November 28-December 1, APTA's Board of Directors (Board) met to fulfill a very
important yearly function—adopting the association's Strategic Plan. During the
4-day meeting, the Board looked to the newly adopted plan to help guide its
discussion and actions on various association initiatives.
Board adopted the APTA Strategic Plan after a rich discussion on the 4 goals of
the plan—effectiveness of care, patient- and client-centered care across the
lifespan, professional growth and development, and value and accountability.
Objectives under each goal—17 in all—were prioritized earlier this year by the
Board. Resources toward the objectives in the plan are determined based on the
priorities, so higher-level priorities receive more resources.
objectives that were given the highest priority by the Board included the
development of the outcomes registry and the advancement of a more appropriate
toward such a payment system for outpatient physical therapy services—called
the Physical Therapy Classification and Payment System (previously known as the
Alternative Payment System)—is under way.
The Board received a report from the task force working on the new
payment system. As APTA finalizes its draft of the proposed payment system, a comprehensive
communication, public relations, education, and professional development plan
will be developed to maximize the opportunity for a successful transition. An
outline of the proposed plan will be presented to the Board in January 2013. A
final plan will go to the Board in June 2013. The final draft of the proposed payment
system is expected to go through several
AMA groups and committees for vetting and valuation in 2013 and 2014. At this
time, APTA is on target for a 2015 implementation of a new payment system.
important priorities contained in the strategic plan include increasing the
number and use of best practice guidelines to reduce unwarranted variation in
care, in support of the goal toward effectiveness of care; exploring innovative
learning opportunities, in support of the goal toward professional growth and
development; and advocating for health policies that embrace value, safety,
access, and integrity, in support of the goal toward value and accountability.
Activities in progress or planned for 2013 to help achieve these objectives
include continuing to expand the content in PTNow, APTA's online clinician's
portal to evidence-based practice; adding a virtual attendance component to
onsite APTA learning venues; and monitoring and influencing health care reform
and metrics for all 17 objectives have been developed and will enable APTA's
Board to track their progress throughout 2013. Progress on the plan will be
communicated to the members throughout the year.
adopting the Strategic Plan, the Board recognized that it is a "bridge
between Vision 2020 and a new vision to be considered in 2013." A proposal
for that new vision also was discussed at the meeting, with the Board reviewing
a report by the Vision Task Force. As the ultimate decision-maker on the vision
of the association, the House of Delegates will consider the proposal in June
meeting activity, the Board approved a 2013 operating budget with revenue of $42,398,480, expenses of
$42,398,480, and zero net revenue. It was noted that almost 24% of total
expenses directly fund Strategic Plan goals.
public policy objectives and strategies were adopted during the meeting, representing
the critical public policy issues the association anticipates will advance
physical therapist practice, education, and research in 2013-2014. The
objectives and strategies include advancing a payment model(s) that promotes
the value of physical therapists (see Physical Therapy Classification and
Payment System above), eliminating physician referral for profit in physical
therapy, and improving access to physical therapy services in integrated
service delivery systems, such as accountable care organizations. The 2013-2014
priorities, developed with input from members and the Public Policy and
Advocacy Committee, will be available to association members shortly. In
keeping with the Board's focus on public policy priorities, a generative
discussion was held on the determination of scope of practice issues. Board and
staff members discussed possible mechanisms that could be used to review and
analyze existing, new, and emerging fields of physical therapy practice to
determine if APTA should endorse, recognize, or exclude the areas as part of
the professional scope of practice.
Board also took action on several new initiatives related to policy and
coming months, the Board will begin to consider the future relationship between
APTA and the Commission on Accreditation in Physical Therapy Education (CAPTE). US Department of Education (USDE) regulations,
new Council for Higher Education Accreditation (CHEA) criteria, and a perceived
conflict of interest between APTA and CAPTE, have prompted discussion about and
initial exploration into whether CAPTE should become partially or fully
independent of the association. As such, APTA will gather financial data,
confirm the various USDE and CHEA requirements impacting CAPTE, collect
information on the 2 proposed models, and consult with the Academic Council,
the Education Section, and other interested parties so that the Board can make
a recommendation that would best serve the interests of education programs, the
promote governance processes and structures that optimize policy development,
the Board voted to develop motions for the 2013 House that will allow necessary
Board discussion and action on the House of Delegates governance proposal. Data
gathered by the Governance Proposal Board Work Group to inform its work as well
as the report submitted to the Board have been posted to the Governance Review Community. The materials can be found in
the Governance Review Community Reference Materials folder with document titles
that begin with the words 'House Governance Proposals.'
first time, the Board meeting was livestreamed. APTA members can watch the video archive of the
meeting until December 15 (refer to the agenda posted on the livestream webpage
to narrow down the date and time of the discussions summarized above). The language for motions
voted upon during this meeting is not considered final until the minutes of
this meeting are approved by the Board. Final motion language
will be reflected in the minutes of the November 2012 Board of Directors
meeting, which will be approved and posted online in December.
APTA has posted a new chart to help members understand the differences between the Physician Quality Reporting System (PQRS) program and a congressionally mandated
functional limitation reporting program that begins January 1, 2013. The chart can be found on APTA's Functional Limitation Reporting Under Medicare webpage.
The Middle Class Tax Relief Act of 2012 mandated that the Centers for Medicare and Medicaid Services (CMS) begin functional limitation data collection on January
1, 2013, for Medicare beneficiaries. The new functional limitation reporting will be done through nonpayable G-codes that are similar in their appearance to PQRS quality data codes. The functional limitation reporting will be visit-driven and must be completed on evaluation, every 10th visit, and at discharge. All practice settings that provide outpatient therapy services must include this information on the claim form. Specifically, the policy will apply to physical therapy, occupational therapy, and speech-language-pathology services furnished in hospitals, critical access hospitals, skilled nursing facilities, comprehensive outpatient rehabilitation facilities (CORFs), rehabilitation agencies, home health agencies (when the beneficiary is not under a home health plan of care), and in private offices of therapists, physicians, and nonphysician practitioners.
Simultaneously, attention is increasing on PQRS as the program changes from an incentive-based program to a penalty program, with the 2013 year being pivotal to the program's changeover, informing both the 2013 bonus and the 2015 penalty. PQRS, the quality reporting program for Medicare Part B, was implemented in 2007. Physical therapists are eligible professionals in this reporting program and can report a variety of measures, including pain assessment on initial evaluation and a measure related to the use of a functional assessment tool. Reporting under the PQRS program is tied to CPT codes. Therapists reporting under this program submit quality data codes for the selected measures with CPT code 97001 and sometimes with 97002.
Results of a study published
in The Spine Journal indicate that
the Oswestry Disability Index, Modified Swiss Spinal Stenosis Scale (SSS), and
Patient Specific Functional Scale possess adequate psychometric properties to
be used in the outcome assessment of patients with lumbar spinal stenosis.
However, further investigation is needed to validate these findings in other
samples of patients with lumbar spinal stenosis and nonspecific low back pain,
the authors add.
This cohort secondary analysis of a
randomized clinical trial of patients with lumbar spinal stenosis receiving
outpatient physical therapy included 55 patients (mean age, 69.5 years;
standard deviation, ±7.9 years; 43.1% females).
Outcome measures were the Modified Oswestry Disability
Index, SSS, Patient Specific Functional Scale, and Numeric Pain Rating Scale
All patients completed the Oswestry Disability Index,
SSS, Patient Specific Functional Scale, and NPRS at the baseline examination
and at a follow-up. In addition, patients completed a 15-point Global Rating of
Change at follow-up, which was used to categorize whether patients experienced
clinically meaningful change. Changes in the Oswestry Disability Index, SSS,
Patient Specific Functional Scale, and NPRS were then used to assess
test-retest reliability, responsiveness, and minimum levels of detectable and
clinically important differences.
The Oswestry Disability Index was the only outcome
measure to exhibit excellent test-retest reliability with an intraclass correlation
coefficient of 0.86. All others ranged between fair and moderate. The Oswestry
Disability Index, SSS, and Patient Specific Functional Scale exhibited varying
levels of responsiveness, each of which was superior to the NPRS. The minimal clinically important
difference for the outcome measures for persons with lumbar spinal stenosis
APTA member Joshua
A. Cleland, PT, PhD, OCS, is the article's lead author. APTA members Julie M. Whitman, PT, T, DSc, OCS, FAAOMPT,
Robert S. Wainner, T, PhD, ECS, OCS, FAAOMPT, and John D.
Childs, PT, PhD,MBA, are coauthors.
Centers for Disease Control and Prevention's (CDC) new STEADI Tool Kit gives health care providers
information and tools to assess and address their older patients' falls risk.
The STEADI (Stopping Elderly
Accidents, Deaths and Injuries) Tool Kit is based on a simple algorithm adapted from the American and
British Geriatric Societies' Clinical Practice Guideline. It includes basic information about falls, case studies, conversation starters, and standardized gait and balance assessment tests (with instructional videos). In addition, there are educational handouts about falls prevention specifically
designed for patients and their friends and family.
who are experts in falls prevention assisted CDC with the development of the
toolkit, specifically with the evidence based community falls prevention
programs. Additionally, APTA staff appear in several videos on tests that were recorded at APTA.
to the toolkit also is available on APTA's Balance and Falls webpage under "Related
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