With most of the objectives of APTA's 2013 Strategic Plan met, the Board of Directors adopted new targets for 2014. The 4 goals of the Strategic Plan remain the same—effectiveness of care, patient- and client-centered care across the lifespan, professional growth and development, and value and accountability. The board agreed on updated objectives under each goal that the association will pursue next year.
As in 2013, the highest priority objectives are development of the physical therapy outcomes registry (PTOR) and advancement of a more appropriate payment system, which APTA has proposed as the physical therapy classification and payment system (PTCPS). For PTOR, APTA aims to launch a pilot by the end of February and fully launch the registry by year-end. For PTCPS, APTA and other stakeholders continue the process that was begun last year, which includes submitting a coding proposal to the AMA CPT Editorial Panel and educate physical therapists in using the proposed system. The association is on track to implement the system, if all approvals are met, in 2015.
Other important priorities also are contained in the 2014 Strategic Plan:
While the 2014 Strategic Plan is an extension of the 2013 plan that was based on APTA's former Vision 2020, it is a "bridge" to the new vision that APTA adopted at the June House of Delegates—"Transforming society by optimizing movement to improve the human experience."
The association's outward facing new vision is apparent in many 2014 Strategic Plan objectives that promote practice in collaborative care models and encourage interprofessional collaboration in education. The 2015 Strategic Plan will be based on the new vision.
Strategies and metrics for the plan’s objectives have been developed and will enable APTA's Board to track their progress throughout 2014. Progress on the plan will be communicated to members throughout the year.
To see the full discussion on this and other topics from the December Board of Directors meeting, watch the archived livestream of all open sessions.
The $43.5 million 2014 APTA operating budget will continue to devote the majority of discretionary funds to the APTA strategic plan.
The budget adopted by the APTA Board of Directors during its December meeting at APTA headquarters predicts a 7.1% increase in revenues with a small use of investment gains to balance out expenditures for a break-even budget for the year.
Similar to the 2013 budget, the newly approved plan continues to designate the majority of the association's "discretionary" funds—money not tied to basic operating activities or offset by direct revenue—to fulfillment of the APTA strategic plan. Strategic priorities (see related story) funded in the budget include the Physical Therapy Outcomes Registry and a physical therapy classification and payment system that promotes high-quality care, reflects the clinical reasoning and judgment of the physical therapist, and maximizes healthcare resources. The budget approved by the board assigns nearly 64% of these funds to strategic plan activities, an amount that represents 22.7% of all APTA expenses.
The profession's definitive description of who physical therapists (PTs) are, what they do, and how they do what they do is poised to release its third edition by fall 2014. The tentative release date and some of the revisions to expect were reported during the Board of Directors December meeting.
In addition to other changes to the Guide to Physical Therapist Practice, first published in 1997, the third edition will be an online-only resource, as the continued evolution of the Guide includes links and references to many other online resources that shouldn’t be separated from the Guide itself. A printed book version can't offer the same connectedness to these other resources, the Board report indicated, and the Guide will lose its full usefulness if it's applied or studied in a vacuum.
Other changes are in store, too. Language will shift to International Classification of Functioning, Disability and Health (ICF) terminology, which APTA adopted in 2008, after the last edition of the Guide was published. The Catalogue of Tests and Measures, introduced in the second edition electronic version, will be archived and available to members, but no longer updated or intended for practical use. Instead, Guide users will find relevant tests and measures within the PTNow website.
Also, the Preferred Physical Therapist Practice Patterns will be available as an online educational tool separate from the Guide, and the range of visits and ICD-9 codes will be removed. With the third edition focusing on the core audiences of clinicians and the academic community, the inclusion of ICD codes was deemed to be unwarranted, especially in light of the pending implementation of ICD-10, which would require APTA to revise all ICD coding in the Guide.
The APTA Board of Directors has decided that it's time the association untangle and clarify the approximately 370 positions, standards, guidelines, policies, and procedures (PSGPP) created through its history in a multiyear review process.
At its December meeting, the Board reviewed a report that described the "challenges" to the current PSPPG documents. Among the issues cited by the work group that submitted the report were unclear definitions, overlap among policies, inconsistent wording and format, complicated organization, and content that is at times too detailed to work as policy.
In response, APTA will begin a comprehensive review of all elements of the PSGPP, and the Board will forward a proposed revision to Standing Rule 21 of the association, which contains definitions for 5 different types of viewpoints and administrative directives. The suggested change reduces the 5 different categories in favor of characterizing all PSGPP documents as binding documents (primarily the Code of Ethics and Standards of Ethical Conduct), policy, and procedure. Neither recommendation was aimed at changing the intent of any PSGPP document but only at creating greater consistency and usefulness.
Pending approval of the new definitions by the House of Delegates, staff and volunteers will begin PSGPP reviews, provide regular progress reports to the Board, and bring proposed revisions to the Board and House, but no firm completion date for the project was set.
Two APTA task force reports on potential physical therapy models of care will be getting a closer look before being reconsidered by the APTA Board of Directors for presentation to the House of Delegates. The Board asked for the additional analysis, including review by an external policy analyst, at its December meeting to get a better understanding of the benefits and risks of pursuing models of care that might widen the range of who could provide services under the direction and supervision of a physical therapist.
The reports were in response to resolutions passed by the House that began with a charge to study whether physical therapists (PTs), physical therapist assistants (PTAs), and physical therapy aides should be the only participants involved in the delivery of physical therapist services. The then-named Health Care Professionals and Personnel Involved in the Delivery of Physical Therapy Task Force began looking at this issue in 2011; the following year, the House expanded on the range of issues to be studied by adding a separate charge that APTA "explore practice models that are responsive to the needs of society and adaptable to our changing health care environment."
The APTA Board of Directors responded by folding the new work into the research already started by the 2011 task force, and renaming the group the Models of Physical Therapy Services Delivery Task Force. The 2013 progress reports created by this task force generated lengthy discussion over 2 days at the December Board meeting held at APTA headquarters in Alexandria, Virginia.
The task force's reports addressed all elements in the resolution and the charge from the House, which included analysis of impact on patient/client access, quality, and cost of physical therapist services in the context of new models of health care delivery; impact of new models of service delivery on personnel standards under Medicare, referral for profit, term and title protection, direct access, and other policies; and the ramifications of potential use of the new model(s) by other qualified providers of rehabilitation or therapy services, such as physicians.
The Board voted to hold off on adoption of the reports until further review. The analysis would cover the entire reports with particular attention paid to how more expansive care models would be implemented in light of scope of practice issues, supervision requirements, and professional licensure requirements for a range of health care professionals.
The Board will revisit the reports—and the additional analysis—at its January 2014 meeting, and it will forward its adopted reports to the 2014 House of Delegates prior to APTA’s Combined Sections Meeting.
To see the full open discussion on this and other topics from the December Board of Directors meeting, watch the archived livestream of all open sessions.
APTA is set to launch an endorsement process that could help significantly increase the use of clinical practice guidelines (CPGs) in physical therapist practice. The plan, which would create a rigorous review system for internally and externally developed CPGs, was approved by the APTA Board of Directors at its December meeting.
Currently, APTA directly facilitates the development of CPGs through its sections, but the process can take 3–4 years to complete. Under the new plan, APTA will also review relevant internally and externally developed CPGs for their quality from a scientific perspective. This process will provide clinicians with high-quality useful CPGs that could help improve care for patients and clients.
The 3-step system begins with staff review to ensure the proposed CPG's accessibility, currency, and consistency with APTA policy. Guidelines passing this review advance to the association's PTNow Evidence-Based Practice Library (EBPL) team, which conducts a critical appraisal to ensure quality. Finally, the EBPL team will recommend endorsement or non-endorsement of the CPGs to the APTA Board. The Board will verify that the process for endorsement was completed properly..All officially endorsed guidelines will be designated with a special icon that will help APTA members easily recognize the status.
The endorsement system is part of the 2013–2014 APTA Strategic Plan to reduce unwarranted variation in care by increasing the number of peer-reviewed CPGs available to members.
The American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) will soon use the more appropriate term "accreditation" to describe a process it currently calls "credentialing." The terminology change, approved by the APTA Board of Directors at its December meeting, will not go into effect until after the 2014 session of the House of Delegates.
The proposed change arose as part of an ABPTRFE effort to refine its policies and standards to ensure alignment with industry standards, and to position the organization for recognition by outside entities such as the US Department of Education and the Council for Higher Education Accreditation. In its report to the Board of Directors, ABPTRFE stated that "credentialing" is widely regarded as a recognition associated with individuals, and "accreditation" is the term more appropriate for recognition of programs.
The Board approved the new terminology with a proviso that the change would not go into effect until after the House meets in June.
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