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  • Proposed 2019 Fee Schedule: Goodbye Functional Limitation Reporting, Hello MIPS?

    It's official: the US Centers for Medicare and Medicaid Services (CMS) is proposing that physical therapist (PTs) join the list of providers who must participate in the CMS Quality Payment Program (QPP), which would mean that beginning in 2019 PTs providing services under Medicare Part B must participate in either the Merit-based Incentive Payment Program (MIPS) or an Advance Alternative Payment Model (APM).

    But that's not the only significant change proposed by CMS. In a win for APTA and its members, the proposed rule would also eliminate functional limitation reporting (FLR), a requirement consistently opposed by the association.

    APTA regulatory affairs staff are reviewing the proposed rule and will provide more detail in the coming weeks. Here are the major takeaways so far:

    MIPS-eligible clinicians would include PTs
    PTs, occupational therapists, clinical social workers, and clinical psychologists who furnish services under Medicare Part B would be added to the list of providers required to participate in the MIPS program or, alternatively, an approved APM as part of the QPP. Currently, PTs may voluntarily participate in the QPP; if the proposed rule is adopted, the program would begin for PTs in 2019.

    MIPS requires reporting in 4 performance categories—quality, promoting interoperability, clinical improvement activities, and cost. Providers earn points in each category, producing a total annual MIPS score, which in turn determines whether the providers earn a payment incentive, remain neutral in payment, or be subject to a penalty. Several of the data points must be reported electronically through certified EHR vendors or registries such as APTA’s Physical Therapy Outcomes Registry. The inclusion of PTs comes as MIPS enters its third year of the program.

    (Editor's note: check out this article from PT in Motion magazine to get the basics on MIPS)

    Goodbye FLR?
    The FLR requirement, long-characterized by APTA as an unnecessary burden on PTs and other providers, would be eliminated under the proposed rule. Change or elimination of the FLR requirement was an ongoing target for the association, which provided data to CMS showing that the requirement didn't accomplish the value-based care goals that CMS envisioned.

    Physical therapist assistant (PTA) differential officially established
    Under the proposed rule, CMS would establish 2 new therapy modifiers to identify the services furnished in whole or in part by PTAs or occupational therapy assistants (OTAs) beginning. January 1, 2020. The change, mandated by the Bipartisan Budget Act of 2018, establishes modifiers to be used whenever a PTA or OTA furnishes all or part of any covered outpatient therapy service, and would set the stage for a planned payment differential that would reimburse services provided by PTAs and OTAs at 85% of the fee schedule beginning in 2022. CMS anticipates the creation of a voluntary reporting system for the new modifiers beginning in 2019.

    Payment would get a slight increase
    After applying adjustment factors mandated by the Bipartisan Budget Act of 2018, the proposed fee schedule conversion factor would be increased slightly, from $35.99 to $36.05.

    KX modifier requirements remain
    The permanent fix to the Medicare therapy cap enacted in 2018 included requirements to continue using the KX modifiers for claims that exceeded a threshold, which in 2018, is $2,010 for PT and speech-language pathology (SLP) services combined. CMS also references the targeted medical review process, noting the threshold amount of $3,000. That system would continue, but the proposed rule emphasizes that not all claims exceeding the threshold would be subject to review.

    More alternatives to MIPS
    Providers who elect to participate in the QPP through APMs would be allowed a bit more leeway in the new rule. For example, providers participating in the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration project would avoid MIPS reporting and payment adjustments if they participate in Medicare Advantage arrangements that are "substantially similar" to APMs.

    "The proposed rule contains provisions that, while not unexpected, have some far-reaching implications for physical therapists," said Kara Gainer, APTA director of regulatory affairs. "APTA will be analyzing the proposed rule in more detail and providing more information as it becomes available."

    The association will also be providing comments on the proposed rule by the September 10 deadline.

    APTA Helps Create New Grant Opportunities for PTs

    A new "mini grant" project aimed supporting implementation of a self-directed and group intervention program for adults living with arthritis is now accepting applications. The grants of at least $2,000 each are available to individual physical therapists (PTs) as well as APTA state chapters. APTA is a cosponsor of the program.

    The grants will be awarded to successful applicants who propose ways to implement the "Walk With Ease" (WWE) program either directly or in partnership with an external agency. Developed by the Arthritis Foundation, WWE is a community-based walking program based on group walking sessions and pre-walk discussions held multiple times per week. The initiative is a US Centers of Disease Control and Prevention (CDC)-recommended physical activity program.

    Grantees are expected to recruit at least 200 participants and work to ensure all participants complete 100% of the intervention by September 29, 2018, the end of the 3-month project period. Selected applicants can anticipate an average award of $2,000, although the number of awards is contingent on the availability of federal funds.

    Applications will be accepted and considered for funding on a rolling basis. Final applications must be received by Friday, July 27, 2018 at 11:59 pm ET and can be downloaded from the grant announcement webpage. Interested applicants must email the completed application to nmccoy@chronicdisease.org.

    APTA collaborated with the National Association of Chronic Disease Directors and the CDC's Division of Population Health Arthritis Program in the creation of the grants program.

    OB-GYN Group Embraces 'Fourth Trimester' Concept, Acknowledges Role of Physical Therapy in Postpartum Care

    A task force for the American College of Obstetricians and Gynecologists (ACOG) says it's time to frame postpartum care as an "ongoing process" requiring a personalized, cross-disciplinary approach—including the use of physical therapy when appropriate. APTA and its Section on Women's Health have registered strong support of the recommendations.

    In a committee opinion issued in May, ACOG's Presidential Task Force on Redefining the Postpartum Visit embraced the concept of the "fourth trimester," the idea that mother and child need ongoing care through at least the first 12 weeks after delivery. According to the task force, the fourth-trimester concept stands in contrast to the practice of an "arbitrary" single encounter with a primary care provider, often at 6 weeks after giving birth.

    Instead, the task force recommends contact with a maternal care provider within the first 3 weeks postpartum, during which the provider and patient would discuss a wide range of postpartum issues—from feelings of depression to the need for physical therapy to address incontinence and resumption of physical activity. Later, but within 12 weeks postpartum, a "comprehensive postpartum visit" should take place, according to the recommendations. That visit would also serve as a transition into ongoing well-woman care.

    The formal acknowledgement of physical therapy's role in postpartum care represents a significant conceptual shift, according to Carrie Pagliano, PT, DPT, president of the APTA Section on Women's Health.

    "Physical therapy has played a role in the postpartum health of women for many years; however, patient access to care was often limited to mothers who have a referring provider having prior experience with physical therapy, or it was simply left to the patient to find her own answers for her postpartum issues," Pagliano said. "Formal recognition of physical therapy in the fourth trimester not only recognizes our expertise in this area of care but provides a clearly stated standard of care for physicians providing postpartum care options for their patients."

    In a joint letter to ACOG on behalf the section and APTA, Pagliano and APTA President Sharon Dunn, PT, PhD, applauded the inclusion of physical therapists as a part of the health team envisioned in the recommendations.

    "Physical therapists' knowledge base and expertise related to the assessment and treatment of urinary and fecal incontinence, and for perinatal musculoskeletal issues including sexual dysfunction, pelvic girdle, and low back pain, as well as diastasis recti and painful scar tissue, will complement the contributions of other health care providers working in this important area of practice," the letter states. "Including physical therapy as a standard of postpartum care will increase the resources available for women to return to or improve their quality of life."

    For its part, the task force hopes the recommendations will influence payment and other policies around postpartum care, and will help to underscore the importance of fourth-trimester care among new mothers, among whom an estimated 40% never attend a single postpartum visit

    "The recognition of the fourth trimester is extremely important," Pagliano said. "Historically, women have talked about postpartum issues among themselves but may have been told 'that's just what happens when you have a baby.' These recommendations move the conversation into the light, providing a clear pathway, opening opportunities to discuss prevention, education, and treatment options for mothers following birth."

    Innovative Collaborative Effort Between APTA, United Healthcare, and OptumLabs Could Introduce Important Changes to Pain Management Policies

    What would happen if payers encouraged patients with low back pain (LBP) to explore low-risk treatments such as physical therapy by waiving copays for initial sessions? Thanks to a collaboration between APTA and the nation’s largest private health insurer, we may find out.

    Through its work with APTA, United Healthcare is identifying 10 markets for a pilot program that would employ a variety of policy changes to its pain management program, including the elimination of cost-sharing for an initial physical therapist (PT) visit, easier appointment scheduling for patients, and stepped-up public and physician education efforts emphasizing the benefits of early referral to a PT for pain. If successful, the pilot could help to transform the payment landscape in ways recommended in a recent APTA white paper on addressing the opioid epidemic through better pain management policies.

    The pilot accelerates the practical application of findings from a joint study by APTA, United Healthcare, and OptumLabs on the potential impact of early physical therapy and other nonopioid strategies to address LBP. That study paid particular attention to cost and downstream utilization associated with early physical therapy for LBP.

    The study was one of the topics covered during the 2018 Rothstein Roundtable at the APTA NEXT Conference and Exposition (see video dispatch below). During the Rothstein discussion, David Elton, senior vice president of clinical programs for OptumHealth, characterized the study's findings as ones that "confirm what we've seen"—that "good things happen" when physical therapy is used early in an episode of LBP.

    While not yet finalized for publication—something that could happen as early as fall of this year—the study's results were convincing enough to cause the insurer to move quickly toward the creation of the pilot program.

    "The collaborative work between APTA, United Healthcare, and Optum is an innovative approach that brings providers and payers together to work on truly transforming the health care system in ways that make a difference to patients," said Carmen Elliott, MS, APTA vice president of payment and practice management. "We are excited about the publication of the joint study and pleased for the opportunity to make real-world changes to improve patient access."

    According to United Healthcare, APTA chapter leadership in the 10 markets under consideration will be contacted to schedule webinars that provide an overview of the pilot.

    OptumLabs and OptumHealth are businesses of Optum. Optum and UnitedHealthCare are benefits and services companies of UnitedHealth Group.

     

     

    From the 2018 APTA House of Delegates: Rimmer, Corcos, Polvinale, Receive Honorary APTA Membership

    Two researchers and a longtime APTA staff member were formally recognized as honorary members of APTA by the 2018 House of Delegates for contributions that have allowed physical therapists (PTs) and physical therapist assistants (PTAs) to better serve patients and clients.

    James H. Rimmer, PhD, has conducted research that is widely known for its emphasis on health promotion and wellness for people with disability, particularly as it relates to physical therapy. This, in turn, has fostered development of models for the integration of health promotion into PT practice. He is also the creator of large-scale centers that promote health and wellness, and currently directs 2 federally funded centers: the National Center on Health, Physical Activity, and Disability; and the Rehabilitation Engineering Research Center on Interactive Exercise Technologies and Exercise Physiology for People with Disabilities.

    Daniel M. Corcos, PhD, a scientist whose research focuses on the neural basis of motor control, has a 30-year history of collaborating with PTs in a variety of ways, from serving as a doctoral chair to coauthoring peer-reviewed publications. In addition, Corcos played critical roles in developing grants that have supported the work of PTs and has been the recipient of grants that have included PTs as principal or co-principal investigators.

    With more than 38 years as an APTA employee, Bonnie Polvinale, former APTA chief operations officer (now retired), is the longest-serving staff member in the association's history. During her tenure with APTA, Polvinale helped to refine or re-envision some of the association's most popular offerings including the NEXT Conference and Exposition, the APTA Learning Center, and the Combined Sections Meeting. APTA President Sharon Dunn, PT, PhD, described Polvinale as a "truly outstanding" individual "committed to helping others" whatever the need. "Bonnie Polvinale possess the same compassion and caring for the individual that called us all to our profession in the first place," Dunn said.

    Final language for these recognitions and all actions taken by the House will be available by September after the minutes have been approved.

    APTA Input Included in Health Care Exec Group's Roadmap for Addressing Opioid Crisis

    In recommendations that at times echo those in a recently published APTA white paper, a new "roadmap" for addressing the opioid crisis adds to the voices calling for increased patient access to nonpharmacological and multidisciplinary approaches to pain management. APTA was among the organizations that helped guide development of the report.

    "A Roadmap for Action" is based on a summit sponsored by the Healthcare Leadership Council (HLC), a coalition of chief executives from hospitals, pharmaceutical companies, health insurers and other organizations. Summit participants, which included APTA, developed what HLC describes as "a concrete set of recommendations that identify best practices, prioritize solutions, and identify policy reforms necessary to collaboratively address the opioid crisis." APTA members may find the roadmap useful in advocacy and consumer education efforts.

    The roadmap focuses on 5 broad "priority areas" that require a range of actions at the legislative, regulatory, and industry level "to remove barriers to improved care, essential flow and use of data, and the development of therapeutic tools," according to the report. They are:

    • Improved system approaches to pain management
    • Improved system approaches to prevent opioid misuse
    • Expanded access to evidence-based substance-use disorder treatment and behavioral health services
    • Improved care coordination through data access and analytics
    • Development of sustainable payment systems that support coordination and quality care

    The list is followed by separate recommendations for "health care leaders," lawmakers, and regulators that are largely consistent with those developed by APTA in its white paper "Beyond Opioids: How Physical Therapy Can Transform Pain Management to Improve Health Care." Both the HLC and APTA resources call for increased public and provider awareness of nonpharmacological options for pain management, increased payer support for nonopioid approaches, and wider use of multidisciplinary teams. The HLC roadmap includes physical therapists as providers whose expertise should be put to use "through recognition and payment of services, as well as integration into care teams and opioid stewardship models."

    "This document is a call to action, not only for lawmakers and regulators, but also for all sectors of American healthcare," the HLC report states. "While public policy has a vital role to play in removing barriers to advancements in care and empowering accelerated therapeutic innovation, private sector leadership is critical on every aspect of this issue, from improvements in pain management to data-driven proactive interventions to strengthened opioid stewardship."

    From PT in Motion Magazine: Pedaling Past Injury

    According to an industry survey, more than 100 million Americans ride a bike each year. Some ride recreationally or for exercise, some bike to work or school, and others race competitively. No matter the kind of riding they do, all riders face some of the same challenges, such as risk for falling, overuse injuries, and improper alignment due to a poor bike fit. That's where physical therapists (PTs) and physical therapist assistants (PTAs) come in.

    A feature in this month’s PT in Motion magazine explores the PT's role in helping cyclists avoid injury, not just recover from it. Author Keith Loria interviewed several competitive cyclists, as well as PTs who have helped cyclists of all types.

    Alex Fraser-Maraun, an emerging elite Canadian road cyclist, said it was after he saw a PT that he learned his injuries “all stemmed from poor training and recovery practices, and from poor bike fits." Fraser-Maraun credits his therapist, Erik Moen, PT, with helping him return to racing. Moen notes, "Physical therapy can help bicyclists achieve their goals by identifying musculoskeletal limiters in their ability to pedal well and maintain positions consistent with bicycling."

    Clinicians also share advice for recreational riders, who often experience overuse injuries, or back, neck, or knee pain. Robert Wellmon, PT, DPT, PhD, who also is a competitive cyclist, told PT in Motion, "One of the best ways to avoid these problems is having a bike that fits well: the seat is the right height and width, and aligned properly."

    Pedaling Past Injury" is featured in the July issue of PT in Motion magazine and is open to all viewers—pass it along to nonmember colleagues to show them one of the benefits of belonging to APTA. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.

    Working with patients who are cyclists? Have them check out MoveForwarPT.com's "Tips for Health Cycling" page.

    Proposed CMS Home Health Rule Includes Major Change to Payment System

    The US Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule for home health payment that resurrects elements of last year's proposal for an entirely new payment methodology by, among other changes, shifting care from 60-day to 30-day episodes and removing therapy service-use thresholds from case-mix parameters. And while the new proposal doesn't mimic last year's proposal in terms of across-the-board cuts, the practicalities of the payment system could have an impact on providers.

    On July 2, CMS unveiled the Patient Driven Groupings Model (PDGM) as part of its proposed 2019 home health prospective payment system (HH PP). If adopted, it would represent 1 of the most significant changes to home health payment in decades by moving to 30-day episodes of care and structuring payment around some 216 case-mix groups that don't include therapy visits as a factor. In a fact sheet on the proposal, CMS asserts that the new system, mandated by the Bipartisan Budget Act of 2018, would "move Medicare toward a more value-based payment system that puts the unique care needs of the patient first while also reducing the administrative burden associated with the HH PP." If adopted as proposed, the PDGM would take effect in 2020.

    APTA regulatory affairs staff will analyze the proposal in-depth over the coming weeks, but initial readings seem to indicate that much of the PDGM is a rehash of the Home Health Groupings Model (HHGM) that CMS proposed last year. That proposal met with stiff resistance from many patient and provider organizations including APTA and the association's Home Health Section, with APTA describing the HHGM as a system with "significant flaws" that "will have a harsh and dramatic effect on patient care."

    Ultimately, CMS backed off from adopting the system in 2017, promising a retooled proposal in 2018. In the intervening months, the agency convened a technical expert panel to review the issue. That panel included APTA member Bud Langham, PT, MBA, with APTA Director of Regulatory Affairs Kara Gainer attending as an observer.

    The proposed PDGM has at least 1 significant change from the HHGM: because it's designed to be implemented in a budget-neutral way, it doesn't include the same $950 million in cuts associated with the 2017 proposal.

    But that doesn't mean providers are out of the woods, according to Gainer.

    “While the budget neutrality will prevent massive across-the-board cuts, CMS notes that the impact on payments as a result of the proposed PDGM will vary by specific types of providers and location," Gainer said. "Some individual home health agencies may experience different impacts on payments due to a variety of factors, most notably the ratio of overall visits that were provided as therapy versus skilled nursing.”

    Essentially, the PDGM classifies 30-day episodes according to a combination of factors related to 5 major buckets. They are:

    Timing—"early" vs "late." Only the first 30-day episode would qualify as "early"—all other episodes would be considered "late."

    Admission source—"community" vs "institutional." A 30-day period would be classified as "institutional" if the patient had an acute or postacute facility stay within 14 days of the start of the episode—if not, the admission source would be labeled "community."

    Clinical group. Based on principal diagnoses, patients would be assigned to 1 of 6 clinical groups: musculoskeletal rehabilitation; neuro/stroke rehabilitation; wounds (both surgical and nonsurgical); behavioral health care (including substance use disorder); complex nursing; and medication management, teaching, and assessment.

    Function level—"low impairment," "medium impairment," or "high impairment." CMS would rely on Outcome and Assessment Information Sets (OASIS) codes to designate a patient's level of function.

    Comorbidity adjustments—"no adjustment," "low," or "high." A single secondary diagnosis that falls within a list of 11 comorbidity subgroups could qualify the patient for a low-comorbidity adjustment; 2 or more that results in comorbidity subgroups interacting could result in an adjustment for high comorbidity.

    The combination of categories are what comprises the 216 PDGM payment groupings. Those groupings would define payment for the 30-day episode and could in turn receive further adjustments if fewer than 2 to 6 visits are furnished during the 30-day episode, depending on the PDGM group.

    The proposed rule also includes changes to certifying and recertifying patient eligibility for continued home health care; an allowance for home health agencies to report the cost of remote patient monitoring; and a transition toward payment for home infusion therapy. The changes proposed by CMS would result in an estimated 2.1% increase in payments in 2019, or about $400 million.

    APTA staff will continue to review the proposal and develop a fact sheet in the coming weeks. The association will prepare comments on the proposal for submission before the August 31 deadline. APTA also will create a template letter that members can use to provide their own comments to CMS.

    NEXT 2018: Rothstein Roundtable Takes on Reasons Payers Are Slow to Make Changes That Support Physical Therapy

    David Elton, senior vice president of clinical programs for Optum Health, describes the opioid epidemic as a lit match—the crisis that sparked payers to sit up and take notice of physical therapy's ability to not only reduce later opioid use, but to lower downstream health care costs for a variety of conditions. It didn't take long for the 2018 Rothstein Roundtable to reflect that same heat, as a discussion initially focused on increasing the use in physical therapy as an alternative to opioids spread to an exchange on both the promise of physical therapy to become more broadly supported by private payers, and the factors that could get in the way.

    The roundtable, a regular part of APTA's 2018 NEXT Conference and Exposition, held true to its reputation for facing hot topics in the profession head-on. This year, the title of the discussion was "Physical therapy decreases opioid use: what will it take to change policy?"

    The answer, more-or-less agreed upon by Elton and his fellow panelists: policy is already changing, but not as quickly—or as broadly—as some in the physical therapy profession might prefer.

    Moderator Anthony Delitto, PT, PhD, FAPTA, launched the discussion by asking, “What’s taking so long?” for payers to act on the evidence that shows physical therapy's efficacy in treating chronic pain, as many payers impose restrictions, high copays, and other barriers that make it hard for patients to get nondrug care.

    It's not simply a matter of payers being unaware of physical therapy's effectiveness, explained panelist Kenneth Schaecher, MD, associate chief medical officer for the University of Utah Health Plans—it's also that most clinicians don't think of physical therapy as an option for their patients. "And even if they do,” he said, “they're not aware of the evidence."

    Stephen Hunter, PT, PhD, physical therapy administrator at Intermountain Health Care, said that financial implications play a role, too. Often, he explained, physical therapy presents a disincentive for patients: multiple visits, with multiple copays—providing, of course, that the patient has made it past her or his high deductible in the first place. "Due to the historical approach to physical therapy … payers have created the circumstances that have pushed people away from physical therapy," Hunter said.

    Elton largely agreed with Schaecher and Hunter, but was more hopeful about the future. The evidence, he said, can no longer be ignored, particularly when an estimated 50% of all health insurance claims are related to back pain, and 75% are related to musculoskeletal conditions—the exact areas in which physical therapy has been demonstrated to be most effective. But, as panelists pointed out, change can't really start happening until payers and the profession itself do a better job of making the case for physical therapy to the public.

    Hunter explained that at Intermountain, it was commonly assumed that the reason patients weren't seeing physical therapists (PTs) is that physicians weren't referring them. That does happen sometimes, he explained, but when they looked closer they found the real problem was with the patients themselves.

    "Patients were referred to PTs but would never show up," Hunter said. "They don't see the value."

    Charles Thigpen, PT, PhD, clinical research scientist for ATI Physical Therapy and director of observational clinical research with the Center for Effectiveness Research in Orthopaedics at the University of South Carolina, agreed, saying that the issue is about "getting in front of the patient."

    "A lot of patients don't understand why they're coming to therapy," Thigpen said. "We have a messaging issue."

    Schaecher thinks it's not simply about better marketing to consumers—those within the physical therapy profession need to rein in unwarranted variation in practice and truly commit to value-based care.

    From a payer perspective, Schaecher said, the practice of physical therapy can seem broad and inconsistent, which can lead to a perception that PTs "are not engaged in a value-based approach to care—they're engaged in making money."

    "You need to start seeing therapists that are looking at their services as a value and not a revenue generator," Schaecher added.

    Elton only partially agreed. The variability issue is present in physical therapy, he countered, but is not nearly as bad as it is in some of the medical specialties.

    Thigpen added that the variability issue in physical therapy may have to do with issues other than revenue generation, such as payer variation and patient market factors that can add to variability in treatment.

    Thigpen said he also worries that for some PTs, their commitment to their profession and a belief in the good it can do can morph into a maybe-unconscious willingness to please the patient at all costs. "You feel obligated to give the patient what the patient wants," he said. "In that way, we sometimes don't do a great job in shared decision-making," he said, which leads to unwarranted variation in practice.

    Delitto acknowledged that the current payer landscape for physical therapy was created at least in part in reaction to what he described as the "free-for-all" days of the 1980s and 1990s, when payers were much less restrictive. Returning to a place where physical therapy receives the level of support warranted through evidence will require PTs to better track and report outcomes, but that begs other questions: will the administrative burden be too heavy? Are there simpler approaches to supplying the needed data?

    Elton pointed out that APTA is already attempting to respond to these questions by way of the Physical Therapy Outcomes Registry. According to Elton, profession-driven data collection efforts could make a key difference.

    But, he added, turning the corner toward value-based care that will open payment doors will also require collaborative efforts between payers, PTs, and other professions. "What we need to be asking is, how do payers and groups like APTA come together to get a total view of this?" he said. APTA and Optum are currently pursuing a joint initiative that will be announced in the coming months, he added.

    It could be possible that payers just don't care about data, Delitto said.

    Oh, but they do, countered Schaecher, because data show where the money's going, and payers care very much about that.

    Elton agreed, but framed the issue differently.

    "Cost is really a proxy for clinical outcomes," he said. The problem is that data are often limited to what happens during and at the end of treatment, with no tracking of what happens over time—if, for instance, the physical therapy patient eventually winds up getting other treatments, undergoing surgery, or pursuing imaging at some point down the road. That's what's known as "the tail" of a particular provider's treatment. The lack of sufficient data on physical therapy's tail is the "Achilles' heel" of the profession, Elton said.

    Still, with all the internal and external challenges in place, Elton believes that for physical therapy, the bottom line is the bottom line.

    "The fact is, there's a 10-to-1 [return on investment] with physical therapy," Elton said. "More physical therapy equals less cost."

     

     

    Study: Ignoring Inappropriate Patient Sexual Behavior Doesn’t Work, but Other Strategies Might

    Inappropriate patient sexual behavior (IPSB) is a problem in health care, but researchers have pinpointed some concrete strategies for responding to these incidents, according to a study in PTJ e-published ahead of print. While several of these strategies can be used by the clinician during treatment, authors say less-than-stellar incident reporting outcomes and lack of administrative support “demonstrate a clear opportunity for the profession to improve.”

    The release of this study happens to coincide with action last week by APTA’s House of Delegates to strengthen the association’s position on sexual harassment in all forms, including encouraging incidents of harassment to be reported, with permission of the affected individual, to ensure that others are not similarly harmed.

    Funded by the APTA Section on Women’s Health, the study follows up a 2017 survey of PTs, PTAs, and students that found 84% experienced IPSB—47% in the previous year. In the prior study, authors defined IPSB as a range of behaviors, "from leering and sexual remarks to deliberate touch, indecent exposure, and sexual assault." Physical therapy clinicians were more likely to experience IPSB if they were female, treating mostly male patients, or newer to the profession.

    Researchers surveyed 1,027 members of APTA specialty sections and students in PT and PTA education programs to learn how individuals who experienced IPSB responded to it, and if those responses were effective at mitigating the problem.

    Similar to the previous survey, 38% had experienced IPSB. The participants described a variety of responses, from simply ignoring the patient’s behavior to documenting and reporting it to management. Respondents who are younger (under age 40) and less experienced (students or clinicians with less than 10 years of experience) were more likely to ignore IPSB. The less experienced group also were more likely to respond by joking with patients. Respondents younger than 40 were more likely to ignore IPBS, while students and newer Not surprisingly, ignoring inappropriate sexual behavior—a strategy used by more than 70% of respondents—was not found to be a successful response.

    Respondents also identified strategies that, according to them, significantly improved the situation more than half the time. They include:

    • Distraction
    • Choosing a more public place for treatment or a different treatment method
    • Direct confrontation
    • Establishing a behavioral contract with the patient
    • Transferring care to a different clinician
    • Using a chaperone

    Authors suggest that clinicians be educated on “assertive communication and redirection strategies” but add that the changes shouldn't stop there.

    There is a “need for clear workplace policies coupled with training for managers and supervisors to support clinicians in resolving IPSB,” authors write. They encourage practices to establish policies on using behavioral contracts and warning letters, chaperones, and transfer of care in response to IPSB.

    (Editor's Note: Articles e-published ahead of print are not the final version. The final version of this article will be published in the September issue of PTJ.)

    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.