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  • Get 'Caught Doing Good,' and APTA May Donate $500 to Your Charity of Choice

     PTDOS

    Making plans for the Global PT Day of Service coming up on October 13? Snap a picture of what you're up to, and your charity of choice could wind up with a $500 donation from APTA.

    Now in its third year, the Global PT Day of Service is an initiative designed to inspire physical therapists (PTs), physical therapist assistants (PTAs), students, and supporters of the profession to step up and make a difference in the lives of others through community service. All types of service efforts are welcomed, from volunteering at a pro bono clinic, to cleaning up a local park, to providing community children with working bicycles. It's a great time to get creative with impactful ideas that help underscore the transformative power of the physical therapy profession.

    Again this year, APTA is highlighting the day by way of a photo contest. The rules are simple: share a photo or set of photos from your community event through social media during the week of October 8-13. Be sure to use the hashtag #PTDOS, and you're entered. APTA will choose a winner and donate $500 to the charity of the winner's choice—as well as publish the photo or photos on the APTA website. Photos must be posted by midnight Friday, October 19, to be considered.

    Looking for more ways to demonstrate the profession's investment in improving communities? Here are a few ideas.

    Pledge to Participate in PT Day of Service
    Join fellow members of the physical therapy profession around the world in a day of service to our communities. Learn how you can make a difference!

    50-Chapter Challenge
    Get your APTA state chapter involved in Global PT Day of Service by sponsoring an activity on October 13. Sponsorships are available for as little as $250, and participation includes any community service activity. It's a great way to build membership, build community, and raise funds for better access to quality PT and PTA services. Contact info@ptdayofservice.com for more information.

    Alexandria, Virginia, Area: Join APTA Staff for Blood Drive
    Join APTA staff members to participate in a neighborhood blood drive at APTA headquarters on October 3, 9:30 am–3:00 pm. The Inova Blood Donor Services mobile donation vehicle will be onsite collecting blood and blood supplies for use in Hurricane Florence relief efforts. Sign up online today.

    Alexandria, Virginia, Area: Join APTA Staff to be a Baseball 'Angel'
    APTA staff and local APTA members will participate in the Miracle League of Alexandria baseball game Saturday, October 13, 1:00 pm–2:30 pm and Wednesday, October 17, 4:30 pm–6:30 pm by acting as "Angels in the Outfield." Volunteers will assist Miracle League players to run bases—either running for them, pushing wheelchairs, or just helping them and encouraging them along. Show up to cheer on the players, or sign up to be an angel.

    Explore Other Possibilities
    Contact a Global PT Day of Service Ambassador to discuss ideas and opportunities—the possibilities are wide open.

    APTA Working for You: Commercial Payer Updates, September 2018

    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.

    APTA partners with the American Chiropractic Association (ACA) to submit application for a dry needling CPT code
    APTA and ACA staff and member experts are presenting the application for a dry needling CPT code at the American Medical Association CPT Meeting in Boston, September 27-29. APTA will provide an update on the results of the meeting after the meeting information is made public.

    Aetna and Magellan Health launch a new UM program in 4 states
    On September 1, 2018, Aetna rolled out a new utilization management (UM) program using Magellan/NIA as the vendor. The program is active in West Virginia, Pennsylvania, Delaware, and New York. APTA is actively engaged with Aetna and Magellan, along with chapter leadership of the included states, to mitigate impacts on patient access and administrative burden.

    APTA hosts another successful Insurers' Forum
    On September 14, 2018, APTA hosted its annual Insurers' Forum. Thirty-four payer representatives and case managers from around the country attended the meeting, an event that brings together representatives from the payer policy, case management, and health care industry to discuss trends in physical therapy that affect payment.

    Again this year, the forum was well-received as an opportunity "to collaborate with other PTs on the insurance side," as one attendee stated.

    APTA staff to lead a National Quality Forum work group on opioid stewardship
    APTA Senior Payment Specialist Alice Bell, PT, DPT, has been identified as a work group lead for the National Quality Partnership Opioid Stewardship Member Network. This group will expand on the work of the National Quality Partnership Opioid Stewardship Workgroup to promote adoption of effective strategies for opioid stewardship. Bell will moderate the first webinar of this group, titled "Partnering With Patients for Pain Management: the Path to Opioid Stewardship," and to held on October 2. To join the Opioid Stewardship Member Network, email the NQF Member Network.

    Aetna's policy clarifications increase access to PT Care
    Major commercial insurer Aetna recently provided clarification on policies related to payment for physical therapy, and it's good news for physical therapists (PTs) and their patients.

    The clarifications help to answer questions related to the company's physical therapy policy, specifically around payment for evaluations and the ways direct access provisions can affect payment. A recent PT in Motion News story covered the highlights.

    More on the Aetna clarifications: evaluations could be eligible for payments sooner than the 180-day wait period
    Although Aetna's policy reads that "physical therapy evaluations will be eligible for payment once every 180 days," Aetna representatives have informed APTA that evaluations performed within 180 days of the original evaluation may be allowed upon reconsideration or appeal, providing the evaluation is for a new or unrelated condition.

    APTA attends National Business Group on Health's "Workforce Strategy" conference
    As part of APTA's ongoing efforts to engage employers and better understand their challenges, APTA staff attended the "Workforce Strategy: The Future of Work, Life and Health" conference sponsored by the National Business Group on Health, (NGBH). The agenda included topics such as employee engagement, digital health, results of health-related pilot projects and emerging innovations for better health and well-being. The importance of determining centers of excellence using data was stressed. Several presenters mentioned physical therapy for low back pain in lieu of surgery and the need to assess the cost savings of avoiding the surgery. The members of the NBGH represent the human resources and health benefits interests for some the largest companies in the US, most with a global footprint. Its goal is to help employers optimize business performance through creative health improvement and health care management initiatives.

    Tiered coding for PT evaluations: new APTA podcast series answers common questions
    As the payment landscape for 2019 comes into focus, it's becoming clear that physical therapists (PTs) will continue coding evaluations according to a 3-tiered system based on patient complexity.

    In its latest efforts to help underscore the importance of continued accurate coding, APTA produced a series of free podcasts on the CPT evaluation codes. The 5-part series covers a general overview of the coding change and addresses common questions related to determining levels of stability, documenting elements, the relationship of examination time to code selection, and coding in reevaluation. With episodes ranging from 5 to 8 minutes in length, the individual podcasts are convenient for quick listens on the go or during breaks at the clinic.

    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. Questions? Email advocacy@apta.org.

    Get Involved: Flash Action September 26-27 Will Focus on Physical Therapy's Role in Pain Management

    Led by students in physical therapist (PT) and physical therapist assistant (PTA) programs, APTA members will focus their energies on advocating for the effectiveness of physical therapy in pain management when this year's Flash Action Strategy (FAS) takes place September 26-27—and you're invited to be part of the action.

    The innovative concentrated advocacy effort will use the APTA Legislative Action Center to contact members of Congress to press for better patient access to nonopioid pain treatments including physical therapy. The effort makes use of APTA's #ChoosePT opioid awareness campaign and emphasizes the importance of team approaches to pain management.

    Getting involved is easy. APTA has prepared resources and will provide a prewritten letter on this issue when the flash action effort starts on Wednesday, September 26. You also can watch the announcements on the APTA Student Assembly Facebook page and Twitter feed (@APTASA) for updates on this important advocacy initiative. In the meantime, spread the word using graphics available for download on the FAS webpage.

    APTA Media Tour Brings #ChoosePT Message to Local, National Media Outlets

    PT in Motion News
    Sarah Wenger, PT, DPT, at left, joined Prevention magazine executive editor Sarah Smith for a live social media broadcast that looked at the #ChoosePT campaign and the role of physical therapy in pain management and other health issues. The interview was part of an APTA nationwide satellite media tour.

    Don't touch that dial: thanks to a recent satellite media tour, APTA's #ChoosePT opioid awareness campaign and the physical therapy profession are receiving local media coverage in more than 30 outlets across the country. And that's not even counting exposure the profession received from a social media broadcast.

    The "tour" involved linking up with TV and radio stations across the country to arrange for short remote interviews with Sarah Wenger, PT, DPT, a clinician and educator with extensive experience in working with patients experiencing chronic pain. Wenger, who was a panelist on APTA's "Beyond Opioids" Facebook Live broadcast in February, is also a board-certified specialist in orthopaedic physical therapy.

    By the beginning of the tour day on September 21, 30 interviews were booked—18 for television and 12 for radio. The interviews varied but generally touched on #ChoosePT, the move toward nonopioid, multidisciplinary approaches to pain treatment, why physical therapy is a key player, and what patients can expect. A few were broadcast live, but the majority of interviews were recorded for later playback—meaning there's a chance you could hear an interview in the coming days and weeks. Check out this video of a live interview from Fox2 Now, in St Louis, for an example.

    In addition to television and radio coverage, Wenger was also the guest for a 30-minute Facebook Live broadcast hosted by Prevention magazine executive editor Sarah Smith. That more in-depth interview allowed Smith and Wenger to discuss at length the more personal, patient-centered relationships physical therapists and physical therapist assistants try to build with their patients.

    Wenger also explained the role of physical therapy in responding to patients in pain.

    "We at APTA definitely believe that it's not opioids or physical therapy, or that physical therapy is the single treatment," Wenger said. "We really do see ourselves as part of the interdisciplinary team. We can work with people who are taking opioids, we can work with people who are weaning off, and we can work with people who are pursuing treatment instead of opioids."

    "The level of interest in the #ChoosePT message in the media is truly encouraging," said Erin Wendel-Ritter, APTA manager of media relations and consumer communications and organizer of the tour. "And we couldn't have asked for a better spokesperson for the campaign and the profession—Sarah handled every interview with enthusiasm and candor, and consistently made the case for physical therapy's role in pain management."

    Want to keep an ear or eye out for #ChoosePT coverage in your area? Here's a list of the outlets and programs that recorded interviews for later broadcast (actual broadcast times not available):

    Radio Interviews
    National Podcast: "The Ron Van Dam Show"
    Boston (WBZ-AM)
    Omaha (KFAB-AM)
    Portland, Oregon (KLCK-AM)
    Roanoke, Virginia (WBTM AM)
    Seattle (KORE-FM)
    Toledo, Ohio (WFIN-AM)

    Television interviews
    National: "NewsWatchTV," ION
    National: "Daily Flash"
    New Orleans (WWL CBS)
    Albuquerque (KOB NBC)
    Baltimore (WMAR ABC)
    Huntsville, Alabama (WYAM IND)
    Odessa, Texas (KOSA CBS)
    Raleigh, North Carolina (WEKS IND)
    Sacramento, California (KXTV ABC)
    San Antonio (KENS CBS)
    Savannah, Georgia (WSAV NBC)
    St Louis (KDKZ IND)
    Tampa (WFTS ABC)
    Terre Haute, Indiana (WTWO NBC)
    Washington, DC (WNC IND)

    Research Roundup Underscores 'Go4Life' Healthy Aging Message

    Even though the National Institutes of Health's "Go4Life" month is wrapping up, the initiative will continue to offer resources to providers and the public. And for good reason.

    Strongly supported by APTA, Go4Life is an ongoing effort to connect the public and health care providers with information and resources related to healthy aging. In addition to information on how exercise improves health, the Go4Life website includes suggested exercises, workout videos, fitness tracking resources, and access to printed materials including infographics, posters, bookmarks, and postcards, all available for free. The program also offers a free "Speaker's Toolkit" to help providers develop presentations to target audiences—available by emailing Go4Life@mail.nih.gov.

    Of course, staying physically active for healthy aging isn't just a good idea—it's a concept supported over and over again by research. A lot of research. To give you an idea of the level of support for the positive effects of physical activity on aging, here's a quick overview of just some of the research articles that have been published on this topic during the month of September alone.

    Is Objectively Assessed Sedentary Behavior, Physical Activity and Cardiorespiratory Fitness Linked to Brain Plasticity Outcomes in Old Age? (Neuroscience)

    From the abstract: "Our results indicate that regular physical activity might be beneficial for preserving brain plasticity in higher age. In this study these associations were not mediated significantly by physical performance. Overall physical activity and exceeding current moderate to vigorous physical activity recommendations were positively associated with [brain-derived neurotrophic factor]. Sedentary behavior, however, seems to be negatively related to neurotrophic factor bioavailability in the elderly."

    Which is more important for cardiometabolic health: sedentary time, higher intensity physical activity or cardiorespiratory fitness? The Maastricht Study. (Diabetologia)

    From the abstract: "These data suggest that sedentary time, higher intensity physical activity, and cardiorespiratory fitness should all be targeted in order to optimally reduce the risk for the metabolic syndrome and type 2 diabetes."

    Physical Activity, Function, and Mortality in Advanced Age: A Longitudinal Follow-Up (LiLACS NZ) . (Journal of Aging and Physical Activity)

    From the abstract: "Higher levels of physical activity were associated with lower mortality and higher functional status in advanced-aged adults."

    Repeated assessments of physical activity and risk of incident venous thromboembolism. (Journal of Thrombosis and Haemostasis)

    From the abstract: "Our findings suggest that regular physical activity is associated with lower risk of venous thromboembolism, particularly in elderly. The association occurred at a low weekly amount of physical activity, and was only partly mediated by body mass index (BMI)."

    Physical Activity and Incidence of Heart Failure in Postmenopausal Women. (Heart Failure)

    From the abstract: "Higher levels of recreational physical activity, including walking, are associated with significantly reduced heart failure risk in community-dwelling older women."

    Association between leisure-time aerobic physical activity and vitamin D concentrations among US older adults: the NHANES 2007-2012 . (Aging Clinical and Experimental Research)

    From the abstract: "Leisure-time physical activity appears to be an effective manner of maintaining adequate vitamin D concentrations later in life. Therefore, promoting physical activity in older adults should be a national public health priority."

    Associations Between Objectively Measured Physical Activity, Body Composition and Sarcopenia: Findings from the Hertfordshire Sarcopenia Study (HSS). (Calcified Tissue International)

    From the abstract: "Community-dwelling older adults in this study were largely sedentary but there was evidence that higher levels of activity were associated with reduced adiposity and improved function. Physical activity at all intensity levels in later life may help maintain physical function and protect against sarcopenia."

    Home-Based Physical Activity Program Improves Depression and Anxiety in Older Adults. (Journal of Physical Activity & Health)

    From the abstract: "A home-based physical activity intervention may be a viable treatment for reducing depression and anxiety in older adults with elevated baseline scores."

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    Are You Fall-Savvy? Take This Quick Quiz

    Falls Prevention Awareness Day is set for September 22, making now a great time to check out falls-related resources on APTA's recently updated Balance and Falls webpage. But before you do, see how you score on this 8-question quiz on falls statistics and screening (scroll down for answers). Good luck!

    1. According to the US Centers for Disease Control and Prevention (CDC), approximately how many Americans aged 65 and older experience a fall every year?
    A. 1 in 3
    B. 1 in 4
    C. 1 in 5
    D. 1 in 6

    2. According to a clinical guideline statement from the APTA Academy of Geriatric Physical Therapy (AGPT), what question should physical therapists (PTs) routinely ask older adult patients?
    A. "What medications are you currently taking?"
    B. "Are you experiencing feelings of dizziness?"
    C. "Have you been diagnosed with diabetes?"
    D. "Have you had any falls in the last 12 months?"

    3. Between 2007 and 2016, death rates due to falls in the US increased by what percentage?
    A. 3%
    B. 15%
    C. 24%
    D. 31%

    4. Authors of a 2012 study in the Journal of Aging and Physical Activity studied a particular activity and found that adults who engaged in this activity had a reduced risk for falls. Which activity did researchers target?
    A. Gardening
    B. Driving a car
    C. Shopping
    D. Light household chores

    5. A recent study in the American Journal of Preventive Medicine found that the falls risk factor affecting the largest number of adults 65 and over is:
    A. Visual impairments
    B. Medication interaction
    C. Home hazards
    D. Vitamin D deficiency

    6. A recent CDC study ranked US states according to older adult death rates due to falls in 2016. At 142.7 per 100,000 individuals, which state reported the highest death rate?
    A. Alabama
    B. Florida
    C. Arizona
    D. Wisconsin

    7. According to the CDC, among men and women aged 65 and older, which group has the highest rate of nonfatal falls, and which has the highest rate of fatal falls?
    A. Men have the highest rates of both fatal and nonfatal falls.
    B. Women have the highest rates of both fatal and nonfatal falls.
    C. Women have higher rates of nonfatal falls; men have higher rates of fatal falls.
    D. Men have higher rates of nonfatal falls; women have higher rates of fatal falls.

    8. According to a survey of emergency department physicians in the US and Canada, the bathroom is the most risky location for a fall in the home among adults 65 and older, with 69% of home falls occurring in that space. Which area comes in second?
    A. Kitchen
    B. Bedroom
    C. Stairs
    D. Living room

    ANSWERS:

    1. B - About 24% of older Americans fall each year—the leading cause of fatal and nonfatal injuries among older Americans, according to the CDC.

    2. D - There are of course many questions that may be appropriate for providers to ask (including some of the choices listed here), but the question that should never be skipped is whether the patient has experienced any falls in the past 12 months, according to the AGPT guidelines. Previous falls are 1 of the strongest falls risk factors, and should never be ignored.

    3. D - Falls-related deaths rose by 31% between 2007 and 2016, according to the CDC. During the 10 years tracked in the study, falls-related deaths among US residents 65 and older rose from 18,334 to 29,668—in terms of rates of death from falls, that's an increase from 47 per 100,000 to 61.6 per 100,000 in that age group. Deaths climbed by about 3% per year, according to the report.

    4. A - In the study, researchers focused on gardening, and concluded that "gardeners reported significantly better balance and gait speed and had fewer chronic conditions and functional limitations than nongardners." They believed the findings "suggest that gardening may be a potential activity to incorporate into future fall-prevention programs."

    5. C  - Home hazards were the leader in terms of falls risk factors, but that isn't to say other factors don't come into play as well, say authors of the study.

    6. DAccording to the CDC, Wisconsin had the highest falls-related death rate among adults 65 and older, at 142.7 per 100,000. Authors aren't sure of the reasons for the variance but suspect that the numbers might be related to demographic variables including differing proportions of older white adults in various states. Another possible explanation: the impact of who completes the death certificate.: According to the CDC researchers, a 2012 study showed that coroners reported 14% fewer deaths from falls than did medical examiners.

    7. C - Women have higher rates for falls, but men have higher death rates related to falls, according to the CDC. Authors of the study speculate that the higher fatality rate "might have resulted from differences in the circumstances of a fall (e.g., from a ladder or while drinking), leading to more serious injuries."

    8. B - Caregiverstress.com reports that at 13%, bedrooms are the second-most-likely place for a fall, followed by kitchens and stairs.

    Donations Now Being Accepted for Florence Relief

    An online giving program established last year to help hurricane victims in Texas, Florida, and Puerto Rico is now focusing its efforts on providing aid to people affected by Hurricane Florence, which recently inflicted billions in damage in the Carolinas.

    Now's your chance to help.

    "Rehab Therapists Give Back," an online giving program designed to provide physical therapists, physical therapist assistants, and other rehabilitation professionals with an opportunity to come together as a unified community to help those in need, is now accepting donations for Florence relief. Accessible through a GlobalGiving website, the initiative allows donors to contribute any amount. Electronic medical records system vendor WebPT and APTA were founding funders of the program.

    Questions? Contact RTGB@webpt.com.

    State-Level PT Advocates Honored at 2018 Policy and Payment Forum

    Recognition of the importance of nonpharmacological pain therapies, adoption of the physical therapy licensure compact, a higher-profile role for physical therapists (PTs) in concussion management, and improving the legal scope of practice for physical therapists were among the accomplishments of this year's APTA State Legislative Leadership and Legislative Commitment Award winners recognized at the association's recent State Policy and Payment Forum in Kansas City, Missouri. The event was co-hosted by the Missouri and Kansas chapters of APTA.

    This year, 4 PTs were honored for their service to the profession at the state level:

    Mark Bishop, PT, PhD, FAPTA, was presented with an APTA State Legislative Leadership Award for his work in Florida to address the opioid crisis. Bishop's leadership and expertise was instrumental in the Florida Physical Therapy Association's development of a legislative amendment, adopted into the Florida Substance Abuse Act, that requires prescribers of controlled substances to complete a 2-hour continuing education course on prescribing controlled substances that must include information on nonpharmacological therapies.

    Cynthia Driskell, PT, also earned an APTA State Legislative Leadership Award in recognition of her achievements over 8 years as state legislative chair for the Arizona Chapter of APTA. Driskell's skills at facilitation were most recently brought to bear on a multisession effort to include PTs among the providers empowered to make return-to-play decisions for athletes and a successful push to include PTs with a sports specialty certification to participate in a concussion management pilot program.

    Derek Gerber, PT, DPT, of Idaho, was the third recipient of a State Legislative Leadership Award. Gerber led a successful push to eliminate the state's prohibition on dry needling by PTs, a change that was signed into law in March. Thanks to Gerber's extensive involvement in the effort, Idaho now allows PTs to practice dry needling after they have completed specified education and training requirements.

    Emilie Jones, PT, DPT, was honored with the APTA State Legislative Commitment Award. Jones, who served 3 years as legislative committee chair for the Washington Chapter of APTA, was instrumental in addressing several crucial issues in the state, including assistive personnel revisions, progress on dry needling, and the adoption of the physical therapy licensure compact.

    The APTA State Policy and Payment Forum focuses on advocacy and legislative issues at the state level. Check out pictures from the event here.

    State Forum Awards
    This year's state legislative award winners (from left): Emilie Jones, PT, DPT; Derek Gerber, PT, DPT; and Cynthia Driskell, PT. Not pictured: Mark Bishop, PT, PhD, FAPTA. Jones, Driskell, and Bishop received State Legislative Leadership Awards; Gerber received a State Legislative Commitment Award.

    The Good Stuff: Members and the Profession in the Media, September 2018

    "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!

    Bringing the PT voice to the table: Amee Seitz, PT, DPT, PhD, is representing APTA on the American Academy of Orthopaedic Surgeons work group developing clinical guidelines for management of rotator cuff injuries. (Northwestern University Medicine News)

    Addressing a pain feedback system gone "haywire": Tara Legar, PT, explains how physical therapy can help people with chronic pain avoid opioids. (Pike County, Ohio, News Watchman)

    Quotable: "All too often, people get the advice to stop everything that they're doing, rest, take some opioid medication. And we know now that's the wrong treatment." –Judith Turner, pain management specialist, on the importance of physical therapy for low back pain. (KABC-7 Eyewitness News, Los Angeles)

    Friend of the court: Julie Moon, PT, has a very special patient—her father, a retired chief justice of the Hawaii Supreme Court. (KHON 2 News, Honolulu)

    Pilates for neurological conditions: Kelsey Garcia PT, DPT, leads a 5-week program that delivers “Pilates-based” physical therapy to individuals with PD, MS, spinal cord injury, and more. (Miami's Community Newspapers group)

    A Special Olympics health leader: Jen Roberts, PT, DPT, was named the winner of a Special Olympics North Carolina "Golisano Health Leadership Award." (Charlotte-Raleigh citybizlist)

    It's manely about physical therapy: John Payne, PT, discusses the benefits of hippotherapy. (Tacoma, Washington, News-Tribune)

    Pelvic floor health: Jaime Rogers, PT, says people shouldn't be hesitant to discuss pelvic disorders with their health care providers. (Lawrence, Kansas, Journal-World)

    The right way to reduce back pain: Karen Joubert, PT, DPT, discusses the best ways to get relief from back, neck, and shoulder pain. (KTLA 5 News, Los Angeles)

    A groundbreaker: Dan Hatch, PT, DPT, was named 1 of Newport, Rhode Island's top 10 "Groundbreakers" for his value-based, cash-based practice.(Providence, Rhode Island, Journal)

    A balanced approach to vertigo: DuPree Zumbro, PT, DPT, outlines 5 things to know about vertigo. (Wilmington, North Carolina, Star News)

    Preventing the first fall: Lori Schrodt, PT, PhD, explains the importance of balance and falls-risk screenings. (Asheville, North Carolina, Mountain Express)

    Quotable: "I know that physical therapy is worth it in the end. It helps me SAFELY continue going about my life. I have never finished a session and thought, 'Well, that was a bad decision.'” – Kendall Harvey, who has Friedreich's ataxia, on the importance of physical therapy in her life. (Friedreich's Ataxia News)

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

    Women in Physical Therapy Summit: Fueling Change in the Profession

    2018 - 09 - 19 - Women in PT Summit
    This year's Women in PT Summit is expected to draw more than 100 attendees.

    Next professional conference you go to, take a look around. Chances are you'll see a disproportionate number of men at podiums, on panels, and walking around with all those extra ribbons on their ID badges—even when the profession itself is supposedly "female dominated." It's a symptom of a bigger problem that many people, including Karen Litzy, PT, DPT, would like to change.

    Litzy will be the first to admit that there's much work to be done. But as the organizer of the Women in Physical Therapy Summit, now in its third year, Litzy can take some pride in knowing that when it comes to at least 1 conference, the problem has been turned on its head.

    The 2-day summit, coming up on September 21 at John Jay College in New York City, focuses on the contributions women have made and the ways they can have an even greater impact. Men are of course welcome (and do attend), but the emphasis is on women—not just as speakers, but as sources of inspiration, insight, and experience. The event is sponsored in part by APTA.

    The summit provides attendees with something different from the usual professional physical therapist (PT) gathering: rather than focusing on research, interventions, and other aspects of providing care, it focuses on the providers themselves and how their perspectives as women in the profession can be brought to the table.

    "There's an incredible depth of knowledge, creativity, and passion that exists among the women in the physical therapy profession," Litzy said. "It seems that, oftentimes, speakers and panels at large conferences are vary male-dominated, and we wanted to give the opportunity for smart, successful women to share their stories and expertise."

    Keynote speakers for this year’s event include Emma Stokes, president of the World Confederation of Physical Therapy; disabilities activist, comedian, actress, and TED speaker Maysoon Zayed; and Eleanor Bergstein, a writer, director, and producer of, among other movies, Dirty Dancing. You might say that when it comes to speakers, nobody puts the summit in a corner.

    In addition to the keynotes, the summit also includes panel discussions and—new this year—a series of 4 workshops, 1 each on public speaking, marketing, diversity, and negotiation.

    "I hope attendees will walk away knowing they have a supportive group behind them who will give them honest advice and do what they can to help them succeed," Litzy said. "This year in particular, I want the attendees to know that they have so much to share, and that we can help provide them with the tools to get their ideas out into the world."

    Getting those ideas out into the world of physical therapy can be a challenge, even though the profession is described as "female-dominated." Actually, Litzy says, that whole "female-dominated profession" concept is tricky to begin with.

    "From a sheer numbers standpoint, of course—there are clearly more female PTs than there are male," Litzy said. "But if you close your eyes and ask someone to describe a leader or CEO in the physical therapy profession, I believe many people would think of a man first. This isn't something unique to physical therapy, of course—it's true of most professions in the world. But it's something I'd love to see change."

    Litzy does see some movement. "I've seen many more women using social media to make changes in the profession and to help establish themselves as thought leaders in physical therapy and beyond," Litzy said. "And I've been seeing more and more women calling out inequities, such as conferences or courses with all-male or mostly male faculty. I know that may sound petty, but if you're a younger PT and you see people that look like you on a panel or speaking at a conference, it does mean a lot."

    It's a trend that Litzy also sees on a more universal level, even within the time since the first summit.

    "Times have changed somewhat for women in the world in general over the past 2 years, with movements like Time's Up and #Metoo supporting women to speak out—not just about sexual assault but about the inequities they may be facing in their personal or professional lives," Litzy said.

    Litzy brings her own experience to the conference as well. The owner of a concierge physical therapy practice in New York, she's also host of the "Healthy, Wealthy, and Smart" podcast series that provides clinical information and business strategies from thought leaders in physical therapy, wellness, and entrepreneurship. She hopes that the summit will make it easier for other PTs to find their own ways to grow in the profession.

    "We want to create a space where physical therapists feel supported to take on any challenge and get inspiration from each other," Litzy said. "We want attendees to come away ready to reach for goals they thought they could never achieve."

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    APTA, Other Health Care Leaders Call for CMS to Rethink Evaluation and Management Payment Plan

    APTA has joined with more than 150 other health care organizations to let the US Centers for Medicare and Medicaid Services (CMS) know that while its "Patients Over Paperwork" efforts are appreciated, one CMS attempt to reduce administrative burdens is likely to result in reduced access to care for some of the sickest Medicare beneficiaries.

    The concerns center around a provision related to evaluation and management (E/M) visits included in the 2019 physician fee schedule rule proposed by CMS over the summer. The change, ostensibly intended to reduce paperwork, would collapse E/M payment rates currently based on a 5-level complexity system for new and established patients into what would amount to a 2-level system—combining levels 1-3 and levels 2-5. CMS acknowledges that the change would result in higher payments for E/M visits at the 1-3 levels while levels 4 and 5 will see reductions based on the 2019 proposed relative value units. However, CMS argues, the reduced paperwork burden would offset the payment drop.

    In a letter sent to CMS last month, APTA and other cosigners praise CMS for its initiative to reduce provider paperwork, but question the wisdom of the E/M plan, arguing that the change would unfairly impact providers who see sicker patients, "ultimately jeopardizing patients' access to care."

    The group also is pushing back against a related plan to reduce payment for multiple services delivered on the same day, something that they argue was already accounted for in previous valuations of the relevant codes.

    As an alternative, the group urges CMS to collaborate with an American Medical Association-sponsored crossdisciplinary work group. That work group has been charged with analyzing E/M coding and developing a better alternative than the one presented by CMS. APTA will be monitoring the work of this group and participating in future meetings.

    APTA Provides CMS With Extensive Comments on Proposed 2019 Medicare Fee Schedule Rule

    APTA delivered a set of comments on the US Centers for Medicare and Medicaid Services' (CMS) proposed 2019 physician fee schedule that were as wide-ranging as the proposal itself, including qualifications on the proposal to extend the Merit-based Incentive Payment System (MIPS) to physical therapists (PT) and clear opposition to a CMS move to lower payment for services provided "in part" by a physical therapist assistant (PTA) or occupational therapy assistant (OTA). Also in the association's comments: recommendations that CMS could strengthen its role in the fight against opioid abuse by better supporting nonpharmacological approaches to pain management, including physical therapy, through payment and education improvements.

    The extensive comments were developed in response to a rule that, if implemented, would include some of the most far-reaching changes in payment and reporting to date, moving PTs into the Quality Payment Program (QPP) and ending functional limitation reporting (FLR) requirements. But that's just 1 facet of the proposal: the rule touches on everything from the use of telehealth to additional current procedural terminology (CPT) codes. APTA's comments addressed both big-picture issues and some of the nuts-and-bolts of the proposal.

    PTs in MIPS: a move that needs to be carefully implemented.
    APTA provided extensive comments to CMS on its proposal to include PTs in QPP—and more specifically in MIPS—characterizing the change as an acknowledgement that PTs "act as integral members of the health care delivery team in outpatient settings."

    APTA's comments outlined a number of concerns and issues, mostly centered on the association's concern that PTs could face serious barriers to participation in MIPS unless CMS provides "certain amnesties." The association also recommends that CMS adopt more flexible approaches when it comes to PTs opting in to MIPS participation, as well as the measures CMS would accept should facility-based PTs be required to participate in MIPS in the future (the current proposed rule only includes PTs in private practice settings).

    APTA also went on record to support a proposed "Physical and Occupational Therapy Specialty Measure Set" within MIPS, and the continued efforts by CMS to eliminate measures that are "topped-out" through high levels of compliance.

    CMS has it all wrong when it comes to adjusting payment for services provided "in part" by a PTA.
    Some of the association's strongest criticism of the proposed rule is aimed at CMS efforts to establish payment differentials, set to go into effect in 2022, based on the extent of a PTA's or OTA’s role in a visit. That criticism is centered on what APTA believes is the impossibility of accurately defining when a PTA or OTA has sufficiently provided services "in part" to trigger a payment differential, and the dangers of creating a rule stating that any PTA involvement constitutes an excuse for lower payment rates.

    While APTA acknowledges that CMS is bound by law to establish a PTA modifier, the association asserts that CMS isn't obligated to go down the definitional rabbit hole associated with pinning down what constitutes care delivered "in whole or in part" by a PTA. In its comments, the association lays out a multipoint case against establishing rules based on terminology that isn't a term of art or statutorily defined, warning that drawing a line on what constitutes "in part" could quickly lead to confusion and loss of access to care, particularly among beneficiaries in rural areas.

    APTA recommends that CMS take more time to reexamine the potential problems and wait until next year's rulemaking to address the "in part" issue. Alternatively, should CMS insist on moving ahead in this rule, the association suggests either of 2 more-straightforward approaches: the so-called "midpoint rule" that would pin 100% reimbursement to whether the majority of services are furnished by the PT; or a "blended rate" approach that splits the fee schedule amount for a code in half and then applies the 100% PT rate to one half, and an 85% rate to the other half, thereby avoiding a single trigger that would shift payment to a lower rate, simply because a PTA provided care "in part."

    Should CMS continue down the PTA payment differential path, APTA strongly recommends CMS exempt rural areas, health professional shortage areas, and medically underserved areas from the proposed policy, due to concerns of how it could affect patient access. Earlier this summer, CMS indicated to APTA and the American Occupational Therapy Association (AOTA) that it did not have the statutory authority to exempt these areas. APTA is investigating whether that's true, and APTA and AOTA also are advocating for Congress to commission a US Government Accountability Office study to examine how access to physical therapy and occupational therapy will be impacted by the payment differential.

    "Given that a [PT] and PTA frequently deliver team-based care, we have serious concerns that requiring the modifier to be applied if any minute of outpatient therapy is delivered by the PTA has serious implications for beneficiary access to care," APTA writes. "Physical therapists and PTAs serve a critical role in the health and vitality of this nation. It is imperative that Medicare beneficiaries continue to have access to high-quality physical therapy services."

    More can be done to fight the opioid crisis if CMS would provide stronger support of (and better payment for) nonpharmacological approaches to pain management.
    APTA recommends that CMS not only step up its promotion of access to team-based nondrug pain management, but that it back up this support with "subregulatory revisions" that could increase patient access through changed payment models. The association also recommends that CMS reduce or eliminate copays for nonpharmacological pain treatments, and that the agency increase efforts to educate both prescribers and the public on the effectiveness and availability of approaches to pain that don't involve the use of opioids.

    Additionally, APTA has a suggestion for providers who continue to prescribe opioids for pain: make a referral to physical therapy a requirement.

    "CMS and other stakeholders must ensure that not only is education for providers enhanced, but that a clear, direct path exists for patients in pain to access all treatment options, including physical therapy," APTA writes. "Given that [the US Centers for Disease Control and Prevention] has concluded that there is insufficient evidence that opioid usage alone improve functional outcomes for those in pain, we recommend that clinicians who prescribe an opioid for pain also must be required to refer a patient to physical therapy."

    Other provisions in the proposed rule didn't escape APTA's notice.
    As is usually the case, the proposed fee schedule covered a lot of regulatory ground. APTA took an equally comprehensive approach in its comments, touching on these additional areas:

    • Barriers to PTs participating in alternative payment models (APMs). While PTs technically are allowed to participate in APMs, APTA argues that from a practical standpoint, the profession is at a disadvantage thanks to barriers thrown up by CMS around the use of certified electronic health record technology (CEHRT). CMS requires at least 75% of all eligible clinicians to use CEHRT—the problem is, PTs have been exempt from "meaningful use" criteria promoting interoperability, and there is a lack of physical therapy-specific CEHRT. The result? "[PTs] are essentially barred from participating in advanced APMs," APTA writes. The association is also advocating to Congress to require CMS to develop physical therapy-specific certification criteria for electronic health record vendors.
    • Payment for technology-based communications. APTA supports CMS efforts to provide payment for physician communications provided via technology and has asked CMS to clarify whether PTs are included in the list of eligible providers. If not, APTA says, CMS should study that possibility and consider expanding provisions in the fut
    • Qualified Clinical Data Registry (QCDR) proposals. Because QCDRs such as APTA's Physical Therapy Outcomes Registry could play such an important role in future value-based care models, the association is paying particular attention to CMS proposals for who gets to be included as a QCDR, and the nature of the relationship between a QCDR and CMS. Specifically, APTA supports a CMS plan to require a QCDR entity to have clinical expertise in medicine and measure development, and it backs the measures selection criteria proposed by CMS. However, the association isn't on board with a CMS proposal that beginning in the 2021 payment year, all approved QCDRs must enter into a licensing agreement with CMS that would allow any QCDR to report on any MIPS measure.
    • Price transparency. In response to a CMS request for perspectives on price transparency, APTA stated its general support for greater transparency but recommended that CMS study state-level initiatives first. The association also cautioned CMS to be careful about how it defines "cost" from a consumer perspective and to avoid divorcing issues of cost from concepts of quality. Additionally, APTA recommended that any price transparency effort be accompanied by extensive public education efforts.

    APTA has additional information and resources on the proposed 2019 physician fee schedule, including fact sheets on the proposal and links to pages with specific information on QPP, MIPS, and APMs. Start with the Medicare Physician Fee Schedule webpage, and sign up for the upcoming webinar, "Everything you need to know about the Quality Payment Program."

    From PTJ: Getting at the Risk Factors for Falls Post-TKA

    Up to a third of patients with total knee arthroplasty (TKA) experience a fall within 6 months to a year after surgery, but a new study suggests that physical therapists (PTs) can reduce this risk by targeting specific deficits for intervention.

    Researchers followed 134 individuals at a Hong Kong hospital for 6 months after TKA to determine falls frequency, circumstances, and risk factors. All patients had been referred for outpatient rehabilitation. The individuals were all between the ages of 50 and 85 with a primary diagnosis of knee osteoarthritis (OA). Results were published in the September issue of PTJ (Physical Therapy).

    Participants attended physical therapy 1-2 times per week for 8-10 weeks, beginning 2 weeks after surgery. Sessions included electrotherapy, mobilizing and strengthening exercises, and gait and balance training. At 4 weeks postsurgery, PTs evaluated knee proprioception, balance, knee pain, knee extension and flexion muscle strength, range of motion, and balance confidence. Patients also were given a log book to record any falls. After the evaluation, authors followed up monthly to ask participants about any falls they may have experienced.

    Researchers found that 23 (17.2%) participants had fallen at least once, with a total of 31 falls. Most occurred in the afternoon (58%) and while walking (67.7%). Most fallers (87.1%) were not using a walking aid when they fell. Falls were most frequently caused by slipping (35.5%) and tripping (35.5%).

    In contrast to previous research, nearly half of falls occurred at home, and nearly a third occurred in “another indoor environment.” These findings, write authors, “highlight the importance in reducing hazards in the home that could cause slipping or tripping, especially in the early stages of recovery from TKA.”

    Fallers were significantly more likely than non-fallers to have had more severe pain and reduced proprioception in the operated knee, and to have poorer sensory orientation prior to the fall. Authors write that “Deficits in knee proprioception, coupled with age-related declines in vestibular and somatosensory function, may challenge the ability to effectively reweight information from different sensory subsystems that maintain body equilibrium.”

    Surprisingly, fallers also were more likely to be younger. “Younger participants may have been more physically active and subsequently more likely to engage in risky behaviors than our older counterparts," authors write.

    Authors note that—outside of age—these factors are modifiable and “warrant greater attention” in falls risk assessment, education, prevention, and intervention for individuals with TKA.

    [Editor's note: for more on the PT's role in TKA, check out this clinical summary that includes sections on prehabilitation and accelerated rehabilitation.]

    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.

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    APTA Honors and Awards Nominations Now Open

    Members of the physical therapy profession do amazing things for people every day, and not just inside the walls of a clinic. Now's the time to honor those contributions by nominating an APTA member for national recognition through the APTA Honors & Awards program.

    The APTA Honors & Awards program is now accepting nominations for the 2019 awards cycle, an annual effort aimed at celebrating members' outstanding achievements in the areas of education, practice and service, publications, research, academic excellence, humanitarian work, and societal impact. The program also includes the Catherine Worthingham Fellows of APTA, the Mary McMillan Lecture Award, and the John H.P. Maley Lecture Award.

    Detailed award descriptions, eligibility information, and nomination instructions for these and the many other awards and honors in the program are available on the APTA Honors & Awards webpage. Deadline for nominations is December 1.

    Award winners will be recognized at the 2019 NEXT Conference and Exhibition, set for June 12-15 in Chicago. For more information, email Alissa Patanarut.

    Help Aging Communities 'Go4Life' in September

    Physical therapists (PTs), physical therapist assistants (PTAs), students, and supporters of the profession shouldn't wait until National Physical Therapy Month in October to spread the word about the importance of mobility and physical activity—September is Go4Life month, a National Institutes of Health (NIH)-sponsored campaign that provides plenty of opportunities to educate the public on the ways older Americans can stay healthy through maintaining or increasing endurance, strength, balance, and flexibility.

    Strongly supported by APTA, Go4Life is an ongoing effort to connect the public and health care providers with information and resources related to healthy aging. In addition to information on how exercise improves health, the Go4Life website includes suggested exercises, workout videos, fitness tracking resources, and access to printed materials including infographics, posters, bookmarks, and postcards, all available for free. The program also offers a free "Speaker's Toolkit" to help providers develop presentations to target audiences—available by emailing Go4Life@mail.nih.gov.

    During September, the campaign offers special resources that include a weekly planning guide and a Facebook Live event set for Thursday, September 13, at 2:00 pm ET. The campaign is an effort from NIH's National Institute on Aging, and can be followed on Twitter through @NIAGo4Life.

    Researchers Say Mobility Is Key Quality-of-Life Issue for Individuals With SCI

    While individuals who have experienced a traumatic spinal cord injury (TSCI) can face a wide range of challenges affecting their health-related quality of life (HRQoL), a new study is helping to clarify that 1 particular functional ability stands out as the most important factor: independent mobility.

    Researchers analyzed data from 195 patients who had sustained a TSCI between 2010 and 2016 and participated in a series of assessments conducted between 6 and 12 months after the injury. Those assessments included the Spinal Cord Independence Measure Version 3 (SCIM-III), a detailed assessment of functional abilities, as well as the SF-36v2 assessment of HRQ0L, a 36-question survey covering 8 domains that produces both a physical component score (PCS) and a mental component score (MCS). Authors say their study is the first to establish correlations between these assessments, allowing the researchers to more specifically pinpoint which factors most affect HRQoL.

    The study population included individuals 17 years and older who sustained a TSCI between C1 and L1 that required surgery. More than half of the study population—65%—experienced tetraplegia (also referred to as quadriplegia) as a result of the injury; the remaining 35% experienced paraplegia. Participants were excluded if a penetrating trauma was the cause of the TSCI or if they did not complete the assessments between 6 and 12 months after the injury. Results were e-published ahead of print in the American Journal of Physical Medicine & Rehabilitation.

    Here's what the researchers found:

    • Overall, the strongest correlation was between mobility in the abilities assessment and PCS in the HRQoL assessment. Researchers also noted a small-but-significant correlation between respiration/sphincter management and PCS.
    • The tetraplegic group showed the strongest correlations between mobility and PCS, particularly for mobility outdoors, mobility indoors, mobility for moderate distances, and stair management.
    • In the paraplegic group, "moderate significant" correlations were also found for lower body bathing.
    • Researchers were unable to establish a strong correlation between the functional abilities assessment and the mental component score on the HRQoL assessment.

    Authors of the study believe their findings line up with previous research into HRQoL among individuals who sustained TSCI, but they note that theirs is the first to examine which specific functional abilities were most important to this population.

    "In our study for both tetraplegic and paraplegic patients, mobility on even surfaces was more strongly correlated with PCS than items related to transfers," authors write, adding that "our study suggests that higher mobility is better correlated to quality of life than higher arm/hand function for both tetraplegic and paraplegic subjects."

    Authors also note that the lack of correlation between function and the MCS on the HRQoL assessment may seem "counter-intuitive," but they suggest that the findings point to the possibility that "mental health after a TSCI strongly depends on other factors that were not considered in the current study," including depression, hope, purpose, and feelings of self-worth.

    "The current study showed that it is of paramount importance to analyze tetraplegic and paraplegic patients distinctly when evaluating impact of function on [quality of life], considering the magnitude of difference between the strength and correlation of SCIM sub-scores," authors write. "Different priorities for patients lead to distinct goals in the rehabilitation effort."

    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.

    Study: Some Changes in Care Occurred After Jimmo Settlement

    The 2013 Jimmo v Sebelius settlement was supposed to bust the "improvement standard" myth under Medicare Part B, but has the agreement actually made a difference in care? Authors of a new study say yes—but there's more work to be done.

    Authors focused on 2 datasets from Medical Expenditure Panel Surveys—one from 2011–2012, and another from 2014–2015, for a representative sample of 1,183 patients receiving physical therapy and/or occupational therapy. The time periods selected were chosen to provide a before-and-after snapshot of care relative to a 2013 court settlement requiring the US Centers for Medicare and Medicaid Services (CMS) to clearly debunk the idea that Medicare coverage can be extended only if that care will actually improve the patient's condition. The fallacy, known as the "improvement standard," was widely used as the basis for denials of claims for individuals with chronic conditions in need of skilled maintenance therapy.

    Researchers assessed the impact of the Jimmo settlement by looking at changes to the number of physical therapy and/or occupational therapy visits per year, per patient, focusing specifically on the number of individuals who had 12 or more therapy visits during a 12-month timespan. Authors also examined variables including race, body mass index, and geographic region. APTA member Justine Dee, PT, MS, coauthored the study.

    The results, e-published ahead of print in The Archives of Physical Medicine and Rehabilitation (abstract only available for free) show that the treatment landscape did in fact change, with the post-Jimmo patients 1.41 times more likely to have 12 or more visits than those receiving care prior to the agreement. There were no significant demographic or other differences between the groups except for age, which was lower in the postsettlement group.

    Other findings from the study:

    • Overall, the median number of therapy visits pre-Jimmo was 7; that number rose to 8 in the postsettlement group.
    • The total estimated number of Medicare recipients receiving physical therapy or occupational therapy rose between the 2 time periods studied, from 6.3 million in 2011 and 2012 to 9.3 million in 2014 and 2015.
    • Prior to Jimmo, nonwhite patients were slightly more likely than white patients to receive extended therapy, with adjusted probability for nonwhite patients estimated at 0.39 compared with a 0.21 probability for whites. After Jimmo, those probabilities reversed, with a 0.30 probability for whites, and a 0.23 probability for nonwhites. Authors describe the reasons for the change as "obscure" but write that the difference did seem to diminish over the time period studied.

    "We can estimate that, at a minimum, the Jimmo settlement will increase utilization by about 12 million visits per year," authors write. "Given typical reimbursements of $80 per therapy visit, costs will increase by approximately $960 million/year. However, if outpatient therapies can help minimize functional decline, avoidable hospitalizations, and nursing home admissions, the Jimmo settlement may result in lower total costs."

    Other stakeholders, including APTA, have reason to believe that utilization numbers may continue to rise, given CMS' weak efforts at getting the word out about Jimmo to its contractors between 2013 and summer of 2017. Last year, the agency was ordered to step up its communications around Jimmo by a federal judge who found that CMS wasn't living up to its end of the settlement agreement.

    "It's likely that numbers are higher now that CMS is doing a better job of education," said Kara Gainer, director of regulatory affairs for APTA. "But now isn't the time for CMS to let up; if anything, CMS needs to be doing even more on Jimmo, particularly in relation to payment changes in the home health and skilled nursing facility settings, where maintenance therapy can play a major role." APTA offers multiple resources related to the Jimmo settlement and the broader concept of skilled maintenance at a webpage devoted to the topic.

    Authors acknowledge that other national health care policy changes also may affect the numbers they observed, but they echo Gainer's perspective that CMS shouldn't take its eye off the ball when it comes to education around Jimmo.

    "Although we do see a change in utilization, the [Center for Medicare Advocacy, one of the groups that brought the Jimmo case to court] and other organizations continue to report that many [Medicare Administrative Contractors] are still requiring that patients demonstrate improvement as a condition of continued coverage. Education and support of the Jimmo settlement guidelines need to continue to ensure that patients are not being inappropriately denied their Medicare benefits."

    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.

    Study: Functional Limitation Reporting Isn't Delivering the Data Goods

    Since the beginnings of Medicare's Functional Limitation Reporting (FLR) program, APTA has maintained that the system was overly burdensome and unlikely to provide meaningful information. Now a new APTA-funded study fleshes out the case against FLR's usefulness, finding that the codes simply have not been submitted in ways that are consistent with regulations. The holes in data make it difficult to rely on FLR as a source for tracking improvement and outcomes—a deficiency pointed out by APTA to the US Centers for Medicare and Medicaid Services (CMS), and a factor in a CMS decision to propose dropping the FLR altogether.

    The study, e-published ahead of print in PTJ (Physical Therapy), used a 5% random sample of Medicare part B fee-for-service claims for outpatient physical therapy provided in 2014, the first year nonparticipation in the FLR system was tied to claim rejection. Authors tracked FLR and Severity Modifier (SM) coding used throughout episodes of care, analyzing not only the completeness of the reporting, but the projection and documentation of patient improvement from physical therapist (PT) initial examination (IE) to discharge. A total of 114,558 unique patients were included in the study.

    The good news for FLR, if there was any to be had, was that PTs had a high level of submitting complete FLR information at IE, with more than 90% of claims including both a current FLR status code and a projected goal status code. The bad news was that complete reporting fell off dramatically after that, with fewer than 17% of claims required during interim reporting periods—at least once every 10 treatment days—including current and projected status coding. Reporting rates were as low as 9.7% for interim reports of current status.

    Similarly, discharge claims also showed a significant drop in reporting, with an average completion rate of 36.8% for FLR discharge status.

    When it came to planned and documented improvement in functional status as reflected in changes to the SM code, most of reports did identify goals for positive change. For the FLR code sets related to specific functional limitations, at least 85% included estimates of planned improvement; the percentage was slightly lower—78.7%—for the code sets related to "other" PT/occupational therapist (OT) care categories, but that didn’t surprise researchers. The actual level of improvement ratings varied, but, overall, the most frequently used SM for projected goal status was "CI," indicating an improvement to 1%-20% impaired or restricted.

    The study arrives at a time when CMS has proposed the elimination of FLR as part of its move to include physical therapists (PTs) among the providers participating in the Quality Payment Program, a major shift toward value-based payment included in the proposed 2019 physician fee schedule. CMS is accepting comments on the proposed rule through midnight on September 10—APTA will submit comments and encourages members to do the same using a letter template the association created to simplify the process. APTA's analysis of FLR reporting was cited as a factor that led to CMS' decision to drop the program. [Editor's note: for more information on the proposed fee schedule, visit APTA's Fee Schedule webpage, and scroll down to the "APTA Summaries and Fact Sheets" header for a 3-part explanation of the proposal]

    Other highlights from the study:

    • Mobility was the most commonly used FLR code, present on 63.4% of all the PT evaluation claims; "carrying, moving, and handing objects" was next at 16%, followed by "changing body positions" comprising 11.7% of claims.
    • Overall, facility-based claims tended to have lower estimates of planned improvement compared with noninstitutional settings, the most significant being improvement ratings for mobility (80.3% for facilities versus 91.2% for noninstitutional) and self-care (83.7% for facilities, 91.9% for noninstitutional).
    • Most of the FLR codes reported at discharge showed improvement by way of changed SMs, with an average improvement of 1 to 2 steps in the graduated SM code set out in 20% improvement increments. Fewer than 2.5% of all FLR codes reflected worse function, and fewer than 15% reflected no improvement.

    Researchers theorize that the lower reporting rates at discharge may be related to the lack of specific Medicare discharge codes for physical therapy, and that patient drop-out also may come into play, "limiting the ability of the physical therapist to document the FLR codes at the time of discharge."

    The low rates of interim reporting, however, is another matter, according to authors, and a big problem for the FLR system.

    "The reason for the very low completion rate for the interim reporting periods is unknown, and to our knowledge this is the first study to report on this," they write, speculating that the "time burden" involved in completing reports at least once every 10 days of treatment could be a factor.

    "We know that the collection of functional data is core to physical therapist practice, so the question becomes why the FLR system has such significant data gaps," said Heather Smith, PT, MPH, APTA program director for quality who coauthored the study with APTA member Meghan Warren, PT, PhD. "Our study indicates that the real issue is the mechanism through which these data are collected—FLR adds burden and complexity without producing much in the way of useful data."

    While authors acknowledge their study's limits—which include the discharge issue, the potential for inaccurate coding, and an inability to generalize findings to apply to Medicare Advantage beneficiaries—they say the bottom line is clear: the FLR system is not producing the data it was intended to produce—at least not when it comes to physical therapy.

    "The Medicare FLR program, in policy, supports evidence-based practice…however, the current data collection process has significant issues that limit the use and application of the data," authors write. "The ultimate solution to these issues may be the collection of functional data through the use of standardized functional outcome measures that allow for benchmarking by patient condition, at the national and local level, and by setting of physical therapist care." They add that data could be strengthened through sources other than claims, including registries such as APTA's Physical Therapy Outcomes Registry.

    "Without feedback on data completeness and change in function over the episode of care, the collection of these data has limited use," authors write. "Therefore, feedback to providers on performance is a crucial component of making these data meaningful to physical therapists and their patients."

    New Pediatric mTBI Guidelines from CDC Take Comprehensive Approach

    In light of what it describes as a "significant public health concern," the US Centers for Disease Control and Prevention (CDC) has issued what it says are the first-ever comprehensive clinical guidelines for the diagnosis and management of mild traumatic brain injury (mTBI) in children. The 19 sets of recommendations address the condition from diagnosis through management and treatment, and cover settings including primary care, outpatient settings, inpatient care, schools, and emergency departments.

    The resource, published in JAMA Pediatrics and available for free, is organized into 3 main areas—diagnostic recommendations, prognostic recommendations, and recommendations related to management and treatment—with each area containing several recommendations based on extensive literature reviews. The 46 discrete recommendations are organized into 19 topic areas, and include do's and don'ts that cover the gamut from the use of serum testing to diagnose mTBI to the best approaches for talking with families about the injury.

    APTA members John DeWitt, PT, DPT, ATC; and Anne Mucha, PT, DPT, MS, were members of the CDC Pediatric Mild Traumatic Brain Injury Workgroup responsible for development of the recommendations, which are published in JAMA Pediatrics. Additionally, APTA submitted extensive comments on the guidelines during the public comment period during fall of 2017. A number of issues highlighted by APTA were included or addressed in the final version.

    Among the highlights from each broad area:

    Diagnostic recommendations: imaging is (mostly) not necessary, but rating scales and testing are crucial.
    Authors of the guidelines acknowledge that while assessing for intracranial injury (ICI) is important, the use of head computed tomography (CT) should not be routine and that providers should rely more heavily on clinical decision rules including those related to the Glasgow Coma Scale (GCS). The guidelines also caution against the routine use of magnetic resonance imaging (MRI), single photon emission CT, and skull radiographs, but they stress the importance of age-appropriate rating scales and cognitive testing. Authors warn, however, that clinicians shouldn't rely solely on the Standardized Assessment of Concussion to diagnose mTBI in children ages 6 to 18. Also not recommended: the use of "biomarkers" to establish the presence of mTBI "outside of a research setting."

    Prognostic recommendations: providers need to be sensitive to factors that can lead to variation in recovery.
    The guidelines support the idea that providers should help patients and families understand that for 70%-80% of children with mTBI, significant difficulties don't persist past 1 to 3 months after the injury and that "recovery from mTBI is unique and will follow its own trajectory." However, authors also advise providers to evaluate any factors that were present in a child before the mTBI that are linked to delayed recovery, such as learning difficulties, the presence of a neurologic disorder, or a history of previous mTBI. Providers should also assess for any risk factors not related to premorbid health or functional conditions, including socioeconomic factors and the severity of the presenting injury.

    Management and treatment recommendations: the keys are education, continued assessment of progress, and understanding when to refer for specialized care.
    The authors stress the importance of patient and family education around what to look for during recovery from mTBI, including warning signs of more serious injury and management of physical and cognitive activity. The guidelines also provide detailed recommendations on returning to activity and school, and stress the importance of careful monitoring in the classroom and provision of educational supports if necessary. Also included in this section are guidelines around headache management and treatment, and the importance of providers' understanding of when to refer a patient for additional treatment, particularly in the areas of vestibule-oculomotor dysfunction, disordered sleep, and cognitive impairment.

    The CDC is accompanying release of the guidelines with an educational push to promote consistent implementation. In addition to the guidelines themselves, providers can also download resources that include screening tools, online trainings, and fact sheets in support of the recommendations.

    According to authors, the guidelines arrive at a time when pediatric mTBI is on the rise, with more than 2 million outpatient visits and just under 3 million emergency department visits for mTBI in children taking place between 2005 and 2009. The CDC believes its resource is the first comprehensive set of mTBI guidelines focused exclusively on children in the US.

    Physical therapists (PTs) play an important role in the treatment of individuals who have suffered concussions. Get the latest information on these injuries and what’s being done to reduce them at the APTA traumatic brain injury webpage (look under the "Concussion or mTBI" header). 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: Making the Switch From Clinician to Manager

    It's no secret that many of the skills that make someone a good physical therapist (PT)—empathy, communication, being goal-oriented—also lend themselves to a management role. The question is, would a management role right for you?

    In this month’s issue of PT in Motion magazine, author Michele Wojciechowski reports on the experiences of several PTs who moved from frontline clinician to manager. They describe why they made the switch, skills a prospective manager may need to develop, and what makes an administrative role rewarding.

    "In my role, I need to understand where people are coming from, then help them problem-solve and find solutions," says COL Deydre S. Teyhen, PT, DPT, PhD. "PTs do that every day with their patients. They do it when they create a plan of care. Some of that can be complicated—involving the family, the patient's specific needs, time commitments, and other factors. You're often dealing with these same variables when you're in the administrative realm."

    Physical therapist clinicians may have an edge over administrators with a nonclinical background. "PTs in general are highly qualified for managerial roles because we tend to be type-A personalities, and we're really organized," says LTC Scott Gregg, PT, MHA, MBA. "We're quantitatively focused because we're so used to writing goals for all of our patients. As a result, we're good at setting goals for ourselves," he says. "When we're talking with providers, we can speak their language—whereas many administrators who don't have a clinical background get lost in these discussions."

    The article also suggests ways for PTs to build the skills or knowledge they don’t have on the business side.

    Not everyone would be happy in a managerial role, so it’s important to understand your strengths and what you value in your job. "You need to spend enough time in the field to know what your passion is," Gregg says. "If it's taking care of patients, then keep doing that. But if your passion is more on the administrative side, more having to do with numbers, then you should look at going in that direction."

    "PTs in Management Roles: How to Make the Journey" is featured in the September issue of PT in Motion magazine and is open to all viewers—pass it along to nonmember colleagues to show them one of the benefits of belonging to APTA. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.

    Aetna's Policy Clarifications Increase Access to PT Care

    Major commercial insurer Aetna recently provided some clarification on policies related to payment for physical therapy, and it's good news for physical theapists (PTs) and their patients.

    The clarifications help to answer questions related to the company's physical therapy policy, specifically around payment for evaluations and the ways direct access provisions can affect payment. Here's what Aetna said:

    Evaluations could be eligible for payments sooner than the 180-day wait period.
    Although Aetna’s policy reads that "physical therapy evaluations will be eligible for payment once every 180 days," Aetna representatives have informed APTA that evaluations performed within 180 days of the original evaluation may be allowed upon reconsideration or appeal, providing the evaluation is for a new or unrelated condition.

    State direct access provisions could allow for reimbursement from Aetna without a referral.
    Aetna’s policy reads that “Aetna considers physical therapy medically necessary when this care is prescribed by a chiropractor, DO, MD, nurse practitioner, podiatrist or other health professional qualified to prescribe physical therapy according to state law." Representatives from Aetna have clarified that in states with direct access provisions for PTs, a PT is considered an “other health professional qualified to prescribe physical therapy,” meaning that PT services will be reimbursed without an order or referral if all other requirements are met.

    "Aetna has been working with APTA to support access to PT services, and understands the importance of making providers aware of how specific policies are interpreted," said Alice Bell, PT, DPT, an APTA senior payment specialist. "We appreciate Aetna's efforts and look forward to continued cooperation on issues that may impact access to care."

    5 Ways to Raise Awareness During National Physical Therapy Month in October

    It's early September, which means that now's the time to begin thinking about what you'll be doing to call attention to the benefits of physical therapy during National Physical Therapy Month in October. Here are 5 ways to get involved:

    1. Get T-shirts, magnets, handouts, social media graphics, and other resources from the #ChoosePT toolkit.
    APTA’s award-winning #ChoosePT campaign has reached millions to promote physical therapist (PT) treatment for pain management. Whether you’re participating in a community event or sharing resources online, the #ChoosePT campaign toolkit has what you need.

    2. Arrange to have the #ChoosePT public service announcement aired on TV and radio stations near you.
    Launched in February, APTA’s latest public service announcement has already reached more than 50 million Americans. You can make that number grow by volunteering to contact your local TV and radio stations. Email public-relations@apta.org to volunteer and APTA staff will provide the specific instructions you need to succeed.

    3. Take the #ChoosePT message somewhere fun—and take a picture!
    Sometimes raising awareness is as simple as getting out in the world wearing a #ChoosePT shirt or holding a #ChoosePT sign (available in the toolkit). So go find a landmark, a park, a mountaintop, and anywhere in between, and take photos of you showing your #ChoosePT pride. Post them to social media using the #ChoosePT hashtag or email them to us at public-relations@apta.org. We’ll share our favorites in October.

    4. Promote MoveForwardPT.com.
    APTA’s official consumer information site serves millions of Americans each year. From symptoms and conditions guides to patient stories, podcasts, and tips pages, MoveForwardPT.com is your go-to resource for showing all the ways PTs and physical therapist assistants transform lives.

    5. Update your Find a PT profile.
    Each year, National Physical Therapy Month activities lead to an increase in traffic to Find a PT, APTA’s national database of practicing physical therapist clinicians. Make sure to update or activate your profile so consumers and other health care professionals can find you.

    Questions? Ideas? Contact APTA's public relations staff at public-relations@apta.org.