5 Ways the US Military Has Shaped the Physical Therapy Profession
This Veteran's Day, we pause to recognize the unique role and contributions of the military in advancing the physical therapy profession. Following are a few accomplishments of our women and men in uniform.
-
The military introduced the country to physical therapy.
The first physical therapists (PTs) were reconstruction aides ("re-aides"), civilian employees of the Medical Department of the US Army during World War I who rehabilitated injured soldiers and taught them how to adapt to everyday life after injuries and amputations.
Credit: U.S. Army Photograph.
-
The US Army was key to the process of standardizing procedures.
According to Col. Emma Vogel, one of the first re-aides, prior to WWI very few physicians performed physical therapy procedures, which looked upon with suspicion by many of their colleagues. It was not a defined discipline with clear standards or guidelines, and there was no research being conducted. Vogel, who later became the first chief of the Women’s Medical Specialist Corps in 1947, wrote that as a result of the success of the re-aides, "civilian practice in this field was given a tremendous impetus" and the Army played a key role in "stabilizing and standardizing physical therapy procedures."
After WWII, thousands of soldiers were treated for amputations, spinal cord injuries, and other injuries. As a result, some hospitals began to specialize in treating specific populations, allowing for study of effectiveness of patient care, including wound healing, prosthesis fitting, gait analysis, progressive resistance exercise, and constant current stimulation. Severe injuries that would have resulted in immobility during WWI now had a much better prognosis.
-
Military therapists served with honor, even behind enemy lines.
Like their WWI predecessors, WWII therapists served stateside as well as overseas. Metta Baxter, stationed in Italy, was a prisoner of war (POW) and received the Legion of Merit. Helen Filbert and Bella Abramowitz Fisher received Bronze Stars for their work in the Dutch East Indies and Okinawa, respectively. Brunetta Kuehlthau and Mary McMillan were captured and held at an internment camp in Manila, Philippines—where Kuehlthau continued to treat patients. These heroes and their colleagues did not gain full commissioned status until 1944.
During the Vietnam War, Army PTs treated soldiers, civilians, and POWs in 3 of the 4 combat zones.
-
The military was the first to train physical therapist assistants.
Late in WWII, the Army recognized the need for formally trained enlisted staff to assist PTs in the clinic. Previously, enlisted men were informally trained to help in the clinics but were needed in combat roles. In 1945, the Army approved the first formal program of instruction for the new classification of "physical therapy technicians."
-
The military leads the way in direct access and team-based care.
Since the 1970s, the military has allowed soldiers with neuromusculoskeletal disorders to see a PT without referral from a physician, expediting recovery for more minor conditions and freeing up physicians to treat patients with traumatic injuries—which is especially important during combat. Rather than relying on old models of care, the military health system evaluates what needs to be in place for successful outcomes and what resources are needed to achieve them. Military PTs treat patients within a multidisciplinary team of providers, offering a model for the private sector in the shift toward value-based care.
To all our military PTs and PTAs, their families, past and present, thank you for your service.
References and further reading:
American Physical Therapy Association. Remembering the reconstruction aides. #PTTransforms Blog. Alexandria, VA: American Physical Therapy Association. March 9, 2018.
American Physical Therapy Association. The Beginnings: Physical Therapy and the APTA. Alexandria, VA: American Physical Therapy Association; 1979.
Greathouse DG, Schreck RC, Benson CJ. The United States Army physical therapy experience: evaluation and treatment of patients with neuromusculoskeletal disorders. JOSPT. 1994;19(5):261–266.
Linker B. War's Waste: Rehabilitation in World War I America. Chicago: University of Chicago Press; 2011.
Moore JH, Goffar SL, Teyhen DS, Pendergrass TL, Childs JD, Ficke JR. The role of US Military physical therapists during recent combat campaigns. Phys Ther. 2013;93(9):1268–1275.
Silvernail J. Primary care and the physical therapist: lessons from the military. #PTTransforms Blog. Washington, DC: American Physical Therapy Association. Published September 10, 2018.
Smith CM. The Medical Department: Hospitalization and Evacuation, Zone of Interior. United States Army in World War II. The Technical Services. Washington, DC: U.S. Government Printing Office, 1956.
Vogel EE. US Army Medical Department, Office of Medical History. "Chapter III. Physical therapists before World War II (1917-40)." In: US Army Medical Specialist Corps History. Anderson RS, ed. Washington, DC: U.S. Government Printing Office, 1968.
Vogel EE, Manchester KE, Gearin HB, West WL. US Army Medical Department, Office of Medical History. "Training in World War II." In: US Army Medical Specialist Corps History. Anderson RS, ed. Washington, DC: U.S. Government Printing Office, 1968.
Transforming the Profession: Reflections of 2019 Minority Scholarship Award Recipients
The 2019 APTA Celebration of Diversity was a record-breaker, attracting some 360 attendees to honor this year's recipients of the APTA Minority Scholarship Awards. The awards recognize professional character and academic excellence among physical therapy students in their final year of an accredited program as well as faculty members pursuing postprofessional doctoral degrees.
[Editor's note: contributions to the APTA Minority Scholarship Fund are still being accepted. To learn more about the awards and make a donation, visit www.apta.org/HonorsandAwards/Scholarships/MinorityScholarship/.]
Recipients of the 2019 awards included:
PT Award
- Abdul Banafa, PT, DPT, Mount St Mary's University–Los Angeles
- Pardis Esmaeili, PT, DPT, University of California–San Francisco
- Briana Sadé Harris, PT, DPT, University of Miami
- Ashley Lynn Wilson, PT, DPT, Nova Southeastern University
- Tiffany Maye, PT, DPT, Columbia University
- Brandon Nguyen, PT, DPT, University of Washington‐Seattle
PTA Award
- Michelle Diaz, PTA, Morton College
- Landon Luna, PTA, Kapiolani Community College
Faculty Award
- Mildred Oligbo, PT, DPT, Kansas University Medical Center
- LD Woods, PT, DPT, Alabama State University
The Celebration of Diversity isn't your typical awards gathering, however. It's an opportunity to reinforce the importance of making the profession as diverse as the populations it serves, and a reminder of the transformational power of making a difference in the individual lives of physical therapists and physical therapist assistants. To get a glimpse into what the scholarship program means at that level, #PTTransforms interviewed recipients Abdul Banafa, PT, DPT, Michelle Diaz, PTA, Briana Sadé Harris, PT, DPT, Brandon Nguyen, PT, DPT, and LD Woods, PT, DPT, about their goals, influences, and views on effective leadership.
#PTTRANSFORMS:
What are your professional goals?
Banafa: My professional goals are to gain enough experience and confidence to open a clinic to serve my community, create opportunities for other minorities to be exposed to the profession of physical therapy, and the value of representation in physical therapy.
Diaz: I strive to help people achieve their goals and provide the best care to my patients and clients. I have an interest in geriatrics, neurological disorders, and aquatic therapy. I hope to specialize in an area in the future, as well as teach and share my knowledge with future students to help the community.
Harris: My professional goals are to have practiced physical therapy in every setting and with every population before I retire, mentor students as a clinical instructor, and express my passion for the profession of physical therapy and cultural competence as a lecturer or professor.
Nguyen: With my background in engineering and my growing knowledge of physical therapy, I am focused on facilitating educational opportunities for ethnic minorities, women, and persons with disabilities in STEM and health care fields. In this capacity, I aim to provide K-12 students with gateway opportunities to successfully participate in STEM and health care-related activities and, in turn, prepare a workforce that more accurately reflects the demographics of America. I also hope to follow in the footsteps of my mentors and continually build networks within rehabilitation and engineering—a collaboration that, I believe, is paramount in moving both professions forward.
Woods: My professional goals are three-fold: First, finish my PhD training. In addition, I would like to progress as an education researcher by publishing articles, engaging in multi-site projects, and disseminating experiences related to teaching and learning practices and diversity, equity, and inclusion within the physical therapy profession. Second, continue to progress in academia to a tenured position at my current institution. Third, continue to serve in leadership roles. As a member of a marginalized community, I feel it is my duty, honor, and privilege to provide my perspective and my voice to the profession.
#PTTRANSFORMS:
How have your personal experiences and contributions influenced your professional goals?
Harris: My clinical instructor at Jackson South Community Hospital in Miami, Florida, solidified for me that I absolutely will be a clinical instructor throughout my career. She was the only CI that I ever had that shared my skin complexion, and she also happened to be the best clinical instructor out of all of my experiences. She did not sacrifice the quality of her work for any reason, she always went the extra mile, and she never once made me feel inadequate as a student learner.
Even though I am just a few months into my career as a physical therapist, I experience pure joy when talking with the students who come to shadow, or with a physical therapy technician whose desire is to get into PT school. I vividly remember when I was shadowing to get into school, and the awkwardness of watching the clinician, dying to ask a question but afraid that it might be a dumb question, or that I would annoy the therapist if I asked too many questions. I strive to create an environment for aspiring PT students to feel that they can ask me anything and everything.
Being able to teach at a physical therapy program, even if just as an annual guest speaker, is my absolute dream. I would truly enjoy the opportunity to inspire students with lectures about the many opportunities this field has to offer, or to discuss the infinite ways that a PT can optimize movement to improve the human experience.
Nguyen: Working with individuals from various walks of life has helped me become mindful of different backgrounds, cultures, abilities, and experiences. It may be impossible to engage with every form of diversity, but by integrating myself and others with different people, we can become better prepared to coexist in the diverse workforces of tomorrow.
Woods: My personal experience has had a direct correlation to my professional goals. My goal to attain a PhD and disseminate scholarly teaching and learning was birthed from my observation of the lack of academically terminally trained physical therapists who identify as minoritized individuals, and lack of effective teaching and learning practices within our academic programs. These observations also inspire my second goal, to continue to progress in academia. I feel I am in an optimal position to provide additional thoughts, perspectives, and ideas to help increase the inclusiveness of our profession. To have an impact in the current structure of our society, I need to have a seat at the table; for that to happen, I need to progress within academia. This feeds into my third goal, to continue within my leadership trajectory. The profession needs to increase the voice and presence of marginalized populations if the profession hopes to achieve its vision and mission. Within this context, I look forward to assisting the profession in bringing a voice that traditionally has not been heard.
#PTTRANSFORMS:
How do you define leadership?
Diaz: Leadership is having the ability to guide and direct a group of people to achieve their goals while showing respect, compassion, and integrity.
Banafa: Leadership is many things, but most important is the ability to connect with the individuals in front of you. Inspiring people is very difficult and is truly something that is earned and must be maintained. The best leaders, in my mind, are people who bring people together, to bring out the best in them and inspire them to do good.
Nguyen: Leadership is about influencing those around you and cultivating a culture that empowers the full potential in others. Great leaders see more in us than what we see in ourselves, and they help us learn to see it, too.
Woods: I would argue that leadership varies based on the individual being led; ironically, within individuals, their leadership expectations change over time. I would define leadership as: actions, thoughts, perspectives, or guidance that place those who are being led in an optimal and advantageous position to achieve their spiritual, personal, or professional goals. Simply put, leadership is being a lightning rod to help people or an organization achieve their goals.
#PTTRANSFORMS:
Who are your biggest professional inspirations?
Diaz: As I attended the Honors and Awards event this year, I was inspired by many physical therapists and physical therapist assistants who have contributed to the profession. I was especially inspired by the professors and directors from many accredited programs because of their dedication, commitment, and hard work. My professor, Dr F. Wedge, influenced me, and I learned a lot from her.
Banafa: My father, Ahmed Banafa, is my biggest professional inspiration. As an immigrant who built himself from the bottom, he continues to inspire me every day. Second, my professors, in particular Dr Alan Lee, and Dr Benjamin Cornell, were my biggest supporters, friends, advocates, and inspirations at Mount Saint Mary's University. They were truly the reason I started looking at obstacles as opportunity to do better versus a difficulty to move past.
Nguyen: My involvement in service, research, and leadership activities follows an example set forth by my mentors' success and enthusiasm, igniting my fiery excitement to advance our physical therapy profession. Being a recipient of the 2019 Minority Scholarship Award is an incredible honor, a recognition of my efforts in minority affairs, and a testament to all of my mentors who have invested their time and efforts in me.
Woods: My biggest professional inspiration is Jesus. For anyone who has a foundation in spirituality, Jesus set an example for forgiveness, situational attitude, and faith. If I walk along the path he set, I feel I can accomplish anything. Another professional inspiration is my mother. My mother is not a physical therapist or academician, but watching her pursue postsecondary education, while raising 2 kids and working full-time, laid a foundation of achievement and a mentality that I can accomplish anything I want. My final professional inspiration is my wife. My desire to set an example and lead my family pushes me to continue to put God first, family second, and my profession third.
APTA congratulates all recipients of this year's Minority Scholarship Awards, which are sponsored by the Minority Scholarship Fund and voluntary contributions. To learn more about the Minority Scholarship Awards and how you can contribute, visit www.apta.org/HonorsandAwards/Scholarships/MinorityScholarship/.
I Am Not a Leader: A Case of Mistaken Identity
By Beth Collier, PT, DPT
I am a taskmaster. My life is full of lists of things to do: lists on post-it notes, lists on organizational planners, and sometimes lists on the back of my hand. I get great satisfaction from scratching off tasks as they are complete. I use lots of ink to strike through each task one by one. I feel total satisfaction when my paper is covered in ink from my write-ins and scratch-offs.
I am a learner. I love learning new things. I have participated in a postgraduate residency program and 2 fellowship programs, and now I'm back in school in pursuit of an EdD degree. Basically, I haven't been out of school since I got out of diapers. In my free time, I use apps to learn different languages, listen to TED talks, and read books. I am a consumer of information.
I get things done, and I am teachable. I am not a leader.
That's what I told myself for most of my life. Each time a leadership opportunity presented itself, I convinced myself: I am a cheerleader for others, a great member, and a team player. I am not a leader.
Then it happened. After several years, my mentor mentioned an open call for nominations for leadership positions within our state professional association. His mention wasn't offhand. It was not casual chat or a simple sharing of information. No, his mention came with a look—a look that anyone with a long-time mentor would recognize. It said to me that this baby bird was about to be pushed out of the nest. It's time to fly or fall.
I did not want to fall. But I pursued the opportunity anyway. Because when someone who has invested so much time and energy into your development gives you the look, you do not say no. Only being 5 years' postgraduation, I told myself I didn't have enough knowledge or experience to be a leader. I was terrified. But I did it anyway.
And it was the most influential experience of my professional career.
As a board member of the Physical Therapy Association of Georgia, I participated in leadership development activities through the R.M. Barney Poole Leadership Academy. I thought this would teach me how to function in my new-found role. I was wrong. It did so much more. Through the Leadership Academy courses, I learned that leadership is much more than a position or title. Leadership simply means that you are influencing others around you.
In this way, leadership happens every day. Every day in the clinic, my actions and words are influencing how my patients perceive themselves and how they behave. Interactions that are observed by other staff members influence their own interactions with other people. My behavior and thoughts are observed by students and influence the way they perceive our profession. I even influence myself, in a weird philosophical way: the way I perceive the world influences the way I interact with the world. And I have control of my own perceptions and actions—I can lead myself. Mind blown!
It turns out that I am a leader. I have been a leader my whole life. And so are you, whether you know it or want it.
Physical therapists are not "treaters" or "fixers" of peoples' problems. We are not educators imparting knowledge to others who will listen. We are leaders. We empower others to maximize their potential through our influential relationships. The only way to achieve APTA's vision for the profession, transformation of society, is through transformational leadership. We need a leadership revolution!
I am a leader. You are a leader. We all lead every day. You are either doing it well…or you're not.
So this is me giving you the look. Pushing you out of the tree. It's time to step up and get involved.
There is no level of knowledge or experience that can prepare you to be a good leader. Just be your best self and keep an open mind. Check out APTA Engage for opportunities. Participate in leadership development. You won't regret it!
Beth Collier is a clinical assistant professor of physical therapy at Mercer University in Georgia, CEO of MentorEvolution, and former vice president of the Physical Therapy Association of Georgia. In 2018, she was recognized by APTA as one of the profession's emerging leaders. Collier is a board-certified clinical specialist in orthopaedic physical therapy, and a fellow of the American Academy of Orthopaedic Manual Physical Therapists.
Your Serve: Getting Involved in Global PT Day of Service on October 12
By Matthew Downy, PT, DPT
The 5th annual PT Day of Service™ takes place on October 12. On that day, thousands of physical therapists (PTs), physical therapist assistants (PTAs), and students will go out and serve their local and global communities.
Service is at the very heart of our profession. Every day we serve our patients and clients. PT Day of Service is a way for us to transform our passion for service into change for our communities. Since 2015, participants from 60 countries have contributed to PT Day of Service's mission to give back.
How it works
Getting involved is easy! You can sign up as an ambassador, participant, or sponsor.
-
Ambassadors
help to plan local service projects. They can plan an event independently or with a larger organization such as their workplace or university. Our ambassadors are provided with toolkits and constant support to help you create a successful service project.
-
Participants
are the driving force of PTDOS, and thousands pledge to participate each year to get involved with local projects.
-
Sponsors
show their support for the PTDOS movement each year. APTA is a regular sponsor of PTDOS, and the contributions from APTA and others help fund and fuel PTDOS's parent organization, Move Together. Move Together is a 501(c)3 nonprofit organization whose mission is to increase access to quality rehab medicine around the corner and around the world. Move Together handles all of the operations and expenses involved with planning, promoting, and executing PTDOS each year.
How to find a project
Once you've signed up as a participant, you're ready to find a project. If you are not already working with a PTDOS ambassador, you can find a local project using our Project Map. We have new projects being added worldwide! If you do not see a local project, consider becoming an ambassador to take charge of your own project.
How to share your experiences and story
One of the exciting things about PTDOS is seeing participants post about their service projects on social media. We ask that participants use social media to share their pictures, videos, and personal experiences and stories on PTDOS along with the hashtag #PTDOS. While it's not the official way we track the impact of PTDOS, it's an inspiring way to watch thousands of participants share their stories worldwide. It's also a good way to earn a chance at a $500 donation to use to the charity of your choice. You can also follow along with PTDOS on Facebook, Twitter, and Instagram to stay up-to-date!
The PTDOS Team is looking forward to working with you this year and in many future years as we all unite to serve our communities. We can be reached by email quickly at info@ptdayofservice.com.
[While you're at it, don't miss out on APTA's "Get Caught Doing Good" photo contest.Take a photo or set of photos from your PT Day of Service community effort and send through social media using the #PTDOS hashtag the week of October 7-13, 2019. A $500 donation will be awarded for best photo to be given to the winner's charity of choice. Photos must be posted by Friday, October 18, 2019, to be considered.]
Matthew Downey PT, DPT, is a physical therapist at Kaiser Permanente San Jose Medical Center. He is the assistant director of PTDOS and is a board-certified clinical specialist in orthopaedic physical therapy.
Working Through the Pain: APTA Continues to Work for Expanded Patient Access to Physical Therapy for Pain Management
Pain Awareness Month, observed each September, is an opportunity to raise public awareness about pain and nonpharmacologic pain management. The opioid crisis has shed a spotlight on the health care community's collective failure to adequately support individuals in adopting safe and effective pain management strategies. As a result, the subject of pain and pain management is one that continues to be at the forefront of health care policy discussions.
The American Physical Therapy Association (APTA) has been actively involved for some time in efforts to raise the awareness of the public, the health care community, legislators, regulators, and payers about the role of physical therapists and other providers in pain management. While acknowledging that pharmaceutical intervention, including opioids, has a role in pain management for certain types of patients, APTA continues to advocate for patient access to the most appropriate care for their condition with the least level of risk and the opportunity for the best outcome. These efforts have resulted in positive changes impacting patients who are seeking care for the treatment of musculoskeletal pain or for conditions that cause pain.
To wrap up Pain Awareness Month, here are some of the ways APTA has contributed to advancing understanding of, and access to, nonpharmacologic approaches to pain management.
Participating in state advisory boards to develop policy recommendations regarding pain management. APTA members have contributed their expertise to numerous state-level efforts to address opioid misuse. This has led to required insurance coverage of physical therapy for chronic pain, lower cost sharing for patients, establishment of prescriber and patient education on nonpharmacologic treatment to manage pain, and the development of workgroups to evaluate the impact of these efforts. As a result of APTA and chapter advocacy, several states have adopted changes in Medicaid policy that provide for access to and payment for physical therapist (PT) services to address pain management.
Influencing federal regulatory decisions on patient access to physical therapy for pain. APTA continues to meet with legislators and agency representatives on this topic and has submitted comments on federal proposals related to pain management, including the US Department of Health and Human Services (HHS) request for information on ensuring patient access and effective drug enforcement and a federal Pain Management Best Practices Inter-Agency Task Force draft report. In addition, APTA maintains a formal collaborative partnership with the Department of Veterans Affairs to promote veterans' access to nonpharmacologic approaches to pain management.
Providing expertise to guide public policy on pain management. APTA has participated in several national committees and work groups to provide recommendations on pain management, including the National Academy of Medicine (NAM) Action Collaborative on Countering the US Opioid Epidemic and the National Quality Partnership Opioid Stewardship Member Network. The latter group will expand on the work of the National Quality Partnership Opioid Stewardship Workgroup, which produced the National Quality Partners Playbook on Opioid Stewardship.
In addition, APTA produced a white paper on reducing opioid use, "Beyond Opioids: How Physical Therapy Can Transform Pain Management to Improve Health (.pdf)."
Promoting commercial payer benefit design changes. Based on findings from a joint study with APTA and OptumLabs, United Healthcare is piloting policy changes to its pain management program, including elimination of cost sharing for an initial PT visit and promoting early and direct access to physical therapy for patients with low back pain. Two follow-up studies found that fewer restrictions on provider choice and lower patient cost sharing led to higher use of physical therapy for low back pain and that patients with low back pain who initially visited a PT were substantially less likely to use opioids.
Advancing interprofessional education on physical therapy and pain management. APTA collaborates with the International Association for the Study of Pain (IASP) in the development of its Curriculum Outline on Pain for Physical Therapy interprofessional pain curriculum and creation of courses on the integration of the IASP curriculum into physical therapist professional education curricula.
APTA's Opioid Awareness Initiative. APTA's award-winning initiative continues to reach out to consumers to educate them about physical therapy's role in safe pain management. Most recently, APTA has transitioned the consumer website MoveForwardPT.com to ChoosePT.com. The site includes the Find a PT directory, symptoms and condition guides, health tips, podcasts, and more.
For more information on the role of physical therapists in pain management, go to www.choosept.com.
Falls Awareness Week: An Ounce of Prevention Is Worth a Pound of Cure
By Kara Gainer, JD
According to the Centers for Disease Control and Prevention, emergency departments treat 3 million older adults for falls each year. More than 800,000 patients are hospitalized after a fall, approximately 20% of falls result in serious injuries, and falls are the second leading cause of accidental or unintentional injury deaths worldwide. Despite these often preventable statistics, individuals enrolled in Medicare often are not screened for risk of falling at their annual wellness visit.
Currently, during the initial annual wellness visit, a provider is required to assess an individual’s functional ability and level of safety with regard to the ability to successfully perform activities of daily living, falls risk, hearing impairment, and home safety. However, the Centers for Medicare and Medicaid Services (CMS) does not require functional status and safety assessments in follow-up wellness visits, in part due to the fact that the United Stated Preventative Services Task Force (USPTSF) has not proffered a recommendation for such.
However, both the American Geriatrics Society and the British Geriatrics Society do recommend an annual screening for all adults aged 65 and older for a history of falls or balance impairment. Accordingly, APTA is advocating for CMS to require functional ability and level of safety screening elements that includes a falls screen during every annual wellness visit for individuals covered under Medicare.
APTA is requesting this change in its comments to CMS on the 2020 Medicare physician fee schedule proposed rule, making the case that falls are both a serious and preventable health risk for older adults and that physical therapists (PTs) are "movement experts with knowledge and skills in identifying, measuring, and improving balance system deficits, functional limitations, and strength and flexibility deficits that have been shown to contribute to falls."
PTs can:
- Assess falls risk
- Design individualized falls-prevention plans
- Conduct home safety assessments and modifications
- Educate older adults about risk factors for falls
- Provide appropriate interventions to decrease falls risk, such the Otago exercise program and strength, balance, and gait training
- Work with other health care professionals to address any underlying medical conditions that could increase falls risk
- Provide recommendations on evidence-based community programs
Physical therapists are a vital component of multifactorial interventions that address modifiable risk factors for falls, and they may work interprofessionally with or within primary care provider offices in this capacity. We see the positive effects of falls prevention up close.
By increasing its focus on falls prevention, APTA suggests, CMS would be demonstrating its commitment to addressing this serious, yet preventable, public health problem.
Kara Gainer, JD, is APTA's director of regulatory affairs. You can connect with Kara on Twitter at @karagainer.
CMS Proposes Changes to MIPS for the 2020 Reporting Year
In January 2019, #PTTRANSFORMS published answers to some common MIPS questions. The Centers for Medicare and Medicaid Services (CMS) recently released its proposed Physician Fee Schedule for 2020, which includes 4 major changes to MIPS that are relevant to physical therapists (PTs).
1. Increase in the Minimum Number of MIPS Points for a Neutral Payment Adjustment
Under MIPS, providers earn points for Quality Performance Measures and Improvement Activities—2 required categories for PTs. In addition, submitting MIPS data via a qualified clinical data registry, such as APTA's Physical Therapy Outcomes Registry, could earn practice points in the Promoting Interoperability category.
In 2019, to receive a neutral payment adjustment, a provider must earn 30 points. Under the CMS proposed rule that number would increase to 45 in the 2020 reporting year.
2. New Measures for Physical and Occupational Therapy
CMS is proposing to add several new measures to the physical therapy and occupational therapy set of measures. These include:
- Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy – Neurological Evaluation
- Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention – Evaluation of Footwear
- Preventive Care and Screening: Screening for Depression and Follow-Up Plan
- Falls: Risk Assessment
- Falls: Plan of Care
- Falls: Screening for Future Fall Risk
- Elder Maltreatment Screen and Follow-Up Plan
- Preventive Care and Screening: Tobacco Use: Screening and Cessation in Intervention
- Dementia: Cognitive Assessment
- Functional Status Change for Patients with Neck Impairment
APTA is pleased to see additional measures added to the set to allow therapists more measures to choose from that meet their practice needs and patient populations.
3. Increase in Required Data Completeness
For the Quality category, currently providers are required to submit data for at least 60% of Medicare Part B patients seen that year. CMS is proposing to increase that number to 70% for the 2020 reporting year.
4. Change in Requirement for Improvement Activity Credit for Groups
Currently, groups, including virtual groups, can attest to an improvement activity if at least 1 clinician in that group participates in that activity. However, under the proposed rule, at least 50% of group members would need to participate in or perform that activity, for the same continuous 90-day period in order to get credit for that activity.
For more information on the entire Medicare Physician Fee Schedule proposed rule, you can listen to APTA's August 15, 2019, Insider Intel webinar, available free to members. A follow-up live webinar is scheduled for later this year, after the rule is finalized.