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  • Recommendations for APTA Board, Nominating Committee Due by November 1

    APTA's transformational vision requires exceptional leadership. Anyone come to mind? How about you?

    The APTA Nominating Committee is seeking recommendations for the 2018 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.

    To submit names of qualified members who would be willing to be considered for the upcoming election cycle, visit APTA's Nominations and Elections webpage and use the online form under the "2018" header. Deadline is November 1.

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

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

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

    Karen Joubert, PT, DPT, who has provided PT services to Jennifer Aniston and P. Diddy, reflects on physical therapy's growing prominence in Hollywood (InStyle)

    Kimberly Steinbarger, PT, discusses kitchen tools that can make cooking easier for people with rheumatoid arthritis (US News and World Report)

    Gerard Breuker, PT, MSc, warns of the dangers of teen inactivity (Kankakee, IL, Daily Journal)

    Annita Winkels, PT, shows a local reporter how physical therapy can benefit overall health (Fox21 News, Duluth, MN)

    Joseph Trani, PT, ATC, offers suggestions on preventing knee injury (USA Today)

    Sue Stella, PT, DPT, explains the importance of physical therapy soon after a breast cancer diagnosis (WTVR6, Richmond, VA)

    Marilyn Moffat, PT, DPT, PhD, FAPTA, describes "killer arm workouts" (Business Insider)

    Raymond Halstead, PT, talks knee replacement (WBBH NBC2, Fort Myers, FL)

    Students from the Navarro College PTA program recently returned from a volunteer service trip to Haiti (Edinburg, TX, Review)

    "A qualified physical therapy professional is an excellent resource to help in learning to move and manage the body to minimize the pain and mobility loss associated with arthritis. Commitment to physical therapy can mitigate a path that would otherwise lead to surgery." –Tips on managing osteoarthritis from the Santa Rosa (FL) Press-Gazette

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

    Photos From NEXT 2017 Now Available

    Remember when people used to take pictures of subjects other than themselves, at distances other than an arm's length away, with devices other than their phones? Actually, that never went away.

    Hundreds of high-quality professional photos from the 2017 NEXT Conference and Exposition, taken with an actual camera, are now available online, and viewing them or purchasing copies is easy.

    Simply go to http://davidbraun.photoreflect.com and click on the "NEXT 2017" link in the middle of the page under "recent photos." Enter password lordosis, then click "GO" and the day/event of your choice. Select your photos and order through the shopping cart.

    Note: once you've clicked on a thumbnail, you can select the size and quantity of the print, or, if you want a digital download, click on the "digital products" button. Questions? Contact photographer David Braun.

    Don't miss other ways to revisit NEXT (or see what you missed): check out a storify page packed with videos, photos, and social media posts, as well as an exclusive " PT in Motion News @NEXT" page that collects news stories and videos from the event.

    From PT in Motion Magazine: Discovering a Second Career as a PTA

    When it comes to pursuing a career as a physical therapist assistant (PTA), it's never too late. Just ask the people who, often in middle age and after being successful in other areas, decided it was time to remake themselves as PTAs.

    In the July edition of PT in Motion magazine, Associate Editor Eric Ries takes a look at PTAs who have taken up physical therapy as a second career. Their stories reveal varied circumstances leading to the decision to become a PTA but a shared satisfaction with their new profession. Featured in the article are:

    • David Emerick, PTA, BBA, who ran a marine construction company and whose PTA interest was piqued when he volunteered to roleplay as a patient to help his wife, then attending PTA school herself
    • Gail Newsome, PTA, BBA, owner of a marketing company who encountered physical therapy after a breast cancer diagnosis, and who entered PTA school at 55
    • Walter Latapie, PTA, business manager and owner of an auto repair shop who says, "I used to fix cars. Now I help fix people"
    • Angie Sawdy, PTA, BS, who sold real estate with her husband but whose background in ballet and yoga pulled her toward the PTA path
    • Lisa Zemaitis, PTA, BS, former cosmetologist and stay-at-home mom who fulfilled a promise she made to a physical therapist who helped her overcome a rotator cuff tear
    • Chris Garland, PTA, BS, who worked as a graphic designer but had been intrigued by physical therapy after seeing how it helped her mother recover from dual anterior cruciate ligament repair
    • Doug Slick, PTA, BM, a working musician whose transition to PTA allowed him to pursue a career he loves while rediscovering the joy of music—this time as a hobby, not a job

    "First Choice for a Second Career" is featured in the July 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.

    APTA Comments on SNFs, IRFs, and Inpatient Payment – And on Medicare as a Whole

    'Tis the season: the time of year when the US Centers for Medicare and Medicaid Services (CMS) accepts public comment on next year's batch of proposed rules. This time around, CMS changed things up a little, asking that in addition to feedback on specific rules, commenters also weigh in on how the entire system could be more transparent, flexible, simple, and innovative. APTA obliged.

    APTA's overarching comments were provided in the association's responses to proposed rules for the 2018 prospective payment systems for acute care facilities, skilled nursing facilities (SNFs) prospective payment system, and inpatient rehabilitation facilities (IRFs) prospective payment system. While each comment letter addressed specific provisions of the individual rules, APTA included general comments advocating for changes to some Medicare policies related to the therapy cap, direct access provisions, and physical therapist (PT) use of telehealth, among other areas.

    Although CMS can't end the therapy cap—APTA is advocating for a bill in Congress proposing just that—the association does suggest that CMS address problems that arise when patient hospital stays are reclassified by auditors after the fact as "observation status" stays. That reclassification means that therapy cap limits, designed for use in outpatient settings, inappropriately kick in at hospital admission. APTA is encouraging CMS to develop an exception policy for these patients.

    APTA also pressed for CMS to look for ways to facilitate greater PT involvement in telehealth. As with the therapy cap, the actual addition of physical therapy to the list of telehealth services included for coverage is something that requires a change in law; however, ATPA believes that new alternative payment models increasingly being introduced by CMS open up opportunities for coverage.

    "As CMS continues to develop new and innovative models, we encourage the agency to maximize the ability of multiple types of providers, including physical therapists, to have the flexibility to use telehealth services to effectively manage patient care," APTA wrote in its comments.

    Direct access was another topic covered in APTA's letters, with the association arguing that "CMS should adopt a broad policy that eliminates physician referral requirements for physical therapy services to improve patients' access to … medically necessary care."

    APTA argued that "physician authorization requirements inadvertently create significant delays in the provision of physical therapy services to individuals who would benefit from treatment by a [PT]. These delays often lead to higher costs, decreased functional outcomes, and frustration to patients."

    All 3 comment letters are available on the APTA website as downloadable pdf files. Here's a quick recap of each.

    Inpatient Prospective Payment System (PPS) proposed rule comments (PT in Motion News summary here)
    The proposed rule would increase payments to acute care hospitals by 2.9%, but long-term care hospitals could see a 3.75% cut. APTA's letter supports a CMS proposal to include dual-eligibility status as a component in calculating penalties, as well as a plan to scrap the current "patient safety for selected indicators" measure in favor of a “patient safety and adverse events composite” measure by 2023, and changes to the priority level of certification requirements for critical access hospitals to reduce administrative burdens.

    IRF PPS proposed rule comments (PT in Motion News summary here)
    IRFs and SNFs would each see a 1% payment increase in FY 2018. CMS also proposes changes to some reporting requirements and value-based purchasing, among other areas. In comments to CMS, APTA stated its support for revamping the existing “pressure ulcer quality” measure and removing the "all-cause unplanned readmission" measures. Additionally, the association agreed with CMS on its plan to update the list of codes on the "presumptive compliance list," a list used to calculate a facility's compliance with the so-called "60% rule" that links payment to treatment of 1 or more of 13 conditions. Also backed by APTA: a proposal to implement survey-based experience-of-care measures.

    SNF PPS proposed rule comments (PT in Motion News summary here)
    The proposed SNF rule contains many of the same elements as the proposed rule for IRFs. APTA was consistent in its support for the quality measure, 60% rule, and patient survey changes proposed by CMS.

    2017 NEXT: Revisit a Great Conference (or See Why You Should Attend in 2018)

    The 2017 NEXT Conference and Exposition held in Boston last month was exciting, inspirational, thought-provoking—and a really good time. If you went, you may feel like reliving it; if you didn't attend you owe to yourself to see what you missed.

    APTA offers 2 ways to check out this year's NEXT event: a storify page packed with videos, photos, and social media posts, as well as an exclusive "PT in Motion News @NEXT" page that collects news stories and videos from the event.

    Physical Literacy Decline in Children Leads to Adverse Effects in Adults

    Physical literacy is as important as literacy in language, music, and mathematics. However, today’s children are becoming less physically literate, which could shorten their lifespan as much as 5 years less than their parents’. That was a point made in “Push Play: The Rise of Physical Therapy in the Physical Literacy Movement,” presented June 22 at NEXT 2017. The presenters were Christy Zwolski, PT, DPT, and Derek Roylance, PT, DPT, both with Cincinnati Children’s Hospital Medical Center.

    Zwolski said that physical literacy extends beyond sports: “Physical literacy is the ability, confidence, and desire to be physically active for life.”

    Although stating that “Humans are designed to move,” Zwolski noted that physical activity declined 32% from 1965 to 2009, and is projected to decline 46% from 1965 to 2030. The decline is occurring in all activity areas: occupational, domestic, transportation, and active leisure.

    The decline in activity also occurs as children age. At age 9, boys participate in approximately 190 minutes of moderate-to-vigorous physical activity (MVPA) a day. Girls engage in approximately 170 minutes of MVPA. By age 15, boys engage in less than 60 minutes, and girls are physically active for barely 30 minutes per day.

    Zwolski attributed part of the decline to a breakdown in the physical literacy cycle, in which desire and motivation lead to participation. Participation leads to ability, the “competence to move.” Ability, in turn, leads to confidence, which reinforces desire and motivation. She cited research suggesting that while confidence in performing activity is relatively high among 9-year-old boys and girls, by age 13 girls’ confidence has dropped sharply. Boys’ confidence remains fairly stable.

    Girls don’t perform as well as boys in many tests of motor competence, such as kick ball, 1-handed catch, and overhand throw, Zwolski said. (They do better than boys in skipping.) Further, girls’ performance lags further behind boys’ as girls age and begin to “disassociate physical activity with happiness.”

    Movement skills, she said, form the foundation for many lifelong activities. For example, when a child learns how to run, he or she can enjoy soccer, basketball, lacrosse, and tennis. Similarly, children who develop balancing skills can enjoy hiking, football, snowboarding, Zumba, and yoga. If basic skills aren’t developed in childhood, though, it becomes far more difficult to learn those other sports. He said physical literacy should be emphasized before sport-specific skills.

    Roylance presented a case series on promoting physical literacy in the community. Saying, “You don’t have to reinvent the wheel,” he explained that he consulted with a community relations specialist who already had identified programs involving youth physical activity. These ranged from a hospital lecture series on parenting skills to a baseball clinic sponsored by the Cincinnati Reds for children and their parents. Other programs included a health fair and a middle school field day.

    Oxford Debate: Specialist vs Generalist Education; Ciccone Declares Results to be the “Closest Ever”

    According to moderator Chuck Ciccone, PT, PhD, FAPTA, the 10th Oxford Debate, held June 23 at NEXT 2017, was the closest in its 10-year history.

    The motion being debated was: “Be it resolved that physical therapist and physical therapist assistant students will demonstrate expertise in a specific focused area of practice immediately upon graduation.”

    The pro team, arguing in favor of the resolution that graduating students should be able to demonstrate expertise in a specific area, consisted of Scott Euype, PT, DPT, MHS; Jody Frost, PT, DPT, PhD; and Frederick Gilbert, PT, DPT. Arguing against the resolution were Janet Bezner, PT, DPT, PhD; John DeWitt, PT, DPT, ATC; and Shawne Soper, PT, DPT, MBA.

    The pro team, dressed as personalities from the television show “The Voice,” led with Gilbert, who interspersed his arguments with a variety of hit songs. After a rousing version of “Ring of Fire,” he said, “We are not ready to treat what’s coming at us in the clinic. Generalists are generally good. But health care demands excellence. Are we prepared for the masses fed up with ‘sick care’?”

    Leading off for the con team was Dewitt, who said, “We are choosing a different path than we expected when we entered PT school. The missteps we take foster innovation and discovery, and that is good.” Citing the view of Gail Jensen, PT, PhD, FAPTA, that the hallmark of physical therapy is the ability to make judgments, often in uncertain conditions, DeWitt said, “Without that foundation, we cannot specialize. We need a robust set of tools to understand the needs of our patients.”

    Next up was Frost. Arguing in favor of specialization, she asked the audience: “Would you see a generalist for women’s health? Or for a spinal cord injury?” She spoke of the need for mentors, posing a question: “Clinicians: How many students chose their specialization after working with you? That’s good. We need specialists in practice. The generalists say they’re jacks of all trades, but there’s no way they could keep up with all the literature and research [required of specialists].” Continuing with the theme of “The Voice,” Frost concluded with a revised rendition of Lee Greenwood’s “God Bless the USA,” with lyrics reflecting the new title “God Bless the Specialist.”

    Soper, supporting the generalist position, responded: “Physical therapy is not about us. It’s about our patients and clients. So, where are they? All over the country. To care for the human experiences, we need physical therapists (PTs) where the need exists. But in rural areas, we have few PTs to cover huge areas. In those areas, it’s essential that patients have their needs met. Consider the patient poststroke or the child with special needs.” If a specialist isn’t where the patient is, “we’re not meeting the needs of society.” Education, Soper said, “needs to support a student’s exploration or else this is an opportunity missed.”

    Then came time for audience comments. Among them:

    “I’m a student and spending so much money. When I graduate, I want to be able to treat every patient who walks through the door.”

    A Florida-based PT said, “I get 7-10 requests a week for referrals. I’ve never been asked for ‘the best generalist.’ It’s always ‘the best neurologist’ or ‘the best orthopedist.’”

    An audience member commented, “We need to become movement specialists first. Then we can go from there.” Another audience member said, “I don’t know what all those letters after your name mean.” A PT based in Alaska said, “Where you care for patients across the state, you don’t know what’s needed until you’re there.”

    Then the program shifted back to the debaters. Wrapping up for the generalists was Janet Bezner, who said, “We have to meet the needs of all the people. Think of all the ICD-10 codes we address. We might see a child or an infant, a baseball player, a professional runner, a homemaker, a steelworker, or a painter. So we have to cast the net broadly to meet the needs of society. We’re not suggesting that there should never be specialists. But that should come after being a generalist.”

    Concluding for the pro team, arguing for specialization, was Euype. He said, “Being generally good is not good enough. We need to have a specialization. Do you want someone poststroke being treated by a generalist?” And, he added, “Students with specializations are more employable.”

    After scoring the debaters and tabulating the audience comments, Ciccone declared the generalist team the winner.

    From NEXT: PTs, PTAs, Must Take on the Challenges of Noncommunicable Disease

    Physical therapists (PTs) and physical therapist assistants (PTAs) are likely familiar with the health burden of noncommunicable diseases (NCDs), and many will even say that the physical therapy profession has a role in addressing that burden. But as 5 APTA Catherine Worthingham fellows would point out, saying that PTs and PTAs have a role is not the same as living out that role—and if the profession wants to achieve the latter, it has a lot of work to do.

    Marilyn Moffat, PT, DPT, PhD, DSc (hon), FAPTA, laid out the breadth of the NCD problem by way of a set of grim statistics, including a World Health Organization (WHO) estimate that 88% of US deaths are attributable to NCDs. Moffat said that although death rates associated with some of the 4 major types of NCDs—cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes—are trending down, the drops largely are related to drugs and surgical interventions and not in preventive lifestyle changes.

    Julie Fritz, PT, PhD, FAPTA, used Moffat's statistics as a springboard to talk about how NCDs affect different parts of society, pointing out that in certain locations, life expectancy is actually declining. "That's an inflection point that's worthy of note by all of us," Fritz said. "If you're poor, it really matters."

    The drivers, however, are less about socioeconomic factors and more about health behaviors, Fritz said. And while she believes changing those behaviors "is in our wheelhouse collectively as health care providers," in her opinion, PTs are "playing a very small role in being part of the solution to this situation."

    "We have to consider more upstream factors and think about care as a continuum," Fritz said. "The real goal is the well-being of the patient in a broader sense." But according to Fritz, PTs are doing little to approach the issue from this more proactive perspective; instead, "we just think more people ought to show up, and we're waiting for them," she said.

    The profession's slowness in making this shift isn't necessarily due to a lack of information or unclear policy directives, according to Lisa Saladin, PT, PhD, FAPTA. Saladin pointed to several resources, including the WHO global action plan on NCDs, that show not just the need for action but also the possibilities for the PT's role in reducing risk factors. But PTs can't go it alone, she added, saying that "we need to increase our level of partnerships."

    If any PTs or PTAs feel hesitant about taking on a more prominent role in the fight against NCDs, they shouldn't, according to Saladin. She cited 4 separate APTA positions, as well as the association's public policy priorities, as support for the physical therapy profession to step up to the plate. Without that action, she added, the policies don't amount to much. "We can talk the talk, and we can understand what our role should be," she said, but that doesn't necessarily mean the profession is acting on that understanding.

    So how does the profession shift to action? Gail Jensen, PT, PhD, FAPTA, said it begins with PTs and PTAs understanding that a "fundamental commitment to social justice" is "a part of who we are" as a profession. Jensen said that action won't happen until the profession fully embraces its ethical professional identity.

    Jensen said that the profession need look no further than its own code of ethics to understand its obligation to address NCDs—specifically, by way of Principle 8 of the code, which states that "Physical therapists shall participate in efforts to meet the health needs of people locally, nationally, or globally." That statement, linked to the core value of social responsibility, makes it clear that PTs and PTAs need to assume a role.

    But it's not simply about acting—it's about acting with a goal in mind, Jensen said, and that's an idea that brings its own challenges. "Do we really understand what it is to have a just health care system?" she asked.

    Karen Paschal, PT, DPT, MS, FAPTA, rounded out the presentations by focusing on how education "across our lifetimes as physical therapists" could spark a more active professional role in addressing NCDs. But bringing education up to speed first will require an examination of priorities, Paschal asserted. She challenged the audience by asking them, "How many of you have hired applicants who say 'I want to help prevent NCDs?'"

    Paschal said that change needs to take place in 3 major areas of educational focus. First, education around rehabilitation needs to provide more than an understanding of the role of NCDs—it needs to address what the PT and PTA can do. "Although we may give that [concept] language, we do not give that action in physical therapy," she said.

    Second, the profession needs to take an honest look at its education efforts around collaboration, including some of the underlying assumptions that color the profession's concept of what collaboration is. Paschal said that, too often, collaboration is understood as equivalent to an orchestral concerto, where "we dream of being the soloist accompanied by the orchestra." Taking up a real role in prevention of NCDs will require a much more humble attitude, she told the audience.

    Third, risk factors for NCDs need to be well-understood by PTs and PTAs, who in turn are ready to address those factors. "We need to change our orientation from rehabilitation and toward health prevention and promotion," Paschal said.

    In closing her portion of the discussion, Paschal may have summed up the crux of the entire presentation: "We need simply to think bigger."

    News From NEXT: Now Is the Time for PTs in Primary Care

    Physical therapists (PTs) "are in the perfect position to be involved in primary care," according to John Heick, PT, DPT, PhD, but to make the most of the opportunity, PTs need to understand the current primary care landscape and its potential for the future.

    That was the aim of "Primary Care Roles of Physical Therapists: A Perspective" presented on June 23 at the APTA NEXT Conference in Boston. Heick was joined by 6 other presenters—Steven Ambler, PT, DPT, MPH; Hadiya Green PT, DPT; Andwele Jolly, PT, DPT, MBA, MHA; Marie Johnson, PT, PhD; Ivan Matsui, PT; and Brian Young, PT, DSc—for a multifaceted look at primary care and the PT. The presenters were part of the team involved in creating a new APTA perspective paper on the topic. The session, with its attention to the here-and-now practicalities of the issue, provided important context for a later Rothstein Roundtable discussion focused on the future of PTs in primary care.

    Green began by providing background for the subject, pointing out that the idea that PTs could play a part in primary care is "not a new concept," but one that has received increased attention from APTA and its House of Delegates. In response, the association has begun to investigate and identify not just the roles of PTs in primary care teams, but which PT services may qualify as part of primary care delivery systems and the opportunities for integrating these ideas into practice, education, and research.

    Heick continued the context by describing primary care's history, which began with the need to treat the wounded overseas during World War I, and took formal shape when the US embraced the primary care model in the 1960s. The PT's role in primary care came later, when states began to create direct access provisions. According to Heick, the potential connection to primary care followed naturally, if for no other reason than that musculoskeletal conditions are the second most common reason for visits to the emergency department (ED) and account for 25%-28% of ED visits overall.

    PT education's part in primary care was covered by Johnson, who described how the curriculum evolved during the expansion of outpatient physical therapy in the 1970s and 1980s. That growth led to more focus on physical therapy as a doctoring profession, including the move toward the DPT and in the inclusion of not-always-explicit primary care concepts in educational guidance such as the Commission on Accreditation in Physical Therapy Education's evaluative criteria. There is more work to be done to increase primary care content, Johnson pointed out, including introducing opportunities for PT residencies in primary care.

    In some ways, the US military may provide insight into the future of primary care education in PT programs, explained Young, a Lieutenant Colonel in the US Air Force. Young presented an outline of the Army-Baylor DPT curriculum plan, which incorporates a significant amount of direct access concepts into its program. The result: PTs well-acquainted with an expanded role in primary care, with outcomes data finding no adverse effects among 472,000 direct access PT visits—which included PTs ordering imaging and prescribing medications.

    But gains aren't just being made in the military, explained Matsui, who serves on the faculty for Kaiser Permanente's Northern California Graduate Education program. Kaiser has been including PTs as primary care providers among its 21 hospitals across Northern California since the mid-1990s, when PTs were embedded in Kaiser-run clinics. Since that time, the program has shifted away from the embedding concept and toward a more consultative role for PTs, Matsui explained, where the PTs are asked to provide insight on the appropriateness of specialty referrals, special tests or imaging, injections, and work modification.

    Jolly focused on payment issues, noting that while the current Affordable Care Act (ACA) does not include PTs in the list of primary care providers, the value-based care programs arising from the ACA could change that. Expanded direct access to PTs would lead to lower utilization, fewer invasive interventions, shorter wait times, greater efficiencies, better patient education, and more appropriate diagnostic strategies—all of which would contribute to the "triple aim" of health care reform to lower costs, better the patient experience, and improve the health of populations, Jolly said. But, he added, there are a host of barriers to be addressed, including reimbursement issues, certification requirements, agreement on a diagnostic classification system, and malpractice and liability considerations.

    Ambler wrapped up the session by reminding the audience that the barriers are worth overcoming, because PT involvement in primary care represents a true benefit to society. He explained that expanded PT direct access in primary care settings would lead to greater coverage of underserved areas, a more diverse workforce, and an enrichment of the primary care body of knowledge, thanks to the unique perspective the PT brings to the table.

    APTA members can go online to read “A Perspective—Exploring the Roles of Physical Therapists on Primary Care Teams,” the association’s new perspective paper on primary care. (Log in to apta.org and look under Hot Topics Related to PT Scope of Practice on the Scope of Practice webpage.)