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  • Summer's Over, but Payment Reform is Just Beginning: Tips on Getting Up to Speed

    A new proposed CPT system for evaluation codes, increasing required bundled payment models, the end of the Physician Quality Reporting System (PQRS) in favor of the Merit-Based Incentive Payment System (MIPS)…feeling dizzy yet?

    Health care reform's swift movement toward value-based payment and away from procedural-based, fee-for-service systems is sweeping up physical therapists (PTs) and physical therapist assistants (PTAs) as it continues to gain momentum. And that momentum built over the summer, even while we vacationed, mowed our lawns, and got the kids ready for another school year.

    So now that it's officially fall, why not spend some time getting up to speed on where the profession stands in relation to payment reform? Here are a few suggestions to help you find out what health care did over your summer vacation:

    See the big picture on payment reform.
    The "Compliance Matters" columns, a regular feature of PT in Motion magazine, connect you with what's going on. Check out the August column, which lays out the basics behind the Center for Medicare and Medicaid's proposed system for new CPT evaluation codes (and 1 reevaluation code), as well as the column from March that explains the workings of the new Comprehensive Care for Joint Replacement (CJR) bundling program. For an even bigger-picture view of the road that has led to the CPT and other changes, this article from the April issue of PT in Motion magazine provides 5 concepts that are central to payment reform.

    Dig a little deeper.
    The newly updated APTA Payment Reform webpage is the jumping-off point to 3 major areas that affect—or will soon be affecting—PTs and PTAs: alternative payment models, Medicare postacute care reform (especially the reform efforts reflected in the IMPACT Act), and the changes associated with the Medicare Access and CHIP Reauthorization Act, or MACRA. All 3 areas contain multiple resources and links that can help you see where things stand now, and where they may be headed. Another resource for some in-the-weeds information: APTA's Insider Intel series, a phone-in program that puts you in touch with staff experts on payment reform. Past intel calls are available as recordings or transcripts; look for another installment later this fall.

    Get a handle on where things stand right now.
    The proposed 2017 Medicare physician fee schedule from CMS is the hot topic of the moment. While awaiting the final rule (expected in late October/early November), find out what it's all about and what changes could impact PTs the most through the recording of a sold-out webinar on the payment system held September 22. You can also access the most recent APTA summary of the proposal (look under "APTA Summaries"). And while you're in a summary state of mind, don't miss out on APTA summaries of the final 2017 inpatient prospective payment system (IPPS) rule, the proposed rule for the 2017 home health prospective payment system, and the final rule on the 2017 skilled nursing facility prospective payment system—all can be found under the "APTA Summaries" header on their respective pages. Want a quick video take? These video dispatches from the APTA State Policy and Payment Forum—on bundled care models and the proposed CPT coding system—provide brief overviews.

    Find out what your association has to say.
    APTA registered its "deep disappointment" with the CMS decision to employ a 3-tiered CPT evaluation system that doesn't differentiate payment among those tiers, but that's not all the association had to say about the proposed 2017 physician fee schedule: you can read the association's comments to CMS in their entirety at the APTA Medicare Physician Fee Schedule webpage (look under the "APTA Comments" header). Then be sure to get the perspective of APTA President Sharon L. Dunn, PT, PhD, who issued a recent statement and update that outlines APTA's efforts around payment reform, and urges members to engage in this issue so that the profession can have a role in shaping the future of payment.

    Fraud Settlements Worth More Than $35 Million Underscore Relevance of New Compliance Resource

    Timing, as they say, is everything. That's certainly the case for a recently released joint guidance document on compliance created by APTA and 3 other organizations, which arrives during a period of increased federal scrutiny of fraud associated with companies providing physical therapist services. That scrutiny resulted in settlements totaling more than $35 million.

    A new resource created by APTA, the American Occupational Therapy Association, the American Speech-Language-Hearing Association, and the National Association for the Support of Long-Term Care helps health care providers understand compliance: what it is, the role of corporate compliance programs, and recommended steps for reporting. The 2-page guide also includes links to Department of Health and Human Services (HHS) Office of the Inspector General (OIG) compliance materials, and OIG national compliance hotline information.

    The importance of compliance has been underscored over the summer through a series of announcements from the US Department of Justice and HHS OIG that have focused on organizations found to have committed fraud related to therapy. These include:

    • A $28.5 million settlement against California-based North American Health Care, for providing medically unnecessary therapy services to TRICARE and Medicare patients in its skilled nursing facilities
    • A $7.1 million settlement against Drayer Physical Therapy, which operates facilities in 15 states, for claiming individual physical therapy billing for sessions that were actually delivered to multiple patients at the same time
    • A report from HHS OIG detailing the operations of an unnamed physical therapy practice in Kansas that submitted 29 improper claims worth $134,967 to Medicare during a 100-day study sample, including services that were not specific to a patient's conditions; claims for unreasonable amounts, frequency, and duration of services; and inappropriate care provided given the patients' conditions

    In both recent settlements, whistleblowers were responsible for alerting HHS to the fraudulent activity. In the Drayer case, those whistleblowers were physical therapists (PTs) formerly employed with the company.

    "Over the past few years, we've witnessed stepped-up efforts by the federal government to root out waste, abuse, and fraud, an effort very much supported by APTA," said Roshunda Drummond-Dye, JD, APTA's director of regulatory affairs. "We're continuing to work to provide members with up-to-date compliance tools, and the joint guidance document we've created helps to bring some of the most relevant information together in one place."

    The compliance guide joins a full array of other compliance resources available at APTA, most of which are featured as part of the APTA Center for Integrity in Practice website. That site houses information on how PTs, physical therapist assistants, and students can continue to uphold the profession's high standards, and includes information on the Choosing Wisely® list of "5 Things Physical Therapists and Patients Should Question;” a primer on preventing fraud, abuse, and waste; a free course on compliance; and other information on regulation and payment systems, evidence-based practice, ethics, professionalism, and fraud prevention.

    State Policy, Insurers Forums: The Future of Health Care – And Payment – Has Arrived. Are You Ready?

    Topics may have ranged from the opioid abuse epidemic, to APTA's physical therapy outcomes registry, to the role of physical therapy in population health, but throughout APTA's recently held Insurers Forum and State Policy and Payment Forum, it wasn't hard to identify the strong common thread woven through nearly every session:

    Things are getting real.

    Over and over, speakers reminded attendees that what used to be conjecture about the move toward value-based care—and particularly its ramifications for payment—is now happening, and that physical therapists (PTs), physical therapist assistants (PTAs), payers, managers, and state policy advocates need to pay attention.

    The forums, 2 separate meetings that took place between September 16 and 19 in Pittsburgh, were designed for different audiences but contained overlapping content. At the Insurers Forum on September 16, representatives from insurers including Humana, Blue Shield of California, American Specialty Health, United HealthCare, and GEICO explored issues from the payer’s perspective. At the APTA State Policy and Payment Forum, held over the following 2 days, state chapter leaders and advocates gathered to discuss opportunities and challenges at the state level, and to get a sense of the larger national issues that will be impacting PTs and PTAs no matter where they practice.

    One of the major areas of focus during both meetings: the Centers of Medicaid and Medicare's (CMS) proposal to employ a new, 3-tiered CPT coding system for physical therapy evaluation (and 1 new code for reevaluation), planned to begin January 1, 2017. The system was proposed as part of the 2017 Medicare physician fee schedule.

    While some payer groups represented at the Insurers Forum will not immediately be required to follow the CMS recommendations, attendees were eager to understand how the American Medical Association-created codes were developed, and why. For participants in the State Policy and Payment Forum, the new system represents a major change, as APTA and its chapters work to ensure that both members and nonmember PTs thoroughly understand the system—and use it accurately.

    As proposed, the new system offers 3 separate evaluation codes based on the complexity of PT decision-making and the severity of the patient, but provides the same level of payment for each. According to CMS, that flat payment rate—opposed by APTA—would remain while PTs are educated on the new system and demonstrate appropriate use of the codes. APTA has published a members-only summary of the proposed 2017 fee schedule. (To access the highlights, visit the APTA Medicare fee schedule webpage, scroll down to APTA Summaries, and click on the related highlights link.)

    In a video interview at the forum, APTA Vice President of Payment and Practice Management Carmen Elliott described the importance of PTs and PTAs understanding the proposed system as a way for the profession to help shape the future of payment.

    "These codes are so important because now it actually represents the patients we are seeing, the complexity of the patients," Elliott said. "It sets us up for future payment models and shows the clinical decision-making, the skills, the technique, and the expertise of the physical therapist."

    APTA is offering multiple resources and education opportunities on the new CPT codes, including the recording of a sold-out webinar scheduled for September 22, which members will be able to access free (fee for nonmembers is $169) after the webinar.



    Check out other videos from the 2016 State Policy and Payment Forum: an overview of the Forum with APTA President Sharon L. Dunn, PT, PhD; a discussion of problems with the fee-for-service model; and an update on the Physical Therapy Licensure Compact and interstate mobility.

    APTA President Sees Potential to Shape Payment Through Proposed Coding System, Misvalued CPT Codes Survey

    With reform efforts picking up steam at the federal level, physical therapists (PTs) now find themselves in a position to influence the future of payment, according to a new statement from APTA President Sharon L. Dunn, PT, PhD. The statement, released on September 15, places particular emphasis on opportunities for PTs to demonstrate their clinical decision-making skills through a new evaluation code system developed under the American Medical Association (AMA) CPT process, and by way of an upcoming survey to provide data to CMS for its review of potentially "misvalued" CPT codes.

    Dunn's statement arrives as CMS moves ahead with a proposal to implement a 3-tiered evaluation code system for PTs, based on level of complexity of the evaluation, but with no differences in payment. Instead, in a departure from recommendations from the AMA's Relative Value Scale Update Health Professions Advisory Committee, CMS has proposed that the codes be valued as a group rather than individually—at least for the time being. CMS is calling for an extensive education effort to promote accurate use of the new system, should it be officially set in place. In comments to CMS, APTA stated that it was "deeply disappointed" in CMS' failure to adopt tiered payment levels for the codes.

    The statement from Dunn also provides an update on efforts by CMS to get feedback on potentially misvalued CPT codes. That effort will begin with an AMA survey to APTA members, who will be asked to provide information on how they use each code in different patient scenarios.

    Dunn describes the proposed evaluation codes and misvalued codes survey as different issues "united by several factors."

    "Both provide an opportunity for APTA members to shape future value-based payment for physical therapy services," Dunn writes. "Both empower us to elevate our practice for optimal care. Both signify the ongoing role [PTs and PTAs] can and should have within the changing health care environment."

    "The tiered evaluation codes in themselves offer an opportunity for PTs to inform the eventual payment values that will be assigned to them in the future," according to Dunn. "By using the new codes appropriately and accurately, we can help shape future payment as we generate data that CMS can incorporate in its decisions on how these codes will be valued."

    Similarly, participation in the misvalued CPT code survey is essential to helping influence future payment. Dunn indicates, writing that "without our input, CMS and AMA will have little practical data 'from the trenches' on which to base valuation decisions." That online survey will be disseminated in early October to a random sample of members, who will have up to 3 weeks to complete it.

    The statement from Dunn also describes how work on corresponding proposed treatment and intervention codes has been put on indefinite hold. According to Dunn, APTA will not be reviving this initiative, and will not advance its Physical Therapy Classification and Payment System as originally proposed, "so that going forward our efforts reflect the progress of the association and other stakeholders."

    Final IPPS Rule Echoes Proposed Rule; APTA Offers Summary

    The final inpatient prospective payment system (IPPS) rule from the Centers for Medicare and Medicaid (CMS) doesn't differ much from what was proposed in April: elimination of the payment cuts associated with the "2 midnight" rule in 2017, a 0.6% payment increase for hospitals, and more expansion of quality reporting and value-based purchasing requirements. The rule was published in August, and APTA has posted a members-only summary of the new rule on its Medicare Payment and Policies for Hospital Settings webpage.

    The rule finalizes CMS' decision to not implement a 0.2% reduction for inpatient services—a cut designed to offset what it had anticipated would be increased spending associated with the 2-midnight rule. The 2-midnight rule was intended to reduce costly admissions in cases better suited to outpatient treatment by stipulating that auditors can presume that an admission is reasonable and necessary if the patient spent at least 2 days as an inpatient, defined as 2 midnights in a hospital bed. The 0.6% payment increase is intended to offset the effects of the penalty in the years since the rule's adoption in 2013.

    Other notable provisions in the new rule:

    • CMS will increase payments to acute care hospitals by 0.95%–a change from the proposed rule.
    • Long-term care hospital (LTCH) payments will be split into 2 payment systems: 1 for care for the most critically ill patients, and 1 for all other LTCH patients.
    • CMS will require the use of a form, called MOON (Medicare Outpatient Observation Notice), to ensure that Medicare beneficiaries who have been receiving outpatient observation status for more than 24 hours are well-informed of how observation status affects cost-sharing and eligibility for Medicare coverage of skilled nursing facility services.
    • The value-based purchasing program will expand to include not only more units but more measures used to evaluate those units—over time. The additional units won't be added until 2019, and the additional measures will be added in 2021 and 2022.
    • Three claims-based measures and 1 new assessment-based quality measure will be included in the LTCH quality-reporting program.

    The new rule is set to go into effect January 1, 2017.

    SC Prohibition on Physician-Owned PT Services Struck Down, Partly on Procedural Issues

    A recent South Carolina State Supreme Court ruling has effectively ended the state's ban on physician-owned physical therapist services (POPTS), but the 3-2 ruling didn't declare the practice act provision unconstitutional. Instead, 1 of the 3 justices in the majority struck down the board’s interpretation solely due to procedural errors.

    The state's physical therapy licensing board and APTA's South Carolina Chapter (SCAPTA) supported the prohibition against POPTS, as did APTA, but physician and orthopedic surgeon groups have been fighting it for a decade. In light of the court’s ruling, as a practical matter physical therapists (PTs) now will be able to work for a physician-owned practice.

    The court's decision in Joseph et al v South Carolina Department of Licensing, Labor, and Regulation, South Carolina Board of Physical Therapy concludes a long, hard-fought, and at times acrimonious legal and legislative battle. The objections began in 2004, when the South Carolina Attorney General (AG) issued an opinion that the practice act's prohibition on fee-splitting applied to arrangements in which a PT is employed by a referring physician. In 2004, the South Carolina Board of Physical Therapy issued a position statement endorsing the AG's opinion. That statement prompted opponents to bring suit to challenge the board's position.

    The challenge to the 2004 statement was rejected by the state's Supreme Court in Sloan v South Carolina Board of Physical Therapy Examiners. However, the licensing board's 2004 position statement and a subsequent statement in 2011 became pivotal in the recent decision to overrule Sloan. Of the 5 justices deciding the Joseph case, only 2 found the statute as interpreted by Sloan to be unconstitutional. The third justice in the majority asserted that the licensing board's position statements were invalid because the board didn't follow procedural requirements for rulemaking. That justice did not comment on the constitutionality of the Sloan interpretation of the practice act.

    APTA provided significant legal, financial, and staff resources both to SCAPTA and individuals who intervened in the case on behalf of the state licensing board, and joined SCAPTA in fending off attempts to repeal the law in the state legislature. The support is part of the association's longstanding efforts to battle physician self-referral at federal and state levels.

    "The court's decision is not based in reality, and it ignores the very real-world problems that are created as a result of physician referral for profit in physical therapy," said APTA President Sharon L. Dunn, PT, PhD. "We are obviously very frustrated by the court's ruling that will negatively impact our patients and practitioners in the state."

    According to Dunn, the ruling will not alter APTA's position against physician self-referral, and will not dampen its "firm resolve" to address the issue in other ways, most notably through support of a bill in the US House of Representatives that would close up self-referral loopholes in Medicare.

    "We are extremely disappointed in the ruling on the Joseph case," said SCAPTA President Aaron Embry, PT, DPT, MSCR. "This ruling does not change our fundamental belief in patient choice or our resolve to abolish conflicts of interest that negatively impact good clinical practice and the patients we serve, and SCAPTA will remain active in state and national efforts to end relationships that have been proven to be abusive and result in overutilization."

    "I want to applaud our South Carolina members and chapter leaders who persevered during this difficult battle on POPTS, which has been waged over the past 12 years," Dunn said.

    Find out more about this issue on APTA's self-referral webpage, and take action now by asking your legislators to close the self-referral loophole. Contact the APTA advocacy staff for more information.

    Bill Protecting PTs Traveling With Sports Teams Passes House

    The US House of Representatives has passed legislation that helps to protect physical therapists (PTs) and other health care providers who travel across state lines with sports teams.

    The Sports Medicine Licensure Clarity Act (HR 921/S 689) aims to provide added legal protections for sports medicine professionals when they're traveling with professional, high school, college, or national sports teams by extending the provider's "home state" malpractice and professional liability insurance to any other state the team may visit. On September 12, the House officially passed the bill in a noncontentious vote.

    Originally, the bill's coverage was restricted to only physicians and athletic trainers. Advocacy staff at APTA worked closely with the office of sponsor Rep Brett Guthrie (R-KY) and House Energy and Commerce subcommittee staff to add PTs to the list. The bill also opens the possibility of coverage for physical therapist assistants who are under the direct supervision of a PT.

    In addition to Guthrie, cosponsors include Rep Cedric Richmond (D-LA) in the House, and Sens John Thune (R-SD) and Amy Klobuchar (D-MN) in the Senate. The Senate has not yet scheduled a date for a vote on the bill, and APTA advocacy staff is working with sponsors to determine next steps.

    Choose Policies That #ChoosePT: 6 Policy Fixes That Could Improve Access to PTs

    The #ChoosePT campaign is helping to call attention to the role physical therapists (PTs) and physical therapist assistants (PTAs) can play in providing consumers with effective, nondrug approaches to pain management.

    But winning the battle against opioid abuse will take more than raising awareness—it will also require real change.

    Much of that change has to happen around the ways everyone—providers, payers, and patients—view pain and its treatment, but those changes could happen more quickly if a few policies were brought up to speed in ways that would make it easier for the public to access and afford sufficient physical therapy. With improved access comes improved understanding of the real, safe alternative PTs and PTAs offer.

    Here are the 6 top policy fixes that need to happen to ensure improved access to PT services for everyone, and resources to help you understand the issues:

    1. Repeal the Medicare therapy cap. The cap—and the unwieldy exceptions process—reflects an out-of-date way of approaching payment, anchored in fee-for-service thinking and not true value. With the flawed sustainable growth rate now a thing of the past, it's time to put this tired idea to bed. Check out: Medicare Therapy Cap Advocacy: Stop the Cap!
    2. Remove federal and state restrictions that get in the way of access to a PT. Yes, all 50 states now offer some form of direct access to a PT, but the words "some form of" are key: many jurisdictions put limits on numbers of visits allowed before obtaining a physician referral, or put other burdens on the PT and patient to make a case for pursuing a particular plan of treatment. Patients' needs—particularly when it comes to chronic pain—can differ greatly. How does it make sense to arbitrarily restrict a patient's access to a nondrug alternative that is working for them? Check out: Direct Access at the State Level webpage.
    3. Ensure comprehensive insurance coverage for services provided by PTs. It's understandable that insurers would want to promote the most cost-effective treatments, but given the ways the opioid epidemic is ravaging the public health landscape, can anyone really argue that the current system, often tied to quick fixes, is really the optimal way to go? Are insurance companies starting to get the message? At least 1 insurer in Oregon sees the possibilities of providing better coverage for physical therapy for the treatment of pain. Check out: Physical Therapy Model Benefit Plan Design: From Position to Practice (2-part podcast).
    4. Provide for fair PT copays under insurance. Even when insurance companies do cover physical therapy, they can put treatment out of reach for customers by making the patient's share of the bill too high. State insurance commissions can play an important part in reducing consumers' out-of-pocket expenses. Check out: APTA Fair Physical Therapy Copays webpage.
    5. Allow PTs to perform to the full extent of their education and training. The evidence base for physical therapy is strong, and getting stronger, and the trend in state legislatures across the country has been predominantly in the direction of increasing, rather than decreasing, the PT and PTA scope of practice. Good news—but advocates need to keep that momentum going. Check out: APTA Professional Scope of Practice webpage.
    6. Protect patient choice of their PT. Patients should not only be able to access a PT, they should be able to make an informed decision about which PT they would prefer to use. The problem is that exceptions to a law prohibiting self-referral allow some physicians to refer patients to physical therapy facilities that they own, or in which they have a financial stake. That not only makes it harder for patients to make an informed choice, it can actually drive up health care costs. Check out: APTA Physician Self-Referral webpage.

    APTA 'Deeply Disappointed' By CMS Decision on New Evaluation Codes in Proposed 2017 Fee Schedule

    Concerned for its members, the physical therapy profession, and the patients and clients served, APTA expressed "deep disappointment" this week that the Centers for Medicare and Medicaid Services (CMS) failed to adopt different payment values to correspond with 3 levels of physical therapy evaluation that the agency did adopt as new CPT codes in its proposed Medicare physician fee schedule for 2017. The association submitted formal comments to CMS on September 6, continuing its efforts on behalf of members toward the most meaningful and beneficial payment reforms.

    APTA strongly urged CMS to revert to the original recommendation from the American Medical Association Relative Update Committee (AMA RUC), which expanded the physical therapy evaluation and reevaluation codes from 1 each to 3 evaluation codes and 1 reevaluation code, including new values for each code. APTA reminded CMS that it conducted extensive analysis and research, and collaborated with many constituents over several years to develop the codes. The association maintains that the codes and the values assigned to them by the AMA RUC are "wholly appropriate to implement … as approved and vetted."

    Instead of adopting the entire recommendation, however, the proposed rule includes descriptors for 3 new evaluation codes and 1 new reevaluation code, but values all 3 evaluation codes the same—using the value of the existing single evaluation code. The new evaluation codes reflect 3 levels of patient presentation: low-complexity (97161), moderate-complexity (97162), and high-complexity (97163), and will replace the current 97001 code. The new reevaluation code (97164) also keeps the same value as its predecessor (97002).

    If CMS does not include the stratified payment values in the final rule, APTA strongly urged the agency to delay any future payment adjustments that would be based on analysis of claims filed in 2017 under the new codes. The association will work diligently with CMS to analyze billing patterns as providers are educated and become familiar with using the new codes, to prevent a negative impact on future payment. APTA also urged discussion of any viable options to delay implementation of the new codes if the tiered values are not applied to them. (After the release of the proposed rule in July, APTA had written to AMA asking that publication of the codes be delayed to allow additional time for member education. The request was denied.)

    As for the education effort, APTA outlined a major campaign to ensure that PTs and PTAs understand the new codes and learn to document appropriately for the 3 evaluation levels, even if there is no difference in their values for 2017. APTA will host a webinar (see below for more information), interactive self-paced learning module, website FAQs, and articles in its publications to support its members in the transition to the new codes. At the same time, APTA says it expects support and coordination from CMS, including getting APTA's input on the agency's own educational resources for physical therapy providers.

    APTA also responded to other provisions of the proposed rule, including the following.

    • In response to a request from CMS for input on 10 potentially misvalued physical therapy codes, the association confirmed its commitment to working through the process to ensure that the codes are assigned appropriate values. (As part of the process APTA members will be asked to participate in a survey this fall to provide input on how they are using these codes.) APTA requested the opportunity to discuss progress with CMS next year before release of the 2018 proposed fee schedule—to ensure that the voice of the profession is heard during the process and that the association's input is incorporated into the 2018 rule.
    • The association asked CMS to use its discretionary authority to permit PTs to perform telehealth services within alternative payment models such as accountable care organizations and the comprehensive care for joint replacement (CJR) bundled payment program, after the agency said it could not override federal law that as of now does not authorize PTs as telehealth practitioners.
    • APTA asked CMS to remove physical therapy from the in-office ancillary services exception to the physician self-referral, or Stark, laws. Given that in the proposed fee schedule CMS updates other aspects of the Stark law using broad authority it has to make modifications that "protect against program and patient abuse," APTA strongly recommended applying that same authority to remove physical therapy from the IOAS exception, arguing that this, too, would prevent abuse of the original purpose of the law.

    Members can read APTA's comments on the 2017 proposed Medicare physician fee schedule in their entirety on the Medicare Physician Fee Schedule page of the association's website. (Scroll to "APTA Comments.")

    Using your clinical judgment as a physical therapist to correctly classify patients' level of evaluation will be critical to collecting data as health care continues its move to value-based care, and to informing future payment for services. APTA's education efforts on the new evaluation codes include a webinar September 22, 2:00 pm–3:30 pm, free to APTA members. Register now at the APTA Learning Center.

    World Physical Therapy Day Focuses on 'Adding Life to Years'

    September 8 is World Physical Therapy Day, and there's still time in this digitally connected world to plan to help your colleagues around the globe raise awareness of the benefits of physical therapy.

    This year's theme, "Add Life to Years," emphasizes that physical therapists and physical therapist assistants can help older people to be independent, improve their quality of life, and reduce health care costs.

    New this year: Join a global tweet chat (#worldptday) to explore the role physical therapists play in healthy aging. To span world time zones, you can participate in any of 3 hour-long chats on Twitter:

    • 8:00 pm AEST (local time Sydney, Australia)
    • 8:00 pm BST (local time London, UK)
    • 8:00 pm EDT (local time New York, USA)

    For more last-minute ideas, the World Confederation for Physical Therapy (WCPT) offers a World Physical Therapy Day toolkit.

    APTA is a WCPT member organization.