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  • ChoosePT: 5 Ways to Participate in National Physical Therapy Month in October

    National Physical Therapy Month (NPTM) is just around the corner. Are you ready?

    October is the profession's opportunity to amplify and promote the benefits of physical therapy, and APTA is here to help you get the message out. This year, #ChoosePT has expanded to include all the benefits of physical therapy, how it is effective for a wide range of conditions including chronic pain, and that connecting with a physical therapist (PT) can be as easy as visiting APTA's Find a PT directory.

    Getting involved in NPTM is easy. Here are 5 ways to share the ChoosePT message:

    1. Help consumers choose you.
    The best way to promote the profession is by increasing the public's engagement and positive experiences with physical therapy—in other words, by doing what you do best. But before you can make that very personal case, the public has to know you're out there and ready to help. APTA's Find a PT directory, a physical therapist member benefit accessible through our consumer website, ChoosePT.com, makes it easy for consumers and other providers to filter results by practice focus or specialization. Take the time to sign up—or if you're signed up already, make sure your information is up-to-date. You can even add a headshot to enhance your profile.

    2. Let the public know about ChoosePT.com.
    APTA's consumer website has a new name and a new look. ChoosePT.com includes the Find a PT directory, symptoms and conditions guides, health tips, podcasts, and more. Get the word out on what the site has to offer—it's easy to navigate and full of resources designed to help the nonclinician understand the value of physical therapy.

    3. Get social.
    This one's easy: use #ChoosePT in your social media posts, and be sure to follow us on Twitter and Facebook.

    4. Spread the word with handouts and flyers (and look awesome doing it).
    APTA’s updated ChoosePT toolkit offers downloadable handouts and graphics that help you get the word out. And because it just wouldn't be a celebratory month without swag, we're also offering new ChoosePT t-shirts that allow you to keep the message close to your heart (scroll to the bottom of the toolkit page to order).

    5. Celebrate Global PT Day of Service on October 12 by helping out in your community.
    PTs, physical therapist assistants, and students have a strong track record for being community-minded all year long, but October 12 is a special day set aside for letting the profession's dedication to community service really shine. Visit APTA's PT Day of Service webpage to find out more, participate in challenges, and find local projects to join.

    Questions? Contact APTA's public and media relations staff.

    The Good Stuff: Members and the Profession in the Media, September 2019

    "The Good Stuff" is an occasional series that highlights recent 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!

    He'll always be our PT Ninja Warrior: Conor Galvin, SPT, made it to the national finals of NBC's "American Ninja Warriors" competition. (Riverhead, New York, News-Review)

    Stiff is for upper lips only: Katie Sun Worrall, PT, DPT, offers advice on how adults can remain flexible as they age. (Wellandgood.com)

    Tiny homes for vets: Tim Terrio, PT, DPT, ATC, MS, is the originator of a plan to build 12 tiny homes to provide permanent housing for homeless veterans. (Bakersfield.com)

    Too much too soon: Nancy Robnett Durban, PT, DPT, MS, shares the kinds of injuries that are common among young athletes who focus intensely on a single sport. (Boston Globe)

    A much-kneeded guideline: Richard Willy, PT, PhD, explains the findings from the recently published clinical practice guideline on runner's knee that he helped to author. (abcFOX Montana)

    Getting back into the workout groove: Karen Litzy, PT, DPT, MS, emphasizes the importance of an evaluation by a physician or PT before getting back into an exercise habit after a long hiaitus. (Time)

    The #ChoosePT message: Matt Kudron, PT, DPT, helps viewers understand the benefits of physical therapy for a variety of conditions. (Fox21 News, Colorado Springs, Colorado)

    Virtually effective: Danielle Levac, PT, PhD, discusses the potential for virtual reality to aid in rehabilitation. (US News and World Report)

    Outrunning injury: Robert Gillanders, PT, DPT, offers advice on how to avoid common running-related injuries. (NBC News)

    Taking aim at injury prevention: Jeff Samyn, PT, provides tips to hunters on getting in shape for the fall hunting season. (Petosky, Michigan, News-Review)

    The view from Kilimanjaro: Scott Winkler, PT, DPT, recounts climbing Mount Kilimanjaro with his son Eric. (Murray, Kentucky, Ledger-Times)

    Getting past pain: Alan Meade, PT, BSPT, DScPT, outlines how physical therapy can help to manage pain. (WJHL News11, Johnson City, Tennessee)

    Don't be a slouch at aging: Eric Robertson, PT, DPT, adds his perspective on how older adults can improve their posture. (AARP magazine)

    #ouch: Collin Kudrna, PT, DPT, discusses the dangers of "text neck" and how to counter the condition. (KXNet.com News, Bismarck, North Dakota)

    Living active with arthritis: Karl Gilliam, PT, DPT, stresses the importance of movement—and physical therapy—to help individuals with arthritis stay active. (NBC2 News, Fort Meyers, Florida)

    Changing the game for lung cancer patients: Nicole Stout, PT, DPT, FAPTA, and Megan Anne Burkart, PT, DPT, discuss the importance of prehab and rehab to keep patients healthy during and after treatment for lung cancer. (Everyday Health)

    Quotable: "If medication requires a $10 copay and physical therapy requires a $50 copay, that's not equitable." – American Medical Association President Patrice Harris on the need to rethink copays as a way to increase patient access to medication-assisted treatment for opioid addiction. (Medpage Today)

    Got some good stuff? Let us know. Send a link to troyelliott@apta.org.

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    5 Ways to Get Ready for Falls Prevention Awareness Day

    An estimated 1 in 4 adults 65 and older experiences a fall each year, and according to a recent study, falls-related deaths among adults 75 and older are on the rise, all of which makes falls prevention more relevant than ever.

    With Falls Prevention Awareness Day coming September 23, now is a great time to check out a few falls-related resources from APTA and its components. Here are a few ways to make the next few days a little more fall-focused.

    1. Check out the tests and measures at PTNow.
    In addition to being your source for clinical summaries, clinical practice guidelines, and research, APTA's evidence-based practice resource also includes a host of tests and measures—including many related to balance. Members can download information on the 360-degree turn stand, the balance error scoring system, the elderly mobility scale, and the falls risk assessment tool, to name a few. Some of the resources even come with accompanying videos. And don't forget other falls-related resources at PTNow, such as this clinical summary on fall risk in community-dwelling elders.

    2. Learn about (and share) the research that supports physical therapy's value in reducing fall risk.
    This 2-page pdf document compiles summaries of recent studies that underscore the important role physical therapists (PTs) and physical therapist assistants (PTAs) can play in falls prevention. It's easy to print out and share.

    3. Get involved with a SIG—or 3.
    SIG stands for an APTA "special interest group," a place where you can connect with other providers who share your passion for a particular subject. When it comes to falls, you have options: the APTA Academy of Geriatric Physical Therapy's Balance and Falls Special Interest Group, the Balance and Falls SIG sponsored by the APTA Academy of Neurologic Physical Therapy, and the APTA Academy of Oncologic Physical Therapy's Oncologic Balance and Falls SIG. You'll need to be a member of the respective academies first, but belonging to any of them has its own merits.

    4. Stay informed.
    APTA's Learning Center makes it easy to grow your knowledge around falls prevention by way of timely (and convenient) continuing education offerings offered at a discount to APTA members. Two relevant and relatively recent examples: "Physical Therapy and the Aging Adult: Management of Falls and Falls Prevention in Older Adults," a 0.4 CEU online learning course, and "Management of Balance Impairments and Fall Risks for Adult Cancer Survivors," a 0.7-CEU online course that explores a perspective surveillance model to decrease fall risk in this population.

    5. Help your patients and clients understand the importance of falls prevention.
    The risk of falls can't be reduced if patients aren't actively engaged—and that engagement begins with education. APTA's consumer focused ChoosePT.com website is designed to do just that, making it easy for nonclinicians to learn about a wide range of conditions and what PTs and PTAs can do to help. ChoosePT.com resources include a Physical Therapist's Guide to Falls that lays out the basics, an overview of how physical therapy can aid in falls prevention, a podcast on falls and falls prevention, and a short video on how balance can be improved—and falls avoided—through physical therapy

     Want more? Check out APTA's Balance and Falls webpage. Resources include tips on developing consumer events on falls and links to other organizations.

    Time to Act: CMS Proposes Significant 8% Cut to Physical Therapy in 2021

    [Editor’s Note: Response to CMS about the proposed PFS has been strong, and the more comments CMS receives the more likely they are to consider our recommendations. Use this prewritten template letter to add your voice by the September 27 deadline and strengthen our message even more.]

    In this review: APTA's response to a CMS plan to cut Medicare physician fee schedule (PFS) reimbursement for physical therapy providers by 8% beginning in 2021. The reduction for 2021 is included in the proposed 2020 PFS.
    Proposed 2020 Physician Fee Schedule (see table 111, p 1187)
    CMS Fact Sheet
    CMS press release

    The big picture: a proposed 8% cut in Medicare reimbursement for physical therapy providers in 2021
    Deep within the proposed 2020 PFS, CMS reveals a plan that puts Medicare beneficiary access to physical therapy at risk by way of an estimated 8% cut to fee schedule reimbursement in 2021. CMS says the reductions, which affect multiple providers to different extents, are driven by changes to reimbursement formulas for evaluation and management (E/M) services furnished by physicians and some other providers.

    APTA's message to CMS: significant cuts to fee schedule reimbursement for physical therapy providers will put challenging and likely unsustainable financial pressures on physical therapists (PTs), particularly in rural and underserved areas where access is already limited. As more PTs feel this pressure and opt out of treating Medicare beneficiaries—or close their doors altogether—patient access to care will suffer.

    "The changes to reimbursement for office/outpatient E/M codes itself are positive ones and we fully support access to primary care services, but the idea that these changes must be accompanied by deep cuts to other crucial services is outrageous," said Kara Gainer, APTA's director of regulatory affairs. "At a time when our aging population is in need of greater access to physical therapy, with its proven benefits and track record for reducing overall costs, CMS has instead decided to turn its back on the facts and put patients at risk."

    What we're doing—and what you can do (before September 27)
    We're preparing a formal comment letter to CMS, but that's just a part of APTA's efforts. Because the proposal affects multiple providers, from PTs and occupational therapists to clinical social workers, clinical psychologists, ophthalmologists, optometrists, and chiropractors, we're circulating a provider organization sign-on letter objecting to the cuts, and we're working with the American Occupational Therapy Association to develop an additional sign-on letter to be circulated among members of Congress.

    Even more important, we're urging APTA members to bring their individual voices to bear on this issue. We've created a customizable template letter that makes it easy to let CMS know how these proposed cuts will pose a real danger to Medicare beneficiaries and negatively impact PTs' ability to practice under Medicare. Make sure you get your comments to CMS by the September 27 deadline (the template letter includes instructions on how to submit to CMS).

    Tip: this letter is the second template letter we've created in response to the 2020 PFS. The first addresses the problematic physical therapist assistant/occupational therapy assistant coding modifier plan, and is still available for download. If you haven't yet completed and submitted that letter, you can combine it with the letter on the reimbursement cuts.

    What's next
    Deadline for comments is September 27, and the final rule will likely be issued by November 1. In addition to the sign-on letters described above, APTA and several other provider associations will meet with CMS officials in mid-September to share concerns and provide recommendations on a range of issues related to the PFS.

    APTA Launches New ‘Find a PT’ and ‘ChoosePT.com’ Website to Support Consumer Awareness

    Every day, people choose physical therapy for a multitude of reasons, from managing pain to building healthy lifestyle habits. Now APTA's consumer-focused website has a new name—and a new look—to support that reality and help connect patients with physical therapists (PTs) through an enhanced "Find a PT" feature.

    This week, APTA unveiled ChoosePT.com, a consumer website that replaces MoveForwardPT.com, now retired after 10 years. The new site is a best-of-both-worlds combination of 2 of the association's most high-profile and far-reaching initiatives—APTA's popular online source for consumer-oriented health information, now operating under a name that leverages the power of the association's award-winning opioid awareness campaign. The ChoosePT site is expected to receive more than 4 million visitors in 2019, with anticipated increases in the coming years.

    The transition to ChoosePT does not significantly change the content on the former MoveForwardPT site, which still includes information on symptoms and conditions, prevention, and pain management, as well as access to podcasts and videos that deliver powerful messages about the difference physical therapy can make in people’s lives.

    But not everything's the same: The changeover has allowed APTA to make improvements to the site's "Find a PT" directory, an APTA member benefit for physical therapists, that makes it easier for consumers and other providers to filter results by practice focus or specialization.

    The upgraded feature is an opportunity that members shouldn't miss, according to Jason Bellamy, APTA's executive vice president of strategic communications.

    “Millions of people will visit ChoosePT.com this year, and one of their most common destinations will be Find a PT," Bellamy said. "APTA members should ensure their information is up-to-date, and add a headshot to make their profile more appealing. Our message to members is, 'do everything you can to help consumers choose you.'"

    ChoosePT.com is also enhanced by geolocation technologies that, with a user's permission, create an online experience customized to the user's physical location. APTA state chapters that have an active geolocation page—49 to date—can add state-specific information to the ChoosePT site, providing visitors with an additional depth of relevant information.

    Bellamy believes the change to ChoosePT.com is the right move at the right time, with more exciting changes coming around the corner.

    “When we launched our opioid awareness campaign we knew our #ChoosePT message was dynamic enough to extend beyond the safe management of chronic pain,” Bellamy said. “With APTA’s centennial approaching in 2021, and the public awareness opportunities that will provide, this was the perfect time to make that our primary call to action.”

    Want t-shirts with the new ChoosePT logo? They're available here.

    New Rule Allows CMS to Deny Enrollment to Providers 'Affiliated' With Sanctioned Entities

    In this review: US Centers for Medicare & Medicaid Services (CMS) Medicare, Medicaid, and Children's Health Insurance programs; Program Integrity Enhancements to the Provider Process (final rule)
    Effective date: November 4, 2019
    CMS Press Release

    The big picture: a new level of authority for CMS
    CMS has released a final rule that gives it the power to revoke Medicare, Medicaid, and Children's Health Insurance Program (CHIP) enrollments of providers or suppliers who have an "affiliation" with previously sanctioned entities, even if those providers and suppliers aren't directly violating any existing rules themselves. CMS says the new authority will help to "stop fraud before it happens."

    While APTA supports efforts to reduce waste, fraud, and abuse in all areas of health care, we believe this rule may create more problems than it solves, particularly given an overly broad definition of what constitutes an "affiliation." The likely result: undue administrative burden for providers and suppliers who have been compliant from the start.

    The rule goes into effect November 4.

    Notable in the final rule

    • "Affiliations" authority. Under the new rule, all Medicare, Medicaid, and CHIP providers must disclose current or past affiliations with any organization that has uncollected debt, has had a payment suspension under a federal health care program, has been excluded from a federal health care program, or has had billing privileges denied or rescinded. If they don't disclose, CMS reserves the right to prevent them from participating in Medicare, Medicaid, and CHIP. These affiliations must be reported even if the other organization was not enrolled in Medicare, Medicaid, or CHIP at the time of the relationship.

    What's an "affiliation"? CMS provides 5 definitions:

    1. Direct or indirect ownership of 5% or more in another organization
    2. A general or limited partnership interest, regardless of the percentage
    3. An interest in which an individual or entity "exercises operational or managerial control over, or directly conducts" the daily operations of another organization, "either under direct contract or through some other arrangement"
    4. When an individual is acting as an officer or director of a corporation
    5. Any reassignment relationship
    • Expanded authority to revoke Medicare enrollment for other reasons. The final rule also gives CMS more power to revoke or deny Medicare participation for providers or suppliers who do any of the following:
    • Try to come back into the Medicare program under a different name.
    • Bill for services or items from noncompliant locations
    • "Exhibit a pattern or practice of abusive ordering or certifying of Medicare Part A or Part B items, services or drugs."
    • Owe CMS money from an overpayment referred to the US Treasury Department.

    Concerns
    When the rule was first proposed in 2016, we voiced our concerns in a comment letter that characterized the plan as an overly burdensome one that would prove costly for providers and, ultimately, decrease patient access to care as providers downscaled or ended their participation in Medicare. Not much has changed since then

    Between the extremely low 5% ownership threshold that triggers disclosure (APTA proposed a 25% bar), the requirements that providers disclose relationships with affiliates who weren't enrolled in Medicare at the time, and a poorly defined "lookback" requirement that puts a 5-year limit on how far back a provider must scour its records for bad-actor affiliates but no similar timeframe on how long ago that affiliate's violations may have occurred, the new rule is burdensome to say the least.

    Under the rule, we wrote, "providers and suppliers will be forced to become private investigators to determine whether an affiliate ever had its enrollment denied, revoked, or terminated. We believe this is simply not feasible and will divert time that physical therapists could spend on improving the quality of patient care rather than on regulatory requirements that will not make the Medicare program appreciably safer."

    Where things stand
    According to Kate Gilliard, APTA senior regulatory affairs specialist, now that the rule is final, the emphasis should be on monitoring for impacts and reporting problems to strengthen APTA's advocacy for changes in future versions.

    "It's clearly important for CMS and the physical therapy profession to make every reasonable effort to eliminate fraud in health care, and APTA will continue to work toward that goal," Gilliard said. "But this rule threatens to sacrifice patient access to care for the sake of a shotgun approach to the problem, adding further unnecessary burden to providers who already follow the rules. That's the message we will continue to bring to CMS."

    The new rule goes into effect November 4. APTA will provide information on how to comply with the new requirements as it becomes available.

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    Posture and Movement Coordination, Sensorimotor Integration May Affect Motor Skills in Children With Autism

    In this review: Postural Control and Interceptive Skills in Children With Autism Spectrum Disorder
    (PTJ, August 2019)

    The message

    In children with autism spectrum disorder (ASD), problems with sensorimotor integration and difficulty in coordinating posture and arm motions may result in impaired motor planning and control. These children also exhibited fewer anticipatory postural adjustments and demonstrated more corrective control during arm movements. Compared with typically developing peers, children with ASD were less likely to use visual cues to plan for motions required to catch an item, such as a ball.

    The study

    To examine the interplay of sensory cues, postural demands, and arm movement during ball-catching, researchers in Taiwan asked children with and without ASD to catch a ball rolling down a ramp toward them. Of the children, 15 had ASD and 15 were typically developing age- and sex-matched peers.

    During the task, each child was asked to catch a foam ball rolling down 3 stationary tubular ramps inclined at 4 degrees. The first ramp was placed directly in front of the child, while 2 others each were placed 35 degrees to the left and right. The first 59-centimeter section of each ramp was enclosed so that the child could not see the ball. A sensor within the tube activated a beep as the ball passed through, and, to test catching with and without visual cues, a second sensor lit up an arrow sign during half of the catching attempts.

    A real-time motion-capture system measured the children's arm movements while catching the ball. The authors measured center of pressure (COP) displacements using a computerized pressure plate and recorded ball-catching on video, both synchronized with the motion capture system.

    Findings

    • Children who were typically developing had a significantly higher success rate for all 3 ramps than did their peers with ASD.
    • Children with ASD were more successful in catching on the left side and right side ramps than they were in catching on the center ramp.
    • Visual pre-cues had no effect on rates of ball catching. However, children with ASD used visual information to plan their arm movements significantly less often than did their typically developing peers.
    • Overall, children adjusted their posture before moving their arms in nearly half of catching attempts. While children with ASD had a lower rate of postural adjustment for lateral ramps compared with their peers, all of the children were more likely to adjust their posture for lateral directions than they were for the middle ramp. Children with ASD made anticipatory postural adjustments later than did children who were typically developing, and all children adjusted their posture earlier when presented with visual pre-cues.
    • Amplitude of shoulder excursion was greater in children with ASD, and was higher overall when visual pre-cues occurred. In contrast, elbow displacements were larger when no visual pre-cues were present. Visual pre-cues were associated with slower arm movements for lateral catches. In general, children with ASD moved their arms faster than did their peers.
    • During lateral catches, both groups demonstrated larger COP displacements and greater COP velocity, but visual pre-cues resulted in slower COP velocity.
    • Children with ASD demonstrated more corrective control during arm movements than did their typically developing peers.

    Why it matters

    Physical therapist interventions for children with ASD, the researchers write, "could focus on the integration between perception and motor components as well as motor adaptability of the motor skills."

    Related APTA resources

    The association offers a Cochrane systematic review and several clinical practice guidelines through the PTNow resource area. Individuals who want to learn more about physical therapist treatment for autism spectrum disorder can visit APTA's consumer-friendly guide at MoveForwardPT.com, the American Physical Therapy Association's consumer website.

    Keep in mind…

    The study excluded children with intellectual disability and attention deficit and hyperactivity disorders, which might reduce generalizability to the entire ASD population. Also, the small sample size limited the authors' ability to analyze the effect of any comorbidities.

    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, where's you'll also find a clinical summary on Autism Spectrum Disorder in Children.

    New Clinical Guidelines Find Strong Evidence Supporting Exercise Therapy for Knee Pain

    In this review: Patellofemoral Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association
    (The Journal of Orthopaedic and Sports Physical Therapy, September 2019)

    The message    
    It's all about movement: In its first-ever comprehensive clinical practice guideline (CPG) on patellofemoral pain (PFP), APTA's Academy of Orthopaedic Physical Therapy (Academy) lays out a set of recommendations that stress exercise therapy as the best approach to improve functional performance in the short, medium, and long term. But that's just 1 facet of the guidelines, which also include recommendations on diagnosis, classification, and examination.

    The study
    A panel of content experts from the Academy conducted an extensive review of scientific articles associated with PFP from 1960 to 2018, evaluating each for its evidence related to physical therapist (PT) clinical decision-making around the condition. From an initial field of 4,691 articles, reviewers winnowed the studies down to 271 that addressed diagnosis and classification (120), examination (56), and interventions (95). The panel then analyzed the overall strength of evidence, and shared a draft of its recommendations with members of the Academy and, later, with a panel of consumer representatives and other stakeholders that included claims reviewers, coding experts, researchers, and academic and clinical educators.

    Recommendations were assigned letters according to the strength of the evidence evaluated: A-"strong," B-"moderate," C-"weak," D-"conflicting," E-"theroretical/foundational," and F-"expert opinion."  

    Among the Recommendations
    Recommendations within the following CPG categories include:

    • Interventions. CPG authors found strong evidence supporting exercise therapy with combined hip- and knee-targeted exercises to reduce pain and improve outcomes, stressing that a combination of hip and knee exercises is better than a focus on knee exercises alone.
      The guidelines also find strong evidence that dry needling shouldn't be used for PFP, and moderate evidence that clinicians should stay away from the use of "biophysical agents" including ultrasound, cryotherapy, electrical stimulation, and laser treatments.
      Taping was supported by moderate-level evidence. The guidelines state that clinicians should combine physical therapist interventions such as foot orthoses, taping, mobilizations, and stretching when appropriate, but that "exercise therapy is the critical component and should be the focus in any combined intervention approach."
    • Diagnosis. Use of diagnostic tests that reproduce retropatellar or peripatellar pain during squatting received an A-level recommendation as a diagnostic tool, as did "performance or other function activities that load the patellofemoral joint in a flexed position, such as stair climbing or descent."
    • Examination. Strong evidence supports the Anterior Knee Pain Scale, the patellofemoral pain and osteoarthritis sub¬scale of the Knee Injury and Osteoarthritis Outcome Score (KOOS-PF), and the visual analog scale (VAS) for activity or the Eng and Pierrynowski Questionnaire (EPQ) as ways to measure pain and function. Moderate-level evidence supports the use of "clinical or field tests" that reproduce pain and allow for assessment of movement. Authors write that "these tests can assess a patient's baseline status relative to pain, function, and disability; global knee function; and changes in status throughout the course of treatment."
    • Classification. The guideline panel found no "previously established valid classification system" for PFP, so it developed one. The system is based on impairment and function-based categories that include overuse/overload, muscle performance deficits, movement coordination deficits, and mobility impairments.


    Why the CPG Matters
    PFP is estimated to affect 1 in 4 adults every year, with women reporting knee pain twice as often as men do. Authors of the CPG write that while the recommendations shouldn't be considered a standard of care that guarantees a successful outcome for every patient, they are a reflection of the best-available evidence around the condition. They add that "significant departures" from the CPG "should be documented in the patient's medical records."

    APTA's Role
    The association provided funding and technical support during development of the CPG. This support is part of an ongoing APTA initiative to work with its sections and academies to produce a range of guidelines that highlight the evidence base for physical therapy in treatment of a variety of conditions. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    3D Technology: All That's Fit to Print?

    When it comes to 3D printing and physical therapy, the future is now—well, almost now.

    In the September issue of PT in Motion magazine: "A New Dimension to Physical Therapy," a feature article that explores the current use of 3D as well as its challenges and possibilities, as seen through the eyes of physical therapists (PTs), a physical therapist assistant (PTA), and a professor of visual arts who heads the University of North Georgia's 3D printing efforts.

    The APTA members interviewed for the story say that in many ways 3D printing has arrived in physical therapy—and already is allowing for the creation of customized equipment and devices, many of which can be produced relatively quickly, and some at a fraction of the cost of their non-3D printed counterparts. The possibilities for orthotics and adaptive equipment for pediatric patients are just some of the reasons the interviewees are excited about the technology's future.

    "Future," however, is the key word: While 3D technology has improved dramatically since its debut in the 1990s, refinements still are needed. And the cost of the devices—particularly those capable of manufacturing with multiple materials—must come down before they become standard equipment in a physical therapy clinic.

    The challenges aren't just technological—a clinic has legal and regulatory considerations should it decide to go all-in on 3D printing now or in the future. Patient safety is an issue, of course, but so is the line between a clinic that produces the occasional customized orthotic and an equipment manufacturer, and the attendant regulatory oversight that entails.

    Still, those challenges shouldn't overshadow 3D printing's potential in physical therapy, and they certainly shouldn't cause physical therapy education programs to shy away from incorporating 3D printing concepts into their curricula.

    Robert Latz, PT, DPT, who was interviewed for the article, says there's good reason for practicing PTs and physical therapy students to keep up with the technology and not wait until it's perfected.

    "We need to learn the technology and apply the development process to this new technology," Latz says in the article. "If we do not do this, someone else will. I guarantee that the technology of 3D printing is only going to continue to improve and that the cost to create with this technology will continue to decrease."

    "A New Dimension to Physical Therapy" is featured in the September issue of PT in Motion magazine and is open to all viewers—pass it along to nonmember colleagues to show them 1 of the benefits of belonging to APTA. Also open to all: highlights from the 2019 APTA NEXT Conference and Exhibition.

    'Fundamentally Flawed': APTA's Comments on CMS' Plan Around PTAs, OTAs Target Potential Harms

    The big picture: a bad plan for determining when services are delivered by a PTA or OTA
    The US Centers for Medicare and Medicaid Services' (CMS) proposed physician fee schedule rule for 2020 includes provisions that would require providers to navigate a complex system intended to identify when outpatient therapy services are furnished by a physical therapist assistant (PTA) or occupational therapy assistant (OTA). If adopted, the plan would trigger a payment differential in 2022 based on how many minutes of services are provided by the PTA or OTA. (See this PT in Motion News story for a more detailed overview of the proposed rule.)

    CMS proposes to accomplish this by way of new PTA and OTA modifiers (CQ and CO, respectively) to be included on claims beginning January 1, 2020. The proposal also requires providers to add a statement in the treatment note that explains why the modifier was or wasn't used for each service furnished that day. In short, the system is rooted in total minutes of service, and would require the use of the applicable modifier that would indicate when a PTA or OTA provided outpatient therapy services for 10% or more of the total time spent furnishing the service.

    The proposal is more than just problematic—it's a threat to patient access to care, a vast overreach of CMS authority, and a documentation nightmare that flies in the face of CMS' "patients over paperwork" initiative to ease administrative burdens on providers. We laid out our concerns in a comment letter to CMS that describes the plan as "fundamentally flawed."

    Some of what's being proposed, CMS reasoning behind it—and what we have to say

    CMS: When the PTA participates in the service concurrently with the PT for a portion of total time, the modifier should be used when the minutes furnished by the therapy assistant are greater than 10% of the total minutes spent by the therapist furnishing the service, which means that the entire service would be subject to the 15% payment adjustment in 2022. This is being done to comply with Section 1834(v) of the Social Security Act.
    APTA: The intent of the therapist assistant provisions in the Social Security Act was to better align payments with the cost of delivering therapy services given that therapist assistant wages are typically lower than therapist wages. It was not meant to apply an adjustment to a PT's services furnished when the therapist assistant provides a “second set of hands” to the therapist for safety or effectiveness.

    The proposal completely ignores the efficacy of team-based care (CMS uses the term “concurrent“) and runs counter to the evolution—ostensibly supported by CMS—toward value-based care. "It is nonsensical to diminish reimbursement for services when safety precautions are implemented, and the overall value of the care is increased," we say in our letter. Bottom line: only services furnished in whole or in part independently by the assistant should count toward the 10% standard.

    CMS: If the PTA and the PT each separately furnish portions of the same service, the modifier would apply when the minutes furnished by the PTA are greater than 10% of the total minutes—the sum of the minutes spent by the therapist and therapy assistant—for that service.
    APTA: This proposal directly contradicts CMS' response to comments in the 2019 fee schedule final rule. In the rule, CMS explained how its claims processing system allows for the differentiation of the same procedure code when the same service or procedure is furnished separately by the therapist and assistant.

    In our letter, we write that “the agency clearly is contradicting itself now, several months later, in proposing to require that the CQ/CO modifier apply when the minutes furnished by the assistant are greater than 10% of the total minutes—the sum of the minutes spent by the therapist and therapist assistant for that service, thereby not allowing for the same procedure code to be reported on 2 different claim lines.”

    But that's just part of the problem. The system CMS is proposing for how providers arrive at this is anything but simple—in fact, we say that it's "outrageous that CMS expects therapy providers—particularly those who do not employ administrative staff and must perform all the coding and billing themselves in addition to delivering treatment to patients—to engage in division, addition, multiplication, and rounding merely to determine whether to affix a modifier to the claim."

    CMS: Beginning in 2022, if the PTA services exceed the 10% limit, reimbursements will be cut by 15%.
    APTA: The cuts pose a grave threat to the delivery of services, particularly in rural and underserved areas, especially when it's combined with the geographic indices that affect payment in these areas—on top of other potential reimbursement reductions in future years. We recommend that if CMS moves ahead with this proposal, it should exempt providers in rural and underserved areas from the requirements.

    CMS: In addition to the use of new modifiers, providers will need to provide a written statement explaining why the modifier was or wasn't used—and it has to be done for each service furnished that day.
    APTA: In our letter we call this plan "wholly unbelievable." Aside from the facts that the modifier proposal itself is extremely complicated and the extra documentation is not required by law, the addition of a statement requirement is clearly an undue administrative burden and a direct contradiction of the CMS "Patients Over Paperwork" initiative.

    We write that the plan "conveys a sense that CMS is being vindictive toward outpatient therapy providers, creating a divisive environment for therapy providers enrolled in the Medicare program." Our comment letter goes on to provide 6 additional reasons why the documentation requirement is a bad idea, including the ways in which it complicates 15-minute timed billing, exceeds requirements of Medicare administrative contractors, and applies a standard to PTs, OTs, PTAs, and OTAs that isn't applied to physicians, physician assistants, and nurse practitioners.

    What's next?
    This letter is the first of 2 comment letters on the fee schedule that APTA will be providing to CMS in the coming weeks. Deadline for comments is September 27, and the final rule will likely be issued by November 1. APTA and several other providers associations will be meeting with CMS officials in mid-September to share concerns and provide recommendations.

    You have an important role to play. Visit APTA's "Regulatory Take Action" webpage to access a customizable template letter on the PTA/OTA modifier, fill it in, and make your voice heard. It's easy—and crucial.

    Stay tuned for additional opportunities for comment on other elements of the proposed rule.