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  • Small-Scale Study Finds Large-Scale Debt Among Recent DPT Grads

    In this review: The Debt Burden of Entry-Level Physical Therapists
    (manuscript e-published ahead of print in PTJ, December 2019)

    The message
    It's a limited study—based on a small number of respondents who are early-career APTA members in Florida—but the conclusions might sound familiar to recent graduates of DPT programs: The average amount of educational debt owed by entry-level PTs is equal to almost two years’ average salary, a 197% debt-to-income ratio. That's more than the average debt-to-income ratio for newly minted family medicine physicians and veterinarians, according to the study's author, and a burden that may affect a PT's choice of practice setting.

    The study
    The analysis was developed from surveys administered to members of the Florida Physical Therapy Association's Early Professional Special Interest Group (SIG) in 2016, all of whom were entry-level professionals (0-5 years after graduation) and practicing as PTs in Florida. The final results were based on responses from 86 individuals (out of approximately 350 PT SIG members) who answered questions related to income, amount of debt held, and clinical practice choices. The study asserts that the sample reflects "all major practice settings." The study was authored by APTA member Steven Ambler, PT, DPT, MPH, PhD.


    • Average (mean) salary for respondents was $69,328. Salaries ranged from $55,000 in a school setting to $82,659 in a home health setting.
    • The most frequently reported debt amount related to the DPT ranged from $100,000 to $124,999, with "relatively small" amounts of pre-DPT or non-educational debt reported.
    • Monthly income dedicated to loan repayment averaged 10%—a figure that skewed lower because several subjects reported 0% repayment based on income-based repayment or loan repayment that had not begun. When those respondents were factored out, the average amount of income devoted to loan repayment per month was closer to 22%.
    • While 83% of respondents indicated that the setting itself was the most important factor in deciding where to practice, 28% said that debt was a barrier to practicing in the setting of their choice.
    • Overall, 57% of respondents acknowledged that student debt had affected their practice choice, with that relationship growing stronger as levels of debt increased.

    Why it matters
    The issue of student debt in general has grown in national prominence, with some studies showing that the levels of debt burden are affecting the overall US economy. Student debt for PTs and PTAs is a major focus for APTA, which views the cost of physical therapy education as a potential barrier to achieving greater diversity in the profession, and a burden that can contribute to burnout and attrition. The association has established a Financial Solutions Center that provides opportunities for loan refinancing as well as financial literacy. APTA also is advocating for federal programs, such as the inclusion of PTs in the National Health Services Corps, that would offer debt relief to participants.

    More from the study
    The 197% debt-to-income ratio identified in the study was more than double the estimated average ratio for family medicine physicians, which ranged from 80% to 90%, and surpassed the average debt-to-income ratio for veterinarians, which studies have estimated at 160% to 180%. Additionally, the average of 22% of monthly income spent on loan repayment among the PTs studied place them in a "hardship category of greater than 20% monthly income-debt ratio," which, Ambler indicates, has been shown in other research "to delay marriage and other personal decisions among young professionals."

    Keep in mind…
    The study has a small sample size, is limited to a single state, and is further narrowed by the fact that respondents were members of the state chapter of APTA and a particular special interest group. Further, the survey questions evaluated what the author describes as "personal, family, and institutional characteristics" that may offer further insights on debt burden. Finally, because information was collected via an anonymous survey, the author acknowledged that the results "are subject to selection bias."

    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.

    Physician Owned? Corporate? Independent? Panel Event to Focus on PT Models of Practice

    Few would argue that health care in the United States has experienced significant change over the past few years—but do those changes require a new look at practice models for physical therapists (PTs)? That's the question at the heart of an event cosponsored by APTA and Arcadia University set for the evening of January 9, 2020, 6:00 pm–9:00 pm ET.

    The panel presentation, Practice Revolution: Physician Owned, Corporate, Health Care Systems, Independent, and More, will include presentations from APTA Chief Executive Officer Justin Moore, PT, DPT, and Bill Boissonault, PT, DPT, DHSc, APTA executive vice president of professional affairs, as well as APTA members Jennifer Gamboa, PT, DPT; Patrick Graham, PT, MBA; and Michael Horsfield, PT, MBA. The PT panelists will be joined by neurosurgeon Ryan Grant, MD, and Louis Levitt, MD, MEd, vice president of The Centers for Advanced Orthopaedics. Past APTA President Paul Rockar Jr, PT, DPT, MS, will serve as panel moderator.

    The event is open to the public—although RSVPs are required by January 2—and will be held in the Great Room of the University Commons at Arcadia, located about 14 miles north of Philadelphia. Remote participation is available. If you can’t attend in person but want to participate, select the option to participate remotely on the RSVP page. Login information will then be provided. The presentation will also be streamed live and recorded for later download.

    For more information, email stephensl@arcadia.edu.

    2020 Physician Fee Schedule Calculator Now Available

    It's back: APTA's members-only Medicare physician fee schedule calculator for 2020 is live.

    This year's calculator incorporates the 50% multiple procedure payment reduction (MPPR) as well as the overall 2% cut to Medicare payments implemented through sequestration. The calculator, delivered by way of an Excel spreadsheet, calculates Medicare physician fee schedule payment for procedures provided to a beneficiary on a given day in a specific geographic location.

    Other features include options for selecting your Medicare participation status—participating, nonparticipating but accepting assignment, or nonparticipating and not accepting assignment—as well as the ability to compare the 2020 payment rate with the rate in 2019. The calculator also features a Merit-based Incentive Payment System (MIPS) adjustment tool, which isn't applicable to physical therapists this year but will become a useful tool beginning in the 2021 payment year.

    APTA Helps You Prepare for Medicare in 2020, Fight Proposed 2021 Cuts

    Get ready, because Medicare is about to roll out some major changes in 2020. But that's not all: the US Centers for Medicare and Medicaid Services (CMS) is considering a potential estimated 8% payment cut for 2021. APTA wants to give you the tools you need to thrive and speak out for the profession.

    We've launched two new webpages designed to be one-stop shops—one for navigating the many Medicare rule changes affecting PTs and PTAs in 2020, and a second devoted to the profession's fight against the estimated 8% cut on the table for 2021.

    Both pages are packed with information and links to additional resources. The 2020 Medicare Changes page provides a general overview and then dives into topics such as the Quality Payment Program (home to the Merit-based Incentive Payment System, or MIPS), the physician fee schedule, PTA payment modifier, and coding updates. Our advocacy page on the proposed fee schedule payment reductions includes links to resources that will provide you with not only history and context, but with opportunities to advocate for the profession.

    Don't let 2020 take you by surprise. And help us challenge a nonsensical plan that could severely harm patient access to the care they need, when they need it.

    Trying to separate Medicare fact from fiction? Check out this #PTTransforms blog post from APTA Director of Regulatory Affairs Kara Gainer as she takes on some of the Medicare myths that have been popping up lately on social media and elsewhere. And stay tuned for part 2 of the series, coming soon.

    2020 Slate of Candidates Posted

    The 2020 Slate of Candidates for APTA national office is now posted on the APTA website. Candidate statements and biographical information will be posted on March 16, 2020.

    Elections for national office will be held at the 2020 House of Delegates on June 1, 2020. Please contact Justin A. Lini in APTA's Governance and Leadership Department for additional information.

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    APTA, AOTA, ASHA: New Home Health Payment System No Reason to Compromise Care

    As a new Medicare Part A payment model for home health agencies (HHAs) gets set to launch January 1, APTA and two other provider organizations are urging HHAs to keep patient access to needed care front-and-center, and not react to the new system with "unnecessary staffing changes."

    In a joint statement by APTA, the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASHA), the organizations state:

    "APTA, AOTA, and ASHA are aware of the potential for clinicians and assistants to be negatively impacted by the reactions of some home health agencies when implementing Medicare’s Patient-Driven Groupings Model (PDGM) on January 1, 2020. Unnecessary staffing changes could affect the clinicians’ practice patterns and their ability to exercise clinical judgment, as well as patients’ access to care — ultimately damaging the quality of therapy provided by home health agencies. Our organizations continue ongoing dialogue with CMS and home health agencies to ensure that Medicare beneficiaries continue receiving the skilled therapy they need. APTA, AOTA, and ASHA are committed to advocating on behalf of our professions and the people they treat."

    The statement summarizes one of the central points APTA, AOTA, and ASHA have been driving home since PDGM was finalized for implementation on January 1, 2020: that PDGM changes nothing in terms of CMS' requirements that HHAs provide high-quality reasonable and necessary rehabilitation services and that clinicians use clinical judgment in determining appropriate frequency, duration, and modality of services.

    As the new system is implemented, the association will be gathering on-the-ground information from physical therapists and physical therapist assistants on how HHAs are responding, and will share those reports with CMS. CMS will also be tracking utilization and patient outcomes under PDGM to ensure appropriate provision of therapy. If you have experiences to share related to implementation of PDGM (or the SNF PDPM), reach out to advocacy@apta.org.

    Learn the basics of how you can manage the PDGM in this "Compliance Matters" column published in PT in Motion magazine. Need more information? APTA has created an entire PDGM webpage with multiple resources to help you understand and make the case for your value in the system.

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    Public Awareness for Physical Therapy Is Ready to Rock Times Square

    When more than a million people gather in Times Square to watch the ball drop and celebrate the beginning of 2020, APTA's ChoosePT message will be there with them.

    APTA has launched digital billboard advertising in Times Square that will run not only on New Year's Eve but through the end of March 2020. An average of 380,000 pedestrians pass through Times Square each day, most of them tourists, giving the advertising national reach.

    APTA's 15-second billboard ad will appear on two adjoining screens at the corner of 43rd Street and Broadway, running a minimum of 20 times per day.

    The larger right screen will play a series of brief video clips that evoke the positive human experience of movement with messages that say, "Choose to ride. Choose to dance. Choose to love. Choose to play. Choose to climb. Choose to thrive. Choose physical therapy." The left screen will consistently share a call to action: "For what moves you, find a physical therapist at ChoosePT.com."



    ChoosePT.com includes APTA's "Find a PT" directory of APTA member physical therapists who are willing to be contacted by consumers seeking care or by other health care providers making referrals.

    "This is a great opportunity to celebrate the positive impact that physical therapy has on people's lives and encourage them to choose physical therapy," said Jason Bellamy, APTA's executive vice president of strategic communications. "With increased traffic expected to Find a PT, it's really important for clinicians to update their profiles with accurate and detailed information to help consumers find the care they need."

    The Times Square advertising caps off a notable year for APTA's ongoing public awareness activities.

    • APTA went all-in on its "choose physical therapy" message, transitioning the 10-year-old Move Forward brand to ChoosePT, with an updated ChoosePT.com website that includes a significantly improved Find a PT database.
    • A national satellite media tour highlighting the benefits of physical therapy for pain awareness month reached more than 100 million viewers.
    • Online digital advertising pushed traffic to ChoosePT.com to record highs, boosting traffic to the improved Find a PT database in recent months.
    • APTA state chapters collaborated to create state-specific landing pages within ChoosePT.com, which are promoted to consumers using geolocation technology.

    Login at APTA.org to activate or update your Find a PT profile, including adding a headshot, selecting your area of practice focus, and ensuring that your current practice location information is accurate.

    Looking to share the ChoosePT message? Access the campaign toolkit.


    APTA's TKA Guidelines: Your Comments Needed by January 3

    APTA is developing a new clinical practice guideline (CPG) on total knee arthroplasty (TKA) and your help is needed.

    The CPG is now in the public review phase of its development, and APTA is asking for public comment. But hurry—deadline for comments is January 3, 2020.

    Funded entirely by APTA, the draft CPG covers topics ranging from preoperative exercise to physical therapy discharge planning and assessment of outcomes. The resource was developed by a volunteer development group that included member expert PTs from many of the Academies, an orthopedic surgeon, a nurse, and a consumer, and was based on systematic reviews of current scientific and clinical information related to the PT management of TKA.

    APTA has created a webpage that links to the CPG and allows visitors to provide comments.

    The Good Stuff: Members and the Profession in the Media, December 2019

    "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!

    Making inclusion happen: Kendra Gagnon, PT, PhD, describes the philosophy behind "Harness School Café," a project that outfitted a school lunchroom with adaptive resources for students with disabilities. (KHSB 41 News, Kansas City, Missouri)

    Ho Ho Ow: Julie Lombardo, PT, DPT, offers tips on avoiding injury during holiday shopping and decorating. (channel3000.com)

    Tackling a career as a PT: Former Denver Broncos safety David Bruton Jr, SPT, has set his sights on earing his DPT at the University of Colorado. (9News, Denver)

    Physical therapy as part of the high school athlete's routine: Evan Chait, PT, discusses the advantages of physical therapy as an ongoing component of a high school athlete's training regimen. (Fox5 News, New York)

    Patelling it like it is: Kristi Fata, PT, DPT, says that with proper precautions, it's possible to continue running while experiencing runner's knee. (yahoo! Lifestyle)

    Go for your guns: Theresa Marko, PT, DPT, MS; Kellen Scantlebury, PT; and Nina Geromel, PT, DPT, ATC, discuss the effects of massage and the effectiveness of home massage guns.(Nutritious Life)

    Getting along swimmingly with a sprain: Margaret Conze, PT, MPT, provides her perspective on the advisability of swimming with a sprained ankle. (US Masters Swimming newsletter)

    Don't blow your big chance in snow business: Lori Thein Brody, PT, PhD, talks about safe ways to shovel snow. (Wisconsin public radio)

    Blood flow restriction therapy: Paula Shulthiess, PT, DPT, shares her thoughts on blood flow restriction therapy now being used in a West Virginia hospital center. (WBOY 12 News, Clarksburg, West Virginia)

    A PT's ankle on recovery: Rachel Tavel, PT, DPT, outlines ways to counter ankle pain. (Men's Health)

    Improving rheumatology: Robert Richardson, PT, MEd, FAPTA; Maura Daly Iveren, PT, DPT, SC, MPH, FAPTA; and Meredith Christiansen, PT, DPT, were among the winners of this year's Association of Rheumatology Merit Awards. (ARP newsletter)

    Quotable: "Unlike expensive new drugs…exercise can reduce costs in the health care system. For these reasons, it’s time for physicians, nurses, and health care organization systems to make their own new year’s resolution — to prioritize exercise as an intervention they prescribe to their patients." – health care writer Sachin Jain, on Encore Wellness, a program that emphasizes exercise as medicine. (Forbes magazine)

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

    Foundation Grants Focus on ICU Survivors, Exercise Effects on Diabetes, Blood Flow Restriction, and More

    An APTA-sponsored $40,000 Health Services Research Pipeline grant will support a project aimed at conducting the first-ever comprehensive evaluation of variability in rehabilitation delivery to older intensive care unit (ICU) survivors. The award was among several Foundation for Physical Therapy Research (Foundation) grants and scholarship awards totaling more than $600,000 in 2019.

    Grant recipient Jason Falvey, DPT, PhD, will investigate both in-home and community- based rehabilitation of the older ICU survivor population, including an exploration of the impact rehabilitation may have on functional outcomes and hospital readmissions. Falvey is a postdoctoral fellow at the Yale School of Medicine.

    APTA is the Foundation's Pinnacle Partner in Research and has been a leading donor in funding major research initiatives such as the Center on Health Services Training and Research (CoHSTAR), investing in research priorities to strengthen the physical therapy profession, and supporting the Foundation's scholarship program each year.

    In addition, the Foundation expanded its portfolio of grant and scholarship opportunities in 2019 with the launch of the Goergeny High-Impact Research Grant, an offering focused on the role of physical therapy in the prevention of secondary health conditions, body structures and functions, activity limitations, or participation restrictions. The first investigator to receive the Goergeny award is Smita Rao, PT, PhD, of New York University, who will receive $240,000 over the next 2 years for a study that will investigate the effects of exercise on hyaluronan accumulation in people with type 2 diabetes.

    Other grant and scholarship announcements from the Foundation:

    Saurabh Mehta, PT, MSc, PhD, the recipient of the $40,000 VCU-Marquette Challenge Research Grant, will examine the feasibility, acceptability, and preliminary outcomes of an evidence-based program (developed by physical therapists in Denmark) for people with knee osteoarthritis. This grant is funded in part by APTA's Supporting the Professions Fund.

    Aliza Rudavsky, PT, DPT, PhD, was awarded the $40,000 Pelvic Health Research Grant. The goal for her project, titled “Concurrent Validity of Novel Transabdominal Pelvic Floor Ultrasound During Glottis Tasks,” is to test a new method of measuring transabdominal ultrasound imaging and comparing it with the gold standard transperineal method. This award is supported by the APTA Academy of Pelvic Health Physical Therapy.

    Cristine Agresta, PT, MPT, PhD, was named recipient the $100,000 Magistro Family Foundation Research Grant in support of a project that will assess the effectiveness of personalized blood flow restriction against current standard rehabilitation procedures after anterior cruciate ligament reconstruction surgery. This project is funded by the Foundation's Magistro Family Endowment Fund and Legacy Research Fund.

    Alyssa LeForme Fiss, PT, MPT, PhD, who was awarded the $40,000 Pediatric Research Grant, will conduct research to determine the effects of adaptive behavior physical therapist intervention delivered in addition to traditional physical or occupational therapist services for families with infants diagnosed with or at high risk for cerebral palsy. This grant is supported by the Pediatric Research Fund and the APTA Academy of Pediatric Physical Therapy.

    “FPTR grants help strengthen the profession and elevate research in physical therapy,” said Foundation Board of Trustees President Edelle Field-Fote, PT, PhD, FAPTA, in a Foundation news release. “With the help of our community of donors, we continue to fund top researchers and the most promising science in the field of physical therapy. Each project has the potential to improve outcomes for the patients we serve as physical therapists.”

    The New Postacute Care Payment Systems: 5 Tips to Help You Find Your Way

    There's no doubt about it: the new payment system that the US Centers for Medicare and Medicaid Services (CMS) put in place in October for skilled nursing facilities (SNFs), and the system that will start up for home health agencies (HHAs) on January 1, 2020, represent major changes by Medicare. And like most major changes, the new approaches have sparked myths, misunderstandings, and inaccurate interpretations—sometimes at the expense of physical therapists (PTs) and physical therapist assistants (PTAs) who work in the SNF and HHA settings and their patients.

    Discussions on what would become the new systems—the SNF payment model is called the Patient-Driven Payment Model (PDPM) and the HHA approach is known as the Patient-Driven Groupings Model (PDGM)—began 3 years ago, and APTA immediately began a dialogue with CMS that continues to this day. Those interactions, fueled by strong grassroots efforts among APTA members and other stakeholders, have helped to shape final rules that are far from perfect but significantly less problematic than many of the early proposals from CMS.

    The reality, however, is that PDPM and PDGM are here, and PTs and PTAs must now learn how to navigate the changed landscapes—and help dispel misunderstandings. Here are 5 things to remember about the new systems.

    1. PDGM and PDPM are changes to payment, not benefits. While some in the postacute care industry have characterized the new systems as a shift in benefit requirements, that's just not true. CMS expects that providers working in both systems—including rehabilitation professionals—will continue to use their clinical judgment to deliver high-quality therapy services that are reasonable and necessary. APTA communicates with CMS regularly on what we hear from members about employers' mischaracterization of the new rules—and CMS is listening (see tip 5).

    2, APTA offers multiple ways to learn more about the models. In addition to our advocacy efforts, we've developed free, publicly available education on the PDPM and PDGM: how to prepare for the changes, as well as how to advocate for and demonstrate the value of the PT and PTA within the new models. If you'd like to dig even deeper and find out what your peers are thinking about the models, check out this free downloadable recording of a recent webinar on postacute care reforms and the continued value of PT practice. A follow-up live Q&A is scheduled for December 13 at 1:00 pm, ET.

    3. PDGM and PDPM don't change what's important to practice. Any new payment system can be subject to misapplication—whether purposeful or not. But those misapplications should never affect the profession's commitment to ethical practice and the prevention of fraud and abuse. APTA's Center for Integrity in Practice website helps you better understand these issues in the context of best practice and reduced risk.

    4. The new systems may open up opportunities. Can changes to payment systems actually strengthen the case for rehabilitation services? Mahmood Iqbal, PT, thinks so. In a two-part blog series for APTA's #PTTransforms (part 1, part 2) this PT and HHA CEO takes a close look at the PDGM and sees a path that could make the role of the PT even more central to care. And while the posts focus on the home health setting, many of Iqbal's observations apply to PDPM as well. Want more perspectives on how to get the most out of the new models? Check out resources from APTA's Home Health Section, the APTA Academy of Geriatric Physical Therapy, and the association's Health Policy & Administration Section.

    5. CMS is watching—and we're listening. As the rules were being debated and developed, one of APTA's major areas of focus was around ensuring that CMS pays careful attention to utilization and outcomes. Our efforts, and the efforts of our collaborators at the American Occupational Therapy Association and the American Speech-Language-Hearing Association have resulted in CMS establishing regulatory guardrails that help to ensure that patients continue to receive the care they need.

    At the same time, APTA is committed to supplying CMS with on-the-ground information about how PDPM and PDGM are working for individual professionals. Your story is important—reach out to advocacy@apta.org to share your experiences.

    From Choose PT.com and Move Forward Radio: 'Dancing With the Stars' Dancer and the Show's PT Talk About Keeping the Cast in Shape

    She's a physical therapist (PT) who might be lucky to get 20 minutes with her patients, tops. And sometimes, there are lights and cameras to contend with. At other times, she has to be aware of the fact that if she uses taping, it must not be visible to the literally millions of people all over the world who will be watching her patient. That's just how showbiz works.

    Welcome to the life of Gina Minchella, PT, DPT. Gina is the PT for "Dancing with the Stars," the immensely popular reality show that pairs celebrities and notables with professional dancers in a ballroom dancing competition.

    Now available through ChoosePT.com's Move Forward Radio podcast: an interview with Minchella and "Dancing with the Stars" professional dancer Valentin Chmerkovsky on the rigors of the show, what it's like to be on a performance tour, and the ways physical therapy keeps Chmerkovsky and the rest of the cast able to crank out those foxtrots, tangos, and two-steps week after week.

    During the conversation, Chmerkovsky doesn't hesitate to credit Minchella for the contributions she makes to the show.

    "A lot of these accolades we get to enjoy are because of Gina," Chmerkovsky says, adding that the excellent PTs he's worked with, such as Minchella, "don't just take care of someone, they teach you along the way."

    Minchella, in addition to being a top-notch PT, is no slouch at understatement. She describes her workplace as "not a typical clinical setting," and points out that "sometimes I have to get really creative." She tells Move Forward Radio that being part of the show has given her a great platform for spreading the word about the difference PTs can make.

    "The public needs to know what we do," Minchella says, "Because they need to know, 'Oh, I could get physical therapy—I could use physical therapy for this.'"

    Move Forward Radio is hosted at ChoosePT.com, APTA's official consumer information website, and can be streamed online or downloaded as a podcast via the Apple Podcast app, Google Play, or Spotify. Other recent additions to the Move Forward Radio podcast library include:

    Study: Among Individuals Who Qualify for Medicare Due to Disability, Opioid Overdose Deaths Nearly 5 Times Higher Than Total US Rate

    In this review: Association of Disability With Mortality From Opioid Overdose Among US Medicare
    (JAMA Network Open, November 15, 2019)

    The message
    While Medicare beneficiaries who qualify for Medicare because of disability account for one quarter of all deaths from prescription opioid overdose annually, not much research has focused on the relationship between various combinations of conditions in this population and their correlations to overdose mortality. It's a connection that authors of a recent study believe is essential to developing successful evidence-based interventions addressing Medicare enrollees with disabilities.

    The study
    Authors examined Medicare data linked to the National Death Index for a random sample of 20% of Medicare enrollees between the ages of 21 and 100 during the time period from 2012 to 2016. They calculated the rate of opioid overdose deaths for the entire Medicare population as well as for individuals with any of 55 chronic or potentially disabling conditions contained within the Centers for Medicare & Medicaid Services Chronic Disease Data Warehouse.

    Opioid overdose deaths were identified by codes for opium, heroin, natural or semisynthetic opioids, methadone, synthetic opioids other than methadone, or other and unspecified narcotics prescribed for their underlying conditions.


    • Enrollees younger than age 65 who qualify for Medicare due to disability comprise approximately 15% of the overall Medicare population. However, they account for 81% of opioid overdose deaths among Medicare beneficiaries overall.
    • While 32% of enrollees who are qualified for disability had at least 2 major condition categories, these individuals accounted for 78% of all opioid overdose deaths among Medicare beneficiaries.
    • Opioid overdose mortality in the disability group increased from 57.4 per 100,000 in 2012 to 77.6 per 100,000 in 2016.
    • Among beneficiaries who qualified for Medicare because of disability, opioid overdose deaths were highest for those aged 51–64. In addition, those who were male and white, had higher income, had Medicare Part D coverage, had been enrolled under disability for less than 15 years, and who lived in metropolitan areas had higher rates of opioid overdose death.
    • Of the disabling conditions examined, substance abuse, psychiatric diseases, and chronic pain were significantly associated with higher rate of opioid overdose deaths. The opioid overdose mortality rate among those with all 3 conditions was 363.7 per 100,000—23.4 times higher than for those with no disabling conditions. Chronic kidney disease, pressure and chronic ulcers, and hepatitis also were associated with a higher likelihood over opioid overdose death.
    • The opioid overdose mortality rate among those who qualify for Medicare due to disability is nearly 5 times higher than that of the general United States population.

    Why it matters
    Subgroups of Medicare beneficiaries "present different risk profiles for opioid overdose death, authors say. "Patients qualifying for Medicare disability have the highest rates of opioid use compared with older Medicare beneficiaries and commercial insurance beneficiaries." Future studies can help develop targeted interventions to decrease opioid overdose deaths in high-risk populations.

    More from the study
    Researchers were surprised to see a positive association between high income and opioid overdose death, as one previous study found that lower-income individuals "were more likely to misuse opioids and had higher rates of opioid use disorder than the general US population" and another showed that higher-income Medicare enrollees had lower rates of long-term opioid prescriptions.

    Authors suggest that future research should examine these associations by opioid type.

    Keep in mind…
    Authors note that "the quality and accuracy of death certificate data associated with overdose varies across states." Likewise, the validity of medical conditions in claims data varies. From the available data, researchers could not distinguish between accidental, suicide, or homicide deaths or whether they occurred in the inpatient or outpatient setting.

    In addition, because they analyzed data only from enrollees with 2 years of continuous enrollment with fee-for-service coverage, the results "may not be generalizable to health maintenance organization populations."

    Authors also did not examine "competing causes of death" or the association of drug interactions or contaminated street drugs with opioid overdose death. They suggest future research on overdose deaths due to different types of opioids.

    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.

    Veteran and Emerging Physical Therapy Leaders Speak Out

    What's the difference between an emerging physical therapy leader and a well-established one?

    Not much—at least when it comes to love for their work and their vision of the profession’s future. (Apologies if you were expecting a punchline.)

    For its December issue, PT in Motion magazine posed an identical set of questions about the physical therapy profession to 2 seemingly different groups: this year's cohort of Catherine Worthingham Fellows of APTA (FAPTAs), and the 2019 class of APTA Emerging Leaders nominated by their chapter or section. Answers from the physical therapists (PTs) and physical therapist assistants (PTAs) tell the story of a profession that embraces its transformative potential but is clear-eyed about the challenges standing in the way.

    Questions posed ranged from the personal ("What was the best piece of career advice you ever received?") to the arguably unlikely ("If you had the undivided attention of Congress for 10 minutes to educate lawmakers about something related to physical therapy, what would you say?"), and points between. The answers, at times, were equally far-ranging.

    At other times, however, a seeming consensus emerged. Most respondents, for example, felt that today's younger generation of PTs and PTAs are better at establishing a healthy work-life balance. Additionally, the seasoned professionals and the relative newcomers generally share a perception that the cost of physical therapy education is making it difficult to create a more diverse physical therapy workforce.

    And, while not articulated in every response, it becomes clear as the article unfolds that nearly every responding PT and PTA places a strong value in the potential for dedicated professionals to make a difference for both individual patients and the physical therapy profession as a whole.

    Interviewee Gammon Earhart, PT, PhD, FAPTA, sees that value as a source of optimism.

    "Our biggest strength is our people. I am inspired by the talented, dedicated leaders in all areas of our profession who are passionate advocates for physical therapy," she said. "My optimism for the future comes not only from these current leaders, but equally from up-and-coming students and early-career professionals who bring great energy and new ideas."

    "Generation Rap: Veteran and Emerging Leaders Speak Out" is featured in the December 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.