Dry Needling…Not a Type of Craft that Your Grandmother Does

Name: Katherine Koch

Undergrad: The Ohio State University

Hometown: Cleveland, OH

Fun Fact: Last summer, I climbed six 14ers

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Dry needlingnot a type of craft that your grandmother does. This type of treatment uses thin filiform needles inserted by a physical therapist into myofascial trigger points, or a tight band of muscle that might be causing pain (1). Dry needling is based on physiological evidence supported by research that is usually part of a broader treatment plan (2). If this needling sounds familiar to you, you’re not alone. Acupuncturists use the same type of needle to adjust the flow of energy, or chi, throughout meridians in the body. Acupuncture is an ancient Chinese medicine and operates based on the belief that these thin needles can relieve tension, stress, and pain when inserted by an acupuncturist (3). While you won’t be getting an itchy sweater from this treatment, it can lead to pain relief for many people. 

However, there is still confusion and debate among physical therapists and acupuncturists concerning the rights and responsibilities of physical therapists in performing dry needling on their patients. This debate of dry needling by physical therapists was recently taken to a Denver district court when the Acupuncture Association of Colorado (AAC) challenged the Colorado State Physical Therapy Board (Board). The AAC claimed that physical therapists had not undergone enough training to perform dry needling and requested the Board reverse the rule that allows physical therapists to practice this method of treatment. The AAC argued that physical therapists only perform 46 hours of training to be certified to practice dry needling, while acupuncturists train for almost 2,000 hours. The association claimed this made dry needling by physical therapists an “unsafe practice of acupuncture” (4). However, this statement is strongly misleading due to the additional 3,400 hours of doctorate level schooling that physical therapists already have behind them before they complete those 46 hours specific to dry needling training. Physical therapists spend three years in graduate school learning how the human body works, what can go wrong with it, and how to fix it within the realm of physical therapy. Additionally, doctors of physical therapy are required to take continuing education courses throughout their careers.

Additionally, the AAC made the claim that dry needling is just a misnomer for acupuncture, while the two are fundamentally different practices. They may look similar to the untrained recipient, but physical therapists and acupuncturists perform their respective treatments with fundamental ideological differences between the two. This is not to say that one is better than the other, and patients may make the informed autonomous decision to receive either or both treatments. However, as the Denver District Court decided, there is no need to prevent members of one profession from performing treatments all together. In December 2017, the court recognized that physical therapists are acting within the Colorado Physical Therapy Practice Act when they perform dry needling.

As the Colorado Chapter of the APTA President Cameron MacDonald put so eloquently,

“this legal debate was brought forth by those who wished to restrict the practice of another profession from their own. This debate could have been about any intervention utilized by physical therapists, and not just dry needling. It is imperative to consider this legal challenge and the lawsuits brought against the Colorado PT Board through the lens of the Colorado consumer of healthcare. Consumers in Colorado are provided access to health care providers which have a defined scope of practice under which to deliver patient care. Health care professionals are expected to provide the best care they can, and to practice under a scope flexible enough to both protect the consumer and not limit the development of practice by health care providers.”

When physical therapists perform dry needling, they are practicing within their professional scope. When acupuncturists perform acupuncture, they are practicing within their professional scope. Both professions can live harmoniously alongside each other while helping patients within their respective realms.

Why does any of this matter? First, any judicial ruling or legislative rule concerning a profession as a whole likely has implications that affect many of its members. In this case, physical therapists that perform dry needling in Colorado were in danger of losing their legal right to treat patients in this way. Further, patients were in danger of losing out on a treatment that can benefit them. To be effective health care providers, it is imperative that physical therapists are informed practitioners in order to best advocate for their profession and best treat their patients. Denying to inform themselves and take positive action does a disservice to future physical therapists and patients who will benefit from the work done to advance the profession today. In order to practice as autonomous providers, physical therapists must continue to advocate for their profession and understand the issues surrounding it. It also stands to reason that since the American Physical Therapy Association participated in this case as an amicus party and presented information that no doubt helped sway the case, physical therapists should support and be members of the organization that advocates for them on this broad level.

This debate is not in Colorado alone; lawsuits in three states have gone the opposite way and the state boards have been forced to remove dry needling provisions from their practice acts.4 Since each state has their own physical therapy act, it is important that the Colorado practice act, which will be revised next year, continues to maintain its inclusive language that provides “for new developments in physical therapy practice, which includes dry needling” (Caplan and Earnest, LLC, personal communication, January 9, 2018). For the good of physical therapists, patients, and the future of physical therapy as a profession, this particular case is closed.


If you are a student physical therapist, like myself, who hopes to perform dry needling as a professional one day or if you simply would like to learn more about its practice, please refer to the references below.

  1. Dry Needling by a Physical Therapist: What You Should Know. American Physical Therapy Association. http://www.moveforwardpt.com/Resources/Detail/dry-needling-by-physical-therapist-what-you-should. Published December 25, 2017. Accessed January 28, 2018.
  2. Gattie E, Cleland JA, Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017;:1-41.
  3. Miller J. Physio Works – Physiotherapy Brisbane. Acupuncture and Dry Needling. https://physioworks.com.au/treatments-1/acupuncture-and-dry-needling. Accessed January 28, 2018.
  4. Migoya D. Acupuncturists sue Colorado’s physical therapy board over the very definition of their craft. The Denver Post. https://www.denverpost.com/2017/04/05/acupuncturists-sue-board/. Published April 7, 2017. Accessed January 28, 2018.

So You’re Interviewing for PT School (and more specifically for REGIS!)…

Name: Erin Lemberger

Undergrad: University of Northern Colorado

Hometown: Littleton, CO

Fun Fact: I sing the national anthem at sporting events!

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It’s almost that time…interviews! I can’t wait to meet this year’s prospective students, and I know everyone else in our Regis DPT community is excited as well.

Those in the midst of or about to interview, I know this is a stressful and exciting time. Just a year ago, I remember the butterflies I was feeling, along with anxiety and anticipation. To start, take a deep breath, trust yourself, and know that this is the fun part. This is the time to find the program that is the right fit for you. You’ve worked hard preparing for this, so remember to take the time to enjoy it too. The more relaxed you are, the more you will be the best version of yourself on interview day.

Kelsie, the Class of 2019 admissions representative, received some questions about the interview process from prospective students last year. Carol, the Class of 2018 admissions representative, and her have shared some answers to these questions that you may be wondering about as well. I hope this helps assuage any concerns you may have!

Q: Should I bring anything to the interview (pen, portfolio, resume, notepad, etc.)?

A: No need to bring anything. You will receive a folder and pen, information about Regis, and a water bottle. Of course, you’re welcome to bring your own paper and pen, but there’s no need. Some people like having a notepad to jot down questions for the faculty or interesting things they learned throughout the day, but it is completely your own preference. Also, keep in mind, you will be carrying whatever you bring around campus during the campus tour.

Q: Are there any questions that stumped you or caught you off guard? What types of interview questions should I expect?

A: Interviews are now done in a group format, so not only will you have the opportunity to answer questions, you’ll be hearing and responding to what others have said. It really feels like the interviewers are sparking a conversation with each question. They want this discussion to be natural and give you the opportunity to be yourself. I really mean it when I say to be yourself as much as you can be. Regis is unique in the fact that they really look for people’s character during the interview, rather than solely admitting students for grades and GRE scores. When the faculty asks you questions, they are not seeking a right or wrong answer. They are seeking to learn who YOU are and how you communicate. With the group interview format, there is opportunity to listen and engage with the faculty as well as the other prospective students, so take advantage of these moments.

Q: How can I prepare for the interview?

A: Some advice is to look at the Regis website and see where the values of Regis fit into your life and how you can express that during interviews. Faculty biographies are good information to look at prior to interviews, and reviewing this information can give you an idea of questions you might want to ask faculty members. If you do feel stumped at any point, don’t be afraid to take a minute to gather your thoughts because they appreciate that more than a made-up answer. It also helped me to look up some common physical therapy school/traditional interview questions and brainstorm answers. Think about what you have experienced already and have those stories ready. If you have some solid examples of your experiences, you’ll be able to adapt to wherever the conversation goes. Finally, make sure you research the topics you’ve been given ahead of time so you can prepare and get your thoughts together. Another piece of advice is to perform a practice interview with friends or family members in a group setting. Practice speaking out loud and ensuring you are speaking clearly and loud enough as they ask you different interview questions.

Q: Is there a chance to meet current students?

A: YES! You will have multiple opportunities to interact with various students throughout your day. Also, from 4:30-6:30pm on both interview days, we will have a meet-and-greet off campus for prospective students to meet with current students. I hope to see you all there! That being said, this is by no means mandatory and your attendance will not affect your admission to the program.

Q: What should I expect from the group interview format?

A: The group interview will consist of two faculty members and three candidates. It is not designed to be all three of you taking turns answering one question at a time nor each of you competing to have the best answer; instead, it is designed to be more of a fluid, facilitated discussion of specific topics among everyone.

Q: What will the whole day be like?

A: Everyone will go through 5 different “stations,” so to speak. They include the interview, campus tour, student Q&A panel, a skills lab observation in one of our classes, and an anatomy lab presentation. They won’t necessarily be in that order, but the whole interview day will include all stations and conclude with lunch. You’ll also stick with the same student-led tour group between each part of your day, so you’ll have plenty of time to get to know them and ask them questions as they come to mind.

Q: What should I wear?

A: I would err on the side of business formal. Most men typically wear matching pants and jacket, a button-up collared shirt, and a tie. Most women wear slacks or a dress skirt, a blazer, and a blouse. Cropped dress pants would work too, and if dresses are your thing, then go for it. It is really important that you feel comfortable in whatever you end up wearing! That being said, when it comes to shoes, heels are great, but as long as you’re really comfortable in them. Flats are perfectly fine; in fact, if you opt to wear heels, I would bring a pair of flats along with you so you can change into them while you go on your campus tour. Also, be sure to bring a jacket in case it’s cold. There will be a coat rack available to store your belongings while you are inside. Simply remember this is a professional interview, so dressing professionally is highly recommended.

Best of luck, interviewees! Feel free to reach out if you have any more questions. I can be reached via e-mail at elemberger@regis.edu. We are all looking forward to meeting you!

– Erin, Kelsie, and Carol

Finals Week: A Beautiful Struggle

It’s that time of the year again…

No, we’re not talking about the holidays.

It’s Finals Week, the crescendo of each physical therapy (PT) school semester.

If you haven’t experienced a finals week in PT school, then here are a few ideas of what Regis students encounter during this time each semester.

  1. …but first, Practicals Week

Gone are the days of “dead weeks” leading up to final exams. Practical Exam Week is usually the week prior to all of the written final exams. This is where the skills you have acquired over the entire semester are put to the test to see how you are able to apply them in a real-life situation. During the days leading up to these exams, you will often see students crowding into room PCH 409 to practice their skills and drill each other on the specific times to use them. Study sessions can extend late into the night for some students (Pssst…PT school secret: often these practicals require knowing information that will also be on the written final, so it’s like studying for two exams at once…now that’s a deal!)

  1. Review Sessions

It is not uncommon for faculty members to hold review sessions discussing what to expect on the final written exam. These are often a great help in refining study strategies (PT school pearl of wisdom: take advantage of these sessions!)

  1. Finals Week Schedules

Each class takes 4-5 exams the entire week, with one exam per day and each one for 2 hours. You can find last minute study sessions dispersed across Claver Hall in the hours leading up to the exams to review any lingering questions or fill any remaining knowledge gaps. And hey, after one exam is over, students have 22 hours to study for the next test…what an ample amount of time!

  1. Work-Life Balance

In the words of The Great Tom McPoil, “take a day for yourself every week.” This may be hard to remember during these challenging weeks, but still very relevant. Students usually make modifications to Tom’s “day” suggestion during finals week, and instead take a few hours to relax and meditate with various types of exercise (or naps) – whatever takes the mind off studying for a few moments.

  1. The Triumph of Completing a Semester of PT School

At the end of each finals week, you will find students celebrating another semester down and another job well done! It’s a time to look back at the terrific accomplishments with pride and relish in the fact that your hard work got you here

– Courtney Backward

Check out this video of first and second year students studying (and relaxing) for their finals!

 

Video Credit: Janki Patel

 

DPT School Nutrition: 4 Ways to Eat Healthy

Name: Janki Patel, Class of 2020
Hometown: Fremont, CA
Undergrad: University of California, Davis
Fun Fact: I hiked a 14er (Mount Democrat) for the first time…three days after moving from the Bay Area’s sea level.
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If you are currently enrolled in physical therapy (PT) school, or attended in your past, you can probably identify with the struggle of eating healthy, stress eating, and forgetting exercise. With one exam after another, I’ve found myself eating one snack after another. And by snack, I mean chocolate-covered espresso beans, chocolate-covered almonds, and chocolate-covered pretzels. Anytime anyone mentions “free food,” my ears perk up, eyes widen, and I suddenly feel as if I’ve been starving for centuries, instantly questioning “Where?! When?!” And, when I do finally find the time and energy to go grocery shopping, I think to myself, “I’m going to get a ton of vegetables, fruits, and healthy foods only.” Yet, I end up walking out with a handful of unhealthy items, which I justify by all the vegetables and fruits I just filled my cart with (it’s all about balance, right?!). Days later, I find myself eating all those unhealthy items first though, while the vegetables and fruits start going bad. And with more stress, I seek out the fatty, carbohydrate-heavy, sugar-loaded foods for comfort and relief. When I talk to classmates, I find many are in the same boat. It’s almost as if we could use a class about how to consistently eat healthy while in PT school…or maybe just a blog post!

We already learned that nutritious foods are better fuel sources for our brains and bodies, leading to improved energy, clearer minds, and overall better productivity. Ensuring proper nutrition takes self-discipline and motivation. Once you make it part of your everyday though, you won’t even have to think twice about it. Just like driving a car or riding a bike or remembering the direction of roll and glide for the convex-on-concave rule of arthrokinematics. It’s simply a matter of training the brain, or neuroplasticity, if you will.

1. Mindfulness

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Photo Credit: Mindfulness Words

 

Take the time to really listen to your body and thoughts in the present moment. When you find yourself reaching for a snack, ask yourself if you’re truly hungry. Is your stomach really rumbling? When was the last time you ate? If the answer is “no” and “just a half hour ago,” then try opting for a drink of water or a piece of gum to chew instead. If you start deeply craving food, ask yourself where that craving is stemming from. What’s really causing it? Hunger? Or, stress and anxiety? If it’s stress or anxiety, then first acknowledge that the true cause of your feeling is stress or anxiety. But, don’t let that acknowledgement stress you out more. Take a minute to close your eyes and take a few deep breaths, rather than running to the cafeteria or kitchen. Try to then relieve the craving by simply changing your position (sitting up straighter, getting up and taking a quick walk, or stretching) or environment. I find that every time I study on the dining room table, I end up grabbing a snack shortly after I start, or I sit with one to begin with so I don’t have to get up later. With the kitchen so close by, there’s little time between my thought and action. Choose a study spot away from food sources so that you’re given more time to think twice about any craving that occurs and prevent yourself from fulfilling it.

Find more activities to relieve cravings in the moment as well, whether it’s having quick play time with your pet, reading a short article (PT in Motion has great ones!), or talking to a family member or friend for a few minutes. Essentially, we want to train the brain to think “this is my cue to grab water, take a walk, or talk to someone” instead of “this is my cue to eat” whenever it receives the signal of a craving or desire to eat that really stems from stress or anxiety rather than hunger.

2. Commit to a List

Photo Credit: Grocery List

 

This is one of my biggest challenges. I always have a few items in mind that I need to get from the grocery store, but the rest of the items in my cart end up being in-the-moment purchases. Make a solid grocery list beforehand and commit to sticking with it by grabbing only the items you need. One way to do this is to first find healthy recipes and then creating a grocery list from the ingredients. For example, I’m subscribed to New York Times Cooking, which sends me daily emails of recipes. I choose and bookmark a few healthy ones every day so that by the end of the week, I have a list of ingredients for my weekend grocery shopping trip (as well as recipes to cook for next week then!). You can go paper-and-pen style or use an app on your phone to keep track of your list.

Another way is to commit to a 5-5-5 rule. Include 5 vegetables, 5 fruits, and 5 protein items on your list every time you make a trip to the grocery store (or any other area, such as fiber or a specific vitamin, that you may not get enough of). Depending on when your next trip will be though, you may have to increase these numbers. Think of your grocery list as being a grading rubric for a class assignment or a list of topics on an exam. Just as you would ensure to cover all required items for your clinical skills check or anatomy exam, and not a single more item than you have to, commit to ensuring you cover all the items on your list, and not more, for groceries as well.

3. Avoid Justifying Unhealthy Items for Costing Less

Photo Credit: Money Fork

I know we’re all “balling on a budget,” but try to not let that be a reason you start compromising healthy foods for less nutritious ones. Order that avocado for the extra 50 cents. Don’t order that whipped cream on the frappachino simply because it comes at the same price without it. If you’re like me and are easily lured by sale items at the grocery store (who doesn’t like buy one, get one free items?!), try to take more time to practice the previous points of being mindful and committing to a list. It’s easy to fall into marketing schemes since sales make “sense” that we would be saving money. However, it does not make “sense” to feed our brains and bodies with foods that have little to no nutritious value.

This goes for restaurants as well, especially if you don’t cook at home or buy groceries often. Think back to the 5-5-5 rule when ordering still: did you have vegetables, fruits, or protein today? Create and commit to a list and find items on the menu that incorporate this “grocery list.” We’re actually lucky that our bodies already give us a grocery list of items they need for optimal functioning: proteins, carbohydrates, fats, vitamins, minerals, water, etc. Seek the specifics your body truly needs on the menu, just as you would seek keywords in multiple choice options on an exam question to know it’s the correct answer.

4. And Of Course, Don’t Forget to Exercise!

Photo Credit: Time for Fitness

 

This last point is more of a reminder to exercise regularly. The benefits of exercise are endless. Schedule it into your calendar as if it were a mandatory class. Additionally, any time you start to feel your energy levels plunge, try exercising rather than reaching for energy bars or sugary foods for a boost, even if it’s simply 10 minutes. If you’re in class and a craving or energy lull hits, try seated calf raises under your desk, flexing and extending your toes in your shoes, or flexing and extending your fingers and hands (set a frequency too!). Again, it’s about creating a healthy response when your brain gets these signals.

We know exercise can cause physiological changes in more than just our muscles, specifically in our metabolic pathways. Keep moving regularly and solidifying healthy eating habits and it’ll soon feel like you never had a struggle with healthy eating, stress eating, or forgetting exercise. You won’t even have to think twice about it. Just like driving a car or riding a bike or remembering the direction of roll and glide for the convex-on-concave rule of arthrokinematics. It’s simply a matter of training the brain, or neuroplasticity, if you will…these are my foods for thought. Happy nutritious eating!

Counting down to more blog posts…

The school year has ramped up!  Our Class of 2019 just finished their first set of exams, the Class of 2018 is finishing their last week of clinicals, and the Class of 2017 is preparing for their third clinical rotation next week.

Along with that, the blog committee has new members and we’re excited to begin posting for the 2016-2017 school year!

Check out our website tomorrow to hear from Kelsie Jordan, our first Class of 2019 featured blogger.

Flat Stanley Goes to Clinical

Name: Nicole Darragh, Class of 2017

Hometown: Columbus, OH

Undergrad: Regis University

Fun Fact: I think kale is totally overrated.

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The Class of 2017 recently returned from their second clinical rotations with a plethora of new knowledge and stories to share.  Some students even had a visitor along the way: Flat Stanley.  Flat Stanley is a small paper figurine that keeps students connected outside of the classroom.  Students take a photo of Flat Stanley completing an activity, learning a new technique, or going to a cool new location, and share those photos with their classmates through social media.  This helped us learn a little bit about each rotation, and keep in touch with our classmates.

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Pictured: Sarah Campbell ’17 with Flat Stanley on her first day of clinical (PC: Sarah Campbell)

Flat Stanley traveled to a wide variety of locations across the country including California, Wyoming, Kentucky, and even Alaska!  Along the way, Flat Stanley learned new documentation systems, new techniques in the clinics, and went on a lot of hikes.  Really, what Flat Stanley is trying to tell you is that while you’re on your clinical rotation, don’t forget to take the time to explore your new surroundings!

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Flat Stanley reviews Functional Electrical Stimulation (FES) while at clinic in Chico, CA (PC: Adam Engelsgjerd)

 

Clinical rotations work in a variety of ways.  The first is the lottery option; students choose ten clinical sites from a large list compiled by the clinical education faculty, and rank them in order from 1-10.  Once the lottery is generated, students are placed at a site.  The second is the first come, first serve option; students can choose a site before the lottery begins that they are particularly interested in, and request to be placed at that site before it is taken.  The third is the set-up option: students are allowed to contact a clinical site that is not affiliated with Regis and set up a clinical rotation with them if they are interested.  When rotations get closer, you’ll learn more specifics about how they work, requirements, etc.

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Flat Stanley’s meet up at Devil’s Tower outside of Gillette, WY (PC: Amanda Morrow)

 

Throughout the clinical process, it is important to know that you might not always end up in Denver, and you’ll have to try something new!  Wherever you do end up, make sure to enjoy your free time.  Clinical can sometimes be very overwhelming, and it is crucial to take time for yourself, whether that be exploring your new surroundings, trying a local restaurant, or binging on Netflix.  And if the thought of being gone for six, eight, or twelve weeks scares you a little, all of us will tell you that the time flies by so quickly.  There isn’t much time to be bored!

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Flat Stanley goes sandboarding in the Great Sand Dunes National Park in southern Colorado (PC: Lauren Hill)

 

If you have any further questions about clinical rotations–or other places Flat Stanley and/or students traveled–please feel free to contact me at darra608@regis.edu!  Also, I would recommend reading the post below called “Class of 2017 DPT Student Lindsay Mayors Reflects on Her Clinical Rotation.” (https://regisdpt.org/2016/05/27/class-of-2017-dpt-student-lindsay-mayors-reflects-on-her-clinical-rotation/)

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Flat Stanley helps out with some end-of-the-day documentation (PC: Amy Medlock)

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Flat Stanley enjoying a nice Moscow Mule after a long week at clinical (PC: Amy Medlock)

 

 

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Flat Stanley joins Lauren Hill and Jenna Carlson to run the Bolder Boulder race (PC: Lauren Hill)

Cover PC: David Cummins, Class of 2019

 

What is it like to be in the military and PT school?

Name: Zach Taillie, Class of 2018

Hometown: Phoenix, NY

Undergrad: SUNY Cortland

Fun Fact: I’ve been in the Air Force for 6 years.
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You may not believe this, but NASCAR Technical Institute is a bit of a dead-end school.  You read that right—there is a school completely dedicated to folks who want to learn about race car maintenance and occasionally take them for a spin.  It is a one-year program outside Charlotte, NC, and was what I thought I wanted to do.  While the program set me up for an awesome career as a tire technician at Sears Auto while living out of my parents’ basement, I decided I wanted more out . I found myself over at the Air National Guard office, and in December of 2009, I enlisted.

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Once I was done with my training and learned that I could get school payed for while serving in the military, I was stoked to get started. Little did I know that when it comes to school and military duty, school usually doesn’t win. The biggest mission we undertake in the Air National Guard is state-level disaster response.  My first emergency response was to a winter storm, and to my surprise, I was told by my supervisor that school takes a backseat to duty.  I remember feeling frustrated at the situation, but once I showed up I realized how much of a positive impact we could have.  The feeling of helping out and giving back to those who needed it far outweighed any disappointment at missing classes or balancing class all day with working at night.  Luckily, I was blessed with great professors who would email me notes and allow me to reschedule tests if necessary.  This understanding and flexibility allowed me to respond whenever the call went out, and it allowed me to still excel in school.

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The military hasn’t been all rough, though.  During one of my winter breaks, I was sent to Germany for training.  I spent Christmas in Kaiserslauten, New Years in Berlin, and my birthday in Amsterdam.  Even when I wasn’t out exploring Europe, I was able to have fun at work coordinating air drops (think Humvees and supplies hopping out of planes) with the 86th Airlift Wing.  I’ve had the opportunity to deploy to the Middle East and serve with coalition troops from all over the world and make some lifelong friends.  Oh, and having part of school paid for is another perk!

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Although I originally thought I wanted to make a career of the military as an officer once I graduated from college, I stumbled upon physical therapy during my junior year and fell in love.  Due to a shoulder injury, I was able to experience what it was like to go from injured back to working out and wanted to give that gift to others.  Fast-forward a couple of years, and here I am: at Regis fulfilling me dream!  Currently, I serve with the 153rd Airlift Wing up in Cheyenne, Wyoming.  I go up once a month and spend at least half of my breaks working.  Luckily, my drill schedule and our finals week seem to always coincide…so I get the opportunity to test how long I can stay awake and study.  Two semesters down, and I’m still here!!  While I listen to my classmates plan super rad trips for our summer break, I’m looking forward to two weeks of work connected by a drill weekend.  All things considered, though, I would do all the same given another chance.  I work with some great people and get to do things for my job that most people only see in movies: riding on C-130s, running through live shoot houses, firing some pretty awesome weapons, and watching live gun runs from planes overhead.  The military/civilian balance can be a challenge at times, but it’s one that’s well worth it!

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If you have any questions about balancing school with the military, please feel free to contact me at ztaillie@regis.edu.

How to Have Fun in PT School

Name: Connor Longacre, Class of 2018

Undergrad: Colorado State University

Hometown: Wyomissing, PA

Fun Fact: I am a huge of soccer, though I haven’t formally played since I was 11.

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“It’s fun to have fun but you have to know how.” (Dr. Seuss, DPT)

Many of you reading this may think of the classroom as a no-nonsense place of learning. Those who distract others with joking and laughter are often unwelcome in such environments.

Hear me out, though.

If, in my time as a Student Physical Therapist, I choose to spend every hour of class, every day, for three years, as a solemn study machine, then what do I expect my career after PT school to look like? I would probably know as much as the dictionary, with the interpersonal skills of … well, a dictionary. Don’t get me wrong. School is serious. Working with patients is serious. Physical therapists must know how to be professional and serious. However, having fun is also an essential part of being a PT. From becoming friendly with our patients to creating engaging ways to make exercises more enjoyable, there is an occupational requirement to be fun-loving, which is why fun belongs in the classroom.

So, how does Regis University put the “fun” back in the fundamentals? Long story short, it doesn’t. All the university can do is give us (the students) time, space, and some freedom. It is not the professor’s job to bring in a beach ball or play funny YouTube videos. Adding the element of fun to academia is the sole responsibility of the student. When done well, it can be seamless—and even educational.

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At the risk of sounding as arrogant as I probably am, I’ve included some tips on how even you can have fun in the classroom:

  1. Learn to love where you are. If you’re in PT school, then the prospect of learning about PT things should be pretty darn exciting. Stay excited. Stay motivated. Learn to dwell on the details like they are the difference between being a good PT and a great PT (because they are).
  2. Find time to unwind. Everyone’s brain candle burns at a different speed. Some people can sit in class for 8 hours attentively, but when they get home, they’re spent. Other students may need to get up and walk around every hour, maybe chit-chat a little between lectures, but will buckle down during independent study. Give your brain time to rest.
  3. Get moving. Hours on hours of lectures can put you into a comatose-like state. Get up and walk around when given the chance. Personally, I like to kick a soccer ball around at breaks.
  4. Finally, get to know those lovely people you call classmates. Play intramural sports, go out to a brewery, maybe even hit a weekend camping trip. Warning: spending time with people may lead to smiling, laughing, inside jokes, and friendships. Friends make class fun.

There you have it, folks, a helpful-ish guide on how to have fun in PT School.

*Shoot, I should have added “write blog post” to the list of ways to have fun.

 

 

Regis DPT Students Plan the Move Forward 5K/10K

Name: Ryan Bourdo, Class of 2018

Hometown: Corvallis, Oregon

Undergrad: University of Oregon

Fun Fact: I ran a 4K snow shoe race once.

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Race day is always the best. It is the culmination of months of training—immediately followed by the chance to take a well-deserved day, week, or month off from running. The atmosphere is always amazing, too. Everyone is still a little groggy from being up way too early for the weekend, but there is still a palpable excitement; the people next to you on the starting line are instant friends because you all share a common goal: finish the race. And that feeling you get after finishing? Incredible. No matter how tough a race is for me, I am always energetic and talkative afterwards. I have been fortunate enough to run some fun races in the last few years, and I want to bring some of that same excitement to Move Forward.

The Move Forward 5K/10K Race (September 17, 2016) is arguably THE most important event of the year for Regis University’s School of Physical Therapy. I argue this because I am the co-director of the race this year, and this is my blog post. Move Forward is a special event for me. It is a chance to help my school share what we know to be the best ways to live healthy lives. I firmly believe anyone can complete a 5K with practice, motivation, and a little help if needed. More than anything, what I want for people to get out of Move Forward this year is to have a good time and learn a little about taking care of themselves.

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Some of the Class of 2018 after the 2015 Move Forward Race

The idea behind this event is to get people to think about their health, get moving, and live better. For those already signed up, make sure to get to the race early to get your grab bags! We will have bagels, bananas, and coffee for those needing an extra boost in the morning. Several of our classmates will also lead group stretching as well. And then we are off! Music will be blaring, water stations will be flowing, people will be cheering. Whether you are running or walking, we will make sure you have a good time. Make sure to stay after the race, too, because we are planning a lot of post-race greatness. Not only will we have burgers, hot dogs, and beer (not the healthiest, we know, but you deserve it) but we are planning a lot of activities, as well. Informational booths will be there to help guide you in taking care of yourself through exercise, nutrition, and general wellness. We also hope to have some yoga and/or Zumba classes after the race. And, because we want this to be a family event, we are looking for fun activities for kids, tool. Check out our website for updates as our race schedule finalizes: https://moveforward5k10k.racedirector.com.

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Not only will this race be a great way to learn about how to stay healthy, but all of the proceeds will go to Canine for Companions and the Foundation for Physical Therapy. Canine for Companions is especially meaningful to us at Regis because we have an annual team of students that assists in raising a dog before it starts training to become a fully-fledged service dog. The Foundation for Physical Therapy is also a great cause; it helps support research in physical therapy. If you have not signed up for the race yet and I have thoroughly convinced you of how awesome this event will be, you can register here: https://moveforward5k10k.racedirector.com/registration-1.

Again, the race will be held on September 17, 2016 and begins at 9:00am.  If you have any questions, please feel free to email me directly at rbourdo@regis.edu.

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Many Ryans running

Ryan Bourdo graduated The University of Oregon with B.S. Degrees in Biology and Human Physiology in 2010. Originally thinking of medical school (never mind the fact that medical school rejected him twice), he soon fell in love with physical therapy, thanks to an amazing therapist in Portland, Vince Blaney, MSPT. Vince showed him everything he originally wanted to be as a physician: using anatomy and physiology to help those with injuries. He soon worked as a physical therapist aide for two years and is currently at Regis University completing a Doctor of Physical Therapy. In his free time, Ryan likes to run, hike, and cook. You can find Ryan at www.ryanbourdo.com, or on Twitter @RyanBourdo

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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.

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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

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  • 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.