Everyone recognizes that cultural competence is a crucial component of the physical therapy profession, and a concept that's strongly tied to APTA's transformative vision. But what is it really? And how will you know when you're living out cultural competency in your practice?
Here are 5 tips on cultural competence, drawn from APTA's extensive online resources that include videos, online and text-based courses, as well as association plans, policies, and guidelines. Take a few minutes to get reacquainted with these basics, and then explore the details through the APTA website.
1. Take an honest look at yourself.
Cultural competence begins with an understanding of how your own culture has shaped you, and how your attitudes and understandings of other cultures impact your behavior toward individuals from outside your cultural experience. Being honest with yourself is a crucial step.
2. Pay attention to systems.
Individual attitudes about cultural differences do matter, but it's important to realize that cultural competence also requires attention to the interplay of systems—the family system, the delivery system, the educational system, and many others. When these systems interact, they can create tensions—or opportunities. The culturally competent physical therapist is mindful of the bigger picture constantly in play.
3. Listen, listen, listen.
Culturally competent treatment is by definition patient-centered. So ask questions, and listen carefully to the answers, without judgment. Questions worth asking: What do you call the problem? What do you think the illness will do to you? What do you believe is the natural course of the illness? What do you fear? Why do you think this illness or problem has happened? How do you think it should be treated? How do you want to be helped? Who should be involved in decision-making?
4. It's not just about race.
Culturally driven attitudes can arise from shared thoughts, beliefs, and customs that may be less about race, and more about ties to ethnic, religious, social, or even age-related groups. Just because your patient or client looks and talks like you doesn't mean you can relax your attentiveness to potential cultural differences (see "Listen, listen listen," above).
5. There's no finish line.
You're never "done" with cultural competence. It's a process that requires constant self-assessment, learning, and openness to honest dialogue with colleagues. There are no books or courses that will make you culturally competent—like maintaining a healthy, active lifestyle, cultural competence requires ongoing effort. But the payoff is tremendous.
According to Medicare administrative contractors (MACs), physical therapy procedures are among the "more common" procedures that get denied due to insufficient documentation. It's a pattern they're hoping to change through additional information aimed in part at physical therapists (PTs).
Earlier this month, a task force made up of all 8 MACs issued a fact sheet and a "task force scenario" (.pdf) that highlights, among other things, what PTs should be aware of when it comes to developing a plan of care. According to the fact sheet, the main problem encountered with physical therapy services is insufficient signatures and dates on plans of care. The fact sheet provides details and links to the specific requirements.
A second document, titled "Task Force Scenario: Documenting therapy and rehabilitative services," is available at all 8 MAC websites, and goes into even more detail on how to reduce the risk of errors attributed to insufficient documentation. Among the tips provided:
For the complete guidance document, visit the website of the applicable MAC (direct links to the scenario document have been provided where possible): Cahaba Government Benefit Administrators, CGS Administrators, National Government Services, Noridian Healthcare Solutions, Novitas Solutions, Palmetto GBA, or Wisconsin Physicians Service Corporation.
Learn more about how to avoid Medicare documentation errors: the APTA Center for Integrity in Practice website offers a webpage dedicated to documentation.
The transformative power of physical therapy to treat diverse conditions is at the heart of recent Move Forward Radio episodes.
A twice-monthly podcast, available for free download from iTunes or at MoveForwardPT.com, Move Forward Radio is a terrific resource to share with your patients. Recent episodes include:
Pregnant and postpartum exercise
During pregnancy and childbirth a woman’s body goes through profound changes in a relatively brief period of time. For women who exercise during or after pregnancy, failure to respect those changes has the potential to lead to problems. Christy Martin, PT, DPT, SCS, who specializes in sports physical therapy, and Vicki Lukert, PT, PRPC, who specializes in pelvic health, outline how pregnant and postpartum women can exercise safely and how to spot warning signs for problems that might require medical attention.
Concussion and mild traumatic brain injury
At Brooke Army Medical Center in Texas, Miriam Hammerle, PT, Cert SMT, often sees patients who have suffered a mild traumatic brain injury or concussion in the line of duty. One of her recent patients, Lt Col Tony Cromer Jr, suffered a concussion when his head was slammed by an opening door. The effects of that workplace accident, including headaches and dizziness, were the same as they often are for soldiers on the battlefield. Hammerle and Cromer discuss his injury and treatment.
Autism spectrum disorder (ASD)
ASD can be treated by a range of therapists who have individual specialties but overlapping goals. Christine Baksi talks about her 4-year-old son Sam, who was diagnosed with ASD at the age of 2, and is benefitting from a variety of therapies including physical therapy. Joining the discussion is Sam's physical therapist Lori Glumac, PT, DSc, PCS, who is a member of a collaborative care team that helps children with ASD develop physically and socially.
Avoiding golf injuries
Having a repeatable swing is key to having a good golf game. But with that repetition comes a risk for injury to backs, elbows, shoulders, and more. Michael Mulcahy, PT, discusses treatment for injured golfers, outlines typical golf-related injuries, and offers prevention tips that can help golfers strengthen themselves and their game.
Stroke awareness, prevention, and recovery
Those fortunate enough to survive a stroke often face problems with mobility, speech, balance, weakness, and memory loss, among other symptoms. Fortunately, depending on the severity of the stroke and the health of the individual, a physical therapist can effectively treat many of these side effects. Julia M. O. Castleberry, PT, DPT, MS, CLT, GCS, NCS, addresses all aspects of stroke, including describing what stroke rehabilitation looks like, how to spot a stroke, identifying who is at risk, and how to lower that risk.
Spinal stenosis is a degenerative disease that causes a narrowing within vertebrae of the spinal column, resulting in pressure on the spinal cord. While it may sound like a serious problem in need of an invasive medical procedure (such as surgery), a recently published study in the Annals of Internal Medicine suggests that surgery should be considered only when other more conservative treatments, such as physical therapy, fail. Lead author Anthony Delitto, PT, PhD, FAPTA, discusses the study, treatment for lumbar spinal stenosis, and what patients need to know about options to avoid going under the knife.
Move Forward Radio is featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as a podcast via iTunes.
APTA members are encouraged to alert their patients 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 firstname.lastname@example.org.
A solid understanding of the Health Insurance Portability and Accountability Act (HIPAA) is crucial to the survival of a physical therapist (PT) practice, so taking the time to read through a free online guide to HIPAA (.pdf) from the Department of Health and Human Services (HHS) is a good investment in your future. The new guide is one of many resources available to PTs and physical therapist assistants at APTA's HIPAA webpage.
Want to test what you already know? Take this quick HIPAA quiz. Scroll down for the answers.
For many physical therapists (PTs) and physical therapist assistants (PTAs), the time will come for them to take a break from active practice. Sometimes it's relatively brief—time off to care for a new baby, for example—and sometimes it's longer-term. And chances are that sooner or later, most of these PTs and PTAs will want to return to the profession they love.
APTA offers a solid set of resources on career management, including career management resources useful for women in physical therapy, that will help you prepare yourself for a break, and get your head around what it takes to reenter the profession.
Here are 5 quick tips on preparing for—and returning from—a break in practice.
A patient injures herself during a physical therapy session. What happens next?
The patient faces a longer recovery time, of course. And depending on the physical therapist's (PT's) approach to risk management, the PT could be facing a potentially costly and career-damaging malpractice claim that might have been avoided.
The latest case study (.pdf) now available from Healthcare Providers Service Organization (HPSO) recounts the story of a self-employed contract PT working at a rehabilitation facility. His patient, a 49-year-old woman, is recovering from a hit-and-run accident that resulted in a vertebrae fracture, a wrist fracture, and a crushed spine. She's morbidly obese, a heavy smoker, and takes prednisone.
Five months into treatment, the patient is injured during a physical therapy session. She files a malpractice claim against the PT.
Could the injury have been avoided? Was the exercise she was performing at the time of the injury set up and monitored correctly? Was the exercise itself evidence-based? And what other elements of the PT's practice are likely to be exposed in mediation or a court hearing? The HPSO case study lays out the facts.
"Case studies like these are a reminder for PTs that risk management is not just a part of practice, but a professional responsibility," said Nancy White, PT, DPT, OCS, APTA executive vice president of professional affairs. "Things can and do go wrong, but a PT who fully understands risk is better able to protect the patient, which in turn protects the PT."
The latest case study joins a series of case studies available at the HPSO website. HPSO is the official provider of professional liability insurance for APTA members. For further information visit www.hpso.com/APTA.
The recently released proposed rules for inpatient prospective payment systems (IPPS) continues the US Centers for Medicare and Medicaid's (CMS) push for more data from facilities, with some payment increases being contingent on quality reporting participation and meaningful use of electronic health records (EHRs).
The rule sets out a 1.1% increase in operating payment rates for acute care hospitals that successfully participate in the hospital inpatient quality reporting program (IQR) and that are "meaningful" users of EHRs. Hospitals that don't meet the IQR requirements could see a one-fourth reduction in payment rates, and hospitals that fail to achieve meaningful EHR use by 2016 would face a cut of one-half of any update issued.
Other features of the proposed rule:
The proposed rule also seeks feedback on a CMS bundled payment initiative that links payments for multiple services during 1 episode of care into a combined payment. The initiative is testing 4 models of bundling, and CMS is asking for comments on future expansion of the plan.
APTA has produced a summary of the proposed rule (.pdf), and will provide comments to CMS on behalf of its membership.
In a health care environment in which health insurance copays are becoming an increasingly powerful driver in care decisions made by consumers, it's valuable to understand the lay of the land when it comes to the ways states regulate insurance companies and what they can demand. That's where APTA's new interactive copay map comes in.
The new resource provides a summary of each state's copay laws, including whether the law imposes limitations based on provider type, diagnosis, and patient variables, and how the law goes about establishing these limitations. Each state summary is captured in an easy-to-download pdf file.
The copay map is housed in APTA's Fair Physical Therapy Copays webpage, which also includes model legislation, examples of individual state efforts to establish fair copay regulations, and talking points on the issue.
Proposed US Centers for Medicare and Medicaid Services (CMS) rules for skilled nursing facilities (SNFs) would increase payments by $500 million in 2016 and set the stage for quality improvement and reporting requirements that, if not met, could result in loss of Medicare and Medicaid funding. The additional $500 million in aggregate funding represents a 1.4% increase.
The majority of the rule focuses on how CMS plans to implement elements of the IMPACT Act. Passed into law last year and supported by APTA, the IMPACT Act is intended to standardize how data is collected and used across postacute care settings.
Other parts of the proposal outline how a value-based purchasing program will be implemented beginning in 2019, and set up requirements for the submission of staffing information beginning in 2016.
To meet provisions of the IMPACT Act, the proposed rule would require SNFs to report on several quality measures, including skin integrity, percentage of residents with new or worsened skin ulcers, incidence of major falls, and changes to their functional and cognitive status. Facilities that don't meet the reporting requirements by 2018 would be subject to a 2 percentage point payment reduction in annual updates.
The proposed rule also sets out mandatory reporting on staffing at SNFs, including data on hours worked, resident case-mix and census, employee turnover and tenure, and hours of care provided per-resident per-day. The data would be collected on direct employees, agency employees, and contract staff; noncompliance could trigger penalties or exclusion from Medicare and Medicaid.
In addition, CMS is seeking comments on an SNF value-based purchasing program, mandated by Congress, that would provide incentive payments to facilities based on performance beginning in 2019. The proposed rule would adopt a measure that evaluates 30-day hospital readmission rates for SNF patients, and CMS is accepting comments on policies related to that measure, mostly having to do with how performance would be measured, scored, and reported.
The proposed SNF rule would also apply to noncritical access hospital "swing beds"—beds that are used for acute care or skilled care as needed.
The relatively small number of Medicare claims that were processed during the brief time between the implementation of the sustainable growth rate (SGR) payment reduction and its repeal—including claims subject to the Medicare outpatient therapy cap—will be automatically reprocessed to reflect the rates in place before the various fixes expired on March 31, according to a recent announcement from the US Centers for Medicare and Medicaid Services (CMS).
The announcement follows news that Congress passed legislation ending the SGR and extending the therapy cap exceptions process through December 31, 2017. The president is expected to sign the legislation into law soon. Beginning July 1, 2015, there will be a .5% update in the payment rates.
The reprocessing was announced to accommodate claims that may have been processed between the time when the previous fixes to SGR and therapy cap expired on March 31 and the establishment of the new law. CMS held claims for 10 business days beginning on April 1 in anticipation of a resolution.
CMS writes that "no action is necessary from providers who have already submitted claims for the impacted dates of service."
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