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  • Washington Post: Female PTs Will Spend Last 4 Weeks of 2017 Working 'For Free'

    Guess what the majority of physical therapists (PTs) will be doing beginning December 2? According to a recent article in The Washington Post, that's when female PTs start working for free for the rest of the year while their male counterparts continue to get paid. And that disparity is actually a bit smaller than the one faced by most women in the workforce.

    The Post article, published on October 26, examines the issue of gender pay gaps by way of establishing "work-for-free" dates in multiple professions—the date after which average wage disparities equate to the lower earning group (almost always women) working without pay for the remainder of the year. On a national level, according to the article, women's salaries are approximately 80% of what men receive, a gap that translates into 10 weeks of work without pay for women. Put into calendar form, that means that when averaged across professions, women began working for free on October 14.

    The physical therapy profession fares better than the national average, with an estimated work-for-free date of December 2 for women. That correlates with an average hourly pay difference of $37.23 an hour for male PTs versus $34.33 per hour for female PTs, according to the article. Data for the report were derived from a study by IPUMS, a census and survey research organization that specializes in microdata.

    The December 2 disparity date for physical therapists is the same as for elementary and middle school teachers. That date is better than the work-for-free date for physicians and surgeons (September 8) and dentists (October 19) but slightly worse than for registered nurses (December 6) and social workers (December 19).

    The article includes graphics, potential causes, and an exploration of various theories that attempt to explain the gap. Those theories include the idea that women tend to choose lower paying jobs ("sort of," the article states), that they choose to work part-time (that's not always by choice, according to the Post), and that younger, more educated women don't experience a wage gap (they do).

    "What this all hints to is that the causes of the gender gap are many and more nuanced than just individual choices or corporate discrimination," writes author Xaquin G.V. "However you slice the data, the gap is there."

    From PT in Motion: The Power and Potential of Clinical Registries

    To succeed in a value-based care environment, all health care providers—including physical therapists—must embrace accountability in the form of standardized patient outcomes data. Clinical outcomes registries are one way many health care professional societies and large health systems are doing so.

    This month’s issue of PT in Motion magazine includes a feature article on clinical outcomes registries such as APTA’s Physical Therapy Outcomes Registry, including a look at how they work, and how practices can increase the power of their electronic health record (EHR) data to inform and improve patient care.

    "Strength in Numbers: The Power and Potential of Clinical Data Registries" explores how other medical professional societies are using registries to collect and analyze outcomes to improve patient care. Nicholas A. Vaganos, MD, a cardiologist whose employer participates in a clinical registry, tells PT in Motion, "When you pay attention to the data…it helps improve your treatment and your documentation."

    The registry directors interviewed for the article share examples of how the findings from large amounts of clinical data can revolutionize the way providers practice by providing real-time insights to supplement clinical practice guidelines. The article includes practical insights from physicians, quality experts, and an EHR software vendor on the nuts-and-bolts of participating in a registry.

    To find out more about APTA's Physical Therapy Outcomes Registry, visit the registry website or email registry@apta.org.

    "Strength in Numbers: The Power and Potential of Clinical Data Registries" is featured in the November issue of PT in Motion and is open to all viewers—pass it along to nonmember colleagues to show them 1 of the benefits of belonging to APTA. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.

    Final Fee Schedule Rule a Mixed Bag; Outpatient Rule More Positive

    The US Centers for Medicare and Medicaid Services (CMS) has issued final rules for the 2018 Medicare physician fee schedule (PFS) and outpatient prospective payment system (OPPS) that don't vary significantly from the proposed rules released earlier in the year—except when it comes to 1 element involving the current procedural terminology (CPT) codes.

    As in the initial proposal, work relative value units (RVUs) for CPT codes will be maintained under the PFS as per recommendations from an American Medical Association review panel. However, CMS has changed its approach to practice expense RVUs: instead of maintaining those RVUs at 2017 levels as proposed, the agency will adopt the panel's recommendation for some reductions. APTA staff are analyzing the entire rule and will issue a detailed summary in the coming days that will clarify the impact those reductions might have. CMS has issued a fact sheet on the final rule.

    Taken as a whole the final PFS rule contains more good news than bad in the wake of a lengthy review of multiple CPT codes—many of which commonly are used in physical therapy—as potentially "misvalued." The review had put those codes at risk of sizable reductions for both work and practice expense RVUs. While some practice expense RVUs may drop, the final rule includes no cuts to the work RVUs and actually increases values for a few. Initial analysis indicates that overall, the increases and cuts likely balance out.

    More positive news related to the fee schedule: CMS will increase the therapy cap from $1,980 to $2,010 beginning in 2018. The therapy cap landscape could be seeing further changes, however, pending the outcome of an effort in Congress to repeal some elements of the therapy cap process.

    The PFS announcement comes on the heels of a final OPPS rule that also includes provisions supported by APTA—particularly moves toward reimbursement for outpatient-based total knee arthroplasty (TKA) and "non-enforcement" of direct supervision requirements for outpatient therapeutic services delivered in designated critical access hospitals and rural hospitals with fewer than 100 beds. The final rule also mirrors the proposed rule's overall 2% payment increase for outpatient hospitals and a 1.9% boost for ambulatory surgical centers. A detailed APTA summary of the OPPS rule also is in the works. CMS has issued a fact sheet on the final rule.

    HHS Unveils Proposal Allowing States to Change Details of Essential Health Benefits

    The US Department of Health and Human Services (HHS) wants to change the ways the Affordable Care Act's (ACA) state insurance exchanges set up their coverage requirements. It's a detailed, complicated proposal, but wade in far enough and you'll get to the real story: a push toward a system that would allow states to dramatically alter the way they manage so-called "essential health benefits" (EHB) that include rehabilitation.

    The result? "Mass confusion and market disruption," according to APTA Director of Regulatory Affairs Kara Gainer, JD. "These changes, if adopted, would also impose a significant financial and administrative burden on consumers and providers, given they may face dramatic changes to their coverage on an annual basis." APTA is preparing comments to HHS on the proposal and will develop template letters for use by members in the coming days. Comments on the rule are due by November 27.

    At the heart of the proposal is a plan that would allow states to play mix-and-match with other states' provisions associated with EHB "benchmark" plans; essentially, the minimum health insurance requirements for policies offered through a particular state's insurance exchange. Although every state must require that insurance policies include coverage for 10 EHBs, just how that coverage is managed—elements such as number of allowed visits for physical therapy, or limits to the kinds of services that are included in an EHB category—can vary.

    Even though some variations in coverage are allowed under the current system, those variations must exist within certain parameters. States currently are restricted to adopting a plan that echoes 1 of several options: the 3 largest group plans in the state, the 3 largest state employee health plans, the 3 largest federal employee health plans, or the largest HMO offered in the state's market. States that opt not to adopt a benchmark plan are assigned a plan that mimics the largest small group plan in the state. Benchmark plans were stable from 2014 through 2016; some may have changed slightly in 2017.

    The proposed rule would change all that. States would be allowed to adopt entire plans or parts of plans from other states, or they could develop their own plan, so long as the new plan isn't more generous than it was before. In addition, the HHS proposal would significantly lower the bar when it comes to the extent of coverage: instead of adopting plans from the list of large plans, the state would be required only to offer a plan that is slightly better than the skimpiest allowable employer-sponsored or self-insured group health insurance plan. Plans could be rejiggered every year.

    This isn't good news for consumers, Gainer says.

    "While it's true that the 10 EHB categories aren't going away, allowing states such broad flexibility in setting their individual EHB benchmark plans could result in consumers losing coverage to a lot of services that fall under the EHB categories," Gainer said. "There is great potential for not only confusion among consumers but disruptions in access to care."

    Here's how it might work. Currently, some states—California, for example—have relatively broad EHB benchmark requirements for rehabilitation benefits, while other states, such as Arizona, have benchmarks that include visit limits for physical therapy and occupational therapy. Under the plan, California could choose to adopt all of Arizona’s EHB benchmark plan or just replace its rehabilitation category with Arizona's rehabilitation category of benefits, leaving consumers in California suddenly facing visit limits and other restrictions.

    Making matters even worse, according to Gainer, is the provision that a state's EHB-benchmark requirements need only be better than the most minimal allowable employer plan or self-insured group health plan, and not exceed the generosity of the state’s 2017 benchmark plan. Using Arizona as an example, if the state chose to build its own EHB-benchmark plan and define the benefits within each category, it could lower the amount of coverage offered, but it would be prohibited from developing a benchmark plan that is more generous than it is today.

    "Some employer and self-insured group health plans can be very restrictive and severely limit actual benefits under each EHB category," Gainer said. "If a state chooses to design its own EHB-benchmark plan, the new plan just has to be slightly better than that."

    APTA has been focused on preserving EHBs throughout 2017, as Congress made repeated attempts to repeal and replace the ACA with plans that would have greatly reduced or eliminated the concept. APTA President Sharon L. Dunn, PT, PhD, issued a statement describing the removal of EHBs as an action that would run counter to APTA principles on health care.

    US Receives Failing Grades on Walking and Walkability

    Ask any kid: you know you're in trouble when the high point on your report card is a C among 2 Ds, 5 Fs, and an "incomplete." That's precisely the spot the US is in when it comes to walking and walkable communities, according to a recently released report card from the National Physical Activity Plan Alliance (NPAPA). APTA is an alliance partner.

    Released this fall, the Walking and Walkable Communities Report Card reflects the NPAPA's assessment of “the extent to which the US population and US communities meet selected standards for participating in walking and providing physical and social supports for behavior." The NPAPA used a similar approach in 2014 when it released a report card on physical activity across the country that reflected an overall 1.5 GPA. Like the earlier report card, the results this time around aren’t honor roll material.

    The best the country could muster, according to the alliance, was a “C” for “adult walking behavior”—the number of adults who report walking on a regular basis for work, recreation, or planned exercise. Assessors were looking for the percent of adults who reported walking for 10 minutes or more at least once in the preceding week: the 63.9% of respondents who reported meeting that mark earned the US its highest grade. The narrative that accompanies the report card points out that walking prevalence has not increased much between 2010 and 2015, though women did experience a 2.6% rise during that time.

    It was all downhill from there.

    In the areas of “pedestrian policies” and “walkable neighborhoods,” the alliance gave the US a D grade for each. Pedestrian policies fall short, says the alliance, because communities aren’t doing enough to support a “complete streets” model that ensures streets are built to support all forms of transportation, not just automobiles. The low grade for walkable neighborhoods reflects the fact that only 16 states report that 30% or more of residents live in a highly walkable neighborhood.

    But the most prevalent grades, by far, were Fs, with 5 failing grades issued by the alliance. According to the report card, the US earned Fs on children and youth walking behavior, pedestrian infrastructure, safety, institutional policies, and public transportation. A grade of “incomplete” was assigned to walking programs because there is no system in place that monitors the prevalence of those programs across the US, according to the alliance.

    Dianne Jewell, PT, DPT, PhD, who served on the advisory panel for the report card, says the report card should be understood more as a way to encourage serious dialogue and advocacy for walking and community walkability, and less a hard-nosed assessment.

    “These grades should be viewed thoughtfully,” Jewell said. “I see them as flares indicating serious potential hazards ahead if we don’t address the issues in each domain, rather than as absolute indicators of performance.”

    "We now have a consolidated baseline picture of our successes and challenges in supporting walking and walkability, and we now can measure change over time,” Jewell added. “There are important lessons underneath those grades, including data on differences in walking behavior by age, gender, and ethnicity, as well as some examples of state-level successes in some of the walkability domains.”

    Jewell has since stepped down from the NPAPA. These days, Chris Hinze, PT, DPT, serves as APTA’s representative to the group.

    Like Jewell, Hinze believes that the report card points to the need for societal change. And he thinks physical therapists (PTs) and physical therapist assistants (PTAs) can play an important role in making that change happen.

    “With their expertise in human movement, PTs, PTAs, and students can and should be key voices in this discussion,” Hinze said. “First, PTs and PTAs should educate themselves on social determinants of health—specifically, how the built environment influences health and health-related behaviors. Then they should consider becoming advocates for policies and infrastructure that encourage active transportation in their communities.” Hinze points to a comprehensive set of strategies and tactics developed by NPAPA that can help inform and guide PTs and PTAs in this work.

    For both Hinze and Jewell, the bottom line is clear: things need to change, and soon.

    “For decades, communities have largely been designed around the automobile, with human movement an afterthought—this needs to change,” Hinze said. “Cities and communities need to be intentional with their policies, planning, and design to make active transportation a safe and convenient choice for moving about."

    “If we can’t even meet the minimum threshold of safety, then efforts in other areas will ultimately be limited,” Jewell said. “Common sense says injury or fatality while walking or cycling should be socially unacceptable without the need for debate, yet we still favor policies and infrastructures designed for motorized vehicles moving at speed with a minimum of interference. Until that perspective changes, I think we will only see small, incremental improvements in many of these grades.”

    Want to learn more about the NPAP and the work of the NPAPA? Check out this video, and read the entire National Physical Activity Plan , a revised roadmap for community-level change.

    APTA to Submit Feedback on USPSTF Draft Falls Prevention Recommendations

    The United States Preventive Services Task Force (USPSTF) issued draft recommendations for falls prevention in community-dwelling adults age 65 or older, and APTA will issue formal comments after receiving feedback from member experts from the Academy of Geriatric Physical Therapy and the Academy of Neurologic Physical Therapy.

    APTA members are encouraged to submit their own comments as well.

    Based on an evidence review, USPSTF concludes with moderate certainty that both group and supervised individual exercise can reduce risk for falls. Regular exercise should include aerobic and strengthening activities, as well as balance and gait training.

    The task force found only a small net benefit to routinely providing a multidisciplinary assessment and a customized “multifactorial” combination of interventions, such as exercise, psychological interventions, and physical therapy, among others; however, authors acknowledge that, for certain older patients with a history of falls and comorbid conditions, an “in-depth multifactorial risk assessment with comprehensive management” may be appropriate. Authors also write that vitamin D supplementation has no benefit in falls prevention.

    Want more on falls prevention? Check out the falls-related resources at PTNow, including a unilateral vestibular hypofunction clinical summary, a summary on falls risk in community-dwelling elders, an osteoporosis clinical summary, and tests and measures such as a fracture risk assessment, a clinical test of sensory interaction and balance, and a self-paced walk test. APTA also offers resources at its Balance and Falls webpage.

    VA Wants to Move Telehealth Beyond State Borders and Into Vets' Homes

    The US Department of Veterans Affairs (VA) would like to remove barriers to telehealth and allow its providers—including physical therapists (PTs)—to conduct telehealth activities across all 50 states and in non-federal sites, including patients' and providers' homes.

    In a proposed rule, the VA describes how its current telehealth program is limited by many state professional licensure laws and regulations, which restrict telehealth activities to within state borders. Additionally, writes the VA, many VA medical centers only allow telehealth on federal property out of concern that its providers will run afoul of state regulations, thereby eliminating the possibility of a patient receiving telehealth at home.

    If adopted, the new rule would change all that. State laws would be preempted by federal provisions that would allow a VA provider to conduct telehealth services with a patient in another state, and in any location. According to the VA, preemption is a more practical way to expand telehealth than if the agency were to lobby state legislatures for changes to individual state laws.

    The VA hopes that the change will help improve veterans' access to mental health services, but it also believes that expanded telehealth will improve care across the board, including ensuring that patients in more remote areas can receive needed services.

    "Monitoring general medical conditions in the beneficiaries' homes empowers beneficiaries to take a more active role in their overall health care without adding the stress of commuting to a medical facility to receive the same type of care," the VA writes. "Telehealth is particularly important for beneficiaries with limited mobility, or for whom travel to a health care provider would be a personal hardship."

    APTA will be commenting in support of the proposed rule, and will notify members of any developments.

    APTA Opposes Graham-Cassidy Due to Patient Impact

    The specifics of the US Senate's latest attempt to repeal and replace the Affordable Care Act (ACA) could evolve before any vote, but the basic outline of the "Graham-Cassidy" (or "Cassidy-Graham") legislation raises enough concern that APTA opposed the bill this week.

    "APTA is open to ACA reform but opposed to eliminating essential health benefits and access for millions," APTA said via Twitter and Facebook on Wednesday. "APTA is opposed to Graham-Cassidy."

    To underline its position, APTA is joining 2 patient/provider groups, the Coalition to Preserve Rehabilitation and the Disability and Rehabilitation Research Coalition, in letters opposing Graham-Cassidy. APTA also has enabled members to contact their senators via the Legislative Action Center and APTA Action app to urge caution before removing various patient protections provided in the ACA.

    "APTA is committed to working with Congress to improve health care, including potential reforms to the ACA, but not at the expense of decreasing access for millions of Americans," said Justin Elliott, APTA's vice president of governmental affairs.

    This is consistent with APTA's position dating back to March, when APTA raised concern that the House of Representatives' American Health Care Act legislation would "create unneeded barriers to care and reduce the access to care for millions of Americans." In May and July, APTA opposed the Senate's American Health Care Act and Better Care Reconciliation Act, respectively.

    Among APTA's concerns in these repeal-and-replace efforts has been the elimination of the ACA's essential health benefits, which include habilitation and rehabilitation services, and the potential to adversely affect millions of Americans who rely on Medicaid. APTA has long advocated for access to adequate, affordable, and quality health care services for all Americans, and the association says these repeal-and-replace bills challenge those principles (.pdf).

    The Graham-Cassidy legislation is expected to be brought to the Senate floor next week.

    Microchips That Reprogram Cells, 'Superglam' Physical Therapy, and Powow Sweat: Highlights From 'Making the Rounds'

    This year, PT in Motion News added a new section to the weekly news blast to members—"Making the Rounds," a collection of interesting reads for the profession from across the Internet. The collections tend to have a wide focus and include articles on everything from exercise to health care policy. Some articles are more technical; others shine a light on how exercise, mobility, and physical therapy are being portrayed in the popular media.

    In honor of "Listember" week at PT in Motion News, here's a collection of some of the more interesting stories that have been featured in "Making the Rounds" over the past few months:

    When the prescription is a recipe
    There's a growing trend among doctors and medical groups to move beyond simply recommending healthy diets and toward helping patients learn how to prepare meals.

    Everything we know about treating tendon injuries is wrong
    From Outside magazine: "After most MCL and ACL surgeries, doctors focus on treating and rehabbing the soft-tissue, while almost completely ignoring motor patterns and biomechanics.

    Islamic prayer has been found to reduce back pain and increase joint elasticity
    The postures used during prayer can be beneficial—but only if they're done properly.

    Pokemon Go players walk an extra 2,000 steps daily, study says
    The American Heart Association says the game is getting people moving.

    Scientists unveil a possible new way of healing wounds in the future
    A microchip placed on a wound delivers signals that reprogram living skin cells to convert them into specific kinds of cells that can aid in healing.

    Can patients make recordings of medical encounters? What does the law say?
    It's complicated, according to the authors of this article in JAMA.

    Fitness pros have a dirty little secret: chronic pain
    Personal trainers are susceptible to overuse injuries.

    Teens get as much physical activity as 60-year-olds, study shows
    Researchers were expecting bad news, but not that bad.

    Knee patients spending millions on wasted treatments, study finds
    In an effort to avoid surgery, patients and their insurance companies are spending millions on ineffective treatments such as hyaluronic acid injections—and not seeking physical therapy, which actually does help.

    "Powow Sweat" promotes fitness through traditional dance
    The Coeur D'Akebe tribe has created an exercise routine—called "Powwow Sweat"—based on traditional dancing.

    How Hollywood is making physical therapy super glam
    From InStyle: "This once daunting pain management therapy reserved for those recovering from surgery or injury has shifted its place in the wellness space, becoming a hot new addition to celebrities’ workout routines, whether they are injured or not."

    She thought she’d pulled hip muscles, but six doctors couldn’t diagnose her pain
    It took a PT to figure out what was going on.

    From PT in Motion magazine: PTs and Chronic Fatigue Syndrome

    Chronic fatigue syndrome (CFS) is real, and physical therapists (PTs) can play a significant role in helping those who experience it regain at least some semblance of their pre-CFS lives—but only if those PTs truly listen to the patient and validate their struggles.

    This month's PT in Motion magazine takes an in-depth look at CFS, tracking its emergence from a set of symptoms dismissively called "yuppie flu" to the more recent establishment of CFS as a very real, very life-changing physiological condition that could come to be more widely known as systemic exertion tolerance disease (SEID). Currently, CFS is the more common term for the condition and is the terminology used in the article.

    But the article is more than a lesson in history: Associate Editor Eric Ries focuses on how PTs, including one with CFS herself, apply their training to help patients respond to a condition that is often misunderstood and can leave people feeling helpless and isolated.

    The feature includes practical insights on the kinds of interventions used by PTs who've worked with patients with CFS, as well as accompanying articles on the basics of the condition, the emergence of consensus around the need for a transition to use of “SEID” instead of “CFS,” and resources for more information.

    However, as stressed by nearly every PT interviewed for the article, working effectively with patients with CFS requires more than an understanding of the physiological elements of the condition, and treatment won't be effective if the PT thinks of treatment from a one-size-fits-all perspective. Instead, PTs needs to fine-tune their ability to truly listen and empathize.

    In being interviewed for the article, Adriaan Louw, PT, PhD, tells PT in Motion that listening and truly being present with the patient can have a powerful impact almost immediately. "Ninety percent of our patients with chronic fatigue syndrome start crying during [the patient interview] process," Louw says, "simply because we're spending time with them, taking them seriously, and demonstrating that we care about them as human beings."

    "The Real Story About Chronic Fatigue Syndrome" is featured in the September issue of PT in Motion and is open to all viewers—pass it along to nonmember colleagues to show them 1 of the benefits of belonging to APTA. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.