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  • Technology's Brave New World of Ethical Challenges Explored in PT in Motion Magazine

    That latest piece of technology you're thinking about weaving into your practice? Maybe it should come with a warning label.

    This month, PT in Motion magazine takes a look at the ethical issues that new technologies can introduce in physical therapist practice. From seemingly offhand social media posts to the use of voice assistant devices (VADs) such as Alexa to mounting cameras in clinics, experts interviewed for the story explain the ethical considerations that need to be weighed before powering up.

    "New Technology: Keeping It Ethical, Keeping It Legal" focuses on 7 general areas of technology: providing online advice, posting photos, VADs, wearable technology, use of cameras, electronic health records, and telehealth. PTs interviewed for the article include APTA Ethics and Judicial Committee Chair Bruce Greenfield, PT PhD, FAPTA; APTA Section of Health Policy and Administration member Robert Latz, PT, DPT, who's also the section's representative on the association's Frontiers in Rehabilitation, Science, and Technology Council; and Nancy Kirsch, PT, DPT, PhD, FAPTA, president of the Federation of State Boards of Physical Therapy and author of PT in Motion's "Ethics in Practice" column.

    As it turns out, although the technologies themselves may be new, the potential ethical pitfalls may sound familiar: issues that can be associated with new technology—such as jurisdictional permission to practice, patient privacy, records confidentiality, and honest patient communications—didn't arrive with the first computer. Longtime ethical standards still apply: the danger lies in the ways rapidly advancing technology can overshadow those standards, potentially harming patients—and ruining careers.

    "New Technology: Keeping It Ethical, Keeping It Legal" 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 1 of the benefits of belonging to APTA. Also among the content available to all viewers: "Serving Veterans Through Community Programs," a primer on care options available to military veterans.

    MedPAC Updates its Medicare 'Payment Basics' Series

    Need a quick, big-picture take on how Medicare payment works in various settings? The Medicare Payment Advisory Commission (MedPAC) offers an updated resource that can help.

    Now available for free download: MedPAC's latest version of "Payment Basics," a series of informational sheets that describe the need-to-know elements of 20 different Medicare payment systems. Areas covered include outpatient therapy, skilled nursing facilities, home health services, hospital acute inpatient services, and more. The newest version of the resource updates the 2018 edition.

    Most information sheets provide background on how the system is organized and flowcharts for a visual representation of how that particular payment system works.

    Quick facts from MedPAC Payment Basics: According to the MedPAC report on outpatient therapy, in 2017 Medicare spent $8 billion on outpatient therapy services, a 6% increase from 2015. Physical therapist services accounted for 72% of all spending in this area. In terms of settings, nursing facilities and physical therapy private practice clinics accounted for 71% of the spending, at 37% and 33%, respectively. Hospitals were next, at 16%.

    New Medicare ID System Goes Fully Operational on January 1, 2020

    Time's (nearly) up: if you haven't transitioned to Medicare's new patient identifier system, you need to make the switch by December 31.

    Recently, the US Centers for Medicare and Medicaid Services (CMS) announced that the 21-month period for transition to the Medicare Beneficiary Identifier (MBI) is nearly complete, meaning that beginning January 1, 2020, claims submitted with Health Insurance Claims Numbers (HICNs) will be rejected.

    The MBI cards feature a unique Medicare identification number that helps CMS move away from identifications that contain the beneficiary's Social Security number. The change, intended to thwart fraud, was required by provisions in the Affordable Care Act and the Small Business Jobs Act.

    According to CMS, participation is already high: it estimates that as recently as the week of October 4, 80% of all fee-for-service claims were submitted with MBIs

    Providers can learn more about the MBI system by way of a Medicare Learning Network MLN Matters article as well as CMS guide to understanding the MBI format. CMS also offers beneficiary-focused flyers on the new system in English and Spanish.

    New Tool for Managing Arthritis Focuses on Prevention and Management in Primary Care

    Nearly 1 in 4 adults in the United States has arthritis—some 54 million people, according to the US Centers for Disease Control and Prevention. Chances are more than good that many of your patients and clients are among them. A new tool developed by the Osteoarthritis (OA) Action Alliance, the US Bone and Joint Initiative, and numerous experts in the field—including a representative from APTA—can expand your knowledge of OA. In addition to provider-facing information, the Osteoarthritis Prevention and Management in Primary Care Toolkit also includes patient handouts and resources that you can use to empower your patients and clients to engage in self-management strategies that complement your clinical care.


    October 12 is World Arthritis Day—spend some of it educating yourself on OA by visiting APTA's arthritis webpage, which links to the OA toolkit and other resources such as community-based programs that can extend the benefits of your treatment and help patients and clients maintain their movement and independence.

    Biased? Me? PT in Motion Magazine Takes a Look at Unconscious Cultural Attitudes

    Want to get an up-close glimpse at a person with cultural biases? Follow these instructions:

    1. Grab a mirror.
    2. Look into it.

      That's one way to summarize the starting point for "Battling Bias's Distorted Images," the cover story for the October issue of PT in Motion magazine. The article makes the case that while unconscious bias—also known as implicit bias—is very much a part of the human condition, it's something that can be acknowledged and managed in ways that minimize its impact on relationships. For health care providers including physical therapists (PTs) and physical therapist assistants (PTAs), that's an important step to take in effective patient care.

      Through interviews with PTs in a variety of settings, author and Associate Editor Eric Ries explores how implicit bias—and these PTs' recognition of it in themselves—has impacted and changed their lives, particularly at the professional level. Several describe the journey as a path that's not always easy, but absolutely crucial to providing the best possible person-centered care.

      The article also delves into how you can uncover implicit biases through self-tests such as the Implicit Association Test series, and what to do after they're identified. PTs interviewed for the article provide insight on how physical therapy education programs can respond to the challenges of implicit bias, and provide practical tips on making behavior changes that may in turn lessen, if not eliminate, a particular bias.

      According to Hadiya Green Guerrero, PT, DPT, interviewed for the story, efforts to counter implicit bias are necessary for PTs and PTAs because the stakes are high.

      "Do your best to think about your biases and check them at the door," Green Guerrero says in the article. "Seek to learn and understand each patient or client to the clinic, what constitutes his or her biggest health concerns, and what barriers that person faces to optimal well-being and needed interaction with the health care system."

      "Battling Bias's Distorted Images" is featured in the October issue of PT in Motion magazine and is open to all viewers—pass it along to nonmember colleagues to show them 1 of the benefits of belonging to APTA.

      Stay Inspired, Motivated, and In-the-Know With These APTA Podcasts

      APTA continues to assemble a collection of free, easy-to-download podcasts that deliver plenty of variety, from personal stories that remind you of why you love what you do, to nuts-and-bolts information that could be crucial to your professional survival.

      Where to start? Here are some suggestions—but you can also check out APTA's podcasts webpage to browse an extensive list of offerings.

      Podcasts that inspire
      A recent example: "A Journey Out of Pain and Addiction, and a PT's Crucial Role"

      What it's about: In his keynote address for the 2019 APTA NEXT Conference and Exhibition, US Army Master Sergeant (Retired) Justin Minyard recounted the injuries he received during rescue attempts first at the Pentagon during the 9-11 attacks and then while on a mission in Afghanistan. But the heart of Minyard's story is about what happened afterward: the multiple fusion and other surgeries, the intense pain, his slide into addiction, and his eventual freedom from opioids. He readily acknowledges that his recovery was thanks in large part to the work of an interprofessional team that included a dedicated physical therapist (PT).

      Why you should listen: Minyard's brutal honesty and his ability to tell a story with both humor and pathos pull you in from the start. And the gratitude he has for his PT—he describes her as not just his physical therapist "but my psychologist, my sounding board, my marriage counselor, my educator of my options, and my kick in the ass"—will remind you of why you love the profession.

      More inspiration: APTA's "Defining Moment" podcast series is the audio companion to PT in Motion magazine's regular feature of the same name, which highlights stories from members about those moments when they felt that special—often life-changing—connection to the physical therapy profession. [Editor's note: If you want to share your defining moment, contact Associate Editor Eric Ries at ericries@apta.org.] For inspiration you can share with your patients, the popular Move Forward Radio is your go-to option: an interview series that features patients, PTs, and physical therapist assistants (PTAs) discussing physical therapy's role in a wide range of issues. Recent podcasts include explorations of physical therapy and people with Alzheimer's disease, foot health, and the treatment of pelvic pain in people who are transgender.

      Podcasts that energize
      A recent example: Just about any podcast from the APTA Pulse series

      What they're about: Some of the liveliest discussion in the profession is taking place at the student level, and the APTA Pulse series of blogs and podcasts brings that energy to you. The Pulse podcast series features mostly students, with the occasional more-seasoned PT, PTA, or other expert. Notable podcasts include "Failure Is a Bruise, Not a Tattoo," "Stereotype Threat," and "Healthy Mental Living: Tips From a Counseling Psychologist."

      Why you should listen: It's a great way to re-charge your enthusiasm for the profession.

      More energy: Want more insight on the PT and PTA student perspective? APTA's Student Assembly records its "#XchangeSA" live chats, which have ranged from discussions about performance therapy and training to building your professional brand. And if you haven't read or heard it already, APTA President Sharon Dunn's address to the 2019 APTA House of Delegates will put some wind in your sails when it comes to the challenges of taking on the high cost of PT and PTA education, dismantling the productivity mindset, and making involvement in the association accessible to all.

      Podcasts that inform
      A recent example: "Ordering of Diagnostic Imaging by Physical Therapists: A 5-Year Retrospective Practice Analysis"

      What it's about: In this interview for APTA's journal PTJ (Physical Therapy), Editor-in-Chief Allan Jette, PT, PhD, FAPTA, interviews researcher Aaron Keil, PT, DPT, about his groundbreaking study on civilian PTs who are able to order imaging.

      Why you should listen: Don't be scared off by the academic-sounding title. With the growth of direct access to PT services comes more serious discussion about the PT’s role in primary care—and the importance of the PT's ability to order diagnostic imaging as a crucial part of that primary care role. It's an issue that needs to be on your professional radar.

      More information: Each month PTJ produces podcasts, like the one highlighted above, that help you get a first-person perspective on some of the latest research in the profession, making the PTJ podcast page worth a regular stop. Another helpful research-oriented podcast: easy-to-follow expert tips on finding evidence and research on APTA's PTNow Article Search and Rehabilitation Reference Center.

      And even more information: If you're interested in keeping up with fast-moving world of payment (particularly related to Medicare and Medicaid), don't miss APTA's "Insider Intel" recordings of its live phone-in series. You won't find Insider Intel on the association's podcast page—they're collected separately—but they're definitely worth tracking down. MIPS, SNF payment, home health rules, new payment models, the physician fee schedule—it’s all there. And you can register for upcoming live events while you're checking out the recorded ones.

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

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

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

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

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

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

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

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

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

      From PT in Motion Magazine: Regenerative Medicine and the PT

      Patient, heal thyself.

      Maybe that's not exactly what regenerative medicine is all about, but it's close: with its emphasis on enhancing the body's own genetically driven capabilities to repair damage and reestablish neural connections, regenerative medicine is pushing the boundaries of what we know about the healing capacities hidden in our own DNA. And physical therapists (PTs) are bringing an important perspective and set of unique skills to the field.

      "PTs on Rehab's Leading Edge," in the April issue of PT in Motion magazine, takes a look at the current state of regenerative medicine, robotics, and genomics in physical rehabilitation, and finds a growing appreciation for what PTs bring to the table and the ways movement and exercise can affect health at the cellular level.

      The article covers current approaches including the use of platelet-rich plasma and neural retraining through the use of robotic exoskeletons, but also explores what the future may hold as researchers such as Richard Shields, PT, PhD, FAPTA, and Steve Wolf, PT, PhD, FAPTA, work to better understand the science of regenerative medicine and prepare the next generation of PTs for what will one day be a very different health care environment.

      "As the field of medical regenerative medicine progresses, so too will physical therapy," Shields tells PT in Motion. "How are you going to manipulate the genetics? You're likely going to do it through various forms of technology that allow us to apply loads and movement, whether through robotics or just plain exercise. Understanding how to dose for cellular response is going to be the new frontier."

      "PTs on Rehab's Leading Edge" is featured in the April 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.

      From Move Forward Radio: Motivated by Physical Therapy Experience, Woman Is Inspired to Give Back

      Sometimes physical therapy doesn't just heal an injury, it changes the course of a patient's life for the better. Colleen Rapp, a press operator for the Denver Post, thought her physically demanding job was exercise enough—until she got a wholistic view of her health status from her physical therapist (PT) after a shoulder injury. Her experience even inspired her to raise funds for doctor of physical therapy students at the University of Colorado.

      Now available from APTA's Move Forward Radio: an interview with Colleen Rapp and her PT Tami Struessel, PT, DPT, a board-certified clinical specialist in orthopaedic physical therapy. "I wasn't taking care of my body the right way," said Rapp. "I thought exercise was my work."

      One day at work, Rapp slipped on some water on the press floor and injured her back so badly that she couldn't stand, walk up stairs, or get out of bed without pain. That brought her to Struessel, who "wove in" education about sleep hygiene and nutrition. "[Rapp] needed to come to a place where she realized she needed to do the hard work, because making lifestyle changes is not easy," Struessel said.

      Rapp said her "aha!" moment came when she realized "this was an opportunity to make this count in my life, and [become] the person I needed to be when I was older." In addition to changing her diet, getting more exercise, and sleeping better, she achieved a better work-life balance. "I learned I want to be the best I can be and do the best I can do, but I don't want to do it incorrectly," she told Move Forward Radio. "Physical therapy has taught me a broad spectrum of things—it changed my life."

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

      Other recent Move Forward Radio episodes include:

      NASCAR and the Role of Physical Therapy
      Jena Gatses, PT, DPT, was the first full-time female PT and strength coach in NASCAR. She discusses her experiences with these specialized athletes and other high-profile clients, including actor Mark Wahlberg.

      Still Dancing: A Woman's Story of Doing What She Loves While Living With Spinal Cord Injuries
      Marka Rodgers envisioned spending her life in the world of dance, even after sustaining and working hard to overcome not 1 but 2 devastating spinal cord injuries. With the assistance of a wheelchair, a service dog, and some primo leg braces, Marka not only continues to dance but also to teach dance.

      Headaches and Physical Therapy
      There are headaches, and then there are headaches. Denise Schneider, PT, DPT, discusses the causes and red flags for more serious headaches, how physical therapy may help, and when referral to another health care provider is the best option.

      Young Woman Shares Experiences With Juvenile Arthritis and Physical Therapy
      Christina Iversen shares her experience with juvenile arthritis, having dealt with it since the age of 2. Now a young adult, she knows well what it's like to contend with the physical, emotional, and social effects of growing up with a condition that's typically associated with older adults.

      Retreat for Injured Veterans and Families Adapts Activities and Helps Them Reconnect With Each Other
      Since 2017, selected veterans who have been injured in active duty or as a result of their service have come to Maine in the summer, along with their families, for an all-expenses-paid vacation courtesy of the Travis Mills Foundation, founded by a veteran who experienced amputation and directed by Kelly Roseberry, PT, DPT.