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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Revised Physical Activity Plan Presents Opportunities for PTs, PTAs

    APTA members familiar with the association's vision to transform society may feel like the vision for the newly revised National Physical Activity Plan (NPAP) has a familiar ring to it. "One day, all Americans will be physically active," it says, "and they will live, work, and play in environments that encourage and support regular physical activity."

    Sounds downright … transformative, doesn’t it?

    The NPAP Alliance has released a long-awaited revision of its namesake document, a comprehensive and high-profile roadmap for supporting and encouraging physical activity among all Americans. The new version is informed by recent evidence-based findings, shaped by comments from stakeholders—including many physical therapists (PTs), physical therapist assistants (PTAs), and students in physical therapy education programs—and developed and finalized by a coalition of organizations including APTA.

    The newest version of the NPAP continues its emphasis on a socio-ecological model of health behavior by stressing the importance of change at the personal, family, institutional, community, and policy levels. According to a news release from the Alliance, the NPAP's overall goals are also consistent with recent policy initiatives in other areas, including the 2015 Elementary and Secondary Education Act, the 2015 Fixing America's Surface Transportation Act, and the US Surgeon General's "Step it Up" campaign to encourage walking.

    Former APTA Board of Directors member Dianne V. Jewell, PT, DPT, PhD, FAACVPR, represents APTA on the NPAP Alliance, and believes the plan offers PTs and PTAs an important opportunity to live out the profession's transformative role by taking the lead in community-based prevention and wellness efforts.

    "Making this plan operational will involve integrating physical activity counseling, promotion, and prescription within PTs' plans of care," Jewell said. "It's a commitment that is very consistent with our expanding roles in primary and secondary prevention and population health."

    Additionally, Jewell believes that the NPAP could help to highlight the ways in which PTs could be leaders not just within communities, but among other health care providers.

    "The NPAP calls for a more comprehensive integration of physical activity principles in health care provider education and training," she said. "As movement system experts, PTs are role models and teachers of this content, and we should seek opportunities to share our expertise with colleagues from all disciplines."

    At its unveiling on April 20, the NPAP was praised by groups that include the President's Council on Fitness, Sports, and Nutrition; the American Heart Association; and the American College of Sports Medicine. Later in the afternoon, the plan was the focus of a briefing hosted by the Congressional Fitness Caucus and the Congressional Bicycle Caucus.

    Jewell hopes that PTs, PTAs, and students in physical therapy programs will see the connection between the NPAP and the profession.

    "The elements in the NPAP are right in our wheelhouse with respect to our expertise with the movement system," Jewell said. "We should take hold with both hands and step up to leadership, not only in our practice each day, but in advocacy, collaboration on community initiatives, and active engagement in the physical activity space."

    From PT in Motion: Coding Reform in Context

    Physical therapy coding reform is coming—and it's part of a much bigger picture.

    The April issue of PT in Motion magazine includes an article that provides context for APTA's efforts to reform the Current Procedural Terminology (CPT) codes that physical therapists (PTs) use. The feature puts complex issues in plain language through a "5 things you need to know" approach, and the accompanying sidebars and infographic help to show how coding reform simply can't be removed from the overall evolution of health care away from the fee-for-service model.

    Need further enticement? Here are a few notable quotes from the piece.

    • On the scale of the issue: "Payment reform is not an 'APTA thing.' It is a commitment to position the physical therapy profession for the future of health care."
    • On the ways coding reform is linked to overall reform efforts, and how those efforts depend on solid outcomes data gathering: "Without good data, it will be hard to develop episodic models that hold providers accountable for their services."
    • On the need to act: "It's time for physical therapy to bring its coding system in line with other forward-thinking professions."
    • On the continually evolving nature of CPT codes, and the importance of scaling reforms to current realities: "The proposed CPT codes are intended to move the profession as far forward as it is now ready to go."
    • On the fact that CPT reform is coming regardless of whether the profession participates in the creation of the new codes: "We must not be on the outside looking in."

    "Coding Reform, to Payment Reform, to Health Care Reform," is featured in the April issue of PT in Motion 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 worth checking out: a recent #PTTransforms blog post from APTA President Sharon L. Dunn, PT, PhD, OCS, on health care reform and the "road less traveled." For background on APTA's work with coding reform in particular, visit APTA's Physical Therapy Classification and Payment System webpage.

    CJR Bundle Webpage Now Includes Free Download of Sold-Out Webinar

    As part of an enhanced collection of APTA resources on the Comprehensive Care for Joint Replacement (CJR) bundled care model, the association's sold-out webinar on the system is now available as a free download for members.

    The APTA CJR webpage contains extensive information on both the nuts-and-bolts of the program, and the considerations PTs should weigh when making practice decisions. The online resource also includes links to evidence-based clinical information and community programs.

    In the webinar available at the webpage, APTA staff presenters Roshunda Drummond Dye, JD, and Heather Smith, PT, MPH explain the model, how it will impact physical therapist (PT) practice, and the factors that could influence a PT's decision to become a collaborator in a bundled care program. The 90-minute program is also aimed at helping participants understand the changes in practice operations that will need to be made, and highlighting some of the APTA resources on the CJR.

    The new recording and updated resources arrive just in time for the April 1 debut of the first-ever mandatory bundled care program created by the Centers for Medicare and Medicaid Services (CMS). The program will require hospitals in 67 metropolitan areas to participate in bundled payment systems for Medicare patients undergoing total knee and total hip replacements. Physical therapists (PTs) may choose to collaborate with a facility in the program.

    First Innovation 2.0 Learning Lab Coming April 21

    Are you ready for a payment model based on performance and improved outcomes? More important—are you doing something new yourself, or about to take on a different approach? Set aside a little time later in April to take a deeper dive into innovative ways of delivering care.

    Coming April 21, 2:00 pm-5:00 pm ET: the first of 4 APTA Innovation 2.0 Learning Labs, an opportunity for members 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. The inaugural online lab will focus on a pay-for-quality program for treatment of patients with LBP.

    The project, conducted through Intermountain Healthcare in Salt Lake City, Utah, and led by Gerard P. Brennan, PT, PhD, and Stephen Hunter, PT, DPT, OCS, focuses on low back pain treatment as the basis for a comprehensive incentive program that doesn't just tally outcomes, but looks at what prevents some patients from progressing. Among other components of the program, Brennan and colleagues intend to develop a "severity adjustment formula" that could predict when a patient has a low chance of achieving a minimally clinically important difference from physical therapy—before physical therapy begins.

    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. Because the event has limited seating, members interested in participating are required to answer a series of questions on the registration form to help APTA select participants who can gain—and later share with others—the most benefit from the lab. To register, visit the Innovation 2.0 webpage and scroll to the "Learning Lab" section.

    Registered participants will receive a template that will help them replicate the model presented in the lab. APTA will post a free recording of the event afterwards.

    Visit the Innovation 2.0 background page for details on all of the projects selected for development, as well as projects that received honorable recognition. Profiles of each project were also featured in a 2015 article in PT in Motion magazine.

    No Turning Back: 4 Ways Bundled Payments Will Change Rehab Care

    Maybe the biggest ICYMI issue in physical therapy so far this year is the impending implementation of Medicare's Comprehensive Care for Joint Replacement model (CJR), a program that will require hospitals in 67 metropolitan areas to use bundled payment systems for total knee arthroplasty (TKA) and total hip arthroplasty (THA). The system launches on April 1.

    You may have some familiarity with the immediate impacts of the CJR on physical therapists (PTs) and physical therapist assistants (PTAs), but the model, and others like it, also set the stage for even bigger shifts in how rehabilitation professionals interact with the health care system.

    In the February issue of Physical Therapy (PTJ), APTA's research journal, APTA Executive Vice President of Public Affairs Justin Moore, PT, DPT, laid out the top 4 long-term practice implications of payment bundles. The article, appearing in PTJ's new "Point of View" feature, provides much more detail (as well as an explanation of how we've arrived at this moment in health care), but here's a quick take on that list:

    1. Bundled care's 3 biggest components, in order: data, data, and data.
    Patient measurement tools will be standardized and integrated into practice, and PTs and PTAs will need to strengthen their profession by strengthening the data that support it. Bottom line: Expect to be participating in registry programs such as the upcoming APTA Physical Therapy Outcomes Registry.

    2. Practice guidelines will be even more important than they already are.
    It will be increasingly important that the entire care team understands the ways PTs and PTAs contribute to the overall treatment process. Everyone will need to know what to expect, which means practice guidelines will play a vital role. As Moore writes, "further development of clinical practice guidelines will only facilitate the inclusion of rehabilitation professionals in the development of the care pathways."

    3. It's not just about you; it's about the team.
    Interprofessional education and practice will become a crucial component of care. Every provider involved in a bundled system will need to understand how the various elements of care are supposed to work (see #2 above) and how they fit in to the system. "Knowing if, when, and in what role rehabilitation professionals are involved in the continuum of service comprising a bundle is essential for success at a patient, system, and provider level," Moore writes.

    4. Bring along your business acumen.
    "The management of resources is essential to best deploy limited access in the most efficient and effective fashion," is how Moore puts it. What that means is, the move to bundling and other value-based systems will require PTs and PTAs to be more savvy when it comes to analyzing what they're doing and at what cost—something that will require "measurement beyond a service-level mentality," Moore writes.

    Read the entire Point of View (a new commentary feature) in the February issue of PTJ, and check out an overview of the CJR featured in the March edition of PT in Motion magazine. Although APTA's March 24 webinar on the CJR is full, a recording of the event will be made available in the days that follow.

    From PT in Motion Magazine: Get the Basics on CMS Bundling Program for TKA, THA

    Remember, back last year, when the Centers for Medicare and Medicaid Services (CMS) said it would be moving from fee-for-service models and toward more outcomes-based payment systems? It wasn't kidding.

    This month in PT in Motion magazine's "Compliance Matters" column: the publication's first detailed look at the coming Comprehensive Care for Joint Replacement (CJR) model. The CJR, which will be mandatory in 67 metropolitan statistical areas, will require that hospitals engage in bundled care systems for total knee arthroplasty (TKA) and total hip arthroplasty (THA).

    The basic idea is that in many parts of the country, CMS will assign a single rate for the entire episode of care for its Medicare beneficiaries who receive TKA or THA, from admission through rehab. Although providers will continue to be paid under their respective payment systems, at the end of the year, CMS will reconcile the payments against the total episode rate. Depending on whether the total payments are above or below that rate, the hospital could be eligible for additional payment—or (in the years to come) be required to pay back CMS. But there's much more to it than that.

    APTA staffers Roshunda Drummond-Dye, JD, and Health Smith, PT, MPH, take readers through the details of how the CJR will work, the ways it will affect PTs and PTAs, and what APTA is doing to prepare its members for the change (including an upcoming webinar devoted to the topic). The article even includes a listing of the metropolitan statistical areas that will be mandated to comply with CJR.

    "The Comprehensive Care Joint Replacement Model" is featured in the March issue of PT in Motion. 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: Lakers' PT Talks About Keeping Elite Athletes Healthy, Offers Advice for the Less-Elite Among Us

    Must be the PT.

    Los Angeles Lakers superstar Kobe Bryant says that he has a "secret weapon" on the court: the team's physical therapist (PT).

    The most recent episode of APTA's Move Forward Radio focuses on a discussion with Judy Seto, PT, DPT, OCS, SCS, MBA, CSCS, PES, CES, who has served as head physical therapist for the Lakers for the past 5 years. Seto is responsible not only for meeting Bryant's physical therapy needs but for keeping an entire professional basketball team healthy through an 82-game regular season, plus preseason, postseason, and the offseason.

    Seto gives listeners an insider's perspective on how these elite athletes maintain their levels of performance through a demanding schedule, but she also provides tips for amateur basketball players who want to stay on the court.

    Other recent Move Forward Radio episodes include:

    Acute Care Physical Therapy
    People find themselves in an acute care hospital for many reasons, but no matter what brings them to the facility, they're likely to encounter a physical therapist while they're there. Sharon Gorman PT, DPTSc, GCS, FNAP, discusses the PT's role, including rehabilitation, prehabilitation, and more.

    Blood Flow Restriction Training and Physical Therapy
    Johnny Owens, PT, MPT, discusses blood flow restriction training, a relatively new approach that involves applying a tourniquet to an injured limb to allow patients to make greater strength gains while lifting lighter loads (and reducing overall stress).

    Success Story: A Knee Injury Ends Basketball Dreams, Inspires Career Path
    What happens when an injury forces you to reevaluate your dreams? For Jonathan, whose basketball hopes were permanently sidelined, it meant finding meaning in helping others return to doing what they love through physical therapy.

    Success Story: A Young Dancer Recovers From Hip Injury to Return to Her Passion for Performing
    Isabella had been passionate about dance for as long as she could remember. After a hip injury threatened to prevent her from pursuing that passion, a PT helped her get back to doing what she loves.

    Success Story: Paralyzed After Giving Birth, This Mom Is Moving Again
    For Laura, an emergency C-section led to a spinal cord infection that left her unable to feel or move her legs. Though she was told she would need a wheelchair for the rest of her life, Laura and her PTs have defied expectations. Now, 3 years after the infection, she has made it to her feet.

    Success Story: Man Loses 300 Pounds and Improves Quality of Life
    At age 50, Scott weighed more than 500 pounds and suffered from chronic venous wounds on his legs. Now he's healthy and happily less than half the man he was (weight-wise), thanks to a PT who treated his immediate conditions and gave him the encouragement and confidence he needed to make life-saving lifestyle changes.

    Innovative Device Encourages Movement in Children With Cerebral Palsy
    Thubi Kolobe, PT, PhD, FAPTA, and Peter Pidcoe, PT, PhD, DPT, discuss their collaboration on a device that provides crucial movement assistance for children with cerebral palsy and other developmental delays. The device was 1 of only 13 featured in a recent "Innovation Festival" sponsored by the Smithsonian Institution.

    Aging Healthy by Decade
    Yes, our bodies change as we age, but we can stay healthy and active by understanding and responding to those changes in effective ways. Robert Gillanders, PT, DPT, OCS, talks about trends he sees in the clinic and provides age-specific advice for healthy aging.

    Physical Therapist Tips to Help You #AgeWell
    As part of National Physical Therapy Month, APTA published a list of PT tips to help individuals #AgeWell. In this episode, Alice Bell, PT, DPT, GCS, discusses some of the themes from that list, which includes information on chronic pain, diabetes, falls, Alzheimer’s disease, heart disease, and several other conditions.

    Muscle Soreness: What's Normal, What's Not?
    You've likely experienced it: you exercise hard after not exercising for a while, and later, your muscles ache—something called delayed onset muscle soreness, or DOMS. Malachy McHugh, director of research at the Nicholas Institute of Sports Medicine and Athletic Trauma in New York, shares his perspective on the effectiveness of many current treatments for DOMS and his predictions for possible prevention methods in the future.

    Chronic Disease and Prevention
    The bad news: chronic disease is widespread in the US. The good news: chronic disease is preventable. Mike Eisenhart, PT, talks about chronic disease prevention, both in terms of a physical therapist's role in preventing chronic disease, and in terms of our own role taking responsibility for our long-term health.

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

    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 e-mailed to consumer@apta.org.