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  • APTA Members Asked to Identify Unnecessary Procedures

    APTA's efforts to make physical therapy a leader in fraud and abuse prevention could soon include a public education campaign to encourage informed care decisions based on member input on physical therapy tests and procedures that are unnecessary.

    As part of its Integrity in Practice initiative, APTA is exploring the possibility of participating in the "Choosing Wisely" program, a national American Board of Internal Medicine (ABIM) Foundation-sponsored project that provides the public with lists of health care tests and procedures that may be unnecessary under certain circumstances. APTA would join over 50 medical specialty societies that each contributed a list of "5 Things a Patient Should Question."

    The first step in the process for APTA, according to a recent all-member email, is to hear from as many PTs as possible about commonly used physical therapy procedures "whose necessity should be questioned and discussed." The association is on the lookout for any PT-controlled procedure that tends to be done frequently or carry a significant cost, yet whose usefulness is called into question by evidence. APTA will convene an expert panel to review and rate all member submissions and create a list of approximately 10 potential items that will be narrowed down to 5 by way of an all-member survey. The top 5 questioned procedures will then go to the APTA Board of Directors for final approval.

    If approved for use by the ABIM Foundation, APTA's "5 Things Physical Therapists and Patients Should Question" would join similar lists (.pdf) provided by organizations including the American Geriatrics Society, the North American Spine Society, the American Academy of Family Physicians, and the American College of Occupational and Environmental Medicine. Procedures called into question by these and other organizations include routine imaging of certain patients with inflammatory arthritis, recommending more than 48 hours of bed rest for patients with low back pain, and screening of adolescents for scoliosis.

    PTs can submit their recommendations online. The deadline for submissions is April 4.

    APTA’s version of "5 Things" would become a component in the association's large-scale initiative to highlight physical therapy's role in eliminating fraud and abuse in health care. The effort is the subject of a feature article (members-only access) in the February issue of PT in Motion magazine and will be the focus of future association education efforts.


    • Why does it seem that APTA is constantly taking the stance that PTs are doing something wrong? I have been a member for 26 years but I am increasingly looking at APTA as an adversary. We are being crushed by regulations, ObamaCare and infringement, but all APTA can do is look for ways we are the bad guys. Does any other profession commit this kind of self-flagellation?

      Posted by Rob Jordan on 3/13/2014 8:37 PM

    • Yes the APTA has always had their ethics that one has to adhere to. Interesting thing is they as an association KNOW that most rehab companies use physical therapy assistants as a means to make the most money and many times, a therapist continually evaluates a patient and this system of evaluation by a therapist and pass them onto a assistant creates a fradulant system. Also a company has high productivity demands and truly a therapists evaluation continues long after the initial evaluation. They know that therapists need to stay employed and they know that some schools are not teaching their students evidence based therapy in PT schools. So, they put the therapist in a jeopardized position from the beginning..Why is the Therapist to blame not the PT school that they attended????

      Posted by LJ on 3/14/2014 1:34 PM

    • Rob: Thanks for your comment. Physical therapy is a universally well-respected profession, but in recent years, it has been brought into the larger conversation about health care fraud, abuse, and waste. Along with other health care professions, physical therapy is under increased scrutiny by law makers, regulators, insurers, and payers. While the vast majority of health care providers are honest and strive to provide high quality care to their patients, a small number of providers are abusing the system and placing beneficiaries’ health at risk. The association’s “Integrity in Practice” campaign is designed to preserve and protect the profession’s excellent reputation by demonstrating to the public and the government the tangible steps the profession is taking to address problems in the health care system. APTA hopes to reduce regulatory burden, protect reimbursement levels, improve quality of care, and preserve your freedom to practice for years to come. We hope you will join us in this important campaign.

      Posted by APTA Staff on 3/14/2014 3:47 PM

    • I totally disagree with this sort of campaign. Keep you hands out of our pockets and our professional lives. All too often the APTA think they know it all along with many of their Orthopedic PT's and because evidence is not yet available for many treatment methods, some pencil pushing, APTA board member or APTA assigned Group along side with their research buddies who are standard Orthopedic PT's who couldn't treat themselves out of a paper bag become the authority on all kinds of cutting edge methods and recommend that they are not suitable etc. for whatever lame reason they identify. Physical Therapy is an ART and a Science. It is NOT a pure science, so lets not make the human body like physicians have done which is separate a person into bits and pieces instead of looking at the whole person. Many of us have spent years putting humpy dumpy back together again because of some of the lame Orthopedic PT's that treat one body part and completely miss the entire picture which is the source of a persons pain. Just stay out of the way and stop destroying creativity and the ART of physical therapy. The word ART is used in the Licensure Language in the State of California. It took high millions to low billions to send a person to the moon in the 60's. That involved an army of people and really was not the complex in comparison to the human body. We discover new things about the human body everyday. What is believed today by some APTA pencil pushers is non evidence based care of today, in fact, could be consider the norm in 20 years but they just don't know it yet because evidence is not available. Look at Dr. Amen as an example. The man spent years walking through fire to do what he did when all of his profession stated that it was not good, yet he is now recognized as one of the leading professionals in Mental Health today. What you folks consider to be freedom is like a nail in a coffen from my perspective. We don't need anymore regulations or policies to follow so an insurance carrier can further ABUSE providers. I say, "Stay out of the Way".

      Posted by Bobby on 3/14/2014 6:00 PM

    • I have always been impressed with the presence and strength of the APTA's lobbying in DC. I have been an advocate of becoming a member of APTA to get more $$ to our lobbyists. I am excited to see that we are looking in to joining ABIM's "Choosing Wisely" campaign. I expect to see our list published. I will be submitting my suggestions. Every field of medicine is guilty of some degree of abuse, fraud, waste. Our system of health care delivery has allowed it. ACA is forcing us like never before to consider what "value" means. Our participation in Choosing Wisely is going to help us clean up our profession. A weakness in PT is non-standardized approach to common problems. I am in the outpatient orthopedic world so I am aware of the inconsistencies in assessment, diagnosis, and treatment that frustrates patients, physicians and payors. We currently have the best evidence for treating backs, knees, shoulders that we've ever had. I assume, with confidence, that similar issues exist for our colleagues in neuro, cardiorehab, peds, wound care, women's health, geriatrics, etc. It is commonly recognized that it takes a frustratingly long time for the new evidence to enter into common practice (on the order of 15 years by some accounts). In addition to getting the current best evidence into mainstream practice as efficiently as possible, we need to efficiently get rid of the stuff of no/little value. It may hurt a little bit, but we'll be better for it. Some of the professional society's took the Choosing Wisely challenge seriously, other's did not. The American Academy of Orthopedic Surgeons is being criticized for not taking it seriously.

      Posted by Joel Dykstra -> =JRaEL on 3/14/2014 6:28 PM

    • So long as recommendations are vetted through scientific evidence and are general in nature. I have no problems with the initiative at all. Once we cross a threshold where they, like the Clinical Practice Guidelines, become a "Gold Standard" or any other "Standard of Care" we will begin to develop a problem. Evidence based practice takes into account the scientific reasoning and evidence that exists, in combination with the unique characteristics and needs, desires, of individual patients. Those things can not all be controlled or accounted for by science, and therefore not all things will always be governed by evidence based practice. If we are routinely using things as "curative" which are clearly not, then we need to stop misrepresenting them. Adjunctive therapeutic measures will always have a small place, but they're not the main intervention I ever provide.

      Posted by Leon Richard -> AJSa@O on 3/14/2014 8:20 PM

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