The impact that loss of mobility can have on hospitalized older adults can reach far beyond the hospital stay, yet there is little consistency in the ways hospitals assess and promote movement, and almost no acknowledgement of mobility as an outcome measure. That needs to change, and soon, say authors of a new white paper advocating for a shift in “a hospital culture that does not value or prioritize mobility.” APTA was among the organizations that participated in a peer review of the document, with member James Tompkins, PT, DPT, conducting the review.
The white paper, produced by the American Geriatric Society’s (AGS) Quality and Performance Measurement Committee, describes the current state of mobility assessment in acute care settings as spotty at best, with a few hospitals conducting regular, validated mobility reviews with patients, and many others using inconsistent assessments or relying too much on hospital physical therapy departments to keep up with tests and measures that could be conducted by nurses. The assessment gaps, coupled with what researchers describe as a “focus on fall prevention at all costs,” result in dramatic and potentially long-lasting losses in mobility in a population already at risk.
Even though the National Institutes of Health’s “Go4Life” month is wrapping up, the initiative will continue to offer resources to providers and the public. And for good reason.
Strongly supported by APTA, Go4Life is an ongoing effort to connect the public and health care providers with information and resources related to healthy aging. In addition to information on how exercise improves health, the Go4Life website includes suggested exercises, workout videos, fitness tracking resources, and access to printed materials including infographics, posters, bookmarks, and postcards, all available for free. The program also offers a free “Speaker’s Toolkit” to help providers develop presentations to target audiences—available by emailing Go4Life@mail.nih.gov.
Of course, staying physically active for healthy aging isn’t just a good idea—it’s a concept supported over and over again by research. A lot of research. To give you an idea of the level of support for the positive effects of physical activity on aging, here’s a quick overview of just some of the research articles that have been published on this topic during the month of September alone.
Next professional conference you go to, take a look around. Chances are you’ll see a disproportionate number of men at podiums, on panels, and walking around with all those extra ribbons on their ID badges—even when the profession itself is supposedly “female dominated.” It’s a symptom of a bigger problem that many people, including Karen Litzy, PT, DPT, would like to change.
Litzy will be the first to admit that there’s much work to be done. But as the organizer of the Women in Physical Therapy Summit, now in its third year, Litzy can take some pride in knowing that when it comes to at least 1 conference, the problem has been turned on its head.
The 2-day summit, coming up on September 21 at John Jay College in New York City, focuses on the contributions women have made and the ways they can have an even greater impact. Men are of course welcome (and do attend), but the emphasis is on women—not just as speakers, but as sources of inspiration, insight, and experience. The event is sponsored in part by APTA.
APTA has earned another national award—this time for collaborative efforts to push for an end to the Medicare outpatient therapy cap.
The American Society of Association Executives (ASAE) announced that APTA, the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASHA) were the joint winners of a 2018 Power of A Gold Award for their combined “Stop the Cap” efforts. The work of the 3 associations was instrumental in a congressional decision to permanently end the flawed cap process.
ASAE’s Power of A (the A stands for “association”) Awards, are the industry’s highest honor, recognizing the association community’s valuable contributions on local, national, and global levels. The award will be presented to APTA, AOTA, and ASHA at an ASAE awards dinner on October 3. As a Gold Award winner, the Stop the Cap program is 1 of 6 campaigns under consideration for ASAE’s Summit Award, which will be announced later this summer.
When I graduated with a DPT in 2013, I never considered that I might someday end up going back to school, in any capacity.
I spent the first four years of my career in the outpatient orthopedic setting full time, and also worked a per diem weekend gig in the hospital in order to pay off my hefty student loan bill as quickly as possible (which I can proudly say I have now accomplished!).
By the end of that I was definitely starting to feel a bit of burnout. However, during that time, I had taken the APTA Credentialed Clinical Instructor course, and had the opportunity to take on the role of Clinical Instructor, in which I found a great deal of joy. This prompted me to consider a more significant role in physical therapy education which, though I knew it was something I enjoyed, at first seemed outside the realm of my abilities and qualifications.
For some patients, physical therapy can both decrease overall health care utilization and save money down the road—especially if delivered sooner rather than later. These were the takeaways from 2 articles in a May 2018 special issue on nonpharmacological management of pain published by PTJ (Physical Therapy), APTA’s scientific journal. PTJ Editor-in-Chief Alan Jette, PT, PhD, FAPTA, interviewed authors of each of the studies via podcast.
One study, coauthored by Xinliang “Albert” Liu, PhD, examined the effect of timing of physical therapy on downstream health care use and costs for patients with acute low back pain (LBP) in New York state. The patients were categorized by whether and how soon they received physical therapy after seeing a physician for LBP: at 3 days, 4–14 days, 15–28 days, 29–90 days, and no physical therapy. Patients who received physical therapy within 3 days (30%) incurred the lowest costs and utilization rates, while those who didn’t see a PT at all saw the greatest of both.
With nearly a third of the total Medicare population enrolled in a Medicare Advantage (MA) plan and growth expected to continue, it’s time for the public-private hybrid system to evolve and move away from excessive use of prior authorization—that’s the message being delivered to the Centers for Medicare and Medicaid Services (CMS) from a coalition of health care and consumer organizations including APTA.
In an April 10 letter to CMS Administrator Seema Verma, the Coalition to Preserve Rehabilitation (CPR) writes that MA’s uses of prior authorization “may be sources of increasing barriers to accessing needed care, particularly inpatient and outpatient rehabilitation services and devices, for beneficiaries nationwide.” The coalition argues that in many cases, prior authorization “often serves as an unnecessary delay for beneficiaries seeking medically necessary care, and often results in no cost savings to the plan.”
APTA’s #ChoosePT opioid awareness campaign makes the case that opioids simply “mask” pain—but a new study in JAMA has concluded that the drugs probably don’t even do that much, at least not any more effectively than nonopioid medications. The research, which focused on individuals with chronic back pain or hip or knee osteoarthritis (OA) pain, led authors to an unequivocal conclusion: there’s no support for opioid therapy for moderate-to-severe cases of those types of pain.
The published findings are based on a study of 240 randomized patients in the Minneapolis, Minnesota, Veterans Affairs (VA) health care system who reported chronic back pain or knee or hip OA pain, defined as daily moderate-to-severe pain for 6 months or more with no relief provided by analgesic use. Participants were divided into 2 groups: 1 that received an opioid regimen, and a second group that received nonopioid drugs.
To more closely resemble real-world treatment, researchers used a “treat-to-target” approach that stepped up the drugs as needed for participants to reach identified goals. The opioid regimen began with immediate-release morphine, hydrocodone/acetaminophen, and oxycodone, but the regimen could advance to sustained-action morphine and oxycodone, and on to transdermal fentanyl. The nonopioid approach began with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDS), but it could move on to topical analgesics and finally to drugs requiring prior authorization (such as pregabalin and duloxetine), including tramadol. All participants also were permitted to pursue nondrug treatment during the study, but researchers did not evaluate data related to those treatments.
Physical therapists (PTs) and patients may face plenty of challenges when it comes to dealing with private insurers, but for those who participate in the Humana system, preauthorization for physical therapy is no longer one of them. In a move strongly supported by APTA, the insurer lifted the prior authorization requirement for outpatient physical therapy, occupational therapy, and speech-language pathology.
Humana made the announcement earlier this month, stating that the change was effective December 18, and applies to both commercial and Medicare Advantage policies. Other elements of the Humana benefit package remain unchanged, including visit limits, referral requirements for some plans, and medical necessity requirements. Prior to the change, PTs, occupational therapists, and speech-language pathologists were required to obtain preapproval from a utilization management/review vendor.
Efforts by the US Centers for Medicare and Medicaid Services (CMS) to make Medicare Advantage (MA) plans more accessible to more vulnerable beneficiaries are laudable, and provisions that would steer patients away from overuse of drugs are understandable, but CMS needs to be mindful of the unintended consequences of these and other changes, says APTA in its comments on proposed MA rules changes for 2019.
At the center of APTA’s comments are proposed changes to so-called “uniformity requirements,” out-of-pocket limits, and frequently abused drugs. Essentially CMS would like to make it easier for more vulnerable individuals to participate in MA plans by reducing cost-sharing requirements, and harder for providers and patients to overutilize certain drugs, including opioids. Both efforts are worth pursuing, APTA says in its comments to CMS.