on the barriers to adopting a similar model in the civilian world, as well as the broad cultural hurdles that will need to be overcome to make the primary care PT more common.

    "Deepening Physical Therapy's Footprint: PTs in Primary Care" 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. Also in the December-January issue: APTA’s Emerging Leaders and the Catherine Worthingham Fellows of the American Physical Therapy Association share their views on such professional issues as the role of research, networking, education, mentors, and the future of the profession. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.

    Study: Clinic Ball Pits Carry Bacterial Risks

    It's no secret that when it comes to their potential for bacterial awfulness, the children's ball pits often found in fast food restaurants are the stuff of a germaphobe's nightmares. Now it turns out that if not properly maintained, ball pits in physical therapy clinics are capable of inducing shudders too.

    In a study recently published in the American Journal of Infection Control (abstract only available for free), researchers tested 6 ball pits in inpatient and outpatient physical therapy clinics in Georgia to find out what, if anything, those pits were harboring at a microbial level. Authors hope that the study will help to spark a conversation about standards for cleaning the enclosures—standards that they say have remained "elusive" to date.

    To conduct the analysis, researchers collected 9 to 15 balls taken from different depths in each ball pit, and then swabbed the entire surface of each ball. Samples were then inoculated on agar plates and allowed to grow for 24 hours at 91.4 degrees Fahrenheit. After the incubation, samples were tested for the number of colony-forming units (CFUS) present. Here's what researchers found:

    • Researchers identified 31 bacterial species and 1 species of yeast, with 9 organisms identified as "opportunistic pathogens." These organisms included bacteria associated with endocarditis, septicemia, urinary tract infections, meningitis, respiratory distress syndrome, streptococcal shock, and skin infections. The variety of yeast found on the balls—rhodotorula mucilaginosa—has "a high affinity for plastics" and has been associated with "multiple cases of fungemia in immunocompromised individuals," authors write.
    • There was "considerable variability" among the clinics, ranging from 36% to 93% of balls tested that produced recoverable CFUs, suggesting that clinics "utilize different protocols" for maintaining their ball pits, according to authors.
    • In the worst instance, bacterial colonization was found at the rate of "thousands of cells per ball, which clearly demonstrates an increased potential for transmission of these organisms to patients and the possibility of infection in these exposed individuals," authors write.

    Lead author and APTA member Mary Ellen Oesterle, PT, EdD, says the results should give clinics pause.

    "Clinics should be concerned about these findings," Oesterle said in an interview with PT in Motion News. "I would not recommend using a ball pit in a clinic until proper cleaning has occurred—and until the clinic verifies that the cleaning procedure effectively cleans the balls."

    Oesterle wasn't necessarily surprised by the findings, both in terms of the presence of pathogens and the variability among clinics. "In my own experience doing early intervention physical therapy for over 10 years, I encountered children who I suspected had contracted infections from ball pits, so this study confirmed something that rang true," Oesterle said. "The variability isn't surprising either," she added. "Each facility has different exposures, environments, and cleaning procedures, so I would expect the results to reflect that."

    And although concerning, Oesterle believes the problem is a solvable one.

    "I don't think it would be that difficult for clinics to reduce risk significantly," Oesterle said. "There are several approaches that may work well—for example, one clinic hangs balls in a mesh bag and disinfects them that way. We would like to do a follow-up study on the best cleaning method."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Ready for MIPS? Take This Quick Quiz

    The decision by the US Centers for Medicare and Medicaid Services (CMS) to include physical therapists (PTs) in its Quality Payment Program (QPP) is huge: not only is it an acknowledgment of the important role PTs can play in the transition to value-based payment; it's an opportunity for the profession to further strengthen its case for physical therapy as a way to reduce costs, improve outcomes, and provide better care.

    It's also going to mean some big changes in the ways many PTs get paid for their services, mostly through participation in the Merit-based Incentive Payment System (MIPS), which is a major part of QPP. And the changes are right around the corner, set to take effect on January 1, 2019.

    All of which begs the question: are you ready for what's coming? Take this quick quiz to find out how much you know about MIPS (scroll down for answers). Then check out APTA's MIPS webpage for extensive resources on this major shift, and sign up for a December 4 webinar, free to APTA members.

    1. True or False: Getting a sense of whether you're MIPS-eligible will be difficult until after January 2019.

    2. PTs in private practice who exceed the CMS "low-volume threshold" of more than $90,000 in allowed charges per year, more than 200 unique Medicare patients per year, and more than 200 professional services delivered per year must participate in MIPS or face a payment reduction of how much?

    A. 3%
    B. 5%
    C. 7%
    D. There is no penalty for nonparticipation.

    3. True or False: PTs who don't meet the low-volume threshold are barred from participating in MIPS.

    4. True or False: Group practices can participate in MIPS only if every clinician in the practice meets the low-volume threshold.

    5. True or False: Beginning in 2019, claims-based reporting will be permitted only in practices with 15 or fewer MIPS-eligible clinicians.

    6. Which of the following statements is the best advice for PTs and practices considering reporting through a vendor or registry to meet MIPS requirements?

    A. Hold off for now. MIPS is still in flux and it's hard to predict which arrangements will work.
    B. Don't bother. Using an electronic health record (EHR) program alone will get the job done.
    C. You missed your chance. At this point, it's too late to integrate with a reporting vendor or registry—your best bet is to go it on your own.
    D. It's worth considering. Participating in a registry or other reporting system gives you feedback on performance throughout the year and can ease reporting burdens if the system is connected to your EHR program by capturing data through your daily documentation.

    7. In 2019, in addition to quality measures similar to those reported through the old physician quality reporting system, PTs in MIPS also will be required to report on:

    A. Improvement activities
    B. Promoting interoperability
    C. Cost
    D. Crossdisciplinary collaboration

    8. How many points need to be earned in 2019 to avoid a downward payment adjustment in 2021?

    A. 15
    B. 30
    C. 45
    D. 50



    1. False. CMS has a QPP participation lookup webpage available right now. While it's true that CMS will update it to reflect the changes coming in 2019, you can prepare yourself for possible participation by checking to see if you exceeded the participation thresholds in 2018.

    2. 7% (C). If you treat Medicare Part B patients and meet all 3 low-volume threshold criteria and don't participate in MIPS in 2019, prepare for a 7% reduction in payment rates beginning in 2021. On the other hand, successful participation in MIPS could result in an upward adjustment of as much as 7%—in fact, it's the only factor on which CMS will be basing increases.

    3. False. You can opt in to the program beginning in 2019 if you treat Medicare Part B patients and meet any of the 3 criteria. You can opt in on the QPP website in early 2019 for the 2019 participation year. Check out this decision tree to better understand your options, and remember that once you opt in you’re obligated to participate the whole year.

    4. False. For group practices, the threshold criteria (charges, unique Medicare patients, number of professional services) are calculated at the group level—and across services delivered, not just physical therapy.

    5. True. Practices with more than 15 clinicians will need to use a vendor to report data.

    6. It's worth considering (D). The right vendor or registry can pay off, both in terms of ongoing performance feedback and as a way to streamline data entry by way of integration with your EHR system. Tip: look for a resource, such as APTA's Physical Therapy Outcomes Registry, that has been awarded Qualified Clinical Data Registry status by CMS—that means your MIPS data can be easily passed on to CMS, and may include other quality measures for reporting to MIPS, thereby helping to strengthen your MIPS score.

    7. Improvement activities (A). Physicians and other clinicians currently participating in MIPS must report in 4 categories: clinical improvement, quality, cost, and interoperability. For the time being, eligible PTs will be required to report only on improvement activities and quality measures. For more information on both of these categories visit the APTA MIPS webpage.

    8. 30 (B). For the 2019 reporting year, participating providers who earn at least 30 points out of a possible 100 can avoid a downward adjustment in 2021.

    CSM Delivers: Aging

    As the US population continues to age, physical therapists (PTs) and physical therapist assistants (PTAs) will take on an even more transformative role in the health of society. Are you ready?

    The 2019 APTA Combined Sections Meeting, set for January 23-26 in downtown Washington, DC, can help keep you on top of some of the latest issues in healthy aging. Check out these suggestions, and find other relevant programming by searching the CSM programming page.

    Geriatric Low Back Pain: Managing Influences, Experiences, and Consequences
    This session focuses on the biological, psychological, cognitive, and social influences of geriatric low back pain (LBP), and presents a comprehensive model of geriatric LBP that accounts for the interface between pain and impaired movement, as well mobility and health risks associated with geriatric LBP. Find out about age-appropriate measurement tools and interventions for geriatric LBP and learn how to implement a comprehensive, standardized management approach that optimizes recovery and mitigates health risks associated with geriatric LBP. Friday, January 25, 8:00 am–10:00 am.

    Staying Fit Beyond Menopause Through Early Screening and Training
    Menopause is a wake-up call for lifestyle changes that many women don't want to think about until they experience symptoms. Unfortunately, they miss their best window of opportunity to modify risk factors in the years prior to and immediately following menopause. Making specific lifestyle changes can build and maintain body strength before, during, and after the menopause transition, enhancing a woman's health long term. This session delivers what you need to know about hormonal influences impacting women's health at menopause, the use of an appropriate screening tool, and clinical applications to physical therapy. Saturday, January 26, 11:00 am–1:00 pm.

    The Skin and Aging: Impact on Wound Prevention and Management
    Wound care for individuals who are aging comes with a price tag of more than $25 billion, an amount certain to increase as the aging population continues to grow. This session will cover histologic changes that occur as people age, and the pathological consequences arising from impaired angiogenesis, degeneration of the extracellular matrix, thinning of the subcutaneous adipose tissue, decreased immune response, and photoaging. Get the latest on guidelines for comprehensive screening and risk assessment, and review case studies that highlight evidence-based interventions to maintain and restore skin integrity through a comprehensive, patient-centered plan of care. Thursday, January 24, 8:00 am–10:00 am.

    Register for CSM by midnight ET on Wednesday, December 5 to grab advance discounts and your chance to win 1 of 2 $500 VISA gift cards.

    APTA Members Eligible for Interdisciplinary Orthopedic Conference Discount

    In this rapidly changing health care environment, it's crucial that practitioners and administrators learn as much as possible from each other—and orthopedics is no exception. An upcoming conference aims to provide a platform for just such an exchange and is offering APTA members a discount on registration.

    The Interdsciplinary Conference on Orthopedic Value-Based Care, set for January 18-20 in Newport Beach, California, is an event that brings physicians, health care executives, nurses, and physical therapists (PTs) together to learn and share insights on everything from improving patient outcomes to understanding how concepts such as "Medicare for all" could affect individual practice. Sponsored by the American College of Perioperative Medicine, the conference features a long list of leaders in orthopedic care, including APTA Board of Directors member Kip Schick, PT, DPT.

    Registration for the conference is open now, with early bird discounts ending November 21. APTA members are eligible for an additional 10% discount—just enter "PERIOP" in the "promotion code" box on the registration form.

    From PT in Motion Magazine: A Primer on Major Medicare Payment Changes

    It's hard to overstate the Medicare-related changes that many physical therapists (PTs) will be facing come January, now that the US Centers for Medicare and Medicaid Services (CMS) has adopted a final rule that includes eligible PTs in the agency's comprehensive Quality Payment Program (QPP). There's a lot to learn about the new value-based payment system, and PT in Motion magazine can help you get started.

    In "Moving Toward Quality Payment" in the November issue of PT in Motion, author Christine Lehmann breaks down the QPP into its 2 paths, particularly focusing on the Merit-based Incentive Payment System (MIPS) and its reporting requirements. The article includes an easy-to-follow decision tree that helps you understand whether you'll be required to participate in MIPS, and, if not, whether you should consider voluntary participation (hint: APTA thinks it's a good idea).

    Lehmann's piece also covers the other QPP path, advanced alternative payment models, as well as the ways in which APTA's Physical Therapy Outcomes Registry could serve as an important resource for PTs moving to value-based payment systems. Sidebars to the article include information on the elimination of functional limitation reporting requirements, and a list of additional APTA resources to help you get up to speed on the changes ahead.

    "Moving Toward Quality Payment" is featured in the November 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.

    CSM Delivers: Management and Leadership

    APTA has a transformative vision for the physical therapy profession. Achieving that vision will require physical therapists (PTs) and physical therapist assistants (PTAs) to think beyond the clinician role and leverage their skills as managers—and change agents.

    The 2019 APTA Combined Sections Meeting, set for January 23-26 in downtown Washington, DC, provides multiple forums for learning more about this crucial area of the profession. Check out these suggestions, and find other relevant programming by searching the CSM programming page.

    Developing Your People: Preparing a Workforce for Value-Based Reimbursement
    In a payment environment driven by patient outcomes and high-quality care, it's crucial to have a well-developed workforce with exceptional clinical, management, and leadership skills. Find out how an organization that serves older adults in over 200 skilled nursing and outpatient facilities in 14 states responded to that challenge by creating a culture that embraces ongoing development and a core set of essential clinical behaviors. Discussions will include the importance of frontline managers and manager development, the selection of a leadership development model, and a multistage rollout of a leadership program. Thursday, January 24, 8:00 am–10:00 am.

    Success Strategies: Metrics That Matter for Private Practice Owners in 2019
    As a private practice owner, you know you need to use your data better, but there's barely enough time to do everything else you have to do. So how can you get at the right data without getting overwhelmed? This session provides an up-close look at how owners of a private practice learned which metrics are key to the success of a practice and which are just background, and will include interactive components during which attendees decide which metrics they should track in their individual clinics and how to best communicate the importance of data and dashboards to their teams. Thursday, January 24, 11:00am–1:00 pm.

    Global Volunteerism: From Organization to Boots on the Ground (3 sessions)
    PTs and PTAs can choose from a vast number of international opportunities for volunteering, but it can be difficult to know which organizations are legitimate when trying to participate in leadership. Join in a 3-part discussion on opportunities for global leadership in education, national organizations, and medical volunteer trips. The speaker, president of the World Confederation for Physical Therapy, discusses the creation of this organization and the opportunities for leadership in the physical therapy profession on a global scale, and reflects on being a woman in a national position of leadership. Thursday, January 24, 8:00 am–10:00 am (part 1); 11:00 am–1:00 pm (part 2); 3:00 pm–5:00 pm (part 3).

    Register for CSM by midnight ET on Wednesday, December 5 to grab advanced discounts and your chance to win 1 of 2 $500 in VISA gift cards.


    CSM Delivers: Practice Tips

    Staying engaged with the profession isn't just about tracking the latest research—it's also about learning new skills, techniques, and approaches.

    The 2019 APTA Combined Sections Meeting, set for January 23-26 in downtown Washington, DC, offers sessions that will challenge you to learn something new that you can apply to your practice right now. Check out these suggestions, and find other relevant programming by searching the CSM programming page.

    Get Rolling! Advanced Wheelchair Skills Training Empowers Optimized Mobility 
    This session is all about helping you understand, perform, and teach wheelchair skills to support wheelchairs users' independence, safety, and quality of life. The speakers will share guidance for optimal wheelchair selection and configuration, efficient education methods, and practical training techniques ranging from basic propulsion to advanced skills for extreme mobility and sports participation. In addition, you'll find out about an evidence-based approach for teaching wheelchair mobility, and get the latest on research and outcome measures. Friday, January 25, 11:00 am–1:00 pm.

    Strategies to Optimize ICU-Based Rehabilitation
    This session—led by an experienced interprofessional panel of stakeholders that includes clinicians, educators, and clinician-scientists—explores how to implement rehabilitation for those who are critically ill in intensive care. Get an update on key critical care literature that informs team management of this population, and explore implementation strategies to optimize clinical practice, including the importance of team communication and organization. Thursday, January 24, 8:00am–10:00 am.

    The Heart of the Matter: Advocating for Physical Therapy in Oncology Survivorship
    Physical therapists have a strong contribution to make in the developing field of oncology survivor care, particularly in the ways physical therapy can address cardiovascular and pulmonary dysfunction as a long-term effect of cancer and its treatment. Find out the considerations at play in providing physical therapy for the cancer survivor, and learn how to advocate for this important role in health care. Saturday, January 26, 11:00 am–1:00 pm.

    Register for CSM by midnight ET on Wednesday, December 5 to grab advanced discounts and your chance to win 1 of 2 $500 in VISA gift cards.

    CSM Delivers: Payment

    You can be on the cutting edge when it comes to the latest research in physical therapy, you can have a deep understanding of the technologies available to enhance patient care, and you can be an expert on tests and measures, but at the end of the day, you have to get paid. And to do that, you must stay on top of a payment landscape that's changing rapidly—and dramatically.

    The 2019 APTA Combined Sections Meeting, set for January 23-26 in downtown Washington, DC, offers multiple sessions all at 1 meeting that help clarify the sometimes-baffling ins and outs of payment, particularly around the Medicare and Medicaid systems. Check out these suggestions, and find other relevant programming by searching the CSM programming page.

    Emerging Issues in Medicare: Payment Updates and Hot Topics
    Medicare laws, rules, and policies are constantly changing and vary depending on the settings in which physical therapists (PTs) and physical therapist assistants (PTAs) practice. This session will explore the latest developments related to fee schedule payments, prospective payment systems, and payment reform. Find out how you can adapt your practice to keep pace with the changing laws and regulations. Friday, January 25, 8:00 am–10:00 am.

    Emerging Issues in Medicare: Quality Programs and Alternative Payment Models
    PTs and PTAs are facing some of the most comprehensive changes to payment in years, thanks to new quality programs—most prominently the Merit-based Incentive Payment System (MIPS)—and alternative payment models under Medicare. Get up to speed on the shifts that come with implementing comprehensive health care reform legislation; alternative payment models; quality reporting programs, including MIPS; and more. Will there be challenges? Yes. But there are also opportunities worth exploring. Friday, January 25, 11:00 am–1:00 pm.

    The Real World: How Therapists Can Thrive in Value-Based Care
    The transition from fee-for-service to value-based payment is upon us, and this new payment model is here to stay. How do therapists, while still being paid fee-for-service, prepare for a successful shift and show that they are ready for value-based care? Presenters at this session will crack the code to success in value-based care with real-life case studies demonstrating what innovative practices are doing to achieve success in value-based payment arrangements today and capitalize on the opportunities of the future. They'll also review the steps PTs should take now to research, prepare for, and realize the opportunities available to them under value-based care arrangements. Saturday, January 29, 11:00 am–1:00 pm.

    A Little Bit of This and a Little Bit of That: Billing and Payment in 2019
    Multiple billing and payment policies work in combination to affect your bottom line, but do you understand how they all fit together? This session looks at payment's component parts: how the monetary value of a CPT code is determined, the payment rates for the most common CPT codes billed under a physical therapy plan of care, elements of the multiple procedure payment reduction policy, the 2019 therapy dollar threshold and use of the KX modifier, and more. Also on the agenda: a discussion of Medicare's "8 minute rule" and the American Medical Association's definition of "substantial," and how they relate to billing determinations for individual visits. Thursday, January 24, 11:00 am–1:00 pm.

    Register for CSM by midnight ET on Wednesday, December 5 to grab advanced discounts and your chance to win 1 of 2 $500 in VISA gift cards. 

    CSM Delivers: Moving Evidence Into Practice

    The evidence base for physical therapy is growing stronger by the day, and patients, payers, and other stakeholders are taking notice. The next step: making the all-important connection between research evidence and real-world practice.

    The 2019 APTA Combined Sections Meeting, set for January 23-26 in downtown Washington, DC, has no shortage of sessions focused on how physical therapists (PTs) and physical therapist assistants (PTAs) can bring that evidence into practice. Here are a few suggestions (and you can always find more by searching the CSM programming page).

    The Ten Commandments for Fear of Falling: Evidence-Based Management Strategies
    This session provides evidence-based guidance for managing fear of falling in older adults in a variety of practice settings. Hear about the evidence for comprehensive interventions such as exercise, floor recovery, hip protection, cognitive-behavioral approaches, and functional mobility training as well as recent developments in emergency alert systems for older adults. The presenters will highlight community-based programs that target fear of falling reduction and fall prevention in older adults. Thursday, January 24, 8:00 am–10:00 am.

    Spotlight on Research: Translating Rotator Cuff-Related Research Into Practice
    Time to get interactive in a session that will present a series of rotator cuff-related abstracts accompanied by a 20-minute discussion focused on translating the evidence into practice, with plenty of opportunities for audience debate. The topics of this session can cover the spectrum of examination, rehabilitation, and treatment outcomes of subacromial pain pathologies, which may include areas such as rotator cuff tendinopathy, subacromial pain or impingement, tears, surgery, and postoperative management, depending on the research submitted to the section. Friday, January 25, 11:00 am–1:00 pm.

    Aquatic Therapy for the Lower Extremity: Applying CPG Recommendations to Practice
    In this session, a board-certified orthopaedic clinical specialist, aquatic therapy specialist, and clinician will review the importance of incorporating recommendations and findings of clinical practice guidelines (CPGs) into practice. The focus will be on linking recommendations from 3 lower-extremity CPGs to aquatic therapy interventions, with plenty of discussion of aquatic therapy research as it relates to the clinical decision-making process. Saturday, January 29, 8:00 am–10:00 am.

    Register for CSM by midnight ET on Wednesday, December 5 to grab advanced discounts and your chance to win 1 of 2 $500 in VISA gift cards.