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.
APTA's September Flash Action Strategy: Student-Led, Member-Powered
This year's Flash Action Strategy (FAS) will take place September 18 and 19, and you can help make it the biggest ever.
What Is FAS?
Flash Action Strategy is an annual student-led campaign in which students, educators, and clinicians use social media and email to educate members of Congress about legislative priorities that impact the physical therapy profession. First held in 2013, FAS has resulted in more than 32,000 emails to legislators.
Social media has become a powerful advocacy tool. Many congressional offices have a dedicated staff member who works on social media, and just a few constituents tweeting about an issue can catch the attention of legislative staff.
This year's goal: to increase the number of cosponsors of the Physical Therapist Workforce and Patient Access Act.
What Is the Physical Therapist Workforce and Patient Access Act?
The legislation, known as H.R. 2802 in the House of Representatives and S. 970 in the Senate, would allow PTs to participate in the National Health Service Corps (NHSC) Loan Repayment Program, which repays up to $50,000 in outstanding student loans to certain health care professionals who agree to work for at least 2 years in a designated Health Professional Shortage Area (HPSA).
The addition of physical therapists to the NHSC Loan Repayment Program will ensure that the 11.4 million individuals in rural and underserved areas have access to nonpharmacological options for the prevention, treatment, and management of pain. Currently, there is no rehabilitative component within the NHSC.
H.R. 2802, which has 48 cosponsors as of this writing, was introduced by Reps Diane DeGette (D-CO) and John Shimkus (R-IL). S. 970 was introduced by Sens John Tester (D-MT), Roger Wicker (R-MS), and Angus King (I-ME) and has 6 cosponsors. (Download APTA's Action App to track the most up-to-date numbers.)
How You Can Participate in #FAS2019?
Get social. The event may be student-led, but everyone can participate! You don’t have to worry about developing your own message or not knowing what to say. APTA has developed messages through the Legislative Action Center for you to use on social media and in emails you can send directly to your members of Congress. It takes only a few minutes to participate, and your reach is wide. It’s already impactful for one person to engage with their legislators on social media, but imagine the influence of several thousand emails and tweets over the course of 2 days, echoing the same message.
Some tips:
- Tell your legislators how the NHSC Loan Repayment Program will affect you
- Tell your legislators what it’s like to be a PT – education is important!
- Tag your posts #FAS2019 to join in the conversation
- Follow @APTAtweets for graphics and other ways to spread the message
Use the APTA Action App.
APTA's app, available for both Android and Apple, makes it easy to for you to contact your members of Congress any time.
Using the app, you can:
- Hit the Federal Action Center button to contact your members of Congress.
- Check for talking points on key issues.
- Look up your senators and representative.
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Join PTeam.
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Give to PT-PAC.
Send letters through the Legislative Action Center. This resource allows members to send form letters—that you can personalize—to your members of Congress.
Sending letters in tandem with our social media messages is a great way to get the attention of lawmakers and staff. Visit www.apta.org/TakeAction for more information.
Things to Remember
Do:
- Encourage others to participate, to increase our voice.
- Stay on message. We are more powerful when we are all asking for the same thing.
- Include the correct bill numbers (H.R. 2802 for the House of Representatives, S. 970 for the Senate) in your messages.
- Refer to members of Congress with their proper titles.
Don't:
- Tag your posts with legislators who are not your own. Use the APTA Action App or visit Congress.gov to find out who your legislators are.
- Be negative or partisan.
- Forget to tag your legislators and use the hashtag #FAS2019.
- Post more than 10 times in a day.
Advocacy Works
There is strength in numbers, and APTA member advocacy is powerful. Due to previous advocacy efforts of members and APTA staff, we have successfully worked to:
- Establish locum tenens for PTs.
- Improve coordination of rehab research through the 21st Century Cures Act.
- Enable PTAs to be covered under TRICARE.
- Eliminate the hard therapy cap under Medicare.
But none of this would have occurred if we didn't educate legislators about how these issues affect their constituents.
Help make a difference on September 18-19 for the physical therapy profession, and for your patients.
Telehealth Ethics, Best Practice, and the Law: What You Need to Know
As physical therapist practice expands to include telehealth, securing patients' protected health information (PHI) is more critical than ever before. In a webinar recorded in October 2018 (free to members), Kara R. Gainer, JD, and Matt Elrod, PT, DPT, MEd, revisited the Health Insurance Portability and Accountability Act (HIPAA) requirements and professional ethical considerations (.pdf) as they apply to remote patient communications. Here is a quick summary, but check out the full webinar.
This is not formal legal advice, and you should always check all state and federal laws regarding telehealth requirements.
When evaluating potential telemedicine solutions for your organization, make sure to consider who can access PHI and how, as well as how data is secured during storage and transmission.
What does HIPAA require?
HIPAA covers protected health information (PHI) and requires covered entities to maintain reasonable and appropriate administrative, physical, and technical security standards.
Specifically, covered entities must:
- Ensure the confidentiality, integrity, and availability of all electronic PHI they create, receive, maintain, or transmit.
- Identify and protect against reasonably anticipated threats to the security or integrity of the information.
- Protect against reasonably anticipated, impermissible uses or disclosures.
- Ensure compliance by their workforce.
Under HIPAA, providers should also make sure contracts with "business associates"—including telehealth software vendors—provide assurances that the information will be properly safeguarded and are HIPAA compliant. The contracts must state how the vendor is permitted and required to use PHI and that the vendor will not use or disclose PHI outside those parameters, as well as requirements for appropriate safeguards to prevent misuse of PHI. There are financial penalties for noncompliance of up to $50,000 per violation.
How do I know if a telehealth technology solution is HIPAA compliant?
Consider the need for encryption of data being transported as well as stored. Additionally, just because a vendor says it is HIPAA compliant doesn't mean that it is, and providers should do their due diligence. Choosing a solution that has undergone an independent audit by cybersecurity risk management advisors provides peace of mind that the solution truly is HIPAA compliant. This independent verification and asking the right questions during solution research are key, as many organizations have higher-level compliance that doesn’t necessarily trickle down to individual services, solutions, or products.
What are best practices for patient consent in telehealth?
Getting your patient’s consent could be a legal requirement in your state, or a condition of getting paid, depending on the payer you’re billing. Some states don’t have any requirements. Others require verbal consent. Still, others require providers to obtain written consent and store it in the patient's health record. (To learn the consent requirements in your state, check The National Telehealth Policy Resource Center's state map.)
Even if patient consent for telemedicine visits are not required in your state, it’s still best practice. According to the American Telemedicine Association, the consent form should:
- Inform patients of their rights when receiving telemedicine, including the right to stop or refuse treatment.
- Tell patients their own responsibilities when receiving telemedicine treatment.
- Have a formal complaint or grievance process to resolve any potential ethical concerns or issues that might come up as a result of telemedicine.
- Describe the potential benefits, constraints, and risks (like privacy and security) of telemedicine.
- Inform patients of what will happen in the case of technology or equipment failures during telemedicine sessions, and state a contingency plan.
In addition, you may want to outline some of your basic telemedicine program policies around billing, scheduling, cancellation, etc.
Can a provider use email or otherwise electronically exchange images, videos, and conversation?
Yes, but providers should use caution. Under the law, PHI should be "reasonably safeguarded." While encrypted email is not required, it is recommended and providers should take certain precautions, such as checking the email address for accuracy before sending, or sending an email alert to the patient for address confirmation prior to sending the message. However, under the HIPAA privacy rulean individual has the right to request that a provider communicate via alternative means, if reasonable.
Under HIPAA, a phone is no different than a computer. So even if you aren't taking photos or videos, even checking your email or texting patients could require you to ensure you phone is HIPAA compliant by using encryption tools, enabling firewalls, installing security software, and maintaining physical control of the device, among others.
Can I use FaceTime or Skype?
Any medium used to transmit PHI must be covered by a business associate agreement. Conduct a risk assessment and make sure the agreement covers all of the programs being used (eg, Skype, Skype for Business, any Microsoft application you use). Apple does not currently enter into business associate agreements. Providers should work with vendors that agree to sign business associate agreements.
Are the rules any different for consultation with a health care provider versus direct interaction with the patient?
A covered entity may use or disclose protected health information for its own treatment, payment, and health care operations activities.
What if there is a data breach or records are lost or destroyed?
A data breach is an impermissible use or disclosure under the HIPAA Privacy Rule that compromises the security or privacy of the protected health information. There are a few exceptions, such as if the wrong employee accidentally received the data.
If a true breach has occurred, "covered entities" must notify all affected individuals within 60 days by first class mail or by email (if the person has consented to electronic notices). The communication must include a brief description of the breach; a description of the types of information that were involved in the breach; the steps affected individuals should take to protect themselves from potential harm; a brief description of what the covered entity is doing to investigate the breach, mitigate the harm, and prevent further breaches; as well as contact information for the covered entity or business associate, as applicable.
Kara Gainer is APTA's director of regulatory affairs. Matt Elrod is a board-certified neurologic clinical specialist and was lead specialist in APTA's Practice Department.
Additional Resources:
Hiding in Plain Sight: How You Can Fight Bacterial Contamination in Your Clinic
By David Levine, PT, DPT, PhD, FAPTA, June Hanks, PT, DPT, PhD, and Henry Spratt, PhD
As health care providers, we see multiple patients each day up close and personal. It's not uncommon to catch a cold from a patient's cough. But did you know your clinical surfaces could be spreading germs as well? Our research team, the Clinical Infectious Disease Control (CIDC) research unit at The University of Tennessee at Chattanooga has been investigating bacterial contamination in physical therapy equipment.
Here are the results of 3 studies, some takeaways, and some common-sense tips to limit potential infections for you and your patients.
Topical lotions can be a source of bacterial contamination. In one study, we sampled 81 containers of common lotions used for soft tissue mobilization, such as Deep Prep®, Palmer’s Cocoa Butter®, and Free Up®, from 22 outpatient rehabilitation centers. Sixteen of the containers sampled—20%—contained bacteria including Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA), and enteric bacteria such as E. coli. The majority of the bacteria found were present on the threads on the tips of the containers.
Ultrasound equipment can harbor germs—a lot of them. In another study, we cultured 31 ultrasound heads and 55 ultrasound gel bottles in 9 rehabilitation centers. Tips of gel bottles had the highest contamination, with 52.7% positive for nonspecific bacterial contamination and 3.6% positive for MRSA. While no MRSA was detected on ultrasound heads, 35.5% had nonspecific bacterial contamination. Disinfecting the ultrasound heads removed over 90% of the bacteria.
In a third study, we found that Staphylococcus aureus placed on ultrasound heads can survive, if not cleaned, for extended periods of time. Nearly 80% of Staphylococcus aureus placed on ultrasound heads in gel survived for 1 hour, with survival of 3 days possible in other types of organic matter, such as skin cells, or even the gel itself.
The takeaway: We need better and standardized cleaning and storage protocols for lotions, gels, and ultrasound heads, as well as general infection prevention protocols.
What Practice Managers Can Do to Prevent the Spread of Infection
Surveillance data collection is more challenging in outpatient settings than in inpatient settings due to short and sporadic patient encounters and the potential use of multiple medical facilities by infectious patients, but practice managers can promote best practices for infection prevention through official policies and protocols. Practitioners working in outpatient settings should follow recommended Centers for Disease Control and Prevention (CDC) health care-associated infection prevention practices, which include:
- Adherence to standard precautions such as cleaning equipment between uses
- Use of appropriate personal protective equipment including masks, gloves, and gowns
- Routine cleaning and disinfection of environmental surfaces most likely to become contaminated
- Strict adherence to hand hygiene practices (more on that later)
To reduce microbe contamination, environmental surfaces should be routinely cleaned and disinfected with appropriate solutions and following manufacturer recommendations. The CDC recommendations for cleaning and disinfecting environmental surfaces are based on the potential of the surface to transmit microbes if contaminated before use. Environmental surfaces are considered to be those that do not routinely come in direct contact with the patient during patient care, such as walls, floors, and knobs or handles on medical devices.
Even if you are a staff PT or PTA who isn't in a position to make decisions about a facility-wide protocol, there are some easy actions you can take right away:
- Routinely clean ultrasound heads with appropriate disinfectants.
- Use a tongue depressor to remove lotions from the container.
- Don't leave gel or lotion jars open.
- Don't reuse disposable bottles of ultrasound gels.
- Practice appropriate hand hygiene.
For patients who have open wounds or are immunosuppressed or immunocompromised, providers should take extra precautions, such as using sterile packets of lotions or gels for soft tissue mobilization or ultrasound, ensuring that any equipment that comes into contact with the patient (such as a goniometer) has been disinfected, and wearing personal protective equipment as needed.
Some Notes on Hand Hygiene
Hand hygiene should occur before and after each patient encounter.
Proper hand hygiene using alcohol-based hand sanitizers (ABHS) or soap and water significantly impacts microbe transmission and should be incorporated into routine patient care.
ABHS are the most efficacious method to reduce bacteria on hands. ABHS should be used according to manufacturer recommendations, which generally include putting the product on the hands and rubbing all surfaces of the hands together for at least 20 seconds until dry.
Handwashing with soap and water is recommended after treating patients with known or suspected norovirus or Clostridium difficile, since ABHS are not effective against these pathogens. To wash hands with soap and water, place the hands under running water, apply the soap, and vigorously rub all surfaces of the hand together for 15-20 seconds, rinse the hands, use a disposable towel to dry, and use the towel to turn off the water faucet.
Fingernails should be kept less than ¼ inch long, and excessive jewelry should be avoided. Frequent use of hand lotions that do not interfere with hand sanitizing products may help reduce hand dryness from frequent cleansing.
Everyone Has a Role to Play
All personnel play a role in the prevention of health care-associated infections. Administrators should ensure that policies and procedures regarding infection control are developed and implemented by health care personnel. Supplies necessary for adhering to standard precautions (eg, gloves, masks) should be readily available for use, and providers must be trained in infection-control measures.
David Levine is professor in the department of physical therapy at The University of Tennessee at Chattanooga (UTC) and a board-certified clinical specialist in orthopaedic physical therapy. June Hanks is associate professor in the department of physical therapy at UTC. Henry Spratt is professor in the UTC department of biology, geology, and environmental science.
Looking Back, and Forward: PTJ Publishes Its 1,000th Issue
As APTA heads toward its centennial year, PTJ has reached its own milestone: August marks its 1,000th issue.
Like the association, previously known as the American Women's Physical Therapeutic Association (AWPTA), the journal—originally The P.T. Review—has evolved over time to elevate the importance of research-based evidence in practice.
In contrast to the current issue—which covers diverse research topics such as diagnostic imaging, Twitter discussions of physical therapy, and perspectives on population health—the inaugural issue's 16 pages included a greeting from Marguerite Sanderson, who created the US Army reconstruction aide program during World War I; a letter from Army orthopedic surgeon Joel E. Goldthwait on the value of physical therapy; articles on the formation of the association and its first election; and the first AWPTA constitution.
(Spoiler alert: The preliminary meeting to discuss the formation of the association was held at Keen's Chophouse on 36th Street in New York City—which still exists today as Keen's Steakhouse.)
Here's a look back at the 1921 issue, edited by Isabel H. Noble, who hoped "to make each copy an improvement over its predecessor."
What's on the Physical Therapy Research Horizon? A Closer Look at 4 Emerging Foundation-Funded Investigators
The Foundation for Physical Therapy Research, now celebrating its 40th anniversary, is one of the profession's leading supporters of key investigations into physical therapy: how and why it works, how policy and practice changes might support its wider use, and how patient outcomes can continue to improve.
One of the most important ways the Foundation fosters research is by helping student and newly emerging researchers pursue their interests. The Foundation's Promotion of Doctoral Studies (PODS) and New Investigator Fellowship Training Initiative (NIFTI) scholarships do just that—this year, by way of $310,000 in Fellowship and Postprofessional Doctoral Scholarships. APTA is the Foundation's Pinnacle Partner, whose contributions help to support PODS and NIFTI programs, among other Foundation initiatives.
In this #PTTransforms post, we take a closer look at 3 postdoctoral students and the emerging investigator who received awards made possible through APTA's contributions to PODS and NIFTI—specifically, we wanted to find out more about their research, their views on the future of the profession, and what attracted them to physical therapy research.
Brian J. Loyd, PT, DPT, PhD
Recipient of the 2019 NIFTI award supported through APTA
What questions do you hope to answer with your research?
Currently, a substantial gap exists in our understanding of the impact vestibular hypofunction has on patient well-being. As researchers and clinicians, we rely upon laboratory and clinically based outcomes that may fail to capture changes in a patient’s participation and community-based performance. This study will provide a comprehensive assessment of the impact unilateral vestibular loss has on community-based performance and determine how well laboratory and clinical outcomes represent true community-level participation.
What brought you to physical therapy research?
I had long been interested in science and had a desire to examine critical questions, but I was first drawn to physical therapy research during my DPT training. In the final year of my curriculum I acquired an internal award that allowed me to complete a project that ultimately led to publication. I found this to be a highly compelling experience and felt that research would provide me the greatest opportunity to have a positive lasting impact in physical therapy. From that point forward, I knew I wanted to pursue research that would enhance the profession.
How will you use the award funding?
I will use the award funding to support my project focused on characterizing laboratory, clinical, and community-based outcomes in people with unilateral vestibular hypofunction. Additionally, this funding will afford me the opportunity to continue to pursue an independent research career. I will do this by applying for future grant applications and gaining additional training in vestibular physiology/rehabilitation and the use of wearable sensors to monitor changes in human movement. Receiving the NIFTI will give me an outstanding start in my early career and help my transition into becoming an independent researcher.
Where do you see the physical therapy profession going in the future?
The physical therapy profession is a central component of the health care system; by adopting models for the management of chronic disease and aging populations I believe it will remain so. Specifically, I believe that by implementing the use of technologies that allow for monitoring individuals during community-based activities we will gain a much greater understanding of the impact different conditions have on participation-level outcomes. As therapists gain access to this technology and data, we will be able to tailor our interventions to best suit the needs of the patient and better understand the long-term effects of our treatment.
Sarah M. Schwab, PT, DPT
University of Cincinnati
Recipient of a PODS I Scholarship, made possible by the APTA Scholarship Fund.
What questions do you hope to answer with your research?
Meaningful motor tasks require an individual to appropriately respond to variable task demands under changing contexts. My research seeks to answer questions about upper extremity motor control in children and adolescents with cerebral palsy under varying contextual conditions by exploring whether certain contextual situations enhance motor performance, and how this knowledge can be used to facilitate meaningful movement.
What brought you to physical therapy research?
As a clinician, I have witnessed the extraordinary ability of physical therapy to transform the lives of patients. That being said, I appreciate that our profession is not satisfied with "good-enough." Physical therapy is an evidence-driven profession, always seeking to improve. I think we can always strive to be better and provide better interventions for our patients, particularly for diagnoses such as cerebral palsy, in which our interventions currently produce modest effects at best.
Where do you see the physical therapy profession going in the future?
It is my hope that physical therapy continues to be an evidence-driven profession with an enhanced emphasis on dynamical systems theory, perception-action research, and nonlinear methods. Such theories and tools have tremendous potential to enhance interventions we provide for individuals with disabilities. I also am looking forward to increased diversity in both research and practice, working to ensure that opportunities exist for all people in our profession.
Rich Severin PT, DPT
Board-Certified Cardiovascular & Pulmonary Clinical Specialist
University of Illinois-Chicago
Recipient of a PODS II Scholarship funded by the APTA Scholarship Fund
What questions do you hope to answer with your research?
I hope to better characterize respiratory muscle performance in morbidly obese patients; in particular, how potential changes in respiratory muscle performance influence physiological responses to exercise and other health-related outcomes. I also hope to identify how measures of respiratory muscle performance can be used as a screening tool for postoperative complications and how respiratory muscle training can potentially attenuate the risk of postoperative complications (mainly pulmonary) after weight-loss surgery.
What brought you to physical therapy research?
Ever since I started physical therapy school I had hoped to pursue a career in research and earn a PhD in addition to my DPT. While my research interests have changed from those earlier times, the motivation has remained similar. I’m fascinated by the amazing things observed in the clinic and the complexities of the human body. I’ve always been a fairly curious individual, and research is a great way to harness that curiosity into something productive that can also help people.
Where do you see the physical therapy profession going in the future?
I would like to see the physical therapy profession move toward more applied and basic science research, even getting into genomics. More evidence is emerging supporting the benefits of movement and exercise on our health; even down to the cellular and genetic level. As the movement profession we should be taking ownership of this area of research and leading from the front. I’ve been fortunate to be involved in such studies during my doctoral training and I hope that this becomes more common in our profession.
Jason Sharpe, PT, DPT
Board-Certified Orthopaedic Clinical Specialist
University of Utah
Recipient of a PODS II Scholarship funded by the APTA Scholarship Fund
What questions do you hope to answer with your research?
I want to understand what influences patients to choose physical therapy and the impact of that decision on patient outcomes, including their subsequent medical utilization. Our understanding of patient choice will provide the foundational knowledge needed to develop a shared decision-making intervention to direct patients who choose not to use physical therapy—even though likely to benefit from it—toward physical therapy.
What brought you to physical therapy research?
My interest in physical therapy research started early in my career while I was working in an outpatient orthopedic physical therapy private practice. In this clinic, the majority of our patients were experiencing chronic symptoms and frequently received care from several health care practitioners before physical therapy. I believed that some patients should have been using physical therapy earlier in their episode of musculoskeletal care to reduce the rates of chronic pain development. To achieve this goal, I decided to pursue a research career examining patients’ choice to use physical therapy, including how to more effectively direct physical therapy care for patients with musculoskeletal conditions.
Where do you see the physical therapy profession going in the future?
Physical therapists have an opportunity to reinforce themselves as the preferred provider for exercise-based interventions, a cost-effective treatment for a wide variety of musculoskeletal diagnoses and conditions influencing movement. By establishing our role in the management of musculoskeletal conditions and conditions influencing movement, we will be able to leverage direct access and improve care for patients throughout the health system.
'Bedrest is Bad': New #everyBODYmoves Campaign Is Combatting Hospital Immobility
Experts agree that immobility can harm patients in hospital, postacute care, and other settings. According to researchers, bedrest can have many negative effects:
- Muscle mass decreases by ~1.5%¬–2% per day during bed rest.
- Risk for development of thromboembolic disease increases.
- Increased risk for atelectasis may contribute to pneumonia.
- Raising the head of the bed causes greater pressure on the skin in the sacral region.
- One study found 61 of 155 patients who survived a critical illness had contractures.
Movement can ameliorate these effects, but for patients in hospital settings that often takes encouragement. And sometimes health care providers need to be reminded about their role in promoting movement.
Enter the #everyBODYmoves campaign, a 3-day event designed to encourage providers to make movement a priority and encourage the sharing of best practices and ideas, including an Online Global Summit focused on immobility harm, July 10-12, 2019. (Additional information in the Q&A below.)
For details, #PTTRANSFORMS spoke with Michael Friedman, PT, MBA, director of Johns Hopkins Activity and Mobility Promotion (AMP) and director of strategic program development in the Department of Physical Medicine and Rehabilitation at Johns Hopkins Medicine.
#PTTRANSFORMS: What is the #everyBODYmoves campaign?
Michael Friedman: It's a campaign developed by Johns Hopkins Medicine to raise awareness and put focus on the immobility harm in the hospital and postacute care. The campaign has brought together different groups around the country and around the world that we have had the good fortune to interface with while developing and disseminating our Activity and Mobility Promotion solutions. We have been successful in positioning hospital immobility as a harm just like deep vein thrombosis (DVT) or falls, and felt we could assist other organizations in raising awareness across disciplines—because you can’t address immobility if your organization doesn't realize it is a problem.
#PTTRANSFORMS: You presented on this topic at the recent congress of the World Confederation for Physical Therapy. Can you tell us about that?
MF: The presentation focused on the need to systematically address hospital immobility harm. Beyond having presenters from the United States, the Netherlands, the United Kingdom, and Australia, what I really enjoyed was that presenters included physical therapy, administration, nursing, and physician perspectives. Each perspective included an element focused on barrier assessment, measurement, training, and engagement. At Johns Hopkins we believe that it is essential to assess and measure mobility across disciplines—physicians, nurses, therapists—using a common tool and to be able to communicate a patient's progress to both the care team and the patient. My colleagues from around the world and across disciplines reinforced for me the importance of a global community working together to solve a common problem—and there you have it, #everyBODYmoves.
#PTTRANSFORMS: It's about shifting the culture or the organization mindset.
MF: It's an entire shift from a culture of immobility. Evidence demonstrates that bedrest is bad for every outcome there is. The July 10-12 summit hopefully will provide a jumping off point or accelerant for organizations to initiate or expand formal mobility programs.
The focus of this whole campaign is simple. You can participate in 3 ways.
- Establish a Mobility-a-thon: Over 3 days, what can you do to make mobility a priority in a patient's care plan? Can you get them up more? Can you get them up for 3 meals a day? What can you do to just make mobility a priority? That's it.
- Share your best practices on social media, patient success stories. Just use #everyBODYmoves and #EndPJparalysis to join the conversation.
- Attend the free online conference, which includes hours of content from around the world. Visit http://bit.ly/everybodymoves for conference details and free resources to support your campaigns and communicate with your teams.
#PTTRANSFORMS: How does this campaign extend to long-term care facilities or skilled nursing facilities?
MF: This approach works in postacute care, long-term care, and also home health care. Sedentary behavior is bad. We should all exercise more than we do. But if you're confined to the home or have a chronic illness, it becomes that much harder, and the cycle of comorbidity, debility, and disease accelerates. As a patient, you might say, "I'm sick, I just need to sit in bed and rest." Maybe you're on pain medication. We as providers need to think about all those barriers to movement and collectively develop solutions, no matter the setting.
#PTTRANSFORMS: How do you balance the concern about falls with the concern about immobility?
MF: Inherently, safe mobility would mean no falls, but we instead have been focused on core measure. Therefore, the easiest way not to have to record a fall in the hospital is for the patient not to get out of bed, but then they're more likely to get a pressure ulcer or pneumonia. When they leave the hospital, they're weaker and more likely to have a fall at home.
This is an unintended consequence of falls regulation and misaligned incentives.
There is an article on this topic called "The tension between promoting mobility and preventing falls in the hospital" that I encourage people to read.
#PTTRANSFORMS: What can a PT who's not in a decision-making position do to promote this type of initiative?
MF: To get things to stick, you need to push them to leadership and get your organization invested in it. Patient stories are so important. If you can bring patient stories forward and tie them to your other initiatives, feed them up through your managers and decision makers, you can turn a single patient interaction into a campaign.
Another thing you can do specifically as a PT is engage the rest of the care team across disciplines. Most patients in the hospital are not seen by a physical therapist and don’t need to be, but how can you still add value for those patients? You need to be thinking: I’m a consultant, I’m the expert on mobility. What can I recommend to the rest of the health care team to do when I’m not in the room?
For the patients you are seeing, you see them maybe for a half hour to 45 minutes. What's happening the other 23 hours of the day? What's happening on the days you're not going to see them? If individual staff PTs can start thinking, "What is the mobility plan for this patient when I'm not here?"—that's a huge start.
#PTTRANSFORMS: What is the most important takeaway?
MF: The single most important thing about the #everyBODYmoves campaign is that it allows an opportunity for rehab providers to engage other disciplines and communicate how important mobility is. Awareness, awareness, awareness.
These 3 days are just a start. To develop this as a full plan, you do need a systematic quality improvement approach. But the first steps are building awareness, engaging your organization, and understanding what you can do as an individual. Immobility is a harm and needs to be not only a rehab imperative but a quality and safety imperative just like any other. If we accomplish that, the rest will move in the right direction.