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  • APTA Says NYT Article Identifies Areas of Concern, But Doesn't Tell Full Story

    The New York Times published an APTA letter to the editor about an article on the recent release of extensive Medicare payment information. The article used data on a single Brooklyn, New York, physical therapist (PT) who received $4 million in 2012 as an example of how physical therapy "has become a Medicare gold mine." The association continues to analyze the Medicare data and will be releasing a full report in early May.

    "The data presented in this article does not tell a complete story," writes APTA President Paul A. Rockar Jr, PT, DPT, MS. "A vast majority of physical therapists demonstrate Medicare utilization patterns consistent with those expected within the profession. With regards to utilization, nearly 90% of physical therapists who bill Medicare Part B receive payments of less than $100,000 per year—with the majority of those receiving significantly less than that (67% receive less than $50,000 per year, and 40% receive less than $25,000)." In fact, only slightly over 10% receive Medicare Part B payments of $100,000, and less than .1%, or only 44 individuals, receive greater than $500,000.

    The data used in the story are drawn from a recent release of extensive Medicare payment information on over 880,000 health care providers. The amount of data shared is large but limited, and includes only utilization data on services billed and paid under Medicare Part B. It does not include information for patients who are enrolled in any form of Medicare Advantage plan, those who receive coverage from other federal programs, or those with private health insurance. It also does not include data on the value, quality, or outcomes of the treatment provided.

    "These data should be viewed in context, and should not be used to draw conclusions about individual providers without information about expenses, quality of care, complexity of patients, and volume of patients treated," Rockar writes.

    The article does, however, bring to light areas of concern that APTA has noted in its preliminary review of the data. "In particular, APTA is concerned about outliers in the data, such as geographic disparities that are difficult to explain, and is analyzing the information to pinpoint variations in care that must be addressed," Rockar writes.

    In addition, in its initial review of the data, APTA has noted outlying discrepancies in patterns of care, such as the use of modalities, support personnel, utilization of consistent procedures for the majority of patients rather than individualized treatment plans, and episodes of care that are difficult to explain based on professional standards.

    Another issue with the data highlighted in the New York Times article is that it represents providers and physical therapists who are billing under an individual National Provider Identification (NPI) number, not an organizational NPI. "Data billed under one provider’s billing code can cover multiple practitioners," Rockar writes. "However, Medicare says that if the supervised physical therapists are not enrolled, the supervising physical therapist must be on the same premises."

    Rockar writes that "The association is committed to reducing fraud, waste, and abuse and has launched a comprehensive campaign to address these areas of concern in the profession." That campaign, called Integrity in Practice, is a multifaceted initiative that was featured in the February issue of PT in Motion. Its goal is to highlight the profession's reputation for excellence and outline the work needed to honor and protect it.

    APTA plans to make a full analysis of the data as it relates to PTs available by May 10. Included in the analysis will be guidance for members on how to read and interpret their own data.

    Good News Hard to Find In Physical Activity Report Card

    Think a 1.5 GPA will get you on the honor roll? Neither does the National Physical Activity Plan Alliance, whose recently released Report Card on Physical Activity for Children and Youth (.pdf) paints a fairly dismal picture of the state of exercise among kids.

    Among the areas analyzed in the report card, the Alliance handed out a B, 2 Cs, 3 Ds, and an F. Rounding up (the Cs were actually C- grades, as were 2 of the 3 Ds), that's a 1.5 GPA. And that doesn't even count the 4 incompletes on the report card.

    The group's grades were handed out in 10 areas: overall physical activity, sedentary behaviors, active transportation (the percentage of children who walk or bike to school), organized sport participation, active play, health-related fitness, family and peers, school, community and built environments, and government strategies and investments. "Each grade reflects how well the US is succeeding at providing children and youth opportunities and/or support for physical activity," the report states.

    The grades issued were:

     Overall physical activity: D- 

    The report found that roughly 25% of children and youth 6 – 15 engaged in at least 60 minutes of moderate-to-vigorous exercise per day. Most of that percentage was borne by children 6 – 11, 42% of whom met the standard. Among youth 12 – 15, that rate dropped to 8%.

     Sedentary behaviors: D

    On average, 53.5% of US children and youth meet guidelines calling for no more than 2 hours or less of screen time per day, with wide variations in rates among racial groups. The disparity was part of the reason for the low grade, according to the Alliance.

    Active Transportation: F

    "The vast majority of American children and youth do not travel to school by active means," the report states. Estimates from 2009 put that rate at 12.7%, down more than 35 percentage points from the 47.7% rate in 1969.

    Organized sport participation: C-

    Although nearly 60% of US children and youth participate in at least 1 organized sports team, gender and ethnic group disparities resulted in a drop in the Alliance grade.

    School: C-

    Just over half of US children and youth attend a physical education class during an average school week, with significant disparities among grade levels. High participation in ninth grade (68.1%) dwindles each year of high school until the senior year, where the participation average is 38.5%.

    Community and the built environment: B-

    A highlight among the grades, access to parks and playgrounds is fairly good, with 84.6% of US children and youth living close to these facilities. The problem, according to the Alliance, is that the access isn't equal across ethnic and socioeconomic groups.

    The remaining categories—active play, health-related fitness, family and peers, and government strategies and investments—did not offer sufficient data to issue a grade, according to the Alliance.

    The Alliance announced its report card at a briefing held on Capitol Hill April 28. DC Chapter Treasurer Marisa Birkmeier, PT, DPT, PCS, c/NDT, Pediatric Section representative for DC Erin Marie Wentzell, PT, DPT, PCS and staff member Michael Hurlbut, senior congressional affairs specialist, attended the briefing on behalf of APTA. An APTA representative also serves on the board of the Alliance.

    APTA has long supported the promotion of physical activity and the value of physical fitness, and has representatives on the practice committee of Exercise is Medicine. The association offers several resources on obesity, including continuing education on childhood obesity, and a prevention and wellness webpage that links to podcasts on the harmful effects of inactivity.

    APTA Board: 'Scope of Practice' Defined and Association Role Clarified

    The physical therapy scope of practice does encompass the relationship of professional, jurisdictional, and personal scope of practice, but it is not a laundry list of activities. This was the conclusion of the task force that developed and presented a definition of the term "scope of practice" that the Board adopted during its April meeting. Noting that "while professional scope of practice is broad, actual scope of practice is unique for each individual," the statements supporting the definition indicate that it is intended to clarify APTA’s role and guide the association in leading and responding to scope of practice inquiries.


    Scope of practice has 3 components: Professional, jurisdictional, and personal.

    • The professional scope of practice of physical therapy is defined as practice that is grounded in the profession’s unique body of knowledge, supported by educational preparation, based on a body of evidence, and linked to existing or emerging practice frameworks. APTA shall take the role as the primary organization for determining whether particular practices fall within the professional scope of practice of physical therapy. APTA shall prepare such determinations in collaboration with appropriate stakeholders. APTA shall also be a resource for stakeholders to address inquiries regarding jurisdictional and personal scope of practice for physical therapists.
    • Jurisdictional scope of practice is established by the practice act governing the specific physical therapist’s license, and the rules adopted pursuant to that act.
    • Personal scope of practice consists of activities undertaken by an individual physical therapist that are situated within a physical therapist’s unique body of knowledge where the individual is educated, trained, and competent to perform that activity.

    Of note is that the Scope of Practice Task Force agreed that such a definition should not include a list of activities, as it would be hard to maintain an accurate and inclusive list. The task force also concluded that a further exploration of the definition of the physical therapist’s professional scope of practice in particular (as opposed to the term “scope of practice”) as determined by the House of Delegates is needed. This Board position can be forwarded to the House as part of that discussion.

    The task force additionally pointed to the physical therapist’s role in the health care system, which was beyond its charge but in need of broad-based, forward-thinking approaches that can evolve as health care systems do. The task force suggested looking beyond the United States to international colleagues with experience and expertise.

    Inquiries about whether new or emerging areas are part of the physical therapy scope of practice will be addressed by a staff-guided review process that the Board adopted along with the definition.

    To see the full discussion on this and other topics from the April Board of Directors meeting, watch the archived livestream of all open sessions.

    Party Like It's 2014: Virtual NEXT Offers Viewing Party Option

    What happens in Charlotte isn't staying in Charlotte.

    APTA's upcoming NEXT Conference and Exposition to be held in Charlotte, North Carolina, June 11 – 14 will have an online version—Virtual NEXT 2014—that will allow members to participate in this cutting-edge conference from their home or office.

    Participating in Virtual NEXT doesn't have to be lonely endeavor, though. APTA is encouraging members to host viewing parties as a way to enhance the experience through networking and local discussion groups. Members need to register, and will then have direct access to NEXT so that they can stream events in a large room. Multiple attendees can participate for the price of one; however, only registered participants will receive a CEU certificate. More information about requirements and responsibilities is available at the viewing party website.

    The Virtual NEXT online learning environment offers session handouts, a chat function to post questions to speakers, and a Virtual Poster Hall featuring the 10 highest-rated scientific posters on display at the NEXT Conference in Charlotte.

    Virtual NEXT will also feature APTA’s signature Mary McMillan and John H.P. Maley lectures on demand. Eight educational sessions will also be archived for on-demand viewing, 7 of which will be livestreamed June 13-14. Session information can be found at the Virtual NEXT webpage.

    Organize a viewing party in your area! Party organizers should contact the Professional Development Department or call 800/999-2782, ext 3206, to participate.