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  • LEAP: Bringing Cochrane to the Clinic

    You're probably familiar with Cochrane systematic reviews, those studies-of-studies that are intended to provide the most reliable take on conditions and treatments. Cochrane reviews provide invaluable information—but how do you put that information into practice?

    Enter "Linking Evidence and Practice" (LEAP), a learning program sponsored by Physical Therapy (PTJ), APTA's scientific journal, that aims to help clinicians get the most out of Cochrane reviews for the benefit of their patients and clients. Each LEAP article is written by an author team that generally includes at least 1 "in the trenches" physical therapist (PT), and includes "at a glance" tables as well as the bottom-line information you need to know to apply the review's findings.

    Here are some of the latest courses based on LEAP articles, available through the APTA Learning Center:

    The LEAP articles also include a case section to show how a review's results inform clinical decisions for a specific patients. Authors answer questions such as "How did the results of the Cochrane systematic review apply to [the patient]?" "How well do the outcomes of the intervention provided to the patient match those suggested by the systematic review?" "Can you apply the results of this systematic review to your own patients?" and "What can be advised based on the results of this systematic review?"

    Don't Slip on Appeal: Tips and Resources to Help You Navigate Payers and Insurance Commissioners

    Everyone knows the old saying about death and taxes being the only certainties in life. Physical therapists (PTs) and physical therapist assistants (PTAs) can probably add 1 more to that list: appeals to insurance company payment decisions.

    Here are a few tips and resources from APTA, to help you get it right.

    The tips

    Appeals are important …
    Yes, the appeals process adds yet another administrative burden to your plate, but don't forgo the process when you feel that medically necessary services have been denied or partially approved. You have a responsibility to protect the patient if payment for appropriate care is denied. And, remember, you won't be able to pursue an appeal at a higher level—the insurance commissioner's office—unless you have done your due diligence and exhausted all other means of reconsideration.

    …but be discerning.
    Appeals are time-consuming for you, but they also time-consuming and costly for the payer. Payers do track the number of appeals filed by providers, and they see a high rate as an unfavorable utilization management vendor statistic.

    Patient voices carry a lot of weight …
    The experiences of patients do matter, and a mass outcry by the consumer will get the ear of the payer, employer (particularly the self-insured), and the insurance commissioner. Delays in authorization approval, visits approved in small increments with waits in between, or denial of medically necessary services are all examples of access issues. The insurance commissioner’s job is to protect consumers, and that office is particularly interested in hearing about access issues.

    … so make sure patients have the necessary resources available.
    Yes, patients should be encouraged to report access issues to the payer, employer, benefit manager, human resources, and office of the insurance commissioner, or whatever the appropriate body may be in the state, in writing or by phone. But they need to know who to contact. Provide consumers with the contact information they need to facilitate timely reporting.

    Know what the insurance commissioner is and isn't interested in …
    You may experience increased burdens and reduced payment as the result of a payer's use of a third-party administrator or utilization management (UM) vendor, but those issues are not in the domain of the insurance commissioner. Instead, be ready to measurably demonstrate through data collection how a UM vendor's policies are adversely affecting patient access to medically necessary services.

    … and work, sometimes collectively, to supply the data that matter.
    Work with your state chapter to collect the data that will demonstrate the issues you and your patients are experiencing—or at the very least, get your clinic to collect clinic-wide data.

    The resources

    Celebrate 20 Years of HIPAA by Giving Yourself the Gift of Compliance

    How time flies. The Health Insurance Portability and Accountability Act—HIPAA—turned 20 in August. In honor of this milestone, APTA PT in Motion News asked staff practice experts to share their top 6 tips to protect patient information. These are easy-to-follow, and, even more important, they encourage good habits that will help you stay in compliance with a law that carries some very serious penalties.

    The top 6 tips are:

    1. Secure all patient information with physical locks and in private areas where access is limited to trusted personnel. Remember that non-business associates—for example, the crew that cleans your office or clinic—can be unintentionally exposed to this information. Take the time to put this information away. And lock it up. (But keep the key!)
    2. Implement safeguards for electronic information, including encrypted communications, and password-protected computer systems. Think the Department of Health and Human Services (HHS) doesn't take this seriously? Look no further than the sixth highest HIPAA fine of all time, a $2.7 million violation by the Oregon Health & Science University incurred when a physician's unencrypted laptop was stolen, followed by a second breach caused by residents storing patient information in an unprotected Google-based cloud system.
    3. Use common sense protections, such as cover sheets for copies and faxes, and discreet patient sign-in sheets to maintain privacy. What is meant by "discreet patient sign-in sheets?" These are sign-in sheets that require the minimal amount of information for "customary and essential" communication—basically, whatever it takes to announce to the patient that he or she is ready to be seen. Anything more—particularly reason for the visit—is treading into dangerous territory.
    4. Make sure patients understand their rights under HIPAA with easy-to-understand disclaimers and materials. HHS offers model privacy notices for patients, as well as details on notice requirements.
    5. Never share patient information over the phone, without a patient's permission, and only after multi-layered identity verification. And remember that patients have the right to request that communication be through certain channels only. Patients can also request that your practice restrict certain disclosures to family members or others about the individual's general condition, location, or death.
    6. Report any known or suspected disclosures immediately to affected patients and the government. Reporting is important, but so is understanding the type of reporting you need to do, depending on whether the breach affects 500 or more individuals. You can find details on who to notify, and when, at the HHS Breach Notification Rule webpage.

    Want to brush up on your understanding of HIPAA, particularly as it relates to electronic health records? Check out the HHS free online guide to the law (.pdf), and get physical therapist-specific details at APTA's HIPAA webpage.

    Innovation 2.0 Series of Learning Labs Continues With Transitions in Care

    A program that teams an academic physical therapist program with a primary care provider of postacute care services to patients after hip and knee surgery shares its insights and experiences at APTA’s second of 4 Innovation 2.0 Learning Labs, now available in the APTA Learning Center. This free webinar includes the recorded session, including the presenters’ slide deck, and a downloadable guide to replicating the program in other facilities.

    The July online Learning Lab in APTA’s Innovation 2.0 series focuses on a partnership between a contract provider of physical therapist services to local skilled nursing facilities, and the University of Utah physical therapy program. The project has developed evidence-based care pathways for patients with hip fracture, total hip arthroplasty, and total knee arthroplasty. In this model, physical therapists are working collaboratively within the health care system to improve value-driven outcomes.

    The Innovation 2.0 series is designed to promote the participation of physical therapy in innovative models of care delivery by replicating successful models throughout the country. Free access to the course and materials is available through the APTA Learning Center.

    Look for other Innovation 2.0 Learning Labs; topics include pay for performance in treating patients with low back pain (available now), PTs as part of an accountable care organization (later this year), and a patient-centered medical home model that addresses childhood obesity (later this year).

    From PT in Motion: The Questions You Should Ask Suppliers

    Suppliers to physical therapists (PTs) and physical therapist assistants (PTAs) may believe their products are the answer to PT and PTA needs, but dig deeper: before accepting the product or service as an answer, see if it stands up to a few critical questions suggested by the suppliers themselves.

    This month in PT in Motion magazine: "Before You Buy: 26 Key Questions to Ask Suppliers," a list of tips on what a good supplier should be able to tell you about their company and product, accompanied by commentary from PTs, PTAs, and the suppliers.

    The list includes the straightforward ("Can you provide me with 3 references?" "How long have you been in business?"), the strategic ("Does your product contain tools for measuring client outcomes and tracking PT productivity?" "Can you respond quickly to changing market conditions?"), and the practical ("Can patients afford this?" "How long does it take to set up the equipment?"). Along the way, contributors offer up comments that help to put the questions in context—for instance, in support of the question about setup time, Jeff Leatherman, PT, writes that "If it takes longer than 2-3 minutes out of our treatment time, it had better be special."

    Suppliers Aretech, Bioodex Medical Systems, Fabrication Enterprises, KLM Laboratories, MW Therapy, and ReDoc provide industry perspective, encouraging PTs and PTAs to ask questions about a supplier's ability to respond to regulatory trends, the product's safety certifications, and any history of enhancements, among other topics.

    "Before You Buy: 26 Key Questions to Ask Suppliers" is featured in the August issue of PT in Motion magazine , 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.

    EMG Lab Accreditation Process Recognizes Role of PTs

    Thanks to the collaborative work of several groups committed to making the case for physical therapists (PTs) as qualified providers of electrodiagnostic studies, the landscape for lab accreditation has changed in ways that create opportunities for PTs, all while following standards more rigorous than previously existing systems.

    The new lab accreditation is an effort of the Federation of Electrodiagnostic Laboratory Accreditation (FELA). But as the name implies, FELA is a group effort, created when members of the American Academy of Clinical Electrodiagnosis (AACE), the American Congress of Electroneuromyography (ACE), and APTA's Academy of Clinical Electrophysiology and Wound Management (ACEWM) came together around a shared goal—creating a program that allows PT-run labs to achieve accreditation.

    According to Greg Ernst, PT, PhD, member of AACE, the idea began 4 years ago. "There was already a lab accreditation process developed by the American Association of Neuromuscular and Electrodiagnostic Medicine [AANEM]," he said. "However, the AANEM accreditation requires that each lab, and all satellite labs, have a physician that performs electrodiagnostic studies—PTs could only function as technicians."

    So Ernst, ACE President Elaine Armantrout, PT, DSc, and Rick McKibben, PT, DSc, chair of ACEWM's clinical electrophysiology practice group, set out to create an accreditation program that would not only acknowledge the PT's ability to oversee electrodiagnostic labs, but would be based on standards that exceeded those created by AANEM. Joining the effort were Robert Sellin, PT, DSc, David Greathouse, PT, PhD, and John Palazzo, PT, DSc. Ernst, Armantrout, McKibben, Sellin, Greathouse, and Palazzo are all board-certified specialists in clinical electrophysiologic physical therapy. Greathouse, additionally, is a Catherine Worthingham Fellow of the American Physical Therapy Association.

    "We all agreed that FELA should be as inclusive and open as possible while maintaining strict adherence to what is needed to represent quality and integrity in an accreditation process," Armantrout explained. "FELA applicants can be from any discipline as long as their state licensure allows, which sets us apart from AANEM's accreditation, to which only neurologists and physiatrists can apply. We think that by restricting the accreditation in that way, the public and payers are misled, and it implies that there aren't other qualified providers, such as PTs."

    Besides the more open qualifications for accreditation, Ernst points to 3 other areas that make FELA distinct from the AANEM path:

    • A higher bar for "exemplary accreditation." While both FELA and AANEM offer 2 levels of accreditation—"regular" and "exemplary"—the requirements to achieve exemplary status through FELA are tougher than the ones used by AANEM, Ernst said
    • Emphasis on waste, fraud, and abuse training. Ernst said that FELA requires evidence of Centers for Medicare and Medicaid Services training on avoiding waste, fraud, and abuse. The AANEM program doesn't.
    • Cost. "The FELA lab accreditation process is less than half the cost of the AANEM accreditation," Ernst said.

    "The accreditation program is completely optional at this stage," Ernst added. "We developed FELA to help show third-party payers and the public that PTs and the labs [where they practice] can provide safe and quality care in the field of electrodiagnostics."

    Anti-Identity Theft Changes to Medicare Cards Coming

    How might changes to Medicare card numbers affect your practice? The Centers for Medicare and Medicaid Services (CMS) has some thoughts, but would like your input, too.

    On Wednesday, July 27, CMS will host a "listening session" to discuss its social security number removal initiative (SSNRI), a plan to end Medicare card numbers that are based on a beneficiary's social security number. The change is mandated under the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) as a way to reduce opportunities for identity theft.

    The session will run from 1:00 pm to 4:00 pm, ET, and will include a presentation on the SSNRI by CMS staff as well as a question-and-answer period. Registrants will be sent the CMS presentation in advance.

    Participants can register online, and are advised to call in 15 minutes before the session starts. CMS will also be accepting written comments on the SSNRI through August 3.

    PTA Advanced Proficiency Program is the Focus of Upcoming Webinar

    Physical therapist assistants (PTAs) and students interested in learning more about APTA's PTA Advanced Proficiency Pathways (APP) program are invited to join a free webinar coming up July 21.

    Now the association's sole postgraduation proficiency recognition program for PTAs, the APP program uses multiple approaches to help applicants gain and demonstrate proficiency in areas of interest that include acute care, cardiovascular and pulmonary, geriatrics, oncology, orthopedics, pediatrics, and wound management. Participants take online core courses common to all of the APPs as well as self-select content-specific courses for the particular program pathway, followed by experiences with a qualified mentor of the participant's choosing. A dedicated program mentor designated by APTA makes sure that participants stay on the pathway and arrive at advanced proficiency as efficiently as possible.

    To help potentially interested PTAs get better acquainted with APP, the association will conduct a free webinar hosted by APTA Director of Postprofessional Credentialing Derek Stepp on July 21 from 12:00 pm to 1:00 pm, ET. Stepp will provide an overview of the program, as well as details on the steps needed to fulfill the requirements for completing it.

    No reservations are required. To sign up for the webinar, simply visit the APP webpage near the July 21 start time and click the "join the webinar" link. For more information on the webinar or the program in general contact Derek Stepp.

    A recorded copy of the webinar will be posted at the APP webpage as it becomes available.

    New APTA Series Gets at the Gaps

    APTA's #PTTransforms blog is now host to a new series that explores the divide between evidence and practice behaviors in the clinic.

    Titled "Narrow the Gap," the series features member and staff-authored posts that touch on the gaps that can exist among any of the components of evidence-based practice. Coming-soon topics include the pros and cons of research with small subject numbers, the ways implicit bias can affect practice (and what to do about it), and a decidedly "non-techie" physical therapist's encounters with the digitized research world.

    Perspectives are fresh, voices are diverse, and dialogue is welcomed. Visit the #PTTransforms blog page regularly to keep up with the series and check out other posts along the way.

    New at PTNow: THA Summary, Pain Resources, Clinical Case Studies, More

    From nonopioid pain treatment approaches to finding the most effective way to integrate into bundled payment systems, physical therapists (PTs) and physical therapist assistants (PTAs) have a lot to juggle. The latest additions to APTA's PTNow website make that juggling just a little easier.

    The association's flagship site for evidence-based practice resources continues to expand in ways that help PTs and PTAs easily find the information they need. If you haven't visited the site lately, check it out soon. New resources include:

    Total hip arthroplasty (THA) clinical summary with "quick take" feature
    A timely addition now that Medicare's Comprehensive Care for Joint Replacement bundled payment model is up and running in metropolitan areas across the country, the summary provides information on PT management of patients undergoing THA, including tests and measures, functional outcomes, exercise and gait training measures, associated conditions such as deep venous thrombosis and infection, and more. A quick take feature allows users to easily access just those sections they need at the moment, and additional links on the page connect the summary with other APTA resources, including consumer-focused materials available at MoveForwardPT.com.

    Pain management resources that include #ChoosePT, CDC, and multiple clinical practice guidelines (CPGs)
    The new PTNow pain management area is an impressive 1-stop shop for an area of health care that is increasingly turning to physical therapy for answers. Offerings on the page include everything from links to the #ChoosePT public education campaign to more than 25 CPGs and 40 Cochrane systematic reviews, plus tests and measures related to osteoarthritis, low back pain, and fibromyalgia.

    New clinical case studies on spinal cord injury (SCI) and both early and late Huntington disease
    The new SCI case tracks a 55-year-old male outpatient with an incomplete C5 SCI and limited insurance coverage. Readers can follow the initial examination and results, functional outcome measures, interventions, and outcomes at conclusion of care. The Huntington disease case studies track care in 2 distinct scenarios—early and late stages of the condition.

    New pediatric and balance tests and measures
    Tests and measures recently added include resources on assessing balance, measuring children's participation in and attitudes about leisure and recreational physical activities, and conducting a pediatric evaluation of disability inventory.

    PTNow is available for free only to APTA members.