• Tuesday, July 29, 2014RSS Feed

    APTA: Disability Rights Convention Should Be Approved

    APTA has added its voice to the long list of supporters of an international treaty on the rights of persons with disabilities, stating that it fits squarely within the association's vision of transforming society. The letter of support from APTA coincided with rallies held on Capitol Hill to press Senate passage of the United Nations (UN) Convention of the Rights of Persons with Disabilities (CRPD) that would establish protections against discrimination and support equal access to education, among other basic human rights.

    The UN drafted the CRPD in large part as a response to nations that, unlike the US, do not clearly articulate the rights of persons with disabilities. "Because of discriminatory practices, persons with disabilities tend to live in the shadows and margins of society, and as a result their rights are overlooked," write the convention's authors. "A universal, legally binding standard is needed to ensure that the rights of persons with disabilities are guaranteed everywhere."

    Nearly 150 countries have already signed the treaty. The CRPD needs Senate approval only but requires a supermajority for passage.

    "APTA commends the purpose of this treaty, as the CRPD embodies the values of the ADA," writes APTA President Paul A. Rockar Jr, PT, DPT, MS, in the letter of support. "As a profession committed to 'transforming society by optimizing movement to improve the human experience,' we support this initiative to facilitate equal access to patients we serve across the lifespan."

    It was unclear at the time of this writing whether the CRPD would be taken up by the Senate before the session's close on August 1. Participants in 2 rallies set for July 29 aim to convince the Senate to move on the treaty before leaving town.


    Tuesday, July 29, 2014RSS Feed

    Medicare Insolvency Deadline Improves, SGR Not Incorporated in Projections

    It's far from rosy, but Medicare trustees are pointing to a slightly improved financial picture for the future of the program's trust fund, and they are no longer incorporating savings from the flawed sustainable growth rate (SGR) in their projections.

    According to an article in Modern Healthcare (free access after sign-on), the Part A hospital insurance trust fund is now projected to be depleted by 2030, 4 years later than last year's projections. In 2012, the insolvency date was projected to be 2024. Medicare spending is projected to rise from 3.5% of GDP to 5.5% in the next 25 years.

    As part of its projection process, the trustees used figures that did not incorporate cuts achieved through the SGR, assuming instead that Congress would replace the cuts with annual .6% raises. Congress has created workarounds to avoid cuts required for the flawed SGR every year since its inception, and in 2013 came very close to ending the SGR permanently. APTA and many other health care organizations have long opposed the SGR.

    The trustee report attributes the improved projections to savings realized under the Patient Protection and Affordable Care Act, but warns that ultimately the program will run out of money. Trustee Robert Reischauer is quoted in the Modern Healthcare story as saying that Medicare is "fiscally unsustainable over the long run."


    Tuesday, July 29, 2014RSS Feed

    PT Recruitment Video Also a Great Reminder

    The life of a physical therapist (PT) can be frustrating and exhausting to be sure—that's why every now and then it's good to take a couple of minutes to slow down and think about why you joined the profession in the first place.

    And if you need some reminders, APTA has you covered.

    Now available on the association's YouTube channel—a short video featuring PTs talking about why they chose their profession. Technically, it's a student recruitment video that you could share with anyone considering the profession, but it's also a great way for an experienced PT to recharge.

    PTs featured in the video offer lots of reasons for their professional choice, ranging from their own childhood experiences with physical therapy, to the ways the profession blends exercise and science, to the opportunities to do real good for people in need. Their reasons are diverse, but they share an obvious love for what they do.

    Check it out, and maybe get reacquainted with your own passion for physical therapy.

    For even more inspiration, read or listen to members’ accounts of their personal passion for physical therapy in “Defining Moment,” PT in Motion magazine’s recurring column. Find them in the PT in Motion archives of every issue (titled “This Is Why” prior to June 2014), and as APTA podcasts.


    Monday, July 28, 2014RSS Feed

    Acetaminophen May Do Little to Speed LBP Recovery

    It may be a prevalent practice, but the use of acetaminophen for acute low back pain does not decrease recovery time, according to a new Australian study of over 1,700 patients who participated in a randomized placebo-controlled trial.

    "Our results convey the need to reconsider the universal endorsement of paracetamol [acetaminophen] in clinical practice guidelines as a first-line care for low back pain," authors of the study write, "and suggest that advice and reassurance, rather than analgesics, should be the focus of first-line care." The study was published online in the July 24 edition of The Lancet (abstract only available for free).

    For the study, patients reporting low back pain (pain between the 12th rib and buttock crease shorter than 6 weeks' duration preceded by 1 month of no pain) were divided into 3 groups: a regular-dose group, an as-needed group, and a placebo group. Each group was supplied with 2 boxes of tablets—1 box contained tablets to be taken every 6–8 hours, and another box contained tablets that could be taken "as needed" for pain relief. The regular-dose group received 665 mg acetaminophen tablets in the "take regularly" box and placebo tablets in the "take as needed" box; the as-needed group received 500 mg tablets in the "take as needed" box and placebos in the "take regularly" box; the placebo group received placebos in all boxes. Participants were instructed to continue taking the tablets until they recovered or for 4 weeks, whichever occurred first.

    Researchers found median recovery times (defined as a self report of 0–1 on the 0–10 pain scale maintained for 7 consecutive days) for all 3 groups to be nearly identical, at 17 days for the regular-dose and as-needed groups, and 16 days for the placebo group. "Our findings suggest that regular or as-needed dosing with [acetaminophen] does not affect recovery time compared with placebo in low back pain, and question the universal endorsement of [this drug] in this patient group," authors write.

    The study's authors also note that participants in the study recovered at a somewhat faster rate "than that typically reported in other cohorts … receiving miscellaneous or usual treatments," and write that for the differences may be attributed to the provision of "good quality advice and reassurance, a feature that is often absent from usual care."

    "While we cannot disregard the possibility of a placebo effect … the provision of advice and reassurance of the favorable prognosis might be the more important factor in the management of acute low back pain than drug therapy," the authors write.

    APTA low back pain resources include a MoveForwardPT.com webpage on low back pain, clinical practice guidelines on low back pain (.pdf), and an APTA Learning Center presentation on manipulation for low back pain. PTNow provides full-text access to the latest clinical practice guidelines and Cochrane systematic reviews related to low back pain and neck pain.

    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.


    Monday, July 28, 2014RSS Feed

    APTA Points Out Potential Harmful Delays in Patient Care From CMS Proposed Rule on DMEPOS

    If past problems are any indication of how the future might go, a Centers for Medicare and Medicaid Services (CMS) proposal to require prior authorization for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) could "impede or delay access to timely medically necessary care" due to a lack of sufficient infrastructure to efficiently administer the new requirement, according to APTA comments recently submitted to CMS.

    In a July 25 letter (.pdf) to CMS Acting Administrator Mary Tavenner, APTA applauds the CMS effort to reduce fraud and abuse with DMEPOS use, but warns that the agency's track record on payment review systems doesn't bode well for fullscale implementation of a plan to mandate authorization reviews for devices and supplies that often require quick patient access. The proposed rule states that CMS contractors will use "reasonable efforts" to issue authorization decisions within 10 days of the receipt of a standard request, or 2 business days for an "urgent" decision. In both cases, APTA points out, the waits "could result in serious decline of a beneficiary's health and safety," particularly if an urgent request is submitted on a Thursday or Friday and a patient must wait over a weekend for a decision.

    Matters have the potential to be made worse, APTA suggests, should the CMS contractors lack sufficient expertise and infrastructure to make informed, timely decisions—problems that have cropped up in other payment review systems, most notably in manual medical reviews for patients exceeding $3700 in outpatient therapy services. The association cites federal government reports that point to problems with lack of specificity in denial rationales, "flawed logic" in tracking systems, contractor statements backed by questionable facts, inaccessibility for providers, poor customer service, and lack of clinical expertise.

    APTA acknowledges the need for a focus on DMEPOS utilization, but suggests that if CMS chooses to move ahead with a prior authorization system, it do so incrementally, with "a small set of items … tested to determine whether the proposed protocols can be operationalized on the front lines of care delivery before the program is launched nationally."

    "APTA recognizes that oversight of DMEPOS utilization is necessary; however, it is of limited value if delays cause detrimental health impacts on beneficiaries or impose additional administrative and financial burdens on providers and suppliers due to operational and technical issues," the letter states. "The prior authorization process should neither delay the provision of care, nor be overly burdensome to providers or patients."

    APTA will update its DMEPOS resource webpage when this rule becomes final and the specific DMEPOS items subject to the rule have been selected.

    Note: see table 4 of the proposed rule for a list of items that may be chosen for prior authorization.


    Friday, July 25, 2014RSS Feed

    US Virgin Islands Gets Direct Access, Improved PT Practice Act

    Virgin Islanders will now have improved access to physical therapist (PT) services—and a much more effective physical therapy practice act—thanks to a new law signed by Governor John P. de Jongh Jr, on July 11.

    The new law, Act No. 760, allows for direct access to evaluation and treatment by a PT without a physician’s referral, and includes changes to the licensing law that protect the term "physical therapy" as an activity that can only be engaged in by a PT, among other improvements.

    Prior to the act's passage a physician referral was required for all PT services. The new law, which takes effect on October 9, 2014, allows for treatment without a referral for 45 days or 12 treatment visits.

    "It’s been a long time coming, but consumers will now have greater access to quality health care provided by physical therapists," said Virgin Islands APTA member Jerry Smith, PT, DPT, ATC. "These changes could not have happened without the work of the physical therapy community here."

    In addition to direct access, Act. No. 7620 also makes significant updates to the physical therapy practice act. Besides the protection of "physical therapy" as a term that can only describe the activities of PTs, the new law provides title protection for "DPT" and "doctor of physical therapy,” an updated definition for the practice of physical therapy, an expanded board of physical therapy, and revised qualifications for licensure.

    "APTA commends the work of the dedicated physical therapists in the US Virgin Islands who worked for many years to bring about these legislative changes," said APTA President Paul Rockar Jr, PT, DPT, MS. "Improved patient access to PT services continues to be a high priority for the profession and APTA."

    Earlier this year both Oklahoma and Michigan enacted direct access legislation. The new Oklahoma law goes into effect on November 1, and the Michigan law on January 1, 2015. All 50 states, DC, and now the US Virgin Islands have enacted laws allowing for direct access to evaluation and some level of treatment without a physician referral.


    Friday, July 25, 2014RSS Feed

    Latest Workshop Helps Participants Refine 'Blueprint' for New Clinical Practice Guidelines

    Evidence-based practice resources for physical therapists (PTs) will continue to expand thanks to the work of APTA members who recently participated in an association-sponsored clinical practice guidelines (CPG) workshop. The 3-day event brought together 36 researchers from 10 sections to discuss 11 potential CPGs.

    The workshop was led by Sandra Kaplan, PT, PhD, and Joe Godges, PT, DPT, MA, OCS, and included a presentation of a CPG development methodology and discussion on how the methodology can be best applied to the PT profession. The gathering is part of a larger APTA strategic objective to reduce unwarranted variations in care and increase PT adherence to best practices.

    Now in its third year, the workshop brings together participants chosen in response to a call to sections to submit nominations for a guideline development group that had identified a clinical topic important to the practice of physical therapy. Topics selected were the ones that could be best addressed through CPGs, which are graded recommendations on best practice for a clinical question based on a systematic review and evaluation of the quality of the scientific literature. These clinical questions were focused on both specific conditions and treatment interventions.

    This year's workshop topics included aquatic intervention, falls prevention, management of patients in the ICU, diabetic foot ulcers, examination and intervention of children with developmental coordination disorder, hip fractures, rehabilitation after total knee arthroplasty, interventions to improve gait speed in patients with neurological conditions, postpartum pelvic girdle pain, postconcussion rehabilitation, and venous leg ulcers.



    In an APTA video dispatch, Kaplan explained that the workshops help CPG developers lay the groundwork for what can be a 2- to 4-year development process. "What we're doing is trying to provide the foundational understanding of what those [CPG development] processes are," she said. "By the end of this workshop, they walk away with a blueprint for how to move forward to produce one of these."

    "What's really exciting about these guidelines is that … for some of them, there are multiple sections coming together," added Godges. He believes PT-focused CPGs can play a "huge" part in helping APTA achieve its vision of transforming society. "I think they're a foundation of transforming patient care, and not only of transforming patient care, but of transforming education," he said, with the effects extending to payment and policy areas worldwide.

    CPGs can be found on PTNow, the association's resource for evidence-based practice. Resources for guideline development and APTA funded CPGs can be found at www.apta.org/CPG.

     2014 - July 25 - CPG Workgroup
    These CPG developers are helping PTs transform society
    through the establishment of best practices in a wide range of areas.


    Thursday, July 24, 2014RSS Feed

    CDC: One Third of Youth Misperceive Weight Status

    For many children in the United States, the battle against childhood obesity may be in part a battle of perception: according to a new report, nearly a third of children don't have an accurate view of their own weight status, with 81% of overweight boys and 71% of overweight girls describing themselves as "about the right weight."

    The report (.pdf), issued this week from the US Centers for Disease Control and Prevention (CDC), says that from 2005 to 2012, 30.2% of children and adolescents aged 8–15 misperceived their weight status. Out of an estimated 9.1 million children and adolescents, 78% characterized themselves as "about the right weight" when they were in fact over or underweight. The remaining 22%, about 2 million of the 9.1 million, were of healthy weight but perceived themselves as too fat or too thin. The findings were based on an analysis of the National Health and Nutrition Examination Survey (NHANES).

    The misperception problem was most prevalent among overweight boys and girls, and varied somewhat according to demographics. Among the findings:

    • Among all weight ranges, misperception of weight status is more common among boys (32.3%) than girls (28%).
    • Weight misperception is lowest among non-Hispanic white children and adolescents (27.7%) and highest among non-Hispanic black children and adolescents (34.4%), with misperception rates of Mexican-American children and adolescents nearly as high, at 34%.
    • In relation to body mass, 87.4% of normal weight youth consider themselves to be about the right weight. That "about right" perception is held by 76% of overweight youth and 41.9% of obese youth.
    • Weight misperception tends to differ by economic status, with a 32.5% misperception rate among youth from lower-income families, compared with a 30.7% rate for middle-income youth and a 26.3% rate for youth from higher-income families.

    "Accurate self-perception of weight status has been linked to appropriate weight control behaviors in youth," write the report's authors. "Understanding the prevalence of weight status misperception among US children and adolescents may help inform public health interventions."

    PTs can provide crucial tests and can assist patients and clients in pursuing the behavioral changes to support achieving a healthy weight, according to Lisa Culver, PT, DPT, MBA, senior specialist for clinical practice at APTA. "Testing for body mass, which includes BMI, is a routine test for physical therapists to perform.” she said. "If we've established that body mass indicates overweight or obesity, we can play an important role in addressing healthy lifestyles, especially getting kids to be more physically active. Physical activity not only assists with loss of and maintenance of the loss of excess body mass, but an individual's level of physical fitness itself is an important and independent indicator of health, in addition to excess body mass."

    APTA offers extensive resources on the PT's role in prevention and wellness, as well as on behavior change in the patient and client.


    Wednesday, July 23, 2014RSS Feed

    Clinical Education Webinar Series Continues With Focus on Partnerships

    A sweeping multiorganizational effort to create a shared vision for physical therapist clinical education continues to advance, and now needs stakeholders to participate in webinars focused on partnerships.

    The webinars are the latest in a series of open forums that allow participants to engage in discussions around position papers that were published in a special issue of the Journal of Physical Therapy Education (JOPTE). The next 2 webinars will focus on the papers by McCallum, et al, and Applebaum, et al. The first will be held on Wednesday, July 23, 8:00 pm–9:15 pm ET, and the second is scheduled for Tuesday, July 29, 4:00 pm–5:15 pm ET. Webinar facilitators will be Peggy Gleeson, PT, PhD, Scott Euype, PT, DPT, MHS, OCS, and Stephanie Piper Kelly, PT, PhD.

    Instructions for joining the webinars can be found here. Participants are strongly urged to read the position papers before the online sessions.

    Discussions from the webinars will inform the creation of a shared vision at the Clinical Education Summit planned for October 12–13 in Kansas City, Missouri, where participants will use the positions from the JOPTE papers as they have been shaped through discussions to reach agreement on best practices. The effort is being led by the American Council of Academic Physical Therapy (ACAPT), APTA, the Education Section of APTA, and the Federation of State Boards of Physical Therapy (FSBT).


    Wednesday, July 23, 2014RSS Feed

    Proposed CMS Rule Would Reduce Prosthetics, Orthotics, Other DME Reimbursement; APTA Posts Summary

    A Centers for Medicare and Medicaid (CMS) proposed rule (.pdf) could reduce reimbursement for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) by more than $7 billion from 2016 through 2020, largely through applying payment rates from the DMEPOS competitive bidding program in noncompetitive bidding areas. APTA has published a detailed "highlights" summary of the rule on the DMEPOS webpage, part of a suite of APTA resources on Medicare payment.

    Additional proposed policies that would impact physical therapists (PTs) include:

    • In 12 competitive bidding areas (CBAs), CMS would provide payment on a continuous monthly rental basis for certain items (including standard manual wheelchairs, standard power wheelchairs, and hospital beds). This payment would cover the item and ongoing maintenance and servicing, as well as replacement of supplies.
    • Where payment is made in a competitive bidding program (CBP) on a capped rental basis, CMS would require contract suppliers for power wheelchairs to retain responsibility for all necessary repairs, maintenance, and servicing of any power wheelchairs they furnish under the CBP.
    • CMS would identify PTs as “individuals with specialized training” to provide custom-fitted orthotics.

    The public will have until September 2, 2014, to submit comments on the rule, and APTA will submit comments on behalf of its members.


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