The Physical Therapy Outcomes Registry

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Blogger: Katie Baratta

My name is Katie Baratta and I just graduated from the Regis University School of Physical Therapy. I had the opportunity to spend two weeks at the APTA doing a student internship. I was able to talk to many different members of the APTA, attend the Federal Advocacy Forum, and learn more about what the APTA has been doing to move our profession forward. I’ve written a series of essays about my experiences here at the Association.

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Data… I love it! As a former engineer who analyzed a lot of data in my pre-PT life, I find it fascinating to see how lots of tiny bits of information, combined together, can provide us with a more comprehensive picture.

The PT Outcomes Registry is one of APTA’s current projects to create a centralized database for outcome data. The idea is to track a set of prioritized outcome measures (currently there are nine outcomes, but this may expand) across the country. Clinicians perform the outcome assessment with the patient at the initial evaluation and again at discharge to measure the patient’s progress and then input the information into the computerized system. The PT Outcomes Registry then compiles the data from all practitioners so that practitioners can see how they measure against a benchmark of other providers.

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Timeline

The program is still in its pilot phase with 216 enrolled users (currently all practicing PTs, no PTAs) at 25 organizations. The most recent development is to include residents and fellows to compare their outcomes both during their residency/fellowship and again afterward to see how their outcomes change with time and experience. Later this year, APTA will collect feedback via user survey of pilot users regarding usability, pros/cons, glitches, and so forth. The team at APTA will then incorporate this feedback into the PT Outcomes Registry system.

The Registry will officially launch at the beginning of 2017, at which time any clinical site will be able to join. Clinicians will pay to enroll in the program, which will give them access to the aggregated data to see how their practice stacks up against national benchmarks. The service will not be limited to APTA members. Karen Chesbrough, the outcomes registry director, states that by the end of 2017 the APTA would love to have 1000 users, with the long-term goal of involving as many clinicians/sites as possible to get as accurate a picture of current practice as possible.

Which types of data are included?

The current outcomes include global measures, such as AM-PAC™ (Activity Measure for Post-Acute Care™), PROMIS (Patient Reported Outcomes Measurement Information System), and OPTIMAL (Outpatient Physical Therapy Improvement in Movement Assessment Log). There are also regional/body-specific outcome measures such as NDI and Oswestry. Other data includes clinician profiles, patient demographics, and pain ratings; practitioners have the ability to enter data at treatment visits along with at initial evaluations, reassessment, and discharge. The types of outcomes included are vetted through an independent group of clinicians and academics (including one Canadian!) called the Scientific Advisory Panel.

The Scientific Advisory Panel is working in conjunction with the SIGs (Special Interest Groups) to develop prioritized objective data that the clinician would also collect as part of the PT Outcomes Registry based on the patient’s diagnosis. These modules may be specific to cervical pain or to infant torticollis, for example, and would include relevant ROM or other objective data.

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How does PT Outcomes Registry collect the data?

During the pilot program, enrollees are entering the data manually. Enrolled clinicians—or their clinic’s administrative support personnel—will log in to the system and select different tabs and boxes to enter the data, much like they do for electronic documentation of patient records.

However, manual data collection is time-consuming, so the current push within the project’s development is to build software “bridges” with all of the various EMR (electronic medical records) systems. These bridges would allow a computer program to connect the PT Outcomes Registry with each EMR system to pull the relevant pieces of data into the database. Each type of information (eg KOOS at initial eval, patient age, etc) will have an associated tag in the registry database, and each EMR will tag the same variable in their database so that the computer program will be able to match the data from the patient records to the PT Outcomes Registry. One EMR has already signed on to the project, and APTA is working to get more to participate. This will streamline the process significantly and will likely increase participation as less time and energy will be required for individual clinicians to enter the data by hand.

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What does this mean for clinicians?

Being a part of the PT Outcomes Registry would allow clinicians to see how their practice stacks up against others throughout the country. If a particular clinic performed very favorably within the Registry, it would be able to advertise this fact to patients and to different entities that may want to contract with the clinic. Participation in the PT Outcomes Registry would also enable a clinic to pinpoint how to improve poor performance in a particular area that they may not have previously recognized without the aggregate data.

The PT Outcomes Registry will provide objective information to support the assertion that PT restores function. We can then use this information to demonstrate our value to different organizations, whether that is with a hospital, an insurance organization, or to the general public.

The outcomes registry director also sees this information as eventually being linked to reimbursement. Linking outcomes to reimbursement would continue the trend to move away from fee-for-service and toward a value-based payment structure. A value-based payment structure rewards effective clinical practice, rather than performing treatment units with the highest reimbursement rates. This would be a win-win for evidence-based practitioners, as well as for their patients.

Eventually, with enough data, there is potential for the information to be used for research as well; the Outcomes Registry represents the exciting future of our profession!

PT Outcomes Registry Site | More info from the APTA

 

A Non-Native’s Guide to Colorado’s Summer Playground

Name: Evan Piche, Class of 2018

Hometown: Northampton, MA

Undergrad: Colorado State University

Fun Fact: I once thought I met Danny DeVito in an airport men’s room.

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Congratulations! If you’re reading this, there is a fair chance that you are either (a) my mother, or (b) a member of the incoming Class of 2019. Welcome, and since both parties will be visiting Colorado this summer, I’d like to help get you acquainted with some of the best trails Colorado has to offer. Denver is not, strictly speaking, a mountain town in the same sense as Telluride, Steamboat Springs, and Crested Butte are. We’re kind of out on the plains, straddling two worlds—but that doesn’t mean you’ll be short on options for running, hiking, or biking. We Denverites are fortunate enough to enjoy a wealth of those opportunities for after-school outdoor recreation, and when you have a long weekend and are up for a few hours in the car, the options for adventure are limitless.

With that, I’d like to offer my favorite hiking/trail running and mountain biking destinations in the Denver-metro area and beyond. From backcountry escapes to a quick after-class workout, you’re sure to find something to do this summer. (And, while I was not specifically asked to include this, I would be remiss in my duties if I did not use this opportunity to act as your ambassador to the world of Denver’s breakfast burritos.)

Hiking/Trail Running

School day: when you only have an hour or two after class, these are the places to check out! (15- 20 minutes away)

  • Matthews/Winters – Red Rocks Loop
    • A rolling, rocky 5-7 mile loop with fantastic views of the foothills west of Denver and the world-famous and aptly named Red Rocks Amphitheater.Mathew_Winters

trailrunproject.com/…/matthewswinters-red-rocks-loop

  • Falcon
    • Hands down the best climb in the Denver area, this trail winds its way up four steep technical miles to the summit of Mount Falcon. From here, either retrace your steps to the parking lot nearly 2,000 feet below or continue on to explore a vast trail network.Mt_Falcon.jpg

trailrunproject.com/…/mount-falcon-east-loop

  • Green Mountain, Lakewood
    • A mostly gentle 5-8 mile single track loop featuring the Front Range’s best sunrise and sunset views.Green_Mtn

trailrunproject.com/…/green-mountain-trail

Weekend: about a 90-minute drive from Denver

  • Sky Pond, Rocky Mountain National Park
    • A classic RMNP hike; after meandering around the base of Long’s Peak, the trail turns vertical and ends with a fun scramble to Sky Pond amid boulder fields and some of the Park’s most impressive glaciers.Sky_Pond_RMNP

trailrunproject.com/…ail/7002175/sky-pond

Long Weekend: 3-5 hours from Denver

  • West Maroon Pass, Aspen to Crested Butte
    • This is considered a rite of passage among Colorado hikers and trail runners. While the towns of Crested Butte and Aspen are separated by one hundred miles of highway, this challenging, backcountry trail connects them so that “only” 10 miles sit between them. Pack a bathing suit (or not) for a dip in Conundrum Hot Springs if you plan to do this trip properly.

cascadedesigns.com/…/hiking-west-maroon-pass-from-aspen-to-crested-butte

Mountain Biking

School day:

  • Lair O’ the Bear 
    • Swoopy, flowing lines, grinding climbs, open meadows, and a breathtaking view of Mount Evans—all less than 30 minutes from Denver. After riding, grab a burger or brew in one of Morrison’s quaint eateries.Lair_of_the_bear

mtbproject.com/trail/703097

  • White Ranch 
    • This is a gem of a park and located only a few miles north of Golden; it offers trails that rival anything in Boulder (after all, you can see the iconic Flatirons from the parking lot) with a fraction of the traffic.White_Ranch

mtbproject.com/trail/632917

  • Apex Mountain Park, Enchanted Forest Trail 
    • Apex is one of Denver’s most well-utilized mountain bike trail networks, and with good reason. The Enchanted Forest descent is not to be missed. Be sure to check the link provided for alternate direction riding restrictions on odd/even days before you go. Bonus: these trails are a blast to ride in the snow after the fat bikers, skiers, and snowshoers do all the dirty work of packing down the snow.Apex_EnchantedF_Forest

mtbproject.com/trail/616137

Weekend:

  • Blue Sky to Indian Summer
    • Regardless of whether you mountain bike or hike (or climb, or paddle, or just enjoy beer), a trip to Fort Collins is always enjoyable. Fort Fun is home to one of the Front Range’s finest fast, flowing mountain bike trails. While options abound for long climbs up to the summit of Horsetooth Mountain Park, the Blue Sky Trail sticks to the lowlands, traversing a spectacular cliff line with scenery reminiscent of your favorite Western movie. Also, New Belgium brewery is not to be missed.

mtbproject.com/…/blue-sky-to-indian-summer

Long Weekend:

  • 401 Trail, Crested Butte, CO
    • Come spring and early summer, the wildflowers on this ultra-classic trail grow to be chest-high. Imagine ripping down 14 miles of high country singletrack, with views of snowcapped mountains disappearing and reappearing as you dive into and out of fields of wildflowers so high and dense as to obscure your line of sight. Be sure to grab tacos at Teocalli Tamale once back in town.401_Trail_CB

mtbproject.com/trail/338027

  • Slickrock Trail, Moab Utah
    • Quite possibly the most famous mountain bike trail in the world—and for good reason. Slickrock offers an other-worldly experience: an ocean of red sandstone surrounds you, with views of the Colorado River far below in the canyon. In the distance, the snowcapped La Sal Mountains dwarf the landscape and offer a stunning contrast to the red, pink, and orange hues of the desert. For après ride fun, check out the Moab Brewery, located right in the center of town—it’s an oasis of alcohol and burgers in an otherwise remarkably dry state.Slickrock

mtbproject.com/trail/158941

Burritos

The breakfast burrito was invented in the kitchen of Tia Sophia’s in Santa Fe, New Mexico in 1975. Since that historic day, it has been possible to eat a burrito for all 3 (or more) meals of the day, a feat now commonly referred to as a “hat trick.” Like most of Denver, the breakfast burrito is not native to Colorado, but found in our city a welcoming home. I am unsure of whether or not Colorado has an “official” state food, but I would nominate the breakfast burrito for that honor.

With the help of acclaimed writer and Denver resident Brendan Leonard, I have assembled the definitive guide to Denver’s Best Breakfast Burritos:

  • Grand Prize: El Taco de Mexico on Santa Fe
  • First Runner Up: Bocaza on 17th Ave.
  • Second Runner Up: Steve’s Snappin’ Dogs
  • Honorable Mention: Illegal Pete’s
  • People’s Choice: Campfire Burritos (food truck)

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    Evan is an avid biker, trail runner and climber.  We hope you enjoyed his pictures and guide to an adventurous CO summer!

 

Physical Therapy Classification and Payment System: a Discussion with Lindsay Still

 

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Blogger: Katie Baratta

My name is Katie Baratta and I just graduated from the Regis University School of Physical Therapy. I had the opportunity to spend two weeks at the APTA doing a student internship. I was able to talk to many different members of the APTA, attend the Federal Advocacy Forum, and learn more about what the APTA has been doing to move our profession forward. I’ve written a series of essays about my experiences here at the Association.

Interview with Lindsay Still, Senior Payment Specialist

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I talked with Lindsay Still, a Senior Payment Specialist, and she explained the current state of the PTCPS.  Read a summary of our interview below!

Overview

The Physical Therapy Classification and Payment System (PTCPS) is an ongoing initiative that was developed as an alternative to the current, fee-for-service codes—ones that easily fail to capture the true value of what PTs do—and instead particularly account for the complexity and skill of clinical expertise required for patients with more involved presentations. It also incorporates the use of standardized outcome measures. PTCPS would include a single CPT (Current Procedural Technology) code for the entire treatment session versus the assortment of 15-minute unit codes that we’re used to today.

The system has gone through multiple iterations in the past several years, and was developed by the APTA in collaboration with a specialty work group within the AMA (American Medical Association) involving members from the professional organizations of OTs, massage therapists, athletic trainers, speech-language pathologists, chiropractors, psychologists, optometrists, podiatrists, physiatrists, neurologists, orthopedic surgeons, osteopathic physicians, and representatives of CMS (Centers for Medicare & Medicaid Services).

Structure of the new coding system

Under the new system, there would be three new evaluation codes that puts a patient into an initial category of lower, moderate, or higher complexity. Certain documentation criteria (e.g. under patient history, presentation, or plan of care) would determine which of the three eval codes you would select. For example, the number of comorbidities for a given patient would play a role in the eval code selection. There would also be a single code for any re-eval visit.

As currently structured, the proposed PTCPS would also incorporate five treatment codes, based on the overall complexity of the patient’s presentation and treatments. These codes, much like our current CPT code for evals (97001 Physical Therapy Evaluation), would not have a set time frame or number of units associated with it. However, treatment billed under the lowest complexity code would likely be much shorter than a treatment session under the highest complexity code, and the reimbursements would reflect this fact.

Implementation

In 2014, pilot testing of the new system was performed with PTs using the new system to code/bill for hypothetical patients, as well as using the new system to code the treatments of actual patients previously coded with the existing system. This testing occurred in various care settings. Overall, the clinicians were very consistent in their ability to categorize patients with the new initial eval codes. However, for the intervention codes, the pilot clinicians were only able to consistently categorize those patients with the least complex and most complex presentations. There was significant disagreement between PTs in regards to cases that fell within the different “moderate” treatment categories.

The definitions and valuation of the proposed eval codes were reviewed and approved by the RUC (Relative Value Scale Update Committee) and will now require CMS approval. Lindsay is hopeful that CMS will accept the new eval codes, as they will be budget-neutral. In August of 2016, CMS will release the 2017 Medicare Physician Fee Schedule Final Rule; this should include the new PT evaluation and reevaluation codes. The new codes will go live on January 1, 2017. PTs will have three brand-new CPT codes to replace the current 97001 Physical Therapy Evaluation. The APTA will provide training and support to clinicians during the time leading up to the release of the new eval codes.

Impediments to the impending treatment code change

The new treatment codes will require further review and refinement, given their inconsistency of use during the pilot testing. This will likely be an interactive process, and not without controversy from the perspective of payers (insurance companies). In the meantime, the RUC has requested a “backup plan” to address ten CPT codes commonly used by PTs which have been identified as “potentially misvalued codes,” most of which PTs probably use frequently:

  • 97032 attended electrical stimulation
  • 97035 ultrasound
  • 97110 therapeutic exercise
  • 97112 neuromuscular reeducation
  • 97113 aquatic therapy with therapeutic exercise
  • 97116 gait training
  • 97140 manual therapy
  • 97530 therapeutic activities
  • 97535 self care home management training
  • G0283 unattended electrical stimulation (non-wound)

These codes are flagged  because they represent a high reimbursement rate and have not been assessed since 1994.

As a result, the APTA is currently redirecting efforts to provide replacements to those 10 codes rather than waiting for the codes to be reevaluated for us. The new treatment codes the APTA envisions to replace them with would be procedure-based: you would still bill in 15-minute increments. However, they would be streamlined; there would be fewer codes, and the codes would reflect the types of treatment PTs currently perform in practice (as opposed to focusing on what treatments PTs may have historically performed).

Future of the proposed treatment codes

The more general patient- and value-based treatment codes initially envisioned by the APTA are still in the works, but Lindsay foresees a longer process before fruition: it will require all parties to agree on a coding system that accurately and cost-effectively describes the type of treatments that PTs perform for patients. This includes the third-party payers who generally prefer the current setup of treatment codes based on billable units. The current coding system is easy to monitor for abuse or overuse of treatments.

I asked Lindsay if she saw outcome measures as one way of giving insurance companies some power to track the value of treatments under the proposed system. While they wouldn’t be able to screen specific procedures in the same way that they are able to under the current system, they would be able to, for example, monitor whether the progress of a “low complexity” patient was lagging behind what would be expected given that patient’s presentation.

She agreed that this could work in theory, but felt that we still have a long way to go in terms of standardization of outcome data across the spectrum of patient presentation. This is one of the reasons the PT Outcomes Registry will be so important! These two issues truly are intertwined in the future of value-based billing for PT services.

For more information, visit: http://www.apta.org/PTCPS and check out the Timeline for payment reform.

From Practicing Clinician to APTA Employee: an Interview with Anne Reicherter

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Blogger: Katie Baratta

My name is Katie Baratta and I just graduated from the Regis University School of Physical Therapy. I had the opportunity to spend two weeks at the APTA doing a student internship. I was able to talk to many different members of the APTA, attend the Federal Advocacy Forum, and learn more about what the APTA has been doing to move our profession forward. I’ve written a series of essays about my experiences here at the Association.

Interview with Anne Reicherter PT, DPT, PhD, OCS, CHES

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What do you do at the APTA?

Anne was hired by the APTA last spring (2015) and works as a Senior Practice Specialist. In this position, she oversees the PTnow website, which provides practicing therapists with tools for evidence-based practice and includes access to current research and other clinical resources. A good portion of her workweek is dedicated to improving the services offered by PTnow* and working to facilitate access and utilization by APTA members.

Practice Specialists at the APTA are all licensed PTs and also work as consultants on whichever issues are current hot topics regarding our scope of practice. For example, dry needling is currently being discussed and spinal manipulation has been a historically important issue.  As one of the few PTs on staff at the APTA, Anne and her colleagues in the Practice Department review products created by the APTA marketing team or other departments prior to publication to ensure that they are accurate from a clinical and research perspective. She says she will sometimes look at a photo and say that “a PT wouldn’t perform that intervention,” or  that they “wouldn’t stand that far from the patient.” Another current project of Anne’s is a collaboration with APTA researchers on an article for the Journal of Health Policy and Administration about obesity. One of her other areas of focus is the importance of work-life balance within the profession.

How did you come to work at the APTA?

Anne graduated with a BS in Physical Therapy at University of Pittsburgh and then worked in a mixed inpatient and outpatient setting at a hospital. She describes that this was fairly common at the time, and that–with few exceptions–PTs were given a lot of autonomy from their referring providers, and that there was not yet a fee-for-service model at the HMO for which she worked. After ten years in that setting, she wanted to progress her career and knowledge, so she attended night school to obtain her Masters of Health Education. In subsequent years she held a variety of jobs in the educational setting (working for Howard University in DC and the University of Maryland, Baltimore) as well as in other clinical settings, including orthopedics and home health. During this time, she obtained her PhD in Educational Psychology, as well as her transitional DPT. She has also performed some educational consulting for various DPT programs.

The position at the APTA for a PT Practice Specialist opened up at the same time that Anne was searching for something more. She wanted a job that fit with her interests and values: the ability to participate in  writing and publishing, advancing the profession through APTA initiatives, and expanding her own knowledge made the job an excellent fit. She says that these meaningful components–including continuing education–were built into her practice as a new clinician (for example, if there was a “lunch and learn” on a given day, the clinicians would leave a bit early that day), as well as into her work as faculty. Today, however, there is an increased emphasis on productivity and fee-for-service; thus, there is limited time and resources allocated to the pursuit of continuing education that distinguish us as professionals. Anne described the difference between professionals and technicians: professionals design a plan of care and add value to the system with professional discernment, and technicians simply deliver a procedure. To maintain the high expectations set of PTs as professionals, most PTs today must spend time beyond their paid workweek to pursue continuing education, APTA involvement, and evidence-based practice.

Where do we plan to see change in the typical PT’s work-life balance?

Anne replied that one of the biggest initiatives currently is the push to change from a billing system with a procedural focus (for example, billing for “therapeutic exercises” x15 min or “therapeutic ultrasound” x15 min) to one based on value. Current reimbursement accounts merely for the delivery of a procedure or modality for a set unit of time, but it does not account for our clinical judgement as professionals. I’ll go more into this initiative in next week’s blog post.

Any advice for new clinicians starting out in their career?

Anne’s advice to new graduates is to consider whether a job or position allows for and encourages professional development: do they fund continuing education? Do they have on-site mentoring programs you can participate in? She also advises new graduates to not allow mentoring to be limited to colleagues within your particular clinical setting but to continue to seek out a supportive network of clinicians for support as you begin to navigate your professional career.

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*PTnow is a valuable resource for us, as new clinicians, to perform literature searches after graduation (as we’ll no longer have access to the school’s library search function) as well as to access clinical reviews, clinical practice guidelines, and clinical summaries prepared by respected experts within the field of physical therapy.

If you haven’t visited the website, you should definitely check it out: ptnow.org

 

Balancing a Relationship with PT School

Being married is the best. I get to do life with my best friend every day, and it was a definite perk that I didn’t have to find a roommate when coming to PT school. For those of you who are starting PT school this fall and are married or in a relationship, here are a few things to think about.

  1. If you’ve gotten this far and are still in a relationship, then your significant other is incredibly supportive of you. Don’t forget to thank him or her! He or she will be your biggest advocate and cheerleader over then next three years. Let them know how much you appreciate their sacrifices so that you can pursue your dream.
  1. Yes, school is tough, and you need to study. A LOT. But make sure that you don’t neglect your relationship. When I interviewed at Regis, my interviewer said to me, “We don’t want to break up marriages.” Your relationship will last far longer than your time in PT school. Do your best in school, but intentionally set time aside to spend with your significant other. They get lonely sitting on the couch quietly watching someone study all the time, so plan on doing fun things and going on dates. There’s a lot to do here in Colorado. Go explore!  Some of our dates have included:
    1. Road trip to Mt. Rushmore (it’s only 5.5 hours away!)IMG_51362. Horseback riding and snow hiking in Estes Park–it’s the entry town to Rocky Mountain National Park (1 hour away)IMG_5263.JPG3.  Hiking in Golden (15 minutes away)IMG_5862 4.  Musical at the Buell (10-15 minutes away)IMG_5634.JPG
  1. Remember that everyone’s relationship is different, and you have to find a balance that works for you. Some of my classmates have significant others who work 8-5 jobs and can have dinner together each night. They usually study during the week and take a day off on the weekends to play. My husband is an ER nurse and works 11:00 a.m. to 11:00 p.m., so there are many days that I leave before he wakes up and to bed before he gets home. He works many weekends, so I do lots of homework during the weekend and then take a day off of studying during the week when he has off.  That’s okay. Do what works for you. There is no one correct recipe for success in this program.
  1. Lastly, be patient with your significant other. He or she really likes to be with you, and it will be an adjustment for both of you adapt to PT school. Don’t get discouraged. You will make it!

Overall, is having a relationship hard during PT school? Absolutely. It’s one more thing to think about and invest in with an already filled schedule. However, you will never see your significant other’s support and kindness more than over the next three years. So buckle up and enjoy the ride!

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Blogger: Katie Ragle

Direct Access: Insight into Some of the Barriers and Current Initiatives

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Blogger: Katie Baratta

My name is Katie Baratta and I just graduated from the Regis University School of Physical Therapy. I had the opportunity to spend two weeks at the APTA doing a student internship. I was able to talk to many different members of the APTA, attend the Federal Advocacy Forum, and learn more about what the APTA has been doing to move our profession forward. I’ve written a series of essays about my experiences here at the Association.

I met with Wanda Evans PT, MHS, CKTP (Senior Payment Specialist) and Elise Latawiec MPH, PT (Senior Specialist, Practice Management) who provided me with their insider understanding on this topic as well as directed me toward further resources.

Direct access physical therapy care means that a patient does not require a referral from a physician or other provider prior to a PT evaluation and/or treatment. All graduating Physical Therapists are required to have a DPT–a clinical doctorate–and, thus, they receive extensive training in the ability to recognize “red flags” and refer patients to the appropriate provider when it becomes apparent that the patient may be at risk for something more severe than musculoskeletal involvement.  Studies demonstrate that direct access decreases the time following an injury to the start of the patient’s PT care, reduces the number of visits of therapy needed and results in lower overall costs. Thus, PTs are not only appropriate for this role, but they can end up saving time, money, and patient suffering (as well as costs for the healthcare system overall).

Legislation

There are currently various types of direct access in all 50 states. Each state has jurisdiction over its own Practice Act, which is why there is some discrepancy from one state to another (state-by-state comparison). There are 18 states with unrestricted direct access—this includes Colorado! Some states require specific certification for a PT to provide direct access care, and others allow only an initial evaluation plus a set number of follow-up visits before the PT must contact the patient’s primary care provider. States with limitations in their practice act for direct access are fighting every day for legislative changes to eliminate these barriers; the APTA is aware of this and is actively assisting in these state-level legislative efforts.

However, the legal foundation is only the first step to getting patients the direct access care that we know would be beneficial. Common barriers to direct access that PTs reported in an APTA survey last year include reimbursement concerns, limitations in marketing, fear of alienating referral sources, restrictions by the PT’s employer, and lack of knowledge of state direct access laws.

Reimbursement                                      

Historically, third-party payers (ie insurance companies) have required a referral from a physician or other designated professional. Aside from Medicare/Medicaid and other federal programs like the VA or Armed Services (which have their own regulations on Direct Access), insurance policies vary by carrier and on a state-to-state basis. As the state legislation changes, the payers have been slowly adapting, with some payers more progressive than others in regards to reimbursement for direct access services. The APTA has been engaging with payers directly to eliminate the referral requirement at events such as the Insurance Forum, in comment letters, during in-person meetings, and in their day-to-day contacts. The APTA communicates this message to large employers who create their own insurance policies for their employees, as well, and are thus able to help employers set the terms of the insurance contract for their employees independently.

How can individual APTA members get involved on the reimbursement front? Each state chapter has a Reimbursement Chair.  The Chair’s responsibilities include learning as much as possible about trends with different payers in that state (and taking note if a lot of PTs have been reaching out with similar issues or complaints regarding the same payer) and assisting those therapists within their own state. The APTA nationally works in conjunction with the state chapters on payment/insurance issues and helps to connect states together when confronted with similar challenges. Patients and their advocates can also petition their Insurance Commissioner if they are inappropriately denied care or access to medically necessary services. The Insurance Commissioner advocates for consumers; s/he does not represent the insurance carrier.

Fear of alienating referral sources

Wanda and Elise described several studies in which direct access evidenced no negative impact on the physician-patient relationship. In fact, a key component of direct access is the necessity of PTs to refer patients to the appropriate provider when a patient’s symptoms and underlying pathologies are outside of our scope of practice. Given that PTs must make referrals back to other providers, it becomes a mutually beneficial relationship amongst different healthcare practitioners.

Education

A lot of concern stems from a a lack of education on the part of employers, insurers and potential patients. PTs need to demonstrate their clinical excellence to, essentially, prove that we are worthy of this responsibility, as well as to continue to educate all stakeholders on the importance and benefit of getting PT before medication/surgery. The first step for every PT is to become educated on what your state’s practice act specifically says about direct access and understand any limitations that may be in effect.  Educating patients, employers, and other healthcare practitioners is the next step. The APTA has developed many resources detailing the benefits and safety of direct access available online (more info).

Resistance to Change or Pushing for Progress?

There are some PTs who are more comfortable in the traditional referral arrangement than with unrestricted direct access. They may not want the additional responsibility, or they may simply prefer to do what they have always done.  That is okay!  Nobody is looking to force them to become direct access providers.

However, if you are one of the PTs who cares about the transition toward direct access and autonomy as a practitioner, make sure you’re an active member of the APTA! This is essential to better educate yourself, your patients, and other healthcare providers and to develop a strong voice with your state chapter and insurance agencies.

For more information on the current APTA involvement, as well as additional resources, check out its Direct Access page.

Class of 2017 DPT Student Lindsay Mayors Reflects on Her Clinical Rotation

Name:  Lindsay Mayors

Hometown: Akron, Ohio

Undergrad: University of Dayton

Fun Fact: My first experience skiing was on my third birthday in Keystone, Colorado!

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Today, the Class of 2017 has reached the halfway point of their 8-week second clinical rotation. The past two semesters have been filled with management courses, case studies, exams, practicals, and research. In April, we completed all three management course series; needless to say we were ready to get out into the clinic! Students are working in a variety of settings including acute care hospitals, inpatient neurological rehab, sub-acute rehab, long-term acute care, home health, outpatient orthopedic, outpatient pediatric, and school-based therapy from Virginia all the way to Alaska. We are applying our freshly developed clinical reasoning skills and continuing to learn immensely from our clinical instructors.

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Lindsay and her first year mentor, Vickie

Many of my classmates will tell you that I am one of the “peds people.” I started the program in August 2014 with my mind set on becoming a pediatric physical therapist. I would be nearly skipping in the hallways on the way to pediatric-based labs or lectures. So, when it came time for me to start my second clinical rotation at a skilled nursing sub-acute rehabilitation facility, I did not know what to expect. It seems to be a common theme among students to not prefer to work with the geriatric population. I know that I even had my doubts. Would I know how to relate to the elderly population? Would my 5’2 stature have the body mechanics to help patients transfer in and out of chairs or their hospital beds? Would I get bored doing seemingly the same exercises with patients day after day? Will this type of rotation be helpful for me if it is not the setting in which I ultimately would like to work?

Within just two days of the clinical rotation I had my answers. I am overjoyed when I get to connect with the elderly population. I remembered and have safely applied the transferring tips from a faculty member with my similar stature (Thanks, Christina!). The exercises that I perform with patients are all but monotonous. I have had the opportunity to apply skills from all three of the management course series with patients. Sure, many of the patients have similar physical therapy diagnoses, but beyond the diagnosis each is incredibly unique.

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Liz, Lindsay and Carol at the Class of 2016’s research night in April

Each has their own personal story, their own medical history, their own family dynamic, their own goals, and their own hobbies. Not one personality resembles another. This is what makes this setting so exciting for me. Learning about what has molded a particular patient into the individual that they are now is the highlight of my day. Shaping treatment plans to match a patient’s personal goals and find the highest level of independence for them allows me to use my creativity in a new way with every patient. We walk (a lot), stand on foamy surfaces and toss balloons, and maneuver wheel chairs around obstacle courses. We talk about the joys, challenges, and hilarities of life. I have recognized that the age of a patient–whether 3 or 93 years young–is not a barrier. We are all human. We enjoy being heard, feeling validated, feeling empowered, and having our days be brightened by a smile.

So, I would like to challenge any student who has similar doubts as I did a mere month ago to take a step into the unknown. Unravel your pre-set plans and experience something on the extreme opposite spectrum from the setting in which you think you want to work. Sure–I am still interested in being a pediatric physical therapist, but at the very least, my mind has been opened to new considerations. No matter the population I ultimately end up working with, I now have a broader understanding, appreciation, and passion for the field of physical therapy because of this rotation.

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Lindsay and her classmates are currently all at clinical rotations across the country

Federal Advocacy Forum: Regis DPT Student Katie Baratta Visits The Hill

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The APTA Federal Advocacy Forum is a national conference for APTA members across the country to convene in DC.   Its purpose? To educate members of Congress on the role of physical therapy in our communities, with the specific goal of gaining their support for the various legislative initiatives* that are currently being debated in Congress.

A part of my experience during my two-week APTA internship through the Regis University DPT program included the opportunity to attend the Forum. We started out listening to several guest speakers in preparation for our visits on Capitol Hill with the senators and representatives. Brad Fitch from the Congressional Management Foundation (CMF) presented some of the results of a survey about what types of factors impact their decision-making process.  Constituents are the citizens that a member of Congress represents, and that includes both providers and their patients. So, it is important for them to know what matters to us! Ideas for getting in touch with them are listed below.

Robert Blizzard, a partner at Public Opinion Strategies, discussed the current political climate–including different scenarios for the presidential race and the outcomes’ implications. We also had the chance to listen to Senator Richard Burr from North Carolina speak. He has been a friend to PT initiatives for a long time. One of the things that has been most refreshing to me to see is that members of Congress really do care about the same issues we care about. Members on one side of the political spectrum may believe in different ways of solving those issues from their colleagues on the other side, but despite that, there is a lot of bipartisan support for the issues we care about. There were also break-out sessions that went into greater depth on key issues facing the profession from a legislative prospective.

On the third day, we embarked with fellow APTA members from Colorado to meet with staff from the offices of our senators and representatives to discuss current legislation. We thanked the members of Congress for their support on legislation they had already co-signed, and we asked for their support on further issues. The Colorado APTA members met with the offices of Colorado’s two Senators: Cory Gardner and Michael Bennet, and also the representatives from different districts. Diana DeGette is the representative from my district, but our group also had the opportunity to meet with representatives from many other CO districts, as well.

I’ll admit it–I was nervous, at first, to speak up in those meetings. It turns out, though, that the staff members are friendly and interested in what we have to say–even as students. It was reassuring to go as a group so that we could chime in and support one other. I felt more and more confident the more I did it! My advice to any PT or student interested in meeting with their elected official would be to review the facts of what you are going to say (and write down information you might not remember easily) so that you don’t have to waste time and energy trying to recall or look up information. Each meeting lasted approximately 10-15 minutes, and it’s surprising how quickly that time goes. Relax, be yourself, and know that nobody is going to bite your head off.   🙂

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What can I, as a student or clinician, do to support advocacy at the government level?

As a citizen in this country it is your right–and, arguably, your responsibility–to petition your lawmakers directly to share the personal impact that different legislation would have on you as a current (or future) provider on your patients’ day-to-day life. Start by downloading the APTA advocacy app which will let you know who your elected officials are and which legislative issues are currently relevant to your district/state. In terms of getting in touch with lawmakers, Brad Fitch shared with us some of the ways that we can connect with Congress on issues pertinent to the PT field:

  • write emails
  • make phone calls
  • attend town hall meetings
  • make an appointment to visit their local office in person with other PTs or on your own
  • follow your legislator on social media and respond to what they post

The more people to reach out, the more impact we can have.

If you are interested in getting more involved in the political and legislative process or have additional questions, feel free to reach out to me at kbaratta@regis.edu! 

*Key issues currently include:

  • Therapy Cap: Medicare Access to Rehabilitation Services Act (currently max out at $1940 for speech and PT combined) HR 775 / S 539  more info
  • PT Workforce Bill: Physical Therapist Workforce and Patient Access (includes PTs in loan forgiveness program for healthcare providers in underserved areas) HR 2342 / S 1426 more info
  • Locum Tenens: Prevent Interruptions in Physical Therapy Act (for Medicare providers to get short-term coverage for their patients when they must take a temporary leave of absence) HR 556/S 313  more info
  • Safe Play: Supporting Athletes, Families, and Educators to Protect the Lives of Athletic Youth Act / SAFE PLAY Act (include PTs in the discussion for developing standardized concussion management guidelines) HR 4829 / S 436 more info
  • Rehabilitation Research: Enhancing the Stature and Visibility of Medical Rehabilitation Research at the NICH Act (streamlines rehabilitation research, improves coordination between different organizations) HR1631 / S 800
  • PTs Travelling with Sports Teams: Sports Medicine Licensure Clarity Act (include PTs along with ATs and physicians in the existing legislation extending the state license of sports medicine providers who travel with a sports team across state lines to treat a traveling team) HR 921 / S 689
  • Self-Referral: Promoting Integrity in Medicare Act (proposes removing PT as an exception to the Stark Law, ie prevents Physicians from referring Medicare patients to entities in which they have a financial interest – eg a physician-owned PT service) HR 2914
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Blogger: Katie Baratta

My name is Katie Baratta and I just graduated from Regis University School of Physical Therapy. I had the opportunity to spend two weeks at the APTA doing a student internship. I was able to talk to many different members of the APTA, attend the Federal Advocacy Forum, and learn more about what the APTA has been doing to move our profession forward. Check in next Tuesday for more!

Crash Course: How to Dress for PT School

The dreaded dress code! Our student handbook says:

As future health care professionals, graduate students in physical therapy are expected to dress in a manner that exemplifies professionalism during class, during on campus activities, and in clinical situations.

As scary as that sounds, it’s really not so bad. There is no need to run out and buy all new clothes! (Unless you only wear yoga pants and track suits. I mean–respect for that, but gotta keep if profesh now). There are tons of ways to make clothing you already have work.

Let’s go over some of the big things:

  • Plain t-shirts are definitely okay. Shirts with logos or writing are not (unless it is the Regis PT logo!).
  • There will be a Regis PT clothing order in the fall! The bookstore only has one thing that says “physical therapy” on it, so don’t worry about buying that–wait for the clothing order!  Items purchased from the clothing order can be worn to class.
  • Buying a lot of basics that you can mix and match is a really good idea. If you have a few pairs of good pants, a variety of colored tops, and good shoes, you can make dozens of outfits. Scarves and jewelry can always be used to accessorize and liven things up.
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Basic Ts, pants and skirts are all recommended!

  • Shoes must have backstraps! Things like Chacos or Tevas are fine, but they need to have a backstrap.
  • Invest in some quality shoes. Sneakers are allowed in the dress code, and you are going to be wearing them a lot. Find some that give you good support, but can also look okay with your class clothes.
  • The main lecture hall—you’ll come to know and love it intimately—can go from freezing to a sauna within 15 minutes. Having layers to put on or take off is always a good idea.
  • You’ll notice that the dress code mentions things like facial piercings, odd hair colors, and tattoos. While I wouldn’t recommend getting 7 facial piercings and 4 new tattoos, this isn’t something to worry about! Many members of the current student body have tattoos and facial piercings; that being said, keep this in mind when finding clothing for class.  It’s okay to have them showing in lab, but try your hardest to keep them covered for lecture.
  • Lab clothes are generally exercise clothes. If you only have one pair of running shorts/leggings, this might be the time to get a couple more. You will wear these clothes a lot!  You are expected to bring your lab and professional clothes to switch between classes, but you all will have lockers if you want to keep clothes on campus.

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    Here’s the Class of 2018 intramural soccer team modeling some great lab clothing examples!

  • For anatomy lab, most people wore scrubs or sweats. Whatever you wear, do not plan on wearing it ever again. The scent of the lab will never leave.

What it really comes down to is this: how do you want to present yourself to your classmates and professors? If khakis, sneakers, and a solid color t-shirt are your comfort zone, awesome! If it’s a skirt and blouse, great! If there’s a collar, lovely! Don’t put too much pressure on yourself to change your entire style. Wait and see what you find yourself wearing to class and what you find comfortable, and do your shopping after school has started.

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Carol, Nolan, and Courtney showing off their professional attire

Keep in mind that this is the clothing you’ll be using when on clinical rotations and at conferences—think about what will make you be the most comfortable and professional clinician possible.

Finally, my classmate, Cameron, wants you all to know that Crocs do count.

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Maroon pants aren’t required, but are strongly encouraged for photo ops like this.

If you have any questions, feel free to email me at msutton001@regis.edu!

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Blogger: Madeleine Sutton

 

APTA Tuesday: Interview with a Lobbyist

Learn more about the APTA and lobbying! Katie interviewed Michael Hurlbut, a lobbyist for the APTA.

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Michael Hurlbut, Senior Congressional Affairs Specialist

Michael’s Background

Michael Hurlbut worked for several years on Capital Hill before he came to us at the American Physical Therapy Association in 2009 as a full-time Congressional Affairs Specialist. He previously worked as a staff assistant/systems administrator for Representative Jerrold Nadler (New York’s 10th district which comprises NYC); he then worked for Representative Robert Ernest  Andrews (for New Jersey’s 1st district, including Camden, NJ) and as a legislative assistant and for Representative Louise Slaughter (New York’s 25th district). Michael has a background in sports medicine and was interested in healthcare and policy. So, when the job opened at the APTA, he felt it was a good fit for his interests and strengths.

Michael was kind enough to explain to me some of the logistics of what goes on in Washington and what it looks like on the ground. I appreciated this perspective; as a PT, this whole world is pretty foreign to me!

Some Definitions

Each congressman or congresswoman has a chief of staff and multiple staff members who listen to issues presented by either individual constituents or lobbyists that represent groups of citizens.  For example, the APTA would count as a group of constituents with similar interests. The staff team then updates their member of Congress on important issues and perspectives.

What does a lobbyist do?

The APTA currently employs three lobbyists, each of whom focuses on different issues within the field of physical therapy. Michael’s areas of specialty include post-acute care, self-referral, workers comp, and Veterans Affairs/armed services. He monitors everything relating to those issues–including bills that are being proposed, progress on relevant ongoing legislative actions, and upcoming meetings which will be held on issues pertaining to his areas of specialty (for example, the congressional committee on Veterans Affairs). In his day-to-day work, he performs research to better understand the issues, he finds data surrounding each of them, he attends hearings and talks to constituents, and he matches up each issue with the correct APTA staff member.

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Once he has all of his information, he prepares the APTA’s position on the topic. This could include creating a few talking points to be included in a conversation, or it could include a formal “Statement for the Record:” this is considered the formal stance of the APTA and must be approved by the APTA’s Executive Vice President for Public Affairs. He will set up meetings with members of the committee or other members of Congress to discuss the relevant issues.

Change in Legislation and Policy

Legislation can start in these committees and proceed out into the House or the Senate for a general vote if approved; legislation can also be proposed by the House or Senate Majority leader. Legislation with broad/bipartisan support in a committee may have a higher chance of being approved by Congress in general, but sometimes this is not the case.

Whether the bill starts in a committee or is proposed by the Majority Leader, Michael emphasizes that it is important to identify members of Congress who will be sympathetic to the issues that the APTA cares about. He notes that getting any bill through Congress is a slow process and it may take several congressional cycles to see any change. It is important to provide data, a convincing argument, and show a “grassroots” initiative–which, for us as PTs, would include individual practitioners and patients contacting our representatives and senators.  Change is typically incremental; as PTs, we can relate to that!  We are accustomed to slow, additive changes with a lot of our patients: even as patients make limited progress (or even have setbacks), we have to keep the bigger picture in mind and continue to work towards change.

Michael also points out that it is essential to recognize when it may be better to work directly with an agency (such as CMS for some of the Medicare/Medicaid issues).

How can we support legislative changes impacting our profession and our patients?

In addition to direct involvement with lawmakers (check in next week to read more about that!), we can support changes in legislation through continued APTA support with both membership dues and with donations to the PT-PAC (Physical Therapy Political Action Committee).katiepic3

PT-PAC pays for one of the Congressional Affairs Specialists (Michael or one of the other lobbyists) to attend the fundraising events for the re-election of members of Congress who have supported our initiatives in the past. Attending events is one of the most important ways to forge stronger contacts with members of Congress and their staff,  and it also increases interaction with other lobbyists who may support similar issues. APTA does not allocate PAC funds to individual candidates in hopes that they will support relevant issues. APTA member dues pay Michael’s and the other Congressional Affairs Specialists’ salaries, but the dues are not used for the PAC. So, when you pay your dues online to APTA, there’s a separate line item that asks you if you would like to donate to the PT-PAC.

The PT-PAC is among the top 10 political action committees of national health care organizations. If every APTA member donated $20, it would be the #1 healthcare PAC–that’s even bigger than the orthopedic surgeons’ organization!

If you are interested in further information or would like to donate to PT-PAC, click here.

Blogger: Katie Baratta

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My name is Katie Baratta, and I just graduated from Regis University’s School of Physical Therapy. I had the opportunity to spend two weeks at the APTA doing a student internship. I was able to talk to many different members of the APTA, attend the Federal Advocacy Forum, and learn so much about what the APTA has been doing to move our profession forward. I’ve written a series of posts about my experiences here at the Association.

Check in next Tuesday to learn more!

Commuting to Class: Meet Leigh Dugan

Name: Leigh Dugan

Hometown: Boston, Massachusetts

Undergrad: University of Massachusetts Amherst

Fun Fact: My husband is in the military and we have moved 4 times in 2 years!!

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Hi, Class of 2019! Congratulations on your acceptance to the Regis DPT program; you will not regret your decision to come here. So, now that you have made the choice to make Denver, CO your home, the next step is deciding where to live. Most of you will live close by, so getting to school will not be a problem. However, there may be a few of you that do not have the luxury to live that close for whatever reason. This was the situation that I found myself in a year ago when I decided to go to Regis in the fall. My family could not relocate to Denver and I made the decision to commute from Colorado Springs each day—a 140-mile roundtrip journey on each side of an 8-5pm class day.

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Leigh, Taylor and Amanada enjoying some time off of school

I decided to write this blog post because I wish that I had been able to talk to someone to tell me that yes, it is possible and yes, it will be tough. If this is something you are trying to figure out before beginning PT school in August, here are a few tips that I would love to share with you to hopefully make your decision easier:

  1. The commute IS indeed possible and was actually quite relaxing after a long school day.
  2. Take the time during your drive to decompress. Sometimes, I would sit in absolute silence and take the time to relax and reflect on the day. It is a good excuse to truly do nothing.
  3. Be prepared to not have much of a life. When you drive for 3 hours each day, most of your free time is devoted to studying. I wish I could say that there wasn’t much work outside of school in the first year, but that is not the case. Be prepared to spend a few hours after class each day doing school work or studying.
  4. To add to the above comment, you have to really make an effort to balance fun times and studying in your free time. This is so important for anyone in PT school to ensure that you keep your sanity!
  5. Group projects can be tough to coordinate, but all of my classmates took into consideration my commute and it worked out fine.
  6. Find a good podcast that is “mindless.” After a long day of learning, you will want something that is entertaining but isn’t taxing on your mind.
  7. Waze, the traffic app, will be your best friend.
  8. You will figure out the best times to leave your house in order to dodge traffic. I really learned to take advantage of the extra time I had at school before and after class to get work done so I wouldn’t have to do it at home.
  9. It is tough to miss out on all of the fun activities after class. A lot of times, my classmates would go out to concerts or for drinks on weekends and it would be hard to miss these moments. Make an effort to still engage with your class! I never regretted spending the night on a couch so I could join in on the fun :).
  10. Do not be afraid to ask for help from your classmates. You will find that everyone in your class is on the same team and they truly want to help. I would not have survived without them!
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Brunch after second semester finals

Feel free to email me if you have any specific questions on commuting or any questions at all about Regis! Congratulations again on your acceptance to Regis!

Blogger: Leigh Dugan, ldugan@regis.edu

APTA Tuesday: Meet Katie Baratta

Meet Katie Baratta, new Regis DPT graduate! Katie participated in an American Physical Therapy Association internship in Washington, D.C. during her final year at Regis.  Check in every Tuesday this summer to hear about her experience and to learn more about the legislation and politics behind all things physical therapy.

Name: Katherine “Katie” Baratta

Undergrad: Rensselaer Polytechnic Institute

Hometown: Boston/Belmont, MA

Fun Fact: I worked for 5 years as a transportation engineering consultant and am the second of six kids!

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Where did you do your last two clinicals?

CE III at St Joseph’s hospital in Denver, acute care, ICU, cardiac care, and CF floors.

CE IV at Denver VA primarily outpatient ortho with emphasis on manual therapy

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How did you get interested in advocacy and how has Regis furthered your interests?

I applied for the APTA internship for two reasons: one relating to learning to better serve patients I will serve as a Doctor of Physical Therapy, and the second pertaining to learning more about the role of Physical Therapy as a profession in the state in which I will practice.

In regards to my future patients, I foresee myself working a significant percentage of my caseload with patients who have considerable needs, vulnerabilities, and/or economic disadvantages—that is what motivates me to put 100% effort into what I’m doing. I know I’ll do everything within my power to provide the best care I possibly can for these patients. However, I also know that there are greater systemic forces at play which can limit any effort I make as an individual practitioner. In order to address these larger issues, I have a duty to advocate as a healthcare professional. Prior to the APTA internship, I didn’t possess a solid understanding of the ways the APTA, as an organization, interfaces with the government and how the political process can be a tool for large-scale change in the healthcare arena. This internship allowed me to observe and participate in this process. It gave me a more nuanced understanding of politics: I now both understand politics in terms of government and politics in terms of group and power dynamics and how these social factors relate to getting things accomplished. So now, as a new graduate, I can bring this understanding back to my individual patients as I push for large-scale changes in the realm of availability of care, funding, and specific physical therapy services.

The second reason I was interested in this internship had to do with the role of the APTA in Massachusetts. According to the APTA state rankings, my home state (and where I eventually see myself practicing) ranked last in APTA involvement in 2014. This is an area of opportunity for the profession. Massachusetts (and Boston) is a leader in many aspects of healthcare. I saw the APTA internship as preparation for increasing the presence of the APTA and the profession of physical therapy in Massachusetts.

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Where are you heading with your career?

My path thus far in life has been winding and full of surprises, and I am sure my future will be as well!

I tremendously enjoyed my work during CE IV at the VA. I found a group of people I connected well with—both the patient population and the rehab team, overall. It was my first true manual/outpatient rotation. By the end of it, I really felt I was starting to get the hang of how to integrate manual skills with tailored exercise prescription for a patient’s short- and long-term function.

I find the role of the nervous system in pain—particularly persistent pain—to be fascinating, and I think that it’s an area that we as DPTs can serve, push the envelope, and dig deeper into understanding.  I see the solution to be very intertwined with integrating exercise, mental and emotional health, and our toolbox of manual skills.

Beyond the practice setting, I envision myself tying in some of the skills I developed in my prior career. I have an extensive background in data analysis, grant writing, and drafting reports on alternatives analysis; essentially, I have experience in demonstrating the “value” of something to decision-makers (including those who provide funding).

One of PT’s biggest issues is lack of PR. Nobody understands or sees our value. Word of mouth is clearly some of the greatest PR, particularly when attracting new patients to an outpatient clinic. But, when there are larger factors at play beyond an individual patient’s choice—when it comes down to hospital policy or insurance policy—we need to speak in the language that those controlling funding allocation understand: numbers (particularly numbers with dollar signs in front of them!).

So, I see utilizing the skills I’ve developed in my past career into my current practice and will be able to demonstrate the value of physical therapy for both patient outcomes and overall costs. There’s a tremendous need for widespread change to healthcare and to PT access and I am excited to be a part of that change!

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Tune in next week to read Katie’s take on direct access barriers and initiatives to direct access.

Global Health Immersion: Students in Peru

In preparing my capstone presentation and reflecting on the last three years in physical therapy school at Regis, I began to see a theme linking all of my most rich experiences from which I learned the most: discomfort. From patient labs and practical exams to clinicals to presentations to service learning, we are constantly thrown into situations where we do not know exactly what to expect, are not sure of our abilities, and have to be willing to be flexible and a little bit vulnerable. These are the times we grow and learn the most. The global health immersion to Peru this spring was no different, and it even amplified those familiar feelings of unease. But I have found that those times of the unknown, unexpected, and unsure are the times when the most growth occurs. I feel fortunate to have had the opportunity to participate in the global health program at Regis, to learn from the people of Peru, to challenge myself to practice with cultural sensitivity, and to gain a better understanding of a culture different from my own.

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Third year students Allie Smith, Elena Absalon, and I traveled with Dr. Heidi Eigsti to Peru where we spent three weeks working with therapists and patients in the city of Huancayo. We spent much of our time with the Catholic Medical Mission Board (CMMB), which is a Non-Governmental Organization that serves primarily women and children.

CMMB has two programs in Huancayo. The first is CHAMPS, which focuses on promoting health, hygiene, nutrition, prenatal care, and access to health care providers. The second, with which we worked, is Rehabilitación Basado en Comunidad (RBC), or Community Based Rehabilitation. The program focuses on serving children with disabilities and their families in the most impoverished neighborhoods in Huancayo, Chilca, and Azapampa. Two physical therapists, Carmen and Loreley, and one psychologist, Lucia, care for 40 children and their families with both home and clinic-based treatment. The goal of the program, in keeping with the World Health Organization’s initiative to improve accessibility for people with disabilities around the globe, is to provide community-based rehab that is relationship focused and incorporates functional activities into everyday routines to improve patients’ participation in their homes and communities.

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The impact that RBC was having on the community in Huancayo was evident. The families with whom we worked were well educated on goals of therapy, extremely involved in home exercise programs, and motivated to do whatever they could to help their child improve. The therapists focused on all aspects of the child’s well-being and had developed strong relationships with them and their families. The Jesuit value of cura personalis was definitely at work, incorporating mind, body and spirit into care. The therapists put together events to connect the families, and they were working to develop of community of support. It was a valuable learning experience to see such a team-based, holistic approach being implemented in an underserved community. CMMB is definitely working to create a sustainable solution to removing the barriers to health and participation faced by the women and children of Chilca and Azapampa. That sustainability is imperative in making a lasting difference in the area, and I am excited for future Regis students to have the opportunity to continue to develop this new relationship with CMMB.

I should mention the whole immersion wasn’t all work. We went on an artisan tour in the mountains surrounding Huancayo where we learned about gourd painting, silver jewelry crafting, and textile production. We hiked to the glacier on Huaytapallana mountain at around 16,000 feet and completed a three-day trek to Machu Picchu City. These experiences introduced us to more of the beautiful landscape and culture of the country, and we were welcomed everywhere we went by warm people of Peru.
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Blogger: Abby Burger, Class of 2016

 

 

What is a Regis DPT service learning project?

Every semester, Regis DPT students participate in a service learning project that gives us the opportunity to work out in the community. Our first semester project didn’t happen due to some pesky snow; this semester, though, we had many options to get involved with different disabled populations. Others in my class spent time at weekend retreat camps for children with motor and mental disabilities, skiing with those with mobility impairments, and bowling with people with Down syndrome. As a former ballet dancer, I was attracted to the dance program that was listed in our options.

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Some students spent some days up at Keystone and helped people with disabilities ski!

Spoke N’ Motion is a fully integrated dance company. When I say fully integrated, I really mean it! During my time with the company, I have met many members who have vision, hearing, and mobility impairments along with other members who have autism, Down syndrome, or lesser detectable disabilities. I remember walking into the rehearsal the first day—I had absolutely no idea how it was going to work. How do you get a group with such different levels to dance together? Honestly, I expected the rehearsal to be messy and difficult.

It was the opposite of that. An individual with visual impairments stood to the side and watched a few times before joining. Those in wheelchairs used their arms to mimic the leg movements. The younger kids kept up with the adults. I was amazed and so honored that I was getting to experience a little slice of it. The company performs regularly! I entered with a narrow mind about what I would be experiencing, but they opened me up to so many new ideas.

My project only required a handful of hours, yet I have found myself going back every week. I’m no longer a person who is dancing with Spoke N’ Motion as a project for school;  I’m a member of the company. I have fun dancing with everyone there. They have a performance coming up next month, and I’m even dancing in the show.

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Our company practicing! Pic: Carl Payne

The atmosphere of the company is of overwhelming joy. One member posts in the private Facebook group every Friday before rehearsals about how excited she is to see everyone the next day. For many there, this company is a place where their varying abilities are highlighted as a good thing. We push the boundaries of what I thought was ‘okay.’ Who would have thought it was okay to stand on the back of a wheelchair to do spins?

Service learning is an amazing opportunity to get out of our ‘school brains.’ We get to work with real people and see how concepts from class can be applied. Being open to new and uncomfortable situations is an important part of our education. I, for one, am glad I go to a university that encourages service learning!

And, if you happen to be around Denver next month: come see us dance! Performances are May 14 and 15th. Look here for tickets: http://www.spokenmotiondance.org/performances.html

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Blogger: Madeleine Sutton

Time and Life Management in a DPT program: Meet Amy Medlock

 

Name: Amy Medlock, Class of 2017

Hometown: Grand Rapids, MI

Undergrad: University of Notre Dame

Fun Fact: My right thumb is 1 cm shorter than the left

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Finals week.  What a great time to be writing this post on time & life management.  PT school is demanding and can often feel overwhelming, but it does not have to take over your entire life. In addition to the responsibilities of school I am married, have two kids (Emma & Lyla), and I have to commute over one hour each day.  I have a secret though: since the end of my 2nd semester, I have not studied after 5pm or on weekends and my GPA is doing as well as ever. Shhh…Don’t tell our faculty!

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My family – Matt, Emma (7) and Lyla (4)

It is definitely not easy getting through a DPT program with extra responsibilities, but with the right discipline and support it is entirely possible. Since starting PT school there are a few tricks and tactics I have learned that may seem simple but have made it possible for me to keep my nights and weekends free for my family.

  1. Give yourself set hours – I arrive at school every day at 7am whether we start class at 8am or 1pm, and I leave everyday between 4:00p and 5:00p even if we get done with class earlier.
  2. Pay attention in class – This may seem obvious, but some people don’t do it.  If you look at people’s computers during lecture you’ll see people checking Facebook, playing Bubble Spinner or reading the news. To avoid becoming distracted by the ever present lure of Facebook or browsing the news, I sit in the front row to help keep my attention focused on taking notes. Class is valuable time that significantly reduces the amount of additional studying.
  3. Schedule everything – I start every week by scheduling out every day from when I am going to exercise, complete upcoming assignments, to when I can meet up with friends.  This keeps me accountable to my goals and keeps me from feeling like I have things hanging over my head or that I am forgetting something.
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A typical week in my life (minus my kids’ and husband’s events)

  1. Study when you study – Again, this might seem obvious, but it is really easy to get distracted by conversations, Facebook, Snapchat, etc. while studying. I have become very selective in the locations I will study and the people I will study with in order to maximize my study time.  I have also found people who are willing to drive down to the ‘burbs where I live on days when the demands of being a mom require that I stay closer to home (Thanks, Tane Owens!).
  2. Exercise & get outside – This helps me so much with feeling healthy, maintaining my energy and focusing while studying.  We are PTs, I don’t need to give all the reasons why this is a must! Being productive and efficient with my studies enables me to still live an active lifestyle.

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    Some of my activities outside of PT school

 

  1. Leave school at school – I understand that it is difficult for those that live with classmates but I avoid doing school work at home. I do my best to be present to my husband and kids whenever I am at home.  I am not saying that I am perfect at this, but I really do try.
  2. Stay involved – I have found ways to stay involved and active in both our academic program as well as our profession as a whole. Adding extra responsibilities and events further forces me to organize my time and priorities. I do not have time to procrastinate; therefore, I do not.
  3. Develop a support network – I feel so blessed to have a supportive and understanding husband who stays home with our kids when they are sick, makes dinner when I get stuck in traffic, and pushes me to be the best wife, mom and student that I can possibly be.  I also have amazing mom-friends who have my back when childcare falls through or when I need a glass of wine and movie night.

I have had to develop these strategies and practices out of necessity due to my responsibilities and commitments outside of PT school. But, we all have responsibilities and commitments outside of the classroom. I hope some of these pointers can help you to stay focused and stress-free(ish!) as you go through this vigorous program.

 

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Service and advocacy with my classmates and colleagues