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."
- 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.
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.
- 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.
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
- 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.
- 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.
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.