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  • Systematic Review: LBP Studies Make the Case for Early Physical Therapy

    Authors of a new systematic review of 11 studies on low back pain (LBP) have found that despite sometimes-wide variation in research design, a picture of the value of early physical therapy for the condition is emerging—and the results are encouraging.

    According to the review, e-published ahead of print in the Archives of Physical Medicine and Rehabilitation (abstract only available for free), evidence supports the cost-effectiveness and better patient outcomes of early physical therapy over later physical therapy for LBP, and even points to a correlation between early physical therapy and lower rates of opioid prescription overall. As for utilization and costs associated with early physical therapy versus so-called "usual care" (UC)? Early treatment by a physical therapist (PT) adhering to APTA guidelines could make a positive difference there as well, authors say, but that's a harder question to answer definitively until studies become more uniform in terminology and design.

    The review synthesized data from 11 studies narrowed down from an initial pool of 1,146 articles. Authors aimed not only to compare early versus late physical therapy for LBP, but also to assess early physical therapy against UC that didn't include physical therapy (at least not initially, for some of the studies). Four of the studies were randomized controlled trials (RCTs), 6 were retrospective cohort studies, and 1 was a prospective cohort study. Study sizes ranged from 60 to 753,450 individuals. The studies were focused on new episodes of LBP, and did not address physical therapy as prevention.

    It didn't take long for authors of the review to realize they were up against some challenges in synthesizing the studies' results, mostly because of the variation in ways the individual projects were set up and conducted. Variation included the timeframes researchers used to define "early," "delayed," and "late" physical therapy, the inclusion of an option for later physical therapy in UC groups in some studies, and the variability of "education" components that were sometimes included in the UC groups, which in 2 RCTs included advice to remain physically active.

    Still, authors of the review were able to identify at least 1 common pattern: in the 6 studies that compared early physical therapy with late physical therapy for LBP, 5 "demonstrated significant reductions in HSU [health services utilization]." Those reductions ranged from an estimated savings of $1,209 after 24 months to $2,991 after 1 year (for a study that compared late physical therapy with "immediate" physical therapy). Early physical therapy also reduced the likelihood of later opioid use, spine injection, and spine surgery compared with late physical therapy.

    When it came to early physical therapy versus UC for LBP, the results were inconclusive, the authors write—2 out of 3 studies that assessed cost found a higher price tag associated with early physical therapy. What makes these results inconclusive, according to the researchers, is that there are simply too many unexplored variables related to "patient characteristics, care-seeking patterns, and physician decision-making."

    "Patients who participate in early [physical therapy] may also be fundamentally different from patients who follow the usual care pathway," the authors write. "Additionally, not all people with LBP go on to seek medical care. Estimates of the proportion of individuals experiencing LBP who seek care is highly variable…with percentages ranging from 9.19% in some geographic locations to 44.5% in others."

    As for the patients who seek physical therapy versus usual care, authors say the patients are more likely female, have higher educational levels, and have higher income compared with those who seek UC. "Therefore, patients who participate in early PT…may be part of a care-seeking group that is more active in seeking treatment than those who receive usual care, who may take a more passive approach," the authors write. "These traits may lead the early PT group to utilize more health services compared to the usual group."

    Finally, authors write, earlier studies "support the idea that not only does adherence to APTA guidelines for acute LBP decrease risk of later HSU, but nonadherence to APTA guidelines and ineffective [physical therapy] treatments could potentially increase future use of health services." The problem is that most of the studies included in the review were unclear about whether or how often the physical therapy interventions adhered to the guidelines.

    Despite the mixed results, the authors believe their findings "support early access to [physical therapy] as a cost-effective intervention for acute LBP that reduces HSU," adding that "receiving early [physical therapy] for acute LBP could not only reduce health care costs, but it may also help combat the opioid crisis

    "Early [physical therapy] for acute LBP…may prevent the potential for recurrences and chronic pain, leading downstream cost savings and better outcomes for individuals," the authors write. "Even if recurrences do occur, which is fairly likely, early [physical therapy] can give people with new episodes of LBP strategies to manage their condition independently in the future, preventing unnecessary overuse of resources."

    APTA members Elizabeth Arnold, SPT; Janna La Barie, SPT; Lisely Da Silva, SPT; Meagan Patti, SPT; Adam Goode, PT, DPT, PhD; and Derek Clewley, DPT, PhD, co-authored the study.

    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.

    New Medicare Home Health Payment System Explained in Upcoming Q-and-A Sessions

    Private practice physical therapists (PTs) aren't the only ones facing major changes in the way Medicare provides reimbursement: PTs and other providers in the home health setting will face an entirely new payment methodology beginning next year. APTA can help you get up to speed.

    Coming in early March: 2 live Q-and-A sessions with APTA experts on the coming payment system, known as the Patient-Driven Groupings Model (PDGM). Presenters for the hour-long sessions—offered on March 5, 2:00 pm-3:00 pm ET, and March 6, 7:00 pm-8:00 pm ET—will answer questions from registered participants who've reviewed a prerecorded webinar that will be available February 20. The recorded webinar and live sessions are free to APTA members.

    Interested? Start by registering now for 1 of the Q-and-A sessions, then check back in on the Home Health Patient-Driven Groupings Model Webinars page on or after February 20 to download and review the recorded webinar. Have your questions ready for the hosts, including APTA Director of Regulatory Affairs Kara Gainer, JD; Bud Langham, PT, MBA; Carol Zehnacker, PT, DPT; and Ellen Strunk, PT, MS, a board-certified geriatric clinical specialist.

    Providers in skilled nursing facilities will face a similar change in payment methodology beginning in October, with implementation of the Patient-Driven Payment Model (PDPM). APTA will host 2 Q-and-A sessions on the PDPM March 12 and 14.

    [Editor's note: Even more information on both the new home health and skilled nursing facility payment models is available on a specially created APTA webpage that includes resources from APTA and the US Centers for Medicare and Medicaid Services.]

    Foundation Has a New Name, Logo, and Website

    What's in a name? For the organization formerly known as The Foundation for Physical Therapy (Foundation), just about everything.

    Earlier this month, the Foundation announced a name change for the organization, from the Foundation for Physical Therapy to the Foundation for Physical Therapy Research. It's a subtle change, but an important one, according to Foundation President Edelle Field-Fote, PT, PhD, FAPTA.

    "After much consideration, the board of trustees concluded that this addition to our name would more clearly define what we do," Field-Fote said in a Foundation news release. "Research has always been the core of our identity. Now it's a part of our name."

    The name change, adopted in the Foundation's 40th anniversary year, was accompanied by a new logo and redesigned website. The shifts were the result of a nearly 2-year communications assessment.

    Rather than an attempt to capture a new direction, the name change is intended to make the Foundation's focus as clear as possible. According to Field-Fote, the work of the Foundation will continue unaltered.

    "Although our name and logo have changed…our everyday work and enduring commitment to the profession remain unwavering," Field-Fote said.

    Since its establishment with the financial support of APTA in 1979, the Foundation has become an independent 501(c)(3) organization that has awarded more than $17 million in grants, scholarships, and fellowships. In addition, the Foundation established the Center on Health Services Training and Research (CoHSTAR), a multi-institutional research and training program. APTA is a Foundation Pinnacle Partner in Research and was a lead donor to the establishment of CoHSTAR.

    New APTA Strategic Plan: Leading the Profession and Association Into the Next Century

    Take a look at the new APTA strategic plan covering the next 3 years, and almost immediately something becomes abundantly clear: the association has no intention of kicking back and cruising into its centennial in 2021. Dig deeper, and you're likely to find that the goals to be reached between now and the beginning of APTA's next century are as ambitious as anything the association has ever attempted.

    The plan, now available on the APTA website, is the result of an 18-month-long Board of Directors effort that included input from nearly 4,000 stakeholders to identify where APTA needs to go to realize its vision of transforming society by optimizing movement to improve the human experience. The end result: a roadmap built around 4 outward-facing goals, with measurable objectives that don't shy away from some ambitious targets.

    In an APTA Media Center interview conducted during APTA's 2019 Combined Sections Meeting, President Sharon Dunn, PT, PhD, characterized the plan as a new phase in the association's evolution.

    Dunn said that APTA's previous 5-year strategic plan served as a "pivot" away from work that supported the earlier "Vision 2020" statement and toward the association's current vision, adopted in 2013. During 2017 and 2018, and especially after listening to stakeholders and evaluating the association's opportunities, it became clear to the Board that the pivot was complete.

    "We were ready to make some bold moves toward actually transforming society," Dunn said.

    The 4 main goals in the new plan are centered on increasing member value and engagement, fostering the long-term sustainability of the physical therapy profession, elevating the quality of care provided by physical therapists (PTs) and physical therapist assistants (PTAs), and maximizing stakeholder awareness of the value of physical therapy.

    Each goal contains 2—and in 1 case, 3—objectives that lay out specific activities that APTA will pursue. The goal aimed at stakeholder awareness of the value of physical therapy, for example, sets APTA on course to advocate for payment policies that increase patient access to physical therapy, to leverage the #ChoosePT campaign and MoveForwardPT.com as public information platforms, and to "embody the APTA mission and vision through an integrated brand strategy." The sustainability goal directs the association to "champion student and early-career issues including debt burden and career-earning potential," and to "make APTA an inclusive organization that reflects the diversity of the society the profession serves."

    The plan isn't designed to be all-inclusive. Many ongoing activities central to APTA—including federal and state advocacy—will continue to be integral parts of the association's operations. Rather than covering every area in which the association will be working, Dunn said, the new plan "looks at what is absolutely necessary to take us into our next century."

    According to Dunn, one of those elements—the long-term sustainability of the physical therapy profession—is a goal that reflects a pervasive sentiment among the stakeholders providing input on the strategic plan's development and, in the case of student debt and early-career earning potential, "one of the things that keep's [APTA] leadership up at night."

    Dunn explained that APTA's efforts in this area must include not only providing program faculty with resources and tools to help keep a lid on education costs but also a wider effort to make the profession itself as diverse and inclusive as possible—something Dunn believes is key to the profession's long-term sustainability.

    "We need to make the path [to becoming a PT or PTA] easy, make it affordable, and engage and mentor along the way," she said.

    All of the goals and objectives in the plan are equally ambitious and equally capable of having a strong impact on the profession and society, according to Dunn. Here's what she had to say about other elements of the plan:

    • On translating the latest research into tools and resources for practice: "There's a lag time to translating evidence into practice. The environment doesn't allow for that lag time anymore."
    • On supporting the growth of the APTA Physical Therapy Outcomes Registry: "Payers have our data, and we need to have our data and use it to advocate for the benefits of physical therapy."
    • On advocating for PTs on the primary care team: "Putting a physical therapist on the front end of anything—pain, chronic disease—rather than the back end, [results in] a lot of quality and cost savings."
    • On expanding the #ChoosePT campaign beyond the opioid epidemic: "[#ChoosePT] will evolve into other opportunities for the physical therapy profession to meet societal need."

    What's next? With the goals and objectives in place, APTA leadership is now developing metrics to not only measure progress but to help keep the association on course as it attempts to achieve results that, as Dunn said, "meet the needs of not only our society but our members as we treat our patients."

     

    'No Bigger Fan': US Surgeon General Believes the Physical Therapy Profession is a Key Player in the Fight Against Opioid Misuse

    If you think the physical therapy profession has an important role to play in improving public health on multiple fronts, you won't get any arguments from US Surgeon General Jerome Adams, MD, MPH. In fact, you might get the rhetorical equivalent of a high-five.

    In an address that repeatedly cited the APTA's community-building mission, Adams told his audience of association leaders that the profession is "well-positioned to change the culture around pain management" in the United States and that "we know that physical therapy is going to be a part of" the evolution toward value-based care. The remarks were delivered as part of the APTA Component Leadership Meeting, an event that preceded the 2019 APTA Combined Sections meeting being held in Washington, DC, January 23-26.

    Adams focused on the opioid crisis and the physical therapy profession's role in addressing it, with an emphasis on the importance of involving and educating communities on nonopioid alternatives to pain management, and compassionate care and treatment of individuals with addictions. It's a concept Adams is extending to public health in general through what he calls "better health through better partnerships."

    Surgeon General Speaks at CSM
    Surgeon General of the United States Jerome Adams, MD, MPH, addressed a meeting of APTA component leaders.

     

    "We can't operate in silos" to address public health challenges such as the opioid crisis, Adams said. "We need partnerships and we need collaborations. We need to bring people and organizations together that we may never worked with, never thought of before."

    The fact that APTA's new mission statement is rooted in the idea of building a community to improve the health of society wasn't lost on Adams, who cited both the association's mission and its #BetterTogether hashtag as a reflection of the values he believes are key to positive change.

    "APTA is a public health leader within communities," Adams said, and among the "game changers and disruptors" that will be necessary players in turning the tide on opioid abuse.

    Adams acknowledged that the country's health care system contributed to the rise of opioids and in many ways was not prepared for the crisis it now faces. In fact, he explained, the issue wasn't on the radar of most public health experts—but attitudes quickly changed. Paraphrasing boxer Mike Tyson, Adams told the audience that "Everyone's got a plan until they get punched in the mouth."

    "The opioid crisis is our punch in the mouth," he said.

    Adams has a firsthand understanding of the devastating consequences of addiction. He told the audience that is brother is currently in prison, serving out a sentence for theft committed to support his opioid addiction.

    "Addiction can happen to anyone," he said. "Even the brother of the United States Surgeon General."

    And while the opioid crisis has ravaged families and communities, "out of this tragedy there is tremendous opportunity," Adams said. That opportunity is rooted in making connections both across health care disciplines and throughout communities. He urged APTA members to become well-educated on opioid addiction and its treatment—including learning how to carry and administer the anti-overdose drug Naloxone—and to help promote nonopioid pain management through initiatives such as APTA's own #ChoosePT campaign and the Office of the Surgeon General's resources on opioid addiction and prevention.

    "It's an indisputable fact that physical therapists are well-positioned to change the culture around pain management," Adams said.

    He also believes the physical therapy profession is a leader that "should be at the table" for a wide range of health policy discussions—particularly when those discussions center on the evolution away from fee-for-service models and toward value-based care. The reason, he said, is simple: "We know that physical therapy is going to be a part of every one of those value-based practices."

    The bottom line for health care should be "stop paying for things that don't work and start paying for things that do work," including physical therapy, Adams added.

    In a brief Q-and-A session with APTA CEO Justin Moore, PT, DPT, after his remarks, Adams extended his community education philosophy to the challenge of changing the country's exercise habits. The problem for health care providers is that "we tend to talk in ways that make sense to us but don't resonate with other folks," Adams said. Instead, the exercise message needs to be built around the concept that regular physical activity can improve economic and social opportunities—better jobs, more time spent with family, and more prosperous communities.

    And if by the end of his address, anyone in the audience was still unsure of the surgeon general's attitude about the physical therapy profession, a follow-up APTA video interview left little room for doubt as to where Adams stands.

    "Physical therapists are key to overcoming not only the opioid epidemic but in creating healthier societies," Adams said. "Know that you have no bigger fan than the United States surgeon general."

    Study: Physical Activity and Higher Motor Skills Create a 'Cognitive Reserve' Even When Brain Pathologies Are Present

    New research combining postmortem examination of brain tissue with testing during life has revealed what researchers believe to be an as-yet unexplained connection: higher levels of physical activity (PA) and motor skills seem to create a "cognitive reserve" that buoys cognitive performance during life, even in the presence of Alzheimer's disease (AD), Lewy body disease, and other brain pathologies associated with dementia.

    For the study, published ahead of print in Neurology (abstract only available for free), researchers examined brain tissue from 454 participants involved in the Rush Memory and Aging Project (MAP). The subjects participated in a battery of annual clinical assessments and agreed to brain donation at the time of death. The clinical tests included 21 cognitive assessments, an analysis of 10 motor abilities, and an estimation of total daily PA drawn from accelerometers worn constantly for 10 days (researchers in this study used only the first 7 days' data).

    After death, brain tissue was analyzed for AD, Lewy body disease, nigral neuronal loss, hippocampal sclerosis, and several other pathologies—10 in all. Researchers then compared the presence of these pathologies with PA, motor skills, and cognitive testing scores obtained during the participants' last MAP visit—typically about 2 years before death.

    Researchers weren't particularly surprised that participants who recorded higher levels of PA and motor skills during their last assessment also tended to score higher on cognitive tests than did those with lower PA and motor skills. What was more intriguing was that this association held up even in the presence of brain pathologies later revealed through tissue analysis. It wasn't that higher activity and mobility decreased the risk of the diseases themselves (although other studies have explored that possibility); it's that increased PA and mobility created what authors call a "cognitive reserve" that lowered the odds for and severity of dementia, even in the presence of AD or other degenerative brain conditions.

    "A more active lifestyle and better motor abilities proximate to death were independently associated with better cognitive function and reduced odds of dementia when controlling for AD and 9 other common age-related pathologies," authors write. "Moreover, there was also no evidence that a more active lifestyle or better motor abilities modified the associations of these brain pathologies with cognitive function prior to death." Authors believe that, together, these concepts point to the possibility that the cognitive reserve associated with PA and better motor skills are related to "molecular mechanisms…that remain to be identified."

    The researchers believe their study should be followed up with more work on the biological mechanisms that resulted in their findings, as well as explorations of which interventions might help to bolster cognitive reserve.

    Authors acknowledge several study limitations, including the lack of data on how active participants were prior to joining the MAP, no examination of other brain pathologies including white matter integrity, and the inability of the accelerometers to identify what kinds of PA were taking place. Still, they argue, the study's findings are important.

    "These findings suggest that a more active lifestyle may provide cognitive reserve or resilience for adults," the authors write, adding that the results "may have important public health implications because they suggest that resilience factors such as more cognitive activities or physical activity might mitigate late-life cognitive impairment even in the absence of effective therapies to reduce AD and other common brain pathologies."

    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.

    APTA Breaks Ground on New Headquarters: APTA Centennial Center

    APTA Breaks Ground on New Headquarters


    Let the construction begin: current and former APTA leaders gathered in Alexandria, Virginia, to celebrate the groundbreaking of APTA Centennial Center, a 7-story, 115,000-square-foot building that will be the association's headquarters beginning in 2021.

    The building will support APTA's workforce of the future and better serve the evolving needs of the association's members. But APTA President Sharon Dunn, PT, PhD, noted that it's also a testament to APTA's proud history.

    "Today marks a culmination of decades of vision, dedication, and leadership," Dunn said at the groundbreaking ceremony. "Today is possible due to the legacy of past leaders in the American Physical Therapy Association. It is a legacy of stewardship and of investing in the next generation."

    The investment is more than symbolic. An exploratory work group of APTA members discovered that the cost of adequately renovating APTA's existing headquarters—the association's national home since 1983—would be similarly expensive with only a marginal increase in asset value for the association. By selling the current buildings, which are likely to be redeveloped into more valuable mixed-use properties, APTA was able to capitalize on the opportunity provided by constructing a new headquarters that is more consistent with the association's values and business needs.

    APTA Centennial Center will be many things that APTA's current headquarters are not. For one, APTA staff will be able to occupy a single building, spread out primarily across 2.5 of APTA Centennial Center's 7 floors, rather than divided across multiple smaller buildings, as currently. The new building also will be much more accessible to those who use public transportation, with a new Metrorail station being constructed just across the street (APTA's current headquarters are 1 mile from the nearest Metrorail station). But perhaps most exciting, APTA Centennial Center will better promote movement and health in its physical presentation and its connectivity to paths that promote active transportation and exercise.

    APTA Board of Directors at Groundbreaking
    APTA Board of Directors at the groundbreaking ceremony for APTA's new headquarters.


    The association anticipates that APTA Centennial Center will be a LEED-certified "Silver" facility that meets environmental sustainability standards, and that it will also receive the highest certification from FitWel, a program that recognizes the ways a building encourages fitness, social equity, more healthful food options, and other factors that contribute to a healthier workplace.

    "Our new headquarters will serve as a continual reminder of APTA's dedication to health, wellness, and rehabilitation, community-building and collaboration, and social and environmental responsibility," Dunn said. "It will be a place where staff, members, and visitors can feel empowered to work toward shared goals in a setting that exemplifies our shared values."

    Association and community members who visit APTA Centennial Center will find more space for them, from a ground floor that is likely to include temporary exhibits to a top floor that significantly expands APTA's conference and meeting space, including a partial roof terrace. (Two-and-a-half floors of APTA Centennial Center will be tenant space.)

    Also encouraging for the long-term value of the association's new property is its burgeoning location. APTA Centennial Center is part of a National Landing region that will include Amazon's new Virginia headquarters, plus a $1 billion Virginia Tech Innovation Campus that will be just down the street. Nearly completed and beginning to be occupied is a new headquarters for the National Industries for the Blind, which will sit next to APTA Centennial Center.

    "This building is an investment in our future and in the Alexandria community that APTA has called home for 36 years," said APTA Chief Executive Officer Justin Moore, PT, DPT. "It's also a commitment to best serve the physical therapy profession, and to empower our members to pursue APTA's vision of transforming society by optimizing movement to improve the human experience."

    Sharon Dunn APTA President
    APTA President Sharon Dunn, PT, PhD, called the building an investment in APTA's future.


    APTA anticipates occupying the building in January 2021, as the association begins its centennial year.

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    Study of Cash-Based PT Services Hints at Possibility of Increased Cost-Effectiveness

    A small-scale study that looks at the effect of cash-based physical therapist (PT) services on utilization points to the possibility that the approach could be associated with lower overall costs and greater patient-reported levels of improvement—although authors say more research is needed before any definite conclusions can be drawn.

    The new research, which authors describe as "the first to provide descriptive statistics for a cash-based PT clinic," involved chart review of 48 randomly selected patients who sought treatment from a Florida-based physical therapy clinic between 2013 and 2016. The clinic accepts only direct payment, and all patients sought treatment via the state's direct access provisions. Results were published in The Health Care Manager (abstract only available for free).

    In their analysis, the authors dispensed with codes from the International Statistical Classification of Diseases and Related Health Problems (ICD) and instead focused on affected body regions. They did, however, stick with the ICD definitions for acute (0 to 4 weeks' symptom duration), subacute (4 to 12 weeks' duration), and chronic (duration of more than 12 weeks) injuries. Patient self-reports were derived from the Numeric Pain Rating Scale (NPRS) obtained at evaluation and discharge. Male patients outnumbered female patients, 27-21. Average patient age was 41 for men and 47 for women.

    Here's what researchers found:

    • The average number of visits per episode of care was 8, with a median of 5. Authors report that a similar study conducted with patients in a traditional insurance-based model identified a 7.3-visit average.
    • Total cost of care for the cash-based practice averaged $780 (median of $600); the insurance-based study identified a total average cost of $936. Patients in the cash-based system averaged a per visit cost of $97.52.
    • Patients seeking treatment for low back pain (LBP) made up the bulk of the case load, at 39.6%. The second most common diagnosis was leg or knee pain (29.2%), followed by cervical/thoracic pain (14.6%).
    • Average patient NPRS score at evaluation was 6.9 (with a variation of plus or minus 1.9 points), and at discharge was 1.1 (plus or minus 1.9 points). In all cases, patients met the minimum clinically important difference for change in NPRS score.
    • Chronic injuries accounted for 28 of the 48 injuries treated.

    The study's authors acknowledge its limitations, including the small sample size, its focus on 1 practice, and its use of descriptive statistics. While they write that the study "provides a foundation for further research," they caution against drawing conclusions about the cost-effectiveness of cash-based versus insurance-based PT services.

    Still, they argue, the study has uncovered some potentially compelling evidence that merits further study.

    "Our data supports the possibility of increased cost effectiveness when compared with traditional insurance-based PT services," authors write. "Fee schedules and outcome measures used when comparing outcomes across multiple cash-based services are necessary areas for future research to be able to fully compare cash-based practice to insurance-based services."

    APTA members Kyle Pulford, PT, DPT; Brittany Kilduff, PT, DPT; William Hanney, PT, DPT, PhD; Morey Kolber, PT, PhD; and Ron Miller, DPT, were among the authors of the study.

    [Editor's note: Interested in cash-based practice? Check out APTA's Cash Practice webpage for background information, tips, and FAQs.]

    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.

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    2019 Federal Advocacy Forum Coming March 31; Registration Open Through March 18

    When it comes to federal advocacy for the physical therapy profession, the watchword is "new"—new priorities after the end of the hard cap on therapy services under Medicare last year, new challenges that have surfaced in the wake of rulemaking and other changes, and a new Congress that needs to be well-acquainted with the profession's message of patient-centered, transformative care. APTA's 2019 Federal Advocacy Forum, set for March 31-April 2, promises to help attendees navigate all those new twists and more.

    Registration is now open for the annual event, which brings together physical therapists (PTs), physical therapist assistants (PTAs) and students together in Washington, DC, for a 3-day conference that provides the latest on regulatory and legislative issues affecting the profession, and ends with an opportunity for attendees to apply what they've learned by making in-person visits to Senate and House offices. Registration deadline is March 18.

    Other activities at the Forum include an evening reception, awards presentations, and breakout sessions on state and federal advocacy, regulatory affairs, and student action.

    "While 2018 was a year of real accomplishment, much more needs to be done with the new Congress that started this month," said Michael Matlack, APTA director of congressional affairs. "There are now almost 100 new members of Congress who need to learn about the essential role that physical therapy plays in the nation’s health care system—and in the lives of their constituents."

    [Editor's note: Want to get a feel for what the Federal Advocacy Forum is all about? Check out the video recap of the 2018 Forum on the Federal Advocacy Forum webpage.]

    The Good Stuff: Members and the Profession in the Media, January 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!

    The PT as gaitkeeper: Colleen Brough, PT, DPT, MS, and Board-Certified Orthopaedic Clinical Specialist, talks about the importance of gait analysis to help prevent injury in runners. (CNN)

    Quotable: "Our profession right now is the sleeping giant." – Sharna Prasad, PT, on the role of physical therapy in contributing to a better understanding of pain and pain treatment. (Straight Shot Health podcast)

    An exemplary Navy PT: Marissa Greene, PT, DPT, has been selected as the 2018 Navy Medicine Physical Therapist of the Year. (Defense Visual Information Distribution Service)

    Guarding the rear: Carrie Pagliano, PT, DPT, discusses the ways sciatica can include pain in the backside. (Women's Health)

    On a roll(er): Jeffrey Yellin, PT, explains the importance of taking the right approach to the use of foam rollers. (Bustle.com)

    Living his dream: Brett Bousquet, PT, DPT, and Board-Certified Orthopaedic Clinical Specialist, describes his role as a PT for the Milwaukee Bucks. (Pacific University, Oregon, Alumni News)

    Punching back at PD: Kristin Hawley, PT, shares the benefits of the Rock Steady Boxing program for individuals with Parkinson Disease. (Muscatine, Iowa, Voice of Muscatine)

    Quotable: “Physical therapy taught me that, even though I was depressed and sad about hurting, movement felt good." – Karla Pankow, whose lifestyle changes (including regular physical therapy) led to a 100-pound weight loss. (NBC News)

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

    From Move Forward Radio: Retreat Helps Veterans With Amputation—and Their Families

    Adjusting to life after an amputation can affect a veteran’s entire family, not just the individual. That reality wasn't lost on the Travis Mills Foundation, which offers a retreat program that aims to help veterans and their families bond with one another and participate in traditional activities that are adapted to teach new skills and strategies to ensure participation for everyone.

    Now available from APTA's Move Forward Radio: a conversation with APTA member Kelly Roseberry, PT, DPT. Roseberry is program director of the Travis Mills Foundation, which was founded by a veteran who had a quadruple amputation. Roseberry describes what this unique program means to veterans, families, and to her personally. "To be able to see a service member do something they never thought they would do again, or to see how happy their family is to watch them get to do that and to share in those moments together is…priceless," Roseberry says.

    Since 2017, selected veterans who have been injured in active duty or as a result of their service have come to Maine in the summer, along with their families, for an all-expenses-paid vacation. They participate in activities such as swimming, biking, kayaking, and a ropes course.

    “We take a great deal of pride in being able to serve the whole family," Roseberry tells Move Forward Radio. "We recognize that rehab is a lifetime process, and when someone is injured or goes through some sort of trauma, not only is the service member injured, but the injury affects the entire family. They may not think they can get on the floor with their kids or take them for a bike ride. We want to be able to not only encourage them but give them the tools to reach outside their comfort zone and do things with their family, because at the end of the day their family is their support system.”

    Move Forward Radio is hosted at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online or downloaded as a podcast via iTunes, Google Play, or Spotify.

    Other recent Move Forward Radio episodes include:

    Maintaining an Active Lifestyle and Avoiding Pain
    Surfing legend and fitness and nutrition expert Laird Hamilton applied lessons he learned through his surfing injuries to his preparation for—and recovery from—hip replacement surgery. In the podcast, he describes how he avoided pain medicine of any kind during the process, and how he surprised his health care team with one of the fastest recoveries they had ever seen.

    A Primer on Sciatica and Physical Therapy
    As many as 40% of people will experience sciatica in their lifetime. APTA member Mark Bishop, PT, DPT, PhD, breaks down sciatica’s symptoms and causes for consumers, and explains how physical therapy can help relieve pain.

    Navigating the Health Care System With Chronic Pain
    APTA member Jen Bambrough, SPT, was in car accident at age 19 but seemed to sustain no initial apparent injuries. Over time, though, a physical toll revealed itself as chronic pain, limiting her activities and compromising her quality of life. Because the root of her pain couldn’t be readily detected, however, she faced skepticism in the medical community and experienced misdiagnoses. Bambrough, now a third-year DPT student, discusses how she became a strong self-advocate and how physical therapy is an important piece of the pain management puzzle.

    A PT With Breast Cancer Turns to Her Peers to Make Life-Saving Decisions
    When APTA member Gwen Simons, PT, felt what she thought might be a lump in her left breast in 2010, it set in motion a series of decisions and scans that led to surgery. Simons shares her story of unexpected mammogram results, a strategically timed lecture, consultations with colleagues in the physical therapy profession, and a decision by Simons that may have saved her life.

    Cancer-Related Falls
    Cancer survivors have a higher prevalence of falls than do people who haven’t been treated for the disease. Even worse, various significant health consequences of falls may be more likely and extensive in cancer survivors. APTA member Elizabeth Hile, PT, PhD, discusses the reasons for increased falls susceptibility in cancer survivors, red flags to heed, and how physical therapy and certain types of community resources can help.

    Using Physical Therapy to Treat Pain in Addiction Treatment Centers
    America is in the grips of an opioid addiction crisis. APTA members Ahmed Rashwan, PT, DPT, and Eric Chaconas, PT, PhD, discuss the treatment for addiction to opioid pain medication. They are working with addiction treatment centers to help medically stabilized patients learn more about their pain and show them how they can use physical therapy to participate in managing it, making relapse less likely.

    APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be emailed to consumer@apta.org.

    JAMA Study: 'Multicomponent' Exercise Interventions During Hospital Stay Can Reverse Functional Decline Among Patients 75 and Older

    The potential for hospitalization to have damaging, long-term effects on function and mobility among patients who are elderly is well-known. But does functional decline have to be a given? New research from Spain says no, and points to the possibility that those effects can be blunted—and even reversed—through the addition of an exercise intervention that goes beyond ambulation-only.

    The study, published in JAMA Internal Medicine (abstract only available for free), focused on a single hospital and tracked 370 patients in who were hospitalized between 2015 and 2017, all of whom were 75 years or older (mean age, 87.3). Most participants were admitted for acute illnesses by way of the hospital's accident and emergency department; all wound up in the facility's Acute Care of Elderly (ACE) unit. Median length-of-stay was 8 days.

    Over the 2-year study period, researchers divided participants into 2 groups: the control group received "usual care" consisting of "standard physiotherapy focused on walking exercises for restoring the functionality conditioned by potentially reversible abnormalities," while a second group received twice-daily exercise interventions that included progressive resistance, balance, and walking training exercises adapted from the Vivfrail exercise program. Researchers then compared patient scores on several tests administered at admission to the ACE unit and again at discharge. Tests included the Barthel Index of independence, the Short Physical Performance Battery (SPPB), the Mini-Mental Status Examination, and a quality of life (QoL) scale.

    Researchers found that not only did the exercise group register better scores than the control group on the Barthel index (a 6.9 difference on the 100-point scale), they tended to record improvements over their own baseline scores. The control group, meanwhile, lost ground, averaging a 5 point drop from baseline. The same basic pattern was found in the SPPB scores, as well as scores that assessed cognitive function, QoL, and depression.

    "Our study shows that an individualized, multicomponent exercise intervention including low-intensity resistance training…can help reverse the functional decline associated with acute hospitalization in older adults," authors write. "Acute hospitalization per se led to impairment in patients' functional ability during [activities of daily living], whereas the exercise intervention reversed this trend."

    The exercise intervention itself consisted of 2 daily 20-minute sessions through the duration of the patient's stay in the ACE unit. The first session, in the morning, included individualized supervised progressive resistance, balance, and walking exercises. The resistance exercises centered around 2 to 3 sets of 8 to 10 repetitions of a load equivalent to 30%-60% of the patient's maximum; walking and balance exercises progressed in difficulty, and included semi-tandem foot standing, line walking, stepping practice, walking with small obstacles, exercises on unstable surfaces, and weight transfer. The 20-minute evening session consisted of "unsupervised exercises using light loads" such as anklets and handgrip balls, and daily walking in facility corridors.

    While authors note that the study focused on patients who possessed "a high level of functional reserve and cognitive capacity high enough to allow them to perform the programmed exercise interventions," the research did not automatically exclude patients with dementia or an inability to walk unassisted. Moreover, the entire population was markedly older than most previous studies on the effects of hospitalization, with about 30% of the study group being 90 or older.

    "Our results indicate that, despite its short duration, a multicomponent exercise approach is effective in improving the functional status … of very old adults," authors write, describing their findings as results that "open the possibility for a shift from the traditional disease-focused approach in hospital acute care units for elders to one that recognizes functional status as a clinical vital sign that can be impaired by traditional (bed rest-based) hospitalization but effectively reversed with specific in-hospital exercises."

    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.

    New Anthem UM Vendor in 5 States May be the Beginning of a Wider Shift

    Physical therapists who bill Anthem Blue Cross-BlueShield (BCBS) in California, New York, Indiana, Wisconsin, and Louisiana, get ready for a change: there's a new utilization management (UM) vendor in town.

    APTA has learned that Anthem BCBS is migrating to a new UM vendor, starting with the 5 states listed above. The new UM group is a subsidiary of Anthem known as AIM Specialty Health and replaces previous UM vendor OrthoNet in Medicaid states

    The migration will begin March 1, 2019, for Medicaid patients in New York, Indiana, Wisconsin, and Louisiana. The shift won't happen in California until March 15, 2019, and will include all commercial enrollees. But the migration isn't likely to stop there, according to Elise Latawiec, PT, MPH, APTA lead senior practice management specialist.

    "Anthem also operates in Colorado, Connecticut, Georgia, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, and Virginia, and manages specialty plans in several other states. From the information received thus far we expect the migration to impact all lines of business in the coming year," Latawiec said, adding that APTA has asked Anthem to notify the association as far in advance as possible so that we may alert membership to the change.

    The new UM system also includes occupational therapy and speech-language-hearing services, and applies to any outpatient place of service, including both on- and off-campus hospital facilities. Anthem BCBS will require that the new UM be applied for patients with all diagnoses for which treatment is delivered in the outpatient setting.

    AIM is holding a series of initial training sessions January 24, January 30, February 24, and February 26, and says it will reach out to invite current Anthem providers to the webinars. Anyone unable to attend a scheduled session will be able to access a recorded version following the 4 trainings.

    APTA will meet with AIM representatives for a follow-up conversation after the initial rollout.

    Want to get a better understanding of the ins and outs of UM? Check out APTA's Utilization Management Toolkit, a members-only online resource with tips, common challenges, and strategies of addressing UM issues.

    While You're in the Neighborhood: 2 Easy-to-Do Opportunities to Help the Local Community During CSM

    Headed to the 2019 APTA Combined Sections Meeting (CSM)? Now you can help out the local community while you're there. It's easy.

    This year, CSM attendees have 2 opportunities to help kids and adults in the DC/Maryland/Northern Virginia (DMV) area. One involves little more than downloading an app and doing what physical therapists (PTs), physical therapist assistants (PTAs), and students like to do anyway—move. The other may require that you pack a little extra something into your luggage before you leave, but hey, do you really need those extra pairs of socks?

    Details on both programs, and how to sign up, are available on APTA's CSM Community Service webpage. Here's a quick rundown of the opportunities:

    1. Walk4Wheels Step Challenge
    What is it? A good old-fashioned count-your-steps-for-charity jam. APTA is poised to donate $10,000 to the MedStar National Rehabilitation Hospital's adaptive sports program, which serves families in the DMV by providing sports programs to anyone with a physical disability at no cost—but we need to meet a step goal first.

    What do I have to do? Just walk. Use the link on the CSM Community Service webpage to download a special app that tracks your steps each day between Monday, January 21, through midnight, January 27. If attendees, members, and staff reach a combined goal of 135 million steps, APTA will make the $10,000 donation. Best of all, you don't need to attend CSM to participate—anyone can download the app and help contribute to this great cause.

    2. Sports Equipment Drive
    What is it? APTA national, the American Academy of Sports Physical Therapy, the Academy of Pediatric Physical Therapy, and the APTA Council on Prevention, Health Promotion, and Wellness have partnered with the nonprofit Level Playing Field (LPF) to sponsor a collection drive for new and used sports equipment to provide to low-income kids in the DMV area.

    What do I have to do? Review a list of needed items, then bring your donations to the CSM exhibit hall during the times listed on the CSM Community Service webpage, or during the Academy of Sports Physical Therapy's social event on Friday, January 25, 7:00 pm–7:30 pm (Mariott Marquis, Salon LM). Alternatively, you can simply make a financial donation to LPF. (Note: don't donate large equipment that's bulky or hard to transport.)

    Draft HHS Report Backs Nonpharmacological Pain Management, Calls for Better Payer Coverage of Physical Therapy

    Much like an APTA white paper on opioids and pain management published in the summer of 2018, a draft report from the US Department of Health and Human Services (HHS) says that it's time to address the gaps in the health care system that make it difficult to follow best practices in addressing pain—including improved access to and payment for physical therapy. APTA provided comments to the HHS task force that created the report.

    The draft "Report on Pain Management Best Practices" now available for public comment aims to identify "gaps, inconsistencies, updates, and recommendations for acute and chronic pain management best practices" across 5 major interdisciplinary treatment modalities: medication, restorative therapies including physical therapy, interventional procedures, behavioral health approaches, and complementary and integrative health. The entire report is predicated on a set of "key concepts" that emphasize an individualized biopsychosocial model of care that employs a multidisciplinary approach and stresses the need for innovation and research.

    The report devotes an entire section to what it calls "restorative therapies"—physical therapy, occupational therapy, therapeutic exercise, "and other movement modalities."

    "Restorative therapies play a significant role in acute and chronic pain management, and positive clinical outcomes are more likely if restorative therapy is part of a multidisciplinary treatment plan following a comprehensive assessment," the report states.

    Authors of the report point out that restorative therapies not only improve outcomes, but can "maintain functionality." The problem, they write, is that "use of restorative therapies is often challenged by incomplete or inconsistent reimbursement policies."

    The reimbursement issue is underscored later in the report, in an analysis of insurance coverage for complex pain management.

    "Although the HHS National Pain Strategy calls for greater access and coverage for pain management services, there is a lack of uniformity in insurance coverage and lack of coverage alignment with current practice guidelines for pain management," the report states. "This is particularly true for the coverage of nonpharmacologic and behavioral health interventions."

    And the problem isn't just about coverage, according to the report—there's also a disconnect when it comes to the hoops patients and providers have to go through to access the most effective pain-management approaches. "Consistently forcing providers to try a series of non-first-line treatments prior to authorizing treatment plans can be problematic, hindering appropriate patient care, creating tremendous inefficiency, and resulting in a loss of time and resources," authors write.

    The HHS report is consistent with a 2018 APTA white paper, "Beyond Opioids: How Physical Therapy Can Transform Pain Management to Improve Health." In that resource, APTA recommends the adoption of public and public health plan benefit models that support early access to physical therapy and other nonpharmacological interventions for pain, and a reduction or elimination of out-of-pocket costs for those approaches.

    Recommendations in the HHS report include stepped-up research on which restorative therapies are the best fit for specific pain syndromes, and minimizing barriers to patient access to them. On the insurance front, the report recommends that the US Centers for Medicare and Medicaid Services and other payers reimburse pain treatment using a chronic disease management model "in the manner they currently reimburse cardiac rehabilitation and diabetes chronic care management programs." The task force also recommends "innovative payment models that recognize and reimburse holistic, integrated, multimodal pain management, including complementary and integrative health approaches."

    APTA will be submitting comments on the draft report, and encourages members and other stakeholders to do the same by the April 1 deadline. The association has even developed a template comment letter that makes it easy to provide your insights—for more information and to download the template letter, visit APTA's regulatory "Take Action" webpage.

    APTA continues to build on its successful #ChoosePT campaign to educate the public on safe, effective alternatives to opioids for pain management. The most recent addition: a downloadable pain profile chart that makes it easy for patients to assess the severity and impact of the pain they're experiencing.

    New CPT Codes Allow PTs to Conduct, Bill for Remote Monitoring

    Sure, the biggest news from the 2019 Medicare physician fee schedule is the new reporting and payment system for many physical therapists (PTs), but that's not the whole story: the 2019 rule also includes new current procedural terminology (CPT) codes that allow PTs to conduct and bill Medicare for remote monitoring of patient factors such as weight, blood pressure, and pulse oximetry.

    Many questions remain as to how the US Centers for Medicare and Medicaid (CMS) will implement the new codes, and APTA is developing online resources that will supply further details as they become available.

    Here's what APTA knows so far: the new CPT codes apply to chronic care, and they allow physicians, clinical staff, or "other qualified healthcare professionals" to conduct remote monitoring in certain circumstances. Because PTs are included in the American Medical Association’s definition of  "qualified healthcare professionals" they are able to participate in the remote monitoring to the extent allowed by state and scope-of-practice laws.

    And while it's true that these services are provided remotely, because they are inherently non face-to-face CMS doesn't consider the activities to fall under "telehealth." That's an important distinction, because under current CMS rules, PTs aren't among the providers permitted to furnish telehealth services.

    The new codes are:

    • Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month (99457)
    • Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment (99453)
    • Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days (99454)

    CMS intends to issue guidance on how exactly the codes can be used, but the agency did supply an important detail when the new rule was released: namely, that CPT code 99457 cannot be furnished "incident to" another provider’s professional services.

    From PTJ: Could Impaired Physical Performance Predict Hospitalization Risk?

    Routine assessments of mobility level by a physical therapist (PT) can help better identify older adults at highest risk for hospitalization, according to a new study in the January issue of PTJ (Physical Therapy). Authors write that their findings "suggest a future role for [PTs] in designing effective screening and intervention programs for older adults participating in…community-based long-term care programs."

    A team of researchers at University of Colorado, led by APTA member Jennifer Stevens-Lapsley, PT, PhD, analyzed data from both electronic medical records and hospital claims for over 1,000 patients participating in the Program of All-Inclusive Care for the Elderly (PACE) in the Denver area. Sponsored by the US Centers for Medicare and Medicaid Services (CMS), PACE is designed for dual Medicare/Medicaid-eligible adults as a way to provide community-based long-term care services from an interdisciplinary team of health professionals, including PTs. The program brings participants to a community day facility, where they participate in social activities and receive health services.

    Authors hoped to identify relationships between physical performance scores, using the Short Physical Performance Battery (SPPB) conducted through PACE, and both all-cause and potentially avoidable hospitalizations. "All-cause" hospitalization covered conditions such as heart disease, fractures, and infections, while "potentially avoidable" hospitalizations included incidents such as falls, congestive heart failure, and poor glycemic control.

    Researchers found that lower SPPB scores were associated with higher rates of hospitalization. Patients with the lowest scores were 1.87 times as likely as those with the highest scores to experience all-cause hospitalization, and 2.27 times as likely to experience potentially avoidable hospitalization. Patients with scores in the middle range were 1.40 times and 1.76 times as likely as the high-score group to experience all-cause and potentially avoidable hospitalization, respectively.

    While having a greater number of chronic conditions also predicted hospitalization, impaired mobility was a significant and independent risk factor for hospitalization, according to the study. "It is likely that impairments in physical performance constitute a valuable biomarker to identify PACE participants that are vulnerable to hospitalization," authors write.

    The study's findings come in the wake of a CMS proposal to include potentially avoidable hospitalizations as a quality metric for postacute and long-term care facilities. Authors of the study note that despite the emphasis on avoidable hospitalizations, there has been little research that looks at the relationship between impaired physical performance and a later hospital visit.

    "The results of this study illustrate the importance of routinely assessing mobility within long-term care settings," said APTA member and lead author Jason R. Falvey, PT, DPT, PhD, a board-certified clinical specialist in geriatric physical therapy. "The study also further supports the role of physical therapists as part of the primary care team for medically complex older adults."

    In addition to Falvey and Stevens-Lapsley, APTA member Allison Gustavson, PT, DPT, was a coauthor of the study.

    [Editor's note: for an in-depth look at PTs in primary care teams, check out "A Perspective: Exploring the Roles of Physical Therapists on Primary Care Teams," a paper produced by APTA. For more on this study, listen to a recent PTJ podcast featuring the study's lead author.]

    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.

    APTA Outcomes Registry Earns Key QCDR Designation for Use With MIPS

    APTA's Physical Therapy Outcomes Registry (Registry) has been approved again by the US Centers for Medicare and Medicaid Services (CMS) as a qualified clinical data registry (QCDR). The designation for 2019 means that physical therapists (PTs) who participate in the Merit-based Incentive Payment System (MIPS) can submit their measures data directly from the Registry—including new measures supported by APTA that now position the Registry as the leading physical therapy registry in terms of the number of QCDR measures offered.

    The approval comes as many PTs are facing a new reporting and payment world, the result of a CMS decision to include physical therapy in its Quality Payment Program (QPP) beginning in 2019. That program, with MIPS as its centerpiece, puts a heavy emphasis on outcomes reporting and ties that reporting to potential payment adjustments.

    That's where the number of measures offered through the Registry comes into play. Basically, more measures mean more data points to report, and more data points mean more opportunities for PTs to meet CMS requirements—and possibly receive payment increases in the future. The Physical Therapy Outcomes Registry now offers more QCDR-related measures than any other physical therapy-only option.

    According to Heather Smith, PT, MPH, APTA's director of quality, while the Registry's role in helping PTs comply with MIPS is important, it's far from the only benefit of the resource.

    "With the Physical Therapy Outcomes Registry, APTA is looking forward, beyond MIPS data submission," Smith stated in an APTA news release. "Because the Registry gives users continual feedback on performance throughout the year, physical therapists can better understand their treatment patterns, interventions, and outcomes for specific patient populations, and apply that information to improve their practice. Ultimately, this will benefit the profession as a whole."

    Headed to the APTA Combined Sections Meeting this month? Check out the Registry booth at the APTA Pavilion. For a detailed look at MIPS and QPP, be sure to attend " Emerging Issues in Medicare: Quality Programs and Alternative Payment Models," on Friday, January 25 at 11:00 am. CMS representatives will be on hand to discuss the programs.

    2019 MPPR Calculator Now Available

    It's back: APTA's members-only multiple procedure payment reduction (MPPR) calculator for 2019 is now live.

    This year's calculator incorporates both the MPPR 50% reduction as well as the overall 2% cut to Medicare payments implemented through sequestration. The calculator, delivered by way of an Excel spreadsheet, calculates Medicare physician fee schedule payment for procedures provided to a beneficiary on a given day.

    Added features this year include options for selecting your Medicare participation status—participating, nonparticipating but accepting assignment, or nonparticipating and not accepting assignment—as well as the ability to compare the 2019 payment rate with the rate in 2018. The calculator also includes a Merit-based Incentive Payment System (MIPS) adjustment feature, which isn't applicable to physical therapists this year but will become a useful tool beginning in the 2021 payment year.

    APTA Partners With VA to Raise Vets' Awareness of Physical Therapy, Create Practice Opportunities for PTs and PTAs

    The link between the physical therapy profession and services to military veterans has always been strong, but recently the relationship received a boost in the form of an official partnership between APTA and US Department of Veterans Affairs (VA) to promote and enhance the health of the nation's veterans.

    On December 28, VA and APTA announced a memorandum of agreement (MOA) that "coordinates the strengths of both organizations to benefit all Veterans and their families, physical therapists, and physical therapist assistants by helping to raise awareness of physical therapy and create new employment and practice opportunities," according to a VA news release.

    APTA and VA will combine efforts in multiple areas including suicide prevention, promotion of nonpharmacological approaches to pain treatment, and greater physical therapist (PT) and physical therapist assistant (PTA) participation in VA sports programs and special events.

    "APTA finds its roots in the military, and we are thrilled to be partnering with VA to give back to America's veterans and ensure that they are receiving the physical therapy care they need," APTA CEO Justin Moore, PT, DPT stated in an APTA news release. "I am confident this agreement will lead to even better health care, results, and, ultimately, improved quality of life for them."

    APTA predicts the collaboration will have "local and national impact" and describes the partnership as a good fit with the association’s mission to build a community that advances the physical therapy profession to improve the health of society.

    “Physical therapy is an important resource for improving Veterans’ health and well-being,” said VA Secretary Robert Wilkie in the VA news release. “This new agreement allows both organizations to develop additional best practices in treatment of Veterans in both the federal and private sector. We look forward to the positive outcomes of this partnership.”