Forget about staying young at heart. For most Americans, simply having a cardiovascular system that isn't lapping them in the race to old age is a challenge, according to a new report that says 69 million US adults have a "heart age" that is, on average, 7 years older than their chronological age.
The findings were released in a "Vital Signs" report from the US Centers for Disease Control and Prevention (CDC). To arrive at a heart age, CDC calculated the age of a person’s cardiovascular system based on risk factors that include high blood pressure, cigarette smoking, diabetes status, and body mass index (BMI). CDC researchers used data collected from every US state and information from the Framingham Heart Study in what they describe as the first to provide population-level estimates of heart age.
Although the older heart age phenomenon was pervasive, the range of differences play out across demographic lines. Half of American men aged 30-74, for example, have an estimated heart age that is, on average, 8 years older. Among women in the same age range, 2 in 5 have an estimated heart age that is an average of 5 years older.
Similarly, while heart age exceeded actual age among all ethnic groups, the age difference was highest among African-American men and women, with an average 11-year gap. Geographically, Mississippi, West Virginia, Kentucky, Louisiana, and Alabama had the highest percentages of adults with a heart age 5 or more years over their actual age. Utah, Colorado, California, Hawaii, and Massachusetts had the fewest adults with a difference of 5 or more years.
Researchers acknowledge that the monitoring and control of individual cardiovascular disease (CVD) risk factors is key to improving overall public health, but they believe the concept of "heart age" might be a good way to get people to pay attention—and do something to lower their risk.
"Use of heart age might simplify risk communication and motivate more persons, especially younger persons, to adopt healthier lifestyles and better comply with recommended therapeutic interventions to prevent heart disease and stroke," authors write in the study used by the CDC. "Moreover, its use might support public health efforts in geographic areas most at risk for poor CVD outcomes and support the implementation of programs and policies that increase the availability of heart-healthy lifestyle options within communities."
The PT's important role in chronic disease was reemphasized at the 2015 APTA House of Delegates, which adopted an association position on Health Priorities for Populations and Individuals (RC 11-15). Want to learn more about the ways PTs can engage in cardiovascular disease management? Download this recorded webinar.
So what exactly is the physical therapist's (PT's) professional scope of practice, and how would you go about describing it as a definition rather than a list of things PTs do? Now's your chance to weigh in.
All APTA members are invited to provide input on the APTA Board of Directors' efforts to create a broad definition of the PT professional scope of practice. The idea behind the project is to create a global description of practice that aims to be an overall description rather than a set of procedures and functions.
Members can evaluate and comment on the draft scope and the guiding principles behind it by visiting an APTA webpage set aside for the survey. Deadline for responses is September 11. Send your completed surveys to Practice-Dept@apta.org.
A proposed change in how Medicare would reimburse for lower-limb prostheses is drawing mounting criticism from patients and stakeholder organizations—including APTA. According to the association, the proposals now being considered would negatively affect patients by "restrict[ing] the ability of a therapist to provide the appropriate medically necessary care if they are providing therapy to a patient who has received an ill-fitting, or non-customized prosthetic or component based on Medicare coverage policies."
In a letter submitted to the durable medical equipment administrative contractors (DME MACs), the association takes issue with a proposal developed by the DME MACS that would impose extensive restrictions on who could receive a lower-limb prosthesis, what kind (or kinds) of prosthesis they could get, and when and under which conditions Medicare would pay for the devices. Though the DME MACs contend that the changes are necessary to counteract steep rises in prosthetics expenditures among Medicare beneficiaries, critics including APTA believe the proposal ignores the realities of rehabilitation and shortchanges the importance of clinical judgment.
"APTA understands the difficult balance of providing quality care that is medically necessary while attempting to curtail costs," the association states in its letter. "However, this [local coverage determination] has the potential to result in lower quality of care while ultimately increasing costs. In the long run, costs could be higher to Medicare due to complications associated with prosthetics that were inappropriate for the patient due to restrictive requirements, provided untimely or not provided at all."
APTA's concerns about the proposal range from what it views as overly restrictive definitions of terms in some sections to a lack of clarity in others, and addresses provisions that the association feels would minimize the importance of the expert individualized determinations made by appropriate health care professionals.
Additional problematic areas of the proposal cited by APTA and other organizations include the potential for CMS to restrict patients to older-model artificial legs if the beneficiary has any form of mobility aid (such as a walker or cane) that they would use for limited purposes, and a requirement that the prosthesis must provide "the appearance of a natural gait." In its letter, APTA points out that "'Natural gait' is a subjective term—and potentially discriminatory, particularly when dealing with individuals with disabilities."
Last week, opponents of the proposal staged a protest at the headquarters of the US Department of Health and Human Services (HHS), an event that drew coverage by CNN and other news outlets. The protest effort received a boost from former Nebraska Senator Bob Kerrey, who himself has an amputation and was quoted in a press conference as saying that "this is as stupid a rule as I've ever seen," and that the rule "completely ignores what's going on with amputees."
The comment period on the proposed changes closed on August 31. CMS has not established a timeline on when any new rules would take effect, according to an article in Modern Healthcare.
US News and World Report is emphasizing the importance of physical therapy home exercise programs (HEPs) and connecting readers with APTA's "Find a PT" resource as a way to make a physical therapist (PT) "match" that can increase the likelihood of follow-though.
An August 31 article, titled "4 Ways to Stick to Your Physical Therapy 'Homework,'" uses real-life examples of individuals who kept up with the HEPs provided by their PTs as a springboard for a set of tips to help keep patients on track. The article also features comments from Jessica Schwartz, PT, DPT, CSCS, a member of the APTA Media Corps.
The basic idea, according to the article, is that "if you want the [physical therapy] treatment to work, it's important to follow your physical therapist's orders," which include exercises to be done at home. Schwartz is quoted as saying that her work "can only take [patients] so far," but that when patients do their home exercises, they're "going to hit this thing out of the park."
Among the 4 tips offered in the article is a suggestion that patients find a PT who is "well-matched" to the patient's personality and lifestyle, given that physical therapy tends to involve a lot of 1-on-1 time between the patient and the PT. To help find what Schwartz describes as "the right person, the right place for you," US News suggests readers check out APTA's "Find a PT" search service offered at the association's MoveForwardPT.com website.
In addition to finding the right PT, the article recommends that patients connect their HEPs with a "broader purpose" or ultimate activity goal, that they strategize time management to identify opportunities to do the exercises, and that they be honest with their PTs when they haven't met their HEP goals.
At MoveForwardPT.com, APTA's consumer-focused website, HEPs are regularly noted in the "Physical Therapist's Guide" series that explains the role of physical therapy in the treatment of various conditions.
Want to join APTA's Find a PT service? Follow these simple instructions to add your listing to the database.
Facebook, WebMD, PatientsLikeMe, Yelp, Angies List, HealthGrades ... sooner or later, the raters are gonna rate.
The question is, should you shake it off?
This month's PT in Motion magazine cover story, "Raters Gonna Rate: What's Your Best Response?" looks at the ins and outs of online rating systems consumers use to evaluate—and, increasingly, to choose—their health care providers, including physical therapists (PTs). PT in Motion Editor Donald Tepper combines an overview of current ratings trends with interviews of PTs who understand the power of online reviews and are taking proactive steps to address the issue.
The good news, according to the article, is that it's mostly good news: ratings tend to skew favorably, with patients eager to share their positive experiences with a health care provider or facility. But there can be bad news from time to time, and PTs should pay attention. "Raters Gonna Rate" also features advice from PTs on how to overcome negative reviews and take steps to reduce the chances of frequent online complaints.
"Raters Gonna Rate," is featured in the September 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.
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.
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