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  • Latest News Reports Touch on Cost, Politics of Opioid Epidemic

    As National Physical Therapy Month approaches in October, APTA continues to share its #ChoosePT message to help the public better understand how physical therapy can play a role in addressing pain and reducing opioid use. It's a message that remains relevant, set against a news cycle that seems to add a new, often harrowing perspective on the opioid epidemic nearly every day.

    Here's a brief roundup of some recent notable reports and stories.

    The prescription opioid epidemic has cost the US $78.5 billion.
    Science Daily reports on a recent study that estimates the cost of the prescription epidemic at $78.5 billion, with about one-third of those costs related to health care, and one-fourth borne by the public sector.

    Private insurers have witnessed a 1,300% increase in costs related to opioid treatment between 2011 and 2015.
    A report in Kaiser Health summarizes research that found insurers' annual payments to providers, hospitals, laboratories, and treatment centers related to treatment for opioid abuse grew from $32 million in 2011 to $446 million in 2015.

    The rate of opioid-dependent babies born in the US has doubled.
    According to a report in Live Science, researchers have found that the rate of newborns diagnosed with neonatal abstinence syndrome—essentially, withdrawal symptoms experienced after being exposed to opioids while in the womb—has increased from 2.8 cases per 1,000 births in 2008 to 7.3 per 1,000 in 2015.

    Drug companies have adopted "a 50-state strategy" to "kill or weaken" anti-opioid legislation.
    The Associated Press has released a lengthy investigative piece that chronicles the efforts of prescription drug makers to use their already-formidable lobbying arm to fight restrictions on opioids, including "funding advocacy groups that use the veneer of independence." The tactics are being used at both the federal and state levels, according to the report.

    Both Trump and Clinton have weighed in.
    From Business Insider: a look at how both presidential candidates have talked about the opioid epidemic—with 1 candidate pressing for the wider adoption of pain treatment guidelines that "identify treatments other than opioids."

    Housed at MoveForwardPT.com/ChoosePT, the #ChoosePT campaign now includes a video public service announcement, as well as other targeted advertising and media outreach. APTA is also a member of the White House’s working group addressing the opioid epidemic.

    Fewer Than a Third of HS Students Receive Recommended Amount of Phys Ed

    When it comes to the number of US high school students participating in physical education in school, the good news is that rates haven't declined much since 1995. The bad news is, rates haven't gone up, either—and remain well below national recommendations.

    Recently, the National Physical Activity Plan Alliance (NPAPA) released an analysis of 22 years' worth of data on US high-schooler participation in physical education classes. They found that after a notable drop between 1991 and 1995, rates have remained fairly consistent, with only 29.4% of students meeting national recommendations for daily classes. Former APTA Board of Directors member Dianne V. Jewell, PT, DPT, PhD, represents APTA on the NPAPA. APTA is an organizational partner of the NPAPA.

    Using data obtained from the CDC's National Youth Risk Behavior Survey, researchers found that the rate for daily participation was the highest in 1991, with 41.6% of students attending physical education classes 5 days a week. By 1995, that rate had dropped to 25.4%, and remained fairly consistent for each study period thereafter.

    Among other findings in the report:

    • Overall, the average number of days per week of physical education attendance reported in 2013 was 4.15—lower than the 4.64 average reported in 1991, but better than 1995, when that average dipped to 3.6.
    • The percentage of students reporting 0 days of physical education each week in 2013 was close to 1991 levels, at 52%.
    • The percentage of students who reported participating in phys ed only 1 day per week increased between 1991 and 2013, from .9% to 1.8%.
    • Participation in phys ed for 1 day a week or more declined as students advanced through high school, with 64.3% of freshmen reporting any physical education, followed by sophomores (50.5%), juniors (39.6%) and seniors (35.2%). The same general pattern held when it came to reports of daily phys ed classes (from 42.2% of freshmen to 20.2% of seniors).
    • Across the entire study period, more boys than girls—57% versus 49%—reported attending physical education classes.

    The study's authors speculate that the drop in participation between 1991 and 1995 may be linked to the widespread adoption of block scheduling in high schools during that time, a scheduling system less likely to offer daily classes in any subject.

    Regardless of the reasons, they write, the fact is that the rates of participation weren't high enough even in 1991 and remain problematic today. Authors call for schools to prioritize the "adoption of policies and programs aimed at increasing participation in physical education," writing that the NPAPA has developed "evidence-based strategies and tactics" that could help to make a difference.

    APTA has long supported the promotion of physical activity and the value of physical fitness. In addition to representation on the NPAPA and other organizations, the association offers several resources on obesity, including a prevention and wellness webpage that links to podcasts on the harmful effects of inactivity.

    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.

    Summer's Over, but Payment Reform is Just Beginning: Tips on Getting Up to Speed

    A new proposed CPT system for evaluation codes, increasing required bundled payment models, the end of the Physician Quality Reporting System (PQRS) in favor of the Merit-Based Incentive Payment System (MIPS)…feeling dizzy yet?

    Health care reform's swift movement toward value-based payment and away from procedural-based, fee-for-service systems is sweeping up physical therapists (PTs) and physical therapist assistants (PTAs) as it continues to gain momentum. And that momentum built over the summer, even while we vacationed, mowed our lawns, and got the kids ready for another school year.

    So now that it's officially fall, why not spend some time getting up to speed on where the profession stands in relation to payment reform? Here are a few suggestions to help you find out what health care did over your summer vacation:

    See the big picture on payment reform.
    The "Compliance Matters" columns, a regular feature of PT in Motion magazine, connect you with what's going on. Check out the August column, which lays out the basics behind the Center for Medicare and Medicaid's proposed system for new CPT evaluation codes (and 1 reevaluation code), as well as the column from March that explains the workings of the new Comprehensive Care for Joint Replacement (CJR) bundling program. For an even bigger-picture view of the road that has led to the CPT and other changes, this article from the April issue of PT in Motion magazine provides 5 concepts that are central to payment reform.

    Dig a little deeper.
    The newly updated APTA Payment Reform webpage is the jumping-off point to 3 major areas that affect—or will soon be affecting—PTs and PTAs: alternative payment models, Medicare postacute care reform (especially the reform efforts reflected in the IMPACT Act), and the changes associated with the Medicare Access and CHIP Reauthorization Act, or MACRA. All 3 areas contain multiple resources and links that can help you see where things stand now, and where they may be headed. Another resource for some in-the-weeds information: APTA's Insider Intel series, a phone-in program that puts you in touch with staff experts on payment reform. Past intel calls are available as recordings or transcripts; look for another installment later this fall.

    Get a handle on where things stand right now.
    The proposed 2017 Medicare physician fee schedule from CMS is the hot topic of the moment. While awaiting the final rule (expected in late October/early November), find out what it's all about and what changes could impact PTs the most through the recording of a sold-out webinar on the payment system held September 22. You can also access the most recent APTA summary of the proposal (look under "APTA Summaries"). And while you're in a summary state of mind, don't miss out on APTA summaries of the final 2017 inpatient prospective payment system (IPPS) rule, the proposed rule for the 2017 home health prospective payment system, and the final rule on the 2017 skilled nursing facility prospective payment system—all can be found under the "APTA Summaries" header on their respective pages. Want a quick video take? These video dispatches from the APTA State Policy and Payment Forum—on bundled care models and the proposed CPT coding system—provide brief overviews.

    Find out what your association has to say.
    APTA registered its "deep disappointment" with the CMS decision to employ a 3-tiered CPT evaluation system that doesn't differentiate payment among those tiers, but that's not all the association had to say about the proposed 2017 physician fee schedule: you can read the association's comments to CMS in their entirety at the APTA Medicare Physician Fee Schedule webpage (look under the "APTA Comments" header). Then be sure to get the perspective of APTA President Sharon L. Dunn, PT, PhD, who issued a recent statement and update that outlines APTA's efforts around payment reform, and urges members to engage in this issue so that the profession can have a role in shaping the future of payment.

    Fraud Settlements Worth More Than $35 Million Underscore Relevance of New Compliance Resource

    Timing, as they say, is everything. That's certainly the case for a recently released joint guidance document on compliance created by APTA and 3 other organizations, which arrives during a period of increased federal scrutiny of fraud associated with companies providing physical therapist services. That scrutiny resulted in settlements totaling more than $35 million.

    A new resource created by APTA, the American Occupational Therapy Association, the American Speech-Language-Hearing Association, and the National Association for the Support of Long-Term Care helps health care providers understand compliance: what it is, the role of corporate compliance programs, and recommended steps for reporting. The 2-page guide also includes links to Department of Health and Human Services (HHS) Office of the Inspector General (OIG) compliance materials, and OIG national compliance hotline information.

    The importance of compliance has been underscored over the summer through a series of announcements from the US Department of Justice and HHS OIG that have focused on organizations found to have committed fraud related to therapy. These include:

    • A $28.5 million settlement against California-based North American Health Care, for providing medically unnecessary therapy services to TRICARE and Medicare patients in its skilled nursing facilities
    • A $7.1 million settlement against Drayer Physical Therapy, which operates facilities in 15 states, for claiming individual physical therapy billing for sessions that were actually delivered to multiple patients at the same time
    • A report from HHS OIG detailing the operations of an unnamed physical therapy practice in Kansas that submitted 29 improper claims worth $134,967 to Medicare during a 100-day study sample, including services that were not specific to a patient's conditions; claims for unreasonable amounts, frequency, and duration of services; and inappropriate care provided given the patients' conditions

    In both recent settlements, whistleblowers were responsible for alerting HHS to the fraudulent activity. In the Drayer case, those whistleblowers were physical therapists (PTs) formerly employed with the company.

    "Over the past few years, we've witnessed stepped-up efforts by the federal government to root out waste, abuse, and fraud, an effort very much supported by APTA," said Roshunda Drummond-Dye, JD, APTA's director of regulatory affairs. "We're continuing to work to provide members with up-to-date compliance tools, and the joint guidance document we've created helps to bring some of the most relevant information together in one place."

    The compliance guide joins a full array of other compliance resources available at APTA, most of which are featured as part of the APTA Center for Integrity in Practice website. That site houses information on how PTs, physical therapist assistants, and students can continue to uphold the profession's high standards, and includes information on the Choosing Wisely® list of "5 Things Physical Therapists and Patients Should Question;” a primer on preventing fraud, abuse, and waste; a free course on compliance; and other information on regulation and payment systems, evidence-based practice, ethics, professionalism, and fraud prevention.

    ED Visit Rates for Youth Soccer-Related Injuries Climb by More Than 100% in 25 Years

    The popularity of youth soccer has grown tremendously since 1990—and with it, the rate of emergency department (ED) visits related to the sport, say researchers, who cite a 111% jump in injury rates for players aged 7-17 over a 25-year period. Those rates also include a nearly 1,600% increase in soccer-related ED visits for concussions, a dramatic change that may be linked to wider awareness of the seriousness of mild traumatic brain injury, according to the study's authors.

    For the study, researchers analyzed ED data reported to the National Electronic Injury Surveillance System 1990-2014, focusing on data linking an ED visit to a pediatric soccer-related injury and tracking demographics of the injured player as well as type and cause of injury received. These data were matched up with soccer participation rates obtained from the National Sporting Goods Association to estimate injury rates over time. The study was published in the journal Pediatrics.

    Among the findings:

    • Between 1990 and 2014, the annual soccer-related injury rate for children aged 7-17 rose by 111%, from 1.53 per 10,000 participants to 15.68. Reported concussion rates increased by 1,595% during the same time period, from .53 per 10,000 to 3.92 per 10,000.
    • The numbers of injuries for boys did not increase significantly between 1990 and 2008, but girls' injuries increased by 101.9% during that time. From 2008 to 2014, those numbers leveled off for girls, but increased for boys by 44.6%.
    • Children of all ages reported increasing numbers of injuries during the 25-year study period, but children 7 to 11 years old reported a more dramatic (61%) increase from 2008 to 2014.
    • When a cause of injury was cited, it was most often "struck by" (38.5%), followed by "fell" (28.7%) and "twisted" (12.8%). “Collision” accounted for 5.6% of injuries.
    • Younger players (ages 7 to 11) were more likely to sustain an injury from a fall or ball, while players 8 to 17 years old were more likely to be injured through twisting or a collision. Female players were more likely than male players to receive an injury from twisting.
    • Sprain or strain made up 34.6% of injuries, followed by fracture (23.2%), soft tissue injury (21.9%), and concussion (7.3%). Among boys, the proportion of concussion was higher in the 7-11 age group; among girls, the concussion number was higher at the 8-17 age range.
    • The most commonly injured body regions were upper extremity (20.7%), ankle (17.8%), head or neck (17.7%), and knee (11.2%).
    • Most—98.3%—players treated at the ED were released. Of players admitted to the hospital 70% were boys. Fractures were the most common reason for admission (60.6%).

    Authors write that while dramatic, the increase in concussion rate, particularly during the past 10-15 years, may not mean that youth soccer players have in fact experienced a 1,600% increase in concussions. While acknowledging that the rate may be increasing, researchers also cite growing awareness among players, coaches, parents, and the general public around the seriousness of concussion as a factor that has itself increased ED visits. Additionally, they write, concussion-related laws, more frequent diagnosis of concussion, and "lower thresholds" for parents to decide to bring a child to the ED could well be pushing up the rate. They note that similar patterns have been revealed in other sports.

    Still, they write, there's no denying that injury rates across the board have increased dramatically. As for what can be done to counter those climbing rates, citing 1 study that linked 12% of all soccer-related injuries to illegal activities, authors call for stepped-up injury prevention efforts that include more emphasis on (and enforcement of) the rules of the sport. They also recommend concussion prevention strategies including preseason neck muscle-strengthening exercises, writing that studies have shown an association between weak neck muscles and concussion risk among high school athletes.

    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.

    Want more information on managing youth athletes and making return-to-play decisions? Check out these e-learning courses available at the APTA Learning Center:

    JAMA: Better Health Care Workplace Violence Prevention Plans Needed

    With half of all workplace assaults involving health care workers already, and the number of violent crime episodes in hospitals on the rise, it's time for health care facilities to address workplace violence "aggressively and comprehensively," say authors of an editorial recently published in JAMA.

    The "Viewpoint," (first-page sample only available for free) written by 2 employees of the Joint Commission and a representative from a Veterans Health Administration workplace violence prevention program, cites data from the Joint Commission, Occupational Safety and Health Administration (OSHA), and Bureau of Labor Statistics (BLS) to outline what they assert is a growing problem. Among the data:

    • Within health care settings, approximately 24,000 workplace assaults occurred between 2010 and 2013, with most threats and assaults occurring between noon and midnight.
    • Between 2012 and 2015, the incidence of violent crime events in hospitals rose from 2.0 to 2.8 per 100 beds.
    • According to BLS, 50% of all workplace assaults involve health care workers, while workers in this labor segment only account for 20% of all workplace injuries.
    • An OSHA study of 100 health care worker or patient fatalities in health care settings found that nearly a third (27%) were attributable to assaults and violence.
    • A Joint Commission study of 33 homicides, 38 assaults, and 74 rapes in health care workplaces between 2013 and 2015 concluded that "root causes of these events were failures in communication, inadequate patient observation, lack of or noncompliance with policies addressing workplace violence prevention, and lack of or inadequate behavioral health assessment to identify aggressive tendencies in patients," authors write.

    Authors of the JAMA article assert that increasing workplace safety will require health care employers to step up the creation of violence prevention programs. These programs, they write, must be rooted in a recognition that "personnel underreport violent events because they believe these experiences are part of the job, reporting is either cumbersome or unlikely to result in action from leadership, or they fear retaliation for reporting." To counter that tendency authors urge the development of reporting systems that are "simple, trusted, secure, and with optional anonymity," result in "transparent outcomes and delivery of a report confirmation," and are "fully supported by leadership, labor unions, and management."

    "Safety in health care workplaces relies on leadership enacting appropriate polices; trained employees intervening and reporting; multidisciplinary teams using evidence-based threat assessments and management practices, communicating safety plans, and analyzing environmental context; and ongoing evaluation of program effectiveness," authors write. "A workplace violence prevention program should be a required component of the patient safety system of all health care organizations."

    State Policy, Insurers Forums: The Future of Health Care – And Payment – Has Arrived. Are You Ready?

    Topics may have ranged from the opioid abuse epidemic, to APTA's physical therapy outcomes registry, to the role of physical therapy in population health, but throughout APTA's recently held Insurers Forum and State Policy and Payment Forum, it wasn't hard to identify the strong common thread woven through nearly every session:

    Things are getting real.

    Over and over, speakers reminded attendees that what used to be conjecture about the move toward value-based care—and particularly its ramifications for payment—is now happening, and that physical therapists (PTs), physical therapist assistants (PTAs), payers, managers, and state policy advocates need to pay attention.

    The forums, 2 separate meetings that took place between September 16 and 19 in Pittsburgh, were designed for different audiences but contained overlapping content. At the Insurers Forum on September 16, representatives from insurers including Humana, Blue Shield of California, American Specialty Health, United HealthCare, and GEICO explored issues from the payer’s perspective. At the APTA State Policy and Payment Forum, held over the following 2 days, state chapter leaders and advocates gathered to discuss opportunities and challenges at the state level, and to get a sense of the larger national issues that will be impacting PTs and PTAs no matter where they practice.

    One of the major areas of focus during both meetings: the Centers of Medicaid and Medicare's (CMS) proposal to employ a new, 3-tiered CPT coding system for physical therapy evaluation (and 1 new code for reevaluation), planned to begin January 1, 2017. The system was proposed as part of the 2017 Medicare physician fee schedule.

    While some payer groups represented at the Insurers Forum will not immediately be required to follow the CMS recommendations, attendees were eager to understand how the American Medical Association-created codes were developed, and why. For participants in the State Policy and Payment Forum, the new system represents a major change, as APTA and its chapters work to ensure that both members and nonmember PTs thoroughly understand the system—and use it accurately.

    As proposed, the new system offers 3 separate evaluation codes based on the complexity of PT decision-making and the severity of the patient, but provides the same level of payment for each. According to CMS, that flat payment rate—opposed by APTA—would remain while PTs are educated on the new system and demonstrate appropriate use of the codes. APTA has published a members-only summary of the proposed 2017 fee schedule. (To access the highlights, visit the APTA Medicare fee schedule webpage, scroll down to APTA Summaries, and click on the related highlights link.)

    In a video interview at the forum, APTA Vice President of Payment and Practice Management Carmen Elliott described the importance of PTs and PTAs understanding the proposed system as a way for the profession to help shape the future of payment.

    "These codes are so important because now it actually represents the patients we are seeing, the complexity of the patients," Elliott said. "It sets us up for future payment models and shows the clinical decision-making, the skills, the technique, and the expertise of the physical therapist."

    APTA is offering multiple resources and education opportunities on the new CPT codes, including the recording of a sold-out webinar scheduled for September 22, which members will be able to access free (fee for nonmembers is $169) after the webinar.



    Check out other videos from the 2016 State Policy and Payment Forum: an overview of the Forum with APTA President Sharon L. Dunn, PT, PhD; a discussion of problems with the fee-for-service model; and an update on the Physical Therapy Licensure Compact and interstate mobility.

    Landmark NIH Plan Delivers 5-Year Roadmap for Rehabilitation Research

    Rehabilitation research, one of APTA's longstanding areas of advocacy, has just received a major boost with the publication of a revised National Institutes of Health (NIH) Rehabilitation Research Plan, a 5-year roadmap intended to address a broad swath of research science. Nearly 2 years in development, the revision is the first change to the plan made in over 2 decades, and was guided by a blue ribbon panel that included prominent APTA members and physical therapy researchers.

    The plan, which will guide NIH support for rehabilitation medicine, addresses 6 priority areas: the need for rehabilitation research, NIH's investment in rehabilitation research, current rehab research activities at NIH, coordination with other federal agencies, and opportunities, needs, and priorities. According to NIH, each area has witnessed significant change since the 1993 edition of the plan, attributable to everything from an increase in rehabilitation researchers and growth in evidence to advances in brain-computer interfaces and other technologies that have altered the rehabilitation landscape.

    Among the topics covered within the priority areas: investigation of new approaches to assistive technology in the home; increasing resources to recruit more researchers; ramped-up efforts to analyze biological, chemical, and genetic components of recovery; and intensified research on rehabilitation and disability across the lifespan.

    A call for a revision to the plan, and the establishment of a 5-year update cycle, were among the recommendations from an NIH blue ribbon panel that was co-chaired by former Physical Therapy (PTJ) Editor-in-Chief Rebecca Craik, PT, PhD, with members that included Anthony Delitto, PT, PhD, and current PTJ Editor-in-Chief Alan M. Jette, PT, PhD.

    Improvements to rehabilitation research and support of NIH work in this area are among APTA's public policy priorities. In addition to its individual advocacy efforts, the association is a member of the Disability and Rehabilitation Research Coalition, a group of more than 40 organizations working together to promote this type of research.

    "The rehabilitation research plan now published will be a major resource, both for researchers and the agencies that provide funding," said Justin Moore, PT, DPT, chief executive officer of APTA. "Rehabilitation science can help providers truly transform lives, and this new plan marks a long-awaited and significant step forward."

    Development of the plan was led by the National Center for Medical Rehabilitation Research (NCMRR), under the leadership of Director Alison Cernich, PhD. NCMRR is part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

    'Flash Action' Connects PT, PTA Students With PT-PAC

    A physical therapist (PT) and physical therapist assistant (PTA) student-led "flash action strategy" held recently was all about education and connection around PT-PAC, the physical therapy profession's primary political action committee.

    And once again, students showed how enthusiasm for the profession can make a real difference.

    In the middle of packed semesters, students from 94 PT and PTA programs participated in a nationwide effort to press for increased involvement in PT-PAC. Primarily using social media, participants concentrated their efforts during a 48-hour window of intense messaging. The awareness campaign helped to raise nearly $8,000 for PT-PAC and, more important, spread the message of the importance of the PAC to the profession—including members of the profession still in training.

    Based on total donations, the top 5 schools in the flash action were, in order, the University of Dayton (Ohio), West Coast University (California), Texas Woman's University, Mount St Mary's University (California), and South College (Tennessee).

    PT and PTA students will be bringing their energy and excitement to the upcoming APTA National Student Conclave, set for October 27-29 in Miami.

    APTA Staff, Members, Supporters Take to the Streets to Support Physical Therapy and #ChoosePT

    Super H 5K Run


    They came. They saw. They ran—and helped to spread the word about physical therapy and the #ChoosePT campaign.

    On September 18, staff, APTA volunteers, and family members returned to the streets of McLean, Virginia, in their running shoes and, this year, orange #ChoosePT t-shirts to participate in the Medstar National Rehabilitation Hospital “SuperH” 5k Run, Walk, and Wheel, a special event that encourages participants of all abilities to come together to support the work of the hospital. APTA has been a sponsor of the event for several years, and this year hosted an information table that offered resources on physical therapy, the public-focused MoveForwardPT.com website, and #ChoosePT, the association's anti-opioid abuse campaign.

    According to APTA CEO Justin Moore, PT, DPT, the event is part of a broad effort to encourage more APTA staff involvement in community service—an effort that grew out of the 2015 Global PT Day of Service last October. APTA staff and volunteers participated in that event, and the association is a sponsor of this year's service day.

    "We've embraced the concept with the moniker of 'APTA Serves,'" Moore said in a video interview. "We're trying to embed service into our staff model and into our employees on a daily basis. That was really launched last year, and it's becoming something we're trying to do year-round."

    Next up on the APTA Serves agenda: a blood drive, hosted at APTA headquarters in Alexandria, Virginia, on October 4, from 9:30 am to 3:00 pm. Participation isn't limited to association staff—local members and supporters are also encouraged to participate, and can sign up online.

    Don't forget—Global PT Day of Service returns this year on October 16. What will you be doing to engage with your community?