Working Together in Challenging Times
The physical therapy profession is facing additional cuts to Medicare payment for services starting April 1.
Dating back to last year, APTA has provided crucial information about these upcoming cuts in all-member e-mails, News Now articles, social media messages, and via the APTA.org homepage. Still, we know that some physical therapists are unaware of what's ahead.
That's why I'm urging you to share this information with your colleagues, which can be as simple as forwarding the link to this blog post.
These cuts will impact physical therapists financially and may affect the access to care our patients receive. Additionally, as health care providers continue to bear the brunt of payment reductions, there is also an emotional toll to these changes, and it's important that we support one another in these challenging times.
I've talked with many physical therapists from across the country, and I know that these challenges are real. I see and feel it in my own practice as we work as a management team to continue to provide the patient care needed by so many with resources that continue to shrink. It is becoming more and more evident that from a financial and reimbursement aspect we are facing a "new normal" that is often hard to understand.
Those familiar with our national advocacy efforts know that APTA works year-round to protect payment for physical therapy services - advocating intensely to repeal the therapy cap and to prevent the MPPR and other cuts from going into effect. Unfortunately, despite successes in many legislative and regulatory areas, physical therapists are not immune to the repeated changes affecting all Medicare providers.
Although APTA alone cannot change the course of sequestration, the association will continue to look for opportunities to fight the MPPR cuts. However, with or without congressional action on these items, these challenges necessitate our consideration of payment reform. It is becoming increasingly clear that we cannot sustain the current payment system - not for ourselves, and not for our patients.
That's why APTA is developing an alternative payment system - the physical therapy classification and payment system (PTCPS) - for outpatient services. The need for reform is clear, and we want the opportunity to help shape payment reform to reward the clinical expertise physical therapists bring to the health care system, rather than having payment reform imposed on us.
Payment in the future will be based on data that demonstrates value, patient engagement, and quality outcomes. The proposed PTCPS embraces that model with the goal of not just improving payment but also quality of care.
No proposed system will be perfect, and while many have embraced this change, other physical therapists have expressed their concern. But with the challenges facing payment in health care, change is essential.
I encourage you to read about APTA's alternative payment system, PTCPS, and consider its impact for the future. But more importantly I urge you to spend 5 minutes sharing the resources at APTA.org with your colleagues to prepare for these challenges in our present.
Moving Beyond Vision 2020: Join the Discussion
Vision 2020 has served as APTA's official vision statement for the future of physical therapy since it was adopted by the House of Delegates (House) in 2000. In 2011, the House adopted a motion to revise Vision 2020, and the APTA Board of Directors (Board) appointed a Vision Task Force to manage the process.
Since then, the task force developed a new proposed vision statement and supporting vision elements, which the Board will propose to the House in June.
To generate conversation about the proposed vision, the Vision Task Force invites comments at the bottom of this post. Additionally, individuals attending the Combined Sections Meeting (CSM) in San Diego are welcome to attend the Beyond Vision 2020 Member Forum (also open to nonmembers) on Wednesday, January 23, 6:00 pm-7:00 pm PT, in Ballroom 6C of the San Diego Convention Center.
The new proposed vision statement and vision elements, and background about their development, can be found on the Beyond Vision 2020 webpage. In seeking your feedback, we feel it is appropriate to briefly highlight where we are and how we got here:
From the beginning of our work, the Vision Task Force was guided by a few very broad themes, inspired by the information we collected early on and the charge from the House. We wanted this new vision to be "outward looking" (focused on our role in society and our obligation to meet society's needs) and to reflect the evolution of a physical therapist's role (beyond treating people who are having problems and then discharging them, not to see them again until another serious problem generates a referral).
Those themes might be best captured in the phrase "my physical therapist," which evokes consumers seeing their physical therapist on a regular basis to maintain a healthy, high quality of life so they move efficiently at their highest personal ability level, whatever that means for them. That kind of streamlined, habitual relationship between the consumer and physical therapist would be direct access at its best.
Guided by these themes, the task force decided to aim high and be bold, which was one of the tips provided to us by our visioning consultant, Marsha Rhea, CAE. The proposed vision that will be submitted to the House reads: "The physical therapy profession will transform society by optimizing movement for all people of all ages to improve the human experience."
As many have pointed out, this is a lofty vision. But that's what we believe a vision should be, providing statements of identity (who we aspire to be) and desired outcome (what we aspire to change), while speaking to the public (not "the choir") in language that those within and beyond the profession would understand.
To realize its vision, APTA would of course repeatedly establish specific strategic priorities and objectives, which would be timed and measurable. A vision can and should be something greater, and we hope this proposed statement reflects that.
As you consider your response to this proposed vision, we encourage you to read (or reread) Mary McMillan lectures by Ruth Purtilo, PT, PhD, FAPTA (2000), Andrew Guccione, PT, DPT, PhD, FAPTA (2010), and Alan Jette, PT, PhD, FAPTA (2012), which are available through PTJ. (In particular, note Purtilo's comments on periods of identity and Jette's comments on systems thinking and positive deviants.)
The Vision Task Force believes that the physical therapist's role in transforming society goes beyond our already familiar, traditional image of physical therapy. There is a leadership role within the public sphere that needs to be embraced, such as advocating for walkable communities and physical education in schools, for example.
We shouldn't sell ourselves or our profession short: improving movement of individuals within society has the power to transform society itself.
We look forward to hearing your thoughts on the proposed vision statement.
Vision Task Force
William McGehee, PT, MHS, Chair and Board of Directors Member
Patricia Brick, PT, MS, GCS
E. Scott Euype, PT, DPT, OCS
Edelle Field-Fote, PT, PhD
Pauline Flesch, PT, MPS
Charles Gulas, PT, PhD, GCS
Colleen Kigin, PT, DPT, MS, MPA, FAPTA
Tasha MacIlveen, PT, DPT, CSCS
Lisa Saladin, PT, PhD
Aging and the Physical Therapist: Helping Your Patients Stay Fit at 50 and Beyond
To promote healthy aging, APTA is launching its "Fit After 50" Move Forward campaign to educate the public about the important role physical therapists play in helping people ages 50 and older remain active, fit, and mobile.
The campaign will launch October 1, at the start of National Physical Therapy Month, with “50 Days, 50 Ways,” a daily series of 50 tips for Baby Boomers from APTA member physical therapists on how to prevent injury and maintain mobility by staying active and fit. The tips will be published via Twitter and Facebook, and on the consumer information page at www.moveforwardpt.com/FitAfter50. To encourage the public to share these tips with their social networks, APTA will give away prizes throughout "50 Days, 50 Ways."
As a Baby Boomer who understands how healthy aging can improve quality of life, I am really excited about the launch of Fit After 50. Our goal with this campaign is to educate people about the importance of staying fit as they age to achieve long-term quality of life. Physical therapists can help people remain active and fit by providing individualized fitness programs that improve balance, increase mobility, and reduce the risk of injury.
APTA also will launch its "Fit After 50 Member Challenge" to allow APTA members to nominate member colleagues ages 50 and older who are committed to being fit, active, and mobile as they age. From March 1, 2013, through April 5, 2013, APTA members and the public can vote for their 1st, 2nd, and 3rd place favorites on www.moveforwardpt.com. Winners will be announced at APTA's Conference & Exposition in 2013.
In recognition of National Physical Therapy Month, I hope you will join us in celebrating and promoting the important work that physical therapists do to help people restore and maintain health as they age. You can learn more about the Fit After 50 campaign in this video. As always, please feel free to post your thoughts about the topics covered on this blog.
A July 'First' for the Board
APTA's Board of Directors continued its 2012 meeting schedule with its first face-to-face July meeting, just 6 weeks after the House of Delegates. This was new territory for everyone-seasoned Board members; new Board members, who hit the ground running; and me as your new president. Through the excellent work of a Board workgroup and APTA staff we had an energizing strategic planning session facilitated by Marsha Rhea, who many of you may remember from the visioning session held during the House in Tampa. We reached agreement on updates to the Strategic Plan that staff now will use to direct APTA's budget planning activities over the next several months in preparation for the fall meetings of both the Finance and Audit Committee and the Board.
We also held our fiduciary session that included an excellent presentation on the status of our association management services. We will continue our discussions on the direction of this area of association business as we consider how to best serve the needs of our components. I encourage you to read and comment on the News Now articles on the Strategic Plan updates and the discussion surrounding APTA's association management services.
In an effort to keep members more up to date on Board activities, I hope to use this blog to communicate the Board's actions and the various issues it discusses throughout the year. As always, please feel free to post your thoughts about the topics covered on this blog.
Thank You, Scott!
This afternoon, outgoing APTA president R. Scott Ward, PT, PhD, was honored for his service at the closing ceremonies of the APTA House of Delegates.
Watch the prerecorded video tribute below, and leave any thanks or memories in the comments.
Comments are published after moderator approval.
Empowering and Positioning PTs and PTAs Through APTA Initiatives
The weekend of April 21-22 and the days surrounding it were some of the most extraordinary in my 6 years as APTA president. On April 20, APTA's Leadership Forum kicked off in Washington, DC, with the Board of Directors (Board) meeting and Leadership Symposium, which was followed by the popular Federal Advocacy Forum. The 4-day event enabled APTA members to participate in some of the most important conversations that are taking place in the physical therapy profession. We'll be continuing work on the topics discussed, with a number of them being considered during upcoming meetings of the House of Delegates (House). I'd like to provide an overview of the topics and the role that the House will play in these association initiatives.
A report submitted to the Board of Directors on updating APTA's governance structures and processes gave Board members a platform for several hours of engaged discussion April 20-21. This report was the result of comprehensive work done by APTA members as part of a number of volunteer groups that began in 2009 to collect and assess data representing APTA's multiple interests and needs. More than 3,000 APTA members also provided their input and feedback as part of this process.
The report now will be forwarded to the House of Delegates so it can consider the recommendations that require a change to our bylaws (bylaws decisions are scheduled for 2013). The report also will be forwarded to our chapters and sections for their consideration.
APTA will provide a summary of the Board proposals and background on their development by May 4. More about the governance review initiative, designed to ensure the association is effective, nimble, responsive, and inclusive in today's environment, is available at www.apta.org/GovernanceReview.
I hope you will take the time to learn about the proposals and the opportunities we have to reformat our structures and processes to best position APTA and the profession to meet the challenges we are facing now, and those challenges that are sure to come.
The Board also held a session on visioning that stemmed from a 2011 House motion calling for APTA to revise its Vision Sentence for Physical Therapy and Vision Statement for Physical Therapy. The objective is to look beyond 2020 and clearly articulate the profession's commitment to society. During this session we discussed the current persona of the physical therapist (PT), skills and competencies of the PT, the profession's culture, and important initiatives the profession will face in the next 10 years. We also identified top priorities and design principles of APTA that the Vision Task Force will use as it continues its work over the next few months conducting focus groups with members, interviews with thought leaders, and an environmental scan.
Later this year the task force will submit a draft of the new vision to the Board for its review. The new vision will go to the 2013 House for its consideration.
One of the most debated motions in last year's House resulted in the creation of a task force to review the current model of the PT, physical therapist assistant (PTA), and physical therapy aide (PT aide) as the only participants involved in the delivery of physical therapist services. The task force was also asked to identify potential new models of delivery of these services. A report from the task force was presented to the Board that, among other things, identified 4 models of service delivery that include using support personnel in selected elements of the PT plan of care. Following much rich discussion—which focused on our ability to best meet the needs of our patients/clients now and in the future, and the barriers to accessing physical therapist services—the Board voted to continue the exploration of a new practice model based on the scenarios in the task force report. Because the House will be considering motions this year on this topic, the Board will not take action on the motion it adopted until the House discusses the motions on its agenda in June. Background material to help inform House discussion on this topic will be posted for the delegates on the House of Delegates community.
On the topic of research, I'm happy to report that a workers' compensation study from APTA's health services research pipeline is wrapping up, and the results will soon be disseminated to association members, policymakers, payers, and other stakeholders. APTA will use a communication strategy similar to that of the direct access study last year in which the results were distributed through webinars, an audio conference, press materials, social media, talking points, and a toolkit for chapters and sections.
In addition to getting study results out to members on a regular basis, the goal of the research pipeline is to equip payers with data so that they can make informed decisions rather than indiscriminately reducing payments. Other projects currently in the pipeline include an investigation into home health care readmissions and a clinical education study.
With each Board meeting, recurring themes emerge and connect the various issues we discuss. Whether our conversation focused on payment, practice models, or APTA's vision, the phrases "raise the floor," "demonstrate the value of physical therapy services," "focus on patient-centered care," and "collaborate with other health care providers" surfaced again and again. These are all positive endeavors, and I challenge you to incorporate them in your practice.
Following the conclusion of the Board meeting, a town hall was held on APTA's alternative payment system (APS). Still in a draft format, this new payment model will be pushed to members in the near future through News Now and other communication channels for their review and comments. This proposed payment system is rooted in the severity-intensity concept described in PTJ in October 2011. Under APS, payment for physical therapy services would reflect why a PT performed an intervention, not what intervention was performed. Some have described the model as being "as much about what you do in your head as it is with your hands."
Updates on APS will be provided to members as they become available.
While much work was accomplished during the April Board meeting, much lies ahead. Your Board remains committed to moving forward the association's initiatives that empower and position each and every PT and PTA to better serve our patients and clients.
Health Care Reform's Triple Aim: Is Physical Therapy Ready for Innovation and Integration?
Coauthored by R. Scott Ward, PT, PhD, APTA president; Paul Rockar, Jr., PT, DPT, MS, APTA vice president and chair of the Public Policy and Advocacy Committee; John Barnes, APTA CEO; and Justin Moore, PT, DPT, APTA vice president of Government Affairs and Payment Advocacy.
Yesterday, a message was sent to association members regarding the recent Board of Directors meeting that references the "Triple Aim" of health care and its influence on policy. We'd like to take this opportunity to further explain the Triple Aim and discuss physical therapy's role in what has become a major focus in the post-health care reform debate.
The Triple Aim originates from the Institute for Healthcare Improvement, a think tank founded by Donald Berwick, MD, in Cambridge, Massachusetts. This philosophy permeated the Centers for Medicare and Medicaid Services (CMS) during Berwick's tenure as its administrator, and is now linked to implementation efforts associated with taking the more than 2,400 pages of health care reform legislation and turning them into volumes of new regulations, programs and federal efforts required to operationalize the Triple Aim. Berwick's tenure ended on December 2, but the Triple Aim is now part of his legacy to reform our health care system.
What is the Triple Aim? To start, it is a proposed solution to our health system's ills. It is well documented that the United States' health care system is the most expensive in the world, disparate in its access, and often doesn't impact or improve one's health status. On November 4, CMS announced that US health care spending growth was 4.0% in 2009, reaching $2.5 trillion in expenditures, or $8,086 per person or 17.6% of the nation's Gross Domestic Product, up from 16.6% in 2008.1 The Triple Aim was outlined in Health Affairs in 2008 as an effort to reverse this trend and simultaneously pursue the 3 objectives of:
- (1) improving the experience of care;
- (2) improving the health of populations; and
- (3) reducing per capita costs of health care.2
The Triple Aim builds upon the 3 goals of the "iron triangle" of health policy, which call for enhanced quality of care, improved access to the right provider at the right time, and reduced health care costs to manage a person's health status.
Can physical therapy achieve the Triple Aim and, if so, how? We believe that we can because the Triple Aim is connected to what we do as physical therapists. The task before us now is delivering this message to policy makers. APTA continues to position and align its organization and priorities to meet the demands of the changing health care landscape, achieve the Triple Aim or contribute our proper role to the Triple Aim for delivery systems, and to demonstrate the essential value of our profession and the services we provide to the public. Connecting these to the health policy environment with which we interact is essential to move the profession forward as a leader in health care delivery. As 2011 comes to a close, there are several critical initiatives ongoing to leverage physical therapists as essential to achieving the Triple Aim.
To improve access, APTA is working to secure a commitment from the new Center for Medicare and Medicaid Innovation (CMMI) to invest in the early access or direct access to physical therapists for musculoskeletal conditions as part of its search for more efficient and effective models of care delivery. APTA's proposal has been submitted and is under consideration by CMMI at this time. Also in this area, APTA saw the completion of a multi-year project on direct access with the publication of an article published in the journal Health Services Research that suggests that "the role of the physician gatekeeper in regard to physical therapy may be unnecessary in many cases." This work by Jane Pendergast, PhD, Stephanie A. Kliethermes, MS, Janet K. Freburger, PT, PhD, and Pamela A. Duffy, PT, PhD, OCS, CPC, should help our state and federal efforts prove the value of direct access to physical therapy in the coming years. APTA also has assembled an issue team led by Roshunda Drummond-Dye, JD, APTA's regulatory and payment counsel, to spearhead our role in integrated models of care delivery. These models, ranging from Accountable Care Organizations (ACOs) to patient centered medical homes, will have key access issues as they become part of our reformed health care system. APTA's work is to demonstrate the value of physical therapy and our role in these models.
To improve quality, APTA hired a full-time policy expert in 2011 to lead the development of a quality work plan and focus on the policy efforts that the federal government is involved in to enhance quality care. This has resulted in a coordinated and consistent approach to position APTA in the quality area and incorporate quality into areas such as a reformed model for payment, the development of a national registry, and health information technology in physical therapy. Just last week, CMS released the updated measures specifications for the Physician Quality Reporting System for the 2012 reporting year, allowing physical therapists to report for an additional individual measure in the 2012-Measure #182: Functional Outcome Assessment. Our work with CMS in this area can be seen each year as physical therapists are included in reporting on new measures.
To reduce costs, APTA continues to seek needed reforms to physical therapy services. As mentioned in yesterday's message to members, APTA is exploring a reformed payment system model, which could include direct billing for physical therapists, and embarking on a regional payment pilot project in the New England area. Also essential to this objective is establishing strong term protection for physical therapy and title protection for the physical therapist. APTA will submit its review of the current status of term and title protection to the 2012 House of Delegates and begin an action plan to improve term and title protection where gaps lie. In addition, we continue to seek policy support through the health service research pipeline to advance our public policy priorities. Work in 2011 began on referral for profit, billing patterns of health care professionals who use the 97000 CPT series (physical medicine and rehabilitation), and bundled payments and the role of physical therapists.
These are just a few of the areas where APTA is working for you and with you to achieve a Triple Aim that advances physical therapy. The key words in health care today are "integration" and "innovation." We are reminded of this daily with announcements such as the following from CMS:
News Alert: The Department of Health and Human Services recently announced the Health Care Innovation Challenge from the CMS Innovation Center, a new initiative designed to test creative ways to deliver high quality medical care and reduce costs across the country. The Challenge will award up to $1 billion in total grants to applicants who can rapidly implement the most compelling new ideas to deliver better health, improved care and lower costs to people enrolled in Medicare, Medicaid and CHIP, particularly those with the highest health care needs.
APTA is a key messenger in this transformation from independent and often fragmented care to more interdependent models. The key message will be the work that physical therapists do daily, our record of compliance, and our value to the health care system in reducing costs while raising the bar on quality. We can have a positive impact on the nation's health-and do so already. Illustrating this by adapting to the current realities of health care and accepting the challenge of innovation and integration will best convey our message.
2011 was a year in which we saw the start of the transformation of our health care system through rules on ACOs, a proposal on the essential benefits program, and payment innovations such as the CMMI bundling project. 2012 promises more transition to a health care system where transparency, accountability, and integration are valued. To deliver the message of physical therapy's role in this transformed health care system that meets the Triple Aim, we need you to participate and build on the successful grassroots efforts and Capitol Hill activities we demonstrated in 2011. It was just 6 months ago when almost 1,000 physical therapists, physical therapist assistants, and students stood in the heat on Capitol Hill ready to share the Triple Aim value proposition that physical therapy is prepared to accept and deliver. We look forward to continuing the momentum in 2012.
Have you thought about your role in achieving the goals of the Triple Aim? Do you see opportunities and challenges to implementing programs in your practice that can improve access and quality and decrease costs? How can APTA's initiatives help support your efforts?
1. Centers for Medicare and Medicaid Services. Historical National Health Expenditure Data. https://www.cms.gov/nationalhealthexpenddata/02_nationalhealthaccountshistorical.asp.
Accessed December 12, 2011.
2. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff. 2008;27(3):759-769.