InTouch Newsletter l December 2020 Print

President's Report

Hello Members,

Happy Holidays!  2020 has been quite a year from cancelling education courses and all in-person events due to COVID-19 to working with insurance companies, athletic trainers, and others that a multitude of issues necessitated during the year.  I am so very thankful for our association members who volunteer many hours to the success of our association.  Also, a huge shout out to our Executive Director, Erin Isenhart, for helping us move into the 21st century as an association. I value her input! 

This newsletter is our first newsletter with a new format.  Each issue from now on will have a focus on a certain aspect of our association and our profession.  Each December issue will focus on practice management – information on new documentation requirements, reimbursement changes, and any new rules and regulations to get you  started on the right foot for the new year!  I hope you find this issue informative and helpful.  Thank you Brian Brunken, our Practice Management Chair, for developing the content for this issue. 

We are announcing our 2020 award winners this issue – please read about each of them – very inspiring! 

Our award nomination cycle is open now for 2021.  We have many inspiring clinicians out there that deserve our recognition!  Get your nominations in.   We are also seeking candidates for our open positions.  Consider running for an open position on our Board yourself! 

Grace

Grace Knott, President, APTA NE Chapter

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Practice Management

1. Medicare Update

After months of advocacy by APTA members, Congress partially addressed the projected 9% payment cut for physical therapist services under the Medicare Physician Fee Schedule that’s set to go into effect Jan. 1.

The COVID-19 relief package, announced yesterday, includes $5 billion in offsets that will reduce the cuts from an average of about 9% to an average of about 3.6%.

This relief falls well short of ensuring patient access to needed services, and a 3.6% cut threatens the viability of thousands of providers who offer safe, cost-effective care that helps older adults maintain their independence and avoid more costly procedures.

Cuts of this nature are unsustainable for the physical therapy profession, and the knowledge that three dozen other health care providers also are facing cuts doesn’t make them easier to withstand. At the same time Medicare improved payment for physical therapist evaluation and reevaluation, it has made it more difficult for PTs to actually treat their patients.

We arrived at this point because the Center for Medicare & Medicaid Services continues to adjust the dials for payment under the Medicare Physician Fee Schedule within its requirements for budget neutrality — but this model is clearly outdated.

First developed in 1992, the Medicare Physician Fee Schedule fails to adequately support or recognize a modern health care delivery system in which multiple health care professionals work collaboratively to advance appropriate health outcomes for their patients.

I am grateful for the thousands of APTA members who used their voice to fight these cuts, as well as dozens of members of Congress who repeatedly supported our efforts. Reducing these cuts is a critical first step to the sustainability of physical therapist services, and we will advocate for additional relief in 2021.

APTA is eager to work with members of the next Congress to ensure that Medicare beneficiaries across the country can receive the high-quality, interprofessional health services they need and deserve.

Click here for a link to the full article on the APTA website. 

2. United Healthcare Community Plan

The coalition that is comprised of members of the Nebraska Speech, Hearing, and Language Association (NSHLA), Nebraska Occupational Therapy Association (NOTA), and American Physical Therapy Association-Nebraska Chapter (APTA-NE), as well as, our lobbyist, Julie Erickson, and Janet Seelhoff, met with the brass from United Healthcare Community Plan (UHCCP) in Nebraska recently. Due to ongoing advocacy efforts, this coalition was able to convince, UHCCP to remove the MPPR applied to reimbursement for therapy services in the State of Nebraska. This involved all members of the coalition and much data collection, as well as guidance from the American Physical Therapy Association, specifically Wanda Evans, PT, to have this unfair reduction in payment applied to our services. We are unaware of the current date for this monumental change, but will keep you posted. Finally, Julie Erickson, our lobbyist, and the aforementioned coalition, will be moving forward with legislation in hopes to permanently remove MPPR from its usage with the Heritage Health, Medicaid companies, within the state of Nebraska. We have a State Senator to sponsor our bill at this time. Further information will be provided at a later date.

Great news on this front!!!!!  CMS did an outstanding thing here!!!!  Please see the link to the APTA website on the changes and some of them are retroactive to 10/1/2020!! https://www.apta.org/article/2020/12/04/ncci-coding-edit-change

Centers for Medicare & Medicaid Services : Ascend Integrated

Top Physical Therapy CPT Codes - Plus Printable Reference Sheet |  CovalentCareers

 

3. Insurance Payer Forum

The Practice and Management Committee will be hosting an Insurance Payer Forum in the second quarter of 2021 to improve our relations with insurance companies and other payers. This will be completed virtually and we will have guest speakers from Creighton University-Program in Physical Therapy, Wisconsin Physicians’ Services, WPS, our CMS intermediary, and the APTA, as well as others. This event will be closed to physical therapists in our state with the exceptions of Committee members and PT Board members.

WPS Government Health Administrators | WPS Health Solutions

4. APTA-NE Working for You

The American Physical Therapy Association-Nebraska Chapter receives emails occasionally from our chapter members regarding practice and reimbursement in our state. Please encourage members to continue to do this so that we may go forward in a united front to solve our reimbursement issues within our state. You may contact me with your questions or concerns and/or to get involved. It only costs you time and no money to be member of a committee within our great State Association.

https://aptanebraska.org/Committee_Information

5. APTA NE Working For You

The American Physical Therapy Association-Nebraska Chapter receives emails occasionally from our chapter members regarding practice and reimbursement in our state. Please encourage members to continue to do this so that we may go forward in a united front to solve our reimbursement issues within our state. You may contact me with your questions or concerns and/or to get involved. It only costs you time and no money to be member of a committee within our great State Association.

https://aptanebraska.org/Committee_Information

6. Private YouTube Channel

There are also plans in the works to create a YouTube channel for private use through our State Chapter to receive video updates of pressing issues regarding legislative actions and reimbursement within our state related to the delivery of physical therapy services. More information to follow on this as well. 

7. Defensible Documentation

Related to our insurance Payer Forum, a webinar will be created to specifically address the complicated topic of Defensible Documentation. We have been contacted by WPS to formally complete this webinar to improve our documentation in all physical therapy settings.  Much work was put into this project by Nick Weber, PT, DPT, OCS.  Specifically, WPS reported 80% of their issues are related to documentation in the Skilled Nursing Facility (SNF) realm. We will let you know when this is available. Take home point…Do internal and consider external audits.

                        How to Write a Soap Note (with Pictures) - wikiHow

 

Example of an Assessment from a daily note for an outpatient physical therapy session for a low back pain patient: 

“Pt. tolerated tx.well.  Gate remains antalgic.  Pt. had LOB during tx.”

Please identify the errors within this note and define a possible correction(s):

a.       There is at least one misspelled word.

b.      One sentence is not accepted by CMS

c.       Too many abbreviations

d.      Too vague with comments on what happened during treatment.

e.       All of the above

The correct answer is ‘e’ all of the above. 

a.       There is at least one misspelled word.  Gate should be spelled gait.

b.      One sentence is not accepted by CMS. CMS does not like ‘tolerated tx. well’.  Consider stating that patient completed treatment without complaint of increased pain.

c.       Too many abbreviations.  In the first sentence, the PT was actually commenting on how the patient tolerated traction, not treatment.

d.      Too vague with comments on what happened during treatment.  Consider commenting on gait—patient presented with normal cadence, but her push off on left was reduced and her right stride length was limited….be more specific.  Regarding the LOB (Loss of Balance), what was the patient doing when she lost her balance, was it more than one time, how did she correct the LOB, and did you do complete education for how to correct for LOB?

e.       All of the above

 

8.    APTA-NE & the AthleticTrainers

In Nebraska and other states, ATC’s have opened their practice acts in the hopes of expanding their ability to practice autonomously.  The NOTA, APTA-NE, and NSHLA have all been working with the Nebraska State Athletic Trainer’s Association on this process.  More updates to follow... 

9.    Patient Satisfaction 

Are You Providing High Quality Care?  Is it just satisfaction surveys?  Facebook ratings?  Do companies enter all of their ratings on their websites or just the favorable ones?

https://www.apta.org/apta-magazine/2020/10/01/how-do-you-know-when-you-are-providing-high-quality-care

 

 

 

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2020 Chapter Awards

Clinical Excellence Award for PTA

Karen Abboud is the Clinical Excellence Award for PTA for 2020. 

The annual Clinical Excellence Award for Physical Therapist Assistant recognizes a PTA who is well respected by their peers, is active in our association, and demonstrates contribution to physical therapy in one or more of the following areas:  Education, management, patient care or research. 

Our awardee this year is well known throughout the association for her many years of being the PTA Caucus representative and her work as the Academic Coordinator of Clinical Education for Clarkson College.  She held the role of the PTA Caucus rep for over 10 years!  Her nominator in her letter stated that Karen is an ambitious colleague, inspiring mentor and a caring peer. Her strong work ethic has served her well allowing her to develop as a clinician and in academia.  She has been a certified lymphedema therapist since 2010 and as she has grown in her current role as Academic Coordinator of Clinical Education, she most recently pioneered a new clinical evaluation tool for PTA students with another regional PTA education program.  She is now researching the effectiveness of the tool and will present at a national conference.  In the past, she has presented with other colleagues on teaching the PT/PTA relationship at regional and national conferences.  She has reached out to UNMC for interprofessional education and understands the importance of that education for the future growth of our profession. 

Congratulations, Karen!


Achievement in Education

Nikki Sleddens is the 2020 Achievement in Education award recipient. 

This annual award honors a member who has made valuable service contributions to physical therapy and to the chapter by developing and delivering quality education experiences that improve the profession of physical therapy. 

Nikki is a graduate of the UNMC PT Education Program.  She currently serves at the Director of Clinical Education for the University of Nebraska Medical Center PT program.  Before that she was involved in the education of physical therapist assistant students serving as the Academic coordinator of Clinical Education and also as program chair at Southeast Community College.  She is a credentialed Trainer for the Level 1 Clinical Instructor course for the APTA.  One of her nominators stated that her influence as an instructor in this course helps clinicians become not only better clinical instructors but helps them in the clinic as better educators. Nikki has also worked tirelessly in developing and engaging clinicians across the state by developing clinical education advisory panels.  She has presented nationally numerous times at the Education Leadership Conference and has also consulted with other programs across the nation.  She brings recognition to our state because of her involvement. 

She has served her state chapter as well in the role of Vice President which oversees the education and clinical education committees of the chapter.  She was instrumental in implementing CEU Locker that has resulted in a more streamlined application process to get CEU approved by the chapter but also increased our ability to generate revenue. She is also involved in nationally with her involvement in the Academy of Physical Therapy Education and the National Consortium of Clinical Education Educators. 

Congratulations, Nikki!


MaryEllen Sacksteder

Lisa Black is the 2020 MaryEllen Sacksteder Award recipient. 

The Mary Ellen Sacksteder Award is the highest honor that the association bestows on one of its members.  Many times it is for a long and distinguished career serving not only the association but the profession.  The member must have been in practice for at least 10 years and the last 5 years in Nebraska.  They also must have made substantial contributions in 5 of 10 areas of professional practice.  Those ten areas are patient care, administration, consultation, education, research, publications, professional organizations, service clubs/community involvement, public relations, and other contributions. Dr. Black has met or exceeded all of these requirements.

Dr. Black has distinguished herself in the area of clinical education serving as the Director of Clinical Education at Creighton University.  She is a nationally known credentialed trainer for practicing clinicians to earn the the “Credentialed Clinical Instructor” designation through the APTA’s Clinical Instructor Education and Credentialing Program. As a Credentialed Trainer, Dr. Black is responsible for teaching workshops both regionally and nationally. She was elected to a national role as Secretary for the Clinical Education Special Interest Group of APTA’s Academy of Education and served on the Academy’s Programming Committee. She has spent thousands of hours over the past 16 years practicing and teaching community-based health promotion skills benefitting dozens of community partners in the Omaha metropolitan area. Her teaching and scholarship have also been recognized by  being selected as “Physical Therapy Educator of the Year” by physical therapy students.

Dr. Black has demonstrated a strong record of collaboration and has published several peer-reviewed journal articles and book chapters. Dr. Black has been involved in a national, multi-site study that describes novice to expert clinical reasoning in practice is innovative and longitudinal in nature, allowing future scholarly impact. Her expertise in clinical education and reasoning resulted in receipt of the APTA’s Academy of Education’s “Stanford Award” which recognizes the paper “containing the most influential educational ideas” for a given year. Dr. Black has also demonstrated a record of grant funding in support of her work related to “scholarship of teaching and learning” and “scholarship of engagement" as evidenced in her CV. She has disseminated research findings through national presentations of the APTA, as well as international venues such as the World Confederation of Physical Therapy and International Social Sciences Conference.

Prior to Creighton University, she practiced in acute care, outpatient, skilled nursing and home environments over her clinical career. She became Vice President for Operations of Excel Physical Therapy, a corporate structure comprising 14 clinics and additional hospital  contracts during her corporate employment.

She has been a frequent and long time volunteer for the Nebraska Chapter of the APTA.  Her expertise and ability to create consensus among practitioners have been used widely over the years.  She has served on many leadership roles within the association including the Reimbursement Committee, Eastern District Chair, Public Relations Committee Chair and Secretary.  She also was appointed to Vice President during a time of turnover in the chapter in 2006.  It was very fortunate she was in this role because her statewide contacts and relationships allowed the chapter’s Executive Committee to mobilize the clinical community in response to legislative issues affecting Nebraskans in need of rehabilitative services.  She has helped the Nebraska Department of Health and Human Services by consulting as a expert witness, and she was appointed to represent APTA Nebraska on the State of Nebraska Credentialing Reform task force.

This particular awardee has carved an impressive record of expertise in patient care, clinic management and corporate administration. She has also demonstrated an ability to generate scholarship and to teach effectively. She has all the key criteria for the prestigious MaryEllen Sacksteder award. The awardee knew Major Mary Ellen Sacksteder, and it is likely that she embodies some of the same “no-nonsense”, perseverant grit and leadership tenacity as the award’s namesake. She is a most humble, mission centered role model for students and established clinicians.

"I am most honored to present the 2020 Mary Ellen Sacksteder Award to Dr Lisa Black. Congratulations, Lisa!" Grace Knott, President, APTA Nebraska


The call for nominations for 2021 chapter awards starts now! 

Click here to nominate a fellow professional for one of these prestigious awards!

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Practice Highlight

In this issue we are highlighting Brian Brunken and Go Physical Therapy.

Go Physical Therapy has been serving patients in the Omaha area since 2006. They see patients at their clinic located at 18101 R Plaza, Suite 106 and in their homes Monday through Friday 7:00 AM to 7:00 PM, and Saturdays from 8:00 AM to noon. They currently have 2 full-time and 2 part-time physical therapists, including two board-certified clinical specialists in orthopedics and one in women’s health. They provide primarily orthopedic services, but also neurologic health services.

Go PT has a strong presence in the community with support for APTA-NE membership and regional PT & PTA student education. GO PT was founded by Nebraska native Brian Brunken who currently serves as Practice Management Chairperson and represents APTA-NE as a member of the Advisory Committee for Nebraska Total Care. Staff therapist Kyle Meyer has been published and presented posters on topics including patellofemoral pain and manual therapy for the thoracic spine and ankle. In addition, to their clinical services they have an option for wellness services for their patients after they complete formal PT.

 

 

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Call for Candidates

APTA Nebraska needs YOU! 

It's that time of year. The Executive Committee is sending out a Call For Candidates! This call is for both the APTA NE and for the NebraskaFoundation for PT and it closes on January 31, 2021. 

Please consider running for one of these open positions OR if you know of someone who would be a good fit, encourage them to run. 

Sumibt your name online OR contact any member of the Nominating Committee to get more information about a position, or to recommend a colleague for a position. It is your work and commitment that make the difference in our organization!

APTA Nebraska and the NFPT will be holding elections virtually this year for the positions listed below.   

  • Vice President: 2-year term – job description
  • Treasurer: 2-year term – job description
  • Delegates (2 open positions): 2-year term
  • PTA Caucus Representative: 2-year term
  • Alternative PTA Caucus Representative: 2-year term
  • Nominating Committee (1 open position) – job description
  • Nebraska Foundation for PT – Board of Directors (4 open positions) Click here for more on the Foundation   l   For more information on Foundation Board and elected positions, please contact NFPT President Terry Grindstaff at [email protected]

 

Remember, APTA Nebraska and the Foundation need YOU!  Please consider running for one of these positions!  The deadline is January 31, 2021.

Thank you!

Amber Herrington

Nominating Committee Chair

[email protected]

 

Nominating Committee Members:

Troy Goetsch, [email protected] 

 

 

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Early Professional Special Interest Group (EPSIG)

EPSIG Membership Drive Underway

The Early Professional Special Interest Group (EPSIG) is in it’s inaugural year in Nebraska and membership is FREE!

If you are in your last semester of school or in your first five years of your physical therapy profession, join your colleagues NOW by becoming a member of EPSIG! Becoming a member takes less than five minutes and is FREE. Just fill out this form

New members will receive a vinyl sticker of the all new APTA NE EPSIG logo!

Click here to join EPSIG today!

Click here to see Board Members, Mentors and more information on how to how to engage with your peers through this fantastic new group! 

Morgan Busboom, President EPSIG

Bobby Greise, EPSIG Mentor

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Legislative News

Legislative Day 

Legislative Day 2021 is going to be a new adventure for all of us in light of this crazy virus they are calling Covid-19.  We are going to go virtual and see if we can still have a great impact on our great Senators in this state.  We are so lucky to have some amazing educators that are going to help  us get this off the ground and will have many more students that can hop on group sessions to interact.

Legislative day will be held on February 9, 2020.  I think we will be using Zoom as our platform, but not completely sure of that at this point. We don’t have all of the specifics for times yet, but it will be in the morning as always to make it easy on our students and Senators who are used to the morning time for this event.

I am hoping we will be able to have some of the non-student active membership attend as well.  If you are interested please let us know so we can send you an invitation and link.

Regards,

Julie Steinmeyer

[email protected]


Athletic Training Update

The Nebraska Chapter continues to work with the Nebraska Athletic Trainer Association to assist them in preparing their bill to submit to the legislature for an expanded practice act.  They are seeking an expanded practice act where they are not limited to just athletes that can benefit from their services but the general population.  The Nebraska chapter has worked with the APTA and as a result the APTA is working directly the National Athletic Training Association in developing a consensual joint legislative principles  document.  We will share once it is approved by both associations.  Right now,  we are working with the athletic trainers and the Nebraska Medical Association in defining physician guidance.  As you know, athletic trainers currently work under the guidance of a physician when working with athletes but trying to figure out what that means with an expanded patient population with co-morbidities.  We will continue to keep you updated.  I want to thank our ATC Practice Act Task Force members – Mark Bertch, Terry Grindstaff, Kirk Peck, Teresa Cochran, Julie Steinmeyer, and Michael Witte for their time and guidance. 

Grace Knott, President, APTA NE

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Series: A Day In The Life

One Day in the Life of a SNF Therapist During the COVID-19 Pandemic

As I walk into the building, I start the daily routine of hand sanitizer, apply my N95 mask and goggles, walk over to get my temperature taken and answer COVID screening questions.  If it is one of our twice a week testing days, I then go directly to get tested and anxiously wait for the next 15 minutes in my office.  I am praying no one comes to my office, as that means the results of the rapid test were positive.   

I start my schedule for tomorrow. “Shoot, I have to redo it,” I think to myself. I forgot that patient will be in the green zone tomorrow and we have to schedule green zone, then gray zone, then yellow zone to reduce risk to all of our patients.  I am our Rehab Program Coordinator, so I have both administrative and clinical duties.  I attend the facility daily stand up meeting….have any guests come up with a  positive test which will move them to the red zone, are there any patients coming out of the red zone today that I need to assure are screened tomorrow if they are not already on therapy services, how many admissions might we get today.  Next, I try to get the best idea I can of potential staffing needs for tomorrow and send it out to the therapy team. 

I start seeing patients for the day, but I am frequently interrupted with various things while I am performing patient care.  A team member in the facility tested positive, and all of a sudden we have more guests in our yellow zone… “Shoot I already worked with one of them, but I still have green zone guests on my schedule as that patient was in the green zone.”  I have to communicate immediately to the team, so that we can try to rearrange schedules as soon as possible for the day. 

I walk in to see my next patient, who hasn’t been able to leave her room for 25 days as her yellow zone keeps getting extended due to another patient or a team member having a rapid test show a positive result.  The patient has dementia, so trying to only work in the room is very challenging.  She needs proactive care, so I continue to work with the nursing team to advocate for her.  She needs help eating as she loses concentration on the task after only a few bites.  She can’t have a family member here to help her eat her meals, but the nursing team cannot always sit in there for the length of time it takes her to eat.  I know I am likely not seeing this patient’s normal behavior, because this is not a normal situation, but I also have to make discharge recommendations based on what I see during her sessions.

Today, when I’m done with work, I’ll go see one of my long term care residents.  We’ve worked together doing rehab a lot.  She recently finished her 20 day COVID quarantine during which she didn’t get any rehab.  She did pretty well, but needed more therapy when the isolation was over.  Tonight, I’m doing her nails.  She hasn’t seen her husband, except through the window in months, even when she had COVID!  A very unprofessional manicure is just a little thing I can do to brighten her spirits. Many of our long term care residents that have not seen their loved one except on the other side of a window for over 8 months now.

So, at the end of the day, I remind myself of the things to be thankful for.  I am thankful for the patients and families that entrust myself and our team to care for their loved ones in these very stressful times. I am thankful that I am able to work, as many have lost their jobs due to the current pandemic.  I am thankful that I get to go home to my family and see them every day.  I am thankful for the team that I am blessed to work with. We are always there for each other when someone needs to talk or have a moment to break down because of this stressful situation that we are all in.

Danielle Ward-Baughman PT, DPT

Board Certified Geriatric Clinical Specialist

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