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  • New Anthem UM Vendor in 5 States May be the Beginning of a Wider Shift

    Physical therapists who bill Anthem Blue Cross-BlueShield (BCBS) in California, New York, Indiana, Wisconsin, and Louisiana, get ready for a change: there's a new utilization management (UM) vendor in town.

    APTA has learned that Anthem BCBS is migrating to a new UM vendor, starting with the 5 states listed above. The new UM group is a subsidiary of Anthem known as AIM Specialty Health and replaces previous UM vendor OrthoNet in Medicaid states

    The migration will begin March 1, 2019, for Medicaid patients in New York, Indiana, Wisconsin, and Louisiana. The shift won't happen in California until March 15, 2019, and will include all commercial enrollees. But the migration isn't likely to stop there, according to Elise Latawiec, PT, MPH, APTA lead senior practice management specialist.

    "Anthem also operates in Colorado, Connecticut, Georgia, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, and Virginia, and manages specialty plans in several other states. From the information received thus far we expect the migration to impact all lines of business in the coming year," Latawiec said, adding that APTA has asked Anthem to notify the association as far in advance as possible so that we may alert membership to the change.

    The new UM system also includes occupational therapy and speech-language-hearing services, and applies to any outpatient place of service, including both on- and off-campus hospital facilities. Anthem BCBS will require that the new UM be applied for patients with all diagnoses for which treatment is delivered in the outpatient setting.

    AIM is holding a series of initial training sessions January 24, January 30, February 24, and February 26, and says it will reach out to invite current Anthem providers to the webinars. Anyone unable to attend a scheduled session will be able to access a recorded version following the 4 trainings.

    APTA will meet with AIM representatives for a follow-up conversation after the initial rollout.

    Want to get a better understanding of the ins and outs of UM? Check out APTA's Utilization Management Toolkit, a members-only online resource with tips, common challenges, and strategies of addressing UM issues.

    Moving Forward With Move Forward Radio's Most Popular Podcasts of 2018

    APTA's popular Move Forward Radio helps you connect with your patients and clients. It's an interview series that features patients, PT and PTA experts, and even the occasional celebrity discussing physical therapy's role in a wide range of issues. In 2018, the podcast kept that tradition alive and well.

    But don't take our word for it: check out the 5 most popular Move Forward Radio podcasts of 2018.

    The Benefits of Exercise on Brain Health
    There’s a growing body of evidence that being physically active benefits brain health and can help slow the decline in brain function that come with age. In this episode, Joyce Gomes-Osman, PT, PhD, discusses her latest research about overall physical activity on brain health. She and her research associates have concluded that when it comes to brain health, the overall and cumulative effect of physical activity is what’s most important.

    Avoiding Muscle Atrophy When Injured
    Individuals who work out regularly can become anxious after they've experienced an injury that keeps them from exercising—worrying about what will happen to their bodies, when they can return to exercise, and how much their age might affect recovery. Ryan Balmes, PT, a board-certified clinical specialist in both sports physical therapy and orthopaedic physical therapy, addresses those concerns and more.

    Beyond Opioids: Transforming Pain Management to Improve Health
    On February 5, 2018, APTA convened a panel of 7 experts to discuss how pain management in America can be transformed to move beyond opioids and improve the health of society. “Beyond Opioids: Transforming Pain Management to Improve Health” was broadcast live on Facebook and included the debut of APTA’s latest public service announcement for the #ChoosePT campaign. This special episode of Move Forward Radio provides full audio from that event.

    Bowel Health: What You Should Know
    Though it may be uncomfortable to discuss, bowel health is important. Improper habits can develop in childhood and follow us into adulthood, or issues can arise through sickness, sensitivities, microbiome changes, pain, or various diseases such as irritable bowel syndrome, Crohn’s disease, and diverticulitis. Jenn Davia, PT, DPT, a board-certified clinical specialist in women's health, discusses matters that most of us might like to keep behind closed doors, including breaking bad habits, why proper positioning is important, and tips to achieve good bowel health.

    Fourth Trimester: What Is It and Why Is It Important?
    Fourth trimester is the term used to describe the weeks and early months after delivery, when the baby has been born but health care involvement remains vitally important to ensure optimal recovery from pregnancy for the mother, and optimal postpartum care of the child. Carrie Pagliano, PT, DPT, a board-certified clinical specialist in both women's health physical therapy and orthopaedic physical therapy, as well as president of APTA’s Section on Women’s Health, discusses why women should be sure to check in with a physical therapist who specializes in women’s health before, during, and after pregnancy.

    Diverse Voices, 1 Community: The Top APTA Blog Posts of 2018

    The past year saw more blog activity than ever at APTA. Readers of the #PTTransforms blog and the student-focused Pulse blog experienced different voices, new perspectives, and even calls-to-action that challenged assumptions.

    It's not too late to get in on the energy. Here are links to some of the year's most popular blog posts, with a quick description of each.

    "Top 5 Questions Physical Therapists Can’t Answer"
    Does the profession know itself? What needs to happen to achieve a better understanding of issues such as variation in care and use of clinical practice guidelines?

    Changes to the Blood Pressure Guidelines: Is It a Change for Physical Therapists?
    A new blood pressure guideline has sparked discussion in the health care community regarding blood pressure targets and best practices. How does the new guideline affect physical therapist practice and the patients we treat?

    2018 Presidential Address
    This video (and accompanying transcription) of APTA President Sharon Dunn's address to the 2018 APTA House of Delegates captures an important moment in APTA's evolution, as the association begins to make bold moves toward inclusivity, collaboration, and strong advocacy for population health.

    My Whole Body Is a Nervous System: The Anxiety Diaries of an SPT
    "Welcome to year 2, day 1, of my doctor of physical therapy program. I leave my musculoskeletal dysfunction class early so I can make my first appointment with a therapist at my school's Counseling and Psychological Services office." A candid and informative discussion of the emotional health challenges experienced by Heather Beaudoin, SPT, a second-year PT student at Northwestern University.

    Stereotype Threat: How Fear Led Me to Passion
    Everyone has felt the pressure of stereotypes of one kind or another. Do you embrace the stereotype that's been applied to you? Do you reject it? Can you tell when a stereotype has become an obstacle to achieving your dreams? Author Ron Peacock, Jr, SPT, provides a heartfelt perspective.

    Primary Care and the Physical Therapist: Lessons From the Military
    The US military has been involving PTs in primary care for several years. It's time for the civilian health care system to take note, writes Jason Silvermail, PT, DPT, DSc.

    How Do I Avoid Burnout? A Perspective From an Engaged PT
    Burnout can happen to anyone, but the nature of the physical therapy profession presents some special dangers. This post provides tips on how to spot burnout in yourself, and what to do to regain that spark.

    Blunt Conversations: Setting Realistic Patient Expectations for Pain
    At APTA's "Beyond Opioids" panel, Sarah Wenger, PT, DPT, observed that clinicians need to give patients realistic expectations for pain and pain relief. But how do we have these difficult—yet important—conversations? In this Q&A, Wenger delves deeper into the topic.

    Move Forward Radio Catches a 'Big Wave' Surfing Legend

    If you're going to face down a 30-foot wall of water armed with nothing but a surfboard, you'd best be someone who's not afraid of a little danger—either that, or someone who's ready to learn from potentially injurious failure. Turns out big wave surfing champion Laird Hamilton is a little of both.

    Now on APTA's Move Forward Radio: an interview with Hamilton, who's made an international name for himself as, yes, a fearless surfer but also as an athlete who, in his own words, has survived his body being "torn, punctured, ripped, scraped, broken…you name it." It's those injuries, he says, that have enabled him to learn more about his own body and the importance of staying active, even when things aren't at 100%.

    Hamilton remembered the lessons he had learned through his surfing injuries and applied them to his preparation for—and recovery from—hip replacement surgery. In the podcast, he describes how he avoided pain medicine of any kind during the process, and how he surprised his health care team with one of the fastest recoveries they had ever seen. He also tells Move Forward Radio that he drew no small amount of inspiration from his wife, volleyball star Gabby Reece, who was featured on 2016 podcast to talk about her drug-free recovery from a total knee replacement (performed the same day as Hamilton's hip operation, by the way).

    Move Forward Radio is archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online or downloaded as a podcast via iTunes.

    PT in Motion Magazine Looks at PTs in Primary Care

    Think the idea of the physical therapist (PT) as a primary care provider is some kind of far-off, pie-in-the-sky concept? Don't tell that to Tony Bare, PT, DPT, ATC; or Rebecca Byerley, PT, DPT; or Kaiser Permanente of Northern California, for that matter. They're already doing it—and doing it successfully.

    This month in PT in Motion magazine: Associate Editor Eric Ries takes an in-depth look at PTs in the primary care space, where they assume roles that range from a "roving PT" member of a multidisciplinary primary care team (the Kaiser approach), to a clinician in private practice who is often a patient's first point of contact with the health care system. Bare and Byerley are examples of the latter, both of whom have thriving practices in very different settings.

    The article features various PTs' perspectives on what it takes to provide primary care and outlines what APTA is doing to promote the concept. Ries also covers the longstanding use of PTs as primary care providers in the military and interviews PTs for their perspectives on the barriers to adopting a similar model in the civilian world, as well as the broad cultural hurdles that will need to be overcome to make the primary care PT more common.

    "Deepening Physical Therapy's Footprint: PTs in Primary Care" is featured in the December-January 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. Also in the December-January issue: APTA’s Emerging Leaders and the Catherine Worthingham Fellows of the American Physical Therapy Association share their views on such professional issues as the role of research, networking, education, mentors, and the future of the profession. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.

    Study: Clinic Ball Pits Carry Bacterial Risks

    It's no secret that when it comes to their potential for bacterial awfulness, the children's ball pits often found in fast food restaurants are the stuff of a germaphobe's nightmares. Now it turns out that if not properly maintained, ball pits in physical therapy clinics are capable of inducing shudders too.

    In a study recently published in the American Journal of Infection Control (abstract only available for free), researchers tested 6 ball pits in inpatient and outpatient physical therapy clinics in Georgia to find out what, if anything, those pits were harboring at a microbial level. Authors hope that the study will help to spark a conversation about standards for cleaning the enclosures—standards that they say have remained "elusive" to date.

    To conduct the analysis, researchers collected 9 to 15 balls taken from different depths in each ball pit, and then swabbed the entire surface of each ball. Samples were then inoculated on agar plates and allowed to grow for 24 hours at 91.4 degrees Fahrenheit. After the incubation, samples were tested for the number of colony-forming units (CFUS) present. Here's what researchers found:

    • Researchers identified 31 bacterial species and 1 species of yeast, with 9 organisms identified as "opportunistic pathogens." These organisms included bacteria associated with endocarditis, septicemia, urinary tract infections, meningitis, respiratory distress syndrome, streptococcal shock, and skin infections. The variety of yeast found on the balls—rhodotorula mucilaginosa—has "a high affinity for plastics" and has been associated with "multiple cases of fungemia in immunocompromised individuals," authors write.
    • There was "considerable variability" among the clinics, ranging from 36% to 93% of balls tested that produced recoverable CFUs, suggesting that clinics "utilize different protocols" for maintaining their ball pits, according to authors.
    • In the worst instance, bacterial colonization was found at the rate of "thousands of cells per ball, which clearly demonstrates an increased potential for transmission of these organisms to patients and the possibility of infection in these exposed individuals," authors write.

    Lead author and APTA member Mary Ellen Oesterle, PT, EdD, says the results should give clinics pause.

    "Clinics should be concerned about these findings," Oesterle said in an interview with PT in Motion News. "I would not recommend using a ball pit in a clinic until proper cleaning has occurred—and until the clinic verifies that the cleaning procedure effectively cleans the balls."

    Oesterle wasn't necessarily surprised by the findings, both in terms of the presence of pathogens and the variability among clinics. "In my own experience doing early intervention physical therapy for over 10 years, I encountered children who I suspected had contracted infections from ball pits, so this study confirmed something that rang true," Oesterle said. "The variability isn't surprising either," she added. "Each facility has different exposures, environments, and cleaning procedures, so I would expect the results to reflect that."

    And although concerning, Oesterle believes the problem is a solvable one.

    "I don't think it would be that difficult for clinics to reduce risk significantly," Oesterle said. "There are several approaches that may work well—for example, one clinic hangs balls in a mesh bag and disinfects them that way. We would like to do a follow-up study on the best cleaning method."

    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.

    Ready for MIPS? Take This Quick Quiz

    The decision by the US Centers for Medicare and Medicaid Services (CMS) to include physical therapists (PTs) in its Quality Payment Program (QPP) is huge: not only is it an acknowledgment of the important role PTs can play in the transition to value-based payment; it's an opportunity for the profession to further strengthen its case for physical therapy as a way to reduce costs, improve outcomes, and provide better care.

    It's also going to mean some big changes in the ways many PTs get paid for their services, mostly through participation in the Merit-based Incentive Payment System (MIPS), which is a major part of QPP. And the changes are right around the corner, set to take effect on January 1, 2019.

    All of which begs the question: are you ready for what's coming? Take this quick quiz to find out how much you know about MIPS (scroll down for answers). Then check out APTA's MIPS webpage for extensive resources on this major shift, and sign up for a December 4 webinar, free to APTA members.

    1. True or False: Getting a sense of whether you're MIPS-eligible will be difficult until after January 2019.

    2. PTs in private practice who exceed the CMS "low-volume threshold" of more than $90,000 in allowed charges per year, more than 200 unique Medicare patients per year, and more than 200 professional services delivered per year must participate in MIPS or face a payment reduction of how much?

    A. 3%
    B. 5%
    C. 7%
    D. There is no penalty for nonparticipation.

    3. True or False: PTs who don't meet the low-volume threshold are barred from participating in MIPS.

    4. True or False: Group practices can participate in MIPS only if every clinician in the practice meets the low-volume threshold.

    5. True or False: Beginning in 2019, claims-based reporting will be permitted only in practices with 15 or fewer MIPS-eligible clinicians.

    6. Which of the following statements is the best advice for PTs and practices considering reporting through a vendor or registry to meet MIPS requirements?

    A. Hold off for now. MIPS is still in flux and it's hard to predict which arrangements will work.
    B. Don't bother. Using an electronic health record (EHR) program alone will get the job done.
    C. You missed your chance. At this point, it's too late to integrate with a reporting vendor or registry—your best bet is to go it on your own.
    D. It's worth considering. Participating in a registry or other reporting system gives you feedback on performance throughout the year and can ease reporting burdens if the system is connected to your EHR program by capturing data through your daily documentation.

    7. In 2019, in addition to quality measures similar to those reported through the old physician quality reporting system, PTs in MIPS also will be required to report on:

    A. Improvement activities
    B. Promoting interoperability
    C. Cost
    D. Crossdisciplinary collaboration

    8. How many points need to be earned in 2019 to avoid a downward payment adjustment in 2021?

    A. 15
    B. 30
    C. 45
    D. 50

     

    ANSWERS

    1. False. CMS has a QPP participation lookup webpage available right now. While it's true that CMS will update it to reflect the changes coming in 2019, you can prepare yourself for possible participation by checking to see if you exceeded the participation thresholds in 2018.

    2. 7% (C). If you treat Medicare Part B patients and meet all 3 low-volume threshold criteria and don't participate in MIPS in 2019, prepare for a 7% reduction in payment rates beginning in 2021. On the other hand, successful participation in MIPS could result in an upward adjustment of as much as 7%—in fact, it's the only factor on which CMS will be basing increases.

    3. False. You can opt in to the program beginning in 2019 if you treat Medicare Part B patients and meet any of the 3 criteria. You can opt in on the QPP website in early 2019 for the 2019 participation year. Check out this decision tree to better understand your options, and remember that once you opt in you’re obligated to participate the whole year.

    4. False. For group practices, the threshold criteria (charges, unique Medicare patients, number of professional services) are calculated at the group level—and across services delivered, not just physical therapy.

    5. True. Practices with more than 15 clinicians will need to use a vendor to report data.

    6. It's worth considering (D). The right vendor or registry can pay off, both in terms of ongoing performance feedback and as a way to streamline data entry by way of integration with your EHR system. Tip: look for a resource, such as APTA's Physical Therapy Outcomes Registry, that has been awarded Qualified Clinical Data Registry status by CMS—that means your MIPS data can be easily passed on to CMS, and may include other quality measures for reporting to MIPS, thereby helping to strengthen your MIPS score.

    7. Improvement activities (A). Physicians and other clinicians currently participating in MIPS must report in 4 categories: clinical improvement, quality, cost, and interoperability. For the time being, eligible PTs will be required to report only on improvement activities and quality measures. For more information on both of these categories visit the APTA MIPS webpage.

    8. 30 (B). For the 2019 reporting year, participating providers who earn at least 30 points out of a possible 100 can avoid a downward adjustment in 2021.

    CSM Delivers: Aging

    As the US population continues to age, physical therapists (PTs) and physical therapist assistants (PTAs) will take on an even more transformative role in the health of society. Are you ready?

    The 2019 APTA Combined Sections Meeting, set for January 23-26 in downtown Washington, DC, can help keep you on top of some of the latest issues in healthy aging. Check out these suggestions, and find other relevant programming by searching the CSM programming page.

    Geriatric Low Back Pain: Managing Influences, Experiences, and Consequences
    This session focuses on the biological, psychological, cognitive, and social influences of geriatric low back pain (LBP), and presents a comprehensive model of geriatric LBP that accounts for the interface between pain and impaired movement, as well mobility and health risks associated with geriatric LBP. Find out about age-appropriate measurement tools and interventions for geriatric LBP and learn how to implement a comprehensive, standardized management approach that optimizes recovery and mitigates health risks associated with geriatric LBP. Friday, January 25, 8:00 am–10:00 am.

    Staying Fit Beyond Menopause Through Early Screening and Training
    Menopause is a wake-up call for lifestyle changes that many women don't want to think about until they experience symptoms. Unfortunately, they miss their best window of opportunity to modify risk factors in the years prior to and immediately following menopause. Making specific lifestyle changes can build and maintain body strength before, during, and after the menopause transition, enhancing a woman's health long term. This session delivers what you need to know about hormonal influences impacting women's health at menopause, the use of an appropriate screening tool, and clinical applications to physical therapy. Saturday, January 26, 11:00 am–1:00 pm.

    The Skin and Aging: Impact on Wound Prevention and Management
    Wound care for individuals who are aging comes with a price tag of more than $25 billion, an amount certain to increase as the aging population continues to grow. This session will cover histologic changes that occur as people age, and the pathological consequences arising from impaired angiogenesis, degeneration of the extracellular matrix, thinning of the subcutaneous adipose tissue, decreased immune response, and photoaging. Get the latest on guidelines for comprehensive screening and risk assessment, and review case studies that highlight evidence-based interventions to maintain and restore skin integrity through a comprehensive, patient-centered plan of care. Thursday, January 24, 8:00 am–10:00 am.

    Register for CSM by midnight ET on Wednesday, December 5 to grab advance discounts and your chance to win 1 of 2 $500 VISA gift cards.

    APTA Members Eligible for Interdisciplinary Orthopedic Conference Discount

    In this rapidly changing health care environment, it's crucial that practitioners and administrators learn as much as possible from each other—and orthopedics is no exception. An upcoming conference aims to provide a platform for just such an exchange and is offering APTA members a discount on registration.

    The Interdsciplinary Conference on Orthopedic Value-Based Care, set for January 18-20 in Newport Beach, California, is an event that brings physicians, health care executives, nurses, and physical therapists (PTs) together to learn and share insights on everything from improving patient outcomes to understanding how concepts such as "Medicare for all" could affect individual practice. Sponsored by the American College of Perioperative Medicine, the conference features a long list of leaders in orthopedic care, including APTA Board of Directors member Kip Schick, PT, DPT.

    Registration for the conference is open now, with early bird discounts ending November 21. APTA members are eligible for an additional 10% discount—just enter "PERIOP" in the "promotion code" box on the registration form.

    From PT in Motion Magazine: A Primer on Major Medicare Payment Changes

    It's hard to overstate the Medicare-related changes that many physical therapists (PTs) will be facing come January, now that the US Centers for Medicare and Medicaid Services (CMS) has adopted a final rule that includes eligible PTs in the agency's comprehensive Quality Payment Program (QPP). There's a lot to learn about the new value-based payment system, and PT in Motion magazine can help you get started.

    In "Moving Toward Quality Payment" in the November issue of PT in Motion, author Christine Lehmann breaks down the QPP into its 2 paths, particularly focusing on the Merit-based Incentive Payment System (MIPS) and its reporting requirements. The article includes an easy-to-follow decision tree that helps you understand whether you'll be required to participate in MIPS, and, if not, whether you should consider voluntary participation (hint: APTA thinks it's a good idea).

    Lehmann's piece also covers the other QPP path, advanced alternative payment models, as well as the ways in which APTA's Physical Therapy Outcomes Registry could serve as an important resource for PTs moving to value-based payment systems. Sidebars to the article include information on the elimination of functional limitation reporting requirements, and a list of additional APTA resources to help you get up to speed on the changes ahead.

    "Moving Toward Quality Payment" is featured in the November 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.