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  • Cap Off the Summer By Taking the Challenge

    Believe it or not, the start of school "is just around the corner" or "can't come soon enough," depending on your tolerance for perpetually sticky surfaces and back-to-back Spongebob Squarepants episodes. And what better way to give summer vacation that last final hurrah (or celebrate its end) than by being active as a family and possibly winning a Fitbit?

    The APTA Summer Fit Family Challenge continues through August, and members are encouraged to get their patients and clients—and their own families—involved in this fun way to stay active as a family.

    It's easy to do. Simply visit the Fit Family Challenge webpage on MoveForwardPT.com, download the challenge list, and get moving. Take family photos and share your progress while doing the activities, then post to Twitter, Facebook, or Instagram, using #FitFam14, and you'll be entered automatically to win a Fitbit. Four families have already scored one of these cool gadgets, and yours could be next.

    Get moving! And get posting! Next prize winners will be announced August 15 and August 29.

    2014 ELI Fellows Graduate From APTA Education Leadership Institute

    Part of being knowledgeable is knowing that you don't know everything, and 15 seasoned physical therapy educators gained a lot of knowledge and skills in the past year, recognizing that despite their years of teaching there was plenty more to learn through the ABPTRFE-accredited APTA Education Leadership Institute (ELI) Fellowship. These PTs, along with mentorship from 6 experienced leaders in physical therapy education, made up ELI's third cohort of ELI Fellows when they graduated July 20 after completing a yearlong higher education program that consisted of:

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

    In addition, the 15 new ELI Fellows cultivated a shared learning community and network with opportunities to integrate curriculum content within their current and future education leadership roles and responsibilities.

    The ELI Fellowship strives to develop physical therapist and physical therapist assistant education program directors with the leadership skills to facilitate change and improvement in the academic environment of the 21st century, think strategically to implement creative solutions in education that respond to changes in health care and society, and engage in public discourse that advances the physical therapy profession.

    Partners who help promote and support the ELI Fellowship include the American Physical Therapy Association, American Council of Academic Physical Therapy, Education Section, and the PTA Educators Special Interest Group. See who graduated from this year's class and find more information about the ELI Fellowship on APTA's website, and view video testimonials of ELI graduates on YouTube.

    'High Rate of Concussions' Found in High School Lacrosse

    Lacrosse has been cited as the fastest-growing high school sport—and it's precisely that popularity that demands a closer look at injury patterns, according to a new study of student athletes that found significant rates of injury among both boys and girls.

    In what authors claim is the first study to use a large national sample of high school lacrosse players, researchers identified competition injury rates of 3.61 per 1,000 athlete exposures (AE) for boys, and 2.26 for girls. Of injuries sustained in both competition and practice, 35.6% of boys suffered strains and sprains, and 21.9% experienced concussions. For girls, the strain/sprain rate was 43.9%, with a concussion rate of 22.7%. The data was gathered from the National High School Sports-Related Injury Surveillance System from 2008 to 2012, and reported in an article appearing online in the July 22 edition of the American Journal of Sports Medicine (abstract only available for free).

    Among other findings in the study:

    • Of 1,406 injuries, 56.8% occurred during competition, with 67.1% sustained by boys.
    • Concussion rates were markedly higher in competition than in practice, with an injury rate of 1.04 per 1,000 AEs in games, compared with a practice rate of .17.
    • Nearly 72% of all athletes returned to activity in less than 3 weeks, with 14.4% returning to play within 1 to 2 days.
    • A total of 8.3% of injuries resulted in disqualification for the season, with strains/sprains accounting for 51.5% of those disqualifications, and concussions making up 19.7%.
    • Surgery was required for 6.9% of all injured players, with 43.3% of those surgeries addressing knee injuries.

    Authors pointed to the girls' concussion rate as possible evidence for use of helmets similar to the ones used by boys (contact rules differ among girls' and boys' lacrosse, as do protective equipment requirements), but acknowledged that "there currently is debate on the potential effectiveness of helmets for preventing concussion injuries."

    The differences in types and settings for injuries merit further research, according to the study, if for no other reason than to stay ahead of a fast-growing sport. "Given the rapidly increasing number of high school lacrosse players and the high rate of concussions among both boys and girls," authors write, "there is a great need to identify injury patterns and to investigate the causes of concussions to drive the development, implementation, and evaluation of evidence-based, targeted preventive interventions."

     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.

    Deal on VA Includes Money for More Providers, New Facilities

    After weeks of appearing to be another victim of a gridlocked Congress, a bill to improve access to health care in the Department of Veterans Affairs (VA) system is now poised for a vote in both chambers.

    Called the Veterans Access, Choice, and Accountability Act, the compromise bill was reached by leaders of the Senate and House veterans affairs committees, and was developed in response to news early this year of lengthy wait times—and alleged administrative efforts to cover up those waits—for patients in the VA system. The issue sparked congressional hearings and ultimately led to the resignation of then-VA head Eric Shinseki, but legislative efforts to address the problem seemed to stall as the summer wore on.

    The $17 billion deal includes:

    • A $5 billion allocation to hire more health care providers with the largest staffing shortages
    • Authorization for the VA to lease 27 new major medical facilities
    • An option for veterans to use a Medicare provider, a federally qualified health center, or a Department of Defense or Indian Health Service facility if the wait for or distance to treatment is too long
    • An extension of the Health Professionals Educational Assistance Program that helps medical professionals through scholarships, tuition reimbursement, and debt reduction
    • Additional authority for the VA secretary to fire or demote employees for mismanagement

    The deal is paid for in part through $5 billion in spending cuts in the agency, with the remainder of the price tag to be considered emergency mandatory spending that would add to the deficit—a problem for some Republicans in Congress. Spending cuts include a ban on performance bonuses in the agency through 2016, and an August 1 deadline for veterans to opt into the private care alternative.

    Reports on the compromise from the New York Times, Politico, CNN, and other outlets described the legislation as having wide support, but not necessarily guaranteed success.

    APTA: Disability Rights Convention Should Be Approved

    APTA has added its voice to the long list of supporters of an international treaty on the rights of persons with disabilities, stating that it fits squarely within the association's vision of transforming society. The letter of support from APTA coincided with rallies held on Capitol Hill to press Senate passage of the United Nations (UN) Convention of the Rights of Persons with Disabilities (CRPD) that would establish protections against discrimination and support equal access to education, among other basic human rights.

    The UN drafted the CRPD in large part as a response to nations that, unlike the US, do not clearly articulate the rights of persons with disabilities. "Because of discriminatory practices, persons with disabilities tend to live in the shadows and margins of society, and as a result their rights are overlooked," write the convention's authors. "A universal, legally binding standard is needed to ensure that the rights of persons with disabilities are guaranteed everywhere."

    Nearly 150 countries have already signed the treaty. The CRPD needs Senate approval only but requires a supermajority for passage.

    "APTA commends the purpose of this treaty, as the CRPD embodies the values of the ADA," writes APTA President Paul A. Rockar Jr, PT, DPT, MS, in the letter of support. "As a profession committed to 'transforming society by optimizing movement to improve the human experience,' we support this initiative to facilitate equal access to patients we serve across the lifespan."

    It was unclear at the time of this writing whether the CRPD would be taken up by the Senate before the session's close on August 1. Participants in 2 rallies set for July 29 aim to convince the Senate to move on the treaty before leaving town.

    Medicare Insolvency Deadline Improves, SGR Not Incorporated in Projections

    It's far from rosy, but Medicare trustees are pointing to a slightly improved financial picture for the future of the program's trust fund, and they are no longer incorporating savings from the flawed sustainable growth rate (SGR) in their projections.

    According to an article in Modern Healthcare (free access after sign-on), the Part A hospital insurance trust fund is now projected to be depleted by 2030, 4 years later than last year's projections. In 2012, the insolvency date was projected to be 2024. Medicare spending is projected to rise from 3.5% of GDP to 5.5% in the next 25 years.

    As part of its projection process, the trustees used figures that did not incorporate cuts achieved through the SGR, assuming instead that Congress would replace the cuts with annual .6% raises. Congress has created workarounds to avoid cuts required for the flawed SGR every year since its inception, and in 2013 came very close to ending the SGR permanently. APTA and many other health care organizations have long opposed the SGR.

    The trustee report attributes the improved projections to savings realized under the Patient Protection and Affordable Care Act, but warns that ultimately the program will run out of money. Trustee Robert Reischauer is quoted in the Modern Healthcare story as saying that Medicare is "fiscally unsustainable over the long run."

    PT Recruitment Video Also a Great Reminder

    The life of a physical therapist (PT) can be frustrating and exhausting to be sure—that's why every now and then it's good to take a couple of minutes to slow down and think about why you joined the profession in the first place.

    And if you need some reminders, APTA has you covered.

    Now available on the association's YouTube channel—a short video featuring PTs talking about why they chose their profession. Technically, it's a student recruitment video that you could share with anyone considering the profession, but it's also a great way for an experienced PT to recharge.

    PTs featured in the video offer lots of reasons for their professional choice, ranging from their own childhood experiences with physical therapy, to the ways the profession blends exercise and science, to the opportunities to do real good for people in need. Their reasons are diverse, but they share an obvious love for what they do.

    Check it out, and maybe get reacquainted with your own passion for physical therapy.

    For even more inspiration, read or listen to members’ accounts of their personal passion for physical therapy in “Defining Moment,” PT in Motion magazine’s recurring column. Find them in the PT in Motion archives of every issue (titled “This Is Why” prior to June 2014), and as APTA podcasts.

    Acetaminophen May Do Little to Speed LBP Recovery

    It may be a prevalent practice, but the use of acetaminophen for acute low back pain does not decrease recovery time, according to a new Australian study of over 1,700 patients who participated in a randomized placebo-controlled trial.

    "Our results convey the need to reconsider the universal endorsement of paracetamol [acetaminophen] in clinical practice guidelines as a first-line care for low back pain," authors of the study write, "and suggest that advice and reassurance, rather than analgesics, should be the focus of first-line care." The study was published online in the July 24 edition of The Lancet (abstract only available for free).

    For the study, patients reporting low back pain (pain between the 12th rib and buttock crease shorter than 6 weeks' duration preceded by 1 month of no pain) were divided into 3 groups: a regular-dose group, an as-needed group, and a placebo group. Each group was supplied with 2 boxes of tablets—1 box contained tablets to be taken every 6–8 hours, and another box contained tablets that could be taken "as needed" for pain relief. The regular-dose group received 665 mg acetaminophen tablets in the "take regularly" box and placebo tablets in the "take as needed" box; the as-needed group received 500 mg tablets in the "take as needed" box and placebos in the "take regularly" box; the placebo group received placebos in all boxes. Participants were instructed to continue taking the tablets until they recovered or for 4 weeks, whichever occurred first.

    Researchers found median recovery times (defined as a self report of 0–1 on the 0–10 pain scale maintained for 7 consecutive days) for all 3 groups to be nearly identical, at 17 days for the regular-dose and as-needed groups, and 16 days for the placebo group. "Our findings suggest that regular or as-needed dosing with [acetaminophen] does not affect recovery time compared with placebo in low back pain, and question the universal endorsement of [this drug] in this patient group," authors write.

    The study's authors also note that participants in the study recovered at a somewhat faster rate "than that typically reported in other cohorts … receiving miscellaneous or usual treatments," and write that for the differences may be attributed to the provision of "good quality advice and reassurance, a feature that is often absent from usual care."

    "While we cannot disregard the possibility of a placebo effect … the provision of advice and reassurance of the favorable prognosis might be the more important factor in the management of acute low back pain than drug therapy," the authors write.

    APTA low back pain resources include a MoveForwardPT.com webpage on low back pain, clinical practice guidelines on low back pain (.pdf), and an APTA Learning Center presentation on manipulation for low back pain. PTNow provides full-text access to the latest clinical practice guidelines and Cochrane systematic reviews related to low back pain and neck pain.

    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.

    APTA Points Out Potential Harmful Delays in Patient Care From CMS Proposed Rule on DMEPOS

    If past problems are any indication of how the future might go, a Centers for Medicare and Medicaid Services (CMS) proposal to require prior authorization for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) could "impede or delay access to timely medically necessary care" due to a lack of sufficient infrastructure to efficiently administer the new requirement, according to APTA comments recently submitted to CMS.

    In a July 25 letter (.pdf) to CMS Acting Administrator Mary Tavenner, APTA applauds the CMS effort to reduce fraud and abuse with DMEPOS use, but warns that the agency's track record on payment review systems doesn't bode well for fullscale implementation of a plan to mandate authorization reviews for devices and supplies that often require quick patient access. The proposed rule states that CMS contractors will use "reasonable efforts" to issue authorization decisions within 10 days of the receipt of a standard request, or 2 business days for an "urgent" decision. In both cases, APTA points out, the waits "could result in serious decline of a beneficiary's health and safety," particularly if an urgent request is submitted on a Thursday or Friday and a patient must wait over a weekend for a decision.

    Matters have the potential to be made worse, APTA suggests, should the CMS contractors lack sufficient expertise and infrastructure to make informed, timely decisions—problems that have cropped up in other payment review systems, most notably in manual medical reviews for patients exceeding $3700 in outpatient therapy services. The association cites federal government reports that point to problems with lack of specificity in denial rationales, "flawed logic" in tracking systems, contractor statements backed by questionable facts, inaccessibility for providers, poor customer service, and lack of clinical expertise.

    APTA acknowledges the need for a focus on DMEPOS utilization, but suggests that if CMS chooses to move ahead with a prior authorization system, it do so incrementally, with "a small set of items … tested to determine whether the proposed protocols can be operationalized on the front lines of care delivery before the program is launched nationally."

    "APTA recognizes that oversight of DMEPOS utilization is necessary; however, it is of limited value if delays cause detrimental health impacts on beneficiaries or impose additional administrative and financial burdens on providers and suppliers due to operational and technical issues," the letter states. "The prior authorization process should neither delay the provision of care, nor be overly burdensome to providers or patients."

    APTA will update its DMEPOS resource webpage when this rule becomes final and the specific DMEPOS items subject to the rule have been selected.

    Note: see table 4 of the proposed rule for a list of items that may be chosen for prior authorization.

    US Virgin Islands Gets Direct Access, Improved PT Practice Act

    Virgin Islanders will now have improved access to physical therapist (PT) services—and a much more effective physical therapy practice act—thanks to a new law signed by Governor John P. de Jongh Jr, on July 11.

    The new law, Act No. 760, allows for direct access to evaluation and treatment by a PT without a physician’s referral, and includes changes to the licensing law that protect the term "physical therapy" as an activity that can only be engaged in by a PT, among other improvements.

    Prior to the act's passage a physician referral was required for all PT services. The new law, which takes effect on October 9, 2014, allows for treatment without a referral for 45 days or 12 treatment visits.

    "It’s been a long time coming, but consumers will now have greater access to quality health care provided by physical therapists," said Virgin Islands APTA member Jerry Smith, PT, DPT, ATC. "These changes could not have happened without the work of the physical therapy community here."

    In addition to direct access, Act. No. 7620 also makes significant updates to the physical therapy practice act. Besides the protection of "physical therapy" as a term that can only describe the activities of PTs, the new law provides title protection for "DPT" and "doctor of physical therapy,” an updated definition for the practice of physical therapy, an expanded board of physical therapy, and revised qualifications for licensure.

    "APTA commends the work of the dedicated physical therapists in the US Virgin Islands who worked for many years to bring about these legislative changes," said APTA President Paul Rockar Jr, PT, DPT, MS. "Improved patient access to PT services continues to be a high priority for the profession and APTA."

    Earlier this year both Oklahoma and Michigan enacted direct access legislation. The new Oklahoma law goes into effect on November 1, and the Michigan law on January 1, 2015. All 50 states, DC, and now the US Virgin Islands have enacted laws allowing for direct access to evaluation and some level of treatment without a physician referral.

    Latest Workshop Helps Participants Refine 'Blueprint' for New Clinical Practice Guidelines

    Evidence-based practice resources for physical therapists (PTs) will continue to expand thanks to the work of APTA members who recently participated in an association-sponsored clinical practice guidelines (CPG) workshop. The 3-day event brought together 36 researchers from 10 sections to discuss 11 potential CPGs.

    The workshop was led by Sandra Kaplan, PT, PhD, and Joe Godges, PT, DPT, MA, OCS, and included a presentation of a CPG development methodology and discussion on how the methodology can be best applied to the PT profession. The gathering is part of a larger APTA strategic objective to reduce unwarranted variations in care and increase PT adherence to best practices.

    Now in its third year, the workshop brings together participants chosen in response to a call to sections to submit nominations for a guideline development group that had identified a clinical topic important to the practice of physical therapy. Topics selected were the ones that could be best addressed through CPGs, which are graded recommendations on best practice for a clinical question based on a systematic review and evaluation of the quality of the scientific literature. These clinical questions were focused on both specific conditions and treatment interventions.

    This year's workshop topics included aquatic intervention, falls prevention, management of patients in the ICU, diabetic foot ulcers, examination and intervention of children with developmental coordination disorder, hip fractures, rehabilitation after total knee arthroplasty, interventions to improve gait speed in patients with neurological conditions, postpartum pelvic girdle pain, postconcussion rehabilitation, and venous leg ulcers.

    In an APTA video dispatch, Kaplan explained that the workshops help CPG developers lay the groundwork for what can be a 2- to 4-year development process. "What we're doing is trying to provide the foundational understanding of what those [CPG development] processes are," she said. "By the end of this workshop, they walk away with a blueprint for how to move forward to produce one of these."

    "What's really exciting about these guidelines is that … for some of them, there are multiple sections coming together," added Godges. He believes PT-focused CPGs can play a "huge" part in helping APTA achieve its vision of transforming society. "I think they're a foundation of transforming patient care, and not only of transforming patient care, but of transforming education," he said, with the effects extending to payment and policy areas worldwide.

    CPGs can be found on PTNow, the association's resource for evidence-based practice. Resources for guideline development and APTA funded CPGs can be found at www.apta.org/CPG.

     2014 - July 25 - CPG Workgroup
    These CPG developers are helping PTs transform society
    through the establishment of best practices in a wide range of areas.

    CDC: One Third of Youth Misperceive Weight Status

    For many children in the United States, the battle against childhood obesity may be in part a battle of perception: according to a new report, nearly a third of children don't have an accurate view of their own weight status, with 81% of overweight boys and 71% of overweight girls describing themselves as "about the right weight."

    The report (.pdf), issued this week from the US Centers for Disease Control and Prevention (CDC), says that from 2005 to 2012, 30.2% of children and adolescents aged 8–15 misperceived their weight status. Out of an estimated 9.1 million children and adolescents, 78% characterized themselves as "about the right weight" when they were in fact over or underweight. The remaining 22%, about 2 million of the 9.1 million, were of healthy weight but perceived themselves as too fat or too thin. The findings were based on an analysis of the National Health and Nutrition Examination Survey (NHANES).

    The misperception problem was most prevalent among overweight boys and girls, and varied somewhat according to demographics. Among the findings:

    • Among all weight ranges, misperception of weight status is more common among boys (32.3%) than girls (28%).
    • Weight misperception is lowest among non-Hispanic white children and adolescents (27.7%) and highest among non-Hispanic black children and adolescents (34.4%), with misperception rates of Mexican-American children and adolescents nearly as high, at 34%.
    • In relation to body mass, 87.4% of normal weight youth consider themselves to be about the right weight. That "about right" perception is held by 76% of overweight youth and 41.9% of obese youth.
    • Weight misperception tends to differ by economic status, with a 32.5% misperception rate among youth from lower-income families, compared with a 30.7% rate for middle-income youth and a 26.3% rate for youth from higher-income families.

    "Accurate self-perception of weight status has been linked to appropriate weight control behaviors in youth," write the report's authors. "Understanding the prevalence of weight status misperception among US children and adolescents may help inform public health interventions."

    PTs can provide crucial tests and can assist patients and clients in pursuing the behavioral changes to support achieving a healthy weight, according to Lisa Culver, PT, DPT, MBA, senior specialist for clinical practice at APTA. "Testing for body mass, which includes BMI, is a routine test for physical therapists to perform.” she said. "If we've established that body mass indicates overweight or obesity, we can play an important role in addressing healthy lifestyles, especially getting kids to be more physically active. Physical activity not only assists with loss of and maintenance of the loss of excess body mass, but an individual's level of physical fitness itself is an important and independent indicator of health, in addition to excess body mass."

    APTA offers extensive resources on the PT's role in prevention and wellness, as well as on behavior change in the patient and client.

    Clinical Education Webinar Series Continues With Focus on Partnerships

    A sweeping multiorganizational effort to create a shared vision for physical therapist clinical education continues to advance, and now needs stakeholders to participate in webinars focused on partnerships.

    The webinars are the latest in a series of open forums that allow participants to engage in discussions around position papers that were published in a special issue of the Journal of Physical Therapy Education (JOPTE). The next 2 webinars will focus on the papers by McCallum, et al, and Applebaum, et al. The first will be held on Wednesday, July 23, 8:00 pm–9:15 pm ET, and the second is scheduled for Tuesday, July 29, 4:00 pm–5:15 pm ET. Webinar facilitators will be Peggy Gleeson, PT, PhD, Scott Euype, PT, DPT, MHS, OCS, and Stephanie Piper Kelly, PT, PhD.

    Instructions for joining the webinars can be found here. Participants are strongly urged to read the position papers before the online sessions.

    Discussions from the webinars will inform the creation of a shared vision at the Clinical Education Summit planned for October 12–13 in Kansas City, Missouri, where participants will use the positions from the JOPTE papers as they have been shaped through discussions to reach agreement on best practices. The effort is being led by the American Council of Academic Physical Therapy (ACAPT), APTA, the Education Section of APTA, and the Federation of State Boards of Physical Therapy (FSBT).

    Proposed CMS Rule Would Reduce Prosthetics, Orthotics, Other DME Reimbursement; APTA Posts Summary

    A Centers for Medicare and Medicaid (CMS) proposed rule (.pdf) could reduce reimbursement for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) by more than $7 billion from 2016 through 2020, largely through applying payment rates from the DMEPOS competitive bidding program in noncompetitive bidding areas. APTA has published a detailed "highlights" summary of the rule on the DMEPOS webpage, part of a suite of APTA resources on Medicare payment.

    Additional proposed policies that would impact physical therapists (PTs) include:

    • In 12 competitive bidding areas (CBAs), CMS would provide payment on a continuous monthly rental basis for certain items (including standard manual wheelchairs, standard power wheelchairs, and hospital beds). This payment would cover the item and ongoing maintenance and servicing, as well as replacement of supplies.
    • Where payment is made in a competitive bidding program (CBP) on a capped rental basis, CMS would require contract suppliers for power wheelchairs to retain responsibility for all necessary repairs, maintenance, and servicing of any power wheelchairs they furnish under the CBP.
    • CMS would identify PTs as “individuals with specialized training” to provide custom-fitted orthotics.

    The public will have until September 2, 2014, to submit comments on the rule, and APTA will submit comments on behalf of its members.

    Shirts May Be No Slouch When it Comes to Posture

    Bad posture? There's a shirt for that. Well, maybe.

    A July 21 Wall Street Journal article reports on preliminary studies of "posture" shirts—essentially shirts with built-in elastic bands that work with muscle groups to correct slumping shoulders and drooping heads—that show improvements in neck and back pain, and some increase in sports performance.

    The WSJ article points out that even if the shirts do alter posture while they're worn, the issues behind the posture problem may not be properly addressed—an idea attributed to Timothy Sell, PT, who was interviewed for the piece. Sell points out that underlying problems, such as an imbalance between pectoral and back muscles, need to be corrected to truly address poor posture.

    Latest Edition of Preventive Services Guide Recommends Physical Therapy for Falls Prevention

    Recommendations around falls prevention, physical activity, and obesity prevention are among the topics covered in the latest edition of the US Preventive Services Task Force (USPSTF) Guide to Clinical Preventive Services, which grades preventive services based on the "net benefit" to the patient.

    The new guide contains USPSTF recommendations released over the past 10 years on screenings for conditions such as breast cancer, cognitive impairments, osteoporosis, and carotid artery stenosis, but also includes recommendations around interventions and counseling on falls in community-dwelling older adults, diet and physical activity in adults and children, and obesity in all age groups. According to USPSTF, the recommendations are intended to be the result of evaluations "free from the influence of politics, special interests, and advocacy."

    While none of the preventive services most strongly related to physical therapy received an A grade, falls prevention in community-dwelling older adults (65 and older) is most strongly supported, with the recommended intervention of "exercise or physical therapy and/or vitamin D supplementation" receiving a B, indicating "high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial."

    Also receiving a B grade were screening and management of obesity in adults and children. The guide gave "healthful diet and physical activity" a C rating, but limited its discussion to the effectiveness of behavioral counseling interventions at the primary care level, and not through referral or linkages with community-based programs. The guide notes that "the correlation among healthful diet, physical activity, and the incidence of cardiovascular disease is strong."

    According to USPSTF, the guide and grading system evolved "as it has become widely recognized that some 'preventive' services were not actually beneficial. Individual health care providers, professional organizations, [and other health care stakeholder groups] … have recognized the need to carefully balance potential benefits and harms using the highest quality evidence."

    Prevention, wellness, and disease management figure heavily into APTA's priorities for physical therapy. As part of its effort to highlight the ways in which physical therapists (PTs) can have a positive impact on these issues, the APTA Board of Directors recently identified specific health priorities that are consistent with the United States National Prevention Strategy. These priorities include active living, injury prevention, and secondary prevention in chronic disease management. The association also provides extensive resources on these topics at its prevention, wellness, and disease management webpage, and has representatives on the board of the National Physical Activity Plan Alliance.

    Can't Seem to Face Up to the Facts? Try This Psycho(metric) Killer Blog

    Choosing appropriate tests and measures is a crucial component of evidence-based practice. But not all measurements are reliable—and even when they are, the test or measure might not have validity for certain uses or types of patients.

    Reliable? Valid? That's where psychometrics come in, via the PTNow blog.

    The latest PTNow blog takes readers through the third installment of its primer to understanding how tests and measures are tested and measured by tackling validity, a multifaceted concept that aims to find out if a given measure is measuring what it's supposed to, how well, and for which populations.

    Too complicated, you say? Nope. The blog is written with the uninitiated in mind as well as for those who could use a brush-up, and uses real-life examples to illustrate major points. Check it out—it's a validating experience.

    Article Questions 'Rush' to EHRs

    A recent Boston Globe article explores some critics' claims that a government-incentivized "rush" to the adoption of electronic health records (EHRs) has created a new kind of patient safety issue with little oversight in place.

    In the July 20 issue of the Globe, reporter Christopher Rowland writes that "the explosion in the use of the electronic records has created the potential for efficiencies and safety benefits but also new risks for patients, the scope of which is still not fully understood." Rowland's lengthy article describes how $30 billion in federal subsidies aimed at encouraging these technologies "has thrust balky, unwieldy, and error-prone computer systems into highly sensitive clinical settings at a record pace."

    Rowland interviews proponents and detractors of EHRs—and a few professionals who are somewhere in the middle—and recounts findings from CRICO, "a Harvard-affiliated malpractice insurance group" that tallied rarely-reported cases in which the use or misuse of EHRs was thought to have caused harm.

    According to the Globe article, the CRICO study looked at a pool of approximately 5,700 cases cited in malpractice claims, and found 147 instances in which EHR problems resulted in adverse events. Of those 147 cases, 46 resulted in patient death. The article also describes 2 Boston-area cases in which some claim EHR-related problems contributed to the deaths of patients.

    The article does not include information on error rates or other problems linked to paper records.

    The Globe article follows a report in the June 20 issue of JAMIA, covered in APTA's PT in Motion News, that looked at the nature of problems related to use of EHRs in the Department of Veterans Affairs (VA) hospital system.

    APTA offers several resources on information technology and EHRs, including a webpage devoted to the use of EHRs.

    APTA Opposes UnitedHealthcare's Plan to Use Functional Reporting Requirements

    APTA is urging that UnitedHealthcare (UHC) stop its plan to implement Medicare outpatient therapy functional reporting code requirements in its Medicare Advantage plans.

    UHC announced its decision to implement functional limitation reporting in their May bulletin (.pdf, p.46). The company plans to require G-codes and severity/complexity modifiers on contracted physical therapist (PT) claims with dates of service on or after August 1, 2014. Claims that do not include the appropriate G-code and modifiers will be rejected.

    In its letter to UHC, APTA argues that the difficulties experienced by PTs during Medicare's changeover to the requirements, as well as limitations in data, make UHC's planned August 1 move ill-advised.

    APTA has its own functional limitation reporting webpage that provides resources to help members meet this reporting requirement.

    Proposed OPPS Rules Subject of New APTA Summary

    A new APTA summary focuses on proposed rules for the 2015 Medicare outpatient prospective payment system (OPPS).

    The PDF document includes information on payment impacts, ambulatory payment classifications (APCs), packaging policies for ancillary services, and other issues. The summary is part of an extensive set of APTA resources on Medicare coding and billing.

    Innovative Physical Therapy Models Chosen for Further APTA Support

    Following a rigorous review that included a "Shark Tank"-like workshop and critique in May, APTA has announced the finalists in its Innovation 2.0 initiative. Through the program, APTA will provide funding and in-kind services over a 12-month period to help advance these innovative models of care delivery that highlight the value of physical therapist services.

    In return, APTA will be able to access model data that potentially helps the association develop and disseminate templates and other resources that enable members throughout the country to promote the impact of physical therapy in the emerging health care environment—a strategic priority of the association.

    "The health care environment is rapidly evolving with an emphasis being placed on collaborative care models that achieve the triple aim of improving health and outcomes and reducing costs," said APTA President Paul A. Rockar Jr, PT, DPT, MS. "Our finalists have demonstrated success in using new and collaborative models to achieve these goals, and we are proud to support them in their pursuit."

    The competition, which began with 60 applicants, included such models as accountable care organizations (ACOs), bundled payment, direct access, patient-centered medical homes, prevention and health promotion, and value-based purchasing. A group of member experts assessed the final 16 submissions to choose the winning 3:

    • Timothy Flynn, PT, PhD, OCS, FAAOMPT, Colorado Physical Therapy Specialists and Northern Colorado Individual Practice Association Inc (NCIPA), and Mountain and Plains ACO LLC, for "Facilitating Access Improving Care—Physical Therapists as Integral ACO Members"
    • Robin Marcus, PT, PhD, OCS, University of Utah, for "Adding Value to Postacute Care Settings Through Evidence-Based Physical Therapy Services"
    • Brian Wrotniak, PT, PhD, Women and Children's Hospital of Buffalo, for "Patient-Centered Medical Home: An Innovative Model for Childhood Obesity Prevention With the Physical Therapist as a Key Player to Improve Quality of Care and Reduce Costs"

    APTA also gave "honorable recognition" to 2 additional models, which will receive a financial award:

    • Craig Johnson, PT, MBA, Minnesota Physical Therapy Association, for "A New Model of Care in Workers' Compensation: Direct Access to Physical Therapist Services by Workers with Low Back Pain"
    • Allison Orofino, PT, Marshall Medical Center, for "Integration of Physical Therapy in 90-Day Postacute Episodes of Care"

    APTA Member Benefit: Rent Some Wheels for Summer Travel

    If you're planning a long road trip this summer, you might be more comfortable, and save money, by leaving the family car at home and renting a vehicle. Every family, and every family's car, is different, but here are some things to consider, good and bad:

    • There's no wear-and-tear on your car when it's home in the garage.
    • A late-model rental car may get better gas mileage than your car.
    • A late-model rental may be more reliable on a long trip.
    • Getting to the rental office for pick up and drop off may be inconvenient.
    • Renting a larger, more comfy car than you normally drive could offer needed luggage space and leg room.
    • If you're in the market for a new car, a road trip makes for a thorough test drive.

    If you decide to give the family car a vacation from driving this summer, your APTA membership can save you up to 25% on your next rental with Avis and Budget.

    To make a reservation:

    • Avis: Click here, or call 800/331-1212 and mention AWD Number T031200.
    • Budget: Click here, or call 800/455-2848 and mention BCD Number X570900. Also, enjoy $25 back with Budget Bucks Payback. Rent with Budget twice through December 31, 2014, and you'll receive a $25 gift certificate toward your next rental. To start earning Budget Bucks, register your Fastbreak RapidRez number at www.budget.com/bucks, or enroll for free.

    Be sure to check out the additional savings coupons when making your reservation online.

    Use your APTA member car rental discount for any occasion-on your summer vacation, next business trip, or when you need some extra wheels.

    American Ninja Warrior, PT, DPT, OCS, MTC, FAAOMPT

    Watching Todd Bourgeois, PT, DPT, OCS, MTC, FAAOMPT, artfully navigate the ramps, ropes, waving pods, and sliding curtain obstacles in his qualifying round on NBC TV's "American Ninja Warrior," you half expect him to shoot webs out of his wrist, Spiderman-style. He's that good.

    But radioactive spider bites aren't at work here. This is pure physical therapy power—well, there may also be some incredible athleticism involved, along with strategic brains and a powerful level of focus that you get the feeling he applies to everything he does. Bottom line: dude is intense.

    Bourgeois, 31, is a lot of things—instructor at the University of St Augustine, PhD doctoral student, third-world mission leader—but, most notably for now, he's in the running for title of American Ninja Warrior, a televised contest in which participants compete to make it through a series on insane obstacle courses in a series of regional competitions that lead to a national championship. Bourgeois qualified for the regionals in his last television appearance, and his regional performance is set to be broadcast on July 28.

    This is Bourgeois' second attempt at the contest. Last year, he didn't make it to regionals. "I was trying to go as fast as I could," he said. This year, he approached the course differently, taking care to achieve the right balance and timing to execute the moves he needed to get through the obstacles. Bourgeois describes the shift as a tough one to make for someone who was a college pole vaulter then, later, winner of several "metro dash" events—compact, more urban-based obstacle races that are all about time. "I had to take a step back and use more skill and finesse than just muscle and brute strength," he said.

    Bourgeois' performance in the qualifying round is even more impressive when you realize that he had just arrived back in Florida at 3:00 am that day after spending a week in Ecuador on a mission trip. This is the third such trip he's organized (the first 2 were to Nicaragua and Costa Rica) to bring physical therapy and occupational therapy to people in need.

    The trips don't operate under a formal name. "I just put together a group of friends," he says, "mostly PTs and OTs. When we get there, everybody just starts doing their thing. We see about 250 people during the week that we're down there." The missions were featured in a short bio that accompanied his televised attempt on the "Warrior" course.

    He says that his background as a physical therapist was instrumental in his success in the first round of the show. "The people on the show, a lot of them are athletes, professional stuntmen, own their own gyms," he said. "Some of them actually constructed these courses in their gyms to prepare. I had to use my knowledge of physical therapy to think about the movements involved, and I made small things to reproduce the motions I'd need to work on."

    Back at the University of St Augustine, his students who got him interested in the show in the first place are cheering him on, as are his fellow faculty members. "We are very proud of Todd," said Wanda Nitsch, PT, PhD, president and chief academic officer of the university. "His focus on health and wellness, sportsmanship, service, and academics makes him a great example of our university core values and quality faculty."

    The opportunity to make a statement for physical therapy is not lost on Bourgeois. "I really want to get people to join in, have fun, and engage in physical activities," he said. "It's an honor to represent physical therapy on a national television show. Hopefully it's portraying an image of a profession that I'm proud of."

    2014 - July 17 - Ninja Warrior
    Double duty: Todd Bourgeois uses his knowledge of physical therapy
    to teach his students
    and to compete in the challenging tasks
    of "American Ninja Warrior."

    Yanni Anyone? Headbanging Linked to Brain Injury, Whiplash

    It turns out that so-called heavy metal "headbangers" do just that, and violently enough to occasionally result in brain injury, whiplash, and other problems.

    The July 5 issue of The Lancet includes a letter to the editor that describes treatment of a subdural hematoma in a 50-year-old man who presented with a worsening headache that had been going on for 2 weeks. He had an unremarkable medical history and denied substance abuse.

    What he did mention was that just before his headache began, he attended a concert by Motorhead, a seminal speed metal band. And like many others in the audience, he spent much of the concert headbanging, which letter author Ariyan Pirayesh Islamian, MD, describes as "a contemporary dance form consisting of abrupt flexion-extension movements of the head to the rhythm of rock music, most commonly seen in the heavy metal genre."

    According to the author, the case he encountered wasn't the first instance of brain injury brought on by headbanging: Islamian's literature search uncovered at least 3 other instances, 1 of which resulted in death. In the case of the patient described in the letter, Islamian reckons that the rapid acceleration and deceleration forces of headbanging "led to rupturing of bridging veins causing hemorrhage into the subdural space." The hematoma was removed and the patient has fully recovered.

    "Although generally considered harmless, health complications attributed to [headbanging] include carotid artery dissection, mediastinal emphysema, whiplash injury, and odontoid fracture," Islamian writes. "This case serves as evidence in support of Motorhead's reputation as one of the most hardcore rock 'n roll acts on earth, if nothing else because of their contagious speed drive and the hazardous potential for headbanging fans to suffer brain injury."

    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.

    Rise in Obesity More About Inactivity Than Caloric Intake

    It's no news that Americans have become more obese during the past 15 years, but a new study adds an interesting perspective—the dramatic gains may be almost entirely due to lack of physical activity, and not an increase in caloric intake.

    In an article e-published ahead of print in the American Journal of Medicine (abstract only available for free), researchers examined data from National Health and Nutrition Examination Surveys (NHANES) administered between 1988 and 2010. Much of what they discovered about rates of obesity, overweight, and abdominal obesity have been well-substantiated, but some twists to the story were uncovered when researchers looked at these data in terms of caloric intake and levels of physical activity.

    What they found was that in comparing the 2 surveys, caloric intake "did not change significantly over time for women or men as a whole, or when stratified by race/ethnicity." On the other hand, they write, the number of Americans who reported engaging in no leisure-time physical activity tripled on average, from 15.3% to 47.6%. Authors believe the results lend more support to the Institute of Medicine's efforts to link physical activity to obesity reduction.

    Comparing the sexes, 51.7% of women reported engaging in no leisure-time physical activity, compared with 19.1% 15 years prior. Inactivity rates for men rose as dramatically, though not as high, from 11.4% to 43.5%.

    During the same period, rates of obesity, overweight, and abdominal obesity (defined as waist circumference of 34 inches or more in women, and 40 inches or more in men) climbed, with women reporting more significant increases than men. Obesity prevalence in women increased from 24.9% to 35.4%, and rose from 19.9% to 34.6% in men.

    "Average BMI, average waist circumference, the prevalence of abdominal obesity increased substantially over the past 2 decades in both women and men," authors write. "These changes have occurred in the context of substantial increases in the proportion of adults reporting no leisure-time physical activity, but in the absence of any significant population-level changes in average caloric intake."

    Among other findings in the study:

    • Over the past 2 decades, the average BMI in the US increased by .37% every year in both men and women.
    • Average waist circumference increased for all groups, but for women was largest among non-Hispanic blacks. Non-Hispanic whites were the male group with the largest rate of increase.
    • Among adults categorized as normal weight based on BMI, the rate of abdominal obesity increased significantly in women, from 9.6% to 13.8%.
    • Among women and men, rates of inactivity were higher among non-Hispanic blacks and Mexican-Americans.

    APTA strongly supports the promotion of physical activity and the value of physical fitness to prevent obesity, and has representatives on the board of the National Physical Activity Plan Alliance. 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.

    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.

    CMS Criticized Over Rate of Improper Payments

    A recently issued congressional report offers a grim assessment of the Centers for Medicare and Medicaid Service's (CMS) attempts to curb improper payments, calling them largely ineffective "pay and chase policies" that provide no reason for recovery audit contractors (RACs) to stop improper payments before they happen. In fact, the bipartisan report (.pdf) from the Senate Special Committee on Aging argues that the RAC incentive structure "could be viewed as an incentive to keep improper payment rates high."

    While other parts of the US government have dramatically reduced their rates of improper payments since 2010, the report states, CMS has experienced an increase, to just over 10% of the $604 billion spent in 2013, "the highest improper payment rate of the past 5 years."

    The 43-page report states that while RACs were established to identify overpayments and underpayments, part of the mission of the contractors included "taking action to reduce future improper payments." The ways RACs are paid, however, provides contingency fees for the number of improper claims identified. These rates have ranged between 9% and 12.5%.

    The committee regards Medicare administrative contractors (MACs) in a somewhat more favorable light, writing that MACs "have done a great deal to reduce improper payments, including implementing many local coverage decisions."

    The committee findings, also subject of a recent report in Modern Healthcare, include an acknowledgement that CMS "does have a number of prepayment checks, or edits in the system which automatically deny payments that appear to be improper," and the agency "should be congratulated on the development of prepayment review systems like the National Correct Coding Initiative and Medically Unlikely Edits."

    Committee staff recommendations include the establishment of financial incentives for the reduction of improper payment rates, rather than an exclusive focus on the identification of improper payments made. The recommendations also address the need for CMS to better define scopes and objectives of systems focused on improper payments, and to better educate providers on improper payments.

    The report comes after a CMS report in late June that touted the use of predictive analytics in its Fraud Prevention System, which the agency claims prevented over $210 million in improper payments in 2013.

    APTA has worked exhaustively with CMS officials to try to produce more effective review systems, by urging them to reduce administrative burden, improve communication among their contractors, focus their investigation and review on the highest risk cases, and minimize disruption to providers.

    The association also is helping physical therapists and physical therapist assistants understand regulations and payment systems through its Integrity in Practice campaign that puts them in touch with tools and resources to promote evidence-based practice, ethics, and professionalism.

    Check out the latest addition to the Integrity in Practice webpage: Preventing Fraud, Abuse, and Waste: A Primer for Physical Therapists (.pdf) is a free guide that examines not only the laws around these issues but the ways to avoid fraud, abuse, and waste with payers, referral sources, and patients.

    Foundation Annual Report Highlights a Big Year

    Want a lot of very good reasons why you should feel good about the future of physical therapy research? Check out the recently released Foundation for Physical Therapy's 2013 annual report.

    The report highlights an extremely "highlightable" year for the Foundation for Physical Therapy, which worked to ensure that its vision for a physical therapy research Center of Excellence would take shape, awarded important research grants, and cheered on Stanley Paris, PT, PhD, FAPTA, FAAOMPT, as he attempted to sail around the world to raise awareness of-and funds for-physical therapy research.

    You Choose the Next 'PT in Motion' Magazine Cover

    If you could decide what's on the cover of PT in Motion magazine, what would you choose?

    APTA has always sought member input for story ideas and feedback on published articles. This time, we're turning over the design authority to you. For the September 2014 issue, we propose 2 different cover designs and are asking members to vote in their favorite.

    Which better illustrates our upcoming cover story on the human brain's role in the origins of pain, and physical therapy's role in managing it? Which would make you more likely to open the magazine and read the articles?

    Take the survey by July 21 to cast your vote. It will take less than a minute to complete-just eye each of the 2 cover options and make your selection!

    Injury Rates for Adolescent Female Soccer Players Could Be Higher Than Previously Thought

    Adolescent female soccer players may be experiencing injury rates much higher than previously believed, and for at least 1 subgroup of these athletes, the secret to prevention could be to play more soccer.

    A new study of 498 female soccer players aged 15-18 in Denmark used a text message-based self-reporting system to track injuries related to the sport and found substantially higher rates than had been established through previous studies, which were based on reports from coaches or medical staff. Differences varied by rate of exposure, but on average the Danish study found a time-loss injury rate of 9.7 per 1,000 hours of exposure-previous studies reported time-loss rates between 2.4 and 5.3.

    For severe injuries, the differences were even more dramatic, with a 1.1 per 1,000 hours rate that is "3 times that previously reported in a female adolescent population, and identical to or higher than ... that reported in elite male and female soccer," according to the authors. The article appears in the July 2 edition of the American Journal of Sports Medicine (abstract only available for free).

    The study involved 4 weekly questions sent via text message to all participants, with subsequent messages sent immediately depending on how participants responded to the initial set of questions. The weekly questions asked whether the participants experienced any discomfort during a match or practice during the past week, whether they missed training or games during the last week and why, how many hours of soccer training they participated in during the past week, and how many minutes of game play they participated in during the past week. Participants who reported pain or discomfort were contacted by telephone and briefly interviewed further. Information-gathering was conducted for a full Danish soccer season, from February to June 2012.

    Researchers then categorized all reported injuries into time-loss and no time-loss injuries, with "time loss" being defined as an injury that resulted in a loss of playing/training time of 1 week or more. From there, they separated time-loss injuries into overuse and acute injuries, and further divided acute injuries into injuries sustained in a match or in training. Injury severity was linked to the time lost from soccer, with time-loss of 4 weeks or more being categorized as "severe." The most common severe injuries involved the knee, ankle, groin, and lumbar spine.

    In addition to the higher overall incidence rates, authors noted a strong correlation between risk of time-loss injuries and lower amount of play and training time. In the lowest-exposure group (less than 1 hour per week of play or training), the predicted incidence of time-loss injuries was 71 per 1,000 hours of exposure-significantly higher than even the second-to-lowest exposure group (1 to 2 hours per week of play or training), whose time-loss injury rate was about 24 per 1,000 hours. Authors write that the "obvious first measure" of prevention for this group would be to increase regular training, and they warn that if the rates hold true, occasional soccer players "may represent a population exhibiting unsafe behavior and a possible major cost to society in terms of medical expenses."

    Overall, authors write, the findings of the study are "highly alarming and suggest that previously reported injury rates in adolescent female soccer may be substantially underestimated, and estimates of injury distribution may be inaccurate."

    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.

    APTA Outlines Medicare 2015 Home Health Payment Proposal

    An APTA summary of the Medicare proposed rule for the 2015 home health prospective payment system guides members through the various proposed policies, including a payment update and provisions related to the therapy functional reassessment requirements, physician face-to-face requirements, speech-language pathology personnel qualifications, quality reporting, and value-based purchasing.

    As reported July 2 in PT in Motion News, the Centers for Medicare and Medicaid Services (CMS) estimates a net 0.3% decrease in payment to certified home health agencies in 2015, among other provisions. The association plans to submit comments to CMS by the September 2, 2014, deadline.

    APTA State Policy and Payment Forum Registration Now Open

    The big state issues that directly affect physical therapists (PTs) and physical therapist assistants (PTAs)—copay legislation, health care reform implementation, scope of practice, dry needling, and much more—will be front and center at the 2014 APTA State Policy and Payment Forum. Registrations are now open for this important members-only gathering, to be held September 13 – 15 at the Grand Hyatt in Seattle, Washington.

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

    In addition to presentations on current advocacy efforts in the states, the Forum will include a case study on state legislation allowing PTs to ordering imaging, a session on infringement from other providers, and 2 luncheon speakers: Washington State Rep Laurie Jenkins and Mark McClellan, MD, PhD, director of health care innovation and value Initiative at the Brookings Institution.

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

    Physical Therapy a Good Fit at Bloggers Convention

    Don't be surprised if the next health and wellness blog you read seems a bit more attuned to physical therapy.

    APTA exhibited at Fit Bloggin’14,a national conference of nearly 300 health, fitness, and wellness bloggers from across the country, held in Savannah, Georgia, June 26-29. Sixteen volunteers from the Physical Therapy Association of Georgia (PTAG) offered hands-on—and feet-on—experiences to the bloggers by conducting screenings on laptop posture and treadmill running gait. The volunteers also took time to educate the writers about the role that physical therapy plays in reducing injury risk and safely maximizing performance.

    APTA member Stephania Bell, PT, OCS, CSCS, injury analyst and senior writer for ESPN, was also on hand to lead a session to a packed house about how to build a respected blog. Bell highlighted the many resources APTA has available to enhance blog content, including Media Corps experts. Staff also met one-on-one with several bloggers to further educate them about how APTA’s experts and information can lend a credible, third-party expert voice to their content.

    And the outreach efforts are already paying off. This week, fitness blogger Toledo Lefty's Perfect in Our Imperfections features a post that includes a lengthy interview with APTA Media Corps expert Robert Gillanders, PT, DPT, OCS, and several exercise and training-related links from the MoveForwardPT.com website.

    Over the next few weeks, staff will be following up with these bloggers to suggest story ideas and experts for their blogs.

    NEXT and House of Delegates Photos Are Ready

    Anyone ever tell you you oughta be in pictures? Turns out, you might be—along with your physical therapy friends and colleagues.

    Scores of photos from the 2014 NEXT Conference and Exposition, as well as the 2014 session of the APTA House of Delegates, are now available as prints or digital downloads from David Braun Photography.

    To purchase, go to http://davidbraun.photoreflect.com and click on "NEXT 2014" under "Recent Photos." Enter password: hamstrings and click on the photo group you’d like to view. Select your photos and order through the shopping cart. If you have any questions, please contact David Braun at info@davidbraun.com.

    New APTA Resource on 2015 Fee Schedule Available

    A new APTA resource provides highlights of the provisions in the Centers for Medicare and Medicaid Services (CMS) proposed 2015 physician fee schedule rule—including one proposal that would move physical therapists (PTs) into a program that currently applies only to physicians.

    A major quality program change that will have a significant impact on physical therapists in private practice, the proposal to expand the value-based modifier (VM) program to all nonphysician eligible professionals (including PTs) in 2017 could carry penalties for PTs in private practice who do not meet reporting requirements. Currently, the VM program applies only to physicians.

    Closely tied to the physician quality reporting system (PQRS), the VM program uses PQRS data and other metrics (quality and cost) to determine an overall value score that will be used to determine Medicare payment. Under this proposal, eligible PTs in private practice who fail to participate in both the PQRS and VM programs in 2015 would be subject to a 4.0% VM penalty and a PQRS penalty of 2.0%, for a cumulative 6.0% penalty in 2017.

    Details on the VM program are included in the APTA summary on the CMS proposed rule and a new APTA resource on the VM program (.pdf). In addition to information on the VM proposal, the highlight summary document (.pdf) covers changes that will affect payments, changes to the PQRS, misvalued codes, accountable care organizations, quality program changes, and more. The new information is part of APTA's Medicare Physician Fee Schedule webpage.

    From the House of Delegates: PTAs, 'Early Career' Individuals Focus of Membership Efforts

    APTA will have an opportunity to further enrich involvement from both physical therapist assistants (PTAs) and early-career physical therapists (PTs) and PTAs, now that the APTA House of Delegates (House) has approved efforts to increase the value of membership for both groups.

    In separate motions approved at the 2014 session of the House June 9-11 in Charlotte, North Carolina, delegates voted to create plans for increasing the value of APTA membership for the PTA and to "explore new and innovative ways to increase membership recruitment and retention of early-career individuals," defined as PTs and PTAs practicing within their first 5 years after graduation.

    The motion approved by the House (RC 11-14) only calls for a general plan to increase the value of APTA membership for the PTA, and "leaves to the wisdom of the [APTA Board of Directors] the discussion of how Board or any other representation by PTAs might be implemented so it would be feasible and effective," according to the motion's support statement. The statement described an opportunity for association growth, pointing out that of an estimated 67,400 PTAs in the US, just over 5,600 were members of APTA. This number could increase, motion sponsors asserted, if PTAs were afforded opportunities for greater decision-making involvement in the association.

    "It seems reasonable that such input through elected representation on the Board of Directors should be considered and could be implemented," the statement noted, adding that PTAs are already included in the leadership of some chapters. The plan is to be presented in December 2014 for consideration at the 2015 House of Delegates.

    To some extent, the issue of PTA involvement has been taken up by the Board of Directors already. At its April meeting, Board voted to draft bylaw amendment proposals for the 2015 House that would allow components to provide PTA members a full vote at the component level, make PTAs eligible to serve as chapter delegates at the discretion of each component, and make PTAs eligible to run for nonofficer positions on the Board. The Board also agreed to explore the possibility of creating a "section-like" component for PTAs in 2015 (see related PT in Motion News story).

    The association will also be developing a plan to reach out to early-career PTs and PTAs in ways that, like the PTA proposal, would make association membership more valuable to this group. A status report is due to the 2016 House of Delegates (RC 15-14).

    "Early-career individuals … are at a highly vulnerable and impressionable point in their careers," according to the motion's support statement. "Early-career PTs and PTAs are arguably in the most influential 5 years of their careers, as their practice habits, clinical values, and ethics are being formed on a daily basis." A stronger presence in the association could not only provide early career PTs and PTAs with an important element of professional identity, but keep the association relevant across a wide range of experience levels.

    Like the PTA proposal, the motion approved by the House leaves the association latitude to develop a variety of approaches. Motion sponsors pointed out that the proposal was not calling for the creation of a new component or governance structure, or supporting the idea that separate classifications or positions be created within the association or its chapters. Instead, the support statement characterized the effort as one that would "funnel interested individuals into existing opportunities," and "better tap into the potential of early career individuals" in ways that would "develop our future leaders and build the strength and voice of our professions for decades to come."

    In other House decisions around membership issues, delegates approved a relatively minor change to APTA bylaws that will allow members of the Student Assembly to remain in the Assembly from graduation to the next House of Delegates (RC 20-14). Prior to the bylaws change, Student Assembly members who graduated before an upcoming House were disqualified from participating; the change allows these recent graduates to serve out one more House term.

    APTA members can view videos of all open sessions of the 2014 House of Delegates online. Final language for all actions taken by the House will be available by September after the minutes have been approved.

    From the House of Delegates: APTA Has a Role in Strengthening PT Education

    If physical therapy wants to truly embrace its vision of transforming society, the profession will need to be equipped with a diverse, well-educated workforce comfortable with innovation and capable of working across disciplines. It's an idea that's as fundamental as it is complex, and one that the 2014 House of Delegates (House) supported through several education-related motions passed at its most recent session June 9–11 in Charlotte, North Carolina.

    The motions approved by the House included "Promoting Excellence in Physical Therapist Professional Education" (RC 12-14), a position that spells out the association's commitment to educational program quality, and its expectation that physical therapists (PTs) who teach in and oversee these programs share in this concern for quality.

    Specifically, the position sets out the expectation that PTs with an interest in teaching possess advanced terminal degrees or a clinical doctorate; and that they agree to teach in or direct only programs that demonstrate a commitment to innovation and excellence. The new position also calls for the Commission on Accreditation in Physical Therapy Education (CAPTE) to adopt stringent criteria "to reflect the needs for qualified faculty and program directors, access to sufficient clinical education sites, and adequate infrastructure (eg, physical, fiscal, and personnel); and the current and emerging needs of society."

    The House also focused on supporting clinical education through the adoption of a motion that directs the association to engage in a collaborative process to establish best practice "from professional level through postgraduate training" (RC 13-14). The motion calls for the association to propose "potential courses of action for a doctoring profession to move toward practice that best meets the evolving needs of society" and requires a report to the 2017 House of Delegates. Areas of focus are to include current models of PT clinical education, mandatory postgraduate clinical training, stages of licensure, findings from related studies, and information on clinical education in other health care professions.

    "Best practice in clinical education and training remains an enigma, and evidence remains limited or nonexistent to determine what is most effective in these areas to enter a doctoring profession," according to the support statement that accompanied the motion. "This situation requires coordinated action to determine best practice in clinical education and training to enter a doctoring profession."

    Delegates also acknowledged the increasingly important role of interprofessional education through a vote to officially endorse the Interprofessional Education Collaborative's core competencies around cross-disciplinary education and collaborative practice (RC 18-14). The competencies address values and ethics, roles and responsibilities, communication, and teamwork, with a focus on the importance of the appropriate use of knowledge of the professional's own role coupled with a solid understanding of the roles of other professions.

    The support statement that accompanied the motion described the "unique opportunity" for physical therapy to join in efforts to promote these competencies. "It is critical to prepare PT practitioners capable of demonstrating these core competencies to be integral members of the health care team in serving the interests and needs of patients, clients, family/caregivers, and other health professionals," according to the statement.

    Ideas of inclusiveness were also extended to more nuts-and-bolts issues of physical therapy education, when the House approved a motion to adopt a definition of an "underrepresented” minority in physical therapy education as "the racial and ethnic populations that are underrepresented in physical therapy education relative to their numbers in the general population, as well as individuals from geographically underrepresented areas, lower economic strata, and educationally disadvantaged backgrounds." [RC 14 -14]

    The support statement accompanying the motion asserted that the definition will assist education programs in developing a diverse student body, and presents a view that is not prescriptive. "The … definition extends beyond traditional racial and ethnic categories to also include individuals from educationally disadvantaged backgrounds (eg, first-generation college students), low socioeconomic status, and geographically underrepresented areas (eg, Appalachia)," according to the statement.

    APTA members can view videos of all open sessions of the 2014 House of Delegates online. Final language for all actions taken by the House will be available by September after the minutes have been approved.

    From the House of Delegates: 'Friend to Physical Therapy' Michael J. Axe Named Honorary APTA Member

    By unanimous vote, orthopedic surgeon Michael J. Axe, MD, became an honorary APTA member during the 2014 House of Delegates, June 9-11 in Charlotte, North Carolina. Called a "friend to physical therapy" in the resolution for his membership, Axe was recognized for his extensive contributions to rehabilitation research and his team approach that includes physical therapists' diagnostics in sports medicine and patient and client care, according to the support statement accompanying the motion. Axe became the 41st honorary member of the association [RC 19-14].

    "He recognizes that surgery, his specialty, is just 1 component of the total picture of rehabilitation," Delaware Delegate Cathy Ciolek, PT, DPT, GCS, said on the House floor in presenting the motion.

    Axe has contributed to research for a variety of patient populations and conditions, including ACL tears, return-to-play management after injury or surgery, knee osteoarthritis, and throwing injuries in baseball. He also has dedicated significant time to teaching entry-level physical therapist students.

    In accepting the membership honor, Axe showed yet another area in which he supports APTA and the profession. Having been convinced that "when a PT is employed by a physician the honesty of the relationship has been compromised," he said, "my colleagues are well aware of my negative stance on physician ownership of physical therapy." The remark received a standing ovation.

    APTA members can view videos of all open sessions of the 2014 House of Delegates online. Final language for all actions taken by the House will be available by September after the minutes have been approved.

    Foundation Gala Nets Nearly $50k

    They came. They gala-ed. They exceeded their physical therapy research fundraising goal by 50%—all in all, a great night for attendees to the Foundation for Physical Therapy's (Foundation) 35th Anniversary Gala held last month during APTA's NEXT Conference and Exposition.

    According to a Foundation news release (.pdf), the gala netted just under $50,000, well over the $35,000 goal set by organizers. A total of 165 supporters used mobile fundraising technology to meet the initial challenge in less than 30 minutes and go on to blow away expectations by taking in $44,750 by the event's end. Paired with money raised through a silent auction, the total raised from the gala was $47,710.

    "We are delighted by the generosity of everyone who made a donation in honor of the Foundation's 35th Anniversary," said Foundation Board of Trustees President William G. Boissonnault, PT, DPT, DHSc, FAPTA, FAAOMPT. "Reaching this milestone holds great significance to us as we look forward to advancing physical therapy for many more years to come."

    Skilled Maintenance Resource Dispels Myths About Coverage

    A new resource at APTA.org helps to dispel some of the myths around skilled maintenance therapy, and provides physical therapists (PTs) with information that can help them better understand documentation, billing, and other issues brought to light in the recent Jimmo v Sebelius settlement.

    The APTA Skilled Maintenance webpage states that "There has been a longstanding myth that Medicare does not cover services to maintain or manage a beneficiary's current condition when no functional improvement is possible." Getting past that myth is only the first step, however, and the webpage includes detailed information on Medicare regulations and practice applications.

    In addition to the Medicare and practice resources, the webpage includes information on the Jimmo v Sebelius settlement, legislative and regulatory activity, and a link to a webinar on defining skilled maintenance therapy and minimizing denials.

    Making Vision Happen: Board Seeks Member Input on Making APTA Vision a Reality

    APTA's vision for the physical therapy profession—transforming society by optimizing movement to improve the human experience—is broad and ambitious, to be sure. But it's also achievable. Getting there, however, will require strong member engagement to truly make that vision a reality, and a big opportunity for just that kind of engagement is now available.

    As part of its effort to align the 2015 APTA strategic plan to the association's vision, the APTA Board of Directors is asking for direct member input on the guiding principles that accompany the vision, as well as reactions to the association's definition of "movement system," a term used frequently throughout the vision's guiding principles.

    Members are encouraged to review the APTA vision webpage, then complete an online feedback form with their ideas on services, products, or activities that the association could provide or engage in to support the guiding principles—note that the form accommodates feedback for 1 principle at a time, so to comment on more than 1, members can fill out and submit the form multiple times. The form also asks for feedback on whether the association's definition and use of "movement system" is sufficient, and how the term might directly relate to practice, education, and research.

    Deadline for participation is August 11. For more information, contact vision@apta.org.

    From the House of Delegates: New Consolidated Policy Covers a Host of State Licensure Topics; Includes 2 New Key Positions

    Anyone interested in understanding APTA's approach to ensuring consumer protection in physical therapy through state licensure of physical therapists (PTs) and physical therapist assistants (PTAs) can now turn to one resource that, among other positions, advocates for greater licensure portability, supports restricted licenses for PTs in clinical internships, and brings policies up to date with recent House decisions in related areas. The new policy was approved by the APTA House of Delegates at its 2014 session June 9-11 in Charlotte, North Carolina (RC 10-14).

    In what was largely a "modernization project to reduce redundancies," according to APTA Vice President Sharon Dunn, PT, PhD, OCS, the House voted to adopt a policy titled "Consumer Protection Through Licensure of Physical Therapists and Physical Therapist Assistants." Essentially, the new policy consolidates positions and policies that existed in 11 separate documents into a single policy that addresses many aspects related to state licensure and regulation. The new resource policy provides APTA’s positions on a variety of state licensure issues including state licensure designations, minimum qualifications and requirements for licensure, protected terms and titles, temporary exemptions to state licensure, and continuing education and continuing competence as a condition for licensure renewal.

    For the most part, the policy incorporates language from existing APTA positions; however, the new document does include 2 new positions that address licensure's reach and portability.

    Specifically, the Consumer Protection document outlines APTA's support for provisional or restricted state licensure for student PTs in clinical internships, as well as for exam-eligible graduates of accredited PT and PTA programs, or individuals who have completed requirements for graduation.

    The new resource also states that APTA supports licensure models that allow for portability, such as an interstate licensure compact for physical therapy.

    Akin to driver's licenses systems, an interstate licensure compact is a legal agreement among participating states that allows for recognition of one state license among multiple states. An interstate licensure compact—achievable only through the adoption of uniform legislation in multiple states—would reduce the requirement for a PT to hold multiple state licenses and would facilitate practice via telehealth. The Federation of State Boards of Physical Therapy (FSBPT) has formed a task force that is investigating what an interstate compact might look like for the physical therapy profession.

    The consumer protection policy adopted by the House also incorporates technical revisions to existing positions to provide for better clarity, as well as language that brings the policy in line with actions taken by this year’s House in other areas (see related PT in Motion News stories on accountability of care and regulatory designation of the PT).

    APTA members can view videos of all open sessions of the 2014 House of Delegates online. Final language for all actions taken by the House will be available by September after the minutes have been approved.

    From the House of Delegates: Legislative Campaign to Transition State Licensure Designation to 'DPT' to Begin in 2025

    Ten years can seem like a long while—unless you're preparing for a national campaign to change the way an entire country refers to your profession. For APTA's House of Delegates (House), that's the appropriate timeframe to make preparations for a nationwide shift from "PT" to "DPT" as the state licensure designator for all physical therapists in all US jurisdictions.

    Delegates to the 2014 House session held June 9-11 in Charlotte, North Carolina, voted to adopt an APTA position that connects the dots between the association's support of the doctor of physical therapy (DPT) as the profession’s entry-level educational degree and the regulatory designation PT licensees are legally allowed to use to denote state licensure. The changeover would begin in January 2025 and will require a significant amount of legwork at both the national and chapter levels. Many states will need to enact state legislation to amend their state PT licensure law to change the licensure designation from "PT" to "DPT" for licensees.

    The current state licensure designation for all physical therapists, regardless of degree earned, is PT. "Most agree that allowing DPT as the state licensure designation is inevitable and that it is just a matter of time," according to a supporting statement that accompanied the motion. Authors of the supporting statement describe a "window of opportunity" over the next few years, and state that "working together to accomplish what this motion proposes can be a rallying and unifying focus within the profession and will send a clear external message. The uniform state regulatory designation of DPT will affirm that an entire profession is practicing at a doctoring level."

    While state chapters will need to wait until 2025 to initiate any legislative or regulatory change, APTA will immediately begin working out a roadmap for the achievement of this goal. This work will likely involve the Federation of State Boards of Physical Therapy (FSBPT), APTA chapters, state legislative leaders, and other stakeholders. The start date to launch the legislative change in 2025 is an acknowledgement of the time needed to prepare for a uniform change in all US jurisdictions, as well as to time to reach a “critical mass” in which the vast majority of practitioners will have obtained a DPT degree.

    The regulatory designation would share an acronym with the doctoral educational degree in physical therapy, but would not substitute for the degree itself, according to the support statement. ."No one is proposing granting degrees unearned," according to the statement. "A unified regulatory designation of DPT demonstrates to our profession and the public the shared competence of the entire profession and the exemplary history of accomplishments in education, research, and practice over the last few decades to arrive at the point where we are recognized as practicing at the doctoring level."

    APTA members can view videos of all open sessions of the 2014 House of Delegates online. Final language for all actions taken by the House will be available by September after the minutes have been approved.

    From the House: PT-PTA Team Reaffirmed; APTA Supports Innovation in Developing Practice Models

    Determining that this is not the right time for a more “permissive” policy on the individuals that should be permitted to perform physical therapist (PT) interventions under the direction and supervision of the PT, the APTA House of Delegates (House) rescinded a 2011 position statement, not yet implemented, that would have supported the expansion of support personnel available to the PT. At the same time, a new House position affirms that APTA can best help PTs and physical therapist assistants (PTAs) navigate the changing health care landscape by encouraging diverse creative approaches to the provision of patient-centered physical therapist delivery of care through consultation, referral, direction and supervision, and interprofessional collaboration. The House reached this agreement after extensive executive session discussion, closed to outside observers and not recorded, at the 2014 House session June 8-10 in Charlotte, North Carolina.

    The newly adopted policy states that APTA positions and policies are "intended to communicate best practice for physical therapist practice," and are "not intended to limit the development of innovative approaches to physical therapist practice in the evolving health care system."

    The related motions and discussion were the result of proposals to refine the position statement, titled "Physical Therapist Responsibility and Accountability for the Delivery of Care," first adopted at the 2011 House and amended in 2012. The position had confirmed that physical therapy is provided by, or under the direction and supervision of, a physical therapist (PT), and that evaluation remains the complete responsibility of the PT. Additionally, the position acknowledged how the changing health care system and the needs of the patient based on the PT’s clinical decision making could have an effect on which personnel the PT may use in treatment, and the nature of those relationships. The actual implementation date had been delayed to allow the association to explore the potential impacts; implement necessary initiatives in education, practice, payment, regulation, and research; and adopt positions, standards, guidelines, policies, and procedures that were consistent with the new position.

    As part of the run-up to implementation, a task force was created to carefully examine how APTA might best reflect the position in its policies and other documents. That task force’s report, delivered to the APTA Board of Directors in December of 2013, sparked the Board to ask for a third-party policy analysis. Meanwhile, amendments to the position were readied for 2014 that could have moved the position ahead.

    In the end, however, the proposal that won favor with delegates was a new motion to rescind the position altogether and return to the position that the PTA is the only individual permitted to assist a PT in selected interventions, under the PT's direction and supervision. APTA will continue to be responsive to how new models of care and accountability are affecting physical therapy, and the association has reemphasized the importance of member ability to develop innovative practice models that best meet the needs of patients and clients. [RC-3, RC-4, RC-22, RC-23]

    APTA members can view videos of all open sessions of the 2014 House of Delegates online. Final language for all actions taken by the House will be available by September after the minutes have been approved.

    PTNow Blog: A Good Guideline That Could Be Better

    Is it about time interdisciplinary practice guidelines got a little more guidance from physical therapists (PTs)?

    That's one of the questions asked in the latest PTNow blog, which discusses the idea that even when a guideline is accurate and useful for PTs, direct PT involvement in its development can only make it better.

    Case in point: the American Academy of Neurology (AAN) concussion guideline now being reviewed for inclusion in CPG+, the APTA initiative that evaluates and rates externally developed practice guidelines using a team of PT experts. The CPG+ team provides a guideline rating, highlights, and “Check Your Practice” tips.

    The AAN guideline fares well—and is even declared a "must read" by 1 reviewer—but the fact that PTs weren't involved in its creation leads to bigger questions.

    Check out the PTNow blog, consider the questions, and join the conversation.

    From the House of Delegates: House Actions Could Increase Reach of Physical Therapy

    Physical therapy should be empowered to assume its appropriate place in a quickly evolving health care system, and should be made available as widely as possible—that was the common thread running through several motions approved by the 2014 APTA House of Delegates.

    During its session June 9-11 in Charlotte, North Carolina, the House approved motions that ranged from position statements supporting the idea that physical therapists (PTs) should be considered "entry point" health care providers (RC 7-14) to another backing the idea that PTs should be included in the list of professionals able to make determinations on disability status for people applying for special license plates (RC 17-14). Delegates also approved motions supporting the use of telehealth technologies (RC 8-14) as well as refinements in the language of existing policies that make it clear that PTs—and the association—are committed to responding to disparities in access and serving a diverse population (RC 5-14, RC 6-14). Viewed in combination, the motions support the profession as an integral part of front-line care that should be widely accessible.

    By a wide margin, the House approved an amended position statement that clearly defines PTs as "entry point providers into the health care system" and reinforces the PT’s ability to provide screening, evaluation, diagnosis, prognosis, intervention, coordination of care, prevention, and wellness and fitness, as well as referral to outside providers when indicated. According to a support statement that accompanied the motion proposal, the idea behind the refined position is to "move external stakeholders—insurers and physician groups—beyond simply tolerating or permitting direct access, to a level of endorsing, embracing, and encouraging the use of PTs as entry-level providers."

    At a more nuts-and-bolts level, the House also approved a new APTA position in support of PTs being included in states' lists of providers authorized to determine mobility status for individuals "for purposes of disability parking placards or license plates," as well as in regional transit authorities as providers able to make paratransit decisions. Currently, in 49 states and the District of Columbia, PTs are not on lists of qualified professionals for these decisions—lists that in some cases include podiatrists, chiropractors, naturopaths, Christian Science practitioners, midwives, and police. The new APTA position could assist chapters seeking to get states and transit authorities to officially acknowledge the PT's ability to make such mobility decisions.

    The House also sought to expand the reach of physical therapy through technology by the adoption of a resolution supporting the provision of physical therapy via telehealth when provided in ways that are consistent with professional ethics, standards, guidelines, and federal, state, and local regulations. The resolution adopted by the House echoes a position adopted by the APTA Board of Directors in 2001.

    A priority for the profession of physical therapy continues to be access for all individuals in need of care despite disparities, according to a support statement that accompanied the motion. "Telehealth technology can transform health care delivery by removing time constraints for local practice, often times providing enhancement for real-time care."

    The resolution states that telehealth "is used to overcome barriers of access to services caused by inaccessibility … unavailable resources, or impaired patient or client mobility," and that the technology "offers the potential to provide physical therapist services where health disparities exist." Provided that PTs deliver the service competently and ethically, document the use of telehealth, and obtain informed consent from patients and clients, APTA now officially views telehealth as "an appropriate model of service delivery for the profession of physical therapy."

    The House also voted to add more precision of language around what has been a longstanding tenet of PT practice and APTA membership—that everyone deserves care, and that the association is an inclusive organization. In tweaks to 2 separate policies, Delegates voted through consent agenda to include the words "sex," "gender identity," and "gender expression" among the lists of characteristics that will not be the basis for discrimination in both PT practice and APTA operations. Both policies still include race, creed, color, gender, age, national origin, sexual orientation, disability, and health status as characteristics that should not be a barrier to PT treatment or association membership and rights.

    APTA members can view videos of all open sessions of the 2014 House of Delegates online. Final language for all actions taken by the House will be available by September after the minutes have been approved.

    From the House of Delegates: Help in Responding to 'Productivity' Issues on Its Way

    By this time next year, physical therapists (PTs) and physical therapists assistants (PTAs) may have a few more tools at their disposal when it comes to talking with employers and others about productivity and performance.

    This year's House of Delegates (House) voted overwhelmingly to identify and develop resources that will help PTs and PTAs negotiate successfully around productivity and performance in ways that ensure the provision of quality physical therapy care. The motion was approved during the 2014 session held June 9-11 in Charlotte, North Carolina.

    According to the statement supporting the motion, the need for more analysis and tools has arisen in the face of a changing health care climate that has created "uncertainties" that have caused some employers to turn to "productivity" measures as the primary measure of PT and PTA performance. These productivity measures may not be realistic and generally do not reflect the value of PT care and the patient related outcomes of PT practice.

    "At such times, PTs and PTAs need not just ethical courage to stand up for what is right, but also tools and resources to fortify them to engage vigorously and effectively in the dialogue and negotiations with administrators/employers and consultants who are pressuring [them] to adopt productivity measures or practices that may represent sincere but archaic or misguided notions of the nature and role of PT practice," according to the supporting statement.

    The motion adopted by the House could result in the development of resources for PTs and PTAs who, according to the support statement, "seek to balance their clinical, ethical, and professional responsibilities against the demands inherent in the employment relationship." The 2015 House will receive a progress report on the efforts [RC-16].

    APTA members can view videos of all open sessions of the 2014 House of Delegates online. Final language for all actions taken by the House will be available by September after the minutes have been approved.

    Chronic Low Back Pain Research Standards Proposed

    Citing a lack of consistency in investigations into one of the most widespread chronic conditions in the world, last month the National Institutes of Health (NIH) released a task force report that seeks to establish standards for research into chronic low back pain (cLBP). The new standards are being recommended to be included as requirements of future NIH grant proposals.

    The NIH Task Force on Research Standards for Chronic Low Back Pain, which includes Anthony DeLitto PT, PhD, FAPTA, issued a June 20 report that featured recommendations around how cLBP is defined, categorized, measured, and reported. The aim, according to the report's authors, is to change the current state of research on cLBP, which they say makes it "difficult to compare epidemiologic data and studies of similar or competing interventions, replicate findings, pool data from multiple sources, resolve conflicting conclusions, develop multidisciplinary consensus, or even achieve consensus within a discipline regarding interpretation of findings."

    The recommendations of the task force include:

    • Definition of cLBP as "a back pain problem that has persisted at least 3 months and has resulted in pain on at least half the days in the past 6 months."
    • Stratification of cLBP impact by "personal impact" considerations including pain intensity, pain interference with normal activities, and functional status.
    • Establishment of a minimum data set for describing individuals participating in all research studies on cLBP that captures demographics, medical history, and self-report of symptoms and function including pain intensity, physical interference, depression, and sleep disturbance.
    • Affirmation of earlier consensus documents on outcome measures for chronic pain.

    The task force recommends the Patient Reported Outcomes Measurement Information System (PROMIS) as a good instrument for self-report measures, but adds that other well-validated measures are acceptable.

    "Any effort to standardize research methods is only a starting point for further testing and refinement," the authors state. "The final recommendations were seen as a first step toward creating standards for research in cLBP. We anticipate that further validation, refinement, and possible extension of these recommendations will require years and the efforts of many investigators."

    APTA has a long history of involvement in the development of information and resources on back pain. Some of the resources available to physical therapists include a MoveForwardPT.com webpage on low back pain, clinical practice guidelines on low back pain (.pdf), and an APTA Learning Center presentation on manipulation for low back pain. PTNow provides full-text access to the latest clinical practice guidelines and Cochrane systematic reviews related to low back pain and neck pain.

    Brain-Powered Movement Achieved in Patient With Paralysis

    Researchers at The Ohio State University have successfully engineered an electronic neural bypass system that has allowed an individual who is quadriplegic to move his hand and fingers with his thoughts alone.

    The system, dubbed Neurobridge, connects a microchip implanted on the motor cortex of a patient's brain to a computer, which uses algorithms to learn and interpret the patient's brain signals and send them on to a sleeve that stimulates the muscles required to perform a certain movement. Total time from thought to movement is reported to be less than a tenth of a second.

    The system debuted recently when Ian Burkhart, a 23-year-old man who was paralyzed in a swimming accident, clenched and unclenched his fingers, rotated his wrist, and picked up a spoon. Stories and videos on the trial have appeared in The Washington Post, ABC News, and Computerworld, among other media outlets.

    Cardiac Rehabilitation More Successful in Men Than Women

    The benefits of cardiac rehabilitation (CR) are well-established, but men may be benefitting more than women, according to a new study that suggests the differences in improvement may point to a need for modified exercise and counseling programs.

    The research, published in the July-August issue of the Journal of Cardiopulmonary Rehabilitation and Prevention (abstract only available for free), compared metabolic equivalents (METs) achieved by 346 women and 758 men assigned to participate in the University of North Carolina's Health Care Cardiac Rehabilitation Program, an outpatient CR program consisting of 3 CR sessions a week for 3 months. Authors of the article measured METs in participants 1 week before beginning CR, and 1 week before completion.

    What researchers found was that men achieved MET improvement 27% greater than women, even when adjusted for BMI and referral indication. Although some of the difference can be accounted for by a higher rate of noncompletion among women—65.6% of the women completed the program, compared with 73.1% of the men—authors describe the difference as "not particularly large" and "unlikely to account for the … improvement."

    According to the article, the sex-based difference may indicate that more attention needs to be paid to structuring exercise programs that are more responsive to the "unique barriers" to exercise encountered by women, which include "a social stigma against overexertion" and a high rate of comorbidities that can make it harder to participate in exercise programs. Authors also suggest that more targeted counseling could help, citing studies that show women experience higher levels of depression after a cardiac event.

    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.

    PTJ Editor in Chief Search Begins, New Editor to Start January 2016

    With Physical Therapy (PTJ) Editor in Chief Rebecca Craik, PT, PhD, FAPTA, in the next-to-last year of her second term, APTA has begun its search for her successor.

    The association has formed an editor in chief (EIC) search team to review applications and identify candidates for interviews. Led by APTA Vice President Sharon Dunn, PT, PhD, OCS, the team includes selected current and former Editorial Board members, the Editorial Board member who represents the Dutch Royal Physical Therapy Society for which PTJ is the official journal, an APTA member at large, and PTJ’s managing editor.

    Applications for the EIC position are due September 15, 2014, with interviews taking place in early 2015. The new EIC is expected to be officially announced at the NEXT Conference and Exposition in June 2015. A transition process will follow, with the new EIC in place on January 1, 2016.

    Editors in chief of PTJ have a 5-year term of appointment, with a single reappointment allowed. Interested applicants are asked to submit a standardized application form. The form and detailed instructions are available online, and the official announcement is available in the July issue of PTJ (.pdf).

    CMS Proposed 2015 Fee Schedule Adjusts Payment Rates, Updates PQRS

    The proposed 2015 Medicare physician fee schedule (PFS) rule released July 3 would result in an estimated 20.9% reduction in payments beginning April 1, 2015, unless congressional action is taken to avert sustainable growth rate (SGR) reductions. If those reductions are avoided, the rule’s aggregate impact on payment is a positive 1% for outpatient physical therapy services. Either way, the first quarter of 2015 would see no change in payment rate due to the Protecting Access to Medicare Act (PAMA) of 2014, provides for 0% PFS update for services furnished between January 1, 2015 and March 31, 2015.

    Additional proposed policies that will impact physical therapists include updates to the Physician Quality Reporting System (PQRS) program, CMS’s proposal to review the values that determine payment for a number of CPT codes reported by physical therapists, and a proposal for a new process for establishing PFS payment rates that is more transparent.

    • CMS proposes to retain the 12-month calendar year reporting period for the PQRS program in 2015 and beyond. The 2015 reporting period data will be used to inform the 2017 payment adjustment of -2.0%. CMS is proposing to make the following changes to the reporting requirements for 2015:
    • Increase the number of measures that an eligible professional must report via the claims and registry-based reporting mechanisms to at least 9 measures, covering at least 3 of the NQS domains, or, if fewer than 9 measures apply to the eligible professional, he or she must report as many as do apply and report each measure for at least 50% of the Medicare Part B fee for service. Of the measures reported, some must be included from the new crosscutting measure set.
    • Make 2015 PQRS data available in 2016 on the Physician Compare website for all providers participating as eligible professionals and for those reporting under the Group Practice Reporting Option (GPRO).
    • Change measures reported by physical therapists for the remainder of 2014 , including the removal of measure #245 Use of Wound Surface Culture Technique in Patients with Chronic Skin Ulcers and the Back Pain Measures Group (#148-#151).

    The proposed rule will be published in the July 11, 2014, Federal Register. The public will have until September 2, 2014, to submit comments in response to this rule, and APTA will submit comments on behalf of its members. After reviewing public comments, CMS will publish a final rule on or about November 1, which will become effective for services furnished during 2015. APTA will provide a more detailed summary of the rule in the upcoming week.

    CMS Issues Proposed Rule on Outpatient Prospective Payment

    The rule proposed July 3 by the Centers for Medicare and Medicaid Services (CMS) includes a 2.1% increase in payment rates for 2015 under the outpatient prospective payment system (OPPS) and changes to hospital admissions requirements.

    The proposed rules affect hospital outpatient departments and ambulatory surgical centers beginning January 1, 2015. Proposals include the implementation of comprehensive payments for certain services, clarification of the requirement for an admission order for all hospital inpatient admissions, and a change that will require physician certification for hospital inpatient admissions only for long-stay cases and outlier cases, not short stays.

    Informed by comments received regarding the requirements for a physician certification of hospital short stays, CMS clarifies that admission orders are a condition of payment for all inpatient hospital admissions. However, CMS will require a physician certification only for long-stay cases (20 days or more) and outlier cases. CMS states that the admission order, medical record, and progress notes must contain sufficient information to support the medical necessity of an inpatient admission without a separate requirement of an additional, formal, physician certification for shorter stays.

    The rule also proposes the implementation of the 2014 OPPS final rule policy creating 28 comprehensive ambulatory payment classifications (APCs) to handle payment for the most costly device-dependent services. The policy would treat all individually reported codes as components of a comprehensive service, resulting in a single prospective payment based on the cost of all individually reported codes. CMS will make a single payment for the comprehensive service based on all charges on the claim, and charges for services that cannot be covered separately by Medicare Part B or that are not payable under the OPPS will not be reimbursed. Further, CMS proposes to conditionally package certain ancillary services when they are integral, ancillary, supportive, dependent, or adjunctive to a primary service.

    In addition, CMS proposes to change its consideration of requests the expansion of physician-owned hospitals under the physician self-referral regulations and establishes an appeal process for Medicare Advantage organizations regarding CMS-identified overpayments.

    Most physical therapy services provided in the outpatient hospital department are not paid under the OPPS and are paid instead under the Medicare Physician Fee Schedule (PFS) (see related news story on the proposed PFS for 2015), though a small subset of ‘‘sometimes therapy’’ physical therapy services are paid under the OPPS when they are not furnished as therapy, meaning not under a certified therapy plan of care. CMS provides an annual update of these “sometimes therapy” services subject to direct supervision requirements. The update can be found at http://www.cms.gov/Medicare/Billing/TherapyServices/AnnualTherapyUpdate.html.

    The proposed rule will be published in the July 11, 2014, Federal Register. Comments on the rule are due September 2, 2014. APTA will submit comments on behalf of its members. A detailed summary of the rule will be available for APTA members shortly.

    A Revolutionary Way to Have Family Fun

    The 4th of July weekend is a great time for fireworks, overcooked meat, and finally getting around to learning to whistle the piccolo part to "The Stars and Stripes Forever," but it's also the perfect time for families to get active—and possibly win a Fitbit, courtesy of APTA and its Section on Pediatrics.

    The APTA Summer Fit Family Challenge is now in full swing, and members are encouraged to get their patients and clients—and their own families—involved in this fun way to stay active as a family.

    It's easy to do. Simply visit the Fit Family Challenge webpage on MoveForwardPT.com, download the challenge list, and get moving. Take family photos and share your progress and while doing the activities, then post to #FitFam14 on Twitter, Facebook, or Instagram, and you'll be automatically entered to win a Fitbit. You can even practice that piccolo thing over and over while you're doing stuff, which your family is sure to enjoy.

    Get moving! And get posting! Next prize winners will be announced July 15 and 31.

    Early Career Dues Discount Program Extended Through 2018

    As if new graduates need another reason to make sure they renew their APTA membership every year, eligible early-career physical therapists (PTs) and physical therapist assistants (PTAs) will continue to benefit from reduced APTA dues under a program that provides discounted rates for members up to 4 years after graduation. The decision to extend the program until 2018 was approved by the Board of Directors at its June 7 meeting in Charlotte, North Carolina.

    APTA created the pilot program earlier this year to extend dues reductions to eligible members in years 2, 3, and 4 postgraduation, so that members receive 40%, 30%, and 20%, respectively off national and participating chapter dues—as long as their membership doesn’t lapse any time during the 4 years. APTA bylaws already stipulate that members receive 50% off national and chapter dues at their first renewal postgraduation.

    The program is optional for chapters, which are being asked to confirm their participation in 2015 by August 31 of this year.

    See APTA's Career Starter Dues webpage for frequently asked questions and more information.

    July 10 DCoE Webinar Focuses on Concussion and Football Helmets

    Football helmets may "work," but what does that really mean in terms of concussions? Physical therapists (PTs) and physical therapist assistants (PTAs) can gain insight into the effectiveness of equipment in reducing concussion incidence while getting information on the pathophysiology of the injury through a free webinar from the US Department of Defense Centers of Excellence (DCoE).

    The 90-minute program is set for July 10, 1:00–2:30 pm ET, and will cover the latest consensus statements about helmets and concussion prevention, the biomechanics and pathophysiology of concussion, the role of acceleration information in characterizing brain injury risk, and the ways in which rule changes and better equipment could reduce risk of brain injury.

    Presenters include Kristy Arbogast, PhD, pediatrics co-scientific director for the Children's Hospital of Philadelphia's Center for Injury Research and Prevention; Donald Marion, MD, MSc, of the Defense and Veterans Brain Injury Center; and Steven Rowson, PhD, assistant research professor at the Virginia Tech School of Biomedical Engineering.

    Webinar participants can register in advance or on the day of the presentation.

    Log 'N Blog: Get Happy—and Help Physical Therapy

    Want to feel good about yourself? Add up all those miles you ran, or biked, or swam, or hours you worked out since February. Whoa, kind of impressive, right?

    Want to feel really good about yourself? Help physical therapy research by documenting those activities in the Foundation for Physical Therapy's Log 'N Blog campaign.

    And yes, there's still time. But not much.

    July 31 is the deadline to join the Foundation for Physical Therapy's "Log 'N Blog" initiative, the physical therapy student-led fundraiser in which teams and individuals compete by tracking their fitness activities. Proceeds from Log 'N Blog are used to support physical therapy research.

    And this year, there's good news for those arriving late to the competition: no matter when you sign up, you can log any activity that began after February 1. After the contest closes at the end of July, recognition will be given to the teams and individuals with the most miles and activity hours.

    Visit the Log 'N Blog website to sign up and check out the competition.

    CMS 2015 Home Health Payment Proposal Estimates .3% Net Decrease, Requires Reassessments Every 14 Days

    Estimating a net decrease of .3% to home health agencies for next year, the Centers for Medicare and Medicaid Services (CMS) has released its proposed rule for the Home Health Prospective Payment System (HH PPS) for 2015. The rule proposes a home health market basket update of 2.2% adjusted for multifactor productivity as mandated by the Affordable Care Act (ACA), and includes a requirement that functional therapy reassessments be conducted every 14 days.

    CMS will implement the second year of the ACA-mandated 4-year phase-in for rebasing adjustments to the HH PPS payment rate by decreasing home health payment by 3.5 percent. The proposed national, standardized 60-day episode payment for 2015 is $2,922.76. The proposed per-visit amount for physical therapy in 2015 is $139.73 for home health agencies (HHAs) in compliance with quality reporting requirements.

    Other rules have been proposed it the following areas:

    • CMS proposes to simplify the home health therapy functional reassessment by reversing the current requirements to complete the assessment at the 13th and 19th visits and/or at least every 30 days and instead require a qualified therapist (rather than an assistant) from each discipline to provide the therapy and functionally reassess the patient at least every 14 days. The requirement would apply to all episodes regardless of the number of therapy visits provided. The current documentation requirements to use objective measurement tools in this assessment would not change.
    • CMS proposes significant changes to the physician face-to-face encounter requirements. First, CMS would eliminate the narrative requirement. Second, CMS would consider only medical records from the patient’s certifying physician or discharging facility to determine if the patient is eligible for Medicare home health. Third, CMS would consider the physician Medicare claim for certification/recertification for home health services (not the face-to-face encounter visit) a noncovered service if the HHA claim was not covered because the patient was found ineligible for home health.
    • CMS proposes that HHAs submit both admission and discharge outcome and assessment information set (OASIS) assessments for a minimum of 70% of all patients with episodes of care occurring during the applicable reporting period. This threshold would increase by 10% each year until reaching a cap of 90% in 2017.

    Last, CMS invites comments on a pilot value-based purchasing (VBP) model for HHAs that would begin in 2016. CMS hopes to test the model in up to 8 states.

    APTA staff is conducting a complete review of the proposed rule and will provide a detailed summary in the coming days.

    New Michigan Law Means All 51 US Jurisdictions Allow Direct Access to PTs

    The people of Michigan are better off—and the physical therapy profession has reached an important milestone—now that legislation has been signed into law allowing allow patients in Michigan to go directly to a physical therapist (PT) for evaluation and treatment without a physician’s referral. The legislative victory now means that all 50 states and the District of Columbia allow for some form of direct access to PTs for evaluation and treatment.

    SB 690, signed into law by Gov Rick Snyder, was sponsored by Sen John Moolenaar and promoted by the Michigan Chapter of APTA (MPTA). The new law creates the option for patients to see a PT without a referral or prescription from a physician for up to 21 days or 10 treatment visits, and will also allow patients to see a PT directly for injury prevention and fitness promotion, with no time or visit limit. SB 690 also strengthens the profession by specifying that only licensed PTs may use the term “doctor of physical therapy” in connection with their services. A similar bill was sponsored in the Michigan House of Representatives by Rep Margaret O’Brien.

    The passage of this legislation is the culmination of many years of hard-fought effort on the part of MPTA that at times faced significant opposition.

    “The goal of direct access to physical therapy in Michigan has been 34 years in the making,” said MPTA President Sue Talley, PT, DPT, C/NDT, in a news release. “This achievement would not have been possible without the commitment of multiple MPTA presidents, legislative chairs, the grass roots efforts of our members and patients, and Sen Moolenaar and Rep O’Brien."

    “This is a significant milestone for the people of Michigan and for the physical therapy profession,” said Paul A. Rockar Jr, PT, DPT, MS, president of APTA. “APTA has long advocated for improved patient access to physical therapists, and I applaud Michigan’s achievement in making this policy a reality.”

    The milestone of achieving some form of direct access to treatment in all 51 US jurisdictions comes on the heels of achieving direct access to evaluation throughout the US in 2013. While notable in its own right, the achievement sets the stage for association efforts to improve access in some states that have more restrictive direct access laws that "are not based on evidence or on the best interests of the patient,” according to Rockar.

    The new Michigan law will take effect January 1, 2015. APTA provided a direct access grant to the Michigan Chapter to support its efforts on SB 690.

    2014 - Michigan Direct Access Signing 
    Gov Rick Snyder signs SB 690, making Michigan the 51st jurisdiction
    to allow some form of direct access to PTs.

    2015 NEXT Proposal Deadline July 14

    Who's NEXT? How about you?

    APTA members have until July 14 to submit proposals for sessions at the 2015 NEXT Conference and Exposition, set for June 3–6 at National Harbor, Maryland, near Washington DC.

    Detailed information on how to submit proposals is available at the NEXT submission site. Proposals are being requested for 90-minute education sessions and daylong preconference courses, and the association welcomes content focused on effectiveness of care, patient and client-centered management across the lifespan, professional excellence, and value and accountability.

    For the 2015 conference, APTA is particularly interested in topics related to health policy, innovative collaborative care, interprofessional education, prevention and wellness, research, and women's health.

    APTA Comments on SNF, IRF, IPPS Proposed Rules Now Available

    Skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and prospective payment systems for acute and long-term care are the subjects of newly available APTA comments on proposed rules from the Centers for Medicare and Medicaid Services (CMS).

    In the SNF letter (.pdf), APTA commends the agency for its work to create an alternative therapy payment methodology and encourages the inclusion of a standardized assessment tool as well as a universal therapy payment model across all postacute care settings. APTA also thanks CMS for its proposal to ease SNF assessment requirements and urges the agency to provide educational resources to providers on how the change will apply to all SNF assessments.

    APTA's letter on IRFs (.pdf) urges CMS not to adopt proposals that would change the 60% rule presumptive compliance list, specifically the deletion of amputation and prosthetic status codes. Most notably, the association strongly recommends that CMS halt finalization of policies to implement a definition and IRF Patient Assessment Instrument (IRF-PAI) reporting requirement for group therapy. As an alternative, APTA recommends that CMS collect data regarding the delivery of therapy in the IRF setting.

    A separate APTA letter on inpatient prospective payment systems and long-term care hospitals (.pdf) includes several recommendations regarding the 2-midnight admission criteria, short stays, and observation status. Specifically, APTA recommends that any therapy services provided as inpatient or observation stay be exempted from outpatient therapy requirements such as functional limitation reporting and the therapy cap. In addition, APTA supports the changes made to the hospital readmission reduction program and makes suggestions to improve the long term care hospital quality reporting program.

    CMS will consider all comments submitted and issue final rules for these settings around August 1, 2014.

    A Map to Everywhere: PT in Motion Looks at Patient and Client Advocacy

    For physical therapists (PTs) and physical therapist assistants (PTAs), patient and client advocacy is all over the map.

    And that's a good thing.

    The July issue of PT in Motion, APTA's monthly member magazine, takes a look at how the sometimes-nebulous concept of advocacy takes shape in the real world of physical therapy. Through a series of short interviews with PTs from across the country, readers find out how PTs are engaging with patients and clients to educate, empower, protect, and fight for the care they deserve.

    What emerges are advocacy efforts that the article describes as "encompassing clinical environments, classrooms, the halls of government, offices of third-party payers, and entire communities." And although the actual approaches vary among the PTs interviewed, the efforts are rooted in a shared commitment to living out an ethical imperative that goes beyond simply doing a job.

    In the article. Nicole Volek, PTA, BA, describes her own work in community education and goes on to characterize the challenge of advocacy in general. "PTAs and PTs aren't just PTAs and PTs," she says. "We're social workers, in a very real sense. To advocate effectively for patients and clients, we've got to be all kinds of people beneath our PTA and PT hats."

    Hardcopy versions of PT in Motion are mailed to all members who have not opted out; digital versions are available online ahead of print to members.