With the official startup date looming and the last dry run complete, the Centers for Medicare and Medicaid Services (CMS) says that at least from its end of things, all systems are go.
In its latest summary (pdf) of end-to-end testing of ICD-10 codes in its reporting systems, CMS reported that the July 20-24 tests did not uncover any new issues with the fee-for-service claims processing systems, and that there were no claims rejections made "due to front-end CMS systems issues."
"Overall, participants … were able to successfully submit ICD-10 test claims and have them processed through Medicare billing systems," CMS states in its report. "The acceptance rate for July was similar to rates in January and April, but with an increase in the number of testers and claims submitted."
During the testing period, CMS received 29,286 claims, with an 87% acceptance rate. Of the claims rejected only 1.8% were rejected because of an invalid submission of an ICD-10 diagnosis or procedure code. Just over half the claims received—52.7%--were from professionals. Institutions supplied 40.9% of the claims, with suppliers submitted 6.4%.
The official start date for ICD-10 use remains October 1. APTA offers a recorded webinar, free to members, and an ICD-10 webpage that is being updated with resources to help physical therapists prepare for the changeover.
Researchers have completed what they describe as "the first comprehensive description" of foreign-educated physical therapists (FEPTs), and produced a snapshot that covers everything from regions-of-origin to why FEPTs decide to make the move, and which states and practice settings they arrive at once they do.
The email survey was sent to 9,334 FEPTs but focused only on those who had been licensed in the past 5 years. The final results were based on responses from 1,978 FEPTs—a 22.4% response rate. The report on the survey was e-published ahead of print in Physical Therapy (PTJ), the journal of APTA. The complete article is available for free to APTA members.
And, sure, PT in Motion News could report on the results in some standard way, but why do that when the highlights can be presented quiz-style for a change? Ready?
1. What's the overall estimated percentage of FEPTs in the US physical therapy workforce?
Answer: FEPTs account for an estimated 4.2% of the workforce, which means the correct answer is C. It's a figure that researchers say is similar to nurses (5.4%). By comparison, medical physicians have an estimated foreign-educated rate of 25.8%.
2. Rank in order, from highest to lowest, the most- to least-frequently cited countries or regions of educational origin for FEPTs in the survey.
D. Middle East
Answer: By quite a margin, the Philippines (49.2%) leads the way, followed by India (31.2%). The Middle East (3.6%) is next on this list, though it's fourth overall (Europe, in third place overall, comes in at 6.3%). Canada (1.8%) registered behind Asia (2.7%), but ahead of Africa (1.6%), South America (1.4%), and the Pacific Islands (1.3%). Correct answer: C,A,D,B.
3. Of the FEPT respondents, 92.1% said they had practiced physical therapy before coming to the US. What was the average number of years they practiced before moving?
Answer: There was some considerable variation here, but the average number of years FEPTs spent as physical therapists in another region was 5.5 years (correct answer: A). FEPTs educated in India reported the least amount of time (approximately 3.6 years); FEPTs from Africa had the highest number of pre-US years, with an 11.1 year average.
4. Which US practice setting was reported as the most common for FEPTs?
A. Hospital inpatient department
B. Home health
C. Assisted living
D. Skilled nursing, long-term care, or extended care
Answer: The most-frequently reported practice setting reported by FEPTs was in skilled nursing, long-term care, or extended care (32.2%,), followed by home health (20.4%), hospital inpatient (10.5%), PT-owned outpatient clinic (9.3%), non-PT owned outpatient clinic (8%), hospital outpatient department (7.8%), and assisted living facility (7%). "Other" was cited among 4.9% of respondents. That makes D the correct answer.
5. A total of 62.1% of all FEPT respondents were initially licensed in 1 of only 5 jurisdictions across the US. Rank the jurisdictions in order from highest to lowest.
D. New York
Answer: Turns out that New York leads the way by a significant stretch, with 32.7%, followed by Illinois (10.3%), Texas (7.1%), Florida (6.9%), and Michigan (5.1%). So for this question, the correct answer is D, B, E, A, C. New York was the jurisdiction most common among FEPTs educated in Asia (78.6%), while FEPTs educated in Africa were more likely to take their first US job in Illinois. Canada-educated FEPTs tended to begin their US practice in Texas. Regardless of jurisdiction, 71.1% of FEPTs reported that their first US job was in a metropolitan area (defined as a zip code in a county with a population over 250,000).
6. What was the most-frequently cited reason for immigrating to the US?
A. Advanced education or training
B. To be with a spouse of family
C. Better working conditions
D. Higher wages or benefits
Answer: In the end, higher wages (26%) beat out an interest in advanced training (20.4%) to be the top reason for the move (correct answer: D). The ability to practice physical therapy at an advanced level was third (14.8%), followed by better working conditions (13%). Being with a spouse or family was in fifth place (10.5%), edging out "adventure or experience in a new culture" (10.2%). Only 1% cited "improved personal safety" as the reason for the move.
APTA has joined the Federation of State Boards of Physical Therapy (FSBPT), the Foreign Credentialing Commission on Physical Therapy (FCCPT), and APTA's Section on Health Policy and Administration (known as HPA: The Catalyst) in the creation of an online course that covers the health care delivery system in the US. The course, to be offered by Duke University, is designed to help PTs educated and trained outside the US overcome hurdles resulting from cultural differences and achieve a smoother and quicker transition to stateside practice.
An alarming rise in opioid abuse is sparking an important related conversation about the effectiveness of physical therapy and other nondrug approaches to treat pain.
Recent coverage has been driven by a US Centers for Disease Control and Prevention (CDC) report that documents a resurgence in heroin use, with rates more than doubling for individuals aged 18-25, and females in particular. The CDC report coincided with an announcement from the White House of a new $13.4 million program to battle heroin trafficking.
The CDC report links the rise in heroin use to increased rates of addiction to opioid painkillers, an addiction that often begins with legitimate prescriptions to treat pain. That link, in turn, has prompted discussion about the importance of nondrug approaches to pain treatment.
Increasingly, coverage of the opioid abuse epidemic includes at least a mention of alternatives to drug therapies for chronic pain. The popular Everyday Health website, for example, recommends that physical therapy and other nondrug approaches be seriously considered as a first-line pain treatment, writing that, at the very least "a team that includes pain specialists, physical therapists, mental health professionals, and primary care providers, tends to be best for patients with chronic non-cancer pain, who often also have mental health concerns such as anxiety or depression." Similarly, a recent edition ofNeurology Now calls for health professionals to "rethink chronic pain" through multidisciplinary approaches that include exercise prescriptions.
The role of physical therapy as a bulwark against painkiller abuse was also noted by the White House Office of National Drug Control Policy, which recently met with APTA President Sharon L. Dunn, PT, PhD, OCS, and Mandy Frohlich, APTA vice president of strategic communications and alliances, who at that time was the association's vice president of government affairs.
APTA has long advocated for the role of the physical therapist (PT) in pain management, using its MoveForwardPT.com website to educate the public on about it, and featuring new approaches to pain treatment being used by PTs in a 2014 feature story in PT in Motion magazine. More recently, the August issue of Physical Therapy (PTJ), APTA’s peer-reviewed journal, includes a discussion of how to interpret the burgeoning effectiveness evidence from recent clinical trials and systematic reviews on pain treatment.
A recent Wall Street Journal (WSJ) article on the potential overuse of ultrahigh therapy hours among nursing homes prompted a response from APTA that delivers the physical therapy profession's perspective.
"Patient care decisions should be made by clinicians in accordance with their clinical judgment and ultimate professional responsibility to their patients," President Sharon L. Dunn, PT, PhD, OCS, writes in a letter to the editor published on August 26 (registration/sign in maybe required to view WSJ version; access an online copy from APTA here). "Value … should be the primary indicator of performance."
The APTA letter was written after the WSJ published an article citing "copious" use of ultrahigh therapy hours billed to Medicare by skilled nursing facilities (SNFs). That report claims that between 2001 and 2013, the use of the ultrahigh category of rehabilitative therapy reimbursement—720 minutes or more a week per patient—has increased from 7% of patient days in 2002 to 54% of patient days in 2013.
"The challenges to ensuring delivery of appropriate patient care against systems that incentivize volume-based rehabilitation services are, unfortunately, well known to those in the rehabilitation profession," Dunn writes. "It isn't uncommon for rehabilitation professionals to find themselves in situations in which they are pressured to meet goals that have less to do with the patient's needs and more to do with the volume of services provided."
The letter also describes the collaborative efforts of APTA, the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASHA) to push for value-based care based on clinical judgment, not productivity goals. "We are deeply committed to ensuring that the correct incentives are invoked in care delivery in a manner that earns our patients' trust," Dunn writes.
More on the value-vs-volume debate, and APTA's efforts to support practice integrity: APTA, AOTA, ASHA Consensus Statement on Clinical Judgment in Health Care Settings (.pdf); APTA Center for Integrity in Practice website (includes a free course on compliance); "Measuring by Value, Not Volume," a recent feature article in PT in Motion magazine that takes a closer look at how some PTs are responding to the challenge.
As rewarding as it may be, the job of the physical therapist (PT) is hard. The hours can be long. The learning never stops. The rules seem to morph constantly.
That's why sometimes it's a good idea to step back, breathe, and take in the big picture of a profession that's evolving, taking a higher-profile role in a changing health care environment, and actually making a difference in people's lives. Getting a handle on some of the big issues can be downright refreshing.
With this idea in mind, APTA is launching a major new online project. Titled "Physical Therapy: A Profession in Transformation," it's a series that looks at what it means to be a professional, enterprising, knowledgeable, and inspirational physical therapist. You’ll discover—or rediscover—some of the transformations happening within the profession, and can check out resources you might have been too busy to notice. Part road map, part directory, part pep talk, think of it as a chance to find your "You Are Here" place.
The series will run through the rest of the year, rolling out a new chapter every 4-6 weeks. All members subscribed to APTA's PT in Motion News emails will receive an additional email every time a new chapter is published, plus the entire series will be posted on the association's website.
Look for Chapter 1, "The Professional Physical Therapist," making its debut this week.
Consumer Reports and The Washington Post are helping to spread the word: physical therapy, not surgery, can be the best first-option treatment when it comes to meniscus tears and spinal stenosis.
The July 24 online edition of the Post includes a feature from Consumer Reports titled "If your doctor says you need surgery, you may want to explore other options." The article lists 4 common surgeries—arthroscopic surgery for a torn meniscus, carotid artery surgery, laminectomy and fusion for stenosis, and hysterectomy—that it describes as "procedures to question if your doctor pushes for them."
The article states that "research shows that [arthroscopic surgery is] often no better than physical therapy at easing symptoms" of a torn meniscus and points to a study, reported in PT in Motion News in early 2014, that found no differences in outcomes for patients who underwent actual vs sham arthroscopic surgery.
Similarly, the report says there's "no evidence" that fusion should be added to a laminectomy procedure to treat spinal stenosis, and that "there's a good chance, in fact, that you don't need any surgery," citing a study authored by Anthony Delitto, PT, PhD, FAPTA, Sara R. Pilva, PT, PhD, FAAOMP, OCS, Julie M. Fritz, PT, PhD, FAPTA, and Deborah A. Josbeno, PT, PhD, NCS. That study, outlined in PT in Motion News in April, found physical therapy's effects similar to surgery for patients with spinal stenosis.
Instead of surgery, the article recommends 6 to 8 weeks of physical therapy.
When it comes to rehabilitative therapy poststroke, a new study reinforces the idea that the higher the intensity of the therapy, the less likely it is that a patient will be readmitted to the hospital 30 or 90 days after discharge.
Researchers examined medical records from 64,065 patients admitted to hospitals in Florida and Arkansas for an incident stroke between 2009 and 2010 and linked 30- and 90-day readmissions with the level of physical therapy, occupational therapy, and speech therapy they received while in acute care. Those levels were defined as none, low, medium-low, medium-high, or high, relative to the sum and distributions of charges within each hospital.
What they found was that after adjusting for demographics, comorbidities, number of chronic conditions, measures of illness severity, and hospital quality measures, the higher the intensity of therapy patients received, the lower their chances of 30-day readmission, from a hazard ratio (HR) of 1.3 for the adjusted no-therapy group, down to a .86 HR for the adjusted high-intensity group. The same relationship held true for 90-day readmission rates, though to a lesser extent. Results of the study were e-published ahead of print inPhysical Therapy (PTJ), the journal of APTA.
The study included only patients who were 45 and older, had not suffered a stroke for 3 months prior to the event that triggered the hospital admission, and were not transferred to another short-term acute-care hospital.
Among other findings from the study:
While authors acknowledged that their findings support clinical guidelines that stress the importance of maximizing patient mobility, they believe that there may be another factor at play: namely, the role of effective discharge planning.
"Because over 75% of the patients in our sample were in the hospital for 3 days or less, our findings may relate more to adequate time for discharge planning and communication among the health team," authors write. "In addition to providing examinations and interventions, rehabilitation providers also educate patients, caretakers, and family members, and they make recommendations for safe engagement in activities and participation after discharge, all of which may impact readmission."
The study's authors, who include Addison Williams Andrews, PT, EdD, NCS, and Janet Freburger, PT, PhD, cite the use of data from only 2 states as a possible limit to their research, and urge that the study of rehabilitation intensity be expanded. Still, they write, those limits don't weaken their conclusion that the current study's results "support the contention of clinical practice guidelines that recommend patients hospitalized with an acute stroke receive rehabilitation services as soon and as much as practicable."
When the US Women's National Soccer Team clinched the World Cup this summer, forward Amy Rodriguez celebrated an additional victory—her successful (and physical therapy-aided) return to the team after having a baby not quite 2 years earlier.
Rodriguez shares her story on the most recent episode of Move Forward Radio—how she approached her pregnancy and return to sport, and the role that physical therapy played in that journey. Although told through the eyes of a world-class athlete, Rodriguez's story will resonate with moms of any athletic ability who want to regain a physically active lifestyle after childbirth.
Other recent Move Forward Radio episodes include:
Total Knee Replacement: A Storybook Approach
Louise Chegwidden, PT, FT, has watched patients and families struggle to cope with the information overload that accompanies total knee replacement surgery, and decided there had to be a better way to prepare families and improve expectations. To fill that void, she wrote a guidebook for families called “Granny Gets a New Knee: and a Whole Lot More.” Chegwidden discusses some of the things patients and family caregivers should know about total replacement surgery, including the benefits of seeing a physical therapist before the procedure. (You can read more about Chegwidden and other physical therapist book authors in PT in Motion’s July feature story “Physical Therapist Authors.”)
What Physical Therapists Tell Their Friends
In the July 2015 issue of Redbook magazine several physical therapists (PTs) were asked to share the advice they give their friends. The answers were diverse: from encouraging children to try multiple sports rather than specializing at a young age, to reminding women that a physical therapist can help them strengthen pelvic floor muscles to avoid problems like urinary incontinence. In this episode, 7 PTs discuss the advice they give their friends or their patients –things they wish everyone knew.
Juvenile arthritis isn’t a specific condition but an umbrella term that includes numerous types and subtypes. Susan Klepper, PT, PhD, discusses those types of juvenile arthritis and describes typical treatments for the disease.
Total Shoulder Replacement
Total shoulder replacements aren’t nearly as common as knee and hip replacements, but they can be an effective treatment option when more conservative treatments fail. Julie Mulcahy, PT, discusses what physical therapy before and after total shoulder replacement looks like. She is joined by Michael Davis, one of her patients who received a shoulder replacement. Also discussed: universal themes such as what it takes to be a good physical therapy patient, and the importance of addressing movement dysfunctions before surgery becomes necessary.
R.J. Williams, PT, DPT, describes how the vestibular system works and how problems with the vestibular system can be treated through physical therapy. He also discusses how vestibular rehabilitation is a rapidly evolving, even being offered to elite athletes who rely on balance to perform on the field of play.
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 firstname.lastname@example.org.
Welcome to "The Good Stuff," an occasional series that highlights (mostly) recent (mostly) local media coverage of physical therapy and APTA members, with an emphasis on good news and stories of how individual PTs and PTAs are transforming health care and society every day. Enjoy!
Here's why you should see a PT every year. (from St. Louis magazine)
"The smiling faces of occupational therapists and physical therapists are very special when you’re down and out. He was on his back and the OT’s and PT’s come in and say, 'We’re here to help you, we’re here to get you back to life as best as we possibly can.'' - Scott Michael Love, PT, professor at the University of St Augustine for Health Sciences, speaking about a program for wounded veterans. (Jacksonville, Florida, channel 4 news)
"Given these results, I think it’s worth giving physical therapy a try before surgery." (Racine, Wisconsin Journal-Times advice column)
Edison Au, PT, heads to the Pan Am Games to serve as lead medical practitioner for boxing. (myCentralJersey.com)
"My physical therapist saved my life." (Orange Rhino challenge blog)
Cora T. Huitt, PT, DPT, BCB-PMD, was interviewed for a story on how physical therapy can help women postpartum. (Richmond, Virginia Times-Dispatch)
"Too bad Humpty Dumpty didn't have physical therapists." (opinion from the Kansas CityStar)
UM-Flint DPT students travel to the Honduras to help people in need. (UM-Flint press release)
An inside look at PTs and PTAs helping to staff the FUNfitness screening program at Special Olympics. (ESPN.com)
A story on the University of Delaware stroke rehabilitation program features Susanne Morton, PT, PhD, and Darcy Reisman, PT, PhD. (Delaware Online)
"The opening bars of Whitney Houston’s 'How Will I Know' echo through a bustling therapy gym as 13-year-old Courtney Turner practices her physical therapy for the day: lip syncing." (profile of Rankin Jordan Pediatric Bridge Hospital from St Louis National Public Radio)
Rocky Mountain University DPT students headed to Malawi to build a new primary school for about 250 students. (from Provo, Utah, Herald)
Got some good stuff? Let us know. Send a link to email@example.com.
APTA has 27 reasons to feel good about the future of physical therapy.
Just announced: the 27 winners of APTA's 2015 Emerging Leaders awards, a program that recognizes physical therapists (PTs) and physical therapist assistants (PTAs) from APTA components for their roles as up-and-coming leaders who have demonstrated extraordinary service early in their careers.
This year, emerging leaders from 21 APTA state chapters and 6 sections were selected based on nominations from their components. A complete list of this year's leaders (.pdf) is available through the Hub, the APTA communities platform, and the winners will also be the subject of a feature story coming in the October issue of PT in Motion magazine.
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