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  • Board Adopts 2013 Strategic Plan and Public Priorities for 2013-2014, Advances Vision Proposal

    On November 28-December 1, APTA's Board of Directors (Board) met to fulfill a very important yearly function—adopting the association's Strategic Plan. During the 4-day meeting, the Board looked to the newly adopted plan to help guide its discussion and actions on various association initiatives.

    The Board adopted the APTA Strategic Plan after a rich discussion on the 4 goals of the plan—effectiveness of care, patient- and client-centered care across the lifespan, professional growth and development, and value and accountability. Objectives under each goal—17 in all—were prioritized earlier this year by the Board. Resources toward the objectives in the plan are determined based on the priorities, so higher-level priorities receive more resources.

    The objectives that were given the highest priority by the Board included the development of the outcomes registry and the advancement of a more appropriate payment system.

    Action toward such a payment system for outpatient physical therapy services—called the Physical Therapy Classification and Payment System (previously known as the Alternative Payment System)—is under way.  The Board received a report from the task force working on the new payment system. As APTA finalizes its draft of the proposed payment system, a comprehensive communication, public relations, education, and professional development plan will be developed to maximize the opportunity for a successful transition. An outline of the proposed plan will be presented to the Board in January 2013. A final plan will go to the Board in June 2013. The final draft of the proposed payment system  is expected to go through several AMA groups and committees for vetting and valuation in 2013 and 2014. At this time, APTA is on target for a 2015 implementation of a new payment system.    

    Other important priorities contained in the strategic plan include increasing the number and use of best practice guidelines to reduce unwarranted variation in care, in support of the goal toward effectiveness of care; exploring innovative learning opportunities, in support of the goal toward professional growth and development; and advocating for health policies that embrace value, safety, access, and integrity, in support of the goal toward value and accountability. Activities in progress or planned for 2013 to help achieve these objectives include continuing to expand the content in PTNow, APTA's online clinician's portal to evidence-based practice; adding a virtual attendance component to onsite APTA learning venues; and monitoring and influencing health care reform regulation.

    Strategies and metrics for all 17 objectives have been developed and will enable APTA's Board to track their progress throughout 2013. Progress on the plan will be communicated to the members throughout the year.

    In adopting the Strategic Plan, the Board recognized that it is a "bridge between Vision 2020 and a new vision to be considered in 2013." A proposal for that new vision also was discussed at the meeting, with the Board reviewing a report by the Vision Task Force. As the ultimate decision-maker on the vision of the association, the House of Delegates will consider the proposal in June 2013.

    In other meeting activity, the Board approved a 2013 operating budget with revenue of $42,398,480, expenses of $42,398,480, and zero net revenue. It was noted that almost 24% of total expenses directly fund Strategic Plan goals.

    Nine public policy objectives and strategies were adopted during the meeting, representing the critical public policy issues the association anticipates will advance physical therapist practice, education, and research in 2013-2014. The objectives and strategies include advancing a payment model(s) that promotes the value of physical therapists (see Physical Therapy Classification and Payment System above), eliminating physician referral for profit in physical therapy, and improving access to physical therapy services in integrated service delivery systems, such as accountable care organizations. The 2013-2014 priorities, developed with input from members and the Public Policy and Advocacy Committee, will be available to association members shortly. In keeping with the Board's focus on public policy priorities, a generative discussion was held on the determination of scope of practice issues. Board and staff members discussed possible mechanisms that could be used to review and analyze existing, new, and emerging fields of physical therapy practice to determine if APTA should endorse, recognize, or exclude the areas as part of the professional scope of practice. 

    The Board also took action on several new initiatives related to policy and advocacy:

    • Noting the need to effectively advocate for the inclusion and integration of physical therapy in emerging payment models, the Board voted to identify or establish and promote criteria/decision support tool(s) to ensure that patients and clients have meaningful access to appropriate physical therapy in all integrated payment models, such as a bundled payment system.
    • The Board approved the development of a pilot program that would make select grassroots and advocacy resources available for nonmember audiences, such as physical therapists and physical therapist assistants, legislative staff, other health care providers, and patient advocates. Opening up access to selected resources would allow enhanced collaborative opportunities in regulatory and legislative priorities.
    • With the formation of state exchanges and the recent release of the essential health benefits proposed rule, and in response to members seeking assistance with language for use in negotiations with legislators, payers, and policy makers, the Board adopted Essential Health Benefits Recommendations as a Board policy. This new policy provides definitions of "rehabilitation" and "habilitation" and guiding principles for these definitions.   

    In the coming months, the Board will begin to consider the future relationship between APTA and the Commission on Accreditation in Physical Therapy Education (CAPTE). US Department of Education (USDE) regulations, new Council for Higher Education Accreditation (CHEA) criteria, and a perceived conflict of interest between APTA and CAPTE, have prompted discussion about and initial exploration into whether CAPTE should become partially or fully independent of the association. As such, APTA will gather financial data, confirm the various USDE and CHEA requirements impacting CAPTE, collect information on the 2 proposed models, and consult with the Academic Council, the Education Section, and other interested parties so that the Board can make a recommendation that would best serve the interests of education programs, the association, and CAPTE.           

    To promote governance processes and structures that optimize policy development, the Board voted to develop motions for the 2013 House that will allow necessary Board discussion and action on the House of Delegates governance proposal. Data gathered by the Governance Proposal Board Work Group to inform its work as well as the report submitted to the Board have been posted to the Governance Review Community. The materials can be found in the Governance Review Community Reference Materials folder with document titles that begin with the words 'House Governance Proposals.'

    For the first time, the Board meeting was livestreamed. APTA members can watch the video archive of the meeting until December 15 (refer to the agenda posted on the livestream webpage to narrow down the date and time of the discussions summarized above). The language for motions voted upon during this meeting is not considered final until the minutes of this meeting are approved by the Board. Final motion language will be reflected in the minutes of the November 2012 Board of Directors meeting, which will be approved and posted online in December.  

    Functional Limitation Reporting vs PQRS: Understanding the Differences

    APTA has posted a new chart to help members understand the differences between the Physician Quality Reporting System (PQRS) program and a congressionally mandated functional limitation reporting program that begins January 1, 2013. The chart can be found on APTA's Functional Limitation Reporting Under Medicare webpage.

    The Middle Class Tax Relief Act of 2012 mandated that the Centers for Medicare and Medicaid Services (CMS) begin functional limitation data collection on January 1, 2013, for Medicare beneficiaries. The new functional limitation reporting will be done through nonpayable G-codes that are similar in their appearance to PQRS quality data codes. The functional limitation reporting will be visit-driven and must be completed on evaluation, every 10th visit, and at discharge. All practice settings that provide outpatient therapy services must include this information on the claim form. Specifically, the policy will apply to physical therapy, occupational therapy, and speech-language-pathology services furnished in hospitals, critical access hospitals, skilled nursing facilities, comprehensive outpatient rehabilitation facilities (CORFs), rehabilitation agencies, home health agencies (when the beneficiary is not under a home health plan of care), and in private offices of therapists, physicians, and nonphysician practitioners.

    Simultaneously, attention is increasing on PQRS as the program changes from an incentive-based program to a penalty program, with the 2013 year being pivotal to the program's changeover, informing both the 2013 bonus and the 2015 penalty. PQRS, the quality reporting program for Medicare Part B, was implemented in 2007. Physical therapists are eligible professionals in this reporting program and can report a variety of measures, including pain assessment on initial evaluation and a measure related to the use of a functional assessment tool. Reporting under the PQRS program is tied to CPT codes. Therapists reporting under this program submit quality data codes for the selected measures with CPT code 97001 and sometimes with 97002.

    New in the Literature: Measuring Outcomes in Patients With Spinal Stenosis (Spine J. 2012;12(10):921-931.)

    Results of a study published in The Spine Journal indicate that the Oswestry Disability Index, Modified Swiss Spinal Stenosis Scale (SSS), and Patient Specific Functional Scale possess adequate psychometric properties to be used in the outcome assessment of patients with lumbar spinal stenosis. However, further investigation is needed to validate these findings in other samples of patients with lumbar spinal stenosis and nonspecific low back pain, the authors add.  

    This cohort secondary analysis of a randomized clinical trial of patients with lumbar spinal stenosis receiving outpatient physical therapy included 55 patients (mean age, 69.5 years; standard deviation, ±7.9 years; 43.1% females).

    Outcome measures were the Modified Oswestry Disability Index, SSS, Patient Specific Functional Scale, and Numeric Pain Rating Scale (NPRS).

    All patients completed the Oswestry Disability Index, SSS, Patient Specific Functional Scale, and NPRS at the baseline examination and at a follow-up. In addition, patients completed a 15-point Global Rating of Change at follow-up, which was used to categorize whether patients experienced clinically meaningful change. Changes in the Oswestry Disability Index, SSS, Patient Specific Functional Scale, and NPRS were then used to assess test-retest reliability, responsiveness, and minimum levels of detectable and clinically important differences.

    The Oswestry Disability Index was the only outcome measure to exhibit excellent test-retest reliability with an intraclass correlation coefficient of 0.86. All others ranged between fair and moderate. The Oswestry Disability Index, SSS, and Patient Specific Functional Scale exhibited varying levels of responsiveness, each of which was superior to the NPRS. The minimal clinically important difference for the outcome measures for persons with lumbar spinal stenosis were:

    • Oswestry Disability Index—5 points
    • SSS— 0.36 and 0.10 for symptoms subscale and functional subscale, respectively
    • Patient Specific Functional Scale—1.3
    • NPRS—1.25 for back/buttock symptoms, 1.5 for thigh/leg symptoms

    APTA member Joshua A. Cleland, PT, PhD, OCS, is the article's lead author. APTA members Julie M. Whitman, PT, T, DSc, OCS, FAAOMPT, Robert S. Wainner, T, PhD, ECS, OCS, FAAOMPT, and John D. Childs, PT, PhD,MBA, are coauthors.

    CDC Releases New Falls Prevention Toolkit

    The Centers for Disease Control and Prevention's (CDC) new STEADI Tool Kit gives health care providers information and tools to assess and address their older patients' falls risk.

    The STEADI (Stopping Elderly Accidents, Deaths and Injuries) Tool Kit is based on a simple algorithm adapted from the American and British Geriatric Societies' Clinical Practice Guideline. It includes basic information about falls, case studies, conversation starters, and standardized gait and balance assessment tests (with instructional videos). In addition, there are educational handouts about falls prevention specifically designed for patients and their friends and family.

    APTA members who are experts in falls prevention assisted CDC with the development of the toolkit, specifically with the evidence based community falls prevention programs. Additionally, APTA staff appear in several videos on tests that were recorded at APTA.

    A link to the toolkit also is available on APTA's Balance and Falls webpage under "Related Resources."