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  • NIH Exoskeleton Shows Promise in Treating Crouch Gait in Children With CP

    Researchers from the National Institutes of Health (NIH) believe they've come up with an exoskeleton with the right combination of features to treat crouch gait in children with cerebral palsy (CP)—the device improves knee extension but does so in a way that allows wearers to use their own muscles.

    Developed by the NIH Clinical Center Rehabilitation Medicine Department, the exoskeleton is intended to nonsurgically address the flexed-knee gait that often leads to losses in walking function and eventual complete loss of walking ability. Crouch gait is common among children with CP, which is the most prevalent childhood movement disorder in the US.

    The study itself was small—just 7 youth aged 5 to 19—but researchers are encouraged by the results. According to an NIH news release, all participants were able to walk independently while wearing the exoskeleton, with 6 of the 7 being able to do so in the first practice session. Knee extension gains of 8 degrees to 37 degrees were recorded for 6 participants, an improvement NIH describes as "similar to or greater than average improvements reported from invasive surgical interventions."

    The most notable part of the improvement, however, was what the exoskeleton didn't do. Unlike exoskeletons designed for use by individuals with paralysis, the crouch gait exoskeleton didn’t take over the movement needed to extend the knee, thereby helping to preserve muscle quality in the wearer.

    A video that accompanies the NIH news release shows a young child with crouch gait walking with and without the device. The change in gait is unmistakable when the exoskeleton is used.

    “The improvements in [the trial participants'] walking, along with their preserved muscle activity, make us optimistic that our approach could train a new walking pattern in these children if deployed over an extended time," said Thomas Bulea, PhD, principal investigator. "This study paves the way for the exoskeleton's use outside the clinic setting, greatly increasing the amount and intensity of gait training, which we believe is key to successful long-term outcomes in this population."

    Still Time to Enter the APTA–Private Practice Section Video Contest

    Fire up those cameras and make room in your bank account, because your video about the power of physical therapy could earn you an extra $3,000.

    APTA and its Private Practice Section (PPS) are calling for entries in a video contest open to all members. Here's how it works:

    1. Create a video no longer than 3 minutes that tells a story about how physical therapists transform society by optimizing movement to improve the human experience, or a video that shows how physical therapy reduces overall health care costs and improves patient outcomes.
    2. Make sure your video meets the technical requirements and that all the appropriate waivers have been signed (details can be found on the video contest webpage).
    3. Submit your video to APTA by September 30.
    4. Dream about what you'll do with $3,000; make notes for your future Academy Award acceptance speech.

    In addition to the $3,000 grand prize, APTA and PPS also will award $1,500 to the second place winner and $1,000 for third place. Check out all the details and download forms at the video contest webpage. Questions? Email Amelia Sullivan. And … action!

    CDC: Rates of Cardiac Rehab Use Among Heart Attack Survivors 'Suboptimal'

    Despite the fact that cardiac rehabilitation (CR) significantly reduces the likelihood that a heart attack survivor will die of a later cardiac-related cause, only about 1 in 3 heart attack survivors in the US receive CR, according to a new analysis from the US Centers of Disease Control and Prevention (CDC). That's a "suboptimal" rate that represents "missed opportunities to access an evidence-based intervention that has been documented to improve patient survival, quality of life, functional status, and cardiovascular risk," the CDC writes in its report on the findings.

    Using results of the Behavioral Risk Surveillance System, a telephone survey conducted annually, the CDC analyzed rates of CR use for 20 states and the District of Columbia in 2013, and 4 states in 2015 (Georgia, Iowa, Maine, and Oregon—also in the 2013 group). Researchers found that not much changed over the 2-year span, with the average use of CR estimated at 33.7% in 2013 and 35.5% in 2015.

    The report also breaks down the use of CR by demographic and other variables. Among the findings:

    • Based on the 2013 data, men received CR more often than did women (36.4% compared with 28.8%), and whites more often than non-Hispanic blacks (35.4% compared with 25.3%).
    • An estimated 46.6% of college graduates received CR, 2 times the rate among individuals with less than a high school degree (23.3%) in 2013.
    • Individuals with some form of insurance in 2013 received CR at a rate of 34.4%, compared with 25.2% of individuals with no insurance.
    • Minnesota was the state with the highest percentage of CR use in 2013, at 58.6%; Hawaii was lowest, with a 20.7% rate.
    • In 2015, among the 4 states studied, Georgia had the lowest CR use rate, at 27.9%. Iowa had the highest rate, with 57.5% of heart attack survivors interviewed reporting that they had received CR.

    Authors of the analysis acknowledge several limitations to their study, including the potential unreliability of the self-reported survey responses, the lack of information on why patients didn't participate in CR, and no details on follow-through among the individuals who did report participating in CR. Still, they argue, those weaknesses don't overshadow the core conclusion: CR is being underused.

    "Health system interventions to promote [CR] referral and use, supported by access to affordable rehab programs within the community, should be prioritized to improve outcomes and prevent recurrent events," authors write. "Some strategies that might improve use of [CR] include higher payments for rehab by insurers, eliminating or reducing copays for patients, and extending [CR] clinical hours to improve access, as well as providing standardized referrals coupled with linkage to [CR] staff member liaisons at hospital discharge or by primary care providers and cardiologists."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    CMS Publishes More Clarification on Jimmo Settlement and 'Improvement Standard' Myth

    The US Centers for Medicare and Medicaid Services (CMS) is making it clearer than ever that the so-called "improvement standard"—the idea that Medicare coverage can only be extended if that care will actually improve the patient's condition—is a fallacy. The new clarity on the validity of skilled maintenance is part of the agency's efforts to comply with a federal court finding that CMS had made "virtually no efforts" to educate stakeholders on the 2013 Jimmo v Sebelius settlement.

    CMS now offers a webpage exclusively devoted to the Jimmo settlement, which established that the improvement standard was a myth (for its part, CMS maintains that it never explicitly supported that standard, even though it was commonly used by contractors as a reason to deny payment). The agency's low-key efforts to educate contractors in the wake of the Jimmo settlement prompted Medicare beneficiary advocates to go back to the courts to compel CMS to do more, arguing that the improvement standard still was being applied by many contractors. APTA was a supporter of those efforts.

    In February, a federal court agreed with the patient advocates and ordered CMS to take "corrective action" that included publishing a new webpage on Jimmo that would contain, among other elements, a clear disavowal of the improvement standard and a list of frequently asked questions about the settlement. The judge gave CMS until September 4 to make it happen.

    CMS complied. Its new webpage states that skilled therapy services are covered by Medicare when an assessment reveals that "the specialized judgment, knowledge, and skills of a qualified therapist … are necessary for the performance of a safe and effective maintenance program " intended to "maintain the patient's current condition or to prevent or slow further deterioration."

    "The Jimmo settlement agreement may reflect a change in practice for those providers, adjudicators, and contractors who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve," CMS states on the webpage. "The Jimmo settlement agreement is consistent with the Medicare program’s regulations governing maintenance nursing and therapy in skilled nursing facilities, home health services, and outpatient therapy (physical, occupational, and speech) and nursing and therapy in inpatient rehabilitation hospitals for beneficiaries who need the level of care that such hospitals provide."

    APTA offers a webpage on skilled maintenance that includes links to a podcast series, a recorded webinar, and several pages of frequently asked questions.

    APTA Provides Comments to CMS, House Subcommittee on Wide Range of Payment and Care Topics

    APTA has released another round of comment letters focused on the future of skilled nursing facility (SNF) payment under Medicare, the US Centers for Medicare and Medicaid Services' (CMS) Quality Payment Program (QPP), and a proposed CMS rule on hospital outpatient prospective payment. But that's not all: the US House of Representatives Ways and Means Committee also received APTA's perspective on a range of issues, including repeal of the Medicare therapy cap.

    Here's a recap of the comment letters. Click on each headline below to access the full version of each CMS comment letter.

    Proposed change to case-mix classification model used in SNF payment
    Although no formal proposed rule has been issued, CMS has signaled that it's interested in feedback on the possibility of replacing the current RUG Version 4 case-mix classification model with a new model called the Resident Classification System, Version I, known as RCS-I (read background on development of the model).

    The RCS-1 model is intended to move SNF payment away from service-based models and tie them to resident characteristics. It's a laudable goal, according to APTA, but the plan itself is based on an inadequate set of patient characteristics and a poor understanding of how comorbidities can impact mobility challenges and needs. The result, according to APTA, is that the model would likely reduce therapy for patients most in need. CMS has acknowledged that RCS-I may incentivize SNFs to reduce therapy services to increase margins.

    APTA's comments make it clear that the association opposes the new model, which it describes as an approach that "perversely disincentivizes the delivery of therapy services without regard for a patient’s clinical needs." Should CMS insist on adopting the RCS-I model, APTA recommends that the new model be phased in over 3 years, beginning no sooner than fiscal year 2020, and that CMS "engage in meaningful dialogue with stakeholders, including APTA, in advance of the release of any proposed rule."

    Proposed Outpatient Hospital Prospective Payment System (OPPS)
    For physical therapists, the biggest news about the proposed OPPS rule may be that CMS is considering paying for total knee arthroplasties (TKAs) as an outpatient procedure, but there's more to the proposal than that: CMS would also like to return to "nonenforcement" of direct supervision of outpatient therapeutic services for critical access and small rural hospitals.

    In its comments to CMS, APTA offers its support for both proposed changes. The association advises that CMS proceed carefully when it comes to outpatient TKA. Paying for TKAs in both the inpatient and outpatient settings would likely mean that the inpatient setting would be left to deal with the more complex cases—no big surprise, APTA writes, but something that CMS should keep in mind when it reviews data to make payment decisions, reviews that take in 3 years of data at a time. "If CMS does not make adjustments to the case-mix rates, it could lead to unintended consequences such as a decline in patient referrals to necessary postoperative services, such as physical therapy, in efforts to lower the episode cost to meet an unrealistic target," APTA writes.

    When it comes to backing off on enforcement of supervision requirements in critical access and small rural hospitals, APTA recommends that CMS make this change clear to contractors and prohibit them from conducting retroactive supervision reviews until the new rule is in place. "A retroactive policy will best reflect CMS’ acknowledgement of the unique burden that CAHs and rural hospitals face to employ a sufficient number of health care professionals to meet direct supervision requirements for specialty services such as physical therapy," according to APTA.

    Proposed updates to QPP
    CMS could expand its comprehensive QPP to physical therapists (PTs) as early as 2019, requiring to participate in programs such as the merit-based incentive payment system (MIPS) and advanced alternative payment models (APMs). These changes will be felt by PTs "across the entire spectrum of the therapy delivery system," APTA tells CMS.

    The association's extensive comments to CMS provide APTA's perspective on how CMS should bring PTs into QPP. Among the association's recommendations for MIPS: add PTs to MIPS in 2021 (starting with data from the 2019 reporting year), create a "pick your pace" program for participation, and include low-volume providers in MIPs. When it comes to APMs, APTA recommends that CMS rethink its thresholds and exclusions around qualified providers (QPs) permitted to participate in APMs, and to offer more guidance and education on participating in APMs.

    "Physical therapists are committed to providing care to Medicare beneficiaries through quality improvement programs and APMs," APTA writes. "APTA looks forward to working with the agency to ensure that MIPS and APMs are structured in a manner that is patient-centered, provides high-quality care, and seamlessly coordinates care throughout the health care continuum."

    House Ways and Means Health Subcommittee on the Medicare Red Tape Relief Project
    The House Ways and Means Health Subcommittee is asking for suggestions on how to reduce Medicare regulations and mandates that impact care delivery. APTA happens to have a few ideas in that department. Though not directly related to any proposed CMS rule, the association's comments to the House subcommittee echo at least 1 of the positions APTA shared with CMS earlier this year: getting rid of the Medicare therapy cap is in the best interests of patients and would make the Medicare system less burdensome.

    The letter to the House committee also recommends the elimination of the 30-day certification and 90-day recertification requirements for patients seeking physical therapy services, making functional limitation reporting more provider-friendly, and modifying the SNF 3-day inpatient stay requirement to count days spent in observation toward satisfying the 3-day inpatient hospital stay requirement for Part A coverage of SNF care.

    Registry to Collect Torticollis Data Through Collaboration With Academy of Pediatric Physical Therapy

    APTA's Physical Therapy Outcomes Registry (Registry) has taken another step in the development of resources that will provide "a continuous feedback loop" for the physical therapy profession—this time, by way of a clinical "module" focused on torticollis.

    Recently the association signed an agreement with the Academy of Pediatric Physical Therapy to collaborate on the creation and integration of a congenital muscular torticollis module within the Registry. The module will be based on the academy’s clinical practice guideline on the topic.

    In Registry terminology, a “module” is a set of data elements that describe and risk-adjust process-of-care and clinical outcomes for a defined patient population. These condition- or disease-specific data elements are based on evidence-based clinical practice guidelines and will help refine the way outcomes data is analyzed and interpreted for specific populations. Modules will build on the current functions of the Registry, which collects a core set of patient and outcomes data from an electronic health record.

    The torticollis module will include more granular information, such as description of the type of cranial deformity, right side or left side of the head, and torticollis severity, among other factors. Analyzing a large amount of this data will help describe typical physical therapist practice patterns, variations in care, and the effectiveness of physical therapy interventions in different types of patients—all key elements in the Registry's mission to amass outcomes data to inform practice and enhance research.

    “This is the Registry’s first module agreement with an APTA section, and we look forward to more such collaborations in the future,” said James Irrgang, PT, PhD, ATC, FAPTA, scientific director of the Registry’s Scientific Advisory Panel. “The process of care and clinical outcomes data from modules will provide a continuous feedback loop not only for physical therapists but for guideline developers.”

    APTA is working with other sections to develop guideline-based modules in other areas, such as shoulder pain and neck pain.

    For more information about participating in the Physical Therapy Outcomes Registry and how sections can play an integral role in module development, visit www.ptoutcomes.com.

    APTA Resource Makes it Easy to Deliver Personalized Comments On Proposed Home Health Rule

    If a rule from the US Centers for Medicare and Medicaid Services (CMS) is adopted as proposed, physical therapists (PTs) and physical therapist assistants (PTAs) who work in home health could find themselves in a very different payment environment as early as 2019. That new environment could include a shift from 60- to 30-day episodes of care, and the startup of a new way to make case-mix adjustments that removes physical therapy service-use thresholds from the mix. All told, the changes being proposed could result in a $950 million payment reduction to home health, according to CMS.

    But the rule won't be finalized until later this year, and CMS is asking for public comments on its proposal. Ready to fire up your computer?

    APTA offers a template letter for PTs and PTAs who want to comment on the proposed 2018 home health prospective payment system (HH PPS) and the plans for changes to the case-mix adjustment methodology being considered for 2019. Among other positions, the letter encourages CMS to approach the new case-mix model, part of what's known as the Home Health Grouping Model (HHGM), in a budget-neutral manner and to audition the program by way of a limited demonstration project before making system-wide changes.

    Posted as a Microsoft Word file, the letter was created with the technical formatting that CMS is accustomed to, but it also includes areas that can be personalized with details and examples from the individual PT's or PTA's practice. Those personal touches can help to underscore the messages that the letter's shared elements deliver to CMS with a unified voice—namely, the concern that the HHGM "severely devalues the clinical importance of physical therapy" and negatively affects the most vulnerable patients who have the greatest need for rehabilitation.

    APTA outlined the basics of the proposed rule in a PT in Motion News story and will submit its own comments to CMS by the September 25 deadline. More information on the proposed rule is available through a CMS fact sheet.

    APTA just completed a live webinar on the proposed home health changes. PT in Motion News will alert readers when a recording of that session becomes available.

    APTA, Women's Section Help Clear Up Misinformation in NPR 'Mummy Tummy' Report

    Despite what you may have heard, if the idea of a single, daily, 10-minute exercise being the solution to diastasis recti, aka "mummy tummy," seems too good to be true, that's because it probably is. APTA and its Section on Women's Health, attempted to set the record straight.

    During the August 7 broadcast of NPR's Morning Edition, correspondent Michaeleen Doucleff reported on her experiences with a daily 10-minute abdominal exercise whose proponent, Leah Keller, a personal trainer, claims will close separated abdominal muscles often associated with women postpartum. The text version of the story that appeared on NPR's website under the rosy headline: "Flattening The 'Mummy Tummy' With 1 Exercise, 10 Minutes a Day."

    According to the story, Michaeleen reduced the separation in her abdominal muscles from 1.2 inches to .6 inches over 6 weeks, and other women in her exercise group did the same or better through the exercise. NPR reported that the program was supported by a pilot study of 63 women who all saw their diastasis recti fixed after 12 weeks.

    Not so fast, said APTA and the Section on Women's Health (SOWH). After the story aired, SOWH Vice President Carrie J. Pagliano, PT, DPT, contacted APTA with a suggestion that the section and the association point out some of the misinformation in the story. Together, SOWH President Patricia Wolfe, PT, MS, and APTA President Sharon Dunn, PT, PhD, drafted a letter to NPR describing several elements of the story that were "misleading to women seeking out help for diastasis recti." Pagliano also holds clinical specialist certifications in both orthopaedics and women's health; Dunn is a board-certified specialist in orthopaedics.

    The letter explained that besides the idea that a single short-duration exercise could be the quick-fix solution to diastasis recti, the story also contained factual errors about the kinds of exercises women postpartum should and shouldn't do. In the story, Keller tells these women to "please don't ever again in your life do crossover crunches or bicycle crunches," claiming that "they splay your abs in so many ways."

    In reality, the opposite could be the case, according to Dunn and Wolfe: contracting the rectus abdominis with a curl-up exercise has been shown to decrease muscle separation, while the exercise described in the story—a contraction of just the transverse abdominal muscle—has been associated with increased muscle separation while potentially improving how well the abdominals handle load. "It's not as simple as the '1 muscle-1 exercise approach' proposed by Keller," they write.

    Further, the authors point out, the study on which the program is based has several flaws, including the fact that only 29 of the 63 women in the study were postpartum, no explanation was provided for how diastasis recti was measured initially, and no control group was used.

    "Diastasis recti is not well understood and more research, including standardization of assessment, etiology, and clinical practice guidelines, is required," write Dunn and Wolfe. "In the meantime, a women's health physical therapist trained in the assessment and treatment of patients concerned about diastasis recti can be beneficial both during and after pregnancy to guide participation in exercise."

    In a follow-up report aired August 20, NPR acknowledged that the story received a "huge" response and included quotes from the Dunn and Wolfe letter. In that story, NPR described the criticism it had received, provided more information on the exercise in question, and included descriptions of other exercises that could be helpful, as well as advice from Dunn and Wolfe that "if done properly, the crossover crunches and bicycle crunches would actually help a woman restore the strength to all of her abdominal muscles."

    CMS MAC Claims Review Process Will Move to More Targeted System

    The US Centers for Medicare and Medicaid Services (CMS) will move away from its current practice of randomly selecting claims for audit in favor of a more targeted approach that it hopes will streamline the process and result in fewer appeals.

    The program, dubbed Targeted Probe and Educate, directs Medicare administrative contractors (MACs) to select claims for items or services "that pose the greatest financial risk to the Medicare trust fund and/or those that have a high national error rate," focusing only on "providers/suppliers who have the highest claim error rates or billing practices that vary significantly out from their peers." The program was piloted in 1 MAC jurisdiction in 2016, and expanded to 3 more in July of this year. All MAC jurisdictions will be following the procedure "later in 2017," according to a CMS fact sheet.

    Once a claim and provider have been targeted, MACs will begin a multiphase process by probing 20-40 claims per provider. If the provider is found to be noncompliant, the provider must participate in education on meeting requirements. After the education phase, the MAC must wait 45 days or more before reviewing another batch of 20-40 claims. At that point, the MAC can either determine that the provider is in compliance or submit the provider to another round of education and later review. Should a third review round not make a difference in compliance, the provider will be referred to CMS for possible further action.

    The new process moves away from the "Probe and Educate" program, a less-targeted process that resulted in more reviews—and more appeals from providers. According to an article in Modern Healthcare, CMS has 667,000 pending appeals and expects that number to rise to 687,000 by the end of 2017, and more than 1 million by 2021.

    2017 ELI Fellows Graduate From APTA Education Leadership Institute

    Eighteen seasoned physical therapy educators have deepened their knowledge and skills over the past year, thanks to the APTA Education Leadership Institute (ELI) Fellowship. These physical therapists (PTs) made up ELI's sixth cohort of ELI Fellows when they graduated in July after completing a yearlong higher education program that consisted of:

    • 9 online modules provided by content expert faculty;
    • 3 2-day face-to-face mentorship sessions and ongoing mentorship provided by experienced physical therapy program directors;
    • higher-education mentorship provided by physical therapy education leaders; and
    • implementation of a personal leadership plan and an institution-based leadership project.

    The ELI Fellowship strives to provide new and aspiring program directors in physical therapist and physical therapist assistant education programs with the skills and resources they need to be innovative, influential, and visionary leaders who can function within a rapidly evolving, politico-sociocultural environment.

    Partners who help promote and support the ELI Fellowship include the American Physical Therapy Association, American Council of Academic Physical Therapy, Education Section, and PTA Educators Special Interest Group. See who graduated from this year's class and find more information about the ELI Fellowship on APTA's website, and view video testimonials of previous ELI graduates.

    The program was first accredited by American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE), the accrediting body for postprofessional residency and fellowship programs in physical therapy, in 2012 and reaccredited in 2017 for a 10-year period.

    What's the Latest at CMS? Your Guide to Recent Proposed and Final CMS Rules

    The US Centers for Medicare and Medicaid Services (CMS) spent its spring and summer issuing proposed and final rules on areas ranging from the Medicare physician fee schedule, to what skilled nursing facilities will be paid and what they'll have to report, to inpatient reimbursement and home health episodes of care.

    Here's a quick guide to where some of these rules stand, and resources available from APTA—including an August 23 webinar focused on big changes CMS is eyeing for home health beginning in 2019 (11:30 am – 1:00 pm, ET). To register for the webinar email advocacy@apta.org.

    Medicare Physician Fee Schedule (MPFS)
    Status: Proposed; comments due September 11
    Resources: CMS fact sheet; PT in Motion News coverage
    The big news from the proposed MPFS for 2018 is that values for current procedural terminology (CPT) codes will be maintained—and a few even increased—after talk of the possibility that some of these codes were "misvalued." APTA is preparing comments on the proposed rule and has created a template letter for individual physical therapists (PTs) to send to CMS that covers both the proposed MPFS and more general Medicare issues.

    Home Health Prospective Payment System (HH PPS)
    Status: Proposed; comments due September 25
    Resources: CMS fact sheet; PT in Motion News coverage; August 23 webinar
    The fact that CMS will further reduce payment in 2018 by an estimated $80 million isn't exactly news—that cut is part of a series of reductions mandated by the Affordable Care Act (ACA). What is news is the CMS plan to reduce the unit of home health payments from 60-day to 30-day episodes of care, and to remove therapy service-use thresholds to make case-mix adjustments to HH payments in favor of "clinical characteristics and other patient information." Both of those changes would begin in 2019 under the proposed rule. APTA is preparing comments and is offering a webinar on August 23 from 11:30 am – 1:00 pm (ET) to outline the basics of the proposal and how to engage with CMS on the rule. To register for the webinar email advocacy@apta.org.

    Inpatient Prospective Payment System (IPPS)
    Status: Final; effective October 1, 2017
    Resources: APTA summary; CMS fact sheet; PT in Motion News coverage
    Acute care hospitals (ACHs) will see an estimated $2.4 billion increase in fiscal year 2018 (which begins October 1, 2017), while long-term care hospitals (LTCHs) will see a $110 million drop. Other highlights of the final rule include a CMS announcement that it will make medical record reviews a "low priority" when it comes to the requirement that physicians must certify that a patient admitted to a critical access hospital (CAH) will be discharged or transferred within 96 hours of admission, and the implementation of a 1-year moratorium on a policy that ties LTCH payment rates to ACH rates if an LTCH admits more than 25% of its patients from a single ACH. Another change: beginning in fiscal year 2019, CMS will include dual-eligibility status as a component in calculating penalties under the readmissions reduction program.

    Skilled nursing facility prospective payment system (SNF PPS)
    Status: Final; effective October 1, 2017
    Resources: APTA summary; CMS fact sheet; PT in Motion News coverage
    The final SNF PPS includes an overall 1% payment increase, changes to reporting requirements, and updates to the list of quality measures related to skin integrity, self-care, and mobility. CMS also will expand the window for its review of claims data related to potentially preventable 30-day readmissions. Previously CMS used a single year's worth of claims data; the rule expands that window to 2 years, an increase that CMS says will increase the number of SNFs with sufficient numbers of cases for public reporting.

    Inpatient Rehabilitation Facility Proposed Payment System (IRF PPS)
    Status: Final rule – effective October 1, 2017
    Resources: APTA summary, CMS fact sheet, PT in Motion News coverage
    Like SNFs, IRFs will see a 1.9% payment increase—about $75 million—for fiscal year 2018. The "60% rule"—a requirement that for an IRF to receive payment, 60% of its patients must require treatment for 1 or more of 13 conditions—has been adjusted to address diagnoses for patients with traumatic brain injury and hip fracture, as well as multiple trauma codes that didn't translate between ICD-9 and ICD-10. The new rule also requires IRFs to report standardized patient assessment data across 5 categories: functional status; cognitive functions; impairments; medical conditions and comorbidities; and special services, treatments, and interventions. Additionally, beginning in FY 2020, CMS will replace the current pressure ulcer measure with an updated version of the measure, an action that APTA supported in its comments.

    CMS Wants to Scale Back CJR Bundling Program for TKA, THA; Proposes Cancelling Bundle Program for Cardiac Care, Eliminating Expansion of CJR to Hip, Femur Fractures

    In brief:

    • Proposed rule would reduce the number of geographic areas required to participate in the Comprehensive Care for Joint Replacement (CJR) bundling model from 67 to 34
    • Low-volume and rural hospitals in all 67 areas would not be required to participate in CJR, but could do so voluntarily
    • Plans to implement a bundling model for cardiac care have been shelved, as are plans to expand CJR to include care of hip and femur fractures
    • Requirements for becoming a qualified provider in the CJR as an advanced alternative payment model would be broadened to include clinicians who don't have a financial arrangement with a facility but who are employed by the facility or have a contractual agreement

    The US Centers for Medicare and Medicaid Services (CMS) wants to significantly scale back the knee and hip joint replacement bundled care model and plans to cancel expansion of bundled care models to cardiac care and hip/femur fractures. The announcements were made as part of a package of proposals unveiled on August 15 that also includes some loosening of requirements for a provider to be considered as a "qualifying provider" under the joint replacement bundle program.

    The hip and knee bundle program, known as the Comprehensive Care for Joint Replacement (CJR) model, launched in 2016 as the first-ever attempt by CMS to mandate bundled care—in the case of CJR, that requirement applies to 67 different geographic areas covering some 800 hospitals. Under the proposed rule change, the number of geographic areas required to participate in CJR would drop to 34, leaving participation voluntary for all hospitals in the other 33 areas, or about 350 facilities. CMS estimates that 60 to 80 hospitals will choose to voluntarily participate. Hospitals that can and do decide to opt out of the program will have episodes beginning at any point during 2018 cancelled.

    In addition to reducing the number of geographic areas required to participate in the CJR, CMS is proposing that low-volume and rural hospitals in the remaining 34 areas also be switched from mandatory to voluntary participation.

    Per the same proposed rule, CMS would cancel a planned expansion of mandatory bundling to cardiac care, as well as expansion of the CJR to include care for hip and femur fractures. Those expansions originally were set to be put in place in February of this year but were later delayed until October 1, and then pushed back again to a January 2018 startup date. The proposed rule effectively would cancel the programs.

    As CMS taps the brakes on the CJR, it also proposes making it easier for clinicians to be included as qualifying participants in the bundling program. Under the proposed rule, providers—including physical therapists—who don't have a financial arrangement with a facility in the CJR program, but who are either directly employed or contractually engaged with a participating hospital, would be accepted into the program. It would be up to the hospitals to supply CMS with an "engagement list" of those providers, and CMS would take it from there, using Medicare Part B claims data to decide whether a clinician can be considered an advanced alternative payment model qualifying provider. Clinicians who get the nod from CMS would not be required to report to under Merit-Based Incentive Payment System (MIPS) and could be eligible for payment bonuses up to 5%. (Because physical therapists are solely voluntary participants in MIPS as of now, they wouldn’t be subject to the MIPS reporting requirement even if they don’t participate in an advanced APM—but that could, and is expected to, change in future years.)

    CMS has issued a fact sheet on the proposal. APTA staff are reviewing the proposed rule and will provide comments by the October 15 deadline.

    The Good Stuff: Members and the Profession in Local News, August 2017

    "The Good Stuff" is an occasional series that highlights recent, mostly local media coverage of physical therapy and APTA members, with an emphasis on good news and stories of how individual PTs and PTAs are transforming health care and society every day. Enjoy!

    Ashleigh Dalton PT, DPT, cofounder of Camp Cliffview, talks about how the program provides opportunities for children with special needs. (BlueRidgeNow.com)

    Jessica Dufault, PT, explains how addressing separation of abdominal muscles in women post-birth requires more than an exercise or 2. (Offspring.lifehacker.com)

    Jan Dommerholt PT, DPT, gives Good Morning Washington a glimpse of what exergaming is all about. (Good Morning Washington)

    Tom Hulst, PT, MHS, and Jen Kurnowski, PT, discuss dry needling for back pain. (West Michigan Fox 17 News)

    The Brenau University physical therapy program's pro-bono physical therapy clinic in Georgia, is benefitting students and patients. (Gainesville, Georgia, Times)

    Caitlin Jones, PT, DPT, talks about the progress of a remarkable 5-year-old recovering from a gunshot wound. (WSB-TV2, Atlanta, Georgia)

    Eric Robertson, PT, DPT, provides insight on how exercise can help keep back pain from becoming chronic. (Oprah.com)

    University of Mary, North Dakota, PT students work with engineering students to create adaptive cars inspired by the Go Baby Go program. (Bismarck, North Dakota, Tribune)

    "Jonathan continues to recover from his accident, and Laura continues to stand beside him as he does. One day, Laura was shadowing Jonathan's physical therapy session when his therapist invited her to help lift him out of his wheelchair. 'As soon as we got him up, he started kissing my neck,' Laura said. 'We hadn't been able to stand and hold each other since before the accident ... It gave me the chills. You don’t realize how much that means until it’s almost taken away from you.'" - Laura Browning Grant, whose husband, Jonathan, is recovering from an automobile accident, on the viral video of their first kiss in months. (Self.com)

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

    Study: Prevalence of Knee OA Today Twice What It Was 75 Years Ago

    Knee osteoarthritis (OA) has more than doubled among Americans since 1940, say researchers, and the increase can't be explained by longer lifespans or a higher prevalence of obesity and overweight in recent decades. Instead, the real culprit could be physical inactivity, which authors describe as "epidemic in the postindustrial era."

    The study, appearing in the Proceedings of the National Academy of Sciences, compared knee joints of 2,756 skeletons from 3 groups of individuals: those who lived in the 1800s and early 1900s ("early industrial," N=1,581), those who lived during the late 1900s through the early 2000s ("postindustrial," N=819), and prehistoric hunter-gatherers who lived between 6,000 and 300 BCE (“prehistoric,” N=176). Researchers were looking for knee joint eburnation—the ivory-like result of bone-on-bone contact that occurs after cartilage erodes—as the indicator for moderate to severe OA.

    Here's what they found:

    • The prevalence of knee OA in the postindustrial skeletons was about 16%, a rate 2.6 times higher than the early industrial group, which had a 6% incidence rate. Knee OA prevalence among the prehistoric sample was 8%.
    • After controlling for body mass index (BMI) and age when that information was available (1,859 of the 2,756 skeletons), researchers were unable to establish a correlation between these factors and prevalence of knee OA—instead, rates remained 2 times higher for the postindustrial group even when compared with early industrial skeletons with similar ages and BMIs. BMI for the prehistoric sample could not be estimated.
    • In the postindustrial individuals with knee OA, 42% had the disease in both knees. Bilateral occurrence was 30% among the early industrial samples with knee OA, and 17% among the prehistoric group.

    "Although knee OA prevalence has increased over time, today's high level of the disease is not, as commonly assumed, simply an inevitable consequence of people living longer and more often having a high BMI," authors write. "Instead, our analyses indicate the presence of additional independent risk factors that seem to be either unique to or amplified in the postindustrial era."

    The researchers believe that risk factor could have to do with "environmental changes"—namely, the reduced levels of physical activity associated with the postindustrial era, despite the human body's need for regular exercise. It's a phenomenon known as a "mismatch disease," when the human body can't easily or rapidly adapt to changes in the lived environment.

    "Although altered loads generated by walking more frequently on hard pavement … or with certain forms of footwear … might be factors, another possibility that merits more study is physical inactivity, which has become epidemic during the postindustrial era," authors write. "Less physically active individuals who load their joints less develop thinner cartilage with lower proteoglycan content … as well as weaker muscles responsible for protecting joints by stabilizing them and limiting joint reaction forces."

    The good news, according to the researchers, is that their findings point to the possibility that knee OA is a largely preventable condition—providing there's a widespread "reappraisal of potential risk factors that have emerged or intensified only very recently."

    "As with other mismatch diseases, it is likely that any effective prevention strategy will involve adjusting physical activity patterns and diets to approximate more closely the lifestyle conditions under which our species evolved," authors write.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Technological Possibilities, Practical Challenges: Report Looks at Assistive Technologies in the Workplace

    Assistive technologies to help individuals in the workplace are developing at a rapid rate, but if the promise of these technologies is to be fully realized then thinking around access, user training, reimbursement, and other barriers needs to catch up. That conclusion echoes throughout a new report from the National Academies of Science, Medicine, and Engineering.  Authors of the study include Physical Therapy (PTJ) Editor-in-Chief Alan Jette, PT, PhD, MPH, FAPTA, and Linda Resnik, PT, PhD, FAPTA, and executive director of the Center on Health Services Training and Research (CoHSTAR).

    "The Promise of Assistive Technology to Enhance Activity and Work Participation" is the result of an extensive review of the literature pertaining to assistive products and technologies, a series of public meetings on the topic, and a public teleconference that invited expert comment. The purpose: to develop an analysis of the adult use of assistive technologies including wheeled mobility devices, upper-extremity prostheses, and technologies designed to assist with hearing, speech, and communication.

    The report, available to download for free, isn't just an account of what's out there and how far assistive technology has come—it's also an examination of the challenges of putting these technologies to their most widespread and effective use.

    "The committee's review of the literature and the expert opinions of its members and others who provided input for this study made clear that appropriate-quality assistive products and technologies … may mitigate the impact of impairments sufficiently to allow people with disabilities to work," authors write. "In some cases, however, environmental and personal factors create barriers to employment despite the impairment-mitigating effects of these products and technologies. In addition, maximal user performance requires that individuals receive the appropriate devices for their needs, proper fitting of and training in the use of the devices, and appropriate follow-up care."

    That concept of barriers and training needs colored most the committee's conclusions, which include recommendations that point to the importance of proper fit, ongoing follow-up, better training for providers, and an understanding among employers and others that a device that may be useful to an employee today may become less useful over time.

    Authors also addressed the lag-time that can exist between effective technologies and a payer's willingness to provide reimbursement for those technologies.

    "The provision of assistive products and technologies … is contingent largely on reimbursement policy rather than patient need," authors write. "In some cases, the products and technologies that are covered by Medicare and other insurers as medically necessary are not those that would best meet the needs of users to enhance their participation in life roles."

    Funded by the Foundation for Physical Therapy , CoHSTAR is a multi-institutional, multi-disciplinary center dedicated to advancing health services and health policy research capacity in physical therapy.

    Population Health Resources Help PTs, PTAs Make the Case for Employer-Sponsored Programs

    Increasingly, employers are warming to an idea already familiar to many physical therapists (PTs) and physical therapist assistants (PTAs): investing in prevention and wellness efforts makes sense both in terms of overall health care and company bottom lines. Now APTA is helping PTs and PTAs interested in making that idea a reality for more employers.

    The "Working With Employers Toward Population Health" webpage is an area devoted to providing PTs and PTAs with resources to help them make the case to employers that preventing noncommunicable diseases among employees—or addressing them before they become symptomatic, disabling, and costly—is a smart move, and one that the physical therapy profession is poised to lead in collaboration with other disciplines.

    The webpage offers a perspective paper and recorded webinar on direct-to-employer physical therapy, and includes past articles from PT in Motion magazine that explore how employer self-insurance opens up opportunities for PTs and PTAs in the population health space. The page also features an inspiring blog post from Mike Eisenhart, PT, that challenges the profession to "actually deliver on the mandate of our vision and, in so doing, deliver on the essential promise that we help individuals and populations alike move away from disease and toward improved health and quality of life."

    The association will continue adding resources as they become available as part of larger efforts by APTA to support PTs and PTAs in promoting population health to transform society. Those efforts include an upcoming webinar looking at the social determinants of health and how they're measured across populations. The webinar itself is set for September 21, 1:00 pm–2:00 pm (ET), but registrants will be provided material to read in advance.

    APTA Formalizes Partnerships with Special Olympics, Move Together, AAOMPT

    There are some great organizations out there doing things that align with APTA's vision to transform society, many of which have worked with APTA informally for years. So what would happen if those organizations took the next step and formally combined forces with APTA to seize on opportunities to work together?

    We're about to find out. 

    APTA has established an "APTA Partners" program aimed at developing formal connections with organizations with shared goals. The first 3 official APTA partners are organizations that already have a history of working with the association. They are:

    The American Academy of Orthopaedic Manual Physical Therapy
    Also known as AAOMPT, the academy is a national organization committed to excellence in orthopedic manual physical therapy, with Fellows who provide the highest level of musculoskeletal care through advanced manual therapy practice. 

    AAOMPT and APTA have enjoyed a strong collaborative relationship for more than 20 years, working together on legislative efforts, advocacy campaigns, and initiatives in education and research. For many years APTA has designated AAOMPT as the US representatives to the International Federation of Orthopaedic Manipulative Physical Therapists, a subgroup of the World Confederation for Physical Therapy. Read more about the partnership in this APTA news release.

    Move Together
    Founded by Efosa Goubadia, PT, DPT, and Josh D'Angelo, PT, DPT, Move Together aims to increase access to quality rehabilitation medicine "around the corner and around the world." Its programs are focused on increasing the quality and quantity of clinics, empowering clinicians, and inspiring leaders. 

    APTA and Move Together have collaborated around the PT Day of Service, an initiative that Goubadia and De'Angelo began in 2015 and that has grown rapidly since. More recently, Move Together launched its Clinic Development Program, where volunteers work side-by-side with local community members, PTs, and municipalities to build rehabilitation clinics from the ground up and then equip and operationalize the facilities for sustainability. Read more about the partnership in this APTA news release.

    Special Olympics International
    This well-known global movement is centered on creating a new world of inclusion and community, where all people are welcomed and accepted regardless of ability or disability. Special Olympics provides year-round sport training and athletic competition in a variety of Olympic-type sports for children and adults with intellectual disabilities, giving them continued opportunities for physical fitness. 

    The Special Olympics-APTA partnership builds on the longstanding relationship that already exists between the 2 organizations, opening up possibilities to team up on joint advocacy initiatives and collaborative research. Read more about the partnership in this APTA news release.

    APTA has a well-established Strategic Business Partners program focused on relationships with for-profit companies, but this is the first time the association has formalized relationships with nonprofit organizations that share many of APTA's values.

    You Down With QPP? Watch and See (And Take the Quiz)

    Medicare payment is poised to change in big ways for physical therapists (PTs) in private practice. Are you ready?

    APTA can help. Since late 2015, the association has been rolling out new resources to help members prepare for what's coming down the pike as the US Centers for Medicare and Medicaid Services (CMS) implements its Quality Payment Program (QPP). The program already is significantly changing how some health care providers report to Medicare, and those changes likely will be required of PTs in the near future.

    The association's latest offering: a 4-minute video featuring Heather Smith, PT, MPH, APTA's director of quality, on reporting through MIPS and APMs, 2 of the biggest changes to how CMS will be doing business.

    Don't miss the video. But before you do, take this quick PT in Motion News quiz to find out just how much you know about what's happening. Consider it a kind of warm-up exercise—answers are at the bottom of this quiz. Also check out another quick questionnaire that looks at your readiness for payment reform in general.

    1. What does MIPS stand for?
    A. Meta-Inquiry on Performance Statistics
    B. Medicare-Implemented Payment Scale
    C. Madness-Inducing Participation Structure
    D. Merit-Based Incentive Payment System

    2. Successful participation in Advanced Alternative Payment Models (APMs) could result in a lump sum additional payment each year of how much?
    A. An amount equal to 2% of the previous year's fee-for-service payments
    B. An amount equal to 3% of the previous year's fee-for-service payments
    C. An amount equal to 5% of the previous year's fee-for-service payments
    D. An amount equal to 7% of the previous year's fee-for-service payments

    3. How soon can PTs expect to be required to participate in QPP?
    A. 2018
    B. 2019
    C. 2020
    D. They are required to participate this year

    4. Which MIPS performance category will include measures that were reported under the Physician Quality Reporting System?
    A. Advancing care information
    B. Improvement activities
    C. Cost
    D. Quality

    5. How high will MIPS noncompliance payment penalties be by 2022?
    A. 5%
    B. 7%
    C. 9%
    D. 12%

    6. True or false: clinicians participating in an advanced APM must continue to participate in MIPS.

    7. True or false: the Comprehensive Care for Joint Replacement model is considered an APM.

    8. To qualify as an approved APM, a program must require at least 50% of eligible clinicians to use certified electronic health record technology during the first year. What percentage is required in the second year?
    A. 50%
    B. 64%
    C. 70%
    D. 75%

    9. How can the APTA Physical Therapy Outcomes Registry help PTs participate in QPP?
    A. Participation in the Registry earns PTs points toward MIPS improvement activities.
    B. The Registry can package data for submission to MIPS.
    C. PTs are able to receive real-time feedback on their performance throughout the year.
    D. All of the above.

    10. True or false: QPP changes will be limited to only Medicare Part B for the forseeable future.



    1. Answer: D. It's the Merit-based Incentive Payment System, and although the change might spark the fear of madness among PTs, things may not be as dire as all that: PTs who report to PQRS already know how to do much of the quality reporting required by MIPS, and PTs can voluntarily participate in MIPS risk-free this year so they can hit the ground running when QPP participation becomes a requirement.

    2. Answer: C. When APMs succeed in reducing providers’ spending, they may receive a payment equal to 5% of the previous year's payments. The payments will be made 2 years after the performance period being evaluated.

    3. Answer: B. While not certain, there is a strong likelihood that PTs will be required to participate beginning in 2019.

    4. Answer: D. Data previously reported under PQRS will be included in the Quality category. The Cost category will contain new measures still being worked out by CMS; Improvement Activities will include elements such as practice access, population management, care coordination, and beneficiary engagement; and Advancing Care Information encompasses the former electronic health records (EHR) "meaningful use" program under PQRS. Although PTs weren't required to participate in the meaningful use under PQRS, they will be required to do so under MIPS—meaning if you haven't established a relationship with an EHR program, now would be a good time to start.

    5. Answer: C. CMS is not playing around. Penalties for noncompliance could be as steep as 9% by 2022.

    6. Answer: False. Clinicians can choose to participate in QPP either through MIPS or through participation in an APM—they don't have to do both; in fact, they have to choose 1 or the other.

    7. Answer: True – for the most part. One of the CJR tracks is an APM, along with several others listed on the CMS Centers for Medicare and Medicaid Innovation webpage.

    8. Answer: D. At least 75% of eligible clinicians must use certified EHR technology by the second year of operation.

    9. Answer: D. APTA's Physical Therapy Outcomes Registry is a storehouse, a data packaging service, and an ongoing feedback loop all in 1.

    10. Answer: False. Look for QPP provisions to spread to private payers—and probably sooner than you think.

    Shaping the Future of PT Clinical Education: Your Perspective Needed

    A sweeping effort to create a shared vision for physical therapist (PT) clinical education has led to a set of recommendations that could help shape the future of the profession. Now your input is needed.

    Launched by the APTA House of Delegates in 2014, the effort is guided by the Education Leadership Partnership, a group including representatives from The American Council of Academic Physical Therapy (ACAPT), APTA, and the Education Section of APTA. The interrelated recommendations now up for input were created by the Best Practices for Physical Therapist Clinical Education Task Force, a group charged with "proposing potential courses of action for a doctoring profession to move toward practice that best meets the evolving needs of society."

    The task force recommendations were reviewed and modified by the APTA Board of Directors and presented in a report to the 2017 House of Delegates.

    The partnership is offering 2 opportunities for feedback: a virtual town hall on August 17, 8:00 pm–9:30 pm (ET), and an in-person town hall on October 12 held as part of the APTA Education Leadership Conference in Columbus, Ohio. Registration information and instructions for preparing for the town halls are available on the task force webpage. That webpage also includes an informational video on the recommendations.

    Can't make either event? Stay tuned for an online survey about the recommendations coming in mid-August. PT in Motion News will announce the survey's launch date when it becomes available.

    From PTJ: PTs Should Wake Up to Their Role in Promoting Sleep Health

    The old "you snooze, you lose" adage couldn't be further from the truth.

    Researchers are gaining more and more insight on the role of sleep in overall health, and physical therapists (PTs) should be equipped to help their patients and clients understand that role, according to authors of an article that provides guidance on basic screening tools and sleep hygiene education. In fact, authors argue, it's an especially important consideration for PTs, who often work with patient populations whose conditions are associated with sleep disruption.

    Appearing the August issue ofPhysical Therapy(PTJ), APTA's scientific journal available for free to all members, the "Perspective" article lays out some stark numbers: between 50 and 70 million adults in the US experience chronic sleep disturbances, and 62% of all Americans experience a sleep problem several nights a week—and it's likely those numbers are low, authors write, because estimates are that as many as 90% of sleep problems go undiagnosed. The problem is so pervasive that the US Centers for Disease Control and Prevention has designated insufficient sleep as a public health problem.

    Writing that sleep "has an important role in the proper functioning of most, if not all, body systems," authors explain sleep's role in immune function and tissue healing, pain modulation and perception, cardiovascular health, depression and anxiety, motor skill learning, and cognitive function. Among the physical therapy patient population, sleep disturbance can be an especially prevalent issue for individuals with Parkinson disease, Alzheimer's diseases, multiple sclerosis, spinal cord injury, neck and back pain, and postoperative status, among a host of neurological and orthopedic conditions, authors write.

    "It is suspected that the prevalence of sleep disorders and disturbances in physical therapy clients is very high, although studies are needed to verify this concentration," state the study's authors. "There is much opportunity for PTs to play an active role in providing sleep health education … and potentially reduce the onset of chronic conditions in addition to promoting sleep health in all clients."

    So what can the PT do? Authors suggest a multistep approach that begins with an assessment of overall sleep health and screening for the risk of a sleep disorder, with a referral for additional assessment if the PT finds increased risk. Additionally, PTs should provide "sleep hygiene education"—the basics of health sleep that include regular sleeping and waking hours, changes to diet to avoid eating large meals close to bedtime, and avoiding light-emitting electronics within 30 minutes of trying to sleep, among other tips (the entire sleep hygiene education list is included in the article).

    Authors write that PTs also should provide an appropriate exercise program that can help regulate sleep, and consider discussions about body positioning in bed, as well as bed mobility issues for clients where indicated.

    In addition to the sleep hygiene tip list, the article includes charts on suggested screening tools to assess for the 3 most common sleep disorders—chronic insomnia, obstructive sleep apnea, and restless legs syndrome—as well as questionnaires to help determine overall sleep quality and daytime sleepiness. Authors also discuss the use of wearable consumer electronics to track sleep, saying evidence supporting their reliability is slim but that they may be useful as a way to help individuals feel they have more control over regulating their sleep patterns.

    Authors of the study also argue that given the increasing weight of evidence showing the relationship of sleep to almost all facets of health, PT clinical education programs "should consider including information about sleep, screening for sleep disorders, and methods to optimize sleep in their curriculum."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    APTA Reaches 100K Member Milestone

    It's official: APTA is now 100,000 members strong.

    Just how many people is 100,000? It's more than would fit in the Rose Bowl, or the Cotton Bowl, or Wembley Stadium in London. The APTA population is larger than the population of Atlantic City, New Jersey, and just about the size of Charleston, South Carolina, or Green Bay, Wisconsin. It's a big number, to be sure, but more important for APTA, it's a number that represents an opportunity for the physical therapy profession to give even stronger voice to its commitment to patient-centered care.

    The association reached the milestone on August 4, after a spring and summer campaign highlighting the ways APTA membership benefits both the individual member and the profession as a whole. The accomplishment comes as the association begins readying itself for its centennial in 2021, and amid a rapidly changing health care environment.

    "I could not be more pleased that APTA has reached this incredible milestone," said APTA President Sharon L. Dunn, PT, PhD, in a news release. "Membership enables personal development and accelerates our profession's collective progress. With health care rapidly evolving, there's never been a more important time to combine our strengths in pursuit of APTA's bold vision of a society transformed through optimized movement."

    The physical therapist whose membership got APTA to the 100,000-member milestone is Sam Seybold, PT, DPT, of Guthrie, Oklahoma. Seybold rejoined APTA after taking an assistant professor position at Langston University.

    “With rapidly changing technology and research, now more than ever it’s important to keep up and stay abreast of all the new stuff,” said Seybold, who cited the camaraderie of interdisciplinary health care teams as 1 of his favorite aspects of being a physical therapist.

    Are you a former member of APTA? Explore the expanded list of benefits and join today!

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    Opioid Crisis in the News: More than 1 in 3 Americans Prescribed Opioids in 2015

    As the statistics pile up, the conclusions become unavoidable: the country's opioid crisis is deeply rooted, and its effects are wide-ranging. Here are some of the latest reports on the magnitude of the problem.

    Reuters: More Than a Third of US Adults Prescribed Opioids in 2015
    "People who were between ages 18 and 49 years, men, or college graduates were less likely to have been prescribed opioids than those who were older, female, or not college graduates."

    New York Times: White House Commission Recommends Declaring National Emergency on Opioids
    "Dr. Tom Frieden, the director of the Centers for Disease Control and Prevention during the Obama administration, said declaring a public health emergency under the Stafford Act, as the commission recommended, was usually reserved for natural disasters like hurricanes."

    USA Today: Proportion of Drivers Killed While Under Influence of Opioids Shows Huge Spike
    "Researchers found that the prevalence of drivers with prescription opioids detected in their systems at the time of death surged from 1.0% in 1995 to 7.2% in 2015."

    UPI: Opioid Abuse Down in Younger Americans, But Up Among Older Adults
    "Researchers found that the prevalence of drivers with prescription opioids detected in their systems at the time of death surged from 1.0% in 1995 to 7.2% in 2015."

    Washington Post: Leftover Opioids Are a Common Dilemma for Surgery Patients
    "At least two-thirds of patients reported having leftover opioids afterward; often more than half the prescribed pills were unused."

    APTA's #ChoosePT campaign is aimed at informing consumers that physical therapy is an effective alternative to drugs for the treatment of pain. Housed at MoveForwardPT.com/ChoosePT, #ChoosePT includes a video public service announcement, as well as other targeted advertising and media outreach. Members can also learn more about the PT's role in pain management through offerings on PTNow, including a webpage with resources for pain management and an opioid awareness checklist.

    Final Inpatient Payment Rule Increases ACH Payments by $2.4 Billion, Cuts LTCH Payments by $110 million

    In brief:

    • Final rule from CMS increases acute care hospital payment by an estimated $2.4 billion, less than the $3.1 billion in the proposed rule
    • Long-term care hospitals (LTCHs) will see payments drop, but by less than proposed—a $110 million cut in the final rule, compared with proposed cut of $171 million
    • LTCH quality-reporting requirements related to skin ulcers will change; requirements will also include information on ventilator weaning
    • Final rule institutes a 1-year moratorium on 25% threshold policy for LTCHs
    • Patient satisfaction survey questions on pain will focus on communication about pain, not pain management

    Acute care hospitals (ACHs) will receive a $2.4 billion increase in payment rates in 2018 and see a relaxation in some reporting requirements related to electronic health records (EHRs) under the final prospective payment system (PPS) rule issued by the Centers for Medicare and Medicaid Services (CMS) on August 2. The long-term care hospital (LTCH) situation isn't as positive, however, with a projected 2.4% cut on the books for fiscal year (FY) 2018.

    The inpatient prospective payment system (IPPS) final rule (CMS fact sheet here) covers a range of areas related to how ACHs and LTCHs will operate in relation to Medicare and Medicaid beneficiaries. Here are a few highlights of the rule:

    • The ACH payment increase amounts to a $2.4 billion increase, less than the $3.1 billion in the proposed rule, but about 3 times the increase in FY 2017 ($746 million).
    • As in the proposed rule, the final rule sees CMS backing off on quality-measure reporting requirements for hospitals involved in Medicare and Medicaid EHR incentive programs. Participating hospitals can anticipate a drop in both the number of times participating hospitals need to report, as well as the number of quality measures they include in the reports.
    • In addition to the 2.4% payment reduction, LTCHs also will have a 1-year moratorium on a policy that applies to LTCHs that admit more than 25% of their patients from a single acute care hospital. Under the current policy, payments for all patients over that 25% threshold are made at a rate comparable to an ACH. The final rule suspends that threshold for a year.
    • The LTCH quality-reporting program will move toward updated pressure ulcer measures and will include additional measures related to ventilator weaning—but not until FY 2020.
    • After suspending consumer survey questions on pain management that some stakeholders felt may have been working at cross-purposes to efforts to fight the opioid epidemic, CMS will reinstate 3 questions related to pain, but the new questions will be focused on communication about pain rather than pain management.

    The new rule will take effect October 1, 2017. APTA regulatory affairs staff members are reviewing the final rule and will publish highlights in the coming weeks. PT in Motion News will share links to those highlights when they become available.

    'Choosing Wisely' App Now Available

    Now it's easier than ever for consumers to make well-informed health care choices—including choices about physical therapist interventions.

    The American Board of Internal Medicine Foundation has unveiled the first "Choosing Wisely" app for iPhone (iPad and Android versions to follow soon), a tool that enables consumers and clinicians to access more than 500 specialty society recommendations on procedures that tend to be done frequently, yet whose usefulness is called into question by evidence. The program was developed in partnership with Consumer Reports.

    Through the new app, clinicians and consumers will be able to search the recommendations using keywords and filter by specialty, age, setting, and service (for example, imaging, medication, treatment, lab, or test). Recommendations are linked to relevant patient-friendly resources, and information can be shared via text or email.

    APTA was the first nonphysician group to release a "Choosing Wisely" list in the fall of 2014, joining more than 50 medical specialty societies participating at the time. The 5 APTA recommendations, which are expanded upon with citations at the Choosing Wisely website and in the downloadable list of "5 Things Physical Therapists and Patients Should Question," are:

    • Don't use (superficial or deep) heat to obtain clinically important long-term outcomes in musculoskeletal conditions.
    • Don’t prescribe under-dosed strength training programs for older adults. Instead, match the frequency, intensity, and duration of exercise to the individual’s abilities and goals.
    • Don’t recommend bed rest following diagnosis of acute deep vein thrombosis (DVT) after the initiation of anti-coagulation therapy unless significant medical concerns are present.
    • Don’t use continuous passive motion machines for the postoperative management of patients following uncomplicated total knee replacement.
    • Don’t use whirlpool for wound management.

    The process for developing the list began with an open call for APTA members to submit their lists of questionable procedures. After receiving more than 170 submissions, APTA convened an expert group of physical therapists from a wide range of practice settings and areas of clinical expertise. The group reviewed all nominations and conducted extensive literature reviews to narrow down the list to 9 procedures. The list of 9 was presented to the members of APTA, who voted on the final 5.

    APTA's participation in "Choosing Wisely" is part of the association's Integrity in Practice campaign to support the profession of physical therapy as a leader in the elimination of fraud, abuse, and waste in health care. The APTA Center for Integrity in Practice houses information on the "Choosing Wisely" program as well as a primer on preventing fraud, abuse, and waste, an online course on compliance and professional integrity, and other resources.

    Final IRF, SNF Rules for 2018 Vary Little From Proposed Rules Calling for 1% Increases, Quality Reporting Changes

    The final 2018 rules for inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) released by the US Centers for Medicare and Medicaid Services (CMS) don't vary much from the proposed versions issued this spring, following through with proposals for an overall 1% payment increase, changes to reporting requirements, and updates to the list of ICD-10-CM codes the agency uses to evaluate facility compliance with the so-called “60% rule.” That rule states that 60% of an IRF's patients must require treatment for 1 or more specified conditions.

    As in the proposed rules, payment increases amounting to $80 million for IRFs and $390 million for SNFs are included, as are increased quality-reporting requirements—and consequences for noncompliance. More detail on the proposed rules appears in a PT in Motion News story published in May. CMS has published fact sheets on both the SNF and IRF final rules.

    In its comments to CMS on the proposed rules (SNF comments here, IRF comments here), APTA supported several provisions, including a plan to revamp the existing "pressure ulcer quality" measure and remove the "all-cause unplanned readmission" measures. Additionally, the association agreed with CMS on its plan to update the list of codes on the "presumptive compliance list," the list on which the 60% rule is based. Those proposed changes remain in the final rules.

    APTA regulatory affairs staff members are reviewing both final rules and will publish highlights in the coming weeks. PT in Motion News will share links to those highlights when they become available.

    From PT in Motion Magazine: The PT as Inventor

    Sometimes, clichés exist because they're true.

    Take "necessity is the mother of invention." Physical therapists (PTs) know all about the necessity part: patients need to regain, increase, or maintain mobility, and PTs constantly need to be on the lookout for ways to help make that happen. And when none of the usual ways seems to work? That's when some PTs become inventors.

    "Inventional Thinking," a feature article in the August issue of PT in Motion magazine, recounts the efforts of several PTs who've developed products or technologies that have helped to fill gaps in rehabilitation. The inspiring PTs profiled include:

    • Romina Bello, PT, DPT, who led a team of PTs and occupational therapists at the Henry Ford Health System in the creation of a high-acuity walker that makes it easier to get patients in intensive care units up and walking while minimizing risk of falls or loss of lines to the patient—and with the assistance of only a PT and respiratory therapist
    • Thubi Kolobe, PT, PhD, who worked with an engineering professor to develop the Self-Initiated Progressive Prone Crawler, a skateboard-like device that allows babies with physical limitations to crawl, an important developmental milestone
    • Daniel J. Lee, PT, DPT, whose prototype limbWISE app is designed to make it easier for patients adjusting to use of a prosthesis to manage fitting issues
    • Scott Rogoff, PT, DPT, ATC, developer of the dynamic ankle rehabilitation trainer (DART), a device—now in its fourth iteration—that aids recovery from ankle injuries by helping to strengthen anterior ankle muscles
    • Bryce Taylor, PT, MSPT, the inventor of the Halo Trainer, a device that gives PTs the ability to put handlebars on stability balls

    In addition to the inventors' own accounts of how they birthed their ideas into reality, the article features tips and advice for PTs thinking about inventing—including possible funding sources.

    "Inventional Thinking" is featured in the August issue of PT in Motion and is open to all viewers—pass it along to nonmember colleagues to show them 1 of the benefits of belonging to APTA. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.