• News New Blog Banner

  • The Good Stuff: Members and the Profession in the Media, August 2018

    "The Good Stuff" is an occasional series that highlights recent media coverage of physical therapy and APTA members, with an emphasis on good news and stories of how individual PTs and PTAs are transforming health care and society every day. Enjoy!

    Innovation + wellness = Grouphab: Patrice Hazan PT, DPT, MA, and Charlotte Walter PT, DPT, discuss the "grouphab" wellness program they designed to help keep people of all ages mobile and injury-free. (WSPA News 7, Spartanburg, NC)

    Lights, camera, caring: Winston-Salem State University PT students Sam Lucier, SPT; Corey Shelton SPT; and Apu Seyenkulo, SPT, discuss the benefits of a WSSU program that incorporates filmmaking into the physical therapy curriculum. (Fox 8 News, Winston-Salem, NC)

    Balance in all things: Libby Krause PT, DPT, and Lori Ginoza PT, DPT, help a USC doctoral student regain her balance after removal of an acoustic neuroma. (University of Southern California News)

    Return of the PT Ninja Warrior: Todd Bourgeois PT, DPT, who participated in the American Ninja Warrior competition in 2014, is back. And this time he's headed for the finals. (Ninjaguide.com)

    Concussion consciousness: Amanda Stewart, PT, explains the signs of possible concussion, and what to do after a concussion diagnosis. (KUTV 2 News, Salt Lake City, UT)

    Doing business like nobody's business: Bryan Wright PT, DPT, owner of Wright Physical Therapy in Twin Falls, Idaho, was named national Small Business of the Month for July. (legistorm.com)

    Alabama's a sweet home for Go Baby Go: University of Alabama-Birmingham PT students joined with UAB engineering students and occupational therapy students to adapt toy vehicles for children with mobility challenges. (CBS42 News, Birmingham, AL)

    When neck pain is a pain in the neck: Karen Litzy, PT, DPT, offers pointers to avoid neck pain. (Health.com)

    Making connections to the pelvic floor: Adrianne McAuley PT, DPT, and Erin Hartigan, PT, share perspectives—and plans for research—on the ways weak pelvic floor muscles can impact recovery from injury to other areas of the body. (Bangor, ME, Daily News)

    Collaboration is crucial: Eric Lederhaus, PT, and Rebecca Fung PT, DPT, write on the importance of applying integrated care to the opioid crisis. (Managed Care magazine)

    Quotable: “I think it’s something that I really want to do because you get to help so many people. You’re working with patients from different backgrounds with the same goal: to get better." - High schooler Heather Artz, on why she wants to pursue a career in physical therapy. (Herkimer, NY, Times-Telegram)

    Got some good stuff? Let us know. Send a link to troyelliott@apta.org.

    2018 ELI Fellows Class Brings APTA's Educational Leadership Program Past 100 Graduates

    Sixteen seasoned physical therapy educators have deepened their knowledge and skills over the past year, thanks to the APTA Education Leadership Institute (ELI) Fellowship. The latest cohort pushes the program past the 100-graduate mark.

    These physical therapists (PTs) made up ELI's seventh cohort of ELI fellows when they graduated in July after completing a yearlong higher education program that consisted of:

    • 9 online modules provided by content expert faculty;
    • 3 2-day face-to-face mentorship sessions and ongoing mentorship provided by experienced physical therapy program directors;
    • higher-education mentorship provided by physical therapy education leaders; and
    • implementation of a personal leadership plan and an institution-based leadership project.

    The ELI Fellowship strives to provide developing and aspiring program directors in physical therapist and physical therapist assistant education programs with the skills and resources they need to be innovative, influential, and visionary leaders who can function within a rapidly evolving, politico-sociocultural environment.

    Partners who help promote and support the ELI Fellowship include the American Physical Therapy Association, American Council of Academic Physical Therapy, Academy of Physical Therapy Education, and PTA Educators Special Interest Group. Find out more information about the ELI Fellowship on APTA's website, and view video testimonials of previous ELI graduates. Questions about the program? Contact eli@apta.org.

    The program was first accredited in 2012 by the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE), the accrediting body for postprofessional residency and fellowship programs in physical therapy, and it was reaccredited in 2017 for a 10-year period.

    Short-Term Insurance Rule Adds More Uncertainty to Care

    As APTA continues to advocate for the maintenance of essential health benefits (EHBs) in insurance offered through Affordable Care Act (ACA) marketplaces, the association and other stakeholders are facing another potential challenge to patient access to care: private insurer short-term, temporary health plans that can skirt many ACA requirements around EHBs, preexisting conditions, and continued coverage.

    Earlier this month, the Department of Health and Human Services (HHS) adopted a final rule on the short-term plans, allowing the policies to provide 1 year of coverage, renewable for up to 3 years. Previously, the plans could only be used for a maximum of 3 months.

    The plans are intended to offer a cheaper insurance alternative than plans available through the ACA (although most individuals who purchase insurance through the ACA marketplaces receive subsidies that lower the out-of-pocket costs). But they are not required to comply with many of the consumer protections included in ACA plans. Instead, the plans are able to deny coverage of a preexisting condition, drop coverage should a customer's health status change, and refuse coverage for services such as mental health, prescription drugs—and, possibly, physical therapy.

    "These plans create more options, but they also create more uncertainty for patients and physical therapists," said Kate Gilliard, APTA regulatory affairs senior specialist. "We're concerned that, perhaps unknowingly, patients who purchase these plans may be moving onto plans that don't cover physical therapy or that offer very limited physical therapy benefits."

    Gilliard said the short-term plans were a hot topic at a recent National Association of Insurance Commissioners (NAIC) conference she attended as a representative of APTA.

    "The plans received mixed reviews from the commissioners," Gilliard said. "Some states openly thanked HHS for allowing more consumer options and for giving states more control over their own markets, but other states criticized the plans for the weaker consumer protections and predicted that the plans will cause prices in the ACA marketplace to rise." According to Gilliard, NAIC attendees described a variety of approaches being taken by states in reaction to the HHS rule, from accepting the provisions as written, to placing shorter time limits on coverage, to banning the plans completely.

    "Many of these states are trying to frame these plans as options that should only be used when consumers are in between major medical plans—like when they are between jobs or waiting for ACA marketplace open enrollment—and not to be relied upon as real, full health insurance," Gilliard said.

    APTA regulatory affairs staff are reviewing the rule to better understand potential impacts to patients and the physical therapy profession. However, the association has already gone on record in support of consistent EHBs and has voiced its opposition to an HHS rule change that allows states to lower the bar on required EHB coverage provisions in so-called "benchmark" plans that set the floor for coverage offered in a state marketplace. Many of the short-term plans are even skimpier than what's being offered through the ACA exchanges, even with the recent benchmark changes.

    "While APTA has always supported the importance of patient choice in health care, we are also committed to advocating for access to needed care and consumer certainty that the care patients receive today will be there tomorrow," said Kara Gainer, APTA's director of regulatory affairs. "Short-term plans offer choice but run the risk of decreasing access and creating uncertainty, and the recent final rule from HHS would appear to make matters worse."

    CoHSTAR Seeks Postdoctoral Fellow

    The Center on Health Services Training and Research (CoHSTAR) has opened its latest call for a full-time postdoctoral fellow—this time for a project related to postacute stroke services.

    The 2-year position, to be located at the University of Pittsburgh, will begin in January 2019. Qualifications for consideration include being a physical therapist with an advanced degree (PhD, ScD, DrPH) completed in the last 5 years and status as a US citizen or noncitizen national. Individuals with strong analytic and writing skills and experience with the analysis of claims data, electronic health record data, and other large data are preferred.

    The successful candidate will work with the Comprehensive Post-Acute Stroke Services (COMPASS) trial, a clinician-led quality improvement model providing early supported discharge and transitional care for individuals who have had a stroke and have been discharged home. The study is entering its fourth year and has produced a wealth of data that provides opportunities for secondary analyses. This fellowship will focus on data related to uptake of rehabilitation care and associated outcomes.

    APTA was a major financial contributor to CoHSTAR, having donated $1 million toward the center's startup in 2015. In addition to APTA’s contribution, funding for CoHSTAR came from gifts from 50 APTA components, as well as foundations, corporations, and individual physical therapists. The Foundation for Physical Therapy also awarded the center a $2.5 grant.

    Study: Estimated 1 in 3 Medicare Beneficiaries Receiving Inpatient/SNF Rehab Report No Improvement in Function

    Authors of a new study on inpatient and skilled nursing facility (SNF) rehabilitation say that when it comes to patients' own opinions of their progress, an estimated 1 in 3 Medicare beneficiaries are likely to report experiencing no improvement in functioning while they were receiving rehabilitation in those settings. And those rates can trend higher depending on certain demographic and health-related variables.

    The study, published in the Journal of the American Medical Directors Association (abstract only available for free), analyzes survey responses from 479 Medicare beneficiaries who received inpatient or SNF rehabilitation between 2015 and 2016. Data were drawn from the National Health and Aging Trends Study (NHATS), with respondents comprising a nationally representative sample of the Medicare population.

    Participants were asked, "While you were receiving rehab services in the last year, did your functioning and ability to do activities improve, get worse, or stay about the same?" Responses were compared with various demographic, socioeconomic, health, and rehabilitation variables to investigate possible correlations. Here's what researchers found:

    • Overall, 33.4% of respondents said that they did not improve in functioning during treatment.
    • Respondents who reported no improvement were more likely to have less formal education, more anxiety, and 1 or more impairments in their ability to perform instrumental activities of daily living (IADL)—preparing meals, doing the laundry, doing light housework, shopping for groceries, managing money, taking medicine, or making phone calls. These respondents also were more likely to require a proxy respondent to answer survey questions due to physiological or cognitive disability.
    • Respondents who reported no improvement were less likely to have received rehabilitation services for surgical reasons.
    • Impairment related to activities of daily living (ADL)—eating, transferring out of bed, transferring out of chairs, walking inside, going outside, dressing, bathing, or toileting—was not associated with lower patient-reported outcomes. The same was true for specific medical conditions and clinically significant depression.
    • Respondents with IADL impairments whose primary condition was "other musculoskeletal condition" or a cardiovascular condition, and who received less than 1 month of rehabilitation services with no outpatient services also were more likely to report no improvement in functioning.

    Authors write that the correlation between lack of improvement and a patient's education level is a "somewhat concerning" finding in the study.

    "Health literacy can be a substantial barrier to effective medical care," authors write, "and perhaps those with less education had a lower level of health literacy, which may have affected their expectations for rehabilitation outcomes and/or negatively impacted their ability to participate in and receive the full benefits of rehabilitation services."

    As for the reasons why impairment in IADLs would be more strongly associated with reports of no improvement than would impairment in ADLs, authors speculate that "perhaps ADL limitations are more amenable to rehabilitation than are IADL impairments, especially because IADL involve more complex tasks that may be particularly sensitive to cognitive status."

    The relationship between rehabilitation of less than 1 month and the absence of outpatient rehabilitation services also was singled out for additional comment by the study's authors, who believe that "effective rehabilitation for some…may be a longer-term process that extends months and spans nursing home, inpatient, outpatient, and/or in-home settings."

    Authors point to a move toward more integrated, multisetting care as a positive step, writing that "As about 1 in 5 community-dwelling Medicare beneficiaries report receiving any rehabilitation services in the prior year, more closely integrating rehabilitation services across service settings (and with other health and social services) offers promise in improving outcomes in Medicare beneficiaries who desire to maintain their independence."

    The study, according to authors, contains its share of limitations, including a relatively small sample size, no differentiation between inpatient facility settings, the use of self-reported data, and lack of information on whether the patients actually met their rehabilitation goals.

    Despite those issues, authors of the study think their analysis opens up areas for future research. They write: "Our findings lead to more questions: does health literacy play a role in patient-reported outcomes? Are those with IADL impairments less able to engage in and thereby benefit from rehabilitation services? How do contextual factors and the dose of rehabilitation services affect patient-reported outcomes? Would patient-reported outcomes among this population be improved if: (1) more of these patients received rehabilitation services longer and/or in outpatient or home settings or (2) if patient-centered rehabilitation targets were more incorporated into treatment planning?"

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    A Stark Reality: APTA Continues Efforts to Shore Up Self-Referral Law

    As the US Centers for Medicare and Medicaid Services (CMS), lawmakers, and others continue to press for more value-based approaches to care, attention has turned to a law that bars physicians from referring Medicare patients to services in which the physician has a financial interest, aka "self-referral." CMS has hinted that the prohibition, known as the Stark law, may interfere with the adoption of new, more integrated models of care, and a US House of Representatives subcommittee held a hearing on "modernizing" the law, perhaps through loosening up restrictions. APTA argues that at least part of the reform efforts should be aimed at eliminating exceptions as a way to increase value-based care opportunities.

    Recently, APTA staff were on Capitol Hill to encourage legislators and their staff to take a careful approach to decisions about the Stark law, which was the subject of a July 17 House Ways and Means Health Subcommittee hearing. During that hearing, legislators were weighing the law's effect on the ability to create alternative payment models (APMs)—systems that often seek to streamline and coordinate entire episodes of care. The hearing echoed a recent CMS request for information from the public on the Stark law, and discussed whether there is a need for "revisions or additions to exceptions to the physician self-referral law, and terminology related to alternative payment models and the physician self-referral law."

    In comments provided to the House subcommittee, the association argues that a reformed Stark law with fewer loopholes could actually promote the growth of value-based care by leveling the playing field for physical therapists (PTs).

    As APTA explains in its comments, the current version of the Stark law includes an exception that allows physicians to self-refer for so-called "in-office ancillary services" (IOAS) that include physical therapy. That exception winds up hurting the development of APMs because it "fail[s] to promote collaboration with small- and medium-sized physical therapy and nonphysician practices," APTA writes.

    "Until [the US Department of Health and Human Services] creates a more level playing field between these different types of providers, physical therapists will be unable to meaningfully participate in Medicare and Medicaid APMs, despite their desire to do so, potentially impeding patient freedom of choice and access to the highest-quality care," the comment letter states.

    The association isn't alone in its commitment to eliminating Stark law loopholes. In 2017, APTA joined with the Alliance for Integrity in Medicare to support a bill in the House of Representatives that seeks to eliminate the IOAS exemptions. That bill, also supported by AARP, has not been scheduled for House committee review

    "We see the recent subcommittee meeting as a chance to highlight the need for more opportunities for physical therapist to participate in alternative payment models, all while protecting patient choice, increasing transparency, and strengthening access," said Justin Elliott, APTA's vice president of government affairs. "Effective value-based care is important. Eliminating conflicts of interest in health care is important. There's no reason why the two can't coexist."

    APTA will share that sentiment with CMS when it delivers the association's response to the CMS request for information (RFI) on the Stark law. The CMS call for feedback is largely focused on how the Stark law could be weakened through the creation of more exceptions or other tweaks, all in the name of promoting more coordinated care models. APTA is coordinating with the APTA Private Practice Section to draft comments by the August 24 deadline.

    The association also has developed a template letter that allows individuals to create a customized-but-consistent response to the CMS request (scroll down the webpage to the second bullet point under "APTA's Current Regulatory Advocacy Efforts).

    APTA is a strong supporter of easing unnecessary regulatory burdens on providers, but CMS and Congress must proceed with caution," said Kara Gainer, APTA's director of regulatory affairs. "We are urging CMS to think very carefully about the unintended consequences of making any changes that increase self-referral. A weaker Stark law could actually impede the transition to value-based care and worsen the patient experience in the process."

    From PTJ: Common Activity Trackers May Be Inaccurate for Patients With PD

    It's important for physical therapists (PTs) to encourage patients with Parkinson Disease (PD) to stay physically active, and it would seem as though commercially available fitness trackers would be a good way to do that, by allowing the PT and patient to set home goals and track progress through step counts. But new research suggests that PTs may want to think twice about the data they get from the devices.

    In an article published in the August issue of PTJ(Physical Therapy), researchers in Boston analyzed data from 4 fitness trackers—2 worn on the wrist and 2 that attach at the waist—to see how the tracker step reports stacked up against videos that allowed PTs to visually observe and count steps taken. The trackers in question were the wrist-worn Fitbit Surge and the Jawbone Up 2 and the waist-worn Fitbit Zip and Jawbone Up Move.

    A total of 33 patients with mild to moderate PD were recruited for the study, which involved tests of both continuous and discontinuous walking while wearing all 4 activity trackers, with the wrist trackers worn on the less-affected arm. The continuous walking tests involved 2 bouts of 2-minute walks around a 92-meter rectangular track, the first lap at a comfortable speed, and second at a fast speed; the discontinuous walking tests consisted of an "obstacle navigation course" and a "household" course, where patients were required walk to different areas to perform typical household tasks such as taking off and hanging up a coat, washing and drying hands, throwing away trash, and picking up and setting down a glass. In addition to recording tracker data, the tests also were video-recorded so that a pair of PTs could count steps taken. Researchers then compared tracker data with the results of the video monitoring. Here's what they found:

    • Overall, the trackers were reasonably accurate at recording steps taken during continuous walking, with the waist-worn Fitbit Zip showing the highest accuracy, followed by the wrist-worn Jawbone Surge, and wrist-worn Fitbit Surge, and the waist-worn Jawbone Up 2.
    • Tracking discontinuous walking proved to be more problematic, with authors of the study describing all 4 trackers as "generally inaccurate" in both courses. The Jawbone Up Move proved to be the least reliable device, with a mean absolute percent error rate approaching 60% in the household course. The Fitbit Zip was the most reliable, but that's not saying much: its error rate in the household course was close to 30%. The devices fared somewhat better in the obstacle negotiation course but still produced error rates ranging from about 10% to 20%. All devices underreported steps taken.

    Authors speculate that the inaccuracies may have something to do with a lack of tracker sensitivity to steps taken "in environments with greater discontinuity, where starting, stopping, and turning occur frequently." The longer, more symmetrical step lengths associated with continuous walking are better suited to the device's abilities, whereas the "smaller, slower, shuffling steps" taken by participants during the discontinuous walking tests tend to be missed by the devices, they write.

    As for waist-worn versus wrist-worn devices, authors think that the higher accuracy of the waist-worn devices may be due to the fact that the device is closer to an individual's center of mass, which allows for more accurate measurement. Wrist devices worn by patients with PD may be less accurate due to the effects of tremor, dyskinesia, extraneous upper extremity movement, and reduced arm swing often associated with individuals with PD, they believe.

    Another common feature of PD—freezing of gait—may also come into play as a factor affecting device accuracy, according to authors. Although only 1 participant in the study experienced freezing during the tests, that individual's devices produced an aggregate 60% error rate in the household course and 20% error rate in the obstacle negotiation course. "In general, the magnitude of this error exceeded that observed among nonfreezers," they write.

    The overarching problem, according to authors, is that none of the devices studied performed reliably in the setting that arguably would be the most important one for PTs treating patients with PD—the patient's home. "Other mechanisms of monitoring discontinuous walking, such as time spent walking, may be better options when the goal of intervention is focused on increasing physical activity in the home environment," they write.

    APTA members Nicholas Wendel, PT, DPT; Chelsea Macpherson, PT, DPT; Tamara DeAngelis, PT, DPT; and Cristina Colon-Semenza, PT, MPT, were among the coauthors of the study.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    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.

    SNF, IRF Final Rules Follow Through on Proposed Shifts in SNF Payment Systems, IRF Reporting Requirements

    The final 2019 rules for skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) are substantially similar to what the Centers for Medicare and Medicaid (CMS) proposed in the spring, but that's not to say physical therapists (PTs) should assume it's a "same rule, different year" situation.

    In fact, the situation is far from a "same as usual" scenario—at least for PTs in SNF settings, who will be facing a dramatic change in how payment is determined.

    The new rules, set to go into effect in October of this year, include increases in payment of 2.4% for SNFS and 0.9% for IRFs, but the heart of the changes have less to do with payment increases and more to do with how payment will be determined and what needs to be reported. For PTs in IRFs, the reporting process could become a bit less burdensome, while PTs in SNFS will need to get up to speed with an entirely new payment system that does away with the Resource Utilization Groups Version IV (RUG-IV) process.

    SNFs: Hello Patient-Driven Payment Model (PDPM)
    The biggest takeaway from the proposed SNF payment rule was the adoption of the PDPM, and the same is true of the final rule. In doing away with the RUG-IV process, CMS adopted a model that bases payments on a resident's classification among 5 components, including physical therapy. Final payment is then calculated by multiplying the patient's case-mix group with each component (both base payment rate and days of service received) and then adding those up to establish a per diem rate. (Editor's note: more detail on the proposed rule appears in a PT in Motion News story published in April.)

    Between its release of the proposed rule and publication of the final version, CMS tweaked a few details—one around clinical categorization in the PDPM having to do with identifying surgical procedures that occurred during the patient's preceding hospital stay, and another related to a new assessment known as the Interim Payment Assessment (IPA), intended to accommodate reclassification of some residents from the initial 5-day classification. In the case of the IPA, CMS decided to make the assessment optional.

    IRFs: Goodbye Functional Independence Measure (FIM)
    As in the proposed rule, the final rule for IRFs drops the FIM and 2 quality-reporting measures related to methicillin resistant staph aureus (MRSA) infection and flu vaccine rates. According to CMS, data associated with FIM are being captured through other parts of assessment, while the costs of gathering data on MRSA and flu vaccines outweigh the benefits. (Editor's note: more detail on the proposed rule appears in a PT in Motion News story published in May.)

    The rule also allows for postadmission physician evaluation to count as one of the required face-to face physician visits and removes requirements for admission order documentation (but not the orders themselves). Additionally, under the new rule physicians will be allowed to lead team meetings remotely—a change that, when proposed, prompted APTA and others to ask CMS to extend that allowance to all team members. CMS stated in the final rule that it will evaluate how the new policy is working out and consider expanding flexibility.

    APTA comments on the proposed rules are available online (for SNF comments, visit APTA's Medicare Payment and Policies for Skilled Nursing Facilities webpage and look under APTA Comments; for IRF comments, look for the same header on the association Medicare Payment and Policies for Hospital Settings webpage). APTA summaries of the rules will be posted in the coming weeks.

    2018 State Policy and Payment Form Offers a Packed Agenda

    Issues that directly affect physical therapists (PTs), physical therapist assistants (PTAs), and society as a whole—population health, the opioid crisis, innovative delivery models, and much more—will be front and center at the 2018 APTA State Policy and Payment Forum. Registrations are now open for this important members-only gathering, to be held September 15–16 at the Westin Crown Center in Kansas City, Missouri.

    The forum is designed to increase PT and PTA involvement in and knowledge of state legislative and payment issues that have an impact on the practice of physical therapy, and to improve legislative, regulatory, and payment advocacy efforts at the state level.

    In addition to presentations on current advocacy efforts in the states, the forum will include information on federal regulatory issues; a presentation on state telehealth policy; and breakout sessions on state issues in pediatrics, value driving payment and contracting, and the physical therapy licensure compact. The event also includes a workshop for legislative chairs and lobbyists, and another aimed at payment chairs.

    Registration is online-only and is open through August 17—no onsite registrations will be offered. Visit the forum registration page to sign up and learn more about the event.