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  • Health Officials Unsure of Link Between Paralysis and Virus; Virus Now in 40 States

    Colorado health officials now report that 10 children are experiencing paralysis and muscle weakness that may or may not be linked to Enterovirus D-68 (EV-D68), a respiratory infection that has now spread to 40 states.

    According to a report in the Denver Post, 8 of 9 children originally diagnosed with myelitis were tested for viral outbreaks, with 4 testing positive for EV-D68, and 4 testing positive for rhinovirus or another enterovirus. At the time the Denver Post report was written, officials had not provided testing information on the 10th child.

    No definitive connection between EV-D68 and the paralysis and weakness has been established. The Denver Post reports that "there are no cases where the children are completely unable to move, just varying degrees of muscle weakness, difficulty swallowing, difficulty breathing, weakness in the neck and trunk, and difficulty walking."

    According to the Centers for Disease Control and prevention, the children tested negative for West Nile virus and polio.

    In response to the reports, the CDC has issued a health advisory asking that health departments inform the CDC of any patients under 21 who have experienced acute onset of focal limb weakness on or after August 1, and who have an MRI showing a spinal cord lesion largely restricted to gray matter.

    While researchers look to establish or eliminate EV-D68's role in the paralysis and weakness, the Washington Post reports that the virus has been found in 40 states and the District of Columbia. Children with asthma or other preexisting respiratory problems tend to be especially hard-hit by EV-D68. According to the Washington Post article,  277 cases have been reported to date.

    Earlier this year, 20 children in California were reported to be experiencing similar neurological symptoms, with 2 testing positive for EV-D68. According to a story from the Associated Press, the CDC is still unsure if there is a connection between the virus and the paralysis and weakness in the California cases.

    APTA Helps Spread the Word About Safe Needle Practices

    APTA has joined a national campaign to help raise awareness about safe needle practices and injections in health care.

    Led by the Centers for Disease Control and Prevention (CDC) and the Safe Injection Practices Coalition (SIPC), the One and Only Campaign brings together professional organizations, health care certification groups, health care systems, private companies, educational institutions, state and local health departments, and others to support the dissemination of safe injection messages using social media, electronic continuing medical education, advertising, and print materials for health care providers and patients.

    In addition to APTA, campaign members include the Ambulatory Surgery Center Association, the American Podiatric Surgery Association, and the Association of Occupational Health Professionals in Healthcare.

    Resources available from the One and Only website include a patient brochure (.pdf), patient frequently asked questions, and a provider training unit on bloodborne pathogens. The campaign also offers a YouTube channel with provider-focused informational videos.

    Safe conduct of any invasive procedure such as dry needling, some forms of wound care, and electromyography are important components of physical therapist practice. In addition the resources now available to members through APTA's partnership with the One and Only Campaign, the association has developed a paper outlining the safe and effective performance of dry needling (.pdf).

    Exercise Programs Likely to Help People With Lower Limb Amputations, But Best Combination Still Unclear

    There is a need for more definitive and rigorous studies, say researchers, but a new systematic review of the effects of exercise programs on gait performance in people with lower limb amputations points to some positive connections—even if specifics were hard to come by.

    The review, published in the September 28 issue of Prosthetics and Orthotics International (abstract only available for free), found 623 article citations for studies of gait among people with lower limb amputations and eventually whittled acceptable research down to 8 studies involving 199 participants. These studies allowed researchers to compare self-selected gait speed among patients who received specific functional exercise programs, but in the end they did not reveal a single exercise program or combination that could be deemed most effective.

    Authors focused on self-selected gait speed as "the only consistent measure of gait performance" among the studies.

    The actual degree of improvement difference was difficult to pin down, authors write, based in part on inconsistencies in the studies, and wide variation of exercise programs used. Still, they write, "The combined evidence suggests that a variety of different types of exercise can improve self-selected gait speed," and that "improvement in gait performance was seen throughout whether participants were in their third or seventh decade, and whether only men or men and women were combined." No study focused on women only.

    The range of exercises in the studies included activities targeted at supervised walking, specific muscle strengthening, balance, gait training exercise, and functional training focusing on coordination exercises "beyond walking and stair negotiation." Exercise treatment duration ranged from 3 days to 14 months, and from 2 to 40 individual sessions of 30 to 90 minutes. Physical therapists were identified as treatment providers in all but 1 study, which did not specify who provided treatment.

    "Little evidence consistently differentiated which type of exercise was most beneficial," authors write, although improvement occurred "whether most exercise was performed as an unsupervised home exercise program, in focused daily treatments provided within a single week, or in regular sessions spanning months."

    Overall, authors write, the evidence reviewed is only sufficient for a "Grade B" recommendation to support the use of exercise programs that use a range of methods, meaning that more research work needs to be done before a solid analysis can be conducted. "No consensus on a best approach emerged," they write. "This review underscores the need for more and higher quality research into the clinical benefits of specific exercise programs in lower limb amputation rehabilitation."

    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 Says Keep Using 59 Modifier for Now

    Until you receive further notice, keep on using the 59 modifier in reimbursement claims to indicate that a health care common procedural code (HCPCS) represents a service that is separate and distinct from another service to which it is paired under the Correct Coding Initiative (CCI) program—that's the bottom line from the Centers for Medicare and Medicaid Services (CMS), which recently responded to an inquiry from APTA as to when—and whether—physical therapists should use a set of new modifiers announced by CMS in August.

    The clarification was forwarded to APTA by CMS after some physical therapists questioned whether they should begin using the new modifiers. The CMS answer: not yet.

    In August, CMS issued a transmittal describing new modifiers—XE, XS, XP, and XU—intended to be used to define subsets of the 59 modifier. The new modifier codes have not been implemented, and CMS has advised that PTs should not use the modifiers until they receive further notice.

    Medicare Pioneer ACO Program Continues to Lose Members

    The Medicare "Pioneer" program that targets more sophisticated health systems to foster the development of accountable care organizations (ACOs) has now lost about 40% of the systems that signed on initially. According to an article in Modern Healthcare (access available via free one-time registration) the most recent withdrawals "suggest even the most sophisticated health systems may be unwilling to take losses as policymakers test new payment and delivery models."

    The most recent exits—Franciscan Alliance, Genesys PHO, and Renaissance Health Network—bring the Pioneer list from its original 32 members to 19. The Modern Healthcare article reports that 9 of the 13 ACOs that dropped out did so within the first year of the program's launch in 2012, opting instead to join the "less risky" shared savings program, the traditional Medicare program that allows other entities to form ACO. Unlike the Pioneer program, the number of entities joining the shared savings program has been steadily increasing.

    The Pioneer program was designed to help ACOs transition from a fee-for-service payment structure to improve patient care, increase Medicare savings, lower costs, and to test alternative program designs to inform future rulemaking for the Medicare Shared Savings Program. The ACOs in the Pioneer program were generally considered ones that were willing to withstand potential losses in hopes of achieving bonuses for meeting various quality and spending metrics.

    Modern Healthcare reports that while the ACO program is generally helping to set the stage for more widespread use, critics of the Pioneer program contend that Medicare's bonus formulas are "skewed in favor of [ACOs] that operate in markets that have above-average health spending, where hospitals and doctors have more opportunities for savings." The article describes how Medicare announced that its ACO initiatives saved $817 million through 2013, and how "dozens" of program participants shared in $445 million in bonuses, "but three-quarters saw nothing after failing to do sufficiently well against the financial benchmarks."

    APTA members can learn more about a physical therapist's role in an ACO by visiting APTA's webpage, FAQ: Accountable Care Organizations (ACOs): Medicare Shared Savings Program and Pioneer Models.

    November PT in Motion Cover? You Decide

    When it comes to deciding on art for PT in Motion magazine, APTA members have it covered.

    It's time once again for members to help PT in Motion magazine decide the design to be used on the cover of the upcoming issue. For November, editorial staff is proposing 2 designs and asking members to vote on their favorite cover to illustrate the concept of physical therapy across the lifespan The design that receives the most votes will be the next cover.

    Take the quick and simple survey by October 1. Just pick the design you think is likely to get you to open up the magazine, and then check out the November issue to see which cover was most popular.

    Suggestions for APTA Board, Nominating Committee Due by November 3

    As APTA continues to grow, so does its need for exceptional leaders. Anyone come to mind? Maybe you?

    The APTA Nominating Committee is seeking recommendations for the 2015 slate of candidates for elected positions. Positions open for election are Board of Directors president, vice president, and 3 directors; and 1 Nominating Committee member.

    Use the online nomination form to submit the names of qualified members who would be willing to be considered for the upcoming election cycle. Deadline is November 3.

    Now's the time. Reach out to a leader you think should take those talents to a national level for APTA, and who's ready to guide the association through some exciting years ahead.

    New Program on Early Mobilization of ICU Patients Seeks Participants

    Physical therapists have long been aware of the importance of early mobilization and rehabilitation for patients in a hospital intensive care unit (ICU). Now a new program is recruiting hospitals to participate in a project to spread that understanding by facilitating practices that can more quickly liberate patients from mechanical ventilation and move them out of the ICU.

    The Comprehensive Unit-Based Safety Program (CUSP) for Mechanically Ventilated Patients (MVP) and Ventilator Associated Pneumonia (VAP) is seeking so-called "coordinating entities" interested in participating in a 2-year program to prevent ventilator-associated events including VAP. A free 90-minute informational webinar on the program will be held on Monday, September 29, at 1:00 pm ET.

    The program focuses on improvement in staff teamwork and communication, analysis of daily process measures, efforts to mobilize patients earlier, and employment of low tidal volume ventilation strategies. Project content will be delivered through webinars, e-mail, and as online resources, and all materials are available on the CUSP 4MVP VAP project website.

    The initiative is funded by the Agency for Healthcare Research and Quality, and is being delivered in partnership with the Johns Hopkins Institute for Patient Safety and Quality, the Michigan Health and Hospital Association, the Department of Population Medicine at Harvard Medical School, and the Harvard Pilgrim Health Care Institute. APTA and its Acute Care Section provided consultation on the development of this program.

    For more information, contact the project helpdesk at cusp4mvp@jhmi.edu.

    Get Ready for National Physical Therapy Month!

    With National Physical Therapy Month (NPTM) coming in October, now's a perfect time to begin making plans to celebrate the profession and increase understanding of how physical therapy can transform society.

    Visit the APTA NPTM webpage for everything you need to create your own NPTM activities. Resources include the 2014 NPTM logo, fact sheet, event planning guide, sample news releases and proclamations, and much more. Even more resources can be found at MoveForwardPT.com, APTA’s official consumer information website.

    NPTM is a great opportunity to give communities a "hands on" experience of physical therapy by demonstrating what physical therapists and physical therapist assistants really do, and how the profession keeps people fit, active, healthy, and mobile.

    This year's APTA focus: a public education campaign to debunk 7 of the most common myths about physical therapy, set to launch during the second week of October. Stay tuned to learn how you can participate!

    National Physical Activity Plan Seeks Input on Revisions

    APTA members have an opportunity to contribute to the first-ever revision of the National Physical Activity Plan (NPAP), a high-profile effort to create a comprehensive set of policies, programs, and initiatives to increase physical activity in all segments of the American population.

    The NPAP Alliance has released an online survey that it will use to guide changes to the plan, which was released in 2010. The Alliance is particularly interested in views on how Americans' physical activity levels can be increased, what strategies could be effective in this promotion, and how the success of the NPAP can be ensured. Deadline for responses is October 31.

    Respondents can comment on and rate strategies in 8 areas: business; education; health care; mass media; parks, recreation, fitness, and sports; public health; transportation, land use, and community design; and volunteers and nonprofits.

    APTA is a member of the NPAP Alliance board of directors.

    Survey tip: the survey form includes many optional "free text" opportunities—if you prefer you can leave any or all free text areas blank.

    PTNow Blog: Getting Beyond the Headlines

    The latest PTNow blog explores the complicated dynamics involved when mainstream media covers sometimes-complex health care issues, and uses coverage of APTA's Choosing Wisely® list as an example.

    "As great as it is when mainstream media outlets bring new health care research to the consumer forefront, sometimes the arrow doesn't quite hit the target," is how the blog describes what happened when National Public Radio (NPR) picked up on the association's list of "5 Things Physical Therapists and Patients Should Question."

    APTA's recommendation was, "Don't employ passive physical agents except when necessary to facilitate participation in an active treatment program," and like all items on the list, the recommendation included citations to evidence supporting the statement.

    NPR's headline? "Farewell, Heating Pad: Physical Therapists Say It Doesn't Help."

    "While NPR correctly emphasized that physical activity is stressed over passive physical agents, 'farewell, heating pad' is an over-reaching interpretation of APTA's recommendation," the blog says. The PTNow post opens up a discussion about how physical therapists and physical therapist assistants might respond to patients who have read the headlines, but haven't heard the full story.

    Have thoughts or experiences in sharing context in ways that patients can understand? Read the blog, and join the conversation.

    WSJ Calls Gait Analysis 'The Serious Runner's Salvation'

    The Wall Street Journal is bullish on gait analysis.

    Describing gait analysis as a way "to identify the root of an injury, or a bad habit that may lead to one," an article in the September 22 WSJ attempts to explain the relationship between common runners' injuries and how those runners move.

    "Increasingly, the runner's road to healthy joints starts with gait analysis," writes WSJ reporter Matthew Futterman. "Medical boots, cortisone shots or even surgeries never solved runners' problems the way 20 minutes of being filmed on a treadmill can, experts say."

    The article interviews athletes who have benefitted from the analyses and health care professionals who perform them, including Michael Silverman, PT, of the Hospital for Special Surgery, in New York City. The online version of the article also includes an infographic that describes which gait-related problems can contribute to runner's knee, stress fractures, proximal hamstring tendinosis, and plantar fasciitis.

    Tip: be sure to check out the reader comments posted at the end of the article for insights on what the running public thinks about gait analysis. And don't forget to share consumer-focused information on running from MoveForwardPT.com—including a Physical Therapist's Guide to Running (.pdf).

    Preventable Hospital Admission Rates Dropping

    In a mostly all-good-news report, the federal Agency for Healthcare Research and Quality (AHRQ) says that rates of preventable hospitalizations for acute and chronic conditions are dropping across the country, with a 14% overall decline recorded between 2005 and 2011.

    The estimates, based on data from the Healthcare Cost and Utilization Project and the Nationwide Inpatient Sample, looked at admission rates "for certain acute illnesses or worsening chronic conditions that might have been avoided with the delivery of high-quality outpatient treatment and disease management." AHRQ estimates that potentially preventable hospitalizations accounted for about 10% of all hospitalizations in 2011—a marked decrease from rates in the last study conducted.

    Among the findings:

    • The overall 14% decrease includes a 20.2% drop in admissions for acute conditions and a 9.5% drop for chronic conditions.
    • All regions of the country showed declines in potentially preventable admissions, with the South showing improvement from a 2005 rate that was 17.2% higher than the national average, to a 2011 rate that has been reduced to 10.5% above the national number.
    • Remote rural areas reported a potentially preventable admission rate 57% higher than the lowest rate reported (small metropolitan areas) in 2011.
    • Potentially preventable admissions for chronic conditions did not drop as dramatically overall, except in the South, which saw a 16% decline—though the South's chronic condition admission rates are still above the national average.

    Rates for acute conditions were tied to admissions for dehydration, bacterial pneumonia, and urinary tract infections; rates for chronic conditions were linked to admissions for diabetes, angina, congestive heart failure, hypertension, asthma, and chronic obstructive pulmonary disease.

    APTA offers a webpage on the role of the physical therapist and physical therapist assistant in reducing hospital readmissions. Check out the page for links to videos, audio courses, patient education materials, and articles on readmissions.

    2015 CSM Registration Open; Early Bird Discounts End November 5

    Start your engines—registration is now open for the 2015 APTA Combined Sections Meeting (CSM) set for February 4-7 in Indianapolis, and members who register before November 5 can receive significant early-bird discounts.

    The 2015 CSM will take place in downtown Indianapolis, and will once again bring together more than 10,000 physical therapists, physical therapist assistants, and students to participate in exceptional programming, networking opportunities, and an exhibit hall. Sessions will focus on content from APTA's 18 sections, and more than 400 exhibitors will be on hand to share the latest and greatest in products and services.

    More information, including registration instructions and session listings, can be found at the APTA 2015 CSM webpage.

    Boston Globe Looks at Effects of Pulling the Plug on EHRs

    Electronic health records (EHRs) may be an important part of needed improvements to health care, but according to a recent article in the Boston Globe, EHRs have 1 potentially problematic quality—they can be turned off.

    So what happens when health care providers lose access?

    In the September 22 edition of the Globe, reporter Christopher Rowland retells the story of a small medical practice in Presque Isle, Maine, that got into a billing dispute with its EHR vendor and one day found itself unable to access any of its 4,000 patients' records. The clinic's vendor, a Germany-based health technology company called CompuGroup, admits that it is denying access until the bills are paid.

    According to CompuGroup, the clinic owes more than $20,000 in maintenance fees it refused to pay for 10 months. According to the clinic, when CompuGroup bought out the original vendor, it began charging unreasonable fees and would not respond to complaints. Now, the clinic argues, patient care is at risk.

    The Globe article uses the CompuGroup scenario to explore the unintended consequences that could arise after "physician practices and hospitals across the country rushed to cash in on $30 billion in federal subsidies for [EHR] systems starting in 2009." According to the article, "as contracts were inked by the thousands in the past few years, say legal experts, not enough thought was given to what happens when the computer systems stop working correctly, vendors or providers struggle financially or go out of business, or parties have a falling out."

    Rowland writes that while reports of cases similar to the Presque Isle practice's are "rare," a federal judge in Wisconsin "expressed little sympathy" for a clinic that was denied EHR access after withholding payments to its vendor in a billing dispute.

    According to Matt Elrod, PT, DPT, MEd, NCS, senior specialist in APTA's department of clinical practice, the Globe article spotlights an important EHR issue. "Prior to signing any contract, it's crucial to understand what will happen to the data and records if there is a separation from the vendor." he said. "Providers need to have legal counsel review these contracts to ensure that care for the patient is not jeopardized, and that the contract clearly identifies who owns and retains that data, and how that data will be accessed if an agreement is dissolved."

    The Globe article quotes Tetyana Buescher, general counsel of CompuGroup Medical USA, as saying that the clinic “had a lot of opportunities to resolve this, including getting on a payment plan; they chose not to do that. You can make an inference about … who is at fault in endangering patients, if that is the case."

    APTA offers several resources on information technology and EHRs, including a webpage devoted to the use of EHRs.

    APTA Shares Its Consumer Outreach Approach With Other Organizations

    APTA has authored the latest installment in the US Department of Health and Human Services "Be Active Your Way" blog that promotes organization-to-organization conversations about connecting with the public on physical activity issues. In that post, the association makes 1 thing clear: for APTA, helping the public understand physical therapy's ability to transform society requires an "all of the above" approach.

    The blog post uses APTA's efforts to educate the public on pediatric back pain as an example of this multi-format approach, and describes how its efforts to support National School Backpack Awareness Day capitalized on a variety of social media and traditional media outlets.

    As with nearly all APTA-sponsored consumer awareness pushes, the pediatric back pain effort relies heavily on MoveForwardPT.com, APTA's consumer-oriented website, but also attempts to stretch the association's reach through partnerships with prominent bloggers outside APTA who are enthusiastic about spreading the word.

    "We have had marked success using this multifaceted approach," according to the blog, "garnering high-profile placements in many top-tier electronic and print publications, including WebMD, Grandparents.com, The Washington Post, The New York Times, and Consumer Reports, to name just a few."

    The "Be Active Your Way" blog is the official blog of the Physical Activities Guidelines program of the US Office of Disease Prevention and Promotion.

    75% of US Adults 45 and Older Not Meeting Strength Training Recommendations

    Only about one-quarter of US adults over 45 are meeting federal recommendations for strength training—and the percentages drop even lower in certain age and other demographic groups, according to a new study from the US Centers for Disease Control and Prevention (CDC).

    Researchers for the CDC used data from the 2011 Behavioral Risk Factor Surveillance System to examine the strength training activities of more than 333,000 adults 45 and over. What they found was that only 23.7% of the population met the US Department of Health and Human Services recommendation that adults 45 and older participate in activities targeting all major muscle groups at least 2 days per week.

    While no subgroup studied met the goal, variations did exist. Among those variations:

    • When compared with respondents 45-54 years old (26% compliance), individuals aged 55-64 were 10% less likely to meet strength training recommendations. The 65-74 age group was 8% less likely than the youngest cohort, and those aged 75-84 were about 20% less likely to meet the goals than the 45-54 group, with a compliance rate of 20.2%.
    • Normal-weight respondents (BMI of 18.5-24.9) met the recommendations at a 30.2% rate; overweight (BMI of 25-29.9) reported a 24.9% rate, obese individuals (BMI of 30 or more) reported a rate of 19.9%. Underweight individuals (BMI of 18.5 or below) reported a 24.2% compliance rate.
    • Females (21.9%) were less likely to meet the goals than males (25.9%).
    • College graduates had a 34.2% compliance rate, compared with an 18.5% rate among those with high school diplomas only and a 14.4% rate among respondents with less than a high school diploma.
    • Individuals with annual income over $50,000 complied at 30.6%, with rates declining as income declined. Those reporting income less than $15,000 per year only had a 16% compliance rate.

    "Our findings indicate that there continues to be a precipitous decline in participation in muscle strengthening activities associated with aging, and that this decline does not stop at age 65," authors write. "The information gained through this research could be used to help identify which sociodemographic subgroups are most in need [of intervention]."

    The importance of appropriate strength training was acknowledged in APTA's recently released list of "5 Things Physical Therapists and Patients Should Question" created as part of the American Board of Internal Medicine Foundation's Choosing Wisely® campaign. The list of APTA recommendations includes one that advises against under-dosed strength training for older adults, and instead promotes matching "frequency, intensity, and duration of exercise to the individual's abilities and goals."

    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.

    Study: Functional Restoration Initiated Early Results in Big Savings

    When it comes to interdisciplinary functional restoration (FR) for chronic disabling occupational musculoskeletal disorders (CDOMDs), the earlier the better, according to a new study, which found that FR programs initiated within the first 8 months after the disabling event can lead to health care and economic cost savings of up to 72%, or about $170,000 per claim.

    The study, e-published ahead of print September 7 in the Journal of Occupational Rehabilitation (abstract only available for free), examined financial and socioeconomic outcomes from 1,119 participants with CDOMDs who received FR at different points from the onset of CDOMD—1 group 4-8 months afterwards, a second group 9-18 months afterwards, and a third group receiving FR after 18 months. The groups were matched for demographics and injured musculoskeletal regions.

    Researchers looked at outcomes 1 year after rehabilitation and found that in terms of return-to-work rates, work retention percentages, and additional health care utilization, all 3 groups were similar, with overall rates of 88% for return to work, 80% for work retention, and small rates of additional health care utilization.

    However, big differences were uncovered when the authors looked at overall medical costs and disability benefits/productivity losses, with the early-intervention group demonstrating savings of 64% and 80%, respectively, over the intermediate and late-FR groups. Additionally, researchers estimated that the actual cost of rehabilitation was up to 56% less when FR was initiated early on.

    "Early rehabilitation is more likely to be a cost-effective solution compared to cases that progress [for 8 months or more] and receive FR as a treatment of 'last resort,'" authors write.

    In addition to cost-savings, authors write that early FR "may potentially prevent or mitigate the development of complex psychosocial barriers to treatment, including depression, narcotic dependence, and complex sequelae of comorbid psychopathology."

    While authors acknowledge several limitations to their study—for instance, the study did not include the costs of prescription medications used during the postrehabilitation period—they write that the findings "are consistent with the general principle … that one of the 'first principles to avoid delayed recovery' is critical in enhancing cost-effectiveness of care for acute and chronic musculoskeletal disorders."

    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.

    Limited Space Available for ICD-10 Testing; Application Deadline October 3

    The first end-to-end testing of Medicare's system for processing claims using the new International Classification of Diseases, 10th Revision (ICD-10) will allow approximately 850 health care providers to see a claim through from submission to remittance advice. APTA is encouraging members to sign up for the program before the October 3 deadline as a good way to gauge their own practice's readiness for the change.

    The testing program will run the week of January 26-30, 2015, and will allow a sample group of providers to work with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractors to evaluate the system for processing the new codes. That testing process will include submission of claims with ICD-10 codes to the fee-for-service claims system, adjudication of claims, and the production of accurate remittance advices.

    The Centers for Medicare and Medicaid Services (CMS) is targeting a broad cross-section of providers and will select testing participants based on needs for the study. Volunteers can apply through their MAC's website but must do so by October 3. The MACs and CEDI will notify the volunteers who have been selected and provide them with information by October 24.

    CMS is planning additional end-to-end testing later in 2015, and more information on the testing process is available online. The ICD-10 codes are scheduled to be implemented on October 1, 2015.

    Need more information on what the change to ICD-10 means for your practice? Visit the APTA ICD-10 webpage, which includes background and resources.

    'Choosing Wisely' List Subject of Move Forward Radio Episode

    APTA's contribution to the national Choosing Wisely campaign,released earlier this week, is designed to encourage conversations between physical therapists (PTs) and patients to avoid waste and improve care. Move Forward radio is helping to get that conversation started.

    To help consumers understand the list and be better informed, Move Forward Radio dedicated an episode to the list of "5 Things That Physical Therapists and Patients Should Question." 'It's really important that patients be involved in decision making about their care, and that they're really comfortable asking questions about the care that's recommended for them,' APTA's senior director of clinical practice and research, Nancy White, PT, DPT, OCS, told Move Forward Radio.

    In the episode, Tara Jo Manal, PT, DPT, OCS, SCS, discusses each of the "5 Things" and explains terminology and concepts found in the list such as "passive physical agents," "under-dosed strength-training programs," and "continuous passive motion machines."

    Manal emphasizes that it isn't a list of 5 things that should always be forbidden.

    Manal says that other than the recommendation related to whirlpools for wound management, "which we have really moved past in current practice," the list is about setting the stage for informed conversations. "It's important that patients realize that this list … is not a list of things that are inherently dangerous," she says. "They really are things that should be discussed."

    "If a therapist is doing interventions that are on this list, I think it's a very reasonable conversation to say, 'Is this really adding to my rehabilitation?' Or, 'Might we be able to spend our time [together] in a more productive way?'"

    PTs are encouraged to use the resources at MoveForwardPT.com to share the Choosing Wisely information with their patients and clients.

    Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as podcasts via iTunes.

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

    Postacute Care Data Reform Legislation Passes Both Houses

    Legislation that would standardize data used across postacute care (PAC) settings has now passed in both houses of Congress and could soon become part of larger reforms. APTA has been working to influence this legislation.

    The Improving Medicare Post-Acute Care Transformation (IMPACT) Act now approved by both the House and Senate would instruct the US Department of Health and Human Services (HHS) to standardize patient assessment data, quality, and resource use measures for PAC providers including home health agencies (HHAs), skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and long-term care hospitals (LTCHs).

    The House passed the legislation last week by voice vote. Late on September 18, the Senate did the same.

    APTA and other supporters of the legislation believe standardization would allow HHS to compare quality across PAC settings, improve hospital and PAC discharge planning, and use this standardized data to reform PAC payments in the future.

    The legislation will:

    • Require PAC providers to begin reporting standardized patient assessment data at times of admission and discharge by October 1, 2018, for SNFs, IRFs, and LTCHs and by January 1, 2019, for HHAs.
    • Require new quality measures on domains beginning October 1, 2016, through January 1, 2019, including functional status, skin integrity, medication reconciliation, incidence of major falls, and patient preference regarding treatment and discharge.
    • Require resource use measures by October 1, 2016, including Medicare spending per beneficiary, discharge to community, and hospitalization rates of potentially preventable readmissions.
    • Require the Secretary of HHS to provide confidential feedback reports to providers. The Secretary will make PAC performance available to the public in future years.
    • Require MedPAC and HHS to study alternative PAC payment models due to Congress in 2016 and 2021-2022, respectively.
    • Require the Secretary to develop processes using data to assist providers and beneficiaries with discharge planning from inpatient or PAC settings.

    The congressional committees have provided a summary (.pdf), including timelines.

    TBI Reauthorization Now Approved by Both Houses of Congress

    Government-sponsored research and data collection on traumatic brain injury (TBI) has support from both houses of Congress, now that the US Senate has approved the TBI Reauthorization Act (S. 2539). The House passed its version of the legislation earlier this summer. APTA was among the organizations advocating for the bills.

    The measure passed in the Senate is substantially similar to the House version, with some differences in funding amounts and a Senate request that the US Centers for Disease Control and Prevention (CDC) review evidence on management of TBI in children. If the bills are reconciled and signed into law, the act will provide funding to the CDC, the National Institutes of Health, and the Health Resources and Services Administration for programs supporting TBI research and individuals with brain injury.

    Advocacy for the reauthorization is part of a broad APTA push to bring attention to TBI and rehabilitation in general. APTA's efforts include involvement in the Joining Forces initiative, promotion of the Protecting Student Athletes From Concussions Act (H.R. 3532) (.pdf), participation in a congressional Brain Injury Awareness Day in March, and a fly-in that allowed APTA members to speak with members of Congress and their staff on the importance of rehabilitation research (see related News story). Concussion management awareness was also the focus of this year's student-led Flash Action Strategy, which resulted in the largest concussion-related grassroots effort in APTA history.

    APTA provides extensive resources to its members on the role of physical therapy in brain injury treatment and recovery, and offers a TBI webpage that includes continuing education courses and links to other interest groups.

    NPR Features APTA's List of '5 Things Physical Therapists and Patients Should Question'

    APTA's list of "5 Things Physical Therapists and Patients Should Question" is reaching a wider audience by way of a recent National Public Radio (NPR) story in "Shots," its medical news blog.

    In her story "Farewell Heating Pad: Physical Therapists Say It Doesn't Help," reporter Nancy Shute summarizes APTA's recommendations by noting a "pattern" in the list. "The emphasis is on physical activity, and on doing it yourself with the guidance of a physical therapist so you work hard enough to get stronger and don't get hurt."

    The recommendations covered in the NPR story are now part of the American Board of Internal Medicine Foundation's Choosing Wisely® campaign. APTA member Anthony Delitto PT, PhD, FAPTA, who chaired the workgroup that reviewed member-submitted suggestions for the list, is quoted in the story.

    A downloadable copy of the list with accompanying citations (.pdf) is available at APTA's Center for Integrity in Practice website, and a detailed consumer-friendly explanation of the list is available through APTA and Consumer Reports, which partnered with the association in the creation of the brochure.

    APTA's list for Choosing Wisely is one part of the association's broad Integrity in Practice campaign. Check out the Center for Integrity in Practice for additional resources, including a primer on preventing fraud, abuse, and waste, and an online course on compliance and professional integrity.

    Help Bring Attention to Falls Prevention Awareness Day

    Thinking about fall? Think about falls—or more precisely, how to prevent them.

    September 23 is the first day of autumn, which also happens to be national Falls Prevention Awareness Day (FPAD), and APTA is encouraging its members to spread the word on the importance of reducing fall risk and the important role that physical therapists (PTs) and physical therapist assistants (PTAs) can play in the effort.

    The National Council on Aging (NCOA) is once again providing extensive online resources to promote the day, which was recognized through events held in 47 states last year. The site includes links to a FPAD toolkit, a webinar, media resources, and a list of suggested activities.

    APTA also offers a wealth of resources on balance and falls, most of them accessible via the association's Balance and Falls webpage. Offerings range from consumer-focused information including a video, a PT's guide to falls, handouts on falls prevention and physical therapy and the balance system (members-only .pdfs), to PT- and PTA-focused information on how to develop community events on balance, falls, and exercise.

    In addition to planning and consumer-related resources, members can also access several continuing education courses related to falls at the Balance and Falls page, and the PTNow evidence-based practice resource includes a clinical practice guideline on falls and fall injuries in the older adult and a clinical summary on falls risk in community-dwelling elderly people.

    Doing something special in recognition of Falls Prevention Awareness Day? E-mail Anita Bemis-Dougherty to share what you’re doing, or take photos of your falls awareness events and share them on Twitter by including the @APTAtweets handle.

    Postacute Care Data Bill Passes House

    Legislation that would standardize data used across postacute care settings has been approved by the US House of Representatives and is awaiting a vote in the Senate.

    The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (H.R. 4994/S. 2553) passed by voice vote in the House. It is unlikely the Senate will take up the bill before leaving for the elections.

    If it becomes law, IMPACT would instruct the US Department of Health and Human Services (HHS) to standardize patient assessment data, quality, and resource use measures for postacute care providers including home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals. A June PT in Motion News story outlined the major provisions of the legislation.

    APTA has been working to influence this legislation and will continue to monitor its progress.

    Bill Introduced in Senate Would Allow PTs to Bring in Another PT During Absences

    A version of a bill that would allow physical therapists (PTs) in private practice to provide Medicare patients continuity of care in the PT's absence has been introduced in the US Senate. Like its companion bill introduced in the US House of Representatives last year, the Prevent Interruptions in Physical Therapy Act (H.R. 3426/S. 2818) would expand so-called "locum tenens" arrangements to include PTs.

    Locum tenens provisions allow health care providers to bring in another licensed provider to treat Medicare patients and bill Medicare through the practice provider number during temporary absences for illness, pregnancy, vacation, or continuing medical education. Current law only extends locum tenens to doctors of medicine, osteopathy, dental surgery, podiatric medicine, optometry, and chiropractic, forcing PTs in private practice to avoid absences or risk gaps in patient and client care.

    APTA and its Private Practice Section (PPS) collaborated on pressing for the legislation which was introduced by Sens Chuck Grassley (IA) and Bob Casey (PA). "This legislation seeks to eliminate an unnecessary limitation on our ability to practice and provide excellent continuous care," said PPS President Tom DiAngelis, PT, DPT. "We commend Senators Grassley and Casey for taking an important step to ensure a patient’s access to uninterrupted physical therapy."

    APTA has advocated for this issue as an easy technical fix bill that should be linked to larger Medicare reforms that are moving through congress. The locum tenens legislation has continued to gain awareness and cosponsorship in the House, and APTA will now advocate for Senate support.

    APTA will monitor the progress of the bill and will post updates to its locum tenens webpage. Resources on the website include a podcast on the importance of this legislation and information on how PTs can get involved in advocating for its passage.

    Corrected Link to Task Force Opportunity

    A story in the Friday, September 5 issue of PT in Motion News contained an incorrect link to more information on the APTA Scope of Practice task force, which is seeking volunteers. That link has been corrected in the original story, and is provided here: http://www.apta.org/VolunteerGroups/TaskForce/ScopeofPractice/ . PT in Motion News regrets the error.

    Therapy Cap Repeal Gets Majority House Support

    It's official: a majority of members of the US House of Representatives are now cosponsors of a bill that would repeal the Medicare therapy cap, a strong sign that the legislation has solid bipartisan support as both a long term therapy cap solution and a component in larger sustainable growth rate (SGR) reform legislation.

    On Tuesday, the cosponsor number for H.R. 713 reached 220—just over the 218-member majority mark, and a level of support not achieved by most legislation. The House has no plans to vote on the legislation before it recesses in advance of the fall elections, but may take up SGR reform after the elections or in 2015.

    APTA advocacy staff see the upcoming 6-week recess as a perfect opportunity for members to personally thank their legislators for supporting therapy cap repeal, and are urging physical therapists, physical therapist assistants, patients, clients, and others to consider attending local town hall meetings hosting practice visits, or setting up office meetings with their representatives while representatives are in their home districts.

    A complete list of therapy cap repeal cosponsors can be found on the Congress.gov website.

    New Website Highlights Integrity in Physical Therapy Practice

    A new website launched by APTA will support the profession’s effort to eliminate fraud, abuse, and waste in the health care system.

    The APTA Center for Integrity in Practice website houses information on how physical therapists, physical therapist assistants, and students can continue to uphold the profession's high standards.

    Resources include information on the recently-released Choosing Wisely® list of "5 Things Physical Therapists and Patients Should Question;” a primer on preventing fraud, abuse, and waste; a free course on compliance; and other information on regulation and payment systems, evidence-based practice, ethics, professionalism, and fraud prevention.

    The site is part of the association's Integrity in Practice Campaign, a broad initiative that seeks to position physical therapy as a leader in responsible patient-centered care.

    Plans are for the website to continue expanding its offerings, and APTA is seeking partners to share resources, work together on advocacy, and possibly develop joint educational offerings to bring the message of practice integrity to the widest possible audience.

    Choosing Wisely: APTA Releases List of Procedures That PTs and Patients Should Question

    Passive physical agents that aren’t part of an active treatment plan, under-dosed strength training for older adults, and the use of whirlpools for wound management are among the "5 Things That Physical Therapists and Patients Should Question," according to a list recently announced by APTA. The list, developed through member suggestions and refined by an expert panel, is now part of a national campaign that encourages patients and health care providers to talk about whether a given procedure is really necessary based on the patient's individual circumstances.

    The list announced today is part of APTA's partnership with the Choosing Wisely® campaign from the American Board of Internal Medicine (ABIM) Foundation. The initiative aims to help consumers make informed health care choices by providing lists of procedures that tend to be done frequently, yet whose usefulness is called into question by evidence. APTA is the first nonphysician group to release a list, joining more than 50 medical specialty societies.

    "A well-informed patient is a well-treated patient," said APTA President Paul A. Rockar Jr, PT, DPT, MS, in a news release. "The Choosing Wisely campaign addresses the patient's role in good health care, and we are happy to join this effort."

    The 5 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 employ passive physical agents except when necessary to facilitate participation in an active treatment program.
    • 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 88,000 members of APTA, who voted on the final 5.

    To help patients and clients understand what APTA’s Choosing Wisely recommendations mean for them, APTA has partnered with Consumer Reports to create a free consumer-friendly summary, which will also be made available in Spanish. Consumer Reports already has reached more than 100 million consumers with Choosing Wisely information through its network of consumer communications partners.

    APTA's Choosing Wisely list is also the subject of a ProfessionWatch paper e-published ahead of print in Physical Therapy. The paper details the process of the list's development and provides professional context for APTA's decision to partner with the ABIM Foundation in Choosing Wisely.

    The partnership is a component of the larger APTA Integrity in Practice campaign, an effort to support the profession of physical therapy as a leader in the elimination of fraud, abuse, and waste in health care. An APTA Center for Integrity in Practice has been created and will be developing resources throughout the course of the campaign, but already offers a primer on preventing fraud, abuse, and waste, and an online course on compliance and professional integrity.

    "Care that is best for the patient has always been a priority for APTA," Rockar said. "Choosing Wisely is an outstanding effort, and its mission to foster better, more efficient care through informative dialogue between patients and health care providers dovetails perfectly with the goal of our Integrity in Practice campaign."

    Otto Payton, Noted Physical Therapy Author, APTA Fellow, Dies

    Physical therapy leader Otto D. Payton, PT, PhD, FAPTA, Catherine Worthingham fellow and author of the seminal Research in Clinical Practice, died September 4 in Richmond, Virginia. He was 84.

    Professor emeritus of physical therapy at the Medical College of Virginia campus at Virginia Commonwealth University, Payton was an internationally known lecturer and author, as well as a practicing physical therapist for more than 50 years. He edited the Journal of Physical Therapy Education and served as chairman of the editorial board for the Clinics in Physical Therapy series of books throughout its 33-volume publication history.

    In addition to Research in Clinical Practice, Payton authored or coauthored several texts including Patient Participation in Program Planning, Psychosocial Aspects of Clinical Practice, and Treatment Planning for Rehabilitation: A Patient-Centered Approach.

    Payton received the Jules M. Rothstein Golden Pen Award for Scientific Writing from APTA in 1981 and the Lucy Blair Service Award in 1988. He became a Catherine Worthingham fellow in 1993.

    In an oral history available for loan from APTA, Payton also mentions that he served on the Maryland physical therapist examining board with Florence and Henry Kendall, and was an early chair of the Physical Therapy Fund, the predecessor of the Foundation for Physical Therapy.

    He is survived by his daughter, Colleen M. Payton, and granddaughters, Jane Yoon and Meredyth Yoon.

    Move Forward Radio Shines a Spotlight on Childhood Cancer

    In recognition of Childhood Cancer Awareness Month, this week Move Forward Radio showcased the impact that physical therapists (PTs) can have on the lives of children with cancer by sharing the story of Mathias Giordano.

    A 13-year-old with osteosarcoma, Mathias had his lower right leg amputated during his battle with cancer in the hopes of remaining as active as possible, and with the goal of returning to the soccer field.

    Before the amputation, Mathias started seeing Mike Reing, PT, MSPT, OCS, and the 2 formed a special bond.

    "I can't save anyone's life; that's not my role," Reing told Move Forward Radio. "But my job for Mathias is, 'All right, let's do everything we can to preserve his quality of life.' And my definition of [quality of life] doesn't really matter. What matters is his [definition]."

    Mathias's mother, Roya Giordano, said that physical therapy has been "incredibly meaningful and important" in her son's journey.

    "Having Mike on our team has been the biggest blessing of all, because Mathias and Mike established a relationship that no one else has," she said.

    Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as podcasts via iTunes.

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

    Volunteers Needed for 2 APTA Task Forces

    Opportunities are now available for APTA members to serve on the Excellence in Physical Therapist Education and Scope of Practice task forces, but applications for the positions must be completed by October 2.

    The first step is to fill out an interest profile on the Volunteer Interest Pool webpage. Once completed, click on the "Apply for Current Vacancies"button and select the task force you're interested in joining. Details on all volunteer groups can be found on APTA's Volunteer Groups webpage.

    APTA relies heavily on its volunteers, who in turn gain valuable leadership and growth opportunities while working with some of the most outstanding physical therapists in the country.

    Free Webinar Will Focus on Aquatic Interventions for OA

    An upcoming 30-minute "Lunch and Learn" free webinar from the Osteoarthritis Action Alliance (OAAA) will focus on the latest thinking around aquatic exercise interventions. The session will be held September 17 beginning at 12:00 pm ET.

    The presentation will feature Dennis Dolny, PhD, and Eadric Bressel, PhD, professors in the department of health, physical education, and recreation at Utah State University. Dolny's work has included research on techniques to monitor skeletal muscle activity while walking and running in water. Bressel's biomechanics laboratory focuses on relationships between anatomical structures, mechanics, and injuries, with specific emphasis on aquatics-based research.

    Registration for the event is available online, and the slide presentation for the webinar can be viewed in advance. OAAA archives its Lunch and Learn webinars for use at a later time. APTA is a member of OAAA.

    Patient Support for Home-Based Telemedicine Growing but Barriers Remain

    More patients are willing than not to consider staying at home for video-based appointments with a health care provider, but the consumer demand for such an option still has a way to go before it could be characterized as overwhelming, according to a new study from the Mayo Clinic.

    In a survey of 263 patients who recently received outpatient treatment at the Mayo Clinic Center, researchers found that about 66% of respondents said that they were "somewhat likely" (28.1%) or "very likely" (38%) to accept an invitation to meet with their provider by way of video from their homes. The survey included questions about familiarity with video calls, what kinds of technology patients owned, patient assessments of the value of video appointments, and costs of travel to the local institution, among other topics. Findings were published in the September issue of Telemedicine and e-HEALTH.

    Not unexpectedly, researchers found a high correlation between a patient's willingness to consider a home-based video appointment and that patient's experience with video calls and the technology involved. Other drivers included age and distance from home to the health care institution—generally the younger and farther away, the more likely the patient was to consider a video appointment. Actual prevalence of the technology was less of an issue, with 75% of respondents reporting that they had a broadband Internet connection—although only 36% had a web camera.

    The real problem, according to authors of the research, is that patients opposed to video appointments are unlikely to change their minds without some significant work on the part of health care providers and others—and that work may have to focus on issues beyond the technology itself. "Of the 4 primary concerns to address," authors write, "3 of the 4 express concern not about logistics of the connection, privacy, or security of the medium … but about the general preferences of face-to-face over video communication. To shift perceptions about the medium may require deploying a focused communication strategy … encouraging the use of the system on a trial basis, or simply allowing technology use behavior to catch up with what technology enables."

    The study describes overall patient demand for video appointments as "nascent," and asserts that growth will be highly dependent on sensitivity to multiple patient factors—something that Matt Elrod, PT, DPT, MEd, NCS, senior practice specialist at APTA believes is crucial to telemedicine's success. "The technology behind telehealth is exciting and presents many opportunities for patients and providers," he said, "but the true benefits of telehealth are realized when it is used for the right patient at the right time and incorporates the patient's, wants, needs, and preferences."

    More resources on telehealth and physical therapy practice can be found at APTA's Telehealth webpage.

    2015 Medicare Changes: Are You Ready?

    It's no surprise that Medicare has changes in store for 2015 payment policies. But the changes themselves could be surprising if you're not prepared.

    Physical therapists (PTs) in home health, rehabilitation, and skilled nursing facilities can get up to speed on the changes, many of which directly affect physical therapy in postacute care settings, by signing up for a 90-minute APTA webinar on what Medicare has in store for 2015. The program is set for October 16 beginning at 2:00 pm ET, and will cover new Medicare definitions, changes to how therapy minutes are recorded, changes to postacute care quality reporting, and more.

    Participants in the live event will be able to pose questions to the presenters, and will also receive a preview of the upcoming 2014 APTA Postacute Care Compliance Seminar. Cost for the webinar is $99 for APTA members and $169 for nonmembers, which includes on-demand access to the webinar for later viewing. The session will provide 0.2 CEUs (2.0 contact hours/CCUs).

    More information and registration instructions are available at the APTA Learning Center.

    APTA Grassroots 'Flash Action' Campaign Delivers Message on Concussion

    In the largest grassroots effort on concussions in APTA history, members, students, and patients sent a loud-and-clear message to members of Congress: greater attention needs to be paid to youth sports concussion, and physical therapists (PTs) and physical therapist assistants (PTAs) can play an important role in managing these injuries.

    The concussion message was the focus of this year's Flash Action Strategy FAS), a student-led advocacy campaign that took place September 8-10. In the span of 72 hours, FAS participants sent letters to every member of Congress through APTA's Legislative Action Center (LAC) and Patient Action Center (PAC) asking them to support the Protecting Student Athletes from Concussions Act (H.R. 3532) and the Supporting Athletes, Families, and Educators to Protect the Lives of Athletic Youth Act (SAFE PLAY Act) (S. 2718/H.R. 5324). Organizers estimate that the FAS required about a minute of a participant's time.

    Although the official FAS wrapped up on September 10, members and others interested in delivering messages to legislators can still get in the game by contacting legislators through the LAC and PAC.

    "Once again the partnership between APTA and the APTA Student Assembly Board of Directors set the stage for a great advocacy effort," said Justin Moore, DPT, vice president, public policy, practice, and professional affairs at APTA. "We are grateful to all of the members, patients, and others who spoke out on this important issue. We've moved the ball down the field on concussion awareness."

    Interested in getting involved in APTA’s advocacy efforts throughout the year? Join the PTeam online or on the APTA Action App. You can also support the PT-PAC by contributing to the $20 campaign.

    Light-Intensity Short Walks Can Prevent LE Vascular Damage Caused by Sitting

    Long bouts of sitting can have serious effects on blood flow that could increase risk of cardiovascular disease, but a new study proposes that lower extremity vascular damage can be prevented by walking as few as 5 minutes every hour—and not even at a particularly fast pace.

    In a study e-published ahead of print in Medicine and Science in Sports and Exercise (abstract only available for free), researchers from Indiana University monitored the ways in which the superficial femoral artery reacted to 3 hours of sitting without leg movement, and compared those results with study participants who took 5-minute walks at 2 miles per hour every hour. What they found was that prolonged sitting does lead to a "significant impairment" in endothelial function, but that the short walks prevented the damage from taking place altogether.

    The study was limited to 12 nonsmoking men in their 20s who did not meet the physical activity guidelines of the Centers for Disease Control and Prevention, and were not taking any anti-hypertensive, lipid lowering, or anti-diabetic medications. Assessments were based on measurements of mean shear rates and flow-mediated dilation of the superficial femoral artery just above the knee.

    "Uninterrupted sitting leads to a progressive decline in antegrade and mean shear rate and corresponding impairment in endothelial function," authors write. "We can hypothesize that repeated bouts of prolonged sitting may contribute to vascular aging, at least in the lower extremities."

    But walking made all the difference. "Even this very light-intensity physical activity prevented the decline … and may explain the protective effect against sitting-induced impairment," they write. "We believe our observations further the argument to have structured public health guidelines on limiting sitting time."

    The study was featured in both the Washington Post and United Press International. Earlier research on the cardiovascular risks of prolonged sitting has been reported in Mayo Clinic Proceedings (.pdf) and elsewhere.

    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.

    'Movement Is Life' Accepting Abstracts, Posters

    Abstracts and poster proposals are now being accepted for the Movement is Life Caucus, a gathering that will focus on the role of early intervention in decreasing musculoskeletal health disparities among women and minorities.

    The 2014 caucus will be held at the Washington Marriott Metro Center in Washington, DC, November 13–14. The submission deadline is October 1, and participants must register for the caucus to have their submissions considered for possible presentation. Registration is free.

    Movement is Life's (MIL) mission is to decrease disparities by raising awareness of their impact on chronic disease management and quality of life. The organization works to slow musculoskeletal disease progression, reduce disability, and encourage physical activity and daily movement to improve the overall health of the nation. APTA is a member of the MIL steering committee.

    For more information, contact Rene Malone.

    Inexpensive Graphene and Rubber Band Composite Could Be the Future of Body Movement Sensors

    The next generation of body motion sensors may be a combination of low and high tech: researchers have found that common rubber bands infused with graphene produce adaptable and accurate sensors capable of functioning at high strain rates, all at a materials cost of "essentially zero."

    Researchers from Surrey University and Trinity College Dublin were able to create "G-bands," body sensors that they claim check all the needed boxes when it comes to monitoring everything from heart rate to high-force, high-velocity joint and muscle movements—they're cheap, lightweight, stretchable, and sensitive. "One can envisage weaving G-band based sensors into clothing to monitor the motion of athletes or patients undergoing rehabilitation," authors write. The results of the research were recently published in the journal ACS Nano.

    The G-bands were created by infusing rubber bands with graphene, a 1-atom-thick layer of carbon molecules capable of conducting electricity. Graphene is able to maintain its ability to conduct throughout stretching and twisting, a quality "generally not compatible with traditional silicon/metal-based electronics," according to authors. The G-bands deliver information even at strains above 800%, they write, and "demonstrate impressive performance as kinesthetic motion sensors, detecting motions as subtle as those associated with breathing and pulse."

    "Ultimately, one can imagine a wearable network of G-bands performing wellness monitoring by continuous recording of functions," authors write. They add that the low cost "will make it possible to roll out G-band based sensors extremely widely; for example, facilitating use in the developing world."

    Business Associate Agreements Must Be Updated by September 22

    September 22 is the deadline for meeting new HIPAA rules on some types of business associate agreements, and APTA is reminding members to make sure they're compliant.

    The HIPAA Omnibus final rule that was published in January 2013 requires that all business associate agreements entered into before January 25, 2013, be updated. A template of the HIPAA-compliant business associate agreement can be found at the US Department of Health and Human Services (HHS) website and on APTA’s HIPAA Resource webpage under the “Model Business Associate Contract Language” link.

    HIPAA requires covered business entities and associates to enter into agreements that outline the provisions necessary to safeguard protected health information. The rule defines a “business associate” as “a person or entity, other than a member of the workforce of a covered entity, who performs functions or activities on behalf of, or provides certain services to, a covered entity that involve access by the business associate to protected health information.” A subcontractor that creates, receives, maintains, or transmits protected health information on behalf of another business associate may also be a “business associate.”

    Although HHS provides a business associate agreement template, it’s wise to tailor the template to your business relationship(s). It’s also wise to consult with an experienced health law attorney in your state when entering into or revising agreements so that the agreement is in compliance with all applicable federal and state laws.

    APTA on Capitol Hill to Push for Lymphedema Coverage

    APTA believes Medicare coverage of lymphedema treatment should be expanded, and the association is helping to bring momentum to the issue by participating in a congressional briefing on the condition. The briefing and other activities are part of Lymphedema Lobby Days on Capitol Hill, and are part of a push for a new law that would increase coverage.

    The September 9 briefing seeks to bolster legislator support for the Lymphedema Treatment Act (H.R. 3877), a bill introduced by Rep Dave Reichart (WA-8) that seeks to provide Medicare coverage and payment for lymphedema treatment items and supplies. APTA is a supporter of the bill, and APTA Board of Directors member and lymphedema specialist Nicole Stout, PT, DPT, CLT-LANA is a member of the expert panel speaking at the briefing.

    In a letter to Reichart, APTA President Paul A. Rockar Jr, PT, DPT, MS, notes that "many of these [lymphedema-related] items and services are either not covered or are only covered on a limited basis. Passage of this legislation would ensure access to these supplies for individuals with lymphatic impairments and conditions." Rockar also points out the crucial role physical therapists play in the treatment of lymphedema and in patient education on how to avoid injury and infection, improve skin care, and modify diet to decrease fluid retention.

    APTA staff will monitor the progress of the bill and update members with news and opportunities for advocacy.

    'Alternative' CR Programs, Better Reimbursement Both Necessary to Close Care Gap

    A recent survey of cardiac rehabilitation (CR) centers across the US has found that even if current facilities were able to expand modestly, more than half of the US patients in need of CR would remain unserved—a care gap that can only be filled through alternative delivery models and significant changes to reimbursement policies, according the study's authors.

    The study, published in the Journal of Cardiopulmonary Rehabilitation and Prevention (abstract only available for free), is based on survey results from 252 CR programs asked to assess their current utilization, current capacity, and potential expansion capacity. The bottom line: most were not running at capacity and could increase services by about 33% without having to expand—and by 68% "if they were given reasonable resources to expand."

    As unlikely as such expansion may be, authors write, the real issue is that even in the rosiest of scenarios in which staffing, facility, insurance copay, and other obstacles resolve themselves favorably, a full 33% of patients in need of CR would still go without due to lack of capacity. "As currently structured and staffed, center-based CR programs simply do not have the capacity, by themselves, to provide services to all eligible patients—even in the setting of perfect referral and enrollment," authors write.

    Authors believe that the current underutilization of CR has more to do with the structural and financial barriers encountered by the programs, and not patient behavior. These barriers, which include high copays, low reimbursements, and a limited range of conditions for which insurance companies will cover CR, make it difficult for the programs to make even marginal progress in addressing current gaps.

    Still, authors write, changes to when and at what level insurance companies cover CR won't themselves cover the shortfall in care—there simply isn't enough capacity. One solution? The development of alternative CR programs.

    "Our data suggest that alternative models of CR delivery will need to be explored and implemented to substantially increase national CR participation rates," they write, suggesting "group-based CR programs in community centers, home-based programs, and web-based methods" to provide the care. Combined with changes to reimbursement policy, authors believe better participation rates could be achievable. "If additional alternative models of CR delivery … were developed as additional options for patients," they write, "it seems possible that participation rates of >80% could become possible."

    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.

    PTNow Blog: Fall for One and One for Fall?

    Been waiting for that "singular test that will, with 100% accuracy, predict who will fall?"

    Keep waiting.

    According to the latest PTNow blog, no such test exists—which is why sound clinical judgment and careful matching of patient to test are critical. There are good falls risk tests out there, according to the blog, but they need to be used appropriately.

    And yet, the blog argues, even if no single test can do the trick, there may be a "magic elixir for falls prevention" after all. Check out the blog for the recipe, and join the conversation.

    New CDC Obesity Map Shows Rates Remain High Everywhere

    And the most obese state is … well it's a tie, actually.

    Mississippi and West Virginia topped the list of states in rates of self-reported obesity, both with a 35.1% rate. At the low end of the scale, Colorado, with a 21.3% rate, was followed closely by Hawaii, which came in at 21.8%. The numbers are part of the annual US Centers for Disease Control and Prevention's "Obesity Prevalence Maps" report, released this week.

    The report is based on responses to telephone surveys conducted in 2013 by the Behavioral Risk Factor Survey System (BRFSS), which collects data from all 50 states, the District of Columbia, and 3 US territories.

    Among the findings:

    • The South had the highest prevalence of obesity (30.2%), with the Midwest not far behind (30.1%). The Northeast (26.5%) and West (24.9%) were lower.
    • Between 2011 and 2013, non-Hispanic blacks reported the highest prevalence of self-reported obesity (37.6%), followed by Hispanics (30.6%), and non-Hispanic whites (26.6%).

    When compared with statistics from 2012, the 2013 rates show a continued rise in obesity in the US, as outlined in the table below

    Self-Reported Obesity Prevalence

    < 20%




    > 35%

    # states in 2013






    # states in 2012






    APTA strongly supports the promotion of physical activity and its value in obesity prevention, maintaining a healthy weight, and assisting in weight loss. APTA has representatives on the board of the National Physical Activity Plan Alliance, and 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.

    Education Leadership Fellowship Opportunities Available

    New and emerging physical therapist (PT) and physical therapist assistant (PTA) academic, residency, and fellowship directors will once again have an opportunity to hone their leadership skills through a one-of-a-kind learning program now accepting applications.

    APTA's American Board of Physical Therapy Residency and Fellowship Education's (ABPTRFE) accredited Education Leadership Institute (ELI) Fellowship is a yearlong invitational learning experience designed to instruct early-career directors in facilitating change, thinking strategically, and engaging in efforts to advance the physical therapy profession. The program is a blended learning experience that combines online and onsite instruction with experienced mentorship.

    Applicants to the program are selected based on the strength of their applications and meeting all eligibility criteria. Application submission deadline is December 1, 2014, at 5:00 pm ET. To learn more about the program, visit the ELI webpage.

    ELI is a collaborative program with ABPTRFE, the American Council of Academic Physical Therapy, the APTA Education Section, the Physical Therapist Assistant Educators Special Interest Group, and APTA.

    Don't Forget World Physical Therapy Day September 8

    There's still time to gear up for World Physical Therapy Day on Monday, September 8—don't miss out!

    This year the theme is "Fit to Take Part," emphasizing the physical therapy’s role in helping people with long-term illnesses or disabilities fulfill their potential by maximizing movement and functional ability.

    To help physical therapists and physical therapist assistants get the word out, the World Confederation for Physical Therapy (WCPT) is offering a toolkit that includes designs for banners, stickers, and t-shirts, as well as press releases and informational booklets. New this year: several posters available in Spanish.

    APTA is a WCPT member organization.

    APTA's Honors and Awards Program Accepting Nominations

    Help your colleagues or students receive the recognition they deserve by nominating them for an APTA national honor or award.

    Each year APTA celebrates members' outstanding achievements in the areas of education, practice and service, publications, research, academic excellence, the Catherine Worthingham Fellows of APTA, the Mary McMillan Lecture, and the John H.P. Maley Lecture. Award recipients are recognized in June with a ceremony and reception at the NEXT Conference and Exposition.

    The 2015 call for nominations is now open and will close December 1, 2014. The electronic submission process is quick and easy; go to APTA's Honors and Awards page, and click on the specific honor, award, or scholarship to obtain guidelines, requirements, and a link to the online submission site.

    Lots of Free Webinars This Month

    September. 'Tis the season for football, yellowing goldenrod, chilly nights by a bonfire … and apparently, webinars. Lots of webinars. All free.

    Mark your calendars for the following online sessions—all but 1 provided by Healthy People —2020—to learn more about a range of health and prevention issues:

    September 9, 1:00–2:00 pm, ET  

    "Prevention and Population Health Education Across the Health Professions"

    This is an hour-long session on "the role that prevention and population health can play in advancing interprofessional education," brought to you by Healthy People 2020. Learn more and register here.

    September 10, 1:00 pm–2:00 pm, ET

    "US Report Card on Physical Activity for Children and Youth"

    Learn more about the activity report card that has been described as a "wake-up call" for more emphasis on regular physical activity in the lives of young people. Sponsored by the National Physical Activity Plan. Learn more and register here.

    September 18, 12:00–1:00 pm, ET

    "Who's Leading the Leading Health Indicators? Webinar: Environmental Quality"

    A Healthy People 2020 presentation that provides a case study on how one organization is improving health by improving air quality in its community, and offers tips on resources on addressing this issue in your community. Learn more and register here.

    September 25, 12:30–2:00 pm, ET

    "Promoting and Measuring Well-Being and Health-Related Quality of Life"

    Learn how health-related quality of life and well-being outcomes are measured, and why they're important. Learn more and register here.

    September 29, 12:30–2:00 pm

    "Prevention, Treatment, and Care of Diabetes and Chronic Kidney Disease"

    This Healthy People 2020 review will address the organization's progress on objectives in advancing treatment and care of these diseases. Learn more and register here.

    After Record-Low Rates of Increase, Health Spending Likely to Rise by 6% Annually Over Next Decade

    After historically low rates of growth in the wake of the Great Recession, health care spending is projected to rise by 5.6% in 2014, and will likely see average growth rates of 6% 2015–2023, according to a new report from the Centers for Medicare and Medicaid Services (CMS) published in Health Affairs.

    A gradually improving economy and aging baby boomers will serve as primary drivers in the increased spending, which will be offset to a degree by "slower growth in Medicare payment rates mandated by health law, cuts made to hospitals and doctors in the congressional budget-cutting efforts, and the increasing use of higher deductibles in private insurance plans," according to a report from Kaiser Health News.

    The CMS report received widespread coverage, and nearly as interesting as the report itself is a Kaiser Health News summary of how various news outlets chose to characterize the predictions as everything ranging from the numbers confirming that "a feared surge in spending isn't happening" (Politico) to the predictions describing "substantial increases over the next decade, expected to be driven by increased coverage due to the Affordable Care Act" (Fox News).

    CPG Development Proposals Due September 15

    APTA will provide financial and training support for the development of clinical practice guidelines (CPGs) for physical therapist practice, but proposals need to be submitted by September 15 to be considered in this review cycle.

    Proposals for CPG development must focus on clinical practice areas that are important and relevant to the practice of physical therapy, and be supported and submitted by an APTA section. Each proposal will be considered individually, and awards of up to $10,000 may be granted based on the relevance to practice and the strength of the proposal.

    The support program is part of an initiative to provide structure, process, and resources for the development of CPGs that enable the translation of research into physical therapist (PT) practice. The CPG development project is part of a larger association goal to better enable PTs to consistently use evidence-based best practice to improve the quality of life of their patients and clients.

    Proposals for the current review cycle are due September 15. For more information or for a copy of the proposal submission document, contact Anita Bemis-Dougherty, director, Practice Department, at anitabemis-dougherty@apta.org or call 800/999-2782, ext 3176.

    Get Involved: Flash Action September 8-10 Will Focus on PTs and Concussion Management

    Led by students in physical therapist (PT) and physical therapist assistant (PTA) programs, APTA members will focus their energies on advocating for the role of PTs and PTAs in the management of youth sports concussions when this year's Flash Action Strategy (FAS) takes place September 8-10. The innovative concentrated advocacy effort will use the APTA Legislative Action Center to contact members of Congress to effect change in this crucial area of health care—and you're invited to be part of the action.

    Getting involved is easy. APTA has prepared resources and provided a prewritten letter on this issue. Beginning Monday, September 8, APTA members can e-mail their legislators using the Legislative Action Center. Nonmembers and patients can use the Patient Action Center. You can also watch the announcements on the APTA Student Assembly Facebook page and Twitter feed (@APTASA) for updates on this important advocacy initiative. In the meantime, spread the word using graphics available for download on the FAS webpage!

    Last year's FAS supporting the Physical Therapist Workforce and Patient Access Act was the most successful advocacy effort in APTA history, with nearly 21,000 letters sent to Congress in only 72 hours. Hopes are that this year's effort will break that record. The FAS is a student-led campaign organized by the APTA Student Assembly Board of Directors in conjunction with APTA.

    Details on the FAS, and a video that provides some background to the effort, are available on the Flash Action Strategy webpage.

    ICD-10 Testing Dates Announced

    After several delays, the Centers for Medicare and Medicaid Services (CMS) is now ready to test its International Classification of Diseases, 10th Revision (ICD-10) system with providers before the October 1, 2015, startup date for use of the new codes. APTA is encouraging members to participate in the testing program to make sure that their own systems, billing companies, and clearinghouses are ready for the changeover.

    The testing program will be held over 3 separate weeklong sessions—one this November 17-21, and 2 in 2015, March 2-6 and June 1-5. Members only need to sign up for 1 session to find out whether their Medicare administrative contractor (MAC) will be able to accept claims with the new codes. The MACs will post information on how to participate in the tests. More information on the program can also be found in a Medicare Leaning Network bulletin (.pdf).

    WCPT President, Vice President Candidates Announced

    Candidates for World Confederation for Physical Therapy (WCPT) president and vice president have been announced and will be finalized at the confederation's General Meeting.

    One candidate has been announced for each position. Emma Stokes, currently WCPT’s vice president, has been nominated for president by WCPT member organizations in Australia, Brazil, Canada, Denmark, Ireland, Japan, Lebanon, Malta, Norway, Singapore, South Africa, Sweden, Taiwan, United Kingdom and the US. Margot Skinner, the Executive Committee member from the Asia Western Pacific Region of WCPT, has been nominated for vice president by member organizations in Bermuda, New Zealand, and Singapore.

    While there is only 1 candidate for each position, it is WCPT’s practice to hold a ballot at the General Meeting. Over the coming weeks, further information about both candidates will be published in WCPT News and on the WCPT website. Candidate CVs and statements will also be included in the General Meeting papers. The new term of office will begin at the close of WCPT Congress 2015 in Singapore in May. APTA is a member organization of WCPT.

    Keep up with the world of physical therapy: registration is now open for the 2015 WCPT Congress in Singapore, May 1–4. Attendees who register before the October 2 deadline can save up to 20%.

    Next PT in Motion Magazine Cover Is Up to You

    Once again, PT in Motion magazine is letting members decide which design will adorn the upcoming issue. For October, editorial staff is proposing 3 designs and asking members to vote on their favorite cover to illustrate our annual edition of the "Best States for PT Practice." The design that receives the most votes will be the next cover.

    Take the quick and simple survey by September 8. Just pick the design you think is likely to get you to open up the magazine, and then check out the October issue to feel the dizzying vindication as a finger-on-the-pulse design pro—or the edifying loneliness of the genius whose artistic vision is woefully under-appreciated, depending on how the voting turns out, of course.

    Report Predicts Coming PT, PTA Shortage in US

    A combination of a dip in the "natural rate of unemployment" and changed labor force numbers associated with the aging of the baby boomer population will likely place physical therapy among the professions experiencing a significant labor shortage over the next decade, according to a new study from The Conference Board.

    In its report "From Not Enough Jobs to Not Enough Workers," the corporate research organization analyzes likely labor market trends in North America, Europe, and Asia and finds that the recent global recession has only "postponed" the coming changes through lingering high unemployment rates. Once those rates begin to drop—as they already have in Canada and Germany—the demographic shift in the workforce will begin to take hold and create relatively rapid labor shortages in a majority of the 464 occupations studied in the report.

    According to a press release from the Conference Board, the US will likely see labor shortages in 3 broad areas: health-related occupations, skilled labor, and jobs in science, technology, engineering, and mathematics. Among the needed health occupations, the report specifically cites physical therapy and occupational therapy as potential areas of labor shortage, with overall need heightened by a greater demand for health care in general among an aging population. The report received coverage from the Wall Street Journal and Bloomberg Businessweek.

    Most of APTA's projections continue to show physical therapy as a growing profession, with projected unmet demand ranging from 13,638 to 27,820 physical therapist (PT) full-time equivalents (FTEs) over the next 5 years depending on the attrition rate of PTs over time. The total number of licensed PTs is projected to rise from about 176,000 to between 203,000 and 232,000 by 2020. The supply and demand data are part of a suite of resources on the physical therapy workforce available on APTA's website.

    Keep up with APTA's work to support PTs and PTAs in the labor market: check out the association's Workforce Education and Legislation webpage.

    APTA Comments on PFS, HHPPS, OPPS, DMEPOS Proposed Rules

    The 2015 physician fee schedule (PFS), home health prospective payment system (HHPPS), outpatient prospective payment system (OPPS), and durable medical equipment prosthetics, orthotics, and supplies (DMEPOS) are the subjects of newly available APTA comments on proposed rules from the Centers for Medicare and Medicaid Services (CMS).

    In the PFS letter (.pdf), APTA raises concerns about the therapy cap and urges timely congressional action. The association also writes that while it supports improved transparency in the valuation of current procedural terminology (CPT) codes, CMS should hold off on implementation of any changes until 2017 and should allow the CPT Editorial Panel to continue its work to develop a new coding structure for the 97000 series. Other areas addressed in the letter include substitute physician billing arrangements (locum tenens), the Medicare Shared Savings Program, the physician quality reporting system (PQRS), and a CMS proposal to expand the value-based modifier program to nonphysicians.

    APTA's letter on the HHPPS (.pdf) makes recommendations on a number of issues, including urging CMS to reduce rebasing percentage cuts and to overhaul therapy payment under the HHPPS. The association also commends CMS on its efforts to simplify therapy reassessment by removing 13- and 19-day timeframes, and recommends that it extend timeframes to every 30 calendar days.

    A separate APTA letter on the OPPS (.pdf) requests that CMS remove physical therapy from the potential services packaged in the proposed comprehensive ambulatory payment classifications (APCs), and that the agency collect cost and utilization data on the proposed packaged ancillary services program and its effects on patient outcomes. The association also writes in support of a CMS-proposed revision to remove the physician recertification requirement for inpatient admission (with the exception of long stays and outlier cases).

    APTA's comments on the DMEPOS rule (.pdf) recognize CMS for its efforts to curb fraud, waste, and abuse but warn that "certain proposed changes … could impede or delay access to timely medically necessary care." The association recommends that CMS proceed carefully with any plans to move to competitive bidding and bundled payment approaches, and urges the agency to conduct pilot testing before implementing any broad program.

    CMS will consider all comments submitted and issue final rules for these settings on or around November 1, 2014.

    Mark Your Calendar for the Latest on Parkinson Disease

    Coming later this month: the latest scientific information on Parkinson disease (PD) will be as close as your own Internet device, when the World Parkinson Coalition (WPC) hosts its first-ever series of free webinars.

    Called "WPC Scientific Update: Parkinson Pipeline Umbrella," the series will include 6 separate panel discussions available as live streaming presentations. Two discussions will be presented each day at 12 pm and 2 pm ET from September 30 through October 2. The program is free and will include presentations on protein folding, mitochondrial biology, therapeutics, treatment, dopamine efficacy, and personalized medicine from leading researchers and experts. Descriptions of the sessions can be found on the WPC website.

    Registration for the presentations is now open. WPC also plans to archive the presentations for later viewing.

    WPC is a nonprofit organization dedicated to providing an international forum to learn about the latest scientific discoveries, medical practices, caregiver initiatives, and advocacy work related to PD. The coalition brings together physicians, scientists, nurses, rehabilitation specialists, caregivers, and people with PD to help expedite the discovery of a cure and best treatment practices.

    APTA offers several resources on the role physical therapy can play in the treatment of PD, including a PT's Guide to Parkinson Disease, a Move Forward radio broadcast on the topic, and evidence-based practice research that can be accessed through PTNow.