• Thursday, July 16, 2015RSS Feed

    5 Tips on Cultural Competence

    Everyone recognizes that cultural competence is a crucial component of the physical therapy profession, and a concept that's strongly tied to APTA's transformative vision. But what is it really? And how will you know when you're living out cultural competency in your practice?

    Here are 5 tips on cultural competence, drawn from APTA's extensive online resources that include videos, online and text-based courses, as well as association plans, policies, and guidelines. Take a few minutes to get reacquainted with these basics, and then explore the details through the APTA website.

    1. Take an honest look at yourself.
    Cultural competence begins with an understanding of how your own culture has shaped you, and how your attitudes and understandings of other cultures impact your behavior toward individuals from outside your cultural experience. Being honest with yourself is a crucial step.

    2. Pay attention to systems.
    Individual attitudes about cultural differences do matter, but it's important to realize that cultural competence also requires attention to the interplay of systems—the family system, the delivery system, the educational system, and many others. When these systems interact, they can create tensions—or opportunities. The culturally competent physical therapist is mindful of the bigger picture constantly in play.

    3. Listen, listen, listen.
    Culturally competent treatment is by definition patient-centered. So ask questions, and listen carefully to the answers, without judgment. Questions worth asking: What do you call the problem? What do you think the illness will do to you? What do you believe is the natural course of the illness? What do you fear? Why do you think this illness or problem has happened? How do you think it should be treated? How do you want to be helped? Who should be involved in decision-making?

    4. It's not just about race.
    Culturally driven attitudes can arise from shared thoughts, beliefs, and customs that may be less about race, and more about ties to ethnic, religious, social, or even age-related groups. Just because your patient or client looks and talks like you doesn't mean you can relax your attentiveness to potential cultural differences (see "Listen, listen listen," above).

    5. There's no finish line.
    You're never "done" with cultural competence. It's a process that requires constant self-assessment, learning, and openness to honest dialogue with colleagues. There are no books or courses that will make you culturally competent—like maintaining a healthy, active lifestyle, cultural competence requires ongoing effort. But the payoff is tremendous.

    Monday, June 15, 2015RSS Feed

    Medicare Provides Tips on Reducing Errors Around Insufficient Documentation

    According to Medicare administrative contractors (MACs), physical therapy procedures are among the "more common" procedures that get denied due to insufficient documentation. It's a pattern they're hoping to change through additional information aimed in part at physical therapists (PTs).

    Earlier this month, a task force made up of all 8 MACs issued a fact sheet and a "task force scenario" (.pdf) that highlights, among other things, what PTs should be aware of when it comes to developing a plan of care. According to the fact sheet, the main problem encountered with physical therapy services is insufficient signatures and dates on plans of care. The fact sheet provides details and links to the specific requirements.

    A second document, titled "Task Force Scenario: Documenting therapy and rehabilitative services," is available at all 8 MAC websites, and goes into even more detail on how to reduce the risk of errors attributed to insufficient documentation. Among the tips provided:

    • Ensure the medical records provide proof the service was certified and rendered.
    • Ensure the medical records provide justification for medical necessity and need for skilled services.
    • Create a complete plan of care that includes signatures, professional designation, and date.
    • Document when the plan of care is modified and why, including an explanation of why previous goals were not or could not be met.
    • Confirm that the plan of care is certified appropriately with the physician or nonphysician practitioner.
    • Clearly document, in minutes, the total time spent on timed-code treatment only and the total treatment time in the patient's record.

    For the complete guidance document, visit the website of the applicable MAC (direct links to the scenario document have been provided where possible): Cahaba Government Benefit Administrators, CGS Administrators, National Government Services, Noridian Healthcare Solutions, Novitas Solutions, Palmetto GBA, or Wisconsin Physicians Service Corporation.

    Learn more about how to avoid Medicare documentation errors: the APTA Center for Integrity in Practice website offers a webpage dedicated to documentation.

    Wednesday, May 27, 2015RSS Feed

    Postpartum Exercise, Concussion, Stroke, and More: Catch Up With Move Forward Radio

    The transformative power of physical therapy to treat diverse conditions is at the heart of recent Move Forward Radio episodes.

    A twice-monthly podcast, available for free download from iTunes or at MoveForwardPT.com, Move Forward Radio is a terrific resource to share with your patients. Recent episodes include:

    Pregnant and postpartum exercise
    During pregnancy and childbirth a woman’s body goes through profound changes in a relatively brief period of time. For women who exercise during or after pregnancy, failure to respect those changes has the potential to lead to problems. Christy Martin, PT, DPT, SCS, who specializes in sports physical therapy, and Vicki Lukert, PT, PRPC, who specializes in pelvic health, outline how pregnant and postpartum women can exercise safely and how to spot warning signs for problems that might require medical attention.

    Concussion and mild traumatic brain injury
    At Brooke Army Medical Center in Texas, Miriam Hammerle, PT, Cert SMT, often sees patients who have suffered a mild traumatic brain injury or concussion in the line of duty. One of her recent patients, Lt Col Tony Cromer Jr, suffered a concussion when his head was slammed by an opening door. The effects of that workplace accident, including headaches and dizziness, were the same as they often are for soldiers on the battlefield. Hammerle and Cromer discuss his injury and treatment.

    Autism spectrum disorder (ASD)
    ASD can be treated by a range of therapists who have individual specialties but overlapping goals. Christine Baksi talks about her 4-year-old son Sam, who was diagnosed with ASD at the age of 2, and is benefitting from a variety of therapies including physical therapy. Joining the discussion is Sam's physical therapist Lori Glumac, PT, DSc, PCS, who is a member of a collaborative care team that helps children with ASD develop physically and socially.

    Avoiding golf injuries
    Having a repeatable swing is key to having a good golf game. But with that repetition comes a risk for injury to backs, elbows, shoulders, and more. Michael Mulcahy, PT, discusses treatment for injured golfers, outlines typical golf-related injuries, and offers prevention tips that can help golfers strengthen themselves and their game.

    Stroke awareness, prevention, and recovery
    Those fortunate enough to survive a stroke often face problems with mobility, speech, balance, weakness, and memory loss, among other symptoms. Fortunately, depending on the severity of the stroke and the health of the individual, a physical therapist can effectively treat many of these side effects. Julia M. O. Castleberry, PT, DPT, MS, CLT, GCS, NCS, addresses all aspects of stroke, including describing what stroke rehabilitation looks like, how to spot a stroke, identifying who is at risk, and how to lower that risk.

    Spinal stenosis
    Spinal stenosis is a degenerative disease that causes a narrowing within vertebrae of the spinal column, resulting in pressure on the spinal cord. While it may sound like a serious problem in need of an invasive medical procedure (such as surgery), a recently published study in the Annals of Internal Medicine suggests that surgery should be considered only when other more conservative treatments, such as physical therapy, fail. Lead author Anthony Delitto, PT, PhD, FAPTA, discusses the study, treatment for lumbar spinal stenosis, and what patients need to know about options to avoid going under the knife.

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

    APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be e-mailed to consumer@apta.org.

    Wednesday, May 13, 2015RSS Feed

    Think You Know HIPAA? Take This Quick Quiz

     A solid understanding of the Health Insurance Portability and Accountability Act (HIPAA) is crucial to the survival of a physical therapist (PT) practice, so taking the time to read through a free online guide to HIPAA (.pdf) from the Department of Health and Human Services (HHS) is a good investment in your future. The new guide is one of many resources available to PTs and physical therapist assistants at APTA's HIPAA webpage.

    Want to test what you already know? Take this quick HIPAA quiz. Scroll down for the answers.

    1. TRUE or FALSE: You keep your practice's protected health records (PHIs) in secured files. However, the janitorial company you hire to clean your office nightly also has access to the room in which these records are stored. That makes your janitorial company a Business Associate (BA) that must enter into a BA contract with your practice.
    2. TRUE or FALSE: Should a breach occur, your notification responsibilities may vary, depending on how many individuals were affected.
    3. TRUE or FALSE: HIPAA applies to all records in your office that contain personal identifying information, including personnel records containing employee information.
    4. TRUE or FALSE: Even though HIPAA is a federal law, state laws can require you to meet additional or stricter requirements.
    5. TRUE or FALSE: Patients can choose where and how they want any communication from your practice delivered to them—for example, requesting that appointment reminder voicemails only be left on a work phone.



    1. FALSE. As long as your PHIs are secured and inaccessible, janitorial companies do not need to sign BA contracts. Other services you might hire out—for example, a web designer who improves your website's ability for patients who want to view or download their personal health information—would be considered a BA.
    2. TRUE. Breaches that affect 500 or more individuals are subject to different notification rules—both to the individuals affected and to HHS.
    3. FALSE. Employment records or records covered by the Family Educational Rights and Privacy Act (FERPA) are not covered by HIPAA rules.
    4. TRUE. HIPAA does not override any state laws that do not conflict with HIPAA or that offer greater privacy protections.
    5. TRUE. Patients have many rights under HIPAA, including the right to request that communication be through certain channels only. Patients can also request that your practice restrict certain disclosures to family members or others about the individual's general condition, location, or death.

    Tuesday, May 05, 2015RSS Feed

    5 Things to Think About Before Taking a Break or Leave From Physical Therapy

    For many physical therapists (PTs) and physical therapist assistants (PTAs), the time will come for them to take a break from active practice. Sometimes it's relatively brief—time off to care for a new baby, for example—and sometimes it's longer-term. And chances are that sooner or later, most of these PTs and PTAs will want to return to the profession they love.

    APTA offers a solid set of resources on career management, including career management resources useful for women in physical therapy, that will help you prepare yourself for a break, and get your head around what it takes to reenter the profession.

    Here are 5 quick tips on preparing for—and returning from—a break in practice.

    1. Know the FMLA like a boss. The Family and Medical Leave Act (FMLA) can protect you, but you should know its limits. How long can you stay out? What is your employer obligated to do? Are the rules different for maternity vs paternity leave? Can your boss switch you to a different job when you return? Get the facts first.
    2. Don't take license with your license. Physical therapy licensing boards vary in their requirements around maintaining licensure during an extended absence. Don't guess at what those requirements might be—get the definitive word from your licensing board. And then do what they say.
    3. Time marches on—especially when it's time away. Unfortunately, reentering physical therapy isn’t like riding a bike. Particularly when it comes to payment changes and evolving evidence, coming back can be like switching from a rotary phone to a smartphone. To help you get up to speed, start with APTA's Reentering Physical Therapy Practice webpage.
    4. Flex your PT muscle. Just because you've been out of the workforce for a time doesn't mean you have to approach your reentry from a position of weakness. After you've learned about how the profession may have changed since you left (see #3), get that confidence back by digging into workforce data that will help you negotiate your opportunities with confidence.
    5. Keep your finger on the job pulse. In addition to understanding the physical therapy workforce, keep tabs on the overall job market so that you can hit the ground running and land the job you want as soon as you're ready. APTA's Red Hot Jobs career centershows you where the opportunities are.

    Friday, April 24, 2015RSS Feed

    What Went Wrong? A Case Study of Patient Injury During Physical Therapy Session

    A patient injures herself during a physical therapy session. What happens next?

    The patient faces a longer recovery time, of course. And depending on the physical therapist's (PT's) approach to risk management, the PT could be facing a potentially costly and career-damaging malpractice claim that might have been avoided.

    The latest case study (.pdf) now available from Healthcare Providers Service Organization (HPSO) recounts the story of a self-employed contract PT working at a rehabilitation facility. His patient, a 49-year-old woman, is recovering from a hit-and-run accident that resulted in a vertebrae fracture, a wrist fracture, and a crushed spine. She's morbidly obese, a heavy smoker, and takes prednisone.

    Five months into treatment, the patient is injured during a physical therapy session. She files a malpractice claim against the PT.

    Could the injury have been avoided? Was the exercise she was performing at the time of the injury set up and monitored correctly? Was the exercise itself evidence-based? And what other elements of the PT's practice are likely to be exposed in mediation or a court hearing? The HPSO case study lays out the facts.

    "Case studies like these are a reminder for PTs that risk management is not just a part of practice, but a professional responsibility," said Nancy White, PT, DPT, OCS, APTA executive vice president of professional affairs. "Things can and do go wrong, but a PT who fully understands risk is better able to protect the patient, which in turn protects the PT."

    The latest case study joins a series of case studies available at the HPSO website. HPSO is the official provider of professional liability insurance for APTA members. For further information visit www.hpso.com/APTA.

    Thursday, April 23, 2015RSS Feed

    Push for More Data Reiterated in Proposed CMS Rule on Inpatient Payment

    The recently released proposed rules for inpatient prospective payment systems (IPPS) continues the US Centers for Medicare and Medicaid's (CMS) push for more data from facilities, with some payment increases being contingent on quality reporting participation and meaningful use of electronic health records (EHRs).

    The rule sets out a 1.1% increase in operating payment rates for acute care hospitals that successfully participate in the hospital inpatient quality reporting program (IQR) and that are "meaningful" users of EHRs. Hospitals that don't meet the IQR requirements could see a one-fourth reduction in payment rates, and hospitals that fail to achieve meaningful EHR use by 2016 would face a cut of one-half of any update issued.

    Other features of the proposed rule:

    • Overall, long-term care hospitals (LTCH) could see a 4.6% decrease in payments, mostly because of the introduction of a 2-track system that will use the standard LTCH prospective payment system for patients who meet certain clinical criteria, and apply lower "site neutral" rates—based on the IPPS—to patients who don't meet the criteria. Cases that do qualify for the standard LTCH prospective payment system rate will get an increase of 1.9%. The 2-track system was mandated by a law passed in 2013.
    • CMS would introduce additional measures required of hospitals. Outcomes being evaluated include care coordination beginning in 2018, and 30-day mortality rates for chronic obstructive pulmonary disease in 2021. Additionally, the agency would expand the range of data collected around hospital-acquired conditions.
    • LTCHs would be required to supply reports on pressure ulcers and falls as part of a CMS effort to implement the IMPACT Act, a 2014 law that strengthens and standardizes the collection of data on postacute care.

    The proposed rule also seeks feedback on a CMS bundled payment initiative that links payments for multiple services during 1 episode of care into a combined payment. The initiative is testing 4 models of bundling, and CMS is asking for comments on future expansion of the plan.

    APTA has produced a summary of the proposed rule (.pdf), and will provide comments to CMS on behalf of its membership.

    Monday, April 20, 2015RSS Feed

    State Copay Laws Mapped Out in New APTA Resource

    In a health care environment in which health insurance copays are becoming an increasingly powerful driver in care decisions made by consumers, it's valuable to understand the lay of the land when it comes to the ways states regulate insurance companies and what they can demand. That's where APTA's new interactive copay map comes in.

    The new resource provides a summary of each state's copay laws, including whether the law imposes limitations based on provider type, diagnosis, and patient variables, and how the law goes about establishing these limitations. Each state summary is captured in an easy-to-download pdf file.

    The copay map is housed in APTA's Fair Physical Therapy Copays webpage, which also includes model legislation, examples of individual state efforts to establish fair copay regulations, and talking points on the issue.

    Friday, April 17, 2015RSS Feed

    CMS Releases Proposed SNF Rule Heavy on Reporting Requirements

    Proposed US Centers for Medicare and Medicaid Services (CMS) rules for skilled nursing facilities (SNFs) would increase payments by $500 million in 2016 and set the stage for quality improvement and reporting requirements that, if not met, could result in loss of Medicare and Medicaid funding. The additional $500 million in aggregate funding represents a 1.4% increase.

    The majority of the rule focuses on how CMS plans to implement elements of the IMPACT Act. Passed into law last year and supported by APTA, the IMPACT Act is intended to standardize how data is collected and used across postacute care settings.

    Other parts of the proposal outline how a value-based purchasing program will be implemented beginning in 2019, and set up requirements for the submission of staffing information beginning in 2016.

    To meet provisions of the IMPACT Act, the proposed rule would require SNFs to report on several quality measures, including skin integrity, percentage of residents with new or worsened skin ulcers, incidence of major falls, and changes to their functional and cognitive status. Facilities that don't meet the reporting requirements by 2018 would be subject to a 2 percentage point payment reduction in annual updates.

    The proposed rule also sets out mandatory reporting on staffing at SNFs, including data on hours worked, resident case-mix and census, employee turnover and tenure, and hours of care provided per-resident per-day. The data would be collected on direct employees, agency employees, and contract staff; noncompliance could trigger penalties or exclusion from Medicare and Medicaid.

    In addition, CMS is seeking comments on an SNF value-based purchasing program, mandated by Congress, that would provide incentive payments to facilities based on performance beginning in 2019. The proposed rule would adopt a measure that evaluates 30-day hospital readmission rates for SNF patients, and CMS is accepting comments on policies related to that measure, mostly having to do with how performance would be measured, scored, and reported.

    The proposed SNF rule would also apply to noncritical access hospital "swing beds"—beds that are used for acute care or skilled care as needed.

    APTA has produced a summary of the proposed rule (.pdf), and will provide comments to CMS on behalf of its membership.

    Thursday, April 16, 2015RSS Feed

    CMS: Some Claims Will be Reprocessed in Light of SGR Repeal Legislation

    The relatively small number of Medicare claims that were processed during the brief time between the implementation of the sustainable growth rate (SGR) payment reduction and its repeal—including claims subject to the Medicare outpatient therapy cap—will be automatically reprocessed to reflect the rates in place before the various fixes expired on March 31, according to a recent announcement from the US Centers for Medicare and Medicaid Services (CMS).

    The announcement follows news that Congress passed legislation ending the SGR and extending the therapy cap exceptions process through December 31, 2017. The president is expected to sign the legislation into law soon. Beginning July 1, 2015, there will be a .5% update in the payment rates.

    The reprocessing was announced to accommodate claims that may have been processed between the time when the previous fixes to SGR and therapy cap expired on March 31 and the establishment of the new law. CMS held claims for 10 business days beginning on April 1 in anticipation of a resolution.

    CMS writes that "no action is necessary from providers who have already submitted claims for the impacted dates of service."