That latest piece of technology you’re thinking about weaving into your practice? Maybe it should come with a warning label.
This month, PT in Motion magazine takes a look at the ethical issues that new technologies can introduce in physical therapist practice. From seemingly offhand social media posts to the use of voice assistant devices (VADs) such as Alexa to mounting cameras in clinics, experts interviewed for the story explain the ethical considerations that need to be weighed before powering up.
“New Technology: Keeping It Ethical, Keeping It Legal” focuses on 7 general areas of technology: providing online advice, posting photos, VADs, wearable technology, use of cameras, electronic health records, and telehealth. PTs interviewed for the article include APTA Ethics and Judicial Committee Chair Bruce Greenfield, PT PhD, FAPTA; APTA Section of Health Policy and Administration member Robert Latz, PT, DPT, who’s also the section’s representative on the association’s Frontiers in Rehabilitation, Science, and Technology Council; and Nancy Kirsch, PT, DPT, PhD, FAPTA, president of the Federation of State Boards of Physical Therapy and author of PT in Motion‘s “Ethics in Practice” column.
When it comes to its most talked-about provisions, the US Centers for Medicare and Medicaid Services’ (CMS)final rule for home health payment under Medicare isn’t much of a change from the proposed version released earlier this year, meaning that an entirely new payment system will indeed be rolled out beginning January 1. But other parts of the rule have been tweaked—and in several areas, those tweaks represent wins for the physical therapy profession and the patients it serves in home health settings.
It’s official: PDGM is on for 2020. There wasn’t much debate about whether this would happen, but the final rule eliminates any doubt: the Patient-Driven Groupings Model (PDGM) will be the system under which CMS pays home health agencies (HHAs). It’s a big change, and APTA offers extensive information on the details of the model, but the bottom line is that the PDGM moves care from 60-day to 30-day episodes and eliminates therapy service-use thresholds from case-mix parameters. The system classifies episodes according to a set of 5 major buckets and subsets within those buckets. Patients are assigned a status within the 5 major areas, and within some of those areas they can be assigned to more detailed clinical categories—the combination of categories assigned to a patient generates a particular case-mix grouping. CMS says it will monitor how HHAs are operating under the PDGM, including the provision of therapy services.
Fewer than 48 hours after the launch of a new Medicare payment system for skilled nursing facilities (SNFs), APTA began receiving word from physical therapists (PTs) and physical therapist assistants (PTAs) that a number of providers were announcing layoffs or shifts to PRN roles with reduced hours and fewer or no benefits. Many were told by their employers that the new system, known as the Patient-Driven Payment Model, or PDPM, was the reason for reduced staffing levels and less therapy.
There’s one problem with that explanation: it isn’t true.
That’s the message APTA is delivering to SNFs, association members, and the media as it works to debunk myths surrounding a system that was designed to support clinician decision-making and push SNFs toward a more patient-focused payment model.
Want to get an up-close glimpse at a person with cultural biases? Follow these instructions:1. Grab a mirror. 2. Look into it.
That’s one way to summarize the starting point for “Battling Bias’s Distorted Images,” the cover story for the October issue of PT in Motion magazine. The article makes the case that while unconscious bias—also known as implicit bias—is very much a part of the human condition, it’s something that can be acknowledged and managed in ways that minimize its impact on relationships. For health care providers including physical therapists (PTs) and physical therapist assistants (PTAs), that’s an important step to take in effective patient care.
Through interviews with PTs in a variety of settings, author and Associate Editor Eric Ries explores how implicit bias—and these PTs’ recognition of it in themselves—has impacted and changed their lives, particularly at the professional level. Several describe the journey as a path that’s not always easy, but absolutely crucial to providing the best possible person-centered care.
The Centers for Medicare and Medicaid Services (CMS) spends much of its spring and summer churning out regulatory rules for the coming fiscal and calendar years. That means it’s an equally busy time for APTA, its members, and other stakeholders to stay on top of the proposals, respond to whatever challenges emerge, and advocate for change when needed.
This year’s standout challenge: advocacy efforts around the CMS proposed physician fee schedule (PFS). The rule as proposed includes at least 2 troubling provisions that demanded a strong response—1 around how CMS would go about determining whether therapy services were delivered “in part” by a physical therapist assistant (PTA) or occupational therapy assistant (OTA), and another that proposes an estimated 8% cut to reimbursement for physical therapists (PTs) and several other professions.
APTA has been aggressively fighting these changes through comments, creating a platform to facilitate a flood of individual member letters to CMS, multiprovider organization sign-on letters, meetings with CMS representatives, and the latest: a bipartisan letter signed by 55 members of Congress urging CMS to rethink the cuts.
September is National Pain Awareness Month—a perfect opportunity to spread the word about the important role physical therapists (PTs) and physical therapist assistants (PTAs) play in the management of pain, and the unique knowledge they bring to the table.
Need a reminder of why patient access to physical therapy for pain is so crucial, or inspiration to get you thinking about your own activities during National Pain Awareness Month? Here are some standout videos—and a podcast—that do just that. All but 1 were produced by APTA.
A Journey Out of Pain and Addiction, and a PT’s Crucial Role What it’s about: In his keynote address for the 2019 APTA NEXT Conference and Exhibition, US Army Master Sergeant (Retired) Justin Minyard recounted the injuries he received during rescue attempts first at the Pentagon during the 9-11 attacks and then while on a mission in Afghanistan. But the heart of Minyard’s story is about what happened afterward: the multiple fusion and other surgeries, the intense pain, his slide into addiction, and his eventual freedom from opioids. He readily acknowledges that his recovery was thanks in large part to the work of an interprofessional team that included a dedicated physical therapist.
While civilian health care policymakers and stakeholders in the US continue to debate whether physical therapists (PTs) should be included as primary care providers, the country’s military health systems have marched ahead with the concept. A new study adds to the evidence that the idea is working, both in terms of patient safety and reduced health care utilization.
Authors of the study, published in Military Medicine and first presented as a poster at the 2019 APTA Combined Sections Meeting, frame their research as an exploration of the potential for PTs to address the nationwide physician shortage by lowering costs and increasing access to care. They assert that the potential for more team-based, effective care could be at least partially realized if civilian PTs were treated like their military counterparts and included as primary care providers. It’s a position that APTA strongly supports in its strategic goals and is consistent with APTA’s own investigations into the PT’s role in primary care settings. In addition, in 2018 the association conducted a practice analysis aimed at determining the feasibility of primary care as a specialty area recognized by the American Board of Physical Therapy Specialties and the American Board of Physical Therapy Residency and Fellowship Education.
Tom McPoil, PT, PhD, FAPTA, said he intentionally structured the title of the 50th McMillan Lecture—”Is Excellence in the Cards?” as a question “to raise an element of doubt or uncertainty in our quest to achieve excellence.” After all, he said during his delivery of the lecture on June 13 as part of the APTA NEXT Conference and Exposition in Chicago, he has several concerns regarding the profession’s ability to achieve excellence.
Before describing the reasons for his uncertainty, McPoil did recognize some of the profession’s remarkable accomplishments since he began his career in 1973. “We no longer serve as a subservient technician in the health care system, our students now obtain an exceptional education and are granted a doctoral degree, we can practice in a variety of specialty areas in multiple practice environments, and we have achieved the ability to practice autonomously with patients having direct access to our services,” he noted.
But he said there still is room for improvement from both clinical and academic perspectives, and the remainder of his lecture outlined those perspectives. From the clinical standpoint, he described 3 areas.
The plan was set: on May 21, APTA would hold a congressional briefing on the importance of increasing patient access to nonpharmacological approaches to pain treatment. The event would be highlighted by the story of Cindy Whyde and her son Elliott, who became addicted to prescription opioids, and eventually heroin, after receiving an opioid prescription to treat a high school football injury 9 years ago. Elliott’s road to recovery has not been easy.
But the briefing didn’t go as planned. Days before the Whydes were to travel to Washington, DC, Elliott relapsed into addiction and disappeared. Cindy came to the event alone, determined to do whatever she could to effect change. At the time of the event Elliott had been missing for 3 days.
“That is one of the worst fears any parent should have to go through, not knowing where their child is and what’s going on with them,” Whyde said.
The final report from a US Department Health and Human Services (HHS) inter-agency task force on pain management best practices is out, and its call for greater collaborative care and improved access to physical therapy comes through loud and clear. It’s a report that in many ways echoes APTA’s white paper on opioids and pain management published nearly 1 year ago.
The “Report on Pain Management Best Practices” changed little from its draft version released in January [Editor’s note: this PT in Motion News article covered the draft in depth]. Like its predecessor, the report identifies gaps and inconsistencies in pain management that can contribute to opioid misuse.
While the task force acknowledges that opioids may be appropriate when carefully prescribed in some instances, it also argues that other approaches—including “restorative therapies” furnished by physical therapists and other health care professionals—should be on equal footing with pharmacological alternatives, particularly when it comes to reimbursement and patient access.