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  • Fighting the Opioid Crisis: APTA Releases White Paper Pointing the Way to Better Policies on Nondrug Pain Treatment

    A new white paper from APTA makes one thing clear to anyone looking for strategies to combat the opioid crisis in the US: no lasting gains can be made in the fight until stakeholders and policymakers in the country's health care system embrace the value of nonpharmacological approaches to chronic pain. And that embrace, APTA says, must include policy changes that increase patient access to physical therapy, as well programs that make it easier for health care providers to work in underserved communities especially hard-hit by the epidemic.

    In its new white paper titled "Beyond Opioids: How Physical Therapy Can Transform Pain Management to Improve Health," APTA points out how the rise of opioid misuse and addiction rates can be linked directly to the widespread use of prescription opioids for the treatment of pain. In the last few years, that stark reality has in turn led to "a growing realization that current strategies for managing pain have to change—that opioid-centric solutions for dealing with pain at best mask patients’ physical problems and delay or impede recovery and at worst may prove to be dangerous and even deadly."

    APTA isn't a newcomer to the opioid fight. The association's involvement dates back to late 2015 and includes the award-winning #ChoosePT public awareness campaign. The white paper is a comprehensive summary of the problem and APTA’s recommendations to address it.

    "Moving forward, the health care system must reexamine its approach to pain, including how causal factors are identified, what tools or measures are used to quantify its impact, and how the approach to treatment is aligned with the patient’s goals and values," the association says in the paper.

    To help fuel that reexamination, the white paper provides a history of the use of opioids in pain treatment, an examination of concepts around pain, and case scenarios that demonstrate how treatment by a physical therapist (PT) can help patients reduce or eliminate opioid use. With context in place, the association then sets out 6 recommendations that it believes need to be part of "a comprehensive response to the opioid crisis:"

    • Better public awareness of pain assessment and options for pain management
    • Public and private health plans that include "benefit design, reimbursement models, and integrated team approaches that support early access to nonpharmacological interventions, including physical therapy, for the primary care of pain conditions
    • Reduction or elimination of patient out-of-pocket costs and increased "access to and payment for person-centered, nonpharmacological pain management and treatment interventions"
    • Stepped-up efforts by health plans to educate providers on the effectiveness of nonpharmacological approaches to pain treatment and best practices in assessment, treatment, and referral
    • Greater attention by policymakers to what's working in pain management care, and a willingness to commit to lower patient out-of-pocket costs and innovative approaches, including bundled-care models and the use of multidisciplinary teams
    • Federal and state student loan repayment programs that incentivize health care professionals to work in underserved communities, thereby increasing the availability of health care providers in areas disproportionately affected by the opioid crisis

    "The opioid crisis is a complex societal and public health issue," said Katy Neas, APTA executive vice president of public affairs. "This white paper addresses a major factor that has fueled this crisis, but there's much work to be done on multiple fronts. APTA and its members can be key contributors in what is truly a life-or-death fight."

    Collaborative Stop the Cap Efforts from APTA, AOTA, ASHA Receive National Award

    APTA has earned another national award—this time for collaborative efforts to push for an end to the Medicare outpatient therapy cap.

    The American Society of Association Executives (ASAE) announced that APTA, the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASHA) were the joint winners of a 2018 Power of A Gold Award for their combined "Stop the Cap" efforts. The work of the 3 associations was instrumental in a congressional decision to permanently end the flawed cap process.

    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. The award will be presented to APTA, AOTA, and ASHA at an ASAE awards dinner on October 3. As a Gold Award winner, the Stop the Cap program is 1 of 6 campaigns under consideration for ASAE's Summit Award, which will be announced later this summer.

    "This award underscores the importance and power of collaboration and coordination," said APTA CEO Justin Moore, PT, DPT, in an APTA news release. "For 2 decades our associations fought side-by-side for patients' rights to care and to tear down this arbitrary roadblock. And we did it. We stopped the cap. That accomplishment was only possible through teamwork. We appreciate this recognition and look forward to continued advocacy on behalf of the people we serve."

    The most recent ASAE award marks the fourth time APTA has been recognized by the association industry group in the past 2 years: in April, APTA's membership renewal efforts earned the association a Gold Circle award for an outstanding member retention campaign, and 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 Provides an Easy Way to Share Your Comments on Proposed SNF Rule

    If a rule from the US Centers for Medicare and Medicaid Services (CMS) is adopted as proposed, physical therapists (PTs) and physical therapist assistants (PTAs) who work in skilled nursing facilities (SNFs) could find those facilities facing some major changes in payment. Those changes could include a new case-mix methodology system and altered therapy reporting requirements, according to CMS.

    The rule won't be finalized until later this year. In the meantime, CMS is asking for public comments on its proposal. APTA has made it easy for you to participate.

    APTA offers a template letter for PTs and PTAs who want to comment on the proposed 2019 skilled nursing facility prospective payment system (SNF PPS) and the plans for implementation of the Patient-Driven Payment Model (PDPM) to replace the Resource Utilization Groups Version IV (RUG-IV). Among other comments, the letter encourages CMS to take a careful look at how proposed coding requirements associated with the PDPM would "pose significant administrative, financial, and compliance burdens on SNFs."

    Posted as a Microsoft Word file, the letter was created with the technical formatting that CMS is accustomed to, but it also includes areas that can be personalized with details and examples from the individual PT's or PTA's practice. Those personal touches can help to underscore the messages that the letter's shared elements deliver to CMS with a unified voice.

    APTA outlined the basics of the proposed rule in an APTA fact sheet and will submit its own comments to CMS by the June 26 deadline. CMS has also issued a fact sheet on the proposed rule.

    APTA's May 16 "Insider Intel" program covered the proposed SNF rule. A recording of the full session is now available.

    From PT in Motion Magazine: Diversifying the Profession

    As society becomes increasingly diverse, it's important for the profession to reflect those differences. But as of a 2013 APTA member demographics profile, nearly 70% of APTA member physical therapists (PTs) were female and 88.5% were white. So how will the profession look in the future, and how is APTA responding to the need for a diverse physical therapy workforce?

    A feature in this month's PT in Motion magazine examines the importance of diversity within the physical therapy profession to improve the health of an increasingly diverse society. Author Michele Wojciechowski reports how several PTs' diverse backgrounds have helped them offer person-centered care that is sensitive to patients' needs and beliefs.

    "Increasing the diversity of the profession and providing information on the importance and understanding of cultural competence have been part of APTA's vision, guiding principles, and mission for many years," said Johnette L. Meadows, PT, MS, program director of minority/women's initiatives in APTA's Department of Practice.

    The PTs interviewed reflect on how their personal backgrounds have given them a unique ability to connect with other minority patients. "We live in a diverse world, and our clients and patients come from diverse communities," noted Dave Kietrys, PT, PhD. "We should be mirroring that. We also should be welcoming people from all backgrounds into our profession. The greater our diversity, the deeper and richer our understanding will be of the needs of a varied population. We'll naturally be more sensitive to underrepresented communities—what they're going through and how they might have been marginalized, stigmatized, or treated with bias."

    "Who Are Tomorrow's PTs and PTAs?" is featured in the June 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.

    APTA Weighs in on Opioid Use Disorder, Opioid Poisoning, Among People With Disabilities

    APTA has contributed to an effort that may help shed light on an often-overlooked facet of the opioid crisis—the impact of opioid use disorder on people with disabilities. While final directions have not been laid out, the comments are helping to shape further calls for research on some important considerations for this population, such as barriers to addiction treatment, difficulty in accessing nonpharmacological pain management, and the relationship between traumatic, disabling injury and opioid misuse.

    The project is the work of the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), a branch of the US Department of Health and Human Service's Administration for Community Living (ADL). The institute hopes to use comments it received from 50 invited respondents, including APTA, to define next steps in research and education. Other groups that responded included the American Association of Nurse Practitioners, the American Psychological Association, and the National Council on Independent Living. In addition, NIDILRR sought comments from consumers, research teams, clinicians, and community organizations.

    The effort is an attempt to address what NIDILRR describes as the "paucity of research focusing on people with long-term disabilities and their likelihood of developing an opioid use disorder." In an interim report, the institute identified 3 key themes that emerged from the initial call for comment. They are:

    People with disabilities are more likely than the general population to misuse opioids but less likely to receive treatment. NIDILRR authors cited one study's estimation that among Medicaid beneficiaries, people with disabilities had a higher incidence of opioid use disorder than did those without a disability (6.4% vs 4.2%) but a lower rate of receiving an approved treatment medication for opioid misuses (11% vs 32%).

    Barriers such as physical accessibility to treatment centers, limited insurance coverage, and policies that withhold opioid prescriptions without offering alternative pain management approaches are more prevalent among people with disabilities. In many rural areas, treatment facilities require long travel, and, once there, those with disabilities can find physical access challenging. Additionally, treatment that focuses primarily on denying or restricting the use of opioids creates treatment gaps that often can lead to secondary health issues, including blood pressure problems, heart palpitations, and falls.

    People with disabilities who have had a serious traumatic injury are at greater risk for opioid poisoning. Traumatic injuries that result in long-term disability can create secondary health conditions that often are treated with opioids. Such treatment exposes this population to an even greater danger of opioid misuse and death from opioid poisoning. One study cited by NIDILRR estimated that 70%-80% of all patients with traumatic brain injuries are discharged with a prescription for an opioid.

    NIDILRR says it is exploring funding opportunities "to generate new knowledge and promote its effective use to address the opioid crisis and its impact on people with disabilities." Future possible funding areas include more research on prevalence of opioid use disorder in this population, individual and environmental risk factors, factors associated with improved access to treatment, and the effects of government policies and programs on health care access and treatment.

    APTA Federal Advocacy Forum Brings the Profession's Energy to Capitol Hill

    Wonder if advocacy for physical therapy is still important now that a permanent fix has been applied to the Medicare therapy cap? Just ask the 270 physical therapists, physical therapist assistants, and students from 48 states who converged on Capitol Hill recently to educate legislators and staff about a range of important issues impacting the profession.

    The meetings took place April 29–May 1, as part of APTA's annual Federal Advocacy Forum in Washington, DC. Attendees discussed several issues, including:

    • The importance of integrating physical therapy into efforts to address opioid abuse
    • Passage of the CONNECT for Health Act (H.R. 2556/S. 1016), which would ease restrictions on the provision of telehealth under Medicare
    • Concerns about H.R. 4508 and its proposed changes to the Higher Education Act (PROSPER), which would affect student loan amounts, forgiveness, and repayment
    • The Sports Medicine Licensure Clarity Act (H.R. 302/S. 808), which would provide portability of malpractice insurance for PTs and PTAs who travel across state lines with professional and collegiate sports teams

    Members also were trained on best practices for advocating through a variety of channels, as well as the role data plays in advocacy. Amy Walter, national editor of the Cook Political Report and former political director of ABC News, was the keynote speaker.

    event also included APTA's annual recognition of outstanding federal advocacy efforts. This year, Linda John, PT, was awarded the Federal Government Affairs Leadership Award for her tireless efforts as an advocate, a Federal Affairs Liaison, a Key Contact, and a mentor. The association also recognized Sen Thom Tills (R–NC) with the APTA Public Service Award for his instrumental role in including physical therapist assistants within the TRICARE system as part of the National Defense Authorization Act in 2017.

    "The level of dedication and engagement at this year's forum was truly impressive," said Jennica Sims, APTA congressional affairs and grassroots specialist. "This kind of energy is crucial in advocacy and helps legislators understand the contribution of physical therapists to ensuring the health and well-being of children, working age adults, and older adults."

    Editor's note: The Federal Advocacy Forum serves as an advocacy recharging station for APTA members—and it's a lot of fun, too. Watch the video below, and check out this #PTTransforms blog post to find out what it's all about.


    As APTA's Financial Solutions Center Marks 1 Year, Student Debt Looms Large in the News

    The challenges associated with college costs, student debt, and postgraduation financial management continue to make headlines, with very little progress being made in identifying ways to curb what seems to be a growing—and worsening—issue.

    APTA's Financial Solutions Center, launched 1 year ago this month, was designed to help physical therapists, physical therapist assistants, and students respond to those challenges by helping them deepen their financial knowledge and potentially refinance student debt at a discounted rate. But as the news will attest, the underlying issues affect a broad swath of those who are pursuing or have completed a college degree. Here's a roundup of recent coverage of college costs and student debt in the news:

    The Urban Institute released an interactive map that charts the intensity and distribution of student debt across the country.
    A new online tool allows users to zero in on county-by-county data on median student loan debt, monthly payments, nonwhite population share, and average household income, among other statistics. The (unsurprising) bottom line: student debt problems are generally more severe in areas with higher-cost colleges, but this article from Inside Higher Ed points out other nuances of the data.

    Where do people have the most college debt? Here are the top 10 states.
    CNBC distilled the data from the Urban Institute project and came up with a list of the "10 states where student debt is a big problem."

    Also from CNBC: an exploration of the disproportionate share of student debt held by women.
    According to the American Association of University Women, women hold about two-thirds of all student debt in the United States. This CNBC analysis identifies 4 major reasons for the disparity.

    Student loan forgiveness programs may be too costly to become widespread.
    Statistics website FiveThirtyEight.com looks at how the federal government may not have anticipated the cost of various loan forgiveness programs. Expansion of those programs is unlikely, and reductions in offerings may lie ahead.

    Many currently enrolled college students face financial trouble including hunger and homelessness.
    National Public Radio was 1 of several media outlets to report on the results of a recent survey of college students that found more than 1 in 3 reporting that they were food insecure, with the same ratio reporting that they were housing insecure. And nearly 1 in 10 said they were homeless.

    The APTA Financial Solutions Center features 3 major offerings: the APTA Financial Education Program, a customizable, multiformat learning platform powered by Enrich; the APTA Student Loan Refinancing Program, provided by Laurel Road, which offers discounts on loan repayment rates for eligible APTA members; and a lookup service that helps users find a Certified Financial Planner. In addition, the webpage offers resources on scholarships, employment, and other member discount opportunities.

    Bill to Weaken ADA Met With Strong Opposition From Senators, APTA, Other Organizations

    A bill that would weaken the Americans with Disabilities Act (ADA) may not be taken up for consideration by the US Senate, thanks to a coalition of senators and strong opposition from disability rights supporters including APTA.

    But the fight isn't over yet.

    Known as the ADA Education and Reform Act (HR 620), the bill would add a "notice and cure" clause to the ADA, effectively shifting the burden of compliance for public accommodations away from public establishments and on to the individual with the disability. Under HR 620 an individual with a disability who experiences discrimination in access to a public accommodation would have to notify the establishment owner, who would have up to 60 days to respond to the complaint. If no response or progress to address the issue is made, the individual with a disability would have to wait another 120 days before being allowed to file a lawsuit.

    Supporters of the bill, which passed in the US House of Representatives, characterized HR 620 as a measure aimed at discouraging frivolous lawsuits. Opponents including APTA see the bill as nothing less than an effort to undermine the ADA.

    "The ADA was landmark civil rights legislation barring discrimination on the basis of disability that was long overdue when it was signed into law more than 25 years ago," said Katy Neas, executive vice president of public affairs for APTA. "This attempt to erode the rights guaranteed in the ADA runs counter to the values of the physical therapy profession and its commitment to assisting all people with disabilities to set and achieve high goals."

    APTA has joined hundreds of organizations including AARP, NAACP, Paralyzed Veterans of America, and the National Disability Rights Network to oppose the bill. Recently, that opposition was taken up by 43 US senators, led by Sen Tammy Duckworth (IL), who signed on to a letter promising to prevent the measure from receiving a vote.

    "When supporters of the discriminatory HR 620 argue for its necessity by citing examples of alleged 'minor' accessibility infractions, they miss the point that this bill undermines the rights of people with disabilities, rather than protects them," the senators write. "There is nothing minor about a combat veteran with a disability having to suffer the indignity of being unable to independently access a restaurant in the country they were willing to defend abroad. There is nothing minor about a child with cerebral palsy being forced to suffer the humiliation of being unable to access a movie theater alongside her friends."

    Although the number of senators who have pledged to oppose the bill is sufficient to prevent passage, Neas says it's important that groups fighting HR 620 keep up the pressure.

    "The leadership of the senators who signed on to the opposition letter provides an important boost to our efforts to stop HR 620, but now is not the time to sit back and relax," Neas said. "We need to keep up the pressure to ensure that this bill never reaches the finish line."

    Individuals who want to join the opposition to HR 620 can find out more by visiting the Disability Rights Education and Defense Fund; APTA members and supporters are encouraged to visit the association's Legislative Action Center, and contact their senators to urge them to not consider HR 620 in the Senate.

    Washington Post: End of Therapy Cap a 'Long-Awaited Gift'

    The end of the hard cap on payment for therapy services under Medicare was big news for patients and the profession—a fact that hasn't escaped the notice of The Washington Post.

    The March 1 edition of the Post featured a story from Kaiser Health News on the elimination of the cap, which is described as a change "buried" in the federal spending plan approved by Congress in February, albeit one that "reveals much about how health care financing often gets done—or undone—in Washington."

    The article recounts the birth of the cap in 1997, efforts to repeal it, and the regular scrambles to apply temporary exceptions to the policy. And to help illustrate the long slog that finally led to repeal, Kaiser reporter Shefali Luthra retells the story of an ambitious physical therapist who left his practice in Michigan and headed to Washington, DC, nearly 20 years ago to help advocate for an end to the cap. His name: Justin Moore, PT, DPT—as it happens, the same Justin Moore who's now CEO of APTA.

    The unceasing advocacy efforts of "a small but impassioned therapy contingent" of APTA members, association staff, and patients is what "laid the groundwork" for the cap fix, according to the Post article. As for Moore, he's quoted as saying "I've got to figure out what to do next." Insider tip: he's joking.

    Humana Coverage Limitations: More of the Same

    Humana’s latest list of physical therapy services it won't cover may not have changed much, but that doesn't mean the limitations should continue, according to APTA. The association recently voiced its concerns over the ways the health insurer characterizes physical therapy, its imprecise terminology, and its continued noncoverage of aquatic physical therapy and group physical therapy.

    The APTA letter was sparked by the release of the latest updates to Humana's medical coverage policy, which has drawn attention in the physical therapy community because of a list of services it says it may not cover. That list includes aquatic therapy, group therapy sessions, sensory integration, community/work reintegration, and work hardening/conditioning.

    While disappointing for physical therapists (PTs) and their patients, the coverage limitations themselves aren't new, according to Alice Bell, PT, DPT, senior payment specialist at APTA. Bell was part of a payment and practice management staff team that reviewed the policy.

    "The latest update from Humana changed very little from the policy in place in 2017 and earlier," Bell said. "Noncoverage of aquatic therapy, group therapy, and work hardening dates back to at least 2014."

    Still, that doesn't mean the policy is acceptable, in APTA's view. Earlier this month, APTA sent a letter to Humana that specifically cites aquatic therapy and group therapy as services that should be covered.

    "Evidence demonstrates that for some patients the progression to land-based exercise and functional movement is effectively facilitated through the use of aquatic therapy," the letter states. When it comes to group therapy, APTA asserts that for certain conditions and patient populations, "the psychosocial benefits of peer support and group interaction can serve to enhance the therapeutic experience and impact," adding that it's distinct from group exercise in its integration into an overall skilled plan of care aimed at optimizing the effectiveness of therapy.

    The APTA letter also points out other areas in which Humana uses sloppy language or just plain gets it wrong. One example: Humana's description of exercise as a modality. "Modalities are passive interventions," the association reminds Humana. "Therapeutic exercise is an active aspect of therapy."

    APTA also describes Humana's statement that "[physical therapy] procedures in general include therapeutic exercises and joint mobilization" as an "extremely narrow" characterization of the profession.

    "Representing the interventions in such a limited way in the description of the practice fails to acknowledge the breadth and depth of the profession, the therapeutic benefit to the patient, and the services covered under the current policy," the letter states. "APTA would like to highlight that the core of skilled physical therapist practice lies in the evaluation, reevaluation, and implementation of therapeutic procedures."

    "Humana has taken some positive steps, particularly when it lifted prior authorization requirements for physical therapy earlier in the year," Bell said. "The latest coverage policy updates do not move any issues forward—or backward for that matter. That's why APTA will continue to advocate for changes that better serve patients."