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  • US House Members Echo APTA, Coalition Members' Call for Reduced Use of Prior Authorization by Medicare Advantage Plans

    Calling the requirements "onerous and often unnecessary," more than 100 members of the US House of Representatives are pressing for improvements to the way prior authorization (PA) is used—and often misused—in Medicare Advantage (MA) plans. The lawmakers' call for changes echoes concerns voiced earlier this year by a coalition that includes APTA.

    A bipartisan group of 103 legislators signed on to the October 10 letter to US Centers for Medicare and Medicaid Services (CMS) administrator Seema Verma, requesting that Verma direct the agency to conduct investigations around the use of prior authorization in MA, and to issue guidance "dissuading" MA plans from including requirements that include unnecessary barriers to care.

    "It is our understanding that some plans require repetitive prior approvals for patients that are not based on evidence and may delay medically necessary care," the lawmakers write. "Many of these PA requirements are for services or procedures performed in accordance with an already-approved plan of care, as part of appropriate, ongoing therapy for chronic conditions, or for services with low PA denial rates."

    The letter underscores the message delivered to Verma earlier this year by way of a letter from the Coalition to Preserve Rehabilitation (CPR), a group of 28 health provider, patient, and care professional and advocacy groups that includes APTA, the American Association of People with Disabilities, the American Occupational Therapy Association, the Brain Injury Association of America, the Epilepsy Foundation, the Michael J. Fox Foundation for Parkinson's Research, and the Paralyzed Veterans of America, among others.

    The CPR letter suggests that CMS take its cue from the private insurance industry, which has been moving away from prior authorization, or at least investigate which prior authorization policies get in the way of medically necessary care. The coalition also recommends that CMS impose greater oversight of MA plans, with "stronger directives to MA plans to limit the use of prior authorization to services that are demonstrably overutilized."

    The legislators' letter to Verma makes reference to the efforts of "key stakeholders"—presumably, CPR and other groups—and requests that "you and your staff engage with these organizations on additional opportunities to improve the PA process for all stakeholders."

    APTA will continue to monitor this issue and share developments as they arise.

    Updated MedPAC 'Payment Basics' Series Provides Medicare Payment System Overview

    Given some of the major shifts in the Medicare payment landscape over the past few years, gaining an understanding of even the big-picture workings of the system can be a tall order. The Medicare Payment Advisory Commission (MedPAC) offers an updated resource that can help.

    Now available for free download: MedPAC's latest version of "Payment Basics," a series of informational sheets that describe the need-to-know elements of 20 different Medicare payment systems. Areas covered include outpatient therapy, skilled nursing facilities, home health services, hospital acute inpatient services, and more. The newest version of the resource updates the 2015 edition.

    Most information sheets provide background on how the system is organized and flowcharts for a visual representation of how that particular payment system works.

    Quick facts from MedPAC Payment Basics: According to the MedPAC report on outpatient therapy, in 2016 Medicare spent $7.6 billion on outpatient therapy services, a 6% increase from 2015. Physical therapy services accounted for 72% of all spending in this area. In terms of settings, nursing facilities and physical therapy private practice clinics accounted for 71% of the spending, at 37% and 33%, respectively. Hospitals were next, at 16%.

    New Report Looks at Link Between Surgery-Related Opioid Prescriptions, Later Opioid Abuse

    Calling surgery "a long-ignored gateway to persistent opioid use, dependence, and addiction," the Plan Against Pain (PAP) has issued a new report that focuses on the relationship between opioid prescriptions for surgical procedures and later opioid dependence and abuse. The bottom line: though there are glimmers of hope, the overall outlook remains bleak, with 12% of patients who had a soft tissue or orthopedic operation in the past year reporting that they had become addicted or dependent on opioids after surgery. APTA's #ChoosePT opioid awareness campaign is a Selected Partner of PAP.

    The report, which tracks surgery-related prescribing rates overall and as linked to 7 common surgical procedures—including total knee arthroplasty (TKA), total hip arthroplasty (THA), and rotator cuff repair—also breaks down statistics by demographic and geographic variables. Researchers relied on data from the National Prescription Audit, the PharMetrics Plus Database, and surveys of 500 US adults who had soft tissue or orthopedic surgery in the past 12 months. In addition, 200 surgeons were surveyed to assess, among other issues, their motivations for prescribing opioids. The study results were released on October 10 in conjunction with the "Summit for Solutions" event In Washington, D.C., attended by APTA.

    Among the findings:

    Overall opioid prescription numbers are declining, but state rates vary dramatically.
    Nationally, in 2017, there were enough opioids prescribed to supply every person in the US with 32 pills, only a slight decrease from the 36-pill rate reported in 2016. And while every state in the country reported a drop in opioid use in 2017, those reductions varied widely, and the improvements for some states, while significant, only made a dire situation slightly better. Example: Alabama, the nation's top opioid-prescribing state, recorded a 10% decrease in opioid prescriptions between 2016 and 2017, but that only brought its opioid pills-per-resident ratio down to 65 pills for every resident—more than twice the national average.

    Progress has been slow in reducing opioid prescription rates related to surgery.
    Researchers found that among the 7 surgeries studied—TKA, THA, rotator cuff surgery, hysterectomy, hernia surgery, colectomy, and sleeve gastrectomy—the average number of opioid pills prescribed dropped, but only slightly, from 85 pills per patient to 82. Authors of the report speculate that the slow progress could be due in part to the level of pressure surgeons feel to prescribe more opioids then they feel are necessary—a pressure reported by 66% of surgeons surveyed.

    The number of pills prescribed doesn't tell the whole story. The use of fewer pills at a higher potency also poses a risk—especially for orthopedic patients.
    The study found that more than half of patients undergoing TKA, THA, and rotator cuff surgery were prescribed opioids of 50 or more morphine milligram equivalents (MMEs), more than double the 20 MME dosage recommended by the US Centers for Disease Control and Prevention (CDC). Nearly 1 in 4 orthopedic patients received prescriptions in excess of 90 MMEs per day, an amount that the CDC says poses a serious overdose risk.

    Average rate of later opioid dependence and addiction among surgical patients hovered at 12%, but was higher for TKA patients.
    Patients who received colectomy reported the highest incidence of later dependence, at 17%, but TKA patients weren't far behind, with a 15.2% rate of later misuse. Rotator cuff surgery and THA patients reported lower rates of later dependence, at 9.5% and 9.3% respectively. The 12% overall average is an increase from the 2017 study, which estimated the later dependence rate at 9%.

    Women—and Millennial women in particular—are the most at-risk for becoming "newly persistent" opioid users after surgery.
    Women were found to be 40% more likely than men to become "newly persistent" users—individuals who received opioid prescriptions 90 to 180 days post-discharge. Millennial women were found to be particularly at-risk, with more than 10% reporting persistent use, compared with 6% or Millennial men. The persistent use rate for Millennial women in the 2018 PAP study represents a 17% jump from the previous survey.

    Authors of the report believe that until better guidelines are developed it's unlikely gains can be made in more careful use of opioids related to postsurgical pain. Although there has been some progress in this area, they write, more needs to be done to "relieve the pressure surgeons often feel to prescribe more opioids than patients actually need and help set patient expectations on the amount of opioids they'll be prescribed."

    "[The lack of clear guidelines] has left surgeons mainly on their own in determining the appropriate quantity and strength of opioids needed to address their patients' pain," authors write. "As this report reveals, the absence of clear guidelines has led to tremendous variation in prescribing patterns and a great deal of overprescribing that can lead to persistent opioid use, addiction and dependence among patients, as well as unused pills that can be misused or abused by others."

    APTA has been heavily engaged in the fight against opioid misuse on several fronts. In addition to its flagship #ChoosePT opioid awareness campaign, the association also hosted a Facebook Live panel discussion and satellite media tour to highlight the effectiveness of nonopioid approaches to pain management. In addition, APTA produced a white paper on reducing opioid use and contributed to the National Quality Partners Playbook on Opioid Stewardship.

    It's World Arthritis Day: 5 Great Resources

    World Arthritis Day, October 12, calls attention to a global problem in need of better public awareness: how exercise and education can reduce the impact of the disease. And there's little time to waste: according to a 2016 study, by 2040, an estimated 25% of Americans will have arthritis, and 1 in 10 will experience a disability related to the condition.

    In honor of the day, here are 5 great resources that can help you develop community-based arthritis programs.

    Understand the basics of evidence-based community arthritis programs.
    What physical activity programs should you be looking for? Why recommend one program over another? What do the programs have in common? This quick reference guide from APTA helps you learn the lay of the land.

    Find the best fit for you and your patients.
    A program's target population, program length, class size, availability, and instructor requirements, can all be important factors in deciding which program would work best for you. APTA's decision aid can help narrow down the options.

    Bring patients and other community members on-board with resources from MoveForwardPT.com.
    APTA's consumer-focused website helps to explain the importance of arthritis programs, and provides an overview of some of the most highly regarded offerings from the US Centers for Disease Control and Prevention), the Arthritis Foundation, the Aquatic Exercise Association (, and others.

    Get help from the experts.
    APTA is a founding member of the US Bone and Joint Initiative (USBJI), a multidisciplinary education and advocacy group that provides extensive resources on arthritis and other musculoskeletal conditions. The USBJI's "Experts in Arthritis" webpage is loaded with videos and other public education resources that can help you help your patients and others understand the disease and the role that exercise can play in countering its effects.

    Dive into a website that's all-things-arthritis.
    As a member of the Osteoarthritis Action Alliance (OAAA), APTA helped to create some of the content and educational offerings available on this expansive site built for both consumers and clinicians. Resources include monthly "lunch and learn" webinars, information for providers, and research roundups.

    [Editor's note: even more information on arthritis is available at PTNow, including tests and clinical guidelines.]

    APTA Advocacy for EMG, Other Diagnostic Services Results in Payment Clarification from CMS

    Good news for physical therapists (PTs) certified by the American Board of Physical Therapy Specialties in electrophysiologic physical therapy: the US Centers for Medicare and Medicaid Services (CMS) has stated in no uncertain terms that those PTs are permitted to perform certain diagnostic services without the need for physician supervision where those services are allowed by state law. The announcement was made after APTA and other stakeholders pressed the agency to clear the air in order to end payment reductions or outright denials to PTs providing the services.

    According to the CMS statement, board-certified clinical specialists in electrophysiology physical therapy are qualified to provide services involving electromyography (EMG), nerve conduction velocity (NCV), and sensory evoked potentials (SEPs) without physician supervision, and should be paid for those services. It's a provision that's been around since 2001, according to CMS; however, the message wasn't always getting through to some Medicare Administrative Contractors and other payers, who would pay only for the technical component of the service, for some codes but not others, or nothing at all.

    In its statement, CMS reminds stakeholders that it assigns a Physician Supervision Indicator (PSI) of “09” to its collection of PT-designated diagnostic services codes, making it clear that physician supervision is not required for the global and professional component codes of these services.

    "APTA was concerned when it became clear to us that PTs weren't receiving appropriate recognition for these services, but grateful that the issue could be resolved through clear communications from CMS," said Kara Gainer, APTA director of regulatory affairs. "We hope that this statement will erase all doubts about whether a qualified PT can receive full payment for the delivery of services that have been permitted for nearly 2 decades."

    From PTJ: Unwarranted Variation in Pelvic Floor Muscle Function Terminology an Obstacle to Advances in Treatment

    Researchers use a wide variety of terms and definitions in published studies on pelvic floor muscle function (PFMF), according to authors of a new study in the October issue of PTJ (Physical Therapy). They say that it's this lack of standardized terminology, combined with too much focus on how to measure versus what to measure, that may be hindering “effective communication, data gathering, and advances in the evidence-based approach to women” with urinary incontinence (UI). [Editor's note: APTA members may access the full article for free through the "sign in via society site" link on the PTJ website.]

    The study examined terms related to PFMF, as well as their "conceptual" and "operational" definitions, used in 64 cross-sectional studies in women with and without UI. Authors of the study were particularly interested in how definitions of terms (or the lack of definitions) impacted both the individual studies as well as the degree to which the studies could be compared with each other.

    Authors began by clarifying what they meant by "conceptual" and "operational" definitions used in the studies they reviewed. For the PTJ study's authors, a conceptual definition involves a description of what needs to be measured—for example, a conceptual definition of the term strength is capacity of a muscle to generate force. An operational definition could be a procedure, such as vaginal manometry, as well as an explanation of how it was performed.

    Authors identified 196 terms used in the various studies and grouped them into 61 categories—for example, "strength" was used as an umbrella term for 11 other terms such as "pelvic floor strength." The authors then looked at how well the studies managed terms and definitions. Here's what they found:

    • Only 29.7% of the studies included operational definitions of terms.
    • A single study might use different terms to refer to the same muscle function.
    • While "strength" was the most commonly researched muscle function, the term was conceptually defined in only 5 studies—in 3 different ways.
    • The operational definitions of "strength" included both dynamometry and manometry; however, several different scales were used, making it impossible to compare results.

    “Concepts are the building blocks for all thinking,” write authors, who warn against “operationism”—focusing on how to measure variables as opposed to “what is relevant to be measured.”

    “Once the concept being measured becomes synonymous to the measurement outcomes, even small changes in method produce a new concept,” researchers say. This leads to an increasing number of terms and definitions that make it difficult to gather and analyze data or generalize results. It also restricts a study’s results to its “particular methodology,” authors write.

    The study results, say authors, “pose an urgent need to build and adopt a standardized terminology based on a sound theoretical framework encompassing the different disciplines, related areas, researchers and policy makers in order to increase understand¬ing of PFMF in women with UI and hopefully to provide higher quality of health care.”

    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 White Paper Presses for Consistent Mobility Assessments, More Outcome Measures for Hospitalized Older Adults

    The impact that loss of mobility can have on hospitalized older adults can reach far beyond the hospital stay, yet there is little consistency in the ways hospitals assess and promote movement, and almost no acknowledgement of mobility as an outcome measure. That needs to change, and soon, say authors of a new white paper advocating for a shift in "a hospital culture that does not value or prioritize mobility." APTA was among the organizations that participated in a peer review of the document, with member James Tompkins, PT, DPT, conducting the review.

    The white paper, produced by the American Geriatric Society's (AGS) Quality and Performance Measurement Committee, describes the current state of mobility assessment in acute care settings as spotty at best, with a few hospitals conducting regular, validated mobility reviews with patients, and many others using inconsistent assessments or relying too much on hospital physical therapy departments to keep up with tests and measures that could be conducted by nurses. The assessment gaps, coupled with what researchers describe as a "focus on fall prevention at all costs," result in dramatic and potentially long-lasting losses in mobility in a population already at risk.

    The lack of thorough and consistent assessments isn't necessarily surprising, given the general lack of attention paid to mobility as an outcome measure for acute care, according to authors of the white paper. "Nursing staff may be assessing mobility routinely and repeatedly, but they are not doing so in the standard or validated manner necessary for mobility quality measurement or intervention," authors write, adding that entities including the Joint Commission and the US Centers for Medicare and Medicaid Services (CMS) largely ignore mobility as an outcome measure.

    To help fuel the needed changes, the white paper offers 7 recommendations:

    • Promote mobility assessment in acute care through "incentives for the use of standard, validated, mobility assessments" by CMS and other regulators
    • Advocate for more research funding for translational research in mobility assessment and intervention programs
    • Develop a consensus on standard methods to assess mobility "appropriate for acute care settings and clinically meaningful for providers and patients"
    • Minimize the burden of mobility measurement through, among other efforts, "optimizing workflow and documentation and minimizing redundancy by specifying the roles of various health care professionals such as nurses and physical therapists"
    • Evaluate the feasibility of a mobility quality measure for use by CMS
    • Reframe the current regulatory focus on falls in acute care to focus on safe mobility "in the face of little evidence of the effectiveness of strategies to prevent falls in acute care"
    • Develop resources for acute care providers available from AGS and other entities

    One bright spot, according to the white paper authors, is that several standardized mobility assessments could fit the bill. Authors identified 6 assessments as especially promising, with most able to be administered by a nurse: the Activity Measure for Post-Acute Care 6-Clicks; the Banner Mobility Assessment Tool; the de Morton Mobility Index; the Hierarchical Assessment of Balance and Mobility; the Johns Hopkins Highest Level of Mobility assessment; the Minimum Data Set 3.0 version 1.14, Section G; and the Minimum Data Set 3.0 version 1.14, Section GG. [Editor's note: many of these assessments are available in APTA's PTNow online resource center.]

    The end result, according to white paper authors: "We anticipate that routine mobility assessment will lead to a new paradigm in which stabilization of or improvement in mobility will be a universal indicator of high-quality hospital care."

    Massive APTA-Supported Opioid Bill Ready for President's Signature

    Expansive legislation aimed at battling the opioid crisis will soon become law, complete with provisions that echo APTA's recommendations for education on—and patient access to—nonopioid approaches to pain management.

    On October 3 the US Senate passed the final version of the legislation by a 98-1 margin after the US House of Representatives passed the measure, 393-8. The bill is headed to the White House, where President Donald Trump is expected to sign it into law.

    The legislation is wide-ranging, covering treatment for opioid addiction and use disorder, initiatives to help promote nonopioid alternatives to pain management, and stepped-up efforts to prevent foreign shipments of illegal opioids such as fentanyl, among other provisions. Changes included in the bill affect "almost every federal agency," according to a report in The Washington Post.

    APTA strongly supported passage of the bill and worked with legislators and staff to advocate for policies that emphasize patient education and clinical research on pain and how it can be effectively managed without the overuse of opioids. The final version of the legislation echoes many of the recommendations included in an APTA white paper on the opioid crisis. Titled "Beyond Opioids: How Physical Therapy Can Transform Pain Management to Improve Health," the document advocates for better public awareness efforts and improved benefit design for both public and private health plans.

    "The bill now on its way to the White House represents a significant step in the right direction," said Kristina Weger, APTA congressional affairs senior specialist. "But there's much more work to be done—there are many provisions that direct agencies to begin reviews and studies on potential changes that we may not see for years. We need to continue our advocacy and outreach to help fight this crisis."

    Among the components of the legislation:

    • Clarification of states' abilities under Medicaid to provide care for infants with neonatal abstinence syndrome in neonatal residential pediatric recovery centers
    • Increased screening for opioid use disorder and other substance use disorders during Medicare wellness and preventive care visits
    • Better education for Medicare beneficiaries on opioid use and pain management, including more information on nonopioid approaches and advice to discuss opioid use and pain management with their physicians
    • Direction that the US Department of Health and Human Services (HHS) submit a report to Congress on how to improve reimbursement and coverage for multidisciplinary, evidence-based nonopioid treatment for chronic pain, due within a year after the legislation is signed into law
    • Stepped-up guidance from HHS to Medicare-participating hospitals for reducing opioid use, developed in consultation with health care organizations, consumers, and other stakeholders
    • Establishment of an HHS technical expert panel to provide recommendations for best practices in surgical settings, including limits on the use of opioids in perioperative settings, with a report due within 1 year of the law's enactment
    • More information on the risks of opioid use and better coverage for nonopioid alternatives to pain management in Medicare Advantage plans and Medicare Part D prescription drug plans beginning in 2021
    • Expanded research overseen by the Interagency Pain Research Coordinating Committee to include investigations into best practices for the use of nonpharmacological pain treatments
    • Development of a demonstration program to test alternative pain management protocols in hospital emergency departments

    APTA's involvement in addressing the opioid crisis dates back to late 2015 and includes the award-winning #ChoosePT public awareness campaign. The association is urging members to promote the profession's role in effective pain management during October as part of National Physical Therapy Month, and recently a physical therapy student-led "flash action strategy" focused on nonopioid pain management for an intensive 48-hour advocacy campaign with legislators on Capitol Hill. APTA also hosted a satellite media tour on the issue that resulted in more than 200 television and radio interviews across the country to an audience of more than 13.1 million, and in February hosted a Facebook Live event, "Beyond Opioids: Transforming Pain Management to Improve Health."

    What's New at MoveForwardPT.com, Fall 2018

    APTA's consumer information website, MoveForwardPT.com, is a continually expanding resource where patients learn about the many conditions and patient populations physical therapists (PTs) treat. The site includes everything from condition-based guides, podcasts, tip sheets, and videos, to our popular 'Find a PT' tool that patients can use to locate a member PT in their area. It's also home to APTA's national award-winning #ChoosePT opioid awareness campaign and toolkit.

    Bottom line: MoveForwardPT.com is an evolving resource. Members are strongly encouraged to help APTA drive traffic to the site to expand awareness of the physical therapy profession.

    Here are some recent additions to the site:

    National Physical Therapy Month resources
    October is National Physical Therapy Month, an opportunity to amplify our promotion of the benefits of physical therapy, and to make more people aware of APTA’s #ChoosePT campaign, the initiative aimed at raising awareness of physical therapy as a safe and effective alternative to opioids for the treatment of chronic pain conditions. Check out the #ChoosePT campaign toolkit for resources and ideas to help you highlight the ways physical therapy can address pain.

    Move Forward Radio podcasts
    The Risk of Cancer-Related Falls
    September 20, 2018: Although falls are common among the elderly, cancer survivors have a higher prevalence of falls than do people who haven’t been treated for the disease.

    Using Physical Therapy to Treat Pain in Addiction Treatment Centers
    September 6, 2018: America is in the grips of an opioid addiction crisis, much of which is linked to overprescribing for the treatment of pain, despite known and very dangerous risks. How does physical therapy work as an alternative?

    Fourth Trimester: What Is It and Why Is It Important?
    August 16, 2018: Most people know pregnancy is divided into trimesters. But what about the fourth trimester?

    The Benefits of Exercise on Brain Health
    August 2, 2018: The benefits of being physically active are well known: it can enhance your cardiovascular system, control your weight, and strengthen your bones and muscles. But now there’s a growing body of evidence that being physically active benefits brain health and can help slow the decline in brain function that comes with age.

    Former Kentucky and NBA Star Rex Chapman Speaks Out About His Experience With Opioid Addiction
    July 19, 2018: Addiction can happen to anyone, including Rex Chapman. The former star basketball player for the University of Kentucky enjoyed a 12-year career in the NBA, but what followed was a 14-year battle with prescription narcotics.

    Young Woman Overcomes Amputation Challenges, Becomes Physical Therapist and World Adaptive Surfing Champion
    July 5, 2018: Fourteen years ago, Dani Burt, a physically active teenager, sustained devastating injuries in a motorcycle accident. After being placed into a medically induced coma, she awoke to learn that her right leg had been amputated above the knee.

    Tips
    8 Tips to Prevent Shin Splints
    Cancer-Related Balance and Falls: What You Should Know

    Newly Updated Condition-Based Guides
    Torticollis
    Multidirectional Instability of the Shoulder
    Pes Anserien Bursitis
    Lower Extremity Stress Fractures
    Total Knee Replacement
    Below Knee Amputation

    APTA-Backed Bill Protecting PTs Traveling With Sports Teams Likely to Become Law

    APTA-supported legislation that protects physical therapists (PTs) and other health care providers who travel across state lines with a sports team is now just a presidential signature away from becoming law. Known as the Sports Medicine Licensure Clarity Act, the bill met with overwhelming bipartisan support in both the US House of Representatives and the Senate, and is on track to receive approval from President Donald Trump.

    When it becomes law the legislation will provide added legal protections for sports medicine professionals when they're traveling with professional, high school, college, or national sports teams by extending the provider's "home state" professional liability insurance to any other state the team may visit. The law would apply to licensed health care professionals who travel with professional and collegiate teams or other athletes and teams sanctioned by a national governing body. The bill was introduced in the House by Reps Brett Guthrie (R-KY) and Cedric Richmond (D-LA), and in the Senate by Sens John Thune (R-SD) and Amy Klobuchar (D-MN).

    "This is a big win for PTs, but an even bigger step forward in safeguarding the health of athletes," said Michael Matlack, APTA director of congressional affairs. "Once enacted, this law will help to support the realities of health care among teams that travel across state lines."

    In its original form, the bill's coverage was restricted to only physicians and athletic trainers. Advocacy staff at APTA and representatives from the American Academy of Sports Physical Therapy (AASPT) worked closely with legislators and staff to ensure PTs and PTAs working under the supervision of a PT would also be included. Once the bill was introduced, APTA and section representatives worked in conjunction with other stakeholder groups to ensure support from as many legislators as possible. The final version of the legislation passed the House easily in 2017, and it received approval from the Senate by a 93-6 margin on October 3.

    "We are grateful not only for the support of the legislators who introduced this bill, but for the sustained hard work of APTA members and members of the American Academy of Sports Physical Therapy to help achieve overwhelming backing in Congress," said Jennica Sims, APTA's congressional affairs and grassroots specialist. "Our success with this legislation shows what happens when individual member voices are part of a collaborative advocacy effort."

    Celebrate National Physical Therapy Month: Support #ChoosePT

    Recent data from the US Centers for Disease Control and Prevention revealed that more than 1 in 5 US adults live with chronic pain. Now's the time to help people understand how physical therapy can help.

    October is National Physical Therapy Month (NPTM), an opportunity to amplify and promote the benefits of physical therapy, and to make more people aware of APTA’s #ChoosePT campaign, an initiative aimed at raising awareness of physical therapy as a safe and effective alternative to opioids for the treatment of chronic pain conditions. [Editor's note: those messages were emphasized as part of a recent national APTA satellite media tour that resulted in more than 200 television and radio interviews across the country to an audience of more than 13.1 million.]

    “Those of us in the profession have long understood that physical therapy is a safe and effective alternative to opioids for the treatment of chronic pain conditions,” said APTA President Sharon L. Dunn, PT, PhD. “APTA offers many creative ways for us to bring that understanding to our communities at a crucial time. My hope is that we can apply our dedication to our profession to an even larger effort to address a crisis that is impacting lives across the country.”

    In honor of NPTM, APTA has distributed a nationwide print and online feature article on the prevalence of low back pain and the many reasons patients and clients should choose physical therapy to safely manage their pain. In addition, APTA continues to add resources to its #ChoosePT online toolkit, a 1-stop shop for tips, tools, and information about the risks of opioids and how physical therapy can help with pain management.

    Getting involved in NPTM is easy. Here are 5 ways to share the #ChoosePT message this month and all year long:

    1. Access handouts, social media graphics, and other resources from the #ChoosePT toolkit.
    APTA’s award-winning #ChoosePT campaign has reached millions to promote treatment by physical therapists (PTs) for pain management. Whether you’re participating in a community event or sharing resources online, the #ChoosePT campaign toolkit has what you need.

    2. Take the #ChoosePT message somewhere fun—and take a picture!
    We want to know how you’re celebrating NPTM. Go find a landmark, a park, a mountaintop, and anywhere in between, and take a photo demonstrating your #ChoosePT pride. Post them to social media using the #ChoosePT hashtag or email them to public-relations@apta.org. We’ll be sharing our favorites throughout the month.

    3. Get the #ChoosePT TV and radio public service announcement aired in your area.
    APTA’s latest public service announcement has already reached more than 50 million Americans. Help us grow that by volunteering to contact your local TV and radio stations. Email public-relations@apta.org to volunteer and APTA staff will provide you with step-by-step instructions.

    4. Promote MoveForwardPT.com.
    APTA’s official consumer information site serves millions of Americans each year. From symptoms and conditions guides to patient stories, podcasts, and tips pages, MoveForwardPT.com is your go-to resource for showing all the ways PTs and physical therapist assistants transform lives.

    5. Update your Find a PT profile.
    National Physical Therapy Month activities lead to an increase in traffic to Find a PT, APTA’s national database of practicing clinicians. Make sure to update or activate your profile so consumers and other health care professionals can easily find you.

    Contact APTA's public and media relations staff at public-relations@apta.org with any questions.

    Jeanne Fischer, Pediatric Physical Therapy Pioneer and Distinguished Mentor, Dies at 94

    One of the first school therapists in Washington State and a lifelong advocate for persons with disabilities, physical therapist (PT) pioneer Jeanne Fischer, PT, died on September 4, 2018, in Tacoma, Washington. She was 94.

    A graduate of the physical therapist educational program at the University of Kansas in 1948, Fischer began her at St Luke’s Hospital in Kansas City, Missouri. In 1958, she began a 31-year tenure as a PT for the Tacoma, Washington, School District while married and raising 3 young daughters. It was during her years as a school-based PT that Fischer gained her reputation as an outstanding mentor and advocate.

    Fischer was a founding member of the former Section on Pediatrics (now the Academy of Pediatric Physical Therapy), serving as the group's vice chair from 1979 to 1983. She also served as head of the Pediatric Specialty Council responsible for the development of the APTA specialty certification in pediatric physical therapy. In 1981, she was honored with the section’s G.E. (Bud) De Haven Award for extraordinary service and, in 1984, received a certificate of appreciation for outstanding service as the pediatric representative to APTA’s initial Task Force in Clinical Specialization.

    The academy further acknowledged Fischer's commitment to mentorship when it created the Jeanne Fischer Distinguished Mentorship Award in 1993. The award, bestowed annually at the APTA Combined Sections Meeting, recognizes an academy member who has demonstrated sustained, altruistic mentorship beyond that expected within their regular employment.

    In addition to honors from the academy, Fischer received numerous national and state awards. APTA recognized Fischer with both a Lucy Blair Service Award and Henry O. and Florence Kendall Award. Fischer received a Distinguished Service Award from the Washington State Physical Therapy Association and the William Duncan Award from United Cerebral Palsy of Washington. In 1996, APTA honored Fischer for 50 years of membership and service, calling her a pioneer in the profession.

    Memorial donations may be made to United Cerebral Palsy. More information celebrating Fischer's life can be found here.

    From PT in Motion Magazine: Moving Away From Opioids

    Health experts, federal agencies, and national organizations such as APTA have been sending a clear message that providers and patients should first consider nonopioid treatments such as physical therapy for chronic pain. But has it made a difference?

    Yes, according to Alice Bell, PT, DPT, APTA senior payment specialist, who represented APTA on the National Quality Forum’s “opioid stewardship action team” earlier this year. She tells PT in Motion magazine that "Across the profession, we're seeing more and more patients who are accessing physical therapy before opioids are prescribed, or who've been on opioids but realize they aren't helping to treat or manage their underlying conditions."

    In this month’s issue of PT in Motion magazine, author Chris Hayhurst writes about APTA’s ongoing efforts to build public awareness and its leadership in policy discussions around nonopioid alternatives to pain management The article includes excerpts from an APTA white paper, “Beyond Opioids: How Physical Therapy Can Transform Pain Management to Improve Health.” The white paper outlines the history of the opioid epidemic and summarizes research on physical therapy’s effectiveness in treating, managing, and preventing chronic pain.

    Moving Away From Opioid Reliance” is featured in the October 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.

    APTA Continues PTA Advocacy: Pushback on PTA Differential, Timeline for TRICARE Startup, More

    Physical therapist assistants (PTAs) play a crucial role on the care delivery team, and APTA is bringing that message to multiple stakeholders. Here's a rundown of some of the latest happenings in the association's advocacy for PTAs.

    Now available: an estimated timeline for PTA inclusion in TRICARE.
    In December 2017, President Trump signed a National Defense Authorization Act that included a change long advocated by APTA: inclusion of PTAs in the TRICARE program used throughout the Department of Defense (DoD) health care system. However, like many federal-level policy changes, implementation wasn't immediate, and it wasn't clear just how or when this change would happen.

    APTA can now shed a little light on the process. Informed by discussions with DoD representatives and others, the association developed a timeline that provides a sense of just how long it might take for the TRICARE policy change to take effect (scroll down to "TRICARE" header).

    The process hinges on when the proposed rule is released to the US Office of Management and Budget (OMB) for review—possibly this fall or spring of 2019. That release triggers a timeline for a series of steps that involve publication in the Federal Register, a public comment period, and agency reviews. Because the OMB release hasn't happened yet, and because various actions could take place before their deadlines, it's hard to pin down a specific date for the end of the process. The only firm date associated with the change is that it has to happen by 2021. The APTA chart helps provide a sense of the length of different steps of the process and helps visitors track progress. APTA will provide updates on the regulatory process, and alert members once the public comment period on the proposed rule has begun. In the interim, APTA is working with congressional allies to keep the pressure on for an expedited process once the proposed rule is released [Editor's note: recently, Rep Rob Wittman (R-VA) submitted a letter to DoD asking when OMB will receive the proposed rule now that 9 months have passed since the legislation was signed into law.]

    Yes, PTAs are included in TriWest.
    APTA also has received clarification that TriWest, the entity that oversees administration of the Department of Veterans Affairs "Veterans Choice" health care program in specific regions of the country, does in fact allow for treatment by PTAs. Unlike the TRICARE change, the TriWest statement describes the current environment and is not dependent on any wait for adoption of new rules.

    APTA continues to push back on US Centers for Medicare and Medicaid Services (CMS) plans to adjust payment provided "in part" by a PTA.
    CMS is bound by law to establish PTA and occupational therapy assistant (OTA) coding modifiers that will go into effect on January 1, 2020 and include a Medicare payment differential beginning in 2022. The problem, in APTA's view, is that the CMS approach—to assign the modifier to services provided "in part" by a PTA or OTA—could significantly impact patient access to care, particularly in rural and underserved areas. The CMS approach is mentioned in its proposed 2019 physician fee schedule.

    APTA made its position clear in comments on the fee schedule, and encouraged members and other stakeholders to provide individual comments critical of the "in part" approach. Additionally, association representatives and representatives from the American Occupational Therapy Association (AOTA) met with CMS representatives in person to discuss the issue. At the same time, APTA and AOTA are advocating on Capitol Hill for Congress to commission a US Government Accountability Office study to examine how access to physical therapy and occupational therapy will be impacted by the pending 2022 Medicare payment differential.

    APTA and Laurel Road now offer an option for PTA student loan debt refinancing.
    News from the APTA Financial Solutions Center: PTAs now have another option for reducing their student loan debt. APTA has expanded its partnership with Laurel Road, a national lending and banking company, to include student loan refinancing for PTAs. Under the new offering, PTAs who have worked for at least 1 year in the profession are eligible to apply to refinance their student loans to a lower rate.

    "It's important to be a member of APTA and engaged on these critical issues that impact PTAs, the profession, and the patients we serve," said David Harris, PTA, BS, MBA, chief delegate of the PTA Caucus. "We all have a professional responsibility to do everything in our power to provide access to all those in need of physical therapy, and our APTA membership gives us all a voice on the national level. Advocacy strengthens with every membership voice."

    Student-Led Flash Action Highlights Physical Therapy's Role in Pain Management

    A physical therapist (PT) and physical therapist assistant (PTA) student-led "flash action strategy" held September 26-27 focused on bringing a clear message to Capitol Hill: physical therapy plays an important role in effective, nondrug management of pain and shouldn't be left out of any approaches to addressing the nation's opioid crisis.

    It was a message that came through loud and clear—to the tune of nearly 7,000 contacts with lawmakers and their staff.

    Despite busy semesters, students from multiple PT and PTA programs took time to participate in the nationwide effort, primarily using social media to concentrate their efforts during a 48-hour window of intense messaging. In addition to contact from students, physical therapists, and physical therapist assistants, the push included 176 contacts from physical therapy patients using APTA's Patient Advocacy Center.

    "The excitement and focused participation during this flash action campaign shows a tremendous level of engagement and commitment to the profession among APTA's student members," said Jennica Sims, APTA's congressional affairs and grassroots specialist. "It's inspiring to see the next generation of the profession taking the lead in this grassroots effort."

    PT and PTA students will bring their energy and excitement to the upcoming APTA National Student Conclave, set for October 11-13 in Providence, Rhode Island.