The New York Times published an APTA letter to the editor about an article on the recent release of extensive Medicare payment information. The article used data on a single Brooklyn, New York, physical therapist (PT) who received $4 million in 2012 as an example of how physical therapy "has become a Medicare gold mine." The association continues to analyze the Medicare data and will be releasing a full report in early May.
"The data presented in this article does not tell a complete story," writes APTA President Paul A. Rockar Jr, PT, DPT, MS. "A vast majority of physical therapists demonstrate Medicare utilization patterns consistent with those expected within the profession. With regards to utilization, nearly 90% of physical therapists who bill Medicare Part B receive payments of less than $100,000 per year—with the majority of those receiving significantly less than that (67% receive less than $50,000 per year, and 40% receive less than $25,000)." In fact, only slightly over 10% receive Medicare Part B payments of $100,000, and less than .1%, or only 44 individuals, receive greater than $500,000.
The data used in the story are drawn from a recent release of extensive Medicare payment information on over 880,000 health care providers. The amount of data shared is large but limited, and includes only utilization data on services billed and paid under Medicare Part B. It does not include information for patients who are enrolled in any form of Medicare Advantage plan, those who receive coverage from other federal programs, or those with private health insurance. It also does not include data on the value, quality, or outcomes of the treatment provided.
"These data should be viewed in context, and should not be used to draw conclusions about individual providers without information about expenses, quality of care, complexity of patients, and volume of patients treated," Rockar writes.
The article does, however, bring to light areas of concern that APTA has noted in its preliminary review of the data. "In particular, APTA is concerned about outliers in the data, such as geographic disparities that are difficult to explain, and is analyzing the information to pinpoint variations in care that must be addressed," Rockar writes.
In addition, in its initial review of the data, APTA has noted outlying discrepancies in patterns of care, such as the use of modalities, support personnel, utilization of consistent procedures for the majority of patients rather than individualized treatment plans, and episodes of care that are difficult to explain based on professional standards.
Another issue with the data highlighted in the New York Times article is that it represents providers and physical therapists who are billing under an individual National Provider Identification (NPI) number, not an organizational NPI. "Data billed under one provider’s billing code can cover multiple practitioners," Rockar writes. "However, Medicare says that if the supervised physical therapists are not enrolled, the supervising physical therapist must be on the same premises."
Rockar writes that "The association is committed to reducing fraud, waste, and abuse and has launched a comprehensive campaign to address these areas of concern in the profession." That campaign, called Integrity in Practice, is a multifaceted initiative that was featured in the February issue of PT in Motion. Its goal is to highlight the profession's reputation for excellence and outline the work needed to honor and protect it.
APTA plans to make a full analysis of the data as it relates to PTs available by May 10. Included in the analysis will be guidance for members on how to read and interpret their own data.
Think a 1.5 GPA will get you on the honor roll? Neither does the National Physical Activity Plan Alliance, whose recently released Report Card on Physical Activity for Children and Youth (.pdf) paints a fairly dismal picture of the state of exercise among kids.
Among the areas analyzed in the report card, the Alliance handed out a B, 2 Cs, 3 Ds, and an F. Rounding up (the Cs were actually C- grades, as were 2 of the 3 Ds), that's a 1.5 GPA. And that doesn't even count the 4 incompletes on the report card.
The group's grades were handed out in 10 areas: overall physical activity, sedentary behaviors, active transportation (the percentage of children who walk or bike to school), organized sport participation, active play, health-related fitness, family and peers, school, community and built environments, and government strategies and investments. "Each grade reflects how well the US is succeeding at providing children and youth opportunities and/or support for physical activity," the report states.
The grades issued were:
Overall physical activity: D-
The report found that roughly 25% of children and youth 6 – 15 engaged in at least 60 minutes of moderate-to-vigorous exercise per day. Most of that percentage was borne by children 6 – 11, 42% of whom met the standard. Among youth 12 – 15, that rate dropped to 8%.
Sedentary behaviors: D
On average, 53.5% of US children and youth meet guidelines calling for no more than 2 hours or less of screen time per day, with wide variations in rates among racial groups. The disparity was part of the reason for the low grade, according to the Alliance.
Active Transportation: F
"The vast majority of American children and youth do not travel to school by active means," the report states. Estimates from 2009 put that rate at 12.7%, down more than 35 percentage points from the 47.7% rate in 1969.
Organized sport participation: C-
Although nearly 60% of US children and youth participate in at least 1 organized sports team, gender and ethnic group disparities resulted in a drop in the Alliance grade.
Just over half of US children and youth attend a physical education class during an average school week, with significant disparities among grade levels. High participation in ninth grade (68.1%) dwindles each year of high school until the senior year, where the participation average is 38.5%.
Community and the built environment: B-
A highlight among the grades, access to parks and playgrounds is fairly good, with 84.6% of US children and youth living close to these facilities. The problem, according to the Alliance, is that the access isn't equal across ethnic and socioeconomic groups.
The remaining categories—active play, health-related fitness, family and peers, and government strategies and investments—did not offer sufficient data to issue a grade, according to the Alliance.
The Alliance announced its report card at a briefing held on Capitol Hill April 28. DC Chapter Treasurer Marisa Birkmeier, PT, DPT, PCS, c/NDT, Pediatric Section representative for DC Erin Marie Wentzell, PT, DPT, PCS and staff member Michael Hurlbut, senior congressional affairs specialist, attended the briefing on behalf of APTA. An APTA representative also serves on the board of the Alliance.
APTA has long supported the promotion of physical activity and the value of physical fitness, and has representatives on the practice committee of Exercise is Medicine. The association offers several resources on obesity, including continuing education on childhood obesity, and a prevention and wellness webpage that links to podcasts on the harmful effects of inactivity.
The physical therapy scope of practice does encompass the relationship of professional, jurisdictional, and personal scope of practice, but it is not a laundry list of activities. This was the conclusion of the task force that developed and presented a definition of the term "scope of practice" that the Board adopted during its April meeting. Noting that "while professional scope of practice is broad, actual scope of practice is unique for each individual," the statements supporting the definition indicate that it is intended to clarify APTA’s role and guide the association in leading and responding to scope of practice inquiries.
Per the adopted DEFINITION OF THE TERM SCOPE OF PRACTICE AND CLARIFICATION OF ASSOCIATION ROLE:
Scope of practice has 3 components: Professional, jurisdictional, and personal.
Of note is that the Scope of Practice Task Force agreed that such a definition should not include a list of activities, as it would be hard to maintain an accurate and inclusive list. The task force also concluded that a further exploration of the definition of the physical therapist’s professional scope of practice in particular (as opposed to the term “scope of practice”) as determined by the House of Delegates is needed. This Board position can be forwarded to the House as part of that discussion.
The task force additionally pointed to the physical therapist’s role in the health care system, which was beyond its charge but in need of broad-based, forward-thinking approaches that can evolve as health care systems do. The task force suggested looking beyond the United States to international colleagues with experience and expertise.
Inquiries about whether new or emerging areas are part of the physical therapy scope of practice will be addressed by a staff-guided review process that the Board adopted along with the definition.
To see the full discussion on this and other topics from the April Board of Directors meeting, watch the archived livestream of all open sessions.
What happens in Charlotte isn't staying in Charlotte.
APTA's upcoming NEXT Conference and Exposition to be held in Charlotte, North Carolina, June 11 – 14 will have an online version—Virtual NEXT 2014—that will allow members to participate in this cutting-edge conference from their home or office.
Participating in Virtual NEXT doesn't have to be lonely endeavor, though. APTA is encouraging members to host viewing parties as a way to enhance the experience through networking and local discussion groups. Members need to register, and will then have direct access to NEXT so that they can stream events in a large room. Multiple attendees can participate for the price of one; however, only registered participants will receive a CEU certificate. More information about requirements and responsibilities is available at the viewing party website.
The Virtual NEXT online learning environment offers session handouts, a chat function to post questions to speakers, and a Virtual Poster Hall featuring the 10 highest-rated scientific posters on display at the NEXT Conference in Charlotte.
Virtual NEXT will also feature APTA’s signature Mary McMillan and John H.P. Maley lectures on demand. Eight educational sessions will also be archived for on-demand viewing, 7 of which will be livestreamed June 13-14. Session information can be found at the Virtual NEXT webpage.
Organize a viewing party in your area! Party organizers should contact the Professional Development Department or call 800/999-2782, ext 3206, to participate.
APTA’s next steps in overhauling the flawed payment system for physical therapist services include a 2014 pilot program to investigate the impact of APTA’s proposed model and a 2015 campaign to educate members on new payment systems in health care. Both were adopted by the Board of Directors at its April meeting, in preparation for a targeted 2016 implementation of a new system.
APTA began in 2012 to draft and refine an alternative to the current fee-for-service Medicare payment system, in part responding to a Board policy adopted in 2011 that endorsed the development of an alternative payment system, and in part as a response to calls from the Centers for Medicare and Medicaid Services (CMS) for a new methodology—the goal of both being a system that would fairly compensate health care providers while doing away with the sustained growth rate (SGR) and arbitrary therapy caps that have confounded providers and CMS alike for more than a decade.
The Physical Therapy Classification and Payment System (PTCPS) is the result of extensive member evaluation of the initial draft. Members provided input on a severity-intensity framework as a basis for payment, the appropriate unit on which to base payment, the proposed evaluation levels, the examination and intervention levels, overall value of the proposed system, supplemental support needed to implement the system, and whether the system effectively reflects the clinical judgment of the physical therapist.
Most recently, during the February 2014 meeting of the AMA CPT Editorial Panel, APTA proposed a new CPT code structure reflecting the PTCPS. While the panel complimented APTA on the proposal, it postponed voting on it, saying the magnitude of the changes to the existing physical medicine and rehabilitation (PMR) code family warranted more time and a pilot test to provide more support and validation for the new codes.
The Board in April committed up to $500,000 to fund the pilot, and APTA will seek collaborative partners to help offset costs. For the pilot, PTs will seek to determine appropriate per-session CPT codes to describe physical therapist services in 2 ways: review of clinical vignettes and chart review of existing medical records of patients.
On the education side, APTA will develop a comprehensive plan to educate members on the new outpatient physical therapy model and other payment models emerging from health care reform, such as collaborative care models, bundling, and new postacute payment models.
In what some Board members described as a "maturation" of the relationship between physical therapist assistants (PTAs) and association governance, the APTA Board of Directors voted to bring bylaw amendments to the 2015 House of Delegates that would enable chapters to allow PTAs to serve as delegates in the House, grant PTAs a full vote at the component level, and enable PTAs to run for non-officer Board of Directors positions.
These decisions and others intended to increase the value of APTA membership to PTAs came after a lengthy discussion of recommendations made to the Board by the Physical Therapist Assistant Board Work Group, which was charged with exploring issues related to the goals of the Physical Therapist Assistant Caucus. The work group focused on 3 major issues: postgraduate development of the PTA, promotion and protection of the work performed by a PTA when a PTA is involved in a plan of care, and active participation in association activities relating to the PTA, including decision-making.
The majority of the Board's discussion was related to 3 major recommendations that addressed PTA participation in their components and in the House of Delegates. The work group's recommendations were intended to make it possible for PTAs to have a full vote within their components (currently PTAs eligible to vote are allotted a half-vote), and to create a way for PTAs to serve as voting chapter delegates in the House (currently only sections, which cannot vote in the House, can choose to have PTAs serve as delegates). Within each recommendation, the Board was presented with an option—basically, to create a bylaws amendment that would mandate the change at the component level, or to offer an amendment that would make the change optional for components. In the end, the Board voted for options that allowed for more choice.
Before taking the votes on the most significant recommendations, APTA President Paul Rockar Jr, PT, DPT, MS, called for an "open forum" to allow Board members to discuss their perspectives on the broad issues of PTA involvement. Board members generally agreed with the sentiment expressed by Director Mary C. Sinnott, PT, DPT, MEd, who said that "it's about time we look at realities" and "take down some of the walls" that have prevented PTA members from full participation.
At the same time, directors questioned 1 recommendation option that called for a seat on the Board of Directors to be set aside for a PTA only. That particular option was ruled out by the Board early on as an approach that would run counter to the idea that Board members serve at-large and not as representatives of constituent groups. PTA Caucus Chief Delegate Amy Smith, PTA, BS, agreed, noting that "Eligibility to serve is a greater equality."
In deliberating the recommendations, the Board repeatedly came back to 2 considerations: the distinction between the PT-PTA relationship in practice and the PT-PTA relationship in association governance; and the distinction between having a PTAs represent their components in the House and having them represent the PTA as its own component.
In the end, the Board voted to draft bylaw amendment proposals for the 2015 House of Delegates that would allow components to provide PTA members a full vote at the component level, make PTAs eligible to serve as chapter delegates at the discretion of each component, and makes PTAs eligible to run for nonofficer positions on the Board . The eligibility proposals will also contain language that would eliminate the PTA caucus by 2020. The Board also agreed to explore the possibility of creating a "Section-like" component for PTAs in 2015.
Other work group recommendations approved by the Board include an effort to collect better data on the value of the PT/PTA team regarding utilization, and that a PT/PTA team toolkit communicating the value of the relationship be "actively supported" and promoted to APTA components.
In another discussion related to the PTA, the Board heard a report on the feasibility of transitioning to a PTA entry-level baccalaureate degree. The report is the result of RC 20-12, a charge from the 2012 House to explore a PTA baccalaureate degree.
In reviewing the implications of the baccalaureate option, the report calls for a practice analysis and identification of best practices to help inform any decision abut changes in degree level.
Editor's note: this article was changed from its originally-released version to reflect the Board's discussion of a "Section-like" component for PTAs.
A new wave of myostatin drugs in or nearing clinical-stage testing could make a significant impact on the ability to build muscle in patients who are elderly or suffering from muscle-wasting diseases, according to a recent article in the Wall Street Journal.
In the April 27 edition of WSJ, reporters Hester Plumridge and Marta Falconi describe the progress being made by several drug companies interested in refining myostatins for human use. These drugs are designed to block the production or detection of myostatin, a protein that slows muscle growth.
According to the article, researchers believe that myostatin drugs could counter sarcopenia as well as muscle-wasting diseases such as sporadic inclusion-body myositis and muscle loss related to chronic illnesses including cancer. Earlier versions of myostatins were attempted in the late 2000s as a treatment for muscular dystrophy but were discontinued after reports of unexplained nose and gum bleeding. The WSJ article reports that the new drugs "work in a slightly different way."
Sarcopenia can be managed through resistance exercises and dietary changes. APTA offers a consumer guide to sarcopenia and frailty at MoveForwardPT.com and features courses on frailty and mobility in the APTA Leaning Center (search "frailty" and "mobility").
Though its pilot test will be delayed until June because of changes to the Physician Quality Reporting System (PQRS), the APTA Physical Therapy Outcomes Registry (PTOR) is becoming more of a reality each day, with workflows, sample data entry screens, and staff ready or nearly ready to proceed.
The APTA Board of Directors received an update on PTOR progress during its April 3-5 meeting in Alexandria, where staff outlined progress on one of the association's top priorities for 2014. Current plans are for PTOR to begin pilot testing in early June, and to make its official debut in conjunction with the 2015 APTA Combined Sections Meeting (CSM) in February.
When complete, the registry will provide a user-friendly system to collect uniform data on patient and client outcomes. That data will help guide best practices, help providers meet regulatory reporting demands, generate benchmarking reports, help shape policy, and contribute to emerging payment models. APTA believes that the overall impact of the registry will be to demonstrate the value of physical therapist practice and the ways it can transform society.
At the Board meeting, APTA staff described the standard elements of the system, which will include visit report forms, workflow and patient management lists, and a data exchange that provides real-time access. Users will be able to opt in to other features that would make it possible to run quality measures on patient populations and connect to other electronic health records (EHR) systems.
Board members also got a glimpse "beyond the build" to learn how APTA is managing the legal, communications, and marketing side of the project, including a logo—a clean design that will help create identity and recognition.
With most of the program creation elements in place, the registry will transition during the first half of 2014 from a project overseen by an APTA task force to a full-fledged association-managed product. Current plans are for the task force to conclude its duties in July.
The PTOR webpage includes a video dispatch created after Board deliberations in August of 2013. APTA will post updates and further information on the registry there as they become available.
Time marches on, and so does APTA's progress on its 2014 strategic plan.
An accounting of activities and achievements shared with the Board of Directors at its most recent meeting adds up to one bottom line: solid gains in each of APTA's goals around effectiveness of care, patient and client-centered care across the lifespan, professional excellence, and value and accountability.
During the Board's meeting April 4-6 in Alexandria, Virginia, staff and board liaisons outlined the work being done to achieve the objectives that support each of the association's 4 major goals. This work is tied to specific metrics that define individual activities and programs and identify timelines to measure progress. It's a long list of activities that ranges from the operational to the aspirational, and touches all of the association's major projects. Highlights from each goal area include:
Effectiveness of care
Patient and client-centered care across the lifespan
Value and accountability
The 2014 Strategic Plan is both an extension of the 2013 plan that was based on APTA’s former Vision 2020, and a “bridge” to the new, more outward-facing vision that APTA adopted at the 2013 House of Delegates—“Transforming society by optimizing movement to improve the human experience.”
The 2015 Strategic Plan will be based on the new vision.
A new clinical report from the American Academy of Pediatrics (AAP) asserts that the continued rise in anterior cruciate ligament (ACL) injuries in adolescent athletes could be partially countered by neuromuscular training to "preprogram" safer movement patterns before an injury occurs. Better training could be of particular benefit to female adolescent athletes, who could see their rates of ACL injury risk drop by as much as 72%.
The recommendation was part of the conclusions and guidance presented in a report (.pdf full text available for free) published in the April 28 edition of Pediatrics. The report addressed diagnosis, treatment, and prevention of ACL injuries in adolescent athletes, which have been on the rise over the past 2 decades due to growing numbers of children participating in sports and more intensive training programs, among other reasons. Intrinsic risk factors include higher BMI, subtalar joint overpronation, generalized ligamentous laxity, and decreased neuromuscular control of the trunk and lower extremities, according to the report.
While incidence rates among adolescent athletes are still lower than among college athletes (5.5 vs 15 per 100,000 athlete-exposures), the rates are increasing and rise more dramatically during puberty—particularly for girls. Authors of the report write that female athletes between the ages of 15 and 20 account for the largest numbers of ACL injuries among adolescent athletes, and that, overall, girls suffer ACL injuries at a rate 2.5–6.2 times higher than boys in gender-comparable sports.
The report cautions against surgical interventions for adolescent ACL injuries, particularly when the surgery may cause growth disturbances, but authors also acknowledge the role patient and parent cooperation play in this consideration. While nonoperative treatments such as braces, rehabilitation, and sports restriction are often recommended until skeletal maturity is reached, authors write that "many … athletes and their parents are less inclined to agree to restrict the athlete's activity," which can lead to additional injuries and early-onset arthritis. "Therefore, most recent literature now supports early surgery for pediatric athletes with an ACL-deficient knee and recurrent episodes of instability," they write. Certain techniques minimize the risk of growth plate injury.
More certain results can be achieved in prevention, where neuromuscular training can have an impact, according to the report. More so than bracing (which authors say is "unlikely" to reduce risk of ACL injury), the training has a preventive effect by helping athletes to "'preprogram' safer movement patterns that reduce injury risk during landing, pivoting, or unexpected loads or perturbations during sports movements," authors write.
Adolescent female athletes could see the biggest risk reduction, if this training is introduced in their mid-teens. Training that "incorporates plyometric and strengthening exercises, combined with feedback to athletes on proper technique, appears to be most effective," authors write. "Pediatricians and orthopedic surgeons who work with schools and sports organizations are encouraged to educate athletes, parents, coaches, and sports administrators about the benefits of neuromuscular training in reducing ACL injuries and direct them to appropriate resources."
Research-related stories featured in News Now 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.
A new study is challenging widely made assertions that vitamin D supplements decrease falls risk, particularly in community-dwelling adults over 65. According to the latest analysis, "there is little justification for prescribing vitamin D supplements to prevent falls"—a conclusion in direct contrast to recommendations published as late as January of this year.
Results of the research, e-published on April 24 in the Lancet (abstract only available for free), were based on a sequential analysis of 20 randomized controlled trials that encompassed 29,535 subjects. The trials were designed to assess the impact of vitamin D supplements, both with and without calcium, on falls prevention. The authors of the Lancet article were unequivocal in their conclusion: there was no demonstration of reduced risk above 15%, regardless of whether the vitamin D regimen was accompanied by calcium. "Further clinical trials of the effect of vitamin D supplements on falls might be difficult to justify," the authors write.
The findings mirrored similar conclusions reached by the same researchers around vitamin D's effects on fracture, cardiovascular events, cancer, and mortality. In all cases, they write, "existing trials reliably show that vitamin D supplementation, with or without calcium, does not produce clinically relevant effects." The Lancet article adds falls risk reduction to that list.
The study runs counter to several guidelines, including a consensus opinion published in the Journal of the American Geriatrics Society earlier this year. That opinion echoed a 2012 recommendation from the US Preventive Services Task Force (USPSTF), which advocated for vitamin D supplementation as part of falls prevention in community-dwelling adults aged 65 years or older.
Authors of the Lancet study defended their use of a 15% risk reduction rate in the analysis by writing that "treatment effects [smaller than 15%] are unlikely to be attractive to patients because the absolute benefit is small and does not justify the effort of taking the treatment. Furthermore, the results did not change when a 10% risk reduction threshold was used."
APTA provides education on exercise prescriptions for balance improvement and falls prevention, and offers other resources for physical therapists, such as how to develop consumer events on balance, falls, and exercise, and information on evidence-based falls programs. Members can also access an APTA pocket guide on falls risk reduction (.pdf) as well as take part in an online community where members can share information about falls prevention.
An unencrypted laptop stolen from a Missouri physical therapy center has resulted in a $1.7 million fine against the center's owners.
The US Department of Health and Human Services Office for Civil Rights (OCR) announced that Concentra Health Services has agreed to pay the fee to settle potential violations of HIPAA rules when a laptop was stolen from the Springfield Missouri Physical Therapy Center, owned by Concentra. The laptop was unencrypted and contained health records protected by HIPAA.
According to a press release from OCR, investigations into the incident "revealed that Concentra had previously recognized in multiple risk analyses that a lack of encryption on its laptops, desktop computers, medical equipment, tablets and other devices containing electronic protected health information (ePHI) was a critical risk," but made "incomplete and inconsistent" efforts to properly encrypt computers and other devices.
“Covered entities and business associates must understand that mobile device security is their obligation,” said Susan McAndrew, OCR’s deputy director of health information privacy in the press release. “Our message to these organizations is simple: encryption is your best defense against these incidents.” In addition to the fines, Concentra has agreed to adopt a corrective action plan and document its efforts at remediation.
Under the HIPAA Omnibus Rule released in January 2013, providers—including physical therapists—can be subjected to extreme financial penalties for data breaches ranging from $100 per violation to a maximum of $1.5 million in a calendar year.
OCR also announced the settlement of a February 2012 breach from QCA Health Plan Inc of Arkansas involving the theft of ePHI of 148 individuals. The settlement in that case was $250,000.
HIPAA rules can be complex, but the consequences of not understanding them can be serious. APTA provides resources on compliance on APTA's HIPAA webpage. In addition, OCR offers 6 educational programs on HIPAA compliance, including a program devoted to mobile device security.
Some of the best opportunities for physical therapy advocacy don't happen on Capitol Hill, but on a legislator's home turf—and now is a great time to prepare by requesting a meeting, and maybe even shooting your own patient or client video, according to the APTA advocacy team.
The US House of Representatives will be in recess from May 12 to 16, and the Senate's recess is set for May 26 to 30. Recently, APTA sent out a notice to members reminding them of the upcoming opportunities to schedule in-person meetings.
One great advocacy suggestion: a short video of a patient telling his or her compelling story, directly addressing the legislator about the importance of physical therapy. It's a strategy that worked for Eva Norman, PT, DPT, CEEAA, who shot a video of her patient the Rev. Marguerite Voekel, and showed it to Rep Keith Ellison (D-MN) during the 2014 APTA Advocacy Forum in Washington, DC. Rep Ellison was so taken by the video that he shot a personal video response to Voekel on the spot.
The ATPA advocacy team offers some tips on video statements:
Not sure where to start? Visit APTA's Advocacy Involvement Opportunities webpage or contact APTA and we will help you start to build a relationship with your legislators. If you're interested in attending a local fundraiser, contact the PT-PAC. PT-PAC provides funds to send APTA members to local events for members of Congress who support the physical therapy profession.
The latest addition to the APTA website helps to provide physical therapists (PTs) with resources on physical therapy in the neonatal intensive care unit (NICU), the source of medical care for more than 3% of all infants born in the US.
Although not intended to provide PTs with everything they need to know to practice in the NICU, the webpage does include information on roles and training, a list of resources, and links to relevant journal articles.
The US Food and Drug Administration (FDA) has issued a warning (.pdf) about the dangers of administering epidural injections of corticosteroids to relieve neck and back pain. According to the FDA, the off-label use could result in blindness, stroke, paralysis, and death.
The potential problems were characterized by the FDA as "rare but serious" for a treatment whose effectiveness "has not been established." The injectable corticosteroids include methylprednisolone, hydrocortisone, triamcinolone, betamethasone, and dexamethasone. Epidural injections of corticosteroids to treat neck and back pain, as well as radiating pain in the arms and legs, have been a "widespread practice for many decades," according to the FDA.
Although many of the reported problems occurred within 48 hours after the injection and were temporary, some patients never recovered. The FDA is advising patients who receive the injections to be on the lookout for changes to vision, tingling in the arms and legs, dizziness, seizures, severe headaches, or sudden weakness or numbness in face, arms, or legs, or on one or both sides of the body.
The FDA recommends that patients "discuss the benefits and risks of [the injections] with your health care professional, along with the benefits and risks associated with other possible treatments."
APTA has a long history of involvement in the development of information and resources on neck and back pain. Some of the resources available to physical therapists (PTs) include a MoveForwardPT.com webpage on low back pain, the PT's Guide to Osteoarthritis, clinical practice guidelines on low back pain (.pdf) and hip osteoarthritis (.pdf), and a Learning Center presentation on manipulation for low back pain. PTNow provides full-text access to the latest clinical practice guidelines and Cochrane systematic reviews related to low back pain and neck pain.
A multifaceted initiative from the American Heart Association (AHA) and the American Stroke Association (ASA) has generated marked improvements in the rate of patients suffering a stroke who receive a critical drug within an all-important treatment window. Those improved treatment rates have resulted in reduced in-hospital mortality, more frequent ambulation at discharge, and more frequent discharge to home, according to a study recently published in JAMA, the journal of the American Medical Association (AMA).
The drug, tissue plasminogen activator (tPA),has been long known to significantly reduce long-term disability for patients with acute ischemic stroke; however, to work effectively it has to be administered early—within 60 minutes of patient arrival. The problem, according to study authors, is that less than one-third of patients who could receive the treatment have been getting it within the 60-minute "door-to-needle" timeframe.
That low rate was the target of a treatment initiative called Target: Stroke created by the AHA and ASA in 2010. The goal was to get hospitals to employ combinations of 10 evidence-based strategies to increase door-to-needle rates. The strategies included prenotification of hospitals by emergency medical services personnel, the creation of a single call system that could activate an entire stroke team, premixing of tPA for likely candidates, and a faster process for getting and reading brain imaging, among other approaches.
The initiative was accompanied by an extensive educational and public relations effort that included webinars, interactive video, case studies of successful approaches used by hospitals, and the publication of an "honor roll" of hospitals that raised door-to-needle rates to 50% or higher.
Authors of the JAMA report analyzed 71,169 patients treated with tPA from 1,030 hospitals participating in the Target: Stroke program. Median age of the patient population was 72, with a median onset-to-arrival time of 51 minutes. Just over 50% of patients were women.
The bottom line, according to authors, is that the initiative worked: the number of patients receiving tPA within the 60-minute door-to-needle time increased from 29.6% to 53.3%, with related decreases in hospital mortality, intracranial hemorrhages, and fewer overall tPA complications (an initial worry among some experts). The improved treatment times also resulted in more frequent ambulation at discharge and a greater number of patients being discharged to home. "These findings suggest that the 10 best practice strategies used with this initiative may have contributed to the benefits observed," the authors write.
"There was a prompt improvement in the percentage of patients meeting guideline-recommended door-to-needle times once this quality improvement initiative was implemented," the report states. Authors attribute the effective strategies to the reductions but also acknowledge the importance of the hospital staff environment in making the initiative a success. "Prior experiences of hospitals successful in improving the quality of cardiovascular care suggest that improvement is most effective when integrated into an environment that includes explicit goals; collaborative, interdisciplinary teams; a patient-focused organizational culture; engaged clinical leaders and senior management; and detailed data feedback," they write.
APTA offers resources to physical therapists including a podcast, around care of patients with limitations in functioning after a stroke, and has created a PT's "guide to stroke" and pocket guide to physical fitness for survivors of stroke at its Move Forward website. In addition, PTNow contains tests and measures used in the examination of patients with stroke and provides access to full text of relevant clinical practice guidelines and Cochrane systematic reviews. PTNow’s search engine searches across several stroke-related evidence sites, such as StrokEngine and Evidence-Based Review of Stroke Rehabilitation (EBRSR).
Research-related stories featured in News Now 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.
If you've ever felt like shouting the benefits of physical therapy from the highest mountain, now's your chance: the Nepal Physiotherapy Association (NPA) has opened registrations for its seventh international conference, to be held in Kathmandu, Nepal, in the Himalayan mountains, November 21-22, 2014.
Clinical physical therapists (PTs), educators, and students are invited to submit abstracts on research for possible presentation at the conference, which will combine academic activities and social events. Featured speakers to date hail from the US, Norway, India, Australia, and Poland.
Details on the conference, including registration information, can be found on the NPRA website. Like APTA, NPA is a member organization of the World Confederation for Physical Therapy (WCPT).
Jonathan Blum, principal deputy administrator for the US Center for Medicare and Medicaid Services (CMS), has resigned his position effective May 16, according to an alert from Modern Healthcare (access via free signup).
Blum was the Obama administration's first appointee to CMS, and he led the development of regulations for accountable care organizations (ACOs) as well as "developing many … value-based payment strategies," according to an e-mail from CMS Administrator Mary Tavenner announcing Blum's resignation. Most recently, Blum oversaw the release of extensive Medicare payment data for 880,000 health care providers.
At the time of this writing, details behind Blum's resignation were not available. In her e-mail Tavenner cited "new opportunities" as the reason for his departure.
It may not be a 1-size-fits-all solution, but least 1 fairly large home health care agency thinks it may have hit upon the technology that can best coordinate care, reduce costs, and minimize privacy concerns: the 7-inch mobile tablet.
A recently published case study (.pdf) from the College of Healthcare Information Management Executives (CHiME) tells the story of Sutter Health at Home, a division of Northern California-based Sutter Health. With a program that employs about 1,300 caregivers who make home visits to nearly 100,000 patients across 23 counties, Sutter was on the lookout for technologies that could improve coordination of care and reduce costs.
After experimenting with individual laptops (too big, too hard to learn, glitchy) and smartphones (too small, limited computing and document-handling capabilities, spotty connections), Sutter switched to 7-inch Android-based devices. The devices themselves are the same tablets commonly available to consumers, but these are equipped with electronic health records (EHR) software specially made for Sutter Health at Home. Caregivers are also supplied with a bluetooth-enabled keyboard and a stylus.
According to the case study, the use of tablets dramatically reduced turnaround for patient documentation from 72 to 24 hours. "In the past, if 1 of the clinicians went to see the patient on Monday and the physical therapist would go on Tuesday, the therapist would not have the information about the Monday visit available," said the program's project manager. "This is better from a productivity perspective and better for the patient." Sutter Health at Home also estimates that it has reduced costs in a number of areas, including supply ordering, which is now done directly through the tablet rather than by calling a medical supply vendor.
The home health agency is also pleased with improvements to privacy safeguards. Built-in cameras allow clinicians to send photos quickly and securely—an improvement over past practice of taking pictures with a separate digital camera (that could be lost) and uploading the photos later (a time-consuming process). Another significant benefit: greater IT control over security and the ability to remotely wipe a device clean if it is lost or stolen.
The case study reports that the switch to tablets is not without challenges. Sutter Health at Home invests heavily in training, requiring 18 hours of education on the tablet for any new user. And while the fact that Sutter is using easily available devices makes purchasing easier, it also means that the devices are subject to the same kind of forced obsolescence that can frustrate individual consumers. The platform has also required the agency's IT department to relinquish control of when patches and updates are installed—for tablets a process typically managed by the communications carriers.
APTA offers a variety of resources on home health and physical therapy, including a free video on the role of home health physical therapy in the continuum of care, and a webpage devoted to payment, coding, and billing for home health patients in the Medicare system. The association also offers resources on electronic health records at its EHR webpage.
Peruse articles on the future of health care, and you're likely to read plenty of references to "interprofessionalism" and how it will become central to effective delivery.
But have we agreed on what the word means? And if we can manage to agree on a definition, do we know how to apply it to real-world situations?
Panelists at this year's Rothstein Roundtable at the APTA NEXT Conference and Exposition will investigate some of the current thinking around interprofessionalism and its implementation in physical therapy in a session titled "Interprofessionalism: Is It Campfire Kumbaya, or the Means to the Triple Aim (Better Health, Better Care, Lower Cost)?" The conversation will focus on successful interprofessional models and how they might be generalized into physical therapist practice, and will address how interprofessionalism can be infused in education.
The session will be held from 3:00pm – 4:30 pm Friday, June 13 as part of NEXT activities in Charlotte, North Carolina. Moderator is Anthony Delitto, PT, PhD, FAPTA, with panelists Aaron Friedman, MD, Mary Knab, PT, DPT, PhD, and Holly Wise, PT.
NEXT evolved from the meeting formerly known as the Annual Conference and Exhibition. Though the focus and tone of NEXT will be on what's ahead for the profession, the event will also feature many of the popular elements of past annual conferences including the McMillan and Maley lectures and the Oxford Debate. As with past annual conferences, NEXT will occur immediately after APTA's House of Delegates.
Registration and housing information can be found on the NEXT webpage along with a schedule of presentations and preconference sessions.
The "staggering" increase in obesity rates among Americans is the most likely reason behind a near-doubling in the prevalence of diabetes over the past 20 years, according to a new study, which also found "striking differences" in diabetes rates among minorities. On average, about 10% of the adult US population now suffers from the disease—up from 5.5% in 1994.
The findings, which appear in the April 15 issue of Annals of Internal Medicine (abstract only available for free), point to general improvements in diagnosis rates, with the rate of undiagnosed diabetes estimated at about 11% of total confirmed cases. The study also reports that prevalence of treatment is also more widespread.
Those were just about the limits of the good news, however. The study reviewed 43,439 participants in National Health and Nutrition Examination Surveys (NHANES) conducted in 1988–1994, 1999–2004, and 2005–2010 and found that rates of diabetes climbed as obesity rates rose. Obesity rates are now estimated at just over 32% of Americans without diagnosed diabetes, according to the report.
The rise in diabetes rates was even more significant for certain ethnic groups. While whites reported an 8.6% diabetes rate, non-Hispanic blacks registered a 15.4% rate, while the rate of diabetes among Mexican Americans was estimated at 11.6%. The results are "particularly concerning because blacks and Mexican Americans are also at greater risk for complications from diabetes, particularly retinopathy and kidney disease," the authors write.
APTA emphasizes the importance of prevention, wellness and disease management, and offers resources on diabetes for physical therapists and their patients through its Move Forward diabetes webpage and in a pocket guide to diabetes. The association also offers 21 clinical practice guidelines on care for patients with diabetes as well as 3 Cochrane reviews related to care for patients with diabetes-related foot ulcers through its PTNow evidence-based research tool.
Research-related stories featured in News Now 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. Read APTA's full website disclaimer.
What is professionalism, exactly? Part of a person's character? A set of learned behaviors? In a health care environment that demands increased levels of interprofessional collaboration, how important is it that individual providers understand professionalism across disciplines?
APTA recently hosted a roundtable via Google+ Hangouts event that brought together representatives from physical therapy, nursing, dentistry, pharmacy, and osteopathic medicine to talk about professionalism—what it is, how it's incorporated into education programs, and the importance of understanding how professionalism is manifested in other health care professions. A recording of the session is free to view on the APTA Interprofessional Education and Collaborative Practice Resources webpage.
Be sure to check out the other resources available on the Interprofessional Education and Collaborative Practice Resources webpage to get the latest information on how professions are learning to work together to provide patient- and client-centered care.
The Foundation for Physical Therapy now is accepting applications for the 2014 Florence P. Kendall Doctoral Scholarships and the 2014 Research Grants.
The Kendall Post-Professional Doctoral Scholarships assist physical therapists and physical therapist assistants with outstanding potential within their first year of postprofessional doctoral degree studies. Research grant opportunities are being offered as up to 2 Foundation grants, a Magistro Family Foundation Grant, and a grant for orthopedic research.
The deadline for all applications is Wednesday, August 6, 2014, noon ET—earlier than past years.
Questions? E-mail the Foundation or call 800/875-1378.
Be among the first to receive news about research, funding opportunities, and much more. Sign up today for the F4PT Alert mailing list by contacting Rachael Crockett.
For adults over 70, could the risk of falls due to the effects of antihypertensive medications outweigh the risks of not taking those medications? According to a recent study of nearly 5,000 community-living adults over 70 with hypertension, it's a valid question that should be asked at the individual level.
In an article e-published ahead of print (abstract only available for free) in the February 24 issue of JAMA Internal Medicine, researchers led by Mary Tinetti, MD,concluded that "antihypertensive medications were associated with an increased risk of serious fall injuries," with those taking antihypertensive medications who have already experienced a fall more than twice as likely to experience a subsequent serious fall than those who are not taking the drugs.
"The morbid effects associated with serious fall injuries … which are comparable to those imposed by myocardial infarction and stroke, suggest that treatment decisions should be predicated on maximizing benefit and minimizing harm," the authors wrote.
The study focused on participants in the Medicare Current Beneficiary Survey from 2004 – 2007 who were older than 70, in a community living environment, and were designated as a traditional Medicare beneficiaries (Medicare Advantage beneficiaries were excluded from the research). In all, 4961 participants with a claims-based diagnosis of hypertension were included with a mean age of 80.2 years. Just over 60% were female.
The group was further divided into 3 subgroups, a no-hypertensive medication group (697 participants), a moderate-intensity medication group (2711 participants), and a high-intensity medication group (1553 participants). Researchers then tracked falls incidents for all participants, but limited their review to only serious falls, "which are more clinically equivalent to the cerebrovascular and cardiovascular events that antihypertensive medications are prescribed to prevent."
According to the study, 446 of the 4961 participants experienced a serious fall injury, with 111 of those participants dying during the follow-up period (rates of death were higher for the medication groups, though it was unclear whether death was directly related to the fall). Broken down by subgroup, serious falls were experienced by 52 participants in the no-medication group, 267 in the moderate-intensity group, and 127 in the high-intensity group. When researchers looked further into the histories of the subgroups, they found that for those who had fallen in the year prior, risk of another fall more than doubled for the medication groups. They found no particular class of antihypertensive medication to be more strongly associated with falls risk than another.
"This article highlights some important factors PTs know, but they're ones that bear repeating and should be on our collective radar," says Mindy Renfro, PT, PhD, GCS, research assistant professor at the University of Montana. "Fall risk is multifactorial, and polypharmacy use is high on the list of modifiable risk factors. Cardiovascular medications, including antihypertensive medications, are only surpassed by psychoactive medications in increased risk for falls in all adults—but even more so in older adults. As the profession of choice for falls prevention and management, we need to consider these risk factors."
Authors acknowledged this risk and framed it in light of the relative benefits of antihypertensive medications. "Because most older hypertensive adults have had hypertension and been receiving treatment for many years," they write, "the clinical question is the likely benefit vs harm of continuing medications" at a time when serious falls risk has increased. Researchers wrote that because the morbidity and mortality associated with serious falls-related injuries such as hip fracture and head injury are comparable to morbidity and mortality associated with cardiovascular events, "It is important … to consider the effects of medications not only on the conditions for which the medications are indicated but on coexisting conditions, including fall injury risk."
Renfro pointed out that while health care providers must always be aware of medication effects, particular attention needs to be paid to when a patient begins taking a drug. "PTs and other health professionals should understand that falls due to antihypertensive or psychoactive meds occur most often in the first 2 weeks after a prescription change," she said.
“This research isn’t necessarily news for PTs, but it does point out how important it is for health professionals to recognize the effect that medications can have on a patient’s function, including the very serious risks associated with falls," said Anita Bemis-Dougherty, PT, DPT, MAS, clinical practice director at APTA. "Informing patients of the potential risks of medications and monitoring the effects of the medication on functioning—not just the effect of the medication on the condition being treated—must be considered, particularly in the older adult population."
Authors acknowledged that "although cause and effect cannot be established" through the study, the nationally representative data on older adults suggests an association between the medicines and falls risk strong enough that it should be weighed against the benefits of the drugs on an individual level. "The potential trade-off between serious fall injury and cardiovascular events and mortality suggests that each older adult's prevention priority should drive decision making," they write.
APTA provides continuing education on exercise prescriptions for balance improvement and falls prevention and offers other resources for physical therapists, such as how to develop consumer events on balance, falls, and exercise, information on evidence-based falls programs, and a clinical summary on falls risk in community-dwelling elderly. Members can also access an APTA pocket guide on falls risk reduction (.pdf) as well as an online community where members can share information about falls prevention.
Hypertension clinical practice guidelines and their lack of information on physical activity was the subject of a recent PTNow blog post. Check it out—and join the conversation!
Read APTA's full website disclaimer.
Either you're on The List, or you're not on The List. And you definitely want to be on The List.
And you definitely need to be on The List by April 21.
Time is running out, but your school can still join "The List" of over 70 physical therapist and physical therapist assistant education programs participating in the Foundation for Physical Therapy's popular Miami – Marquette Challenge. The challenge encourages students to be creative in raising funds for physical therapy research, and awards prizes to the top performing schools.
Watch this video to learn more about the Foundation's largest fundraising event. Make your donation to this year's Miami-Marquette Challenge online or mail in the donation form (.pdf) to be sure your school or alma mater is on The List.
Physical therapist (PT) residency and fellowship education programs enrolling their first participants after December 31 will be required to follow new standards for American Board for Physical Therapy Residency and Fellowship Education (ABTRFE) accreditation.
The new procedures include applying for and obtaining recognition as a developing program followed by applying for and obtaining candidate status.
If a residency or fellowship program is currently developing and plans to enroll its first participant on or before December 31, 2014, that program must apply for accreditation using the current procedures by December 31, 2014. Any program that will not enroll its first participant until after December 31, 2014, must follow the new accreditation procedures.
More information, including the ABPTRFE Rules of Practice and Procedure and details on these new procedures, can be found on the ABPTRFE website. For additional questions, please contact APTA staff at firstname.lastname@example.org.
The enforcement delay for the Centers for Medicare and Medicaid Services' (CMS) "2 midnights" rule has apparently left an opening for a legal attack. This week, the American Hospital Association (AHA) announced that it has filed 2 lawsuits against the US Department of Health and Human Services challenging the rule as "wholly arbitrary," according to an AHA press release (.pdf).
Intended to reduce costly admissions in cases better suited to outpatient treatment, the rule stipulates that auditors can presume that an admission is reasonable and necessary if the patient spent at least 2 days as an inpatient, defined as spending 2 midnights in a hospital bed. AHA and some physician organizations view the rule as a usurpation of medical judgment by CMS.
The primary suit (.pdf), filed in the US District Court for the District of Columbia, states that "CMS’s newly-minted 'two-midnights' rule has deprived and will deprive hospitals of Medicare reimbursement for reasonable, medically necessary care they provide to patients. And the rule is arbitrary and capricious: It undoes decades of Medicare policy. It unwisely permits the government to supplant treating physicians’ judgment. And most important, it defies common sense. The word 'inpatient' simply doesn’t mean 'a person who stays in the hospital until Day 3,' and CMS is not at liberty to change the meaning of words to save money."
Although the rule was implemented in October 2013, Medicare Recovery Audit Contractors (RACs) were prohibited from auditing inpatient claims under the 2 midnights rule until September 30, 2014. When Congress passed the sustainable growth rate (SGR) patch legislation in March, the delay on enforcement was extended to March 31, 2015.
CMS still allows Medicare Administrative Contractors (MACs), who process claims for payment, to review and deny payment for short stays if the medical record does not support medical necessity under a “probe and educate” program. This program, which assesses provider understanding and compliance with the 2 midnights rule, will be carried out by the MACs on a prepayment basis through March 31, 2015.
AHA is joined in the lawsuit by several state hospital associations and individual hospitals.
Physical therapists (PTs) have until October 31 to submit abstracts for possible presentations at the 2015 World Confederation for Physical Therapy's (WCPT) Congress in Singapore May 1-4.
WCPT's International Scientific Committee is accepting proposals for platform and poster presentations of research or special interest reports. Platform presentations will be delivered in “classic” format (a session of 8 platform presentations with speakers presenting for 8 minutes) “rapid 5” format (combinations of 10 presentations each delivering key messages using no more than 5 slides in 5 minutes, followed by 15 minutes of discussion of all presentations), or a “state of the art” format (moderator leads a platform presentation session to include sequential high quality abstract presentations of 10 minutes). The "state of the art" format is reserved for presentations "in cutting edge fields likely to influence physical therapy practice," according to WCPT.
Posters will be on display for 1 day during exhibition hours, with presenters assigned a 45-minute period to discuss their poster with delegates.
For more information and instructions, visit the WCPT call for abstracts page, or contact René Malone. The WCPT Congress is held every 4 years, and is the world's largest gathering of physical therapists. APTA is a member organization of WCPT.
Think APTA membership matters? Have we got a week for you.
This week, APTA celebrates the importance of association membership through its "Membership Matters" campaign. It's a time for APTA members to celebrate their connection to the profession's association and to communicate the value of membership to others.
The APTA Membership Matters webpage offers a variety of inspirational resources, including videos and testimonials from physical therapists all over the country sharing why membership is important, and how the association has contributed to their own professional development. There's even a "Promoting Membership" page that offers tips on how to make the case for involvement in APTA.
As helpful as the tips may be, as always, it's the APTA members themselves who make the best case for joining. "I am unable to separate the value of being a physical therapist from the value of APTA," said Leslie Torburn PT, DPT, in her webpage testimonial. "They each exist as they are today because of the other."
With the Centers for Medicare and Medicaid Services' (CMS) release of provider payment data now 3 days old, media attention is turning to discussions of what the data really mean, and the American Medical Association (AMA) is facilitating the discussions by way of media guidelines and a webpage that explains how the data could be easily misinterpreted.
On its "9 ways CMS' claim data could mislead patients, reporters" page, AMA walks readers through issues of accuracy and context that should be considered before drawing conclusions from the massive amounts of data on payments to over 880,000 health care providers. AMA was opposed to the data release.
According to the AMA webpage, the "key takeaway" from the data is to "verify the data before you publish." The physicians' group cites problems from potential errors in actual numbers to the ways in which the data may not accurately represent a physician's entire patient population. Other shortcomings of the data, according to AMA, include its lack of information on patient demographics, the effects of geographic differences in coding and billing, and a lack of specificity around specialty descriptions. "Physicians who appear to have the same specialty could serve very different types of patients and provide a dissimilar mix of services, making some subspecialists appear to be 'outliers,' " the webpage states. APTA has similar concerns about the limits of the data.
APTA staff members are continuing to review the data, which contains information on some 37,000 physical therapists (PTs), and will share findings and updates in News Now and other APTA resources.
President Barack Obama moved quickly today to nominate a replacement for Kathleen Sebelius, who announced her resignation as Secretary of the US Department of Health and Human Services (HHS) on Thursday, by nominating Office of Management and Budget Director Sylvia Mathews Burwell for the post.
The Sebelius announcement came about 6 months after the flawed rollout of HealthCare.gov, the federal insurance marketplace intended to serve uninsured Americans. Although problems were fixed and the program met its goal of getting 7 million signups by March 31, Sebelius weathered harsh criticism for the initial problems.
Burwell has been involved in the federal government since the Clinton administration, having served as chief of staff to former Treasury Secretary Robert Rubin. Before taking the OMB job, she ran the Walmart Foundation and served as president of the Gates Foundation's Global Development Program. She received unanimous consent from the Senate for her appointment to OMB.
A groundbreaking plan to jumpstart physical therapist research in health services and health policy is about to take a big step toward becoming a reality. The Foundation for Physical Therapy has announced that is has released its request for applications for a $2.5 million grant to create a "Center of Excellence" (COE) that would serve as a one-of-a-kind center focused on providing physical therapists with the training they need to expand the profession's research portfolio into underrepresented areas.
The 5-year grant will be awarded to an institution or health systems network to create and oversee the Center of Excellence in Physical Therapy Health Services and Health Policy Research and Training, whose goal is to "develop sustainable research infrastructure and centralized resources to enhance interdisciplinary health services/health policy research by physical therapist scientists," according to the request document.
Letters of Intent to apply to this funding mechanism are being accepted until 5:00 pm June 30. The full application deadline is September 30. The final selection will be announced in early 2015.
“The COE will provide the skills and training to a whole new generation of physical therapists who will produce research that identifies the most efficacious and effective ways to provide high-quality care for our patients,” said Foundation Board of Trustees President William G. Boissonnault, PT, DPT, DHSc, FAPTA, FAAOMPT, in a press release (.pdf).
In 2013, the Foundation raised $3 million, including a $1 million pledge from APTA and donations from over 40 APTA components, to fund the COE and will continue to raise funds for this campaign.
According to a recent federal report on the health of Americans, the US is making steady gains in the number of adults who meet guidelines for physical activity, but obesity rates haven't changed much for any population age group—including children.
The latest findings are included in a progress report (.pdf) on 26 leading health indicators (LHIs) tracked by Healthy People 2020, a federal program that monitors a long list of health objectives. The report compares current LHIs against a baseline as well as goals for the campaign. In the case of adults meeting aerobic physical activity and muscle-strengthening guidelines, the report shows a 2012 rate of 20.6%--up from the 2008 baseline of 18.2% and slightly above the goal of 20.1%.
The news wasn't as good for obesity rates. For adults, obesity rates have actually increased from a 2005-2008 baseline of 33.9% to 35.3%, well away from the 30.5% goal. Obesity rates among children also rose from 16.1% to 16.9%, drifting further away from the program's goal of 14.5%. The latest news on childhood obesity rates runs counter to earlier reports from the US Centers for Disease Control and Prevention that pointed to a dramatic drop.
Overall, the report describes the latest data as "generally positive," with 10 of the 26 indicators showing improvement and 8 showing little or no change since the baseline year. The indicators being monitored through the program are related to more broad topics that include access to health services, preventive services, environmental quality, injury and violence, maternal and child health, mental health, nutrition and physical activity, oral health, reproductive health, social determinants, substance abuse, and tobacco use.
Among other findings in the report:
APTA has long supported the promotion of physical activity and the value of physical fitness, and has representatives on the practice committee of Exercise is Medicine and the board of the National Physical Activity Plan Alliance. The association offers several resources on obesity, including continuing education on childhood obesity, and a prevention and wellness webpage that links to podcasts on the harmful effects of inactivity.
In a study they describe as the first to incorporate analyses of International Classification of Functioning, Disability, and Heath (ICF) data, researchers make a cautious assertion that for individuals poststroke, the use of virtual reality—including commercially available video game systems—produces "a significant moderate advantage" in ICF outcomes compared with conventional therapies.
The findings were the result of an analysis of 26 randomized controlled trials that focused on the use of virtual reality (VR) to augment or replace conventional therapy in populations largely or solely comprising individuals poststroke. Of the studies analyzed, 4 focused on the use of commercially available gaming platforms such as the Nintendo Wii, while the rest used more specialized virtual environment (VE) equipment designed for rehabilitation. The study was published in the March 28, 2014, edition of PLoS ONE.
Although other systematic reviews have been conducted around the effectiveness of VR in rehabilitation, authors of the study in PLoS ONE included more recent trials (14 in all since the last such review) and incorporated ICF data into the meta-analysis. While the authors didn't find any trials that examined ICF outcomes related to body function and structures or environmental factors, and found only 3 that analyzed participation restrictions, they did note "a moderate but reliable advantage of VR therapy over [conventional therapy] in the components of body function and activity."
The authors concede the findings are tempered with limitations. While authors found "strong evidence" for the effectiveness of therapies that incorporated VE, they described the evidence around commercial videogame platforms as "promising" but "too small to draw conclusions." Researchers also cited a "high degree of variability" in the trials, and an insufficient number of studies to allow authors to control for stroke severity or the effects of time poststroke on the outcomes of conventional therapy. In fact, they write, future studies should attempt to clearly define “conventional therapy” to make results more useful.
Research-related stories featured in News Now 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.
Read APTA's full website disclaimer.
When it comes to physical activity and its impact on hypertension, absence definitely doesn't make the physical therapist's heart grow fonder. In fact, the lack of serious consideration of lifestyle interventions in recently published hypertension guidelines could point to a bigger issue, according to the latest PTNow blog post.
The new post recounts the development of 3 sets of blood pressure management guidelines by groups that mostly agree on the use of drug therapy, but disagree on the best way to reach these conclusions.
For physical therapists, however, the real news is what isn't in the guidelines—namely, any serious consideration of lifestyle interventions.
Are the guidelines missing important evidence, or is important evidence just ... missing? Check out the blog and join the discussion.
The Centers for Medicare and Medicaid Services' (CMS) release of payment data sparked plenty of dramatic headlines across the country, but sweeping pronouncements may need to be approached carefully until the information is fully analyzed from multiple perspectives, including overall usefulness.
On April 9, CMS opened public access to payment records on more than 880,000 providers, including almost 37,000 physical therapists (PTs), 48 of whom are listed in the top 2% of providers receiving payment. News sources quickly reported on the overall data, with some even offering an online tool to look up information on providers.
While almost all media outlets tagged the release with headlines pointing to "big payouts" for a small percentage of providers—the New York Times' headline of "Sliver of Medicare Doctors Get Big Share of Payouts" being 1 such example—at least 1 news source noted the need for a more nuanced approach. In its article on the release, the Los Angeles Times reports that "federal officials cautioned against drawing sweeping conclusions about individual doctors from the numbers. High payouts do not necessarily indicate improper billing or fraud, they say. Payments could be driven higher because providers were treating sicker patients who required more treatment or because their practice was focused more on Medicare patients."
APTA staff members are reviewing the data and its organization, and already have one caveat. “It’s important to look at this data in context,” said J. Michael Bowers, chief executive officer of APTA. “It should not be used to draw conclusions about physical therapists and physicians without information about expenses, quality of care, complexity of patients, and volume of patients treated.”
In preparation for the 2014 House of Delegates (House), APTA posted this year's House motions to the House of Delegates page of the APTA website.
Motions are accessible to members and nonmembers, with the opportunity to leave comments or discuss the motions on Twitter using motion-specific hashtags.
APTA members are encouraged to use these public forums, but not as a substitute for contacting their delegate directly to provide feedback.
Delegates are welcome to engage in these public forums but should continue using the House of Delegates Community (open to all APTA members), to participate in or monitor delegate discussion. The Packet I discussion board is for conceptual discussion surrounding this year's motions, and the Motion Cosponsors discussion board is for delegations to indicate cosponsorship for a motion (only the chief, section, and assembly delegates, or their designees, may post messages on these House discussion forums on behalf of their delegations).
"Packet I," a compilation of all main motions to this year's House of Delegates, can be accessed on the House of Delegates Community. The House of Delegates Handbook, which contains reports to the House, was also posted to the House of Delegates Community. Delegates are welcome to use the House Handbook discussion board for discussion related to House reports. Background papers for the House motions will be posted on April 25.
The 2014 House will convene June 9-11 in Charlotte, North Carolina, and will be livestreamed for APTA members.
Please contact Cheryl Robinson with any questions.
Planning on attending the NEXT Conference and Exposition this June? Take some time out to be fabulous.
The Foundation for Physical Therapy has announced that tickets are now available for its 35th Anniversary Gala at The Westin Hotel in Charlotte, Thursday, June 12, 7:30 pm-12:00 am. Tickets are $150 for individuals and $100 for students, and include dinner. Table sponsorships are also available for $2,000 and include 10 tickets. Tickets can be purchased when registering for the NEXT conference online or by calling 877/585-6003.
In addition to honoring this year's Foundation service award winners (.pdf), the gala will commemorate 35 years of Foundation efforts to support physical therapy research.
New this year: Program sponsorship opportunities that offer full or half-page ad space in the program that will be distributed to all gala attendees. The deadline for reserving ad space is April 28.
For any questions about ticket purchases or to find out more about table sponsorship opportunities, please contact Erica Sadiq.
The National Institutes of Health (NIH) center that oversees the NIH grant portfolio for rehabilitation research has announced its search for a director. The National Center for Medical Rehabilitation Research (NCMRR) is looking for "an exceptional and visionary leader" to manage operations that involve over 150 research projects with a budget of more than $66 million.
The primary focus of NCMRR is on research around the health, productivity, independence, and quality of life for people with disabilities. According to the vacancy announcement recently posted, the center's areas of research include a range of subjects from improving movement, promoting recovery, and adapting to a disability to evaluating rehabilitation effectiveness and training in rehabilitation methods and techniques.
Procrastination almost never pays off. But sometimes its consequences can be avoided.
APTA members have been given a brief do-over on early registration discounts for 2 upcoming events, but the windows will soon close, and close for good. So make plans to stop procrastinating.
APTA members who missed the discounted registration deadline for the NEXT Conference and Exposition June 11-14 in Charlotte now have until April 10 to register at the low rate by using the discount code NEXTEB2014E. NEXT evolved from the meeting formerly known as the Annual Conference and Exhibition, and though the focus and tone of NEXT will be on what's ahead for the profession, the event will also feature many of the popular elements of past annual conferences including the McMillan and Maley lectures and the Oxford Debate.
For the even more dedicated procrastinators who also happen to be interested in getting a geographically diverse view of physical therapy, discounted rates have been extended until April 11 for the North American Caribbean Region continuing education conference taking place April 25-27 in Miami. A list of courses and continuing education units awarded is available at the APTA Learning Center. The NACR is a regional body of the World Confederation of Physical Therapy (WCPT), of which APTA is a member organization. APTA is hosting the meeting. For more information on the conference, contact René Malone.
In results that even study authors describe as "surprising," electrical stimulation of the spinal cord accompanied by a home exercise program has helped 4 people with paraplegia regain movement in muscles that had been paralyzed for more than 2 years. The technique, which uses a 16-electrode array implanted on the spinal cord, allowed all 4 patients to regain some voluntary control of previously paralyzed muscles within days of the start of stimulation. The study quickly received coverage from media outlets such as CNN and the Los Angeles Times.
The report, published in the journal Brain, follows up a pilot trial of 1 patient that began in 2009. In that pilot, patient Rob Summers was implanted with the electrodes and engaged in intensive physical therapy using a harness suspended over a treadmill. According to a press release from the National Institutes of Health, which helped fund the study, "with his stimulator active Summers was able to gradually bear his own weight and could eventually stand without assistance from physical therapists for up to 4 minutes." In addition, other related impairments improved over time absent the stimulation, including bladder control and sexual function.
The follow-up study focused on 3 patients, 2 of whom have complete sensory and motor paralysis, and 1 who, like Summers, has complete paralysis but some sensation below the injury. With the stimulator active, all 3 patients were able to engage in some level of voluntary movement in response to auditory cues. Researchers posted a brief video of 1 patient moving his legs and feet voluntarily.
While by no means a return to full function, the ability to engage in voluntary movement of any kind was exciting news for the researchers, who wrote that "We have uncovered a fundamentally new intervention strategy that can dramatically affect recovery of voluntary movement in individuals with complete paralysis even years after injury."
APTA members from across the country met with their legislators on Capitol Hill this week to discuss issues impacting the physical therapy profession as part of the APTA Federal Advocacy Forum, a 3-day event that focuses on the importance of educating legislators on the role, value, and interests of physical therapists (PTs) and physical therapist assistants (PTAs).
The Forum featured several speakers, including Brad Fitch from the Congressional Management Foundation, Stephanie Cutter, host of CNN’s Crossfire, and Rep Jackie Speier (D-CA).
Fitch shared strategies for building relationships with members of Congress and tips for attending events with legislators, and later led a breakout session on how to turn patient stories into effective advocacy tools. Cutter discussed the political climate in Washington, DC, and its impact on health care policy. Speier rallied attendees by sharing her experience with physical therapy and the profound impact it has had on her life.
APTA also presented the 2014 Public Service and Federal Government Affairs Leadership awards at the Forum. Sen Mark Kirk (R-IL) was the recipient of the Public Service Award for his support of the physical therapy profession and for helping bring the benefits of physical therapy to a national stage. The Federal Government Affairs Leadership award was given to Mark Anderson, PT, MPT, from Utah. Anderson has been advocating for the profession for 21 years and during that time has built meaningful relationships with Utah legislators. He also helps mentor students and other Utah members who are getting started in advocacy at the federal level.
The Forum ended April 8, but APTA members can get involved and advocate for the profession by scheduling a district meeting or attending a local town hall event. The House and Senate will be in recess April 14 through 25, and members of Congress will be in their home states and districts during this time. Members who are interested in getting involved in advocacy and grassroots can also join the PTeam to stay up-to-date on the latest legislative issues.
The US Centers for Medicare and Medicaid Services (CMS) is poised to release a publicly available flood of data on individual payments made to over 880,000 providers in the system. The information, which could be posted to the CMS website as early as April 9, would allow anyone to look up an individual provider to track frequency of services, average monthly charges, average monthly payment, and number of beneficiaries treated.
In an April 2 letter (.pdf) to the American Medical Association (AMA), CMS Principal Deputy Administrator Jonathan Blum wrote that CMS decided to release the data in part to "assist the public's understanding of Medicare fraud, waste, and abuse, as well as shed light on payments to physicians for services furnished." As reported in the Washington Post, The Wall Street Journal, and other news outlets, AMA is opposed to the release of the data due to concerns about physician privacy and worries that the data could be taken out of context.
Blum wrote that the Freedom of Information Act (FOIA) requests that were the impetus for the change required CMS to "weigh the balance between the privacy interest of individual physicians and the public interest in disclosure." In making the decision in favor of the release, he stated, CMS "did not consider" how someone might use the data because "a requester's personal interest in disclosure is irrelevant to the public interest analysis."
The data set will be organized by National Provider Identifier Code, Healthcare Common Procedure Coding System code, and place of service (facility or office setting). Each listing will include number of services, average charges and standard deviation, average allowed amount and standard deviation, average Medicare payment and standard deviation, and total beneficiaries treated. CMS will not publish data sets that reflect fewer than 11 beneficiaries and will release no information that would link payments to an identifiable beneficiary.
CMS also plans on easing the ability of researchers to use these data by, among other actions, lifting the prohibition on redisclosure of physician-identifiable information.
APTA is engaged in a large-scale initiative to highlight physical therapy's role in eliminating fraud, abuse, and waste in health care. The effort is the subject of a feature article (members-only access) in the February issue of PT in Motion.
While ankle sprains may be common, some of the commonly held assumptions about self-treatment should be more carefully considered. That's the thinking behind a new Yahoo! Health article that features APTA Media Corps member Eric Robertson, PT, DPT, OCS, FAAOMPT.
In an article published April 3, reporter Laird Harrison interviews Robertson and other health care providers to evaluate whether the widely known "rest, ice, compression, elevation" (RICE) formula is truly the best approach in all cases. According to Robertson, the answer is maybe not. He said that RICE and its related PRICE approach (the "P" is for "protection") "doesn't necessarily reflect modern science."
Interviewees for the article generally support early mobility and exercise, with one provider saying that the RICE approach is good to use while the individual with the injury is waiting to receive treatment. Robertson agreed that while RICE "is not necessarily too dangerous," the public should know "that there is a better way."
Members of APTA’s Media Corps are regularly called upon to share their expertise for media stories on a variety of topics. Media relations staffers stay in constant contact with media who cover health, wellness, and fitness to position physical therapists as the experts in improving and restoring motion in people’s lives.
A recently released report (.pdf) from the federal Food and Drug Administration (FDA) proposes regulating health management health information technology (IT) based on where and how the IT product is used, and not on platforms or product names and descriptions. APTA provided comments on a draft version of the report, which sets the stage for a more nuanced approach to how the government may regulate health IT applications ranging from billing software to robotic surgical control.
The proposed strategy identifies 3 types of health IT functions—administrative, health management, and medical device—and evaluates levels of risk associated with each. Administrative IT functions such as billing and claims processing, inventory management, and scheduling "pose limited or no risk to patient safety and, thus, do not require additional oversight," the report states. The FDA describes health management IT—applications such as provider order entry, patient identification, and access to clinical results—as slightly higher-risk but still not a particular target for FDA oversight. In fact, the report states, even if a particular product meets the definition of a "medical device," if its functionality is within the health management area, "FDA does not intend to focus its oversight on it."
The agency would continue to focus attention on medical devices whose functionality "generally pose a greater risk to patient safety."
APTA presented case scenarios in its comments to the FDA to illustrate its concerns about consumer safety with certain unregulated fitness and wellness health applications. APTA did not request regulation of these health technologies, but advocated for monitoring and enforcement mechanisms. The FDA took note of the concerns, and reiterated in the Health IT report that it “intends to exercise enforcement discretion," even when the applications don't fall into the FDA's high risk categories, a position the agency published in earlier draft guidance documents issued in response to stakeholder comments.
The framework that the FDA proposes for the future of health management health IT consists of 4 "key priority areas:" the identification and adoption of best practices, the use of tools that can assess IT quality, the creation of "an environment of learning and continual improvement," and the establishment of a "Health IT Safety Center" that would allow the public and private sectors to share information on how to continually improve health IT safety and accountability.
The report was required as part of the Food and Drug Administration Safety and Innovation Act of 2012. The Federal Communications Commission and the US Department of Health and Human Services also contributed to the report.
Want more background on health IT from a physical therapy perspective? Check out APTA's online resources on electronic health records and HIPAA. Also check out a CMS website on health IT in general called "eHealth University."
APTA is calling on components to submit their nominations for the 2014 State Legislative Leadership Award, the annual association recognition of an individual member who has provided outstanding service and leadership on behalf of a component's legislative efforts.
The award will be presented at the State Policy and Payment Forum, September 13-15, 2014, in Seattle, Washington. APTA will pay travel expenses for the selected recipient to attend the forum. In addition, the recipient will receive recognition on APTA's website as well as in its publications.
Nominations will be accepted until Friday, May 16. More information on the award, including the nomination form (.pdf), is available at the award webpage. Contact Angela Chasteen with questions.
Dry needling is now included in the scope of practice for licensed physical therapists (PTs) in Utah thanks to legislation signed into law by Utah Governor Gary R. Herbert on April 1.
"We are pleased that the Utah Chapter took this legislative action to ensure that physical therapists in the state are able to legally provide the full range interventions within the physical therapist scope of practice," said APTA President Paul A. Rockar Jr, PT, DPT, MS, in an APTA press release. "This is a step in the right direction to ensure that all patients have access to the care they need from their physical therapists."
The change was initiated after a December 2013 Utah Attorney General opinion that dry needling was not within the legal scope of practice for PTs. The Utah Chapter of APTA pushed for the legislation in what chapter President Curtis Jolley, PT, MOMT, described as "a great team effort and win for the practice of physical therapy in the state of Utah."
The new law requires PTs to meet additional education and training requirements for the intervention, and restricts the activity to PTs who have been licensed for 2 or more years.
Making an ethical decision or evaluating the ethics of a colleague's action requires careful consideration of facts and circumstances that can vary dramatically from one situation to the next. It can be a complicated process for any practitioner, particularly when opinions on ethics can differ, but familiarity with ethical decision-making can help—that's the thinking behind a reorganized APTA members-only offering that collects all of PT in Motion's "Ethics in Practice" articles into one easy-to-access webpage.
The articles, a regular column of the monthly APTA member magazine and written by Nancy R. Kirsch, PT, DPT, PhD, tackle current and complex ethical issues as they appear in real-world practice. APTA's webpage organizes the articles by topic as well as by their relationship to provisions in the Code of Ethics for the Physical Therapist and Standards of Ethical Conduct for the Physical Therapist Assistant. The page also includes links to articles that guide readers through an ethical decision-making process.
The listing of the 2014 candidates for APTA offices appearing in the printed edition of the April issue of PT in Motion contains 2 errors. The office of Speaker is incorrectly labeled “Secretary” and 2 candidates—not 1—are to be elected to the Nominating Committee.
PT in Motion regrets the error.
A corrected slate of candidates will appear in the May issue of PT in Motion. The online April edition of PT in Motion incorporates the corrections.
The elections will take place during the 2014 House of Delegates Meeting in Charlotte.
The deadline for donations to the Foundation's popular Miami – Marquette Challenge annual fundraising event is April 21, which means there's still time to join "The List" of over 60 physical therapist and physical therapist assistant education programs in a contest that can give your program national recognition—and a few prizes, too. Watch this video to learn more.
The Miami-Marquette Challenge encourages students to develop creative ways to raise funds locally and awards prizes to the top performing schools. All participating schools will be recognized in several national publications, and the winning school gets the honor of cohosting next year's challenge. The program has become the Foundation’s largest fundraising event, with all contributions assisting the Foundation in awarding a research grant and a Promotion of Doctoral Studies Scholarship (PODS) to deserving researchers.
Over its 25-year history, the Challenge has involved over 170 PT and PTA programs and raised more than $2.5 million for physical therapy research.
Make your donation to this year's Miami-Marquette Challenge online or mail in the donation form (.pdf) to be sure your school or alma mater is on The List.
April 2 is the last day to get discounted rates on registrations for the APTA-hosted North American Caribbean Region (NACR) continuing education conference in Miami, April 25–27.
The conference brings together physical therapists from the Caribbean, United States, Canada, and South America. This year's conference theme is "baby boomers and women's health," and presentations highlight collaboration across borders and disciplines.
A list of courses and continuing education units awarded is available at the APTA Learning Center. The NACR is a regional body of the World Confederation for Physical Therapy (WCPT), of which APTA is a member organization.
Questions? Need more information? Contact René Malone.
APTA sections have until May 2 to nominate individuals for an association program that will help them develop clinical practice guidelines (CPGs). Successful nominees will be invited to participate in a free July workshop that will address both the big picture and nuts-and-bolts of CPG creation.
The July 23-25 workshop will be held at APTA headquarters in Alexandria, Virginia, and will include a pre-workshop assignment, presentation of a CPG development methodology, and interactive discussion on how to apply the methodology to successfully develop CPGs for the physical therapist profession. This is the third year the association has offered the program.
Sections interested in participating must submit nominations for a guideline development team leader and 2 to 3 team members who have defined a key clinical question or topic that the section has identified as important to its membership. APTA may fund as many as 3 individuals from each guideline development team, and sections can nominate more than 1 team to attend the workshop. More details, including consideration criteria and the nomination forms, are available at APTA's CPG workshop webpage.
For more information, contact Matt Elrod.
A new leg brace that is reducing amputations and allowing wounded soldiers to run again was the focus of a recent National Public Radio feature story that included an interview with the physical therapist (PT) involved in the project.
The story, which aired during the March 31 broadcast of "All Things Considered," describes the success of the IDEO brace, a "deceptively simple" device that is being used on wounded veterans at the Center for the Intrepid facility in the Brooke Army Medical Center near San Antonio, Texas. According to reporter Melissa Block, when used correctly the device allows some wearers to run again, "virtually pain free."
Johnny Gray Owens, PT, was recorded for the story as he helped 2 brace wearers familiarize themselves with the device and monitored their exercises—including running. Owens described the feeling of helping soldiers use their limbs when they might have otherwise requested amputation after seeing other veterans achieve greater mobility through prosthetics.
"Two guys that haven't run, that didn't think they were ever going to run since their injuries—first day, and they're running?" Owens said. "Pretty cool."
Whether you call it a "change" or a "clarification," the fact is this: the Centers for Medicare and Medicaid Services (CMS) is providing more details on skilled maintenance care in the wake of the landmark Jimmo v Sebelius settlement. An article in the April edition of PT in Motion, APTA's monthly member magazine, helps to explain the explanations.
In this month's "Compliance Matters" column, APTA Director of Regulatory Affairs Roshunda Drummond-Dye, JD, writes that the CMS manual updates "shatter the longstanding myth that skilled therapy services can be provided to Medicare beneficiaries only if material improvement in the patient's condition can be proven." The column outlines the history of the settlement and the ways in which CMS has revised Medicare manuals to shed light on exactly how maintenance care will be evaluated.
The PT in Motion article touches on CMS distinctions between restorative care and maintenance therapy, and addresses requirements for documentation in home health settings. The CMS clarifications also were the subject of a recent article in the New York Times that characterized the new language as "a quiet sea change" in coverage.
Hardcopy versions of PT in Motion are mailed to all members who have not opted out; digital versions are available online to members.
Learn more about the impacts of the Jimmo v Sebelius settlement agreement—download a recent APTA podcast that explores what it means for physical therapists.
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