APTA members have until July 6 to complete the Vision Environmental Scan Survey and provide their views about the physical therapy profession's future. The survey was e-mailed last week to all members for whom APTA has permission to e-mail, with a personal link to the survey. If you did not receive the e-mail and would like to participate in the survey, contact firstname.lastname@example.org.
The analysis of the collected data will help APTA identify the preferred future direction of the profession that will culminate in the presentation of a revised vision to the 2013 House of Delegates for adoption. Responses also will be used to inform APTA's strategic planning process. All individual responses will remain strictly confidential, and results will be reported in aggregate form only.
Questions or requests for additional information can be sent to Marc Goldstein, EdD, APTA's senior director of research, at email@example.com.
A new web resource helps physical therapists (PTs) provide Medicare beneficiaries with access to their services and remain in compliance with laws and regulations. Since 2005, Medicare beneficiaries have been able to access PT services without a referral or visit to a physician. The 2005 revisions to the Medicare Benefit Policy Manual eliminated the physician visit requirement. However, a patient must be "under the care of a physician," which is indicated by the physician certification of the plan of care.
The Direct Access and Medicare webpage provides information on what the rules say, how they affect PTs, and how to report information on the certifying physician/nonphysician practitioner on claims for outpatient therapy services.
A new tool available from the Joint Commission Center for Transforming Healthcare aims to help health care organizations with the process of passing necessary and critical information about a patient from 1 caregiver to the next, or from 1 team of caregivers to another, to prevent miscommunication-related errors.
The Hand-off Communications Targeted Solutions Tool™ (TST) is an application that guides health care organizations through a step-by-step process to accurately measure their organization's actual performance, identify their barriers to excellent performance, and direct them to proven solutions that are customized to address their particular barriers.
Using TST and the solutions from the center's Hand-off Communications Project, health care organizations have reduced readmissions by 50%, and have reduced the time it takes to move a patient from the emergency department to an inpatient unit by 33%, says the Joint Commission. Health care organizations also report an increase in patient and family satisfaction, staff satisfaction, and successful transfers of patients.
TST is available on the Joint Commission's new Transitions of Care Portal.
A "Hands-On Approach to 'Hand Off' Communication," which appeared in the April 2010 issue of PT in Motion, provides an overview of APTA's position statement titled Physical Therapist of Record and "Hand Off" Communication.
In a historic and long-awaited decision, the Supreme Court today upheld the Affordable Care Act (ACA). APTA, which has remained neutral on ACA and the subsequent Supreme Court case, announced that its current legislative and regulatory strategies will continue, and reiterated its philosophy that the nation's health care system must address several fundamental patient-centered issues: coverage, access, quality, and costs.
"APTA has for years been an advocate for a health care system that includes rehabilitation as a core benefit, demonstrates the value of physical therapy to patients, embraces innovation in reforms that are patient centered, and provides a solution to a system that for too long has been high in costs and disparate in outcomes and quality," APTA President Paul Rockar Jr, PT, DPT, MS, said in a statement. "We will continue to work with legislators, policy makers, insurers and other decision makers to ensure that these priorities are addressed in this law and future health care reforms—whether at the national or state level, or through individual private payment systems."
APTA's Government Affairs staff is currently reviewing the Supreme Court decision and will provide a more detailed analysis to members in the coming days and weeks as more information becomes available.
"We are committed to providing our leaders, members, and components with the information they need to advocate effectively for these priorities nationally and at the state level," added Rockar.
Members should continue to follow News Now, Twitter, Facebook, and APTA's health care reform webpage for the latest information and updates.
The Version 5010 enforcement discretion period ends June 30. As of July 1, all noncompliant providers and entities, including physical therapists, will be subject to enforcement action under the existing HIPAA transaction and code set enforcement process. Providers still experiencing issues regarding use of the new electronic standards in their transactions should refer to their respective vendor, clearinghouse, payer's website, or provider service department for assistance.
All HIPAA-covered entities were required to upgrade to the new ASC X12 Version 5010 (Version 5010) and NCPDP Versions D.0 and 3.0 by January 1. However, the Centers for Medicare and Medicaid Services (CMS) initiated an enforcement discretion period to give the industry additional time to upgrade to the new transaction standards.
Physical therapists who have not completed their Version 5010, D.0 or 3.0 implementation should consider the following steps:
For more information regarding the updated standards, visit the Versions 5010 and D.0 & 3.0 section on the CMS' website. APTA also provides resources to help physical therapists transition to HIPAA Version 5010. Go to CMS' ICD-10 website for the latest news and resources to help in preparations for the transition to ICD-10.
Anita Bemis-Dougherty, PT, DPT, MAS, lead clinical practice specialist in APTA's Public Policy, Practice, and Professional Affairs Unit, recently was elected secretary of the United States Bone and Joint Initiative (USBJI). Bemis-Dougherty joins APTA members Jan K. Richardson, PT, PhD, OCS, FAPTA, and Paul A. Ullucci Jr, PT, DPT, ATC, SCS, LAT, CSCS, C-DSc, who serve on the USBJI board of directors. Richardson and Ullucci represent the American College of Rheumatology and the National Athletic Trainers' Association, respectively.
USBJI is a global, multi-disciplinary initiative targeting the care of people with musculoskeletal conditions. Its focus is on improving quality of life as well as advancing the understanding and treatment of those conditions through research, prevention, and education. APTA is a founding member of USBJI.
Preliminary evidence from a randomized controlled trial (RCT) conducted in Australia shows that it is safe and feasible to implement an exercise program for patients during an acute exacerbation of chronic obstructive pulmonary disease (COPD), say authors of an article published in Journal of Cardiopulmonary Rehabilitation and Prevention.
Patients with an acute exacerbation of COPD admitted to the hospital were randomly assigned to 1 of 3 groups—a low-intensity exercise group that participated in twice-daily aerobic and resistance exercise sessions and physical therapy, a moderate- to high-intensity exercise group that participated in twice-daily aerobic and resistance exercise sessions and physical therapy, or a control group that participated only in physical therapy. Primary outcomes were the number and classification of adverse events and program adherence.
In 174 exercise sessions, there was 1 serious adverse event of arrhythmia in the low-intensity exercise group that resolved within 1 hour. There were 12 other minor adverse events involving 5 patients with no significant differences between groups. Patients completed an average of 80% of their scheduled sessions with no significant between-group differences. The exercise groups improved significantly in walking distance. However, no significant between-group differences were observed.
APTA's revised Code of Ethics for the Physical Therapist (Code) and Standards of Ethical Conduct for the Physical Therapist Assistant (Standards) went into effect in July 2010. Since then, numerous Ethics in Practice articles have appeared in PT in Motion that explore a variety of ethical scenarios on topics such as reimbursement, confidentiality, discharging patients, gifts, professional integrity, and professional behavior. View these and other recent articles titled "Shop Treatment," "On the Road Again," "No Vacation," "Seeking a Continuance," "When Is More Too Much?" and "Attitude at an Altitude" on APTA's Ethics Decision-Making Tools webpage.
Clinicians should screen all adults for obesity and offer or refer patients with a body mass index (BMI) of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions, says a recommendation issued Tuesday by the US Preventive Services Task Force (USPSTF). When selecting interventions, clinicians should consider other risk factors for cardiovascular disease, a patient's readiness for change, social support and community resources that support behavioral change, and other health care and preventive service priorities. The task force further recommends that health care professionals offer or refer people who are obese to a comprehensive weight loss and behavior management program with 12 to 26 sessions in the first year.
Supporting documents and related items on the recommendation, which include a clinical summary, consumer fact sheet, news bulletin, and evidence synthesis, are available on USPSTF's website.
In a separate recommendation, USPSTF determined that for people who have low risk for heart disease, counseling to encourage healthy lifestyle choices, such as a healthful diet and physical activity, offers only small benefits in reducing the risk for cardiovascular disease. The task force also states that this counseling may be beneficial to some people, depending on their individual risk factors, including known cardiovascular disease, high blood pressure, and high cholesterol.
These recommendations are available in the Annals of Internal Medicine and on the task force website.
APTA has extended the deadline for this year's photography competition to August 15. Association members are encouraged to participate in the competition by submitting entries that reflect physical therapy practice, education, or research. Winning entries should:
Winners will be selected by a distinguished panel of judges. Winning entries will be displayed at association headquarters, may appear in APTA's online or print publications, and on APTA's website.
The first-place winner will receive $500. The second and third place winners will receive $250 each. No cash prizes will be awarded for honorable mentions. Winners will be announced in a future issue of PT in Motion. Complete contest rules and additional details are available on APTA's website. All entries must be received by August 15. Winners will be notified by December 14.
An 11-member expert panel and 115 wound care researchers have identified 19 research principles aimed at developers and users of new or existing products, devices, or interventions, such as wound assessment techniques, mobility/exercise, nutrition, treatment "bundles," or prevention regimens that are being used or will be used in the treatment of acute or chronic wounds. APTA is a member of the Alliance of Wound Care Stakeholders, which created the expert panel from its participating organizations.
For this study, the Delphi approach was used to reach consensus, using a web-based survey for survey participants and face-to-face conferences for expert panel members. Principles were rated for validity using 5-point Likert scales and comments. A 66% response rate was achieved in the first Delphi round from the 173 invited survey participants. The response rate for the second Delphi round was 46%.
"While some principles seemed obvious to respondents," say the authors," other principles elicited considerable controversy," such as the principle related to new products and devices entering the wound care market that are derivations of previously marketed products.
Of the 19 final principles, 3 include detailed numbered lists:
With the wide variation in design, conduct, and reporting of wound care research studies, the authors hope that the principles will improve the standard and practice of care in this field.
Free full-text of the article is available in the May-June issue of Wound Repair and Regeneration.
This October during National Physical Therapy Month (NPTM), APTA will be launching "Fit After 50," a multi-faceted public relations campaign aimed at helping people keep mobile as they age. In the coming weeks and months APTA members will hear much more about this campaign. In the meantime, APTA needs members' help in identifying tips to help Baby Boomers remain mobile and prevent injury after age 50. What advice do you give your patients? APTA is looking for unique ideas and tips, which could possibly be featured during the campaign in its social and traditional media relations efforts. E-mail firstname.lastname@example.org with your tips as soon as possible.
Women who participate in moderate recreational physical activity exercise may reduce their risk of breast cancer by as much as 30%, says a HealthDay News article based on a study published in the June 25 online edition of Cancer.
Researchers collected data on more than 1,500 women with breast cancer and a similar number of women without the disease. All the women had taken part in the Long Island Breast Cancer Study Project.
The results show that women who exercised before or after menopause had a reduced risk of breast cancer. Women who exercised 10 to 19 hours a week had the largest benefit—about a 30% reduced risk.
The risk of breast cancer was cut with any amount of exercise. The risk reduction was seen mostly for hormone receptor-positive breast cancer, which is the most commonly diagnosed type among American women.
However, weight gain may undermine the benefit of exercise, the article says. Even among active women, gaining a significant amount of weight, particularly after menopause, increased the risk of breast cancer, negating the beneficial effect of exercise.
Lead researcher Lauren McCullough, MSPH, said the reasons that exercise is linked with a reduced risk of breast cancer aren't known. Yet it is known that maintaining a normal body weight is associated with reduced breast cancer risk.
"It is thought that a reduction in body fat results in less exposure to circulating hormones, growth factors, and proinflammatory markers, all of which have been shown to be related to breast cancer risk," McCullough told HealthDay News.
"Other mechanisms include enhanced immune response, antioxidant capacity, and DNA repair," she added.
APTA requests members' assistance in completing its Vision Environmental Scan Survey to gather views about the physical therapy profession's future. The survey was e-mailed this week to all members for whom APTA has permission to e-mail, with a personal link to the survey. If you did not receive the e-mail and would like to participate in the survey, contact email@example.com.
The analysis of the collected data will help APTA identify the preferred future direction of the profession that will culminate in the presentation of a revised vision to the 2013 House of Delegates for adoption. Responses also will be used to inform APTA's strategic planning process. All individual responses will remain strictly confidential and results will be reported in aggregate form only.
The deadline to complete the survey is July 6. Questions or requests for additional information can be sent to Marc Goldstein, EdD, APTA's senior director of Research, at firstname.lastname@example.org.
A Post-House Packet containing draft final motion language for all the motions acted on at the 2012 House of Delegates (House) in Tampa is posted in the House community in the archive folder 2012 (found under the reference materials). The House of Delegates minutes, with final language for all motions, will be posted by September 4. In addition, a House of Delegates summary has been prepared in both Word and PowerPoint formats to serve as foundational elements for articles in newsletters and presentations at chapter, district, or facility meetings to educate both members and nonmembers on the actions taken by the House. In response to the passage of RC 30-12, the reports of the 4 Governance Review Subgroups (House, Board of Directors, Chapter, and Section) have been posted to the governance review community in the Reference Materials document library.
More than 12 million Americans will receive $1.1 billion in rebates from insurance companies this summer because of the Affordable Care Act's 80/20 rule, known as the Medical Loss Ratio standard. These rebates will be an average of $151 for each family covered by a policy.
The health care law generally requires insurance companies to spend at least 80% of consumers' premium dollars on medical care and quality improvement. Insurers can spend the remaining 20% on administrative costs, such as salaries, sales, and advertising. Beginning this year, insurers must notify customers how much of their premiums actually have been spent on medical care and quality improvement.
Insurance companies that do not meet the 80/20 standard must provide their policyholders a rebate for the difference no later than August 1.
Consumers owed a rebate will either receive a rebate check in the mail, a lump-sum reimbursement to the same account that they used to pay the premium if by credit card or debit card, or a reduction in their future premiums, or their employer will apply the rebate in a manner that benefits its employees.
Consumers in every state will receive a notice from their insurance company informing them of the 80/20 rule, whether their company met the standard, and, if not, how much of the difference between what the insurer did or did not spend on medical care and quality improvement will be returned to them.
A detailed breakdown of the rebates by states and market is available on HealthCare.gov.
Advocacy efforts by the Hawaii Chapter successfully helped prevent cuts in outpatient rehabilitation benefits under Hawaii's Medicaid program, known as QUEST.
Gov Neil Abercrombie's office recently announced that the state "will still tighten income eligibility for adults in QUEST starting in July, which means about 3,500 adults could lose health insurance coverage, but will cancel limits on hospital stays and the elimination of outpatient rehabilitation, optometry services and prosthetics." The administration announced last month that it would cancel cuts for durable medical equipment, such as wheelchairs and oxygen tanks.
"We're extremely pleased with the Abercrombie administration's decision to keep outpatient rehabilitation benefits intact for QUEST beneficiaries," said Art Lum, PT, MA, president of the Hawaii Chapter. "This victory could not have been possible without the support of our chapter's membership and APTA staff, and the work of the chapter's legislative team."
Authors of a comparative effectiveness review released by the Agency for Healthcare Research and Quality report that the "body of evidence is not informative" regarding effectiveness or comparative effectiveness of multidisciplinary postacute rehabilitation for adults with moderate to severe traumatic brain injury (TBI).
Multidisciplinary Postacute Rehabilitation for Moderate to Severe Traumatic Brain Injury in Adults examines 5 key questions related to characterizing the interventions, effectiveness and comparative effectiveness, minimal clinically important differences, sustainability of intervention effectiveness, and adverse events. The authors state that, "Although we found stronger evidence on the comparative effectiveness of different approaches to multidisciplinary postacute rehabilitation for participation outcomes, we found a limited number of eligible studies and no clear demonstration that one approach was superior to another."
The authors call for further research to "address methodological flaws common in these studies and further address effectiveness research questions."
APTA member Douglas E. Bidelspach, PT, MPT, served on the expert technical panel. Bidelspach also served as a peer reviewer with APTA member Karen Lohmann Siegel, PT, MA.
APTA has additional information available about evaluation and treatment of people postbrain injury on its TBI webpage.
Supervised outpatient exercise and physical therapy are associated with improvements in quality of life and exercise tolerance, a reduction in IV antibiotic days, and a trend toward reducing lung function decline in children with cystic fibrosis (CF), say authors of an article published in Pediatric Pulmonology. The cost of IV antibiotics was reduced by $104,000 in 2010 when compared with 2009. Such cost benefit may have implications for workforce planning and service provision, they add.
Twelve children (6 girls) with CF aged 10 years or older (mean age 13.3 years) who had received 4 or more courses of IV antibiotics in 2009 were enrolled in the study. The children participated in supervised exercise and physical therapy once every 2 weeks throughout 2010. In addition, they were expected to exercise 3 times weekly. If unwell, the children completed additional physical therapy sessions to usual chest physical therapy. Assessments of exercise capacity using the Modified Shuttle Test (MST) and quality of life (QOL; CFQ-UK) were recorded at baseline and after 1 year. Regular spirometry was performed before and throughout the study. Data were collected on IV antibiotic days.
A significant reduction in IV antibiotic days from 60 days in 2009 to 50 in 2010 was noted, along with improved MST distance (735 vs 943) and level attained (9.4 vs 11.1).
Significant improvements in CFQ-UK scores for physical (59 vs 83), emotional (63 vs 84), treatment (41 vs 61), and respiratory (54 vs 76) domains were noted. The mean rate of change of FEV(1) was -4 (-18, +10)% in 2009, but was +6 (-2, +13)% in 2010, although this did not reach statistical significance.
Order your PT 2012 images and downloads today. Go to David Braun Photography Inc and click on APTA PT 2012-All. Enter password: seashell2012, click the GO button, and select any day or event gallery link. Click on thumbnails to view larger images. Use the drop-down menu on the upper right to change between daily galleries. Prices for prints appear on the right when viewing an image. To order file downloads, click on the Digital Products link below the print prices.
Slightly more than 48% of adults aged 18 and older met the 2008 federal physical activity guidelines for aerobic activity in 2011, the highest percentage ever reported, says the early release of estimates for 15 selected health measures by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS).
As age increased, the percentage of men and women who met the guidelines decreased. In all age categories, women were less likely than men to meet the recommendations. In addition, just over 20% of adults met the guidelines for both aerobic and muscle-strengthening activities.
For 2011, 8.9% of adults aged 18 and older reported having been diagnosed with diabetes, which was not significantly different from the 2010 estimate of 9.2%. The prevalence of diagnosed diabetes increased with age for men and women combined. For the age groups 55-64 and 65 and older, men had a higher prevalence of diagnosed diabetes than women. The age-sex-adjusted prevalence of diagnosed diabetes was 12.4% for non-Hispanic black people, 12.0% for Hispanic people, and 7.0% for non-Hispanic white people.
Other measures in the report include lack of health insurance coverage and type of coverage, having a usual place to go for medical care, obtaining needed medical care prevalence of smoking and alcohol consumption, and receipt of vaccinations.
CDC published the measures prior to final data editing and final weighting to provide access to the most recent information from the 2011 National Health Interview Survey (NHIS). The estimates will be updated as each new quarter of NHIS data becomes available.
APTA researchers Gail Jensen, PT, PhD, FAPTA, Jan Gwyer, PT, PhD, FAPTA, Laurita M. Hack, PT, DPT, MBA, PhD, FAPTA, Elizabeth Mostrom, PT, PhD, and Terry Nordstrom, PT, EdD, recently selected 2 academic and 2 clinical sites for the first phase of their project Physical Therapist Education for the 21st Century (PTE-21).
MGH Institute of Health Professions, in Boston, and the University of Delaware, in Newark, will serve as the project's academic sites. Good Shepherd Penn Partners, in Philadelphia, and Madonna Rehabilitation Hospital, in Lincoln, Nebraska, will serve as the clinical sites for the project.
"We received excellent nominations from multiple academic programs and clinical sites," said Jensen, who is the project's lead investigator. "The 4 sites selected will serve as foundational qualitative case studies that uncover and examine the crucial dimensions of excellence in physical therapist education across academic and clinical settings." Jensen is faculty associate in the Center for Health Policy and Ethics at Creighton University. She also is dean of the university's graduate school, associate vice president of academic affairs, and professor of physical therapy, School of Pharmacy and Health Professions.
Research team visits to the sites will be made over the next 9 months. These visits will include individual and focus group interviews, observations, and document review focused on the teaching and learning that lead to effective preparation of physical therapists. These case findings will be used for a larger Delphi survey of academic and clinical education leaders that explores the feasibility of implementing specific changes consistent with excellence. The study also builds on the findings of the Carnegie Foundation's comparative study, Preparation for the Professions, involving 5 professions (clergy, engineering, law, medicine and nursing).
The group will issue a final report on the first phase of the study in the fall of 2013. Also in 2013, Jensen and colleagues will begin fundraising for the second phase of the study that will include an additional 6 sites.
Phase I of the study is funded by a 2-year APTA award of $50,000. The funding is the result of a request for proposal (RFP) for "Innovation and Excellence in Academic and Clinical Education Funding" developed by APTA and announced in November 2010. The RFP was targeted at stakeholder groups throughout the profession.
Gwyer is professor and vice chief of education in the Doctor of Physical Therapy Division at Duke University; Hack is professor emeritus, Temple University; Mostrom is professor and director of clinical education at Central Michigan University; and Nordstrom is chair of the Department of Physical Therapy at Samuel Merritt University.
On June 18, APTA's Janet Bezner, PT, PhD, appeared as a guest on RN.FM’s online radio station to discuss the Coalition for Patients’ Rights and its mission to protect patient access to the full range of care providers, as well as the importance of multidisciplinary care teams. Other guests included Lisa Summers, CNM, DrPH, senior policy fellow at the American Nurses Association. RN.FM is a BlogTalkRadio show created by 3 nurses. To hear a recording of the show, go to the BlogTalkRadio website.
Physical activity and other healthy behaviors can hasten recovery from the immediate side effects of cancer treatment, prevent long-term effects, and may reduce the risk of recurrence and increase survival, says a first-ever report by the American Cancer Society (ACS) that tracks the growing population of cancer survivors in the United States.
Developed in collaboration with the National Cancer Institute, the report estimates that there are 13.7 million cancer survivors alive in the United States today. The number will grow to almost 18 million by 2022.
The 3 most common cancers among male survivors are prostate cancer (43%), colon and rectal cancer (9%), and melanoma skin cancer (7%). The 3 most common cancers among female survivors are breast cancer (41%), uterine cancer (8%), and colon and rectal cancer (8%). Those percentages are expected to stay roughly the same through 2022.
The report also finds that 45% of cancer survivors are 70 years old or older, and only 5% are younger than 40. The median age of patients at the time of cancer diagnosis is 66.
ACS released the report, Cancer Treatment & Survivorship Facts & Figures, and an accompanying journal article in CA: A Cancer Journal for Clinicians last week.
As reported May 2 in News Now, ACS issued its first formal guidelines in April on cancer survivorship. The guidelines stress the importance of physical activity in reducing the chance of recurrence of many cancers and increasing the likelihood of disease-free survival after a diagnosis.
APTA encourages members to submit proposals for 90-minute and 3-hour sessions for PT 2013, to be held June 26-29, 2013, in Salt Lake City. The association would like to focus on the areas for programming where latest or emerging ideas are shared and discussed:
Proposals must be submitted by July 9. The Call for Proposals with further details is posted on the submission site Welcome Page. For questions or to discuss specifics about programming, contact Mary Lynn Billitteri, APTA Professional Development.
The Elsevier Foundation seeks new grant proposals for its New Scholars program, which provides funding for projects to help support women scholars during the early stages of their careers in science, technology, engineering, and math (STEM). The program is designed to actively address the attrition rate of talented women scientists caused by the difficulty of balancing a demanding academic career with family responsibilities. The foundation provides grants to STEM institutions and organizations that are working toward a more equitable academia by:
Grants will range between $5,000 and $50,000 per year for up to 3 years for a project total of $100,000.
Preliminary proposals are due June 24. Applicants invited to submit a full proposal will be notified in July and asked to expand their proposals by September 2.
"Generation STEM," a feature in this month's PT in Motion, discusses the national effort to encourage more students—especially females—to study STEM, and how it will affect physical therapy.
After many hours of thoughtful discussion and debate, APTA's House of Delegates (House) last week amended the position Physical Therapist Responsibility and Accountability for the Delivery of Care that was first adopted at the 2011 House. The position confirms that physical therapy is provided by, or under the direction and supervision of, a physical therapist (PT). Evaluation remains the complete responsibility of the PT.
In its deliberations, the House cited the ways that APTA's Vision 2020 and Standards of Practice for Physical Therapy support the position. However, the House noted that current APTA positions, standards, guidelines, policies, and procedures may be in conflict with the new position as some of them stipulate the use of specific personnel (ie physical therapist assistants and aides) rather than recognize the responsibility and accountability that accompany the independent judgment of contemporary physical therapist practice, which characterizes the autonomous professional. Thus, the position will take effect upon the implementation of necessary initiatives in education, practice, payment, regulation, and research, and adoption of requisite APTA positions, standards, guidelines, policies, and procedures.
In discussing this issue, the House also commented on the need for PTs to respond to changes resulting from health care reform, including new models of care that might provide opportunities for PT leadership. Accordingly, APTA will explore practice models that are responsive to the needs of society and adaptable to the changing health care environment. Steps toward the adoption of any new practice models will include:
Draft language adopted by the 2012 House will be available on the House Community next week. Final language for all actions taken by the June 2012 House will be available by September after the minutes have been approved.
Three motions adopted by the House of Delegates (House) illustrate the continued focus on improvements to APTA's governance and the importance of clarity in the roles of the House and Board of Directors (Board).
The House passed a motion calling upon the Board to amend APTA's Articles of Incorporation (Articles) prior to the 2013 House of Delegates so that the Articles reflect the Board's duty to manage APTA in compliance with the bylaws of the association. [RC-17]
The House also rescinded Principles of Governance (HOD P06-11-17-08), which the House passed last year and requested that the reports and recommendations of the Governance Review Task Force be made available on APTA's website. [RC-15] [RC-30]
To examine how the physical therapist assistant (PTA) can best support the physical therapist in the current and future health care environment, APTA will collaborate with appropriate stakeholders to conduct a feasibility study to determine whether or not transitioning the entry-level degree for the PTA to a bachelor's degree is indicated. In accordance with the motion adopted by the House of Delegates, the study will identify the following:
A report on the study will be submitted to the 2014 House, with an interim report to the 2013 House. [RC-20]
The House of Delegates passed a motion calling for APTA to identify and make available resource materials for physical therapists, physical therapist assistants, and physical therapist/physical therapist assistant students serving in the role of an expert or factual witness. Resources may include information on ethical obligations relative to acting as an expert or factual witness, references to existing APTA resources, and other materials such as the American Bar Association's Model Rules of Professional Conduct that can assist in providing general information on this topic. [RC-22]
The use of social media by physical therapists (PTs), physical therapist assistants (PTAs), and students for professional, work, educational, and personal purposes creates opportunities to communicate in a public forum, and with that the potential for conflicts in patient/client management, APTA's House of Delegates said last week in adopting the new position Standards of Conduct in the Use of Social Media. To use social media productively and avoid these conflicts, the new position calls on PTs, PTAs, and students who engage in social media activities to demonstrate appropriate conduct in accordance with the Code of Ethics for the Physical Therapist and Standards of Ethical Conduct for the Physical Therapist Assistant. The standards also call for PTs, PTAs, and students who identify content that appears to be unprofessional to alert the colleague who posted it so that he or she can remove it or take other appropriate actions. Furthermore, the new position requires that PTs, PTAs, and students not misrepresent themselves, APTA or other organizations, educational institutions, clinical sites, or employers on social media. [RC-23]
An action taken by the House of Delegates (House) aims to promote the engagement of early-career individuals in the association and in their career development by encouraging components to create an early-career liaison position to their boards of directors and initiate other mechanisms to reach these 2 goals—including inclusion of early-career individuals on committees and special interest groups, nominations of these individuals to positions and organizations, promotion of events aimed at students and early-career individuals, and a formal mentoring process within the component. [RC-24]
The House adopted a related statement of action that encourages physical therapists and physical therapist assistants to use best practices for mentoring for early-career PTs and PTAs. [RC-21]
The House of Delegates passed a resolution calling for complimentary "read only" access to Hooked on Evidence for all health care practitioners and health care students world-wide in an effort to advance evidence-based practice by all physical therapists and physical therapist assistants.
In adopting Access to Hooked on Evidence, the House cited language in APTA's Vision 2020 that supports the use of evidence-based practice by all physical therapists. [RC-25]
Physical therapists (PTs) play a unique role in the emergency department (ED) setting, particularly given that 25%-28% of visits to EDs involve musculoskeletal conditions. Furthermore, early physical therapy in the recovery process has been shown to result in fewer days of missed work and shorter overall case duration in patients and clients with acute low back injuries and other musculoskeletal injuries.
While physical therapy practice is growing in EDs, it is still not recognized even among many PTs. Therefore, a House action calls for APTA to develop materials to support the role of PTs in EDs. Materials may include resources to help PTs assess readiness for practice in this setting, negotiate the value of the role of physical therapy in the ED, and promote PT professional services in the emergency care environment.
The new materials will augment current resources available to APTA members that include an Emergency Department Toolkit and a podcast series on PTs in EDs. [RC-26]
Draft language adopted by the 2012 House will be available on the House Community next week. Final language for all actions taken by the June 2012 House will be available by September after the minutes have been approved.
Quoting national and international statistics on coronary heart disease, diabetes, cancer, COPD, high blood pressure, cigarette smoking, and obesity, showing that these diseases are epidemic in their incidence, the House of Delegates adopted Physical Therapists as Expert Providers for Exercise and Physical Activity—recognizing physical therapists as health service delivery providers of choice to prevent or treat these noncommunicable diseases (NCDs) and their related risk factors.
The position holds that APTA seeks participation in the development and/or update of physical activity or exercise guidelines for these NCDs. [RC-27]
While there are many resources that define entry-level and minimum standards, a doctoring profession should have standards of excellence that reflect exceptional practice. To that end, the House passed a motion calling for a study of the feasibility of developing mechanisms to recognize centers of clinical excellence. An interim report will be provided to the 2013 House with a final report to the 2014 House. The final report will include costs, interests, and the effect on the profession and the public of developing these mechanisms. [RC-28]
A new position adopted by the House of Delegates calls for physical therapists (PTs) and physical therapist assistants (PTAs) to be involved with and leaders of safe patient handling programs at the local, state, and federal levels, and to lead by example—appropriately supporting and employing the concepts of safe patient handling during patient care.
The Role of Physical Therapy in Safe Patient Handling also endorses several concepts related to access to safe patient handling equipment and departmental policies and training in safe patient handling procedures. [RC-29]
Last week the House of Delegates amended the following positions:
Last week, APTA's House of Delegates (House) participated in a visioning session as part of the process to revise the association's Vision Sentence for Physical Therapy 2020 and Vision Statement for Physical Therapy 2020. Stemming from a 2011 House motion, the objective is to look beyond 2020 and clearly articulate the profession's commitment to society.
During the session, the House discussed 9 design principles or "images" of physical therapy ranging from the physical therapist's role in human movement and performance, evidence-based practice, and innovative contributions of the profession to meeting the diverse needs of society and developing and applying new technologies.
In April, the Board of Directors took part in a similar visioning session. As part of the process to revise the vision, APTA is conducting focus groups with members, interviews with thought leaders, and an environmental scan survey. Later this year the Vision Task Force will submit a draft of the new vision to the Board for its review. The new vision will go to the 2013 House for its consideration.
APTA joined representatives from several major health care organizations Tuesday on Capitol Hill to participate in a panel briefing on what the expiration of Medicare extenders will mean to health care for patients and providers in rural areas. The briefing was sponsored by the American Hospital Association and hosted by Reps Cathy McMorris Rodgers (R-WA) and Mike Thompson (D-CA).
"The therapy cap has a disproportionate impact on older, more chronically ill beneficiaries and those from underserved areas, including rural areas," said APTA Senior Government Affairs Director Mandy Frohlich in remarks delivered Tuesday on behalf of the association. She went on to say "data indicates that there is a higher prevalence of chronic disease in rural areas, and beneficiaries with chronic conditions are most likely to hit the therapy cap."
APTA believes that extension of the therapy cap exceptions process into 2013 is imperative if patients are to continue to have access to the vital care they need. However, the real fix is in reform of the payment system. APTA has begun crafting a reformed payment system for outpatient physical therapy services that it believes will strike a balance between ensuring access to services while improving accuracy of payment.
"The impact of this briefing was significant as more than 100 Hill staff were in attendance," said APTA Vice President of Public Policy, Practice, and Professional Affairs Justin Moore. "APTA represented the more than 40 organizations involved in the therapy cap coalition and continues to serve as the leader on this issue and in the rehabilitation community."
Two systematic reviews by Frank et al published in the May issue of Journal of Rehabilitation Medicine provide an overview of the effectiveness of conceptual approaches, additional therapies, and basic techniques used in lower limb physical therapy in children with cerebral palsy (CP).
For both systematic reviews, the authors searched 5 electronic databases, extracting literature published between 1995 and 2009. Studies were evaluated using the framework recommended by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM), which classifies outcomes according to the International Classification of Functioning, Disability and Health (ICF). Three independent evaluators rated the strength of evidence of the effects according to the AACPDM levels of evidence classification, and the quality of the studies according to the AACPDM conduct score system.
One systematic review included 37 studies that used conceptual approaches (neurodevelopmental treatment [NDT], conductive education, Vojta therapy, sensory integration, functional training and goal-oriented therapy) and 21 studies that focused on additional therapies (aquatic therapy and therapeutic horseback riding). Level II evidence was found for the effectiveness of therapeutic horseback riding on posture and for NDT and functional training on gross motor function. Goal-oriented therapy and functional training were effective on the attainment of functional goals and participation. With level IV evidence, NDT was effective on all levels of ICF. (J Rehabil Med. 2012;44:396-405.)
The other systematic review examined basic techniques and included 83 studies divided into the following categories: stretching; massage; strengthening; electrical stimulation; weight-bearing; and balance, treadmill, and endurance training. Interventions targeting problems at body function and structure level generally influenced this level without significant overflow to activity level and vice versa. The more recent studies evaluating strength training mainly demonstrated level II evidence for improved gait and gross motor function. There was limited evidence for specific information on intensity, duration, and frequency of training. (J Rehabil Med. 2012;44:385-395.)
(Bonita) Lynn Beattie, PT, MPT, MHA, vice president of Injury Prevention at the National Council on Aging (NCOA), and lead for the National Falls Free© Initiative, represented APTA at the 2012 Transforming Fall Management Practices Conference, May 22-24. Beattie welcomed 191 attendees on behalf of APTA and its more than 80,000 members. She noted the growing activities of the 70-member NCOA-led Falls Free© Coalition, of which APTA is an active member, and of the 41 state coalitions on falls prevention. Beattie pointed out APTA's strong focus in the area in falls prevention and that it would devote 3 days of programming to falls prevention during PT 2012 in Tampa. She also acknowledged that many state chapters are similarly engaged with their state coalitions in promoting awareness, education and training of providers, and investment in evidence-based interventions that link health care providers to community resources and falls prevention programs. Beattie invited attendees to join their state and local coalitions.
The annual conference, held in Clearwater, Florida, is provided by the VISN 8 Patient Safety Center of Inquiry and the Tampa Veterans Administration Research and Education Foundation. Sponsoring organizations included APTA, Gainesville Geriatric Research Education and Clinical Center, and the National Center for Patient Safety.
New resources from APTA help explain how the health insurance exchanges (exchanges)—a fundamental component of the Affordable Care Act—will affect providers of physical therapy services. The health care reform law created exchanges to provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options on the basis of price, quality, service, and other factors. The primary purpose of the exchanges is to enhance competition in the health insurance market, improve choice of affordable health insurance, and give small business the same purchasing clout as large business.
Find links to general resources, APTA comments and summaries of exchange rules, and related resources, particularly essential health benefits, on APTA's new Health Insurance Exchanges webpage.
Following UnitedHealth's announcement on Monday that it would maintain several health coverage protections included in the Affordable Care Act regardless of the Supreme Court's ruling on the law, Aetna Inc and Humana Inc made similar pledges later in the day, says an article by Reuters.
The 3 insurers will allow children to stay on their parents' plans up to age 26 and will maintain a provision that provides clear ways for members to appeal coverage claim decisions.
UnitedHealth and Humana said they will keep 2 other provisions—forgoing lifetime dollar coverage limits on policies and eliminating rescissions, which are generally considered to be retroactive policy cancellations, except in the case of fraud. It was not immediately clear where Aetna stood on those provisions, says the article.
Cigna Corp, another large national insurer, said it was "prepared to proceed as appropriate on behalf of our customers when the court deliberations reach their conclusion."
Despite APTA's urging for continued Medicare coverage of TENS for chronic low back pain (CLBP) and additional research regarding the circumstances when the use of TENS for CLBP is effective, the Centers for Medicare and Medicaid Services (CMS) finalized the requirement of enrollment in an approved clinical study to receive coverage for TENS for CLBP.
In its final decision memo, CMS said that the clinical study requirement is to support additional research on the use of TENS for CLBP, and this requirement will expire in 3 years. CMS says in the memo that based on its review of the evidence, "… we have determined that TENS is not reasonable and necessary for CLBP under 1862(a)(1)(A) of the Act. Neither the comments we received, nor the discussions that we have had with industry and investigators, have provided us with the persuasive scientific evidence to reach a different conclusion." Thus, at the expiration of the 3-year clinical study requirement, TENS for CLBP will not be covered, as it will be considered not reasonable and necessary.
Links to APTA's comments and summary on the National Coverage Analysis Tracking Sheet for TENS for Chronic Low Back Pain can be found on APTA's Medicare Coverage Issues webpage.
APTA members commented extensively on CMS's proposal memo in News Now coverage posted March 14 and April 3.
A week of cognitive and physical rest—which included taking time off from school or work and avoiding talking on the phone, exercising, watching TV, socializing, or working at a computer—alleviated symptoms of concussion in 49 high school and college athletes, according to a Reuters Health article based on a study in The Journal of Pediatrics.
To measure the effect of "an intensive bout of rest" after a concussion, researchers evaluated the athletes between April 2010 and September 2011 and assigned them to groups based on the time elapsed between sustaining a concussion and the onset of rest. Fourteen of the patients started the rest within a week of their injuries. Another 22 patients began resting within a month of the concussion, and 13 patients began the week of rest between 1 and 7 months after the concussion.
At the beginning of the study, all of the patients had symptoms related to the injury, such as headaches and trouble concentrating.
After the week of rest, all groups saw their symptoms improve regardless of the time between concussion and onset of rest. Among the athletes who started the rest within a week of their concussion, their symptoms improved from a score of 22 on a 132-point scale down to 7, says the article.
APTA's new Joining Forces Initiative (JFI) webpage includes background on this comprehensive national initiative, launched by First Lady Michelle Obama and Jill Biden, EdD, to mobilize all sectors of society to give service members and their families the opportunities and support they have earned. JFI is designed to bring attention to the unique needs and strength of America's military families while showcasing the skills and dedication of America's veterans and military spouses. The initiative will highlight employment, education, and wellness as issues of special importance to military families across the country.
As an invited participant in JFI, APTA has made several commitments to ensure that the nation's military personnel and their families receive the care they deserve and that physical therapists have the best, most up-to-date information on traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and postcombat depression.
Access the webpage to learn more about APTA's commitment to JFI and find education, advocacy, and related resources on TBI and PTSD.
UnitedHealth Group Inc will maintain several health coverage protections included in the Affordable Care Act (ACA) regardless of the Supreme Court's ruling on the law, says an article by Reuters.
UnitedHealth will continue to provide coverage for dependents up to age 26 under their parents' plan and offer certain preventive health care services, such as annual check-ups, screenings for high blood pressure and diabetes, and immunizations without requiring a copayment. The company also will continue to forgo lifetime dollar coverage limits on policies.
The other provisions to be maintained include providing clear ways for members to appeal coverage claim decisions and eliminating rescissions, which are generally considered to be retroactive policy cancellations, except in the case of fraud, says the article.
UnitedHealth, which is the largest US health insurer by market value and serves more than 38 million members, said the protections are effective immediately and will be available to current and future plan members.
ACA also bars insurers from denying coverage to children up to age 19 with preexisting medical conditions. UnitedHealth said that while it recognized the value of this provision, the company "cannot take that step" alone, but is "committed to working with all other participants in the health care system to sustain that coverage," says Reuters.
A new literature and financial analysis, published online June 4 in Archives of Internal Medicine, supports the National Physicians Alliance's recommendation against routine imaging in patients with acute low back pain, says an article by Medscape Medical News.
The recommendation to avoid early imaging for low back pain within the first 6 weeks of onset unless red flags are present was published August 8, 2011, as part of the alliance's list of Top 5 Health Care Activities for Which Less Is More. The Less Is More series is focused on areas that responsible physician stewardship can help improve the quality and reduce the potential harms of care.
In the current literature review, the authors report that imaging for low back pain is extremely common and does not improve clinical outcomes in patients without indications of serious underlying conditions. Furthermore, they estimate that "nearly $300 million could be saved annually by restricting imaging during the first 6 weeks of lumbar back pain to specific severe indications, including severe or progressive neurological deficits or when serious underlying conditions, such as osteomyelitis, are suspected," Medscape says.
Reasons why physicians may continue to order imaging for acute low back pain include legal concerns, patient preferences, time pressures that might make it easier to order an imaging procedure than to discuss the condition, and financial incentives, say the authors.
Outgoing APTA president R. Scott Ward, PT, PhD, was honored for his service at the closing ceremonies of APTA's House of Delegates on Wednesday. The association invites physical therapists, physical therapist assistants, and students to watch this video tribute from APTA's Board of Directors and to leave thanks to or memories of Ward at the following blog post.
A summary of Ward's address at Wednesday's Opening Ceremonies is available in today's PT 2012 Daily News. The June 8 issue also includes coverage of the keynote address, delivered by Terry Bradshaw, Football Hall of Fame quarterback and NFL analyst for Fox; the 43rd McMillan Lecture, presented by Alan M. Jette, PT, PhD, FAPTA; and educational sessions on imaging, patient adherence, and the Human Genome Project. Access the issue at the PT 2012 webpage under "The Basics."
The Health System Measurement Project tracks government data on critical US health system indicators. The project focuses on 10 critical dimensions of the ever-changing health care system and the availability, quality, and cost of care, in addition to the overall health of Americans. The project examines the evolution of these aspects of the system over time and assesses the status of the dimensions of the system with respect to subgroups of the population, with a particular emphasis on vulnerable populations. An All Measures page lists every measure available in the system. Users can browse measures by population characteristics, by an alphabetic index, or by the audience the data might interest.
Developed by the Department of Health and Human Services (HHS), the project aims to ensure a robust monitoring system through which people inside and outside the government can assess how the health care system is doing and identify areas that need improvement. One important purpose of the project is to track the consequences of implementation of the Affordable Care Act across this broad set of dimensions of the health system.
APTA recently launched a Facebook page for the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE). Physical therapists and students are encouraged to visit www.facebook.com/ABPTRFE, 'like' the page to get the latest news and updates, and connect with other programs and participants. E-mail feedback related to the page and content to email@example.com.
Today's issue of PT 2012 Daily News is available online. Read about the 8 chapters and sections that were recognized at Sunday's Component Leadership Meeting for their inspirational and outstanding work. A summary on the career of Alan M. Jette, PT, PhD, FAPTA, who delivered the 43rd annual McMillan Lecture this morning, also is available. Access the issue at the PT 2012 webpage under "The Basics."
The 5-year outcome in most patients with chronic patellofemoral pain syndrome (PFPS) who undergo knee arthroscopy and participate in a home exercise program is equally good to patients who participate in a home exercise program only, say authors of an article published in the British Journal of Sports Medicine. However, some of the patients in both groups do have long-term symptoms, they add.
Fifty-six patients with PFPS were randomized into 2 groups—an arthroscopy group (N=28) and an 8-week home exercise program, and a control group (N=28) treated with a similar 8-week home exercise program only. The primary outcome was the Kujala score on pain and function at 5 years. Secondary outcomes were visual analogue scales (VASs) to assess activity-related symptoms.
According to the Kujala score, both groups showed a marked improvement during the 5-year follow-up—a mean improvement of 14.7 in the arthroscopy group and 13.5 in the controls. No differences between the groups in mean improvement in the Kujala score (group difference 1.2) or in the VAS scores were found. None of the investigated factors predicted the long-term outcome, but in most of the cases the treatment result immediately after the exercise program remained similar also after the 5-year follow-up.
The following members were elected to APTA's Board of Directors and Nominating Committee Monday night at the House of Delegates in Tampa, Florida: Paul A. Rockar, Jr, PT, DPT, MS, was elected president; Sharon L. Dunn, PT, PhD, OCS, was elected vice president; Jeanine M. Gunn, PT, DPT, was elected director; Mary C. Sinnott, PT, DPT, Med, was reelected director; and Nicole L. Stout, PT, MPT, CLT-LANA, was reelected director. Jerry A. Smith, PT, MBA, ATC/L, was elected to the Nominating Committee. Stephen M. Levine, PT, DPT, MSHA, was elected in a second election to serve the remaining year of Dunn's unexpired term as director. These terms become effective at the close of the House of Delegates on Wednesday.
In 2010, the APTA House of Delegates adopted RC 21-10 Action to Protect the Use of the Term, Title, and Designation of Physical Therapy and Physiotherapy. This motion directed APTA to develop and implement a plan to achieve full title and term protection for physical therapy and physiotherapy in all US jurisdictions. As part of the effort to fulfill RC 21-10, APTA has launched its new Term Protection Resource Center to provide members with resources on this issue. Included on the resource center site is background information on term protection, a basic summary of the current status of state term protection laws, information on filing complaints, and resources for chapters that seek to enact state legislation to provide for physical therapy term protection. As part of its term protection advocacy campaign, APTA will launch its new advertisement on term protection for physical therapy aimed at state policy makers, and designed educate them on the need to enact term protection laws. The full-page color advertisement will run in future editions of State Legislatures magazine, the monthly publication of the National Conference of State Legislatures which is provided to state legislators, legislative staff, and other state policy makers in all US jurisdictions.
In addition, APTA, in conjunction with the law firm Tucker Arensberg PC, recently finished an exhaustive research and analysis of the various state term protections laws. APTA state chapter leaders will be provided a legal analysis of the current term protection laws in their state, and the mechanisms for enforcement to assist with moving forward on future advocacy efforts aimed at term protection for physical therapy.
A proposed rule released Friday by the Department of Health and Human Services (HHS) would establish data reporting standards for states necessary to implement parts of the Affordable Care Act related to essential health benefits (EHB) that must be part of most qualified health plans (QHPs) offered in states' affordable health insurance exchanges (Exchanges). This proposal provides guidance on the type of data certain health plans participating in the Exchanges will need to provide to states; the issuers of the 3 largest small group products in each state must report information regarding covered benefits. Additionally, the proposed rule establishes a process for recognizing entities that will be accredited to certify QHPs that will be offered in states' affordable health insurance exchanges. It is important to note that this proposed rule does not provide comprehensive information regarding EHBs, other than data reporting and the accreditation process. That information will be forthcoming in future rulemaking.
Specifically, the purpose of proposed rule is to gather enough information on each states' benchmark plans' benefits to allow any plans that wish to offer coverage in the Exchanges to know what benefits will be included in the EHB benchmark. It also proposes that certain issuers of applicable plans submit benefit and enrollment information to HHS, such as data on all health benefits in the plan, any treatment limitations imposed on health care coverage and drug type coverage. This information would be used by HHS and eventually states, exchanges, and issuers to define, evaluate, and provide EHB.
Until accrediting entities are established to certify qualified health plans, the National Committee for Quality Assurance (NCQA) and URAC will be recognized by HHS on an interim basis for the purpose of accreditation of qualified health plans.
APTA's 2011 Annual Report now is available online. Read reports by APTA's president and treasurer, the House of Delegates, and components and check out the many accomplishments the association achieved last year. Year-end financial information also is available.
Hear how 3 APTA members use the association's position Physical Therapy Model Benefit Plan (MBP) Design to ensure consumer access to physical therapy services in 2 new podcasts in a series on MBP.
Steve Levine, PT, DPT, MSHA, who has nearly 20 years of experience as a consultant to physical therapy providers, local and national third-party payers, regulators, and case management agencies, explains how standardizing coverage guidelines can help address issues such as under- or overutilization of services. Levine calls MBP "an effective tool to use with third-party payers, regulators, and health policy makers to ensure that coverage design meets the needs of all of the stakeholders who will be affected by the coverage policies enacted by those who control the physical therapy coverage benefit."
Private practitioner Mick Bates, PT, uses MBP "to explain to my patients what 'good' coverage looks like when it comes to physical therapy so they can get the most of what they do have and negotiate for better coverage with their employers and carriers at renewal." Bates, who serves on the West Virginia Chapter's Reimbursement Committee, says the committee uses MBP as part of a tool kit for patients to file complaints with the insurance commissioner over coverage denials for medically necessary services. The committee also plans to use it in an upcoming meeting with the medical director and executive director of the Public Employees Insurance Association to negotiate for improved physical therapy coverage within the insurance plan for state employees.
Hear more from Levine and Bates in Physical Therapy Model Benefit Plan Design: From Position to Practice, Part I.
In Part II, Carole Galletta, PT, MPH, insurance relations chair for the Pennsylvania Chapter, describes how the chapter uses MBP to educate payers and support its efforts aimed at reducing out-of pocket payments and separating physical therapy benefit limits from other disciplines. She says, "…I think MBP provides us with an opportunity to clarify just what physical therapists do, to enlighten payers with our definition of medically necessary care, to identify how excessive cost sharing limits patient access to care, and to emphasize how physical therapy services can reduce disability and clinical costs."
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