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  • Gregory Hicks Appointed to APTA’s Board of Directors

    Gregory Hicks, PT, PhD, FAPTA, has been appointed by the APTA Board of Directors (Board) to complete the leadership term of Sheila K. Nicholson, PT, DPT, MBA, MA, following her death in June this year.

    Hicks, who has been an APTA member for 17 years, is chair of the Department of Physical Therapy at the University of Delaware, where he also is director of the school’s Advancing Diversity in Physical Therapy program, known as ADaPT.

    In 2018, Hicks was named a Catherine Worthingham Fellow, APTA’s highest membership category, for demonstrating unwavering efforts to advance the physical therapy profession through leadership, influence, and achievement. Also that year, he received the University of Delaware College of Health Sciences’ inaugural Diversity Advocate Award.

    “My Board colleagues and I are elated that Greg has consented to serve our association,” said APTA President Sharon Dunn, PT, PhD, board-certified orthopaedic clinical specialist. “Greg will bring wisdom, experience, and leadership to help propel our pursuit of APTA’s 3-year strategic plan.”

    Hicks’ Board service begins immediately and ends with the completion of Nicholson’s 3-year term in June 2020, at which point the vacant seat will be filled through the annual slate of candidates process and election by the House of Delegates.

    Final SNF Rule Sets New Payment System Into Motion October 1

    It's final: the US Centers for Medicare and Medicaid Services (CMS) is moving ahead with a rule governing skilled nursing facilities (SNFs) that's almost identical to what it proposed in April, including a change advocated for by APTA—a revised definition of what constitutes "group therapy" in SNFs. Aside from that alteration, it's a rule that hews to CMS' original plans to dramatically change the payment system for SNFs.

    As anticipated, the final rule proceeds with implementation of the Patient-Driven Payment Model (PDPM). The model is based on a resident's classification among 5 components (including physical therapy) that are case-mix adjusted, and employs a per diem system that adjusts payment rates over the course of the stay. APTA has developed a number of resources on PDPM.

    Other notable elements of the final rule:

    • In a win for APTA and its members, CMS moved away from a rigid 4-person definition and adopted the association's recommendation that the definition of group therapy as 2 to 6 patients doing the same or similar activities—the same definition used in inpatient rehabilitation settings.
    • The final rule adopts a "subregulatory" process to keep up with nonsubstantive updates to the ICD-10 codes used in PDPM, while substantive changes will be made through the traditional notice-and-comment rulemaking process.
    • CMS will implement 2 new quality measures—transfer of health information to the provider-post-acute-care, and transfer of health information to the patient-post-acute-care—to be provided by the SNF at the time of transfer or discharge.
    • The rule also adopts a number of standardized patient assessment data elements that assess cognitive function and mental status; special services, treatments, and interventions; medical conditions and comorbidities; impairments; and social determinants of health.
    • CMS projects aggregate payments to SNFs will increase by $851 million, or 2.4%.

    PT in Motion News covered the PDPM in detail when the rule was proposed. Since that time, APTA has launched an education campaign on the new system that includes a webpage on PDPM as well as a prerecorded webinar and Q and A session. A live webinar with CMS on SNF PDPM and demonstrating value is scheduled for September 4.

    Proposed Outpatient Payment Rule From CMS Continues Previous Trends

    The US Centers for Medicare and Medicaid Services (CMS) is pushing for an outpatient environment in which payments vary less according to who owns a facility, hospitals get a supervision break, and patients have access to clear information on how much they're being charged for items and services. All 3 concepts figure heavily into the proposed 2020 outpatient payment system (OPPS) rule.

    The proposed rule, released July 29, would complete a 2-year CMS effort to move toward a "site neutral" payment model in its reimbursements for physician services, doing away with a system that pays so-called "off campus" hospital-owned facilities more than it does their independent equivalents. Payment for physical therapy services in outpatient settings are paid under the CMS physician fee schedule and so are not impacted by the OPPS site-neutral policies.

    Other trends continue as well, including an APTA-supported move toward easing supervision burdens placed on hospitals. The proposed rule would change supervision requirements for outpatient therapeutic services in all hospitals from "direct" to "general," meaning that while a given procedure would be furnished under a physician's overall direction and control, the physician's physical presence no longer will be required during the performance of the procedure. The change is viewed as a particularly positive one for critical-access hospitals and other facilities in underserved areas.

    A shift toward greater transparency also is reflected in the proposed rule, with CMS aiming to require hospitals to make their standard charges public for all items and services. These standard charge lists—a facility's gross and payer-negotiated charges for supplies, procedures, beds and food, practitioner services, and a host of other items—would also be required for a limited set of so-called "shoppable services" that can be scheduled by a consumer in advance. CMS puts teeth into the requirement through monetary penalties and publication of violations for facilities that don't comply.

    Another trend APTA is watching: prior authorization, which in the proposed rule would be required for several cosmetic procedures including rhinoplasty. While this doesn't directly affect services associated with physical therapy, APTA advocates in general against prior authorization requirements that slow the delivery of care and limit patient access to appropriate interventions.

    Also included in the proposed OPPS:

    • Payment rates for outpatient hospitals and ambulatory surgical centers (ASCs) would increase by 2.7%.
    • CMS is soliciting comments on adding 4 safety measures to the Outpatient Quality Reporting Program that have already been required of ASCs: patient falls, patient burns, wrong site/side/procedure/implant, and all-cause hospital transfers/admissions.

    A CMS fact sheet on the proposed rule is available online. APTA is analyzing the proposed rule and will provide comments to CMS by the September 27 deadline.

    Proposed DMEPOS Rule From CMS Aimed at Predictability, Clarity

    In its proposed 2020 rule for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), the US Centers for Medicare and Medicaid Services (CMS) aims to make payments for devices a little more predictable in light of the ever-increasing—and ever-advancing—range of options available to providers and patients. The agency's solution? A "comparable item analysis" system that CMS thinks will help make it easier to nail down exactly what Medicare will pay for those devices.

    In what a CMS fact sheet describes as an attempt to "improve the transparency and predictability of establishing fees for new DMEPOS items," the proposed rule establishes 5 major categories under which providers can compare older DMEPOS with new ones: physical components, mechanical components, electrical components (when applicable), function and intended use, and "additional attributes and features."

    The idea, according to the proposed rule, is that when the old and new items are comparable, CMS will use the fee schedule amounts for the existing older item in determining payment amounts for the new one. If there are no comparable older items, CMS says it will base payment on commercial pricing data such as internet pricing and supplier invoices. Those prices for the noncomparable items won't necessarily stay fixed: if commercial pricing drops, so will CMS rates.

    In addition to the comparison system, CMS is also proposing to revamp requirements around face-to-face meetings between providers and patients in need of DMEPOS that "may have created unintended confusion for stakeholders." The current requirements—essentially a collection of ad-hoc provisions that have accrued over the past 13 years—would be replaced with what CMS describes as a "single list of DMEPOS items potentially subject to a face-to-face encounter and written orders prior to delivery, and/or prior authorization requirements."

    APTA is analyzing the proposed rule and will provide comments to CMS by the September 27 deadline.

    Proposed Fee Schedule Rule Wrestles With PTA, OTA Services Delivered 'In Part'; Includes Changes to MIPS

    Despite serious questions and criticisms from APTA, the American Occupational Therapy Association (AOTA), and other stakeholders, the US Centers for Medicare and Medicaid Services (CMS) intends to move ahead with its plans to require providers to navigate a complex system intended to identify when therapy services are furnished by a physical therapist assistant (PTA) or occupational therapy assistant (OTA). The approach, which in 2022 would trigger a payment differential depending on how many minutes of services are provided by a PTA or OTA, is included in the proposed 2020 physician fee schedule rule released by CMS on July 29.

    As always, the physician fee schedule (PFS) rule is an extensive document that covers a wide range of providers and settings, with an emphasis on individual provider payment rates. But for the physical therapy profession, the big story for the 2020 proposed rule is related to how CMS plans to require providers to comply with a law requiring identification of services furnished "in whole or in part" by a PTA or OTA. The approach being contemplated by CMS—to set a "de minimis" 10% bar—has been criticized by APTA as one that has "serious implications for beneficiary access to care," particularly in rural and underserved areas.

    The proposed 2020 rule would require the new PTA and OTA modifiers (CQ and CO, respectively) to be included in claims beginning January 1, 2020, with a payment differential implemented in 2022. CMS also proposes to add a requirement that the treatment notes explain, by way of a short phrase or statement, why the modifier was or wasn't used for each service furnished that day. In short, the system is rooted in minutes of service, and would require the use of the applicable modifier that would indicate when a PTA or OTA provided outpatient therapy services for 10% or more of the total time spent furnishing the service.

    And yet, as most physical therapists (PTs) and occupational therapists (OTs) well understand, the provision of therapy services isn't quite that simple. Questions start to pile up fairly quickly: what if the PTA or OTA services are provided concurrently with the PT or OT? What if the PTA or OTA services are administrative or nontherapeutic? What about group therapy? How is time designated when delivering supervised modalities?

    CMS attempts to anticipate these and other potential complications by making a few definitive decisions—for instance, administrative or nontherapeutic services provided by a PTA or OTA that could be provided by others without PTA or OTA education and training don't count—and providing examples of how the time allotments would be calculated in various scenarios.

    Despite the extensive requirements and explanations (and accompanying charts), a CMS fact sheet on the proposed fee schedule states that the system imposes "the minimum amount of burden for those who bill for therapy services while meeting the requirements of the statute."

    APTA disagrees with that assertion, and has voiced additional concerns about how the system would impact patient access to care. While acknowledging that CMS is bound by law to create a PTA modifier, the association takes issue with CMS’ interpretation of “in part,” and asserts that the agency's attempt to quantify what "in part" means is excessively complex, discounts the role of the therapist, and exceeds the intent of the law. That mischaracterization of the law, APTA argues, will quickly lead to confusion and loss of access to care, particularly among beneficiaries in and underserved rural areas.

    APTA plans on continuing its advocacy for a less complex, more patient-friendly system, including lobbying federal legislators to take a closer look at the plan and seeking meetings with CMS. APTA also will provide comments on the PTA/OTA modifier plan and other elements of the proposed fee schedule by the September 27, 2019, deadline, and will create a customizable template letter, available on APTA's Regulatory Action webpage, for individual provider comment.

    Here are other highlights of the proposed rule:

    Payment would increase slightly
    CMS estimates that the 2020 conversion factor would be $36.0896, just about a nickel more than 2019's $36.04.

    MIPS measures and performance thresholds for PTs and OTs would change—and CMS is looking at ways to make things less complex
    The proposed rule would add measures for diabetes mellitus neurological evaluation, diabetes mellitus evaluation of footwear, screening for depression and follow-up plan, falls risk assessment, falls plan of care, elder maltreatment screen and follow-up plan, tobacco use screening and cessation intervention, dementia cognitive assessment, falls screening for future falls risk, and functional status change for patients with neck impairments. The rule also removes 2 measures: pain assessment and follow-up, and functional status change for patients with general orthopedic impairments.

    Additionally, CMS has proposed that MIPS-eligible clinicians with a final score of 45 would receive a neutral payment adjustment, a change that CMS believes will lead to more clinicians receiving positive adjustments than negative ones. The current neutral payment adjustment score is set at 30.

    CMS is also proposing the concept of shifting to a streamlined version of MIPS, which it has dubbed "MIPS Value Pathways," (MVPs) for 2021 and beyond. According to CMS, the MVP system would help providers align activities across the 4 existing MIPS categories by specialties or conditions. MVPs would focus on population health priorities and reduce reporting burden by limiting the number of required specialty- or condition-specific measures so that all clinicians or groups reporting on a clinical area would report the same set or sets of measures. The change would also provide more data and feedback to clinicians, which in turn "helps clinicians quickly identify strengths in performance as well as opportunities for continuous improvement," according to a CMS press release on the proposed rule.

    It's not a "limitation," it's a "threshold amount"
    In a change that adds semantic reinforcement to the end of a hard cap on therapy services established in 2018, the proposed rule clarifies that the dollar amounts assigned to therapy services aren't limitations per se, but "threshold amounts" that, when exceeded, require the KX modifier. In turn, the KX modifier would be regarded as confirmation that the additional services are medically necessary. CMS also says it will clarify regulations on the medical review threshold and the applicable years for the targeted medical review process

    New dry needling codes, and changes to codes and RVUs for biofeedback
    The American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel approved 2 new CPT codes to report dry needling of musculature trigger points in 2020. These codes, with proposed relative value unites (RVUs) of .32 (205X1, needle insertion without injection, 1 or 2 muscles) and .48 (205X2, needle insertion without injection, 3 or more muscles), were surveyed and reviewed by the Health Care Professions Advisory Committee, a group of non-MD/DO health professionals, including a PT representative. Those new codes are included in the proposed PFS.

    Also, in September 2018, the AMA CPT Editorial Panel replaced CPT code 90911 (Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry) with 2 new codes to describe biofeedback training initial 15 minutes of 1-on-1 patient contact and each additional 15 minutes of biofeedback training.

    As a follow-up to another CPT editorial panel decision in 2018 that replaced a single CPT biofeedback code with 2 separate codes, CMS is also proposing an RVU of 0.90 for CPT code 908XX (biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry when performed; initial 15 minutes of one-on-one patient contact) and 0.50 for code 909XX (biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry when performed; each additional 15 minutes of one-on-one patient contact). The proposed rule also designates the 2 codes as “sometimes therapy” procedures, meaning that an appropriate therapy modifier is always required when this service is furnished.

    Intensive cardiac rehab (ICR) would be expanded
    CMS is proposing that coverage for ICR, which tends to be more structured, rigorous, and integrative in its emphasis on diet and cognitive-behavioral factors, be expanded to beneficiaries with stable chronic heart failure. It's also looking to expand coverage for both ICR and cardiac rehabilitation to other cardiac conditions as identified through a national coverage determination—providing that determination finds clinical support for an expansion.

    CMS is looking for comments on bundled payments
    Can concepts and principles associated with bundled payment models—particularly the idea of per-beneficiary payments for multiple services or condition-specific episodes of care—be applied to the PFS? CMS believes it has the flexibility to implement bundling concepts in future rules, and is looking for public comment on the idea.

    Want to hear more about the proposed fee schedule directly from the APTA experts? Be on the lookout for an upcoming special "Insider Intel" phone-in session exclusively devoted to the PFS in the coming weeks. We'll announce the date and time via PT in Motion News and social media.

    9 Conversations to Have With Your Legislators While They're Back Home in August

    Members of the US Senate and House of Representatives are headed to their home states and districts during the August congressional recess, which means more opportunities to meet in-person and advocate for policies important to the physical therapy profession and its patients. And the timing couldn't be better, because it's been a particularly active year for the introduction of legislation that could affect physical therapists (PTs), physical therapist assistants (PTAs), and students on multiple fronts.

    Bottom line; there's lots to talk about. To help you prepare for that town hall, office visit, or random coffee shop encounter, here's a rundown of some of the top APTA-supported legislation to discuss with your congressperson. [Editor's note: for a listing of APTA's legislative advocacy targets, visit the association's Legislative Action Center; to receive information and legislative action alerts, sign up for PTeam and download the APTA Action App on your mobile phone.]

    You don't have to cover all 9 topics. But if you see any that resonate with you, your practice, or the patients and clients you serve, consider sharing your perspective with your legislators while they're back home.

    1. Let's bring care to where it's needed—and help relieve student debt
    It's called The Physical Therapist Workforce and Patient Access Act (S. 970 / HR 2802)—legislation that would list PTs among the professions included in a federal program to provide greater patient access to health care in rural and underserved areas. If passed into law, the program could open up access to a student loan repayment program for participating PTs—and help address the nation's opioid crisis in areas that have been especially hard-hit.

    The bill would allow PTs to participate in the National Health Service Corps (NHSC) loan repayment program, an initiative that repays up to $50,000 in outstanding student loans to certain health care professionals who agree to work for at least 2 years in a designated Health Professional Shortage Area (HPSA). An estimated 11.4 million Americans are served by the NHSC. The bill was introduced by Sens John Tester (D-MT), Roger Wicker (R-MS), and Angus King (I-ME) and is cosponsored by Sens Kyrsten Sinema (D-AZ), Kevin Cramer (R-ND), and John Boozman (R-AR). The House version was introduced by Rep Diana DeGette (D-CO) and John Shimkus (R-IL). That bill has 43 cosponsors.

    2. Let's strengthen care by increasing educational opportunities
    One of the association's strategic goals is to foster a physical therapy profession as diverse as the society it serves, and The Allied Health Workforce Diversity Act of 2019 (HR 3637) could add momentum to that effort. The proposed legislation would set aside money in the Health Resources and Services Administration specifically for use by accredited education programs in physical therapy, occupational therapy, audiology, and speech-language pathology. Those programs would in turn issue scholarships or stipends to students from underrepresented populations including racial or ethnic minorities and students from disadvantaged backgrounds including economic status and disability. The bill was introduced by Reps Bobby Rush (D-IL) and Cathy McMorris Rogers (R-WA).

    3. We can help the right care happen faster (while relieving administrative burden)
    The Improving Seniors' Timely Access to Care Act of 2019 (H.R. 3107), is aimed at improving access to health care for older Americans through, among things, reducing administrative burdens on providers—specifically by scaling back the use of prior approval. The bill was introduced into the US House of Representatives by Reps Suzan DelBene (WA), Mike Kelly (PA), Roger Marshall (KS), and Ami Bera (CA).

    4. Let's remove obstacles to skilled nursing facility care
    Current Medicare rules require a 3-day inpatient observation period before allowing a patient to be transferred to a skilled nursing facility (SNF)—an unnecessarily complicated and costly process. The Improving Access to Medicare Coverage Act (HR 1682/S 753) would ease that restriction by allowing for an individual receiving outpatient observation services to qualify under the same 3-day rule. The bill was introduced by Rep Joe Courtney (CT) in the House and by Sen Sherrod Brown (OH) in the Senate.

    5. We can respond to the student debt crisis
    In 2011, the Budget Control Act cut off graduate student access to federal direct subsidized loans, which tend to offer lower interest rates and more flexible repayment terms. The Protecting Our Students by Terminating Graduate Rates that Add to Debt (POST-GRAD) Act would end that ban. Rep Judy Chu (CA) introduced the bill, which is endorsed by APTA and a range of other professional and education groups. Cosponsors include Reps Peter DeFazio (OR), Jan Schakowsky (IL), Suzan DelBene (WA), Darren Soto (FL), Scott Peters (CA), Juan Vargas (CA), Grace Napolitano (CA), Raul Grijalva (AZ), Brenda Lawrence (MI), Julia Brownley (CA), Eric Swalwell (CA), Gwen Moore (WI), Derek Kilmer (WA), Dina Titus (NV), Linda Sanchez (CA), and Barbara Lee (CA-13).

    6. Children with disabilities deserve full educational funding under the IDEA
    More than 40 years ago, Congress passed the Individuals with Disabilities Education Act (IDEA) to help ensure that children with disabilities received full educational opportunities, but it never lived up to its funding promise that the federal government would pay 40% of the additional cost to educate IDEA-eligible students. The IDEA Full Funding Act (S 866 / HR 1878) would mandate that level of funding. The bill was introduced in the Senate by Sen Chris Van Hollen (MD) and in the House by Rep Jared Huffman (CA). The House bill has 113 cosponsors; the Senate version has 10.

    7. We can improve home health
    Two separate legislative efforts are focusing on different areas of home health.

    The Home Health Payment Innovation Act (S 433 / HR 2573) aims to shore up a potential source of instability in the new Patient-Driven Groupings Model payment system set to begin in 2020 by requiring the US Centers for Medicare and Medicaid Services (CMS) to base payment adjustments on provider data. That's different from the system as proposed, which would use "behavioral assumptions" as the basis for adjustments. APTA and other supporters of the legislation view the proposed approach as arbitrary and potentially harmful to patient access to care. The bill was introduced by Sen Susan Collins (ME) in the Senate and by Rep Terri Sewell (AL) in the House.

    The Home Health Planning Improvement Act (S 296 / HR 2150) is designed to eliminate an overly restrictive requirement in the way patients are deemed eligible for home health care—namely, by loosening up a rule that limits eligibility certifications to physicians only. Instead, the legislation would permit nurse practitioners, physician assistants, and other advanced practice nurses to certify Medicare beneficiary eligibility for home health services. The bill was introduced by Sen Susan Collins (ME) in the Senate and by Rep Janice Schakowsky (IL) in the House.

    8. Medicare should do more around lymphedema
    As unbelievable as this sounds, Medicare currently doesn't cover compression treatment items for beneficiaries with lymphedema. The Lymphedema Treatment Act (S 518 / HR 1948) would change that. The bill was introduced in the Senate by Sen Maria Cantwell (WA) and has 62 cosponsors. Its companion bill was introduced in the House by Rep Janice Schakowsky (IL) and has 311 cosponsors.

    9. Patient choice is important
    It's back: Reps Jackie Speier (D-CA) and Dina Titus (D-NV) have introduced a bill, known as the Promoting Integrity in Medicare Act (PIMA) of 2019 (HR 2143), that seeks to close Medicare self-referral loopholes for physicians. That loophole allows physicians to refer Medicare patients for physical therapy and other services to a business that has a financial relationship with the referring provider, a gap that has been a target of APTA advocacy efforts for several years. The proposed legislation would tighten up self-referral prohibitions under federal law (known as the “Stark Law”) to remove physical therapy, advanced imaging, radiation oncology, and anatomic pathology from the so-called "in-office ancillary services" exception.

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    Help Highlight the Importance of 'Safe and Sound' Workplaces in August

    One way to achieve the physical therapy profession's goals of a healthier society is to help that society avoid sickness and injury to begin with. That's why physical therapists (PTs) and physical therapist assistants (PTAs) should consider taking part in an upcoming week focused on workplace safety and health.

    The US Department of Labor (DOL) Occupational Safety and Health Administration’s (OSHA) "Safe and Sound" week is set for August 12-15 this year, and now's the time to prepare to help bring attention to the initiative, and highlight the role the profession can play in a healthier, injury-free workforce. APTA is an official partner of the program.

    Both DOL and APTA offer resources that can help you highlight the week. Visit the DOL’s Safe and Sound webpage to sign up, get ideas for how to participate, and download resources to recognize your participation. APTA can help you understand the profession's connection to the issue through its webpage on the PT's role in promoting a productive and healthy workforce. That page includes a variety of resources, including tips on initiating discussions with employers about what PTs and PTAs have to offer and the APTA Academy of Orthopaedic Physical Therapy Occupational Health Special Interest Group. In addition, the association offers a webpage exclusively devoted to OSHA resources.

    Members-Only Webinar Will Focus on Demonstrating Value in New Home Health Payment System

    Physical therapists (PTs) and other providers who furnish services through home health agencies that bill Medicare will face an entirely new payment system beginning in January, 2020—one in which demonstrating the value of a particular intervention will be key. A new multidisciplinary webinar that includes experts from the US Centers for Medicare and Medicaid Services (CMS) can help you prepare for the shift.

    APTA has joined with the American Occupational Therapy Association, the American Speech-Language-Hearing Association and CMS to offer a free members-only live webinar on how therapy providers can best navigate the new Medicare Patient-Driven Groupings Model planned to go into effect January 1, 2020. The collaborative presentation is set for August 5 at 2:00 pm ET. Advanced registration is required.

    A recording of the webinar will be made available at later date. For more information on the presentation, contact advocacy@apta.org.

    [Editor's note: want to get up to speed before the webinar? This  PT in Motion News story summarizes the biggest elements in the CMS proposed home health rule, and an APTA webpage devoted to the PDGM includes recordings of presentations held earlier in the year.]

    APTA Working for You: Commercial Payer Updates, July 2019

    The commercial payer world is varied and continually evolving. APTA helps its members by staying on top of changes and bringing the physical therapy profession's voice to the table on a wide range of private payer-related issues. Here's a quick rundown of some of the latest news and APTA activities.

    The results of an APTA survey on administrative burden are in
    APTA highlights the results of a 2018/2019 survey on administrative burden in a new infographic. The survey revealed significant concerns from PTs and PTAs, particularly around the impact excessive requirements are having on clinical outcomes. A summary report on the findings is also in the works.

    The survey and infographic will be the subject of a presentation on administrative burden at the 2019 APTA Insurers' Forum. APTA encourages members to review the infographic and summary (when it's released) and use the resources in discussions with payers and other stakeholders.

    OSHA responds to APTA by affirming the PT's role in first aid
    In response to a meeting with APTA and our subsequent request for clarification, the US Department of Labor Occupational Safety and Health Administration (OSHA) issued a statement affirming that in workplace injury incidents, soft tissue massage is considered first aid for recordkeeping purposes, regardless of whether the health professional providing the treatment holds a certification in Active Release Techniques (ART). Details on the clarification, which is good news for physical therapists, can be found in this PT in Motion News story.  

    Use of third-party administrators is growing—and staying on top of the changes will require communication
    APTA continues to track the increased use of third-party administrators to manage the physical therapy benefit as national payers implement systems regionally with the intent to include all states and lines of business over time.

    APTA and its chapters collaborate and coordinate efforts to mitigate adverse patient impacts and provider administrative burden related to utilization management (UM) vendors. At the same time, the association seeks to develop a working relationship with payers and UM vendors to advocate for members when issues arise. Those efforts are strengthened through members' ongoing communication with APTA. Download this step-by-step guide for tips on when and how to report new or significantly changed UM programs.

    APTA's work with eviCore is increasing provider access to information
    Utilization management firm eviCore has made it easier for providers to find provider engagement staff assigned to their geographic area. The list, available as a pdf document on the eviCore website, is among the resources available on the company's "training resources" webpage.

    Front-end claim edits are on the rise
    Front-end edits—when a payer automatically denies a claim with a certain profile, forcing the provider to appeal the denial and provide documentation supporting the appeal—are being implemented by several payers and third-party administrators. For PTs, the most frequent trigger for a front-end edit is the use of the 59 modifier.

    APTA has taken several steps to address this issue, including asking the US Centers for Medicare and Medicaid Services (CMS) to remove edits associated with codes commonly used by PTs, engaging commercial payers in discussions about challenges associated with these edits, and providing resources to providers, including this infographic on use of the 59 modifier. APTA urges providers to consult with the association about appropriate use of the 59 modifier, and to follow through with the appeals process if documentation supports its use. Appeals can make a difference—Aetna has already indicated that if the turnover rate on appeals is high for a particular type of claim, the front-end edit will be removed.

    An APTA-sponsored session at a self-insurers' conference focused on the PT's role in population health
    APTA member Michael Eisenhart, PT, presented an APTA-sponsored session titled “Population Health: How Physical Therapists Can Help Your Employees” at the 2019 National Council of Self Insurers annual conference in June. Eisenhart's presentation showcased the role of physical therapy in the workplace and emphasized its potential for employers who self-insure their workers' compensation programs.

    Workers' Compensation programs are evolving in positive ways
    APTA has observed a greater recognition among workers' compensation (WC) programs that physical medicine not only helps address musculoskeletal issues, it also promotes patient participation in recovery and self-management and reduces the risk of reinjury. While overall injury rates and frequency have been declining, the percent of claims with physical medicine involvement have increased by 13%.

    Ohio is an example of the how this shift is playing out. In 2018, the Ohio Bureau of Workers’ Compensation mandated 60 days of conservative care before the authorization of lumbar fusion surgery. Accordingly, a national WC third-party administrator reported a rise in nonsurgical physical therapy referrals, with an attendant drop in surgical referrals—from 11% in 2017 to 5% in 2018.

    New York is also embracing the value of physical therapy in WC. The New York Workers’ Compensation Bureau (NYWCB) adopted a revised fee schedule in October 2018 that became effective on April 1, 2019. NYWCB increased the relative value units (RVUs) to 18 for evaluations and 15 for reevaluations. The bureau also raised RVUs from 8 to 12 for follow-ups. The net result of this change, plus the fee schedule increase, will result in payment increases. APTA's New York Chapter provides a detailed accounting of the changes.

    APTA, AOTA, and ASHA create a guide to assessing habilitation and rehabilitation benefits
    APTA, together with the American Occupational Therapy Association (AOTA) and American Speech-Language-Hearing Association (ASHA), collaborated to create a guide to assessing habilitation and rehabilitation benefit adequacy that emphasizes transparency, access, and affordability. Available on APTA's Essential Health Benefits webpage, the guide forgoes offering a laundry list of specific benefits in favor of establishing a set of principles that the associations believe lead to appropriate coverage of habilitative and rehabilitative services.

    Anthem's transition to a new UM vendor in 13 states is still on, but delayed
    Anthem Blue Cross-BlueShield is moving ahead with its use of utilization management (UM) vendor AIM Specialty Health in 13 states, but technical issues have delayed implementation.

    Providers who bill Anthem in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, and Wisconsin can still expect to be required to use the new vendor in the near future—Anthem says it will update providers toward the end of July on when actual implementation will occur

    In the meantime, APTA urges providers in the impacted states to participate in vendor-sponsored training available through the AIM Rehabilitation Provider Portal. If you experience difficulty enrolling in training or other problems, inform your APTA chapter.

    APTA offers a range of resources for learning more about commercial payment and staying connected: sign up for the Coding, Billing, and Payment online community to join the conversation and share experiences; stay informed by visiting APTA's commercial insurance webpage to access information and download tools including customizable appeals letters; and subscribe to the Payment edition of APTA's Friday Focus newsletter series to receive a monthly compilation of payment-related news and resources. Have questions or want to make your voice heard in local, state, and national advocacy? Email advocacy@apta.org.

    APTA, Alliance for Physical Therapy Quality and Innovation Report Explores Relationship of 'Baseline' Patient Factors and Patient-Reported Outcomes

    Many patients who see a physical therapist (PT) bring more than just a movement system issue to the clinic: they bring a host of "baseline" factors that can impact patient-reported outcomes (PROs). That reality raises a big question: given a patient's individual mix of comorbidities, socioeconomic status, payer type, and other elements at the onset of treatment, how can PTs, payers, and patients know what constitutes a "typical" amount of improvement—and can currently available data provide any insight?

    APTA and the Alliance for Physical Therapy Quality and Innovation (Alliance) are aiming to get a handle on those questions and already have taken a significant step forward in the release of a report that explores benchmarks of quality care. In a joint news release, the 2 organizations describe the document as "the largest multipractice analysis of open-source, risk-adjusted clinical outcomes in the outpatient physical therapy industry."

    To tackle this project, APTA and the Alliance contracted with the Center for Effectiveness Research in Orthopaedics to take a close look at baseline and PRO data from 375,000 patient episodes in 50 states, all related to outpatient orthopedic physical therapy involving spine, shoulder, and knee care. The data were supplied by WebPT, Intermountain, ATI, and PTNorthwest. Those 4 companies, along with APTA, the Alliance, Select Medical, BMS Practice Solutions, ATI Physical Therapy, and US Physical Therapy compose the Physical Therapy Industry Outcome Workgroup responsible for developing the final report

    Among the workgroup's findings:

    Baseline patient data currently available through typical electronic medical records (EMRs) can explain a lot.
    "Payer type, patient socio demographic factors, and comorbidities at baseline all had strong effects on PRO changes over episodes of care," the report states. "Differences in these baseline patient factors must be accounted for to ensure fair performance comparisons of physical therapists."

    Despite baseline patient factors, physical therapists are making an overall difference in patients' lives.
    Researchers found that clinically important improvements in PROs were achieved in all 3 body regions over 12-14 visits.

    When it comes to risk adjustment, the data are there...
    The project also explored just how much patient baseline data are needed to establish risk-adjustment algorithms, labeled "minimal," "practical," and "optimal." In the end, researchers found that the "practical" dataset—commonly available EMR data that include payer source, weight, BMI, sex, patient zip code, and the presence of comorbidities and history of smoking—were sufficient to provide insight on variation in PROs.

    …The data can be put to use right now…
    The report includes risk-adjusted regression models for neck, shoulder, and spine patients that estimate levels of PRO change for every baseline variable in all 3 dataset models: "minimal," "practical," and "optimal."

    …And more is always better.
    "The completeness of data necessary for risk adjustment was a limitation of this project with only 8.8% of the patient episodes received [having] appropriate baseline and discharge PROs and only 6.3% [having] measures of the appropriate set of risk-adjustment factors," the report states. "Physical therapy organizations must be committed to institutional strategies that promote the collection of PROs at baseline and baseline patient factors into existing EMRs."

    Heather Smith, PT, MPH, APTA's director of quality, believes the report sheds light on 2 important issues: the value of physical therapy no matter the patient baseline characteristics, and the crucial need for consistent and thorough data that can help drive that point home.

    "The findings in this report add more depth to what we already know—that physical therapy improves patients' lives in ways patients can see and feel, even when other factors affect outcomes," Smith said. "But just as important, it points to the absolute necessity of widespread, standardized data collection and outcomes reporting throughout the profession. The more data we compile, the more we can help our patients and make the case for the effectiveness of our interventions."

    [Editor's note: APTA's Physical Therapy Outcomes Registry is a key player in the collection of data to improve patient care and strengthen the profession, and actively collects PROs as well as risk variables. Find out how you can participate in the Registry.]

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

    "The Good Stuff" is an occasional series that highlights recent media coverage of physical therapy and APTA members, with an emphasis on good news and stories of how individual PTs and PTAs are transforming health care and society every day. Enjoy!

    "Life is always going to find a way": Dakota Kay, PT, DPT, who grew up in the Navajo Nation in Kayenta, Arizona, endured hunger and homelessness in pursuit of his undergraduate degree and DPT. (Inside Edition)

    Back to basics: Theresa Marko, PT, DPT, MS, explains the importance of exercise that strengthens the lower back. (livestrong.com)

    Staying strong and giving back: Nelson Almeida, PT, DPT, describes how he doesn't allowing speaking with a stutter to stand in the way of being a great PT, and how he's helping other individuals with stutters become confident in their abilities. (WLRN News, Miami)

    The hip new thing: Karena Wu, PT, DPT, shares her perspectives on how to choose the best pillow for hip pain. (bustle.com)

    Mythbuster: Chris Wilson, PT, debunks 6 common myths about back pain and how to treat it. (Wasilla, Alaska, Frontiersman)

    Gaining in the poles: Jon Schultz. PT, MPT, has launched a Nordic urban poling program at his clinic. (WFLA News 8, Tampa, Florida)

    A song of ice and…heat: Robert Gillanders, PT, DPT, evaluates the pros and cons of ice baths and hot therapy for recovery. (Yahoo! Lifestyle)

    Hanging leg tuck and overhead throw, anyone? Amy Schultz, PT, DPT, explains why the hardest exercises in the US Army's new fitness test may be good for cyclists. (Bicycling)

    PT Ninja Warrior: Conor Galvin, SPT, has been wowing viewers across the country with his skills on "American Ninja Warrior." (Riverhead, New York, Times-Review)

    Water you waiting for? Patrice Hazan, PT, DPT, MA, provides tips on exercises that can be performed while in the pool with family and friends. ("Your Carolina," WSPA TV, Spartanburg, South Carolina)

    Rising falls numbers, and what to do about them: Mindy Renfro, PT, DPT, PhD, and Leslie Allison, PT, PhD, editor of the Journal of Geriatric Physical Therapy, discuss recent research into rising rates of falls-related deaths among Americans who are older, and how falls prevention programs can help made a positive change. (Kaiser Health News)

    Physical therapy's role in addressing developmental delays: Beth Ennis, PT, EdD, explores the role pediatric physical therapy can play in helping children develop. (MD-Update)

    Finding that tweet spot for phone-viewing: Eric Robertson, PT, DPT, has some suggestions for avoiding neck pain from overuse of handheld devices. (Popular Science)

    Exercise after giving birth: Susan Clinton, PT, DScPT, and Marianne Ryan, PT, BS, offer advice for women who are ready to begin (or restart) exercise postpartum. (New York Times)

    Quotable: "With physical therapy, you can see patients make so many strides, and miracles happen," she said. "I've been in PT, and I've witnessed these miracles, and I believe that physical therapy is a field through which I can make a difference in the world. I believe I can help people realize, during their worst times, the strengths they may not know they have and watch as they make amazing progress." Heather Callahan-Williams, University of North Georgia student, on her plans to pursue a degree in physical therapy. (University of North Georgia News)

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

    2019 ELI Fellows Graduate From What's Now a National Award-Winning Program

    The 18 seasoned physical therapy educators who have honed their knowledge and skills over the past year through the APTA Education Leadership Institute (ELI) Fellowship program know they've been a part of something special. Apparently, the American Society of Association Executives (ASAE) agrees—it named the program as a recipient of a national award for leadership and innovation.

    The graduates of the program in July were the eighth cohort of fellows from ELI, a program that provides developing and aspiring program directors in physical therapist and physical therapist assistant education programs with the skills and resources they need to be innovative, influential, and visionary leaders.

    The final in-person gathering was held at APTA headquarters in Alexandria, Virginia, and capped off a yearlong program that included:

    • 9 online modules provided by content expert faculty;
    • 3 2-day face-to-face mentorship sessions and ongoing mentorship provided by experienced physical therapy program directors;
    • mentorship provided by higher education leaders; and
    • implementation of a personal leadership plan and an institution-based leadership project.

    This year, program faculty and participants learned that the program has earned an ASAE "Power of A" Silver Award for its leadership in "advancing society and improving the economy." The Power of A awards, according to ASAE, bestow "the highest recognition an association can receive for any program they conduct with their members."

    Partners who help promote and support the ELI Fellowship include the American Physical Therapy Association, American Council of Academic Physical Therapy, Academy of Physical Therapy Education, and PTA Educators Special Interest Group. Find out more about the ELI Fellowship on APTA's website, and view video testimonials of previous ELI graduates. Questions about the program? Contact eli@apta.org.

    The program was first accredited in 2012 by the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE), the accrediting body for postprofessional residency and fellowship programs in physical therapy, and it was reaccredited in 2017 for a 10-year period.

    2019 ELI Graduates
    This year's ELI fellows were the 8th cohort in the award-winning program.


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    APTA Programs Earn National Recognition

    APTA has once again received national honors from the American Society of Association Executives (ASAE)—this year, for APTA resources on financial literacy and student debt management, as well as for a collaborative program that helps aspiring physical therapist (PT) and physical therapist assistant (PTA) education program directors hone their leadership skills.

    ASAE announced that APTA was the recipient of 2 "Power of A" awards: a Gold Award for the association's Financial Solutions Center, and a Silver Award for its Education Leadership Institute (ELI) fellowship program. ASAE's Power of A (the A stands for "association") Awards are the industry's highest honor, recognizing the association community's valuable contributions on local, national, and global levels.

    Launched in 2017, the APTA Financial Solutions Center is a free online financial resource that includes a customizable financial education platform featuring learning on topics such as student loan debt, repayment options, loan consolidation, budgeting, and mortgages. The center also features a student loan refinancing provider that offers eligible members a discounted interest rate. In addition, the center links to certified financial planner information, scholarships, awards, grants, and the APTA Career Center, among other resources. APTA has identified student debt burden and career earning potential as challenges to the long-term sustainability of the physical therapy profession, a key element in the association's strategic plan.

    APTA's ELI program is a yearlong educational experience that includes online learning, direct mentorship, and 3 in-person meetings focused on helping PT and PTA program directors connect with resources and develop the skills they need to be innovative, influential and visionary leaders. Partners who help APTA promote and support the ELI Fellowship include the American Council of Academic Physical Therapy, Academy of Physical Therapy Education, and PTA Educators Special Interest Group.

    "We're proud to be recognized by ASAE this year, but it's even more gratifying to know that members see the value in these programs," said APTA CEO Justin Moore, PT, DPT. "Just like the awards we've received in previous years, this year's honors are a testimony to our members' level of engagement with their association, and their investment in building a professional community."

    The most recent ASAE awards marks the third consecutive year APTA has been recognized by the association industry group. In 2018, APTA, the American Occupational Therapy Association, and the American Speech-Language-Hearing Association received a joint Power of A Gold Award for their collaborative effort to end the hard payment cap on therapy services under Medicare, and APTA's membership renewal efforts earned the association a Gold Circle award for an outstanding member retention campaign. In 2017, ASAE recognized APTA's public service announcement video for its #ChoosePT campaign as the winner for best video of the year, as well as the entire #ChoosePT campaign as one of the nation's top public awareness campaigns.

    APTA Centennial Website Makes Its Debut

    Since its beginnings, APTA has shown what can be accomplished when members are connected and engaged—it's a sense of community at the heart of the association's greatest achievements, and now it's a key element in plans to celebrate APTA's 100th anniversary in 2021. That's where a new APTA centennial website—and you—come in.

    This week, APTA launched what will become the definitive online resource highlighting the association's first century, complete with multiple opportunities for members to contribute to the effort.

    The easy-to-navigate site will evolve over time, serving as a destination not only for gaining a better understanding of the association's history but for sharing artifacts, stories, and memories, learning about opportunities for centennial-related public service initiatives, and keeping up with the latest on just how APTA plans to mark its birthday in 2021.

    In fact, right now APTA is asking members to contribute ideas, photos, and thoughts via a submission form at the bottom of the webpage. Of particular interest: members' opinions on the most important milestones in the physical therapy profession.

    Check out the new site and find out how you can get involved, then be sure to revisit in the coming months for more opportunities and announcements.

    Summer Reading: 8 Great APTA Blog Posts You Might've Missed

    Graduations, vacations, family reunions, binge-watching season 3 of "Stranger Things"…it's entirely understandable if you've been a little distracted over the past few months.

    Not to worry—PT in Motion News can help, when it comes to catching up on some engaging reads. While you were out dominating the Slip 'n Slide, contributors to both the #PTTransforms and APTA Pulse Blog were exploring a range of issues, from the personal to the societal.

    Wondering what you missed? Here are quotes from 8 notable posts, with links to the articles.

    "It's the path we take when we embrace the idea that every day deserves our heartfelt best effort—not just to live that day to the fullest but to shape the future more than it shapes us. Because we want to pay it forward. Because we demand that we leave something better than we had for ourselves." -2019 Presidential Address  

    "Many black professionals have been conditioned to mask parts of their natural selves in order to avoid exclusion from professional and academic opportunities, whether in school or in a career setting." -Pressure: A Commentary on the Black Physical Therapy Student Experience  

    "When [patients] leave the hospital, they're weaker and more likely to have a fall at home. This is an unintended consequence of falls regulation and misaligned incentives." -'Bedrest is Bad': New #everyBODYmoves Campaign Is Combatting Hospital Immobility  

    "Sometimes we need to take a step back and look at things from above the ground and see that one therapist over here seems to be getting patients a little bit better, a little bit quicker… The data that the Registry will collect will help us better direct patient care, as well as identify continuing education needs." -Notes From the Field: MIPS, Quality Improvement, and the Physical Therapy Outcomes Registry  

    "After having my first academic year and clinical rotation under my belt, I sought to shift gears and get back into what made me the most happy: involvement. I decided to extend myself beyond the classroom by applying for a leadership position in my state's student special interest group." -Why Doing More Than Studying Made Me a Better Student  

    "When conducting focus groups in medically underserved communities in Chicago about residents' knowledge and use of physical therapy, my colleague and I heard several things. Two statements in particular stuck with me: 'Physical therapy is for the rich and famous,' and, 'Why don't you put a physical therapy clinic in our community?'" -Our Profession Should Be Community-Minded—and Community-Invested  

    "A few days later my grade was posted. I nonchalantly logged into the grading portal to find a 65%. Was I seriously that bad at this whole physical therapist thing? Am I just walking through life overly confident in my abilities?" -I Don't Care About My Grades  

    "Witnessing the patient's request and partaking in his end-of-life directive really forced me to contemplate and consider our physical therapist scope of practice and our role in complex situations." -Reflecting and Coping With End-of-Life Care: A Student Perspective

    Proposed Home Health Rule Moves Ahead With New Payment System, Allows Therapist Assistants to Furnish Maintenance Therapy

    The US Centers for Medicare and Medicaid Services (CMS) intends to go full steam ahead with its plans to shift to a new payment system for home health beginning in 2020. The plans are accompanied by other changes that include allowing maintenance therapy to be furnished by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs), providing a payment "add on" for rural home health care, and adopting an APTA-supported "notice of admission" requirement to avoid duplicate billing. The new provisions, which include a 1.3% payment increase, are included in CMS’ proposed rule released on July 11.

    The biggest shift has been more than a year in the making: a transition to a new payment system known as the Patient-Driven Groupings Model (PDGM). The PDGM moves care from 60-day to 30-day episodes and eliminates therapy service-use thresholds from case-mix parameters. Instead, the system classifies 30-day care episodes according to a set of 5 major buckets and subsets within those buckets. Patients are assigned a status within the 5 major areas, and within some of those areas they can be assigned to more detailed clinical categories—the combination of categories assigned to a patient generates a particular case-mix grouping. APTA offers extensive information on the new system and will participate in a live August 5 webinar on the model jointly hosted by APTA, CMS, the American Occupational Therapy Association, and the American Speech-Language-Hearing Association. APTA members can participate in this webinar (free to APTA members, login required APTA members can participate in this webinar).

    But that's not all in the proposed rule (.pdf). CMS also plans to allow PTAs and OTAs to perform maintenance therapy services under a maintenance program established by a qualified therapist, as long as the services fall within scopes of practice in state licensure laws. In addition to supervising the services provided by the therapist assistant, the qualified therapist still would be responsible for the initial assessment; plan of care; maintenance program development and modifications; and reassessment every 30 days. CMS believes the change would bring home health in line with other care settings and give home health agencies (HHAs) more latitude in how they allocate resources.

    The rule also would phase out the split payment approach that requires HHAs to submit a Request for Anticipated Payment (RAP) at the beginning of the initial episode for 60% of the anticipated final claim payment amount. A final bill for the remaining 40% is submitted at the end of the 60-day episode. RAP submissions are operationally significant, as they establish the beneficiary’s primary HHA by alerting the claims processing system that the beneficiary is under a home health plan of care and home health services are subject to consolidated billing, meaning Medicare makes payment for all home health items and services to the single HHA overseeing the plan of care.

    Instead, CMS proposes requiring HHAs to submit a notice of admission to alert the claims processing arm of CMS that a beneficiary is under a home health episode of care. The new system is a direct result of APTA advocacy, which was fueled by members in private practice settings who shared data with the association to help APTA make its case. The change will be phased in next year and fully implemented in 2021.

    APTA and its members successfully argued that the split percentage approach is fraught with logistical inefficiencies that often result in confusion for CMS and therapy providers in outpatient settings. The proposal to replace the RAP with the notice of admission, to be submitted within 5 days of the start of care, would be needed to establish the primary HHA so the claims processing system would be alerted to a home health period of care, helping to eliminate the possibility of any lag time between a beneficiary's admission in home health and the HHA's notice of the admission to CMS. This too-common delay trips up outpatient providers who begin treatment (and billing) before CMS knows that the beneficiary has transitioned to home health. CMS describes the change as "an important step in paying responsibly and appropriately for home health services," according to an agency fact sheet on the proposed rule.

    As for payment, home health would see an overall 1.3% boost—about $250 million. The increase, initially targeted at 1.5% to comply with the Bipartisan Budget Act of 2018, was decreased by .2% to accommodate a rural add-on policy.

    Among other elements of the proposed rule:

    SPADE requirements are expanding. CMS is continuing its efforts to increase the range of standardized patient assessment data (SPADE) reported by HHAs. The use of SPADE in home health was instituted to bring HHAs up to speed with provisions of the 2014 IMPACT Act, a law that mandated more uniformity in reporting across postacute care settings. The proposed rule would follow through with the expansions, but it also includes requirements for reporting on cognitive function and mental status, comorbidities, and social determinants of health, among other categories. HHAs would be required to report these additional elements beginning in 2022 for admissions and discharges that occur between January 1 and June 30, 2021.

    A pain measure would be discontinued. Partially in response to concerns about the potential for overprescription of opioids, CMS is proposing to remove the Improvement in Pain Interfering with Activity Measure (NQF #0177) from the Home Health Quality Reporting Program (HH QRP) beginning in 2022. Under this proposal, HHAs would no longer be required to submit OASIS Item M1242, "Frequency of Pain Interfering with Patient’s Activity or Movement" for quality reporting purposes beginning in 2021.

    A pain-related question would be deleted from patient surveys. CMS proposes to remove a patient survey question that asks whether the patient and provider talked about pain in the past 2 months. The question, currently in the "Special Care Issues" composite measure, would be dropped beginning July 1, 2020. Similar to the pain measure being proposed for deletion, the survey question is being eliminated due to concerns about the ways it might influence unnecessary drug prescriptions. The changes are consistent with an earlier CMS decision to eliminate pain-related items from hospital patient surveys.

    APTA continues to review the proposed rule and will provide comments to CMS by the September 9 deadline. In the coming weeks, APTA also will post a unique template letter on its Regulatory Take Action webpage for individuals to use to submit their own comments on the proposed rule.

    APTA-Backed Bill to Provide Diversity-Based Scholarships, Stipends Introduced in House

    APTA's efforts to create a physical therapy profession as diverse as the society it serves could be getting a significant legislative boost: a new bill introduced in the US House of Representatives seeks to provide $5 million per year in scholarships and stipends aimed at increasing the number of students from underrepresented populations in physical therapy and other allied health education programs.

    Introduced by Reps Bobby Rush (IL) and Cathy McMorris Rogers (WA), the Allied Health Workforce Diversity Act of 2019 would set aside money in the Health Resources and Services Administration specifically for use by accredited education programs in physical therapy, occupational therapy, audiology, and speech-language pathology. Those programs would in turn issue scholarships or stipends to students from underrepresented populations including racial or ethnic minorities and students from disadvantaged backgrounds including economic status and disability. APTA, the American Occupational Therapy Association (AOTA), the American Speech-Language-Hearing Association (ASHA), and the American Academy of Audiology (AAA) were instrumental in crafting language for the bill.

    The legislation falls squarely in line with APTA's strategic plan, which identifies greater provider diversity as necessary to ensure the long-term sustainability of the physical therapy profession.

    "We must build a diverse profession by ensuring there are opportunities that allow for inclusion of all individuals who want to become physical therapists and physical therapist assistants," said APTA President Sharon Dunn, PT, PhD, in a joint news release issued by APTA, AOTA, ASHA, and AAA. "The population we serve is evolving and becoming more diverse. We know that patients who receive care from providers who share their racial and ethnic backgrounds tend to respond better to treatment. That's one reason this legislation is so important, and we applaud the representatives who have introduced it."

    APTA government affairs staff will track the bill's progress and share opportunities for grassroots advocacy. The association will add information to its Legislative Action Center later this week for members to use to support the legislation.

    Survey of PTs Reveals 'Significantly Inadequate' Rates of BP and HR Measurement

    Despite the frequency with which physical therapists (PTs) in outpatient settings encounter patients who have or are at risk for cardiovascular disease (CVD), rates of blood pressure (BP) and heart rate (HR) screening remain "significantly inadequate," say authors of a new study based on a nationwide survey of PTs. The survey reveals that only 14.8% of respondents reported measuring BP and HR on initial examination of new patients, and sheds some light on factors that influence the tendency to perform the screens—or forgo them.

    The analysis, published in the July issue of PTJ (Physical Therapy), is based on survey responses from 1,812 PTs who worked in outpatient settings and were members of the APTA Academy of Orthopaedic Physical Therapy at the time of the survey. The survey was administered online and consisted of 30 multiple-choice questions that delved into CVD-risk screening behaviors and related rationales as well as demographics and education background of the respondents, and patient characteristics.

    The results showed that although 51% of PTs reported that at least half of their current caseload included patients with or at moderate-to-severe risk of developing CVD—and 28% reported that more than 50% of their patients were in this category—only 14.8% said that BP and HR screenings were a regular part of their initial examination of a new patient. When researchers dug deeper into the results, they uncovered other interesting details, including:

    • Nearly 7 in 10 PTs (68.9%) said they encountered a new patient with or at risk for CVD at least twice a week, and 29% said they encountered this kind of new patient daily.
    • In terms of how frequently BP and HR were measured at the initial visit, 63.74% of the respondents reported doing the measurements less than 50% of the time; 39.8% said they conducted the screenings less than 25% of the time; and 13% responded by saying that they never measured BP or HR.
    • The most commonly reported barriers to BP and HR screening were lack of time (37.44%) and "lack of perceived importance" (35.62%). Most respondents reported that they were adequately equipped to perform routine screening and felt confident in their ability to do so.
    • When it came to factors that were linked to more frequent BP and HR measurements, respondents with higher percentages of patients with or at risk for CVD tended to perform the screenings more often, as did PTs who had completed a residency or fellowship training program, and clinicians with more than 20 years of practice experience. Possessing a board-certified specialization credential of any kind was not linked with increased likelihood of conducting the screenings.

    Authors of the PTJ article describe the results as "surprising," particularly given the typical respondent caseload and the PTs' apparent confidence in their ability to perform BP and HR screenings. They write that current rates, while better than in the past, are still "significantly inadequate in relation to the high rates of CVD risk factors present in the patient population."

    As for what might be done to improve the rates, the researchers point to the link between postprofessional education (specifically, residencies and fellowships) and increased screening as one promising possibility, but they also stress other avenues for increasing clinician knowledge, such as wider use of social media to "improve clinician knowledge and practice patterns." Clinics could make a difference as well, they add, by changing policy to emphasize the importance of initial BP and HR measurements.

    APTA members Richard Severin, PT, DPT, PhD(c); Adam Wielechowski, PT, DPT; and Shane Phillips, PT, PhD, were among the authors of the study. Severin is a board-certified cardiopulmonary clinical specialist; Wielechowski is a board-certified specialist in orthopaedic physical therapy.

    [Editor's note: for an exploration of the importance of blood pressure screening and the role of PTs, check out this #PTTransforms blog post that discusses the impact of changes made to blood pressure guidelines in 2018.]

    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.

    JAMA Neurology: Telerehab Program Works as Well as Clinic-Based Program for Improved Arm Function Poststroke

    It's probably not news to physical therapists (PTs) when research backs up the idea that patients who experience arm impairments poststroke will tend to make greater functional improvements with larger and longer doses of rehabilitation. Unfortunately, PTs are also familiar with the fact that what's optimal isn't necessarily what's typical, with challenges such as payment systems, logistics, and clinic access making it difficult to achieve the best possible results. That's where telerehabilitation could make a big difference, say authors of a new study that found an entirely remotely delivered rehab program to be as effective as an equal amount of clinic-based sessions.

    The findings lend further support to the ideas behind APTA's efforts to increase telehealth opportunities for PTs and their patients—a significant component of the association's current public policy priorities. In addition, APTA provides multiple telehealth resources on a webpage devoted to the topic, and has created the Frontiers in Research, Science, and Technology Council that provides interested members and other stakeholders with an online community to discuss technology's role in physical therapy.

    The study, published in JAMA Neurology (abstract only available for free), involved 124 participants who experienced arm motor deficits poststroke. All participants were enrolled in a rehabilitation therapy program that included 36 70-minute treatment sessions, half of which were supervised, over a 6- to 8-week period. The only major difference: one group's supervised sessions were face-to-face with a physical therapist (PT) or occupational therapist (OT), while the other group received telerehab from a PT or OT via a computer with video capabilities, accompanied by the use of a gaming system.

    Researchers were interested in finding out how patients fared in each approach, using scores from the Fugl Meyer (FM) assessment of motor recovery poststroke as their primary measure. Authors of the study also measured patient adherence with therapy as well as levels of patient motivation related to how well they liked the therapy they were receiving and their degree of dedication to treatment goals.

    Using a treatment approach "based on an upper-extremity task-specific training manual and Accelerated Skill Acquisition Program," researchers set up matched programs that included at least 15 minutes per session of arm exercises from a common set of 88 possible exercises, at least 15 minutes of functional training, and 5 minutes of stroke education. The clinic-based participants received in-person instruction on the exercises and used "standard exercise hardware"; the telerehab patients received instructions via video link and engaged in functional exercise via a videogame interface. Here's what the researchers found:

    • Both groups improved at about the same rate, with the telerehab participants averaging a 7.86 FM gain, compared with an average gain of 8.36 points for the clinic-based group.
    • Improvements were also about the same for the subgroup of participants who entered rehabilitation more than 90 days poststroke, with these "late" participants averaging a 6.6-point gain for the telerehab group and a 7.4-point increase for the clinic-based group.
    • While both groups reported high levels of dedication to treatment goals, the clinic-based group tended to report better levels of motivation and satisfaction. Adherence was also high for both groups, with a 93.4% adherence rate for the clinic-based group and a rate of 98.3% for the telerehab group.
    • Both groups increased their knowledge of stroke at similar rates.

    As for the technical details of the telerehab sessions, the system included a computer linked to the internet, a table, a chair, and 12 "gaming input devices." Keyboards were not necessary. The supervised sessions began with a 30-minute videoconference between the patient and therapist, and the functional training games used were designed to match the functional task work being done with the clinic-based participants. Unsupervised sessions adhered to the same content but didn't include contact with the therapist.

    "In an era when prescribed doses of poststroke rehabilitation therapy are declining, adversely affecting patient outcomes, these and prior findings suggest that outcomes could be improved for many patients…if larger doses of rehabilitation therapy were prescribed," authors write. "Our study found that a 6-week course of daily home-based [telerehab] is safe, is rated favorably by patients, is associated with excellent treatment adherence, and produces substantial gains in arm function that were not inferior to dose-matched interventions delivered in the clinic."

    Authors acknowledged that patient satisfaction with telerehab might be improved by increasing the amount of time spent with the therapist—providing that therapist is properly trained. "Current results underscore the importance of maintaining a licensed therapist's involvement during [telerehab]," they write.

    Ultimately, it's still too early to determine just how generalizable the findings are to other populations and conditions, the researchers say, but all indicators seem to point to the need for increasing the availability of telerehab and its inclusion in health plans.

    "The US Bipartisan Budget Act of 2018 expanded telehealth benefits," authors write. "Eventually, home-based [telerehab] may plan an ascendant role for improving patient outcomes."

    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.

    From PT in Motion Magazine: Social Determinants of Health

    Health care is one thing. But the context of that care, the constellation of factors that can affect health for individuals and entire communities? That's something else entirely—and physical therapists (PTs), physical therapist assistants (PTAs), and physical therapy education programs are engaged.

    Now available in the July issue of PT in Motion magazine: "Addressing Social Determinants of Health," an exploration of the ways the physical therapy profession is responding to the concept that improving the health of society demands providers, researchers, educators, and policymakers get involved with the economic, environmental, and behavioral factors that can shape health. These factors, broadly referred to as social determinants of health (SDOH), can seem overwhelmingly systemic, but that isn't stopping some APTA members from taking them on in a variety of creative, impactful ways.

    The article shares the work of several PT-led organizations, including Move Together, which works to provide physical therapy infrastructure to areas in need (among other programs); Mama LLC, a physical therapy consulting service focused on improving women’s health domestically and internationally; and the Arlington, Virginia, Free Clinic, led by Nancy White, PT, DPT, which has embraced SDOH-conscious practices in its programs. Author Christine Lehmann also looks at SDOH-related research being performed by PTs, as well as the ways physical therapy education is responding to the concept.

    As the article explains, SDOH can include cultural and economic variables, but other factors such as the built environment and climate change can even come into play. At the same time, the concept also calls for PTs and PTAs to change their day-to-day approach to working with patients by considering—and acknowledging—the realities of a patient's environment, from micro to macro.

    "Addressing Social Determinants of Health," featured in the July issue of PT in Motion magazine, is open to all viewers—pass it along to nonmember colleagues to show them 1 of the benefits of belonging to APTA. Also open to all: "Looking at Physical Therapy Holistically," an article on how PTs are addressing both the body and mind in treatment, and "Providing Onsite Physical Therapist Services," a look at PTs who bring their services to patients.

    APTA, AOTA, ASHA Create Guide to Assess Habilitative, Rehabilitative Insurance Benefits

    Insurers' habilitation and rehabilitation benefits come in all shapes and sizes—which is exactly the problem, according to APTA, the American Occupational Therapy Association (AOTA), and the American-Speech-Language-Hearing Association (ASHA). That's why the 3 organizations collaborated on a guide to assessing benefit adequacy that emphasizes transparency, access, and affordability throughout benefit plans that can be all over the map.

    The guide, available on APTA's Essential Health Benefits webpage, forgoes offering a laundry list of specific benefits in favor of establishing a set of principles that the associations believe lead to appropriate coverage of habilitative and rehabilitative services. Those principles are rooted in the idea that the benefits are necessary not just to improve function but also to maintain it, and that physical therapy, occupational therapy, and speech-language pathology are the "key" services in any habilitation/rehabilitation benefit package. The collaborative document echoes many of the themes included in APTA's public policy priorities, which emphasize increased patient access, cost and coverage transparency, and use of telehealth in service delivery.

    The resource addresses how best to ensure adequate scope of coverage and access, appropriate provider qualifications, and essential benefit information needed for consumers to determine if a plan meets their needs. It also provides tips and recommendations for consumers as well as plan providers and policymakers.

    However, the guide isn't just a collection of broad statements—APTA, AOTA, and ASHA also dig into some specifics when it comes to adequate habilitation and rehabilitation coverage, including:

    • Using the definition of habilitative and rehabilitative services adopted by the US Department of Health and Human Services
    • Creating separate rather than combined visit limits for physical therapy, occupational therapy, and speech-language pathology
    • Ensuring direct access to all 3 therapies
    • Providing clear information to consumers on whether benefits can be delayed due to utilization management practices, whether telehealth is permitted, and if same-day physical therapy, occupational therapy, and speech-language pathology services are allowed

    As for recommendations for plan improvements, the 3 organizations offer 14 ideas they believe would advance "optimum value" and increase patient access to therapy services. Those suggestions include wider use of telehealth, recognition of the role of therapy providers in population and preventive health, ending policies that limit coverage of each therapy discipline to 1 condition, and stronger acknowledgement that "rehabilitative maintenance therapy and habilitative services are allowed for individuals with chronic, progressive conditions…to prevent further deterioration of function."

    APTA Members Can Now Get $175 Off MedBridge Subscription

    MedBridge, a leading provider of health care continuing education, is now a part of APTA's Member Value Program (MVP). That's good news for APTA members, who can now save $175 off the regular $375 subscription to the company's extensive list of offerings.

    The addition of MedBridge allows APTA to expand the range of educational resources offered to its physical therapist (PT), physical therapist assistant (PTA), and student members by opening up discounted access to more than 1,000 MedBridge-sponsored video courses and live webinars. For more information, APTA's MedBridge discount webpage.

    "This offering increases the value of APTA membership and supports our members in their ongoing commitment to provide the best possible care,” said APTA CEO Justin Moore, PT, DPT.

    APTA's Member Value Program provides discounts and other opportunities for APTA members, in addition to standard member benefits. To maximize the value of membership, visit the APTA Member Benefits and Value page.

    APTA Survey: PTs Say Administrative Burdens Delay Access, Affect Clinical Outcomes

    Think that administrative burdens are hurting your ability to provide the best possible care? You're not alone: results of a recent APTA survey of physical therapists (PTs) nationwide reveal that nearly 3 in 4 believe that overreaching documentation and administrative mandates negatively affect patient outcomes—and 8 in 10 point to excessive requirements as a contributor to clinician burnout.

    The results are now part of an infographic that helps with the association’s efforts for legislative and policy changes to rein in excessive requirements around areas including prior authorization and claim denial appeals. Among the findings:

    Prior authorization requirements delay care and affect clinical outcomes.

    • Three quarters of respondents said that prior authorization requirements delay access to medically necessary care by 25% or more.
    • 72% of survey participants estimated that they wait at least 3 days for a prior authorization decision from an insurer.
    • Just over 1 in 4 respondents said that the wait time is usually more than a week.
    • Approximately 3 in 4 PTs agreed or strongly agreed that prior authorization requirements negatively impact patients' clinical outcomes.

    Claim denial appeals are time-consuming (and often contradictory).

    • 40% of respondents told APTA that payers who say they don't require prior authorization later deny approximately 25% of claims for lack of prior authorization.
    • 65% of PTs said that it takes more than 30 minutes of staff time to prepare an appeal for 1 claim.
    • When it comes to rates of claim denials, appeals, and final dispensation, respondents estimated that 13% of filed claims are denied; of that 13%, 66% are appealed. And in the end just over half of the appeals—52.34%—are overturned.

    Administrative burden is adding to cost—and burnout.

    • The survey revealed that large percentages of both front desk staff and clinicians spend more than 10 minutes per patient requesting approval for continued visits, ranging from 64.6% of clinicians working with Medicaid fee-for-service beneficiaries, to 77.3% of front desk staff requesting continued visits for Medicaid managed care patients.
    • More than three-quarters of facilities—76.5%—reported that they've had to add nonclinical staff to handle administrative burden.
    • 85.2% of respondents agree or strongly agree that administrative burden contributes to clinician burnout.

    As for what changes would make the most difference, just over half of respondents believe that standardizing documentation requirements would be a big help. Other popular adjustments were elimination of the requirement for the Medicare plan of care signature and recertification (38.8%), standardization of coverage policies across payers (38.1%), unrestricted direct access (36.1%), and standardization of the prior authorization process (36%).

    "APTA has long argued that excessive administrative burden negatively impacts care—what's important about this survey is the consistency of responses and the level of shared perception among PTs who experience this issue every day," said Kara Gainer, APTA director of regulatory affairs. "Administrative burden isn't a nebulous issue for providers—it is a very real barrier to delivering care, with identifiable pain points and very specific areas in need of change."

    The association continues to place the reduction of administrative burdens high on its advocacy list and has again identified the issue as among it 2019-2021 public policy priorities. One recent opportunity: a request for information (RFI) from the US Centers for Medicare and Medicaid Services (CMS) on reducing administrative burden. APTA will provide comments by the August 12 deadline and has made it easy for individual clinicians to submit comments by way of a template letter that can be personalized to suit specific circumstances. APTA is also developing a template letter that can be used by patients and will post a link to it on the association's regulatory "take action" webpage.

    At the same time, a legislative advocacy opportunity emerged in the form of a congressional bill aimed at improving access to health care for older Americans through, among things, reducing administrative burdens on providers. Known as the "Improving Seniors' Timely Access to Care Act of 2019," (H.R. 3107), the bill was introduced into the US House of Representatives by Reps Suzan DelBene (WA), Mike Kelly (PA), Roger Marshall (KS), and Ami Bera (CA). APTA staff will add information to the Legislative Action Center in the coming weeks for members to use to advocate in support of this legislation.

    “Current prior-authorization programs hinder patient access to medically necessary services and must be modified,” said Katy Neas, APTA executive vice president for public affairs. "But this is just 1 element of the wider administrative burden issue, and APTA will continue to advocate for change on multiple fronts."