Thank You For Attending Well-Timed Legislative Impact Day

Thank you to all the PTs, PTAs, PT students and PTA students for attending the PTWA Legislative Impact Day on January 26! And thank you to those who did their part from afar by contacting their legislators regarding our legislative issues for the 2017 Legislative session. Our presence in Olympia was well timed as our Licensure Compact bills (SB 5191 and HB 1278) were heard in the respective healthcare committees that week and our Years of Service bills (SB 5283 and HB 1374) will be heard in their respective appropriations committee meetings this week and next.

 

This year we offered continuing education as a secondary benefit of coming to Olympia. Members learned about how to get your spinal manipulation endorsement and heard prior authorization updates from Jim Freeburg from the Office of the Insurance Commissioner.

 

Please continue to follow the legislative process and interact with your legislator. Your involvement is critical this year and for the long haul. You demonstrate a level of professionalism that demonstrates your commitment to our profession and clients/patients of Washington state.

 

Thank you to our Legislative Impact Day sponsors.  Your example of leadership and support is outstanding and appreciated.

 

Our hard working and smart lobbyist Melissa Johnson continues to guide and assist us in our legislative efforts.  She paves a smooth path for our access to legislators. 

 

And lastly, thank you to our PTWA staff for their excellent organization and commitments to membership.

 

Watch for continued updates from Melissa during the legislative session and stay engaged throughout the year!  Your connections and expertise does matter.

Erik Moen

PTWA President

The Skinny on Sarcopenia

One definition of sarcopenia by Santilli et al1, states: Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength and it is strictly correlated with physical disability, poor quality of life and death. Risk factors for sarcopenia include age, gender and level of physical activity.

To diagnosis sarcopenia three of the following need to be present:

  • HR >84 bpm at rest
  • Orthostasis: a decrease in systolic 20 bpm or diastolic 10 bpm within three minutes of standing compared to sitting or supine
  • Muscle weakness: a general 3/5, no specific muscle group
  • Impaired mobility: need assistive device, need assist with bed mobility, difficulty with transfers
  • Heart rate increases 10-20 bpm with verbal exam
kele-murdin

Kele Murdin

As PTs we should be drooling at this. All of these are WELL within our scope to treat and VERY treatable! Treatment of deconditioning typically targets activity HR 20 beats greater than resting (light load). And remember to educate your patients to be patient as recondition takes two times longer than deconditioning.

Ikezoe2 found that older adults need knee extension force of 45 percent of their body weight and sit to stand of 5.6 times in 30 seconds to retain their ability to walk independently.

There is a wealth of research to support the benefits of low intensity strength programs that improve knee extension strength and functional mobility in frail older adults. Westoff3 demonstrated significant strength increases using these parameters: one to three sets of four to eight reps, with one minute rest, using TheraBand and using criteria that when they can perform three sets with good form to increase load.

Sarcopenia cost over 18 billion dollars in healthcare costs per year.  We as PTs have the power to impact that and significantly improve the quality of life of our older adults! What a great job we have!!

Kele Murdin, PT
Geriatric Certified Specialist
Geriatric Training Certification
Certified Exercise Expert for Aging Adults

References:
1) Santilli V, Bernetti A, Mangone M, and Paolone M. Clinical Definition of Sarcopenia. Clin Cases Miner Bone Metabv. 11(3); Sept-Dec 2015. Published online 2014 Dec 10.
2) Ikezoe, et. al, Muscle Strength and Muscle Endurance Required for Independent Walking in the Elderly. Journal of Physical Therapy Science. 9(1):19-22. January 1997. DOR 10.1589/jpts9.19
3) Westhoff M, Stemmerik L, Boshuizen H. Effects of a Low-Intensity Strength-Training Program on Knee-Extensor Strength and Functional Ability of Frail Older People. Journal of aging and physical activity. 8(4):325-342. October 200. DOI: 10.1123/japa.8.4.325

 

We Are Moving

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Jim Rivard

Vision statements are typically born of small groups with big passion. Brainstorming, discussing, wrestling, and finally writing a statement of direction for the future – a vision. A vision statement is something not yet achieved, not a description of what is already. A vision may never be achieved, but defines the work and energy of the organization moving forward.

In 2013, the APTA adopted a new vision: Transforming society by optimizing movement to improve the human experience. The APTA as an organization, and physical therapy as a profession, has much work ahead to achieve this ambitious vision. I have had the pleasure and pain of spending time in different groups and task forces pounding out strategic plans and visions. Often the hard work of these small groups is lost in translation when attempting to have the larger body adopt the vision and move toward steps of implementation. The APTA is putting equal energy behind their new vision, with the most recent being The Movement System Summit held near the home office December 8-10, 2017.

 

The Movement System Summit involved 100 therapists stuffed in a room for three days in a collaborative discussion and debate as to the implementation of The Human Movement System as a primary tenet toward achieving the APTA’s vision statement. A safe and open environment of discussion, debate and dissention was established and maintained throughout the meeting, allowing all voices, thoughts and opinions to be heard. As president of the American Academy of Orthopaedic Manual Physical Therapists, I was invited to attend this summit. This is not to establish my credentials, but more to exemplify the inclusiveness of the group, having representation from within and outside of the APTA. Every corner of the profession was represented, including several students. The diversity in brain function—listening, critical thinking, communication—across the room was remarkable. Regardless of where you place yourself in the diverse landscape of physical therapy, you had fair representation. That said, having 100 physical therapists agree on anything related to the profession is unrealistic. Thankfully, lunch had been previously decided upon and was not open to debate.

So, what exactly is the Movement System? The definition is a moving target (pun intended). Currently it stands as follows: The movement system is the term used to represent the collection of systems (cardiovascular, pulmonary, endocrine, integumentary, nervous and musculoskeletal) that interacts to move the body or its component parts. The overall intention is to brand physical therapists as movement specialists that are the go-to profession for addressing the Movement System. We are the profession with a unique set of skills to define and own this area within the healthcare system. If we cannot define our advanced clinical skill set to the consumer and medical profession, we risk being replaced by a less expensive, lower-quality product to address movement and performance.

If you were mentally challenged by the naming of a “new system” that encompasses these other systems, then include yourself in minority group of participants (including myself) that pushed to remove the word system but continue with the concept. But semantics aside, bringing all branches of physical therapy together with a common language for defining, describing and evaluating movement is a worthy goal. For example, an imaginary line between orthopedic and neurologically trained PTs would be replaced with a common training and language to define basic movement. Those participating at the summit attempted to create a basic short list of movements, regardless of specialty, that all therapists could assess and describe. A branding shift toward movement specialists would place the focus on our ability to evaluate and restore these movements across a wide variety of clinical presentations. Movement could then be assessed by an annual visit to a physical therapist, much as with an annual dental exam, to identify movement impairments and potential interventions. The preventative approach could go a long way toward “Transforming society by optimizing movement to improve the human experience.”

The summit’s objectives:

  1. Describe the history and development of the term “movement system” as the identity
  2. principle with the APTA’s new vision. (You can read more on the APTA’s website at: Movement System).
  3. Develop a common understanding of the definition of the movement system and the role of physical therapy in the movement system.
  4. Identify the potential benefits of integrating the movement system in physical therapy education, research and practice.
  5. Discuss the movement system as it relates to both ICF language and the patient‐client management model in the Guide to Physical Therapist Practice.
  6. Begin to identify essential activities that should be included in the patient/client examination for assessment of movement performance and the criteria for how to measure these.
  7. Agree upon criteria for adopting or promoting movement system diagnostic labels.
  8. Describe the implications of using movement system diagnostic labels, including selection of treatment options, communication with other professionals, clinical documentation, reimbursement, education and research.
  9. Develop an action plan for the integration of the movement system into practice, education, research. This document will be a recommendation to the APTA Board of Directors.

Further discussions revolved around the need for movement system diagnoses. A collaborative lecture between physical therapists and an orthopedic surgeon colleague established a much easier consensus on removing terms such as shoulder impingement from the list of diagnoses we use, as they are inaccurate, often describe nothing and are often too vague to directly assist in establishing an intervention. The need to establish a movement diagnosis instead, that better describes the impairments leading to the symptoms of an impingement, did cause more spontaneous movements of heads nodding up and down. What replaced this nodding with cervical paralysis and reflexive oral expulsion was the intention of replacing all pathoanatomical descriptions for diagnosis with movement-based diagnosis. As the gloves came off, and the once cordial discourse was replaced by factions of dissention, the challenge of the broader strokes of this fundamental shift in the branding of our profession became more apparent. The diagnosis of shoulder impingement, having many causes, does little to establish a frame of thinking for intervention. Likewise, cerebral palsy as a diagnosis provides nothing in the clinical frame for which a clinician can make decisions for intervention. The insertion of classification schemes has attempted to address this clinical conundrum. One of the many arguments for maintaining the pathoanatomical description is that physical therapy has a long history of specific intervention to address specific tissue pathology. Influencing collagen repair, bone density and healing, as well as cartilage lubrication, has a long history in physical therapy. The arguments at the summit to maintain both the movement and pathoanatomical diagnoses then moved to which one would be first. As you re-read this paragraph, and your head begins to ache, it may occur to you how we create movement-based diagnoses and intervention when there is only pain, or normal walking for only short distance, or the patient presents with a wound. The last day of the summit did not ignore these issues but dug in, attempting to lay out a working plan to address them all.

The analogy for the Movement Summit was moving from sea level to summiting a mountain. It was obvious after three days that we had gained some altitude but there is much more to address to make it over the hill with this movement systems concept. We only scratched the surface on professional interaction between disciplines, organization and countries. Billing, coding and reimbursement would also need to see a significant overhaul.

If you have made it this far in reading you have demonstrated the grit required to be engaged in this process. The APTA has provided all the details and progress on this issue on their website, and is asking for comments, input and energy. The APTA is not some outside body, it is made up of all of us. We are the APTA. The leadership of the APTA is leading, and should be commended for thinking boldly. We have an opportunity here to better define who we are and what we do, finding better ways to message and deliver this to both colleagues and clients. Regardless of how you currently feel about this issue, acceptance is the key; this is happening. If all participants in the summit were honest, they would admit entering with a little bias on the issue. Maybe there was even a little confirmation bias in how some of us prepared for the summit. But all participants left with a broader understanding of the issues we face and how they affect all corners of the profession, not just within our own bubble.

You can elect to sit as we Move Forward, but we are stronger with all voices. Move with us.

Jim Rivard, PT

Doctor of Manual Therapy
Orthopedic Clinical Specialist
Fellow of the American Academy of Orthopaedic Manual Physical Therapy
AAOMPT President

New Year Starts with a Bang for Many Reasons

Happy New Year.

 

A lot happened in 2016 to say the least. My office started the new year with a new EMR and the utilization of the new evaluation codes. I am thankful to our American Physical Therapy Association for the resources they have been providing on these codes since September. We at PTWA have been updating you with links to these great resources.

January always starts with a bang as it coincides with our state’s legislative session. This year is a long session for our legislators. We will be hosting our annual Legislative Impact Day (LID) on January 26th at the Capitol in

Erik Moen_EditedOlympia. I would strongly encourage you to attend. The legislative session is the culmination of year-round work to assess need, create language and gain legislator support. Our most pressing issues this session include the areas of interstate licensure compact, public school system years-of-service credit and continued work with prior authorization. Our legislative efforts are not limited to these three issues. We have other items our Legislative Committee is working out with their year-around process, including work on the scope of assistive personnel. Our legislative work is crucial to the practice of physical therapy within the state of Washington. Legislative work is truly that…work. It takes time, relationships, working for consensus..and did I mention time? Your involvement with this process should be one of your personal prioritized professional duties. It can be as simple as getting to know who your district legislators are and being able to articulate how their work affects our/your profession.

Still feeling a little lost?  I would ask that you attend the PTWA LID. Not only will you gain a greater appreciation for Washington state’s legislative process, you will get to know your legislators with peers from your district and have the opportunity to gain some CEUs in the process. PTWA will host concurring complimentary CEU opportunities during this year’s LID. This will allow you the ability to further your professional obligation for licensure requirements.

I would like to thank the members of the Legislative Committee for their year-round work. This committee is always open for volunteers to join the ranks. Has your legislative fire been lit? An obvious opportunity awaits for you on the Legislative Committee and/or Legislative Impact Day on January 26th. I look forward to seeing you all on January 26th in Olympia!

Erik Moen

PTWA President

Helping Others, Simplicity the Hallmarks of PT at Seattle King County Clinic

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From left: Physical therapists Andi Love and Mandie Majerus

My name is Andi Love. I am a physical therapist and owner of Salmon Bay Physical Therapy in Ballard. My husband and I work hard to make sure our clinic is involved in charitable events. Every year we have food drives, make Thanksgiving baskets and participate in YWCA’s adopt-a-family. I love to see how our wonderful community gets behind these events to help those in need. Lately, however, I’ve had the feeling that there is more that I should and can do, as a human, a community member, and as a PT. That is why on Saturday, October 29 I volunteered at the Seattle King County Clinic at the Key Arena.

Seattle’s free clinic is one of the largest in the country. Due to the persistence of Matt Currier, PT, of Group Health, physical therapy was included this year for the first time. I learned of the clinic via an email that circulated through the close knit Seattle physical therapy world. I responded with an emphatic “YES.” However, the unknown started to make me nervous. Salmon Bay PT is a small, outpatient orthopedic clinic. Would I be treating wounds?  Amputees? What if I couldn’t provide the best care for people who were seeking my help?

The clinic is run like a well-oiled machine. There are people who line up the night before to get in for care the following day. If they don’t get to everything they need, they get back in line for the next day. The treatment areas are set up in suites. There are clinics from PT, to blood labs, to HIV testing to acupuncture. The floor of the arena seemed to be all dentist’s chairs with the hum of constant drilling in the background.

As physical therapy was new to this venue, we only had one suite with two massage tables. The day I was there, we were a team of four for most of the afternoon. We were cramped, but we made do. We would share the tables, treat on the floor, or treat people out in the hallway. We routinely had a line of five to eight people waiting for treatment. Towels, Theraband, reflex hammers, mobilization belts and all other equipment was brought by the volunteering therapists.

We saw everything from old spinal-cord injuries to low back pain to sprained ankles. Most of the people I saw did not have insurance and those who did, could not afford the deductible. A good percentage of the people I saw needed an interpreter. 100% of the people I saw were kind and so so grateful for what we were doing. The toughest part was not handing over my card and telling these people I would just see them for free. Forever. (Because I wanted to.)

Physical therapists have a gift to give people. We aren’t offering a passive treatment. Every person who walked into that room, including their family members, was educated about how to help themselves. While I referred many to social work for future care, everyone went home with stretches, exercises, stick figure drawings, posture instructions – something that they could do for themselves. On Saturday, we had so many people who wanted to get into PT, that they closed the line early because the wait was so long.

My hope for next year is that we have so many therapists who volunteer that we get the same four to five treatment rooms that the acupuncturists and chiropractors had. I hope we get one treatment table per volunteering PT. I hope that we don’t have to close the line early and turn people away because we don’t have enough PTs to handle the volume of people who need our care. I hope that there is a waiting line of PTs who want to volunteer their time. I hope that all volunteers can work without judgement or questions in order to give this community the care they need.

To end, I would like to thank Matt Currier, PT, once again for seeing the need for us to be there and fighting to get PT included. He was there all day, every day from Thursday through Sunday. Because of Matt, I know we will have a bigger presence next year!

And from Andy Lodato:

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From left: Physical therapists Matt Currier and Andy Lodato

The Seattle King County Clinic (SKCC) is the biggest free medical clinic in the country. The event encompasses four days and provides various services to the uninsured and underinsured in the area. For the first time (thanks to Matt Currier), physical therapy was a service provided during this clinic. I had the privilege of volunteering for the first day of the clinic on October 27th.

It was an amazing experience to volunteer and provide a needed service to so many who were so grateful we were there. I could probably ramble on for days about what the experience was like for me, but I felt there were three overriding themes to my day volunteering:

  1. Helping Others – At one time or another, PTs ultimately get the question: “Why did you want to get into physical therapy?” Typically, that answer circles around to the desire to help others. That theme has stuck with me for the past 16 years, but through the other requirements of the profession, it can get lost. All of the other outside noise such as PQRS, pre-auth, productivity, etc. can get in the way of what this profession is really about – which is helping others. My volunteer time at the SKCC brought home why I do this for a living. Shuffling in patients every 20-30 minutes and providing them with an exercise, a little education or a little motivation without the administrative burden our normal clinical life was profoundly powerful.
  2. Simplicity – Since it was the first time for PT, there was no script or template of equipment to provide, resources available or how we were going to manage the workflow. We literally had zero equipment other than two treatment tables. We documented everything with pen and paper. My world famous stick figure drawings translated well for HEPs. It was a nice break for a day to step away from the EMR system and to use just my head and hands to provide care to so many.
  3. Everyone has a Story – I was blown away by the stories of our patients on that day. 90 percent of our patients had full time jobs where it was cheaper for them to take an unpaid day off to receive medical care than to use whatever insurance they had. Many of our patients were in line at 4 a.m. to reserve a spot, some were in line from midnight. We got so backed up, that some patients waited 30-40 minutes to be seen. Each of them was grateful for our services and for volunteering our time.

It was a long day of treating patients (11 hours to be exact), but it flew by. After the end of the weekend I spoke with Matt and PT treated 174 patients roughly providing around $30,000 of free care. I would encourage anyone who is interested to volunteer at an event like this one, it is a great way to give back and to grow as a PT.

State of the Association 2016

I would like to start by thanking you for your professional membership and your commitment to professionalism. Your commitment to professionalism matters; it does make a difference.

PTWA has had an eventful year. Many hands have helped with “the lift.”

Our Accomplishments
We’re #3! Each year APTA ranks states in the United States regarding which is the best Erik Moen_Editedstate in which to practice physical therapy. We are on the rise from last year’s ranking of 11.

We had a record number of conference registrants in Tacoma this year. Our conference had diverse educational offerings with excellent speakers. This year’s conference featured a new Student Conclave. APTA President Sharon Dunn kicked off the Student Conclave festivities. It was a thrill for the students. Studies show that engaged students and new professionals stay engaged in professional associations. We felt a Student Conclave was well worth our professional investment. Ten of the students were “sponsored” to attend the Friday night WPT-PAC party.

This is the first full year after the rule-making for spinal manipulation was finalized for PTs in the state of Washington. This has been a long and drawn out task. Your prolonged commitment to the process paid off.

This was the first year that the PTA had a full vote in elections and at our state conference. No more half votes to count.

We have had many of our members/leaders representing us at APTA meetings including the federal and state legislative forums, the membership conference and the house of delegates. These volunteer efforts on your behalf have been invaluable to ensure Washington is up to date with national trends and initiatives. You benefit from this as a member of PTWA.

You should also know that your PTWA leaders are highly respected on the national scene.  They are task force members, committee members, directors, invited speakers and much more.  Their knowledge and skills are at the front of the APTA.

PTWA has held numerous district meetings and webinars. These meetings and webinars have included CEUs for sports/ortho, pediatrics and admin. This is a membership benefit for your continuing education efforts.

We have had numerous meetings with state and federal legislators on your behalf. These have included a recent King County District Town Hall meeting with multiple legislators, a fundraiser for Representative Eileen Cody hosted by Sound PT, attendance at fundraisers for Governor Inslee, Congressman Heck, Senator Becker and the new Democrats (multiple federal legislators). These behind the scenes work benefits you by making legislative relationships that benefit the profession of physical therapy.

Our Unexpected News
We received news from the Department of Health (DOH) regarding the Sunrise Review of dry needling. It was not positive. PTWA and members have sent in rebuttals to the draft summary.  It should go without saying that tireless and voluminous work has gone into this effort. Stay tuned and be prepared to engage when the time is right. You can become involved. Join our Legislative Committee and Dry Needling Task Force for future work regarding this issue.

Our Goals
It wouldn’t be physical therapy without having goals.

We as a state association need to regrow our financial reserves. We will be evaluating opportunities to increase our non-dues revenue and membership.

New evaluation codes go into effect January 1, 2017. APTA will keep you up to date with code implications and their appropriate use in your practices.

Payment:  if we don’t get paid, we can’t run businesses. We will continue working toward legislative initiatives and collaboration with third party payers. We want to ensure that our patients can have access to the care they need and that we as professionals are compensated fairly for our evidence-based interventions.

We will be pursuing the licensure compact legislation in this upcoming legislative session. Our neighbors in Oregon were the first state in our nation to pass this legislation. We hope to join them as early adopters. This benefits our state as early adopters will be part of the rule making process right from the beginning.

We are committed to our school-based physical therapists. We are supporting legislation to ensure they are compensated fairly for their years of service. This will help ensure our children in state-funded schools will get the care they need to successfully navigate their education experience.

PTWA will petition the DOH to add PTs to the Health Professional Conditional Scholarship Program (RCW 28B.115). This program encourages health care professionals to serve in shortage areas. This is currently offered to medical students but we will work to make this available for PT students too. This is a non-legislative process that can be requested through the DOH. This idea came from a recent discussion with a state senator.

We encouraged you to participate in National Physical Therapy Month and PT Day of Service. PTWA hosted the exhibition of falls prevention exercise programs at our recent conference as a means of providing members with some ideas to promote #healthyaging and #ChoosePT. Please share your PT Day of Service and PT month activities with PTWA. We would like to feature and celebrate your efforts.

PTWA will provide suicide assessment training this coming spring 2017. Suicide assessment training is now part of your license requirement.

I would like to recognize the excellent efforts with regards to our PTWA staff. They are excellent, creative, resourceful and incredibly hard working.  Please meet them and thank them for their work.

We thank you for your membership and your commitments toward being excellent health care professionals in the state of Washington and beyond.
Sig_Erik-Moen_First-Name-Only
Erik Moen PT
PTWA President

What Emilie Said About PTs Performing a Singular Technique – Dry Needling

PTWA Legislative Committee Chair Emilie Jones delivered this eloquent testimony during yesterday’s dry needling sunrise review at the Washington State Department of Health.

My name is Emilie Jones and I’m a physical therapist and legislative chair for PTWA.

We are here today to discuss whether physical therapists can perform a singular technique – dry needling.

In the American Academy of Medical Acupuncture’s website, Dr. Joseph Helms describes acupuncture as “one discipline extracted from a complex heritage of Chinese medicine – a tradition that also includes massage and manipulation, stretching and breathing exercises, and herbal formulae.” Physical therapists do not desire to perform acupuncture. We do not want to treat patients for allergies, stress, fatigue, poor digestion, menstrual discomfort, hormonal issues, ileus, asthma, hiccups, constipation or sleep disorders.  These patients are not seen in our practice.

Acupuncture is a well-respected profession with a long history and extensive body of knowledge.

We do not ask massage therapists to go to physical therapy school to perform manual therapy techniques.

We do not ask phlebotomists to go to nursing school to puncture veins.

We do not ask nurses or medical assistants to go to medical school to give injections.

None of these practitioners are performing acupuncture when they insert a needle into a patient’s arm to give them a TB test. They do not know whether they are interacting with an acupuncture point when they do this.

Physical therapists do not need to go to medical acupuncture school to perform a single technique just because the tool is the same. We desire to use our extensive background in anatomy, physiology and manual treatment techniques to assist the patients we are already treating with myofascial trigger points to get better, faster. This is allowing patients to receive care in the model they choose, helping the most patients by improving their access to care, and  help us provide the most effective care to our patients with neuromuscular dysfunction.