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  • CSM Delivers: Pain Science and the Challenge of Opioids

    Addressing the opioid crisis means not only steering health care's approach to pain treatment away from drugs but fostering a better understanding of pain itself. There's no time to lose.

    The 2019 APTA Combined Sections Meeting, set for January 23-26 in downtown Washington, DC, will deliver thought-provoking content on pain and opioids at a crucial time. Check out these suggestions, and find other relevant programming by searching the CSM programming page.

    Pain Talks: Conversations With Pain Science Leaders on the Future of the Field
    Join some of the most influential leaders in the field of pain science and rehabilitation for a discussion of the history of pain rehabilitation and how they personally became interested in the field, followed by an exchange on the current state of research on pain and its translation into clinical practice. The audience will be able to submit questions via text or email to the moderator for individual or panel discussion. Friday, January 25, 8:00 am–10:00 am.

    Opioid Issues in Athletes
    Opioid analgesics are the second most abused drug in the United States, with nearly half of students in seventh through twelfth grade having been prescribed these narcotics. These youth typically are athletes recovering from an injury or surgery—sometimes with devastating results. Find out about national efforts to address this issue, and hear the story of one athlete's journey from injury to addiction, and his long road back to health. Thursday, January 24, 8:00 am–10:00 am.

    Remapping Neuroplasticity and Pain in the Clinic: A Case Series Session
    There's growing evidence that graded motor imagery (GMI) can be used clinically to help desensitize a hypersensitive nervous system and provide hope for patients who are "too hot to handle." Body maps can be retrained within minutes through GMI, including normalizing laterality, motor imagery, mirror therapy, sensory discrimination, sensory integration, and more. Learn from published case studies and case series showcasing how brief GMI interventions can be readily applied in real-life clinics and result in immediate changes, thus accelerating recovery in people struggling with persistent pain. Saturday, January 26, 8:00 am–10:00 am.

    Interprofessional Pain Management for Older Adults With Cognitive Impairment
    Patients with cognitive impairment have difficulty or inability to communicate pain and discomfort because of cognitive, developmental, or physiologic issues, which is a major barrier to adequate pain assessment and achieving success in pain management interventions. This session is designed to help you respond to that challenge. You'll enhance your skills in recognizing pain in this population, identifying deficits and solutions through standardized tests and measures, and using interprofessional practice to improve outcomes. Saturday, January 26, 11:00 am–1:00 pm.

    Register for CSM by October 24 to grab early bird discounts and your chance to win a roundtrip ticket to the conference.

    It's World Arthritis Day: 5 Great Resources

    World Arthritis Day, October 12, calls attention to a global problem in need of better public awareness: how exercise and education can reduce the impact of the disease. And there's little time to waste: according to a 2016 study, by 2040, an estimated 25% of Americans will have arthritis, and 1 in 10 will experience a disability related to the condition.

    In honor of the day, here are 5 great resources that can help you develop community-based arthritis programs.

    Understand the basics of evidence-based community arthritis programs.
    What physical activity programs should you be looking for? Why recommend one program over another? What do the programs have in common? This quick reference guide from APTA helps you learn the lay of the land.

    Find the best fit for you and your patients.
    A program's target population, program length, class size, availability, and instructor requirements, can all be important factors in deciding which program would work best for you. APTA's decision aid can help narrow down the options.

    Bring patients and other community members on-board with resources from MoveForwardPT.com.
    APTA's consumer-focused website helps to explain the importance of arthritis programs, and provides an overview of some of the most highly regarded offerings from the US Centers for Disease Control and Prevention), the Arthritis Foundation, the Aquatic Exercise Association (, and others.

    Get help from the experts.
    APTA is a founding member of the US Bone and Joint Initiative (USBJI), a multidisciplinary education and advocacy group that provides extensive resources on arthritis and other musculoskeletal conditions. The USBJI's "Experts in Arthritis" webpage is loaded with videos and other public education resources that can help you help your patients and others understand the disease and the role that exercise can play in countering its effects.

    Dive into a website that's all-things-arthritis.
    As a member of the Osteoarthritis Action Alliance (OAAA), APTA helped to create some of the content and educational offerings available on this expansive site built for both consumers and clinicians. Resources include monthly "lunch and learn" webinars, information for providers, and research roundups.

    [Editor's note: even more information on arthritis is available at PTNow, including tests and clinical guidelines.]

    What's New at MoveForwardPT.com, Fall 2018

    APTA's consumer information website, MoveForwardPT.com, is a continually expanding resource where patients learn about the many conditions and patient populations physical therapists (PTs) treat. The site includes everything from condition-based guides, podcasts, tip sheets, and videos, to our popular 'Find a PT' tool that patients can use to locate a member PT in their area. It's also home to APTA's national award-winning #ChoosePT opioid awareness campaign and toolkit.

    Bottom line: MoveForwardPT.com is an evolving resource. Members are strongly encouraged to help APTA drive traffic to the site to expand awareness of the physical therapy profession.

    Here are some recent additions to the site:

    National Physical Therapy Month resources
    October is National Physical Therapy Month, an opportunity to amplify our promotion of the benefits of physical therapy, and to make more people aware of APTA’s #ChoosePT campaign, the initiative aimed at raising awareness of physical therapy as a safe and effective alternative to opioids for the treatment of chronic pain conditions. Check out the #ChoosePT campaign toolkit for resources and ideas to help you highlight the ways physical therapy can address pain.

    Move Forward Radio podcasts
    The Risk of Cancer-Related Falls
    September 20, 2018: Although falls are common among the elderly, cancer survivors have a higher prevalence of falls than do people who haven’t been treated for the disease.

    Using Physical Therapy to Treat Pain in Addiction Treatment Centers
    September 6, 2018: America is in the grips of an opioid addiction crisis, much of which is linked to overprescribing for the treatment of pain, despite known and very dangerous risks. How does physical therapy work as an alternative?

    Fourth Trimester: What Is It and Why Is It Important?
    August 16, 2018: Most people know pregnancy is divided into trimesters. But what about the fourth trimester?

    The Benefits of Exercise on Brain Health
    August 2, 2018: The benefits of being physically active are well known: it can enhance your cardiovascular system, control your weight, and strengthen your bones and muscles. But now there’s a growing body of evidence that being physically active benefits brain health and can help slow the decline in brain function that comes with age.

    Former Kentucky and NBA Star Rex Chapman Speaks Out About His Experience With Opioid Addiction
    July 19, 2018: Addiction can happen to anyone, including Rex Chapman. The former star basketball player for the University of Kentucky enjoyed a 12-year career in the NBA, but what followed was a 14-year battle with prescription narcotics.

    Young Woman Overcomes Amputation Challenges, Becomes Physical Therapist and World Adaptive Surfing Champion
    July 5, 2018: Fourteen years ago, Dani Burt, a physically active teenager, sustained devastating injuries in a motorcycle accident. After being placed into a medically induced coma, she awoke to learn that her right leg had been amputated above the knee.

    Tips
    8 Tips to Prevent Shin Splints
    Cancer-Related Balance and Falls: What You Should Know

    Newly Updated Condition-Based Guides
    Torticollis
    Multidirectional Instability of the Shoulder
    Pes Anserien Bursitis
    Lower Extremity Stress Fractures
    Total Knee Replacement
    Below Knee Amputation

    Are You Fall-Savvy? Take This Quick Quiz

    Falls Prevention Awareness Day is set for September 22, making now a great time to check out falls-related resources on APTA's recently updated Balance and Falls webpage. But before you do, see how you score on this 8-question quiz on falls statistics and screening (scroll down for answers). Good luck!

    1. According to the US Centers for Disease Control and Prevention (CDC), approximately how many Americans aged 65 and older experience a fall every year?
    A. 1 in 3
    B. 1 in 4
    C. 1 in 5
    D. 1 in 6

    2. According to a clinical guideline statement from the APTA Academy of Geriatric Physical Therapy (AGPT), what question should physical therapists (PTs) routinely ask older adult patients?
    A. "What medications are you currently taking?"
    B. "Are you experiencing feelings of dizziness?"
    C. "Have you been diagnosed with diabetes?"
    D. "Have you had any falls in the last 12 months?"

    3. Between 2007 and 2016, death rates due to falls in the US increased by what percentage?
    A. 3%
    B. 15%
    C. 24%
    D. 31%

    4. Authors of a 2012 study in the Journal of Aging and Physical Activity studied a particular activity and found that adults who engaged in this activity had a reduced risk for falls. Which activity did researchers target?
    A. Gardening
    B. Driving a car
    C. Shopping
    D. Light household chores

    5. A recent study in the American Journal of Preventive Medicine found that the falls risk factor affecting the largest number of adults 65 and over is:
    A. Visual impairments
    B. Medication interaction
    C. Home hazards
    D. Vitamin D deficiency

    6. A recent CDC study ranked US states according to older adult death rates due to falls in 2016. At 142.7 per 100,000 individuals, which state reported the highest death rate?
    A. Alabama
    B. Florida
    C. Arizona
    D. Wisconsin

    7. According to the CDC, among men and women aged 65 and older, which group has the highest rate of nonfatal falls, and which has the highest rate of fatal falls?
    A. Men have the highest rates of both fatal and nonfatal falls.
    B. Women have the highest rates of both fatal and nonfatal falls.
    C. Women have higher rates of nonfatal falls; men have higher rates of fatal falls.
    D. Men have higher rates of nonfatal falls; women have higher rates of fatal falls.

    8. According to a survey of emergency department physicians in the US and Canada, the bathroom is the most risky location for a fall in the home among adults 65 and older, with 69% of home falls occurring in that space. Which area comes in second?
    A. Kitchen
    B. Bedroom
    C. Stairs
    D. Living room

    ANSWERS:

    1. B - About 24% of older Americans fall each year—the leading cause of fatal and nonfatal injuries among older Americans, according to the CDC.

    2. D - There are of course many questions that may be appropriate for providers to ask (including some of the choices listed here), but the question that should never be skipped is whether the patient has experienced any falls in the past 12 months, according to the AGPT guidelines. Previous falls are 1 of the strongest falls risk factors, and should never be ignored.

    3. D - Falls-related deaths rose by 31% between 2007 and 2016, according to the CDC. During the 10 years tracked in the study, falls-related deaths among US residents 65 and older rose from 18,334 to 29,668—in terms of rates of death from falls, that's an increase from 47 per 100,000 to 61.6 per 100,000 in that age group. Deaths climbed by about 3% per year, according to the report.

    4. A - In the study, researchers focused on gardening, and concluded that "gardeners reported significantly better balance and gait speed and had fewer chronic conditions and functional limitations than nongardners." They believed the findings "suggest that gardening may be a potential activity to incorporate into future fall-prevention programs."

    5. C  - Home hazards were the leader in terms of falls risk factors, but that isn't to say other factors don't come into play as well, say authors of the study.

    6. DAccording to the CDC, Wisconsin had the highest falls-related death rate among adults 65 and older, at 142.7 per 100,000. Authors aren't sure of the reasons for the variance but suspect that the numbers might be related to demographic variables including differing proportions of older white adults in various states. Another possible explanation: the impact of who completes the death certificate.: According to the CDC researchers, a 2012 study showed that coroners reported 14% fewer deaths from falls than did medical examiners.

    7. C - Women have higher rates for falls, but men have higher death rates related to falls, according to the CDC. Authors of the study speculate that the higher fatality rate "might have resulted from differences in the circumstances of a fall (e.g., from a ladder or while drinking), leading to more serious injuries."

    8. B - Caregiverstress.com reports that at 13%, bedrooms are the second-most-likely place for a fall, followed by kitchens and stairs.

    Help Aging Communities 'Go4Life' in September

    Physical therapists (PTs), physical therapist assistants (PTAs), students, and supporters of the profession shouldn't wait until National Physical Therapy Month in October to spread the word about the importance of mobility and physical activity—September is Go4Life month, a National Institutes of Health (NIH)-sponsored campaign that provides plenty of opportunities to educate the public on the ways older Americans can stay healthy through maintaining or increasing endurance, strength, balance, and flexibility.

    Strongly supported by APTA, Go4Life is an ongoing effort to connect the public and health care providers with information and resources related to healthy aging. In addition to information on how exercise improves health, the Go4Life website includes suggested exercises, workout videos, fitness tracking resources, and access to printed materials including infographics, posters, bookmarks, and postcards, all available for free. The program also offers a free "Speaker's Toolkit" to help providers develop presentations to target audiences—available by emailing Go4Life@mail.nih.gov.

    During September, the campaign offers special resources that include a weekly planning guide and a Facebook Live event set for Thursday, September 13, at 2:00 pm ET. The campaign is an effort from NIH's National Institute on Aging, and can be followed on Twitter through @NIAGo4Life.

    Aetna's Policy Clarifications Increase Access to PT Care

    Major commercial insurer Aetna recently provided some clarification on policies related to payment for physical therapy, and it's good news for physical theapists (PTs) and their patients.

    The clarifications help to answer questions related to the company's physical therapy policy, specifically around payment for evaluations and the ways direct access provisions can affect payment. Here's what Aetna said:

    Evaluations could be eligible for payments sooner than the 180-day wait period.
    Although Aetna’s policy reads that "physical therapy evaluations will be eligible for payment once every 180 days," Aetna representatives have informed APTA that evaluations performed within 180 days of the original evaluation may be allowed upon reconsideration or appeal, providing the evaluation is for a new or unrelated condition.

    State direct access provisions could allow for reimbursement from Aetna without a referral.
    Aetna’s policy reads that “Aetna considers physical therapy medically necessary when this care is prescribed by a chiropractor, DO, MD, nurse practitioner, podiatrist or other health professional qualified to prescribe physical therapy according to state law." Representatives from Aetna have clarified that in states with direct access provisions for PTs, a PT is considered an “other health professional qualified to prescribe physical therapy,” meaning that PT services will be reimbursed without an order or referral if all other requirements are met.

    "Aetna has been working with APTA to support access to PT services, and understands the importance of making providers aware of how specific policies are interpreted," said Alice Bell, PT, DPT, an APTA senior payment specialist. "We appreciate Aetna's efforts and look forward to continued cooperation on issues that may impact access to care."

    From PT in Motion Magazine: How to Defend Yourself Against Scams and Cyberattacks

    As technology and information sharing evolves at a rapid pace, it becomes harder to keep up with criminals and scammers—even if you are an experienced professional. Last year, a staggering 83% of physicians said they had experienced some form of cyberattack, according to an American Medical Association report. What kind of scams are out there? What should you be wary of? What new threats are emerging?

    A feature in this month's PT in Motion magazine describes common cybercrimes and scams, including data breaches, phishing, and ransomware. Author Katherine Malmo reports that cyberattacks happen to more organizations than we might think, since people don't want to share their experiences. Robert Latz, PT, DPT, told PT in Motion, "The question is less if there will be a breach and more what to do when the breach happens."

    The article examines other scams that take advantage not of security holes but human error, such as fraudulent job ads that require financial transactions or predatory scholarly journals that publish anything as long as you pay, which can damage your credibility. "What is most astounding," Chad Cook, PT, DPT, comments, "is that really talented people submit to these publications."

    "How to Defend Yourself Against Scams and Cyberattacks" 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 one 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.

    From PT in Motion: PTs Improving the Health of Communities

    Physical therapists (PTs) and physical therapist assistants (PTAs) have long understood the connection between mobility, physical activity, and the prevention of society's most serious health conditions. Some committed PTs say now's the time to start sharing that understanding at the community level.

    Featured in the May issue of PT in Motion magazine: "Reaching Beyond the Clinic," an exploration of how PTs are engaging in community health promotion in a variety of settings. And "variety" is a key word here: as explained in the article, "community health promotion" can be conceptualized in a number of ways, which can in turn create multiple opportunities for PTs and PTAs to make a difference.

    Among the PTs interviewed for the article are Rupal Patel, PT, PhD, who created a 12-week group-based lifestyle program to reduce diabetes risk among Asian Indians; Beth Black, PT, DSc, the co-instructor of a 6-week program for people who have multiple sclerosis; and Jessica Berglund, PT, DPT, chair of APTA's Council on Prevention, Health Promotion, and Wellness, and an employee of a home health company that offers a "7 elements of well-being" program to older adults. Accompanying articles include a list of relevant APTA resources and a report on a new clinical model that helps PTs overcome unease about asking people about their unhealthy habits.

    The article also addresses the question of whether PTs and PTAs should be involved in community health in the first place, and arrives at a definitive "yes." While education and training alone would seem to make the case for PTs stepping into this space—Berglund describes the PT's background as "ideal" for this kind of work—there's also a compelling ethical argument to be made for the profession becoming a leader in community health, according to longtime proponent Janet Bezner, PT, DPT, PhD, FAPTA. Bezner is on the steering committee for the APTA council mentioned above.

    "We can't ignore that [preventable diseases] are harming society and fueling skyrocketing health care costs," Bezner says in the article. "If we don't address them, we're complicit—frankly, we're contributing to the problem."

    "Reaching Beyond the Clinic" is featured in the May 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.

    Coming to NEXT in June? Don't miss "Utilizing Community Collaboration to Reduce Health Disparities," a session focused on the ways PTs have developed and implemented community-based programs.

    Payers Looking for More Coding Detail

    Physical therapists (PTs), take note: the 59 modifier is a potential red flag for the US Centers for Medicare and Medicaid Services (CMS) and commercial payers.

    The 59 modifier is the code under the health care common procedural code system (HCPCS) used to represent a service that is separate and distinct from another service it's paired with. In an effort to tease out precisely why the service is distinct, CMS is requiring that in certain cases, providers use different modifiers instead of the 59 modifier. The modifiers—XE, XP, XS, and XU—are intended to bypass a National Correct Coding Initiative edit by denoting a distinct encounter, anatomical structure, practitioner, or unusual service.

    When the X modifiers were introduced in 2015, PTs weren't required to use them. But movement toward the use of these modifiers—and greater scrutiny of claims using the 59 modifier—is happening.

    CMS recently issued detailed guidance on the use of the 59 and X modifiers, complete with examples of what it considers appropriate and inappropriate applications. Providers should carefully review the CMS guidance document, as well as check their commercial payer payment policies regarding the use of the 59 modifier versus the X modifiers.

    APTA will continue to monitor this issue and share news of any changes.

    From PT Pintcast: Now's the Time to Embrace Outcomes Registries

    Medical specialty societies and associations have a responsibility to help members define, measure, and report value—or someone else will do it for them. And registries such as APTA's Physical Therapy Outcomes Registry are important vehicles for staying ahead of the curve.

    This was 1 takeaway from a recent PT Pintcast podcast featuring Heather Smith, PT, MPH, APTA director of quality, and Nathan Glusenkamp, a registry expert who is director of registries at the American Academy of Orthopaedic Surgeons (AAOS).

    For Glusenkamp, associations are ideal for developing clinical registries because they bring "specialized experience" that can’t be matched. He is "a firm believer that if [medical specialty societies] are not engaged in defining value, reporting value, measuring value—that’s still going to happen, but it’s probably going to happen in a way [members] don’t like."

    Smith believes that association-run registries also serve another important function: helping providers get a handle on the seemingly inevitable move toward value-based health care.

    "I can’t stress enough, being prepared ahead of time and really getting involved as early as possible to start to think about the value that you bring," Smith says in the podcast. "Not just in the care that you deliver today, but think more broadly in new and different ways we may be able to bring value to the health care system. Being able to support payment for these services in new and emerging models is really exciting. So you’ve got to be involved to reap the benefits of the new frontier we’re moving into."

    Listen to the full podcast at www.ptpintcast.com. Learn more about the Physical Therapy Outcomes Registry at www.ptoutcomes.com.