PT in Motion

8/13/2019 PT in Motion

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|June 2012

Beyond2020PhysicalTherapy

Electronic Billing RulesFighting Fraud & Abuse Sparking STEM Interes


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http://link.argifocus.com/322-6


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P T i n M o t i o n m a g . o r g2 J u n e 2 0 1 2

J u n e 2 0 1 2 , V o l 4 N o 5

Searching for BillionsFledgling and Foreseen Science and Technol-

ogy

16 Virtual Realities: Visions of Science,

Technology, and Physical Therapy Tey are conceivable, coming, or already here. Find out what edgling

and foreseen advances await in science and technology, and how theymay affect the physical therapy profession of tomorrow.

24 Fighting Fraud and Abuse In Physical Therapy One P nearly lost his business after a Medicare audit found a 99%

error rate. Another P resisted extreme pressure to get on board andcommit fraud. Tey and others tell their stories and share what otherPs can do to practice legally and ethically.

34 Generation STEM Teres a national effort to encourage more studentswomen and girls

in particularto study science, technology, engineering, and math. Howmight this affect physical therapy? What roles are Ps playing now?

2012 by the American Physical Terapy Association (APA). PT in Motion(ISSN 1949-3711) is published monthly 11 times a year, with a combined December/January issue, byAPTA, 1111 N Fairfax St, Alexandria, VA. SUBSCRIPTIONS:Annual subscription, included in dues, is $15. Single copies $20 US/$25 outside the US. Individual nonmember subscription$85 US/$100 outside the US ($150 airmail); institutional subscription $105 US/$130 outside the US ($180 airmail). No replacements after 3 months. Periodicals postage paid at Alexandria,VA, and additional mailing offi ces. POSTMASTER:Please send changes of address to PT in Motion, APTA Member Services, 1111 N Fairfax St, Alexandria, VA 22314-1488; 703/684-2782.

Available online in HTML and a pdf format capable of being enlarged for the visually impaired. To request reprint permission or for general inquires contact: [email protected].

APA is committed to being a good steward of the environment. PT in Motionis printed using soy-based inks as dened by the American SoybeanAssociation, is packaged using recyclable lm, and uses Cadmus Communications, a Forestry Stewardship Council-certied supplier that recyclesunused inks into reusable black ink, recycles all press plates into aluminum blocks, recycles all manufacturing waste, and purchases ink from suppliers

whose manufacturing processes reduce harmful VOCs (volatile organic compounds).

24

STEMming a Science Imbalance

16 34

Cover Image:Masterle Royalty-Free


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J u n e 2 0 1 2 , V o l 4 N o 5

44 Version 5010: A New Standard for Electronic Billing Readiness assistance for the impending transition.

48 Shop Treatment

A special delivery that gives pause.

52 Woman on a MissionTe many benets of volunteering abroad.

68 Upon Examination Hands-on work, hands-down results.

columns and departments

columns

Compliance Matters 44

Ethics in Practice 48

PTAs Today 52

This Is Why 68

departments

PT Resource

Health Care Headlines 8

Practice Partner 10

Research Roundup 12

The Funny Bone 12

Data Points 14

Continuing Education 58

Career Opportunities 62

Marketplace 64

Index to Advertisers 66

Five Managerial Myths

10

Helping Abroad

48


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DISCLAIMER:Te ideas and opinions expressed in PT in Motionare those of the authors, and do not necessarily reect any position of the editors, editorial advisors, or the AmericanPhysical Terapy Association (APA). APA prohibits preferential or adverse discrimination on the basis of race, creed, color, gender, age, national or ethnic origin, sexual orientation,disability, or health status in all areas including, but not limited to, its qualications for membership, rights of members, policies, programs, activities, and employment practices. APA iscommitted to promoting cultural diversity throughout the profession.

ADVERTISING:Advertisements are accepted when they conform to the ethical standards of APA. PT in Motiondoes not verify the accuracy of claims made in advertisements, and pub-lication of an ad does not imply endorsement by the magazine or APA. Acceptance of ads for professional development courses addressing advanced-level competencies in clinical specialty

areas does not imply review or endorsement by the American Board of Physical Terapy Specialties. APA shall have the right to approve or deny all advertising prior to publication.

APTA Board of Directors

Officers

PresidentR. Scott Ward, PT, PhD

Vice PresidentPaul A. Rockar Jr, PT, DPT, MS

SecretaryLaurita M. Hack, PT, DPT, MBA, PhD, FAPTA

TreasurerElmer R. Platz, PT

Speaker of the HouseShawne E. Soper, PT, DPT, MBA

Vice Speaker of the HouseWilliam F. McGehee, PT, MHS

Directors

Sharon L. Dunn, PT, PhD, OCS

Jennifer Green-Wilson, PT, EdD, MBA

Roger A. Herr, PT, MPA, COS-C

Dianne V. Jewell, PT, DPT, PhD, CCS

Aimee B. Klein, PT, DPT, DSc, OCS

Kathleen K. Mairella, PT, DPT MA

David A. Pariser, PT, PhD

Mary C. Sinnott, PT, DPT, MEd

Nicole L. Stout, PT, MPT, CLT-LANA

Editorial Advisory Group

Charles D. Ciccone, PT, PhD

Gordon Eiland, PT, MA, SCS, ATC

Chris Hughes, PT, PhD, OCS

Elizabeth Ikeda, PT, MS, OCS

Benjamin Kivlan, PT, MPT, SCS, OCS

Peter Kovacek, PT, DPT, MSA

Robert Latz, PT, DPT, GCFP

Tannus Quatre, PT, MBA

Keiba Lynn Shaw, PT, MPT, EdD

Mike Studer, PT, MHS, NCS

Sumesh Thomas, PT, DPT

Mary Ann Wharton, PT, MS

American Physical

Therapy Association1111 N Fairfax StreetAlexandria, VA 22314-1488

703/684-2782 800/999-2782

[email protected]

Association Staff

PublisherLois Douthitt

Vice President for CommunicationsFelicity Feather Clancy

Director, Art Department

Barbara Cross

Chief Executive OfficerJohn D. Barnes

Advertising ManagerJulie Hilgenberg

[email protected]

Magazine Staff

EditorDonald E. Tepper

[email protected]

Associate EditorEric Ries

[email protected]

Production ManagerPrint andDigital MediaSuzanne B. Kitts

[email protected]

Art Director, PT in MotionAlden Escobar

[email protected]

Advertising Sales Office

Ad Marketing Group2200 Wilson Boulevard, Suite 102-333

Arlington, VA 22201-3324

Product Display AdvertisingJane Dees Richardson, President

703/243-9046, ext 102

[email protected]

Recruitment and Course AdvertisingMeredith Turner

703/243-9046, ext 107

[email protected]


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COMING THIS MONTH

PT in Motion EXTRA

PT in Motion Extra debuts in June with

a digital-only, special edition of APTAssuccessful print publication PT in Motion.

Designed to reach youwhenever you want, wherever you are,

this cutting-edge digital edition will remind you of the print experience

youve come to love, combined with the best technology has to offer.

PT in Motion Extrabrings content to life with animation and

interactivity and puts the motion inPT in Motionfor a unique

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Enjoy these periodic special editions on any device including

desktop computers, tablets, e-readers, and mobile phones.

PT in Motion Extra a special delivery

coming to your inbox in June.


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HealthCareHeadlines


PTResource

Wellness Programs SpreadingEver more employers are instituting wellness programs,

according to a Willis North America survey. Sixty percentof the more than 1,200 employers surveyed in the2011Willis Health and Productivity Surveyreported having someform of wellness program in place. Thats an increase from43% in 2010.

The survey also found an increase in the number of com-panies using aggressive wellness tactics such as health riskassessments, biometric screenings, and financial incentives,particularly among midsize employers. Forty-nine percent of

companies with fewer than 1,000 employees characterized theirwellness programs as intermediate or comprehensive, com-pared with 37% in 2010.

The 2011 study alsofound more employersoffering cash and otherfinancial incentivesbased on program par-ticipation and comple-tion of certain activitiesor fitness goals. Fortypercent of respondentsoffered cash rewards tied to completion of a health risk assess-ment, up from 33% in 2010. Further, 41% offered reductions

of employee health care premiums in exchange for completionof a biometric screening, up from 20% in 2010.

More info: http://www.businessinsurance.com/article/20120403/NEWS03/120409977

Staffing Overtakes Finances as Top Barrier toHospital IT Implementation

Staffing resources has overtaken financial support as the topbarrier to health care information technology (IT) implementa-tion, according to a recent survey of health care IT executives.The survey, conducted by the Healthcare Information andManagement Systems Society, is based on 302 responses frominformation officers representing more than 600 hospitalsacross the United States.

For the past several years, survey respondents had identi-fied inadequate financial support as the top barrier to IT

implementation. However, 22% of respondents in the currentsurvey cited inadequate staffing resources as their top challenge,followed by inadequate financial support (14%) and vendorsinability to effectively deliver products or services to respon-dents satisfaction (12%).

Fewer than 1% of respondents indicated that laws andregulations prohibiting technology sharing with referring pro-viders was a barrier to IT implementation. None indicated thatan inability to secure data was a barrier to implementation.

More info: www.himss.org/2012SURVEY

40%CashReward

Phantom Publications in Medical ResidencyApplications Rising

Researchers studying 804 applications for plastic surgeryresidency from 2006 to 2009 found that 14% of peer-reviewedjournal articles listed on those applications could not be veri-

fied. Researchers also found an overall significant positivetrend in the percentage of phantom publications during the4 application years (p=0.005).

Researchers used the Electronic Residency ApplicationServices database and extracted applicant demographicinformation and listed citations. Researchers verified thepeer-reviewed journal article citations using methods includ-ing PubMed, Institute for Scientific Information Web ofKnowledge, and Google. Unverified articles were categorized asphantom publications and then evaluated with respect to appli-cant demographic information and characteristics.

Two hundred seventy-six (14%) peer-reviewed publications

could not be verified and were categorized as phantom publica-tions. In addition to identifying a growing trend in phantomarticles, the researchers found the more publications listed byan applicant, the greater the likelihood of phantom publica-tions. A negative predictive factor for phantom publications

was being a female applicant (p=0.03). On the other hand, apositive predictive factor was being a foreign medical graduate(p=0.02).

The researchers concluded, Program directors and facultyare advised to scrutinize listed publications carefully whenevaluating applicants.

Chung C, Hernandex-Boussard T, Lee GK. Phantom publications among plastic surgeryresidency applicants.Annals of Plastic Surgery. 2012;68(4):391-395.


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PTResource

The 5 Myths of ManagersHave you recently been tapped on the shoulder and told

you are management material because you are high per-former? If so, are you really passionate about becoming a man-ager? Your decision to become a manager is an important onebecause management requires a different set of skills to performa different type of work. As you ponder your next possiblecareer move, here are a few things to consider:

Myth #1: The teams highest performer is the most

qualified to become the manager.Reality:Its common for high achievers in physical therapyto be promoted to management positions. And its good prac-tice to ensure that high performance is a pre-requisite for anypromotion. But high performance shouldnt be the only crite-rion. Quite often, new managers become frustrated when theydiscover that the same skills they used to perform well as indi-vidual contributors dont work when it comes to managing oth-ersespecially their former peers. Clearly, a managers successdepends on a different set of skillsparticularly people skillsand the ability to connect with people in different ways.

Myth #2: A manager is a reflective,methodical planner.

Reality:The average manager is buried by trivialities andday-to-day crises, and must multi-task frequentlysometimesspending mere minutes on any taskthroughout the dayjustto keep the day-to-day operations moving forward.

For 10 years researchers studied the behavior of busy man-agers in nearly a dozen large companies. Their findings on

managerial behavior showed that 90% of managerssquander their time in all sorts of ineffective

activities. In other words, a mere 10%

of managers spend their time in acommitted, purposeful, and

reflective manner.1

Myth #3: Effective managers can find theinformation they require.

Reality:Managers dont always have access to the informa-tion they need. In surveying 1,000 middle managers of largecompanies in the United States and United Kingdom, 59%miss important information almost every day because it existswithin the company but they cannot find it.2

Myth #4: A team will see its manager as fair

ifthe manager treats everybody the same.

Reality:Effective managers adapt their approach basedon different circumstances. For example, managers should taketime to acknowledge high performers as well as provide feed-back and/or consequences to members on a team when per-formance falls below expectations. When a manager does notaddress poor performance, then often other members on theteam become discouraged and ultimately lose their motivationto perform well.

Myth #5: Most managers care onlyabout the

bottom line.Reality: Effective managers recognize that there are many

bottom lines. Ensuring that team members are satisfiedwith their work and their work environments and that theyare successful directly affects the overall success of the prac-tice or department. Therefore, the managers direct relation-shipswith each member on the team and with the teamas a wholeare critical to ensure that many bottom lineslook good.

Be prepared. Books and courses can help you get started onthe right track to becoming a successful manager, but on-the-job applied experience is invaluable. Try to gain some practicalexperience before assuming any formal management role. Take

time to observe, reflect, and learn from other managers. Youcan learn a lot by watching the good managers, as well as thebad ones, in action.

Jennifer Green-Wilson, PT, MBA, EdD

References:

1. Bruch H, Ghoshal S. Beware the busy manager. Harvard Business Review. 2002;80(2):6269.2. Wall Street Journal. May 14, 2007. Cited at www.keyorganization.com/time-management-

statistics.php

PracticePartner


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PTResource

24

18

12

6

More than

40%of

printouts arediscarded

within 24hours.

Daniel Lyons,

The PaperChasers,

Newsweek

December 1,

2009

Estimates have the

sum of all human

knowledge now dou-

bling at the rate of

every 24 months.University of Houston,

Brief History of Training

& HRD

More info: http://www.keyorganization.com/time-management-statistics.php

e

-

ston,

ing

From 1750 to 1900(150 years),

all human knowledge doubled.

From 1900 to 1950(50 years),it doubled again.

From 1950 to 1965(15 years),it doubled again.

1750Factoids: Workplace and Time Management

45%of senior executives felt

that employees would

be more productive if

meetings were banned

once a week.

OfficeTeam

,

Le

tsN

ot

Meet

,May

17,2009


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PTResource

Health Care Employment DemandRose in March

The Monster Employment Index U.S. showed annualgrowth of 5% in March, an eased pace from the 11% annualgrowth recorded in February. Demand for health care practi-tioners and technical rose 11% on an annual basis. Demandfor health care support showed an annual increase of 16%.

Commerce activity continues to maintain steady momentumwith transportation and warehousing, and retail and wholesaletrade recording solid annual growth rates. Public administrationremains the weakest, dropping 16% on an annual basis.

Sixteen of the 20 industries monitored by the index showedpositive annual growth trends. Transportation and warehousing(up 32%) remained the top growth position. Retail trade (up18%) and wholesale trade (up 13%) continued to drive growthin the index in March.

Annual online demand for workers rose in 20 of 23 occupa-tional categories in March. Transportation and material mov-ing (up 31%) registered the highest annual growth in March.Education, training, and library (down 6%) recorded the slow-est annual growth.

Meanwhile, online advertised vacancies rose 246,300 inMarch to 4,669,600, according to The Conference BoardHelp Wanted OnLine (HWOL) Data Series. The March riseis the fourth consecutive monthly rise. The supply/demandrate stands at 2.9 unemployed for every vacancy; however,nationally there are still 8.4 million more unemployed thanadvertised vacancies.

In March, 19 of the 22 Standard Occupational Classifi-cations (SOC codes) that are reported separately posted gainswhile 3 declined.

Health care practitioners and technical occupations fell

18,800 in March to 578,100. Largely responsible for thedrop were decreased advertised vacancies for registered nurses,occupational therapists, speech pathologists, and physicaltherapists. Even with the decline, job opportunities continueto outnumber unemployed looking for jobs.

The number of advertised vacancies for health care practi-tioners continues to be quite favorable and outnumbers job-seekers by 2.4 to 1 (0.41 S/D). The supply/demand ratiofor health care support is 2.0.

More information: www.monster.com and www.conference-board.com.

HLS: HealthSouthTHC: Tenet HealthcareUSPH: US Physical Therapy IncKND: Kindred Healthcare

* Last 4 quarters+Rounded to nearest dollar

Information updated: 5/3/12

Source: Fidelity Investments: Available at www.Fidelity.com

4 Finished goods, 1-month percent change5 Civilian workers, 3-month percent change

Source: Bureau of Labor Statistics, Department ofLabor. Available at www.bls.gov/eag/eag.us.htm

4thQtr

February2012

March2012

Unemployment Rate1 8.3 8.2

Change in Payroll Employment2 240P 120

Consumer Price Index3 -0.4 0.3

Producer Price Index4 -0.1R 1.3

Employment Cost Index5 0.4

* All data seasonally adjustedP Preliminary

1 Percentage2 In thousands3 All items, 1-month percent change

Economy at a Glance

Average Hourly Earnings of Production WorkersOffices of Specialty Therapists, NAICS Code 62134

2010 20112008 2009

0

5

10

15

20

25

30

24.93 25.57

Feb 2012

25.7123.38 24.57

Source: Bureau of Labor Statistics, Department of Labor. Available at www.bls.gov

DataPoints%

65.3%

2010

2020

change

62,300

103,000

PT Employment Trends 2010-2020:Offices of Physical Therapists

Source: Bureau of Labor Statistics, Department of Labor. Available at www.bls.gov

Operating MetricsOf Selected Health Care Companies

HLS THC USPH KND IND. AVG.

Income/Employee 5,218 676 8,316 -774 42,126

Revenue/Employee 93,610 154,320 93,980 75,960 1,427,630

Asset Turnover 0.89x 1.06x 1.53x 1.42x 2.02x

Receivables Turnover 9.17x 6.77x 7.89x 5.85x 14.36x

Current Ratio 1.34 -- 2.51 1.46 1.34

All data are TTM (trailing twelve months).


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20/7218 J u n e 2 0 1 2 P T i n M o t i o n m a g . o r g

Challenges await, to be sureasprosaic as equipment costs, as fraught asthe unknowable legacies of health carereform, as individualistic as the need for

PTs to accept and deftly navigate learn-ing curves, and as tricky as the profes-sions success in establishing and main-taining interdisciplinary dialogue withother health professions. But the bottomline, says Steve Wolf, PT, PhD, FAPTA,is that you cant fear changeyou mustembrace it. As a longtime and highlyvocal advocate of genomics education forstudents and PTs, the Emory Universityphysical therapy professor practices what

he preaches.Yes, the year 2020 is fast approaching.But the future already is here, PTs inter-viewed for this article say. And far fromfearing it, they revel in it. Tunik effective-ly speaks for them all when he calls thismoment in history an exciting time.

Tricks of the EyeThe purpose of Tuniks lab, to quote

its Web site, is to study the neural basesof perception and action in health anddisease, and to characterize neuroplasticchanges in patients receiving neuroreha-bilitation. Tunik rewords that descrip-tion as a multi-part question. Whathe asks, can we learn from neuroscienceabout how the normal brain works,what happens when theres a pathologysuch as a stroke or cerebral palsy, andhow best to deliver therapy based onthose findings?

The implications, as he sees it, arehuge. If we can individualize and tailortherapies to specific patients based ondeficits or lesions, isnt that the ulti-matethe Holy Grail of therapy?

Tunik is quick to emphasize thatwere not there yet. But his labwork-ing with Alma Merians, PT, PhD, andGerard Fluet, PT, DPT, of UMDNJ,and Sergei Adamovich, PhD, of the NewJersey Institute of Technologys Robot-Assisted Virtual Rehabilitation Labis

laying the groundwork. Virtual reality isemployed to, for example, create an envi-ronment in which a patient might lookat a monitor and see not his or her actual

hand, which is covered by an instru-mented glove, but a doppelganger image.

We manipulate the virtual hand,creating a visual illusion and pushingthe individual, with the aid of robotics,in the movement direction in which wewant him or her to go, Tunik explains.We trick the nervous system, and usefMRI [functional magnetic resonanceimaging] and transcranial magnetic stim-ulation to measure how it is responding

to the manipulations.The early results are encouraging.Were seeing a very robust response atthe nervous system level, Tunik says. Hecautions, however, that this technologyis in still evolving. Right now, were oneof the few labs that combine roboticswith virtual reality for use as both a reha-bilitation and an assessment tool. Its notready for integration into clinics.

He adds, though, I definitely fore-see that. In another decade or so, Ibelieve youre going to see work stationswith these types of systems set up insome rehab facilities. And presumablytheyll be more turnkey than they arenowjust press a few buttons andgoso clinicians wont have to worryabout the technology. At present itsvery intricate, requiring a great deal oftechnical expertise to tweak, program,and de-bug the systems.

In the near term, cost will be another

barrier to widespread replication. Youeasily could spend close to a hundredgrand on all the nuts, bolts, hardware,and software, Tunik says. However, headds, Over the next decade I expectcosts to drop dramaticallyas weve seenwith computers and other technologies.

Large academic facilities that houseboth research and clinical arms likely willbe the first to feature the types of workstations he describes. Down the road,though, he says, I see these systems

moving into mid-sized and smaller clin-ics, to be used with both adult and pedi-atric populations.

One of Tuniks favorite visions has

virtual reality being used with strokepatients at acute care hospitals. Thepatient with acute stroke has limitedmovement, which, in turn, limits whatthe PT can do to assist that patient,Tunik notes. But with virtual realitytechnology, even a slight trace of move-ment in a patient with acute strokecan be amplified to make it appear asif much more pronounced movementis occurring. That, in and of itself, can

trigger activity in the patients nervoussystem and push the individual forward,toward regained function.

Tunik sees robot-aided virtual real-ity as a rehabilitation tool that one dayin the not too-distant future will allowPTs to serve more patients in less time.What were seeing in early pilot stud-ies of virtual reality training of strokepatients are outcomes similar to whatyou see from traditional types of physi-cal therapy, he says. That means youmight see a PT tailoring each work sta-tion to a particular patients needs, allow-ing that PT to see 10 patients in thesame amount of time it now takes himor her to see just 1.

Next-GenerationApplications

As corporate director of technologyintegration for Select Rehabilitation,

which provides contract services atabout 500 locations across 30 states,its truly the business of Bob Latz, PT,DPT, CHCIO, to be ahead of the curvewhen it comes to technology trends. Infact, that last set of letters after Latzsname stands for certified healthcarechief information officer. That cre-dential, bestowed by the College ofHealthcare Management Executives, isonly 4 years old and isnt necessarilymarketed toward PTs, says Latz. Hes


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ments in which participantscould escape for a few hoursto, say, Victorian England or abalmy tropical island.

In service to PTs of the 21st

century, however, Latz foreseesa role for holodecks thats moreeducational than recreational.

As the expense of processingchips comes down, the possibilitybecomes more real that PTs willbe able to project pictures of thepatients home environment outinto clinic space and effectivelyconduct home therapy right thereat the facility.

Latz emphasizes that hedoesnt see any of these techno-logical advances in any way sup-planting physical therapy and thework PTs do.

People always are going tohave problems with pain, weak-ness, odd movement patterns,and decreased coordination, hesays. Theyre always going toneed our skills to pinpoint theissue and help them return todoing the things they most wantto be able to do. Technologyoffers tools that can comple-ment and further our abilityto serve patients. We must par-ticipate in its design and availourselves of it. But its the PT,when all is said and done, whodrives successful rehabilitation.

Got Bots?I never thought to myself, I

want to work with robots, RyanCardinal, PT, DPT, recountedearlier this year in a This Is Whyessay published in this magazine.(See Related Articles at left.)As fate would have it, though,his love of pediatric physicaltherapy and compassion for chil-dren with severe spasticity issuesintersected with the creation of

the Riley Hospital for ChildrenRobotic Rehabilitation Centerin Indianapolis, where Cardinalnow works as a graduate assistant.

His essay concerned robotics

impact on a specific child withcerebral palsy, but at our centerwe treat kids with pretty muchany kind of movement disorder,he saysCP, spina bifida, tumor

resection, stroke. The facility,which opened in fall 2010, usesinteractive robots and computergames to help reprogram chil-drens brains and improve their

motor functions through repeti-tive, controlled motion.

Our hope and vision, saysPeter Altenburger, PT, PhD, isthat the technologies were using

A young patient inthe Hocoma Lokomatexoskeleton walkingdevice. At right isRyan Cardinal, PT,DPT.


24/7222 J u n e 2 0 1 2

and the evidence we producewill become ingrained in a con-tinuum of care for children withmovement disorders all across the

country, increasing their func-tionality and facilitating theirintegration into the commu-nity. (The center is a collabo-ration between Riley Hospitalfor Children at Indiana Healthand the Indiana UniversityDepartment of PhysicalTherapy; Altenburgeris the departments chair.)

We started out by looking

at the effects of using the MIT-Manus Shoulder-Elbow Robot[developed by researchers atthe Massachusetts Institute ofTechnology] on arm strength,

range of motion, and func-tional capacity in kids withhemiparesis CP, Altenburgersays, and were now looking

into the impact of the HocomaLokomat, an exoskeleton walk-ing device. Were also pilot-testing a brand-new device, theMIT-Manus Anklebot, whichfocuses on kids with deficits intheir ability to lift their toes upor point them down.

The devices manufacturersSwitzerland-based Hocoma andInteractive Motion Technologies

of Cambridge, Massachusettsare very appreciative of ourfeedback, says Cardinal. All ofthe robots we use were designedfor use by adults, so were inthe first wave of clinicians andresearchers identifying designwrinkles for their best applica-tion to children.

The research is ongoing butthe early returns are positive,Altenburger and Cardinal say.

When people hear thewords robotic technology, theirnatural tendency is to have highexpectations, Cardinal notes.We really try to temper thoseby emphasizing that theres verylittle research yet on efficacywith children and stressing thatwere just getting started with

this. Nevertheless, he says, therobotic devices have been a hitwith children and their parents.

Youve got to understand

that were dealing with kidswhose disabilities have neces-sitated their undergoing physicaltherapy from a very early age,Cardinal advises. Its not newto them, so the novelty of therobots really adds excitementand fun. And weve found thatparents have been overwhelm-ingly pleased. One little girl ini-tially had to ride in her mothers

cart when they shopped atTarget, but she trained withthe lower-extremity robot andnow can walk around the entirestore with the aid of a walker.Another child trained on theupper-extremity device andnow can toilet independently atschool. A few children whoveused the upper-extremity robotnow can eat using their affectedhand. Parents have creditedthe robotics for the improve-ments. Ive got to emphasize,however, that each of these chil-dren has undergone other thera-pies, as well, and that we lackhard data on whats attributableto the robots.

The technology doesnt comecheap. The Lokomat alone cost

Patients at theLaboratory forMovementNeuroscience atthe Universityof Medicine andDentistry of NewJersey. Standing isits director, EugeneTunik, PT, PhD.


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about $350,000 for the basic device andupgrades such as a televised avatar thatserves to further motivate and engagethe child. This means, Cardinal notes,

not every physical therapy clinic isgoing to have a robotic device anytimesoon. However, because we can so pre-cisely control repetition, consistency, andduration of exercise with the equipmentwe have here, Cardinal says, I see usteasing out the most important findingsand sharing those results with the physi-cal therapy community through theliterature, so that other PTs can take ourinformation and apply it as best they can

with whatever resources are available tothem. Ideally that will start happeningeven before 2020.

An App for ThatSteve Wolf, Allon Goldberg, PT,

PhD, and Catherine Curtis, PT, EdD,are members of a small task force ofAPTA members and staff that for thepast several years has been emphasizingto the wider physical therapy profes-sion, via conference programming andother means, the importance of genom-ics education in both academic andprofessional circles. A 2009 piece inthis magazine (see Related Articles)highlighted the implications for physi-cal therapy of breakthroughs in geneticresearch, the importance of interdis-ciplinary communication among thehealth professions, and the need forPTs to be able to factor genetic predis-

positions into patient care.To those ends, Wolf is involved in

a clinical trial thats examining theimplications of certain genetic varia-tions, or polymorphisms, on motorrelearning in stroke patients. Goldberg,director of the Mobility ResearchLaboratory and an assistant profes-sor of physical therapy at Wayne StateUniversity in Detroit, is studying theeffects of polymorphisms of the angio-tensin-converting enzyme, or ACE,

gene on physical performance measuresin older adultswith the hope ofreducing fall risk in that population.Curtis, who for several years has taught

an online course on implications of thehuman genome to doctor of physicaltherapy students at New York MedicalCollege, is in the process of integrat-ing that content throughout the entireDPT curriculum.

Last October, Wolf and MaryRodgers, PT, PhD, chair of theUniversity of Marylands Departmentof Physical Therapy and RehabilitationScience, discussed genomics educa-

tion at the APTA Education SectionsEducational Leadership Conference.Their 2-hour presentation centered onrecommendations from the PhysicalTherapy and Society (PASS) Summit.2

That APTA-sponsored think tankevent, held in February 2009 nearWashington, DC, brought togetherPTs and non-PTs from the government,health policy, academic, engineering,bioscience, and information technologyarenas. PASS participants endorsed thePTs role as partner in a consumer-centered multidisciplinary health careteam; cited the need to break downsilos between academia, the clinic,and the research lab; and emphasizedthe importance of capitalizing on lead-ership opportunities in prevention,health, and wellness.

Wolfs school, Emory, recentlybrought together DPT, neuroscience,and bioengineering students in a course

on clinical problem solving. The needfor the physical therapy profession tode-silo both internally and externallywas a recurrent theme in Wolfs andRodgerss presentation and ensuinggroup discussions among the educa-tional leadership. Ideas generated dur-ing last Octobers conference includedestablishing residencies, fellowships,and cross-university collaborations insuch content areas as regenerative medi-cine, bioengineeering, telemedicine,

global health, and genomics. (Geneticsis the study of a single gene, genom-ics the study of all genes and theirinterrelationships.) Within genomics

education specifically, ideas includedcreating a prerequisite foundationcourse, involving geneticists in teachingpathophysiology to DPT students, anddesigning online learning modules.

Wolf, Curtis, and Goldberg expressconcern that their peers are slow to fullyappreciate the importance of genomicseducation. Goldberg suggests PTs mightbest summon the future simply by look-ing down at their apps-laden phones.

It might sound far-fetched now, butI can see the genetic profiles of patientsand their entire families being storedon a physicians server, where theyllbe available by password and code toselected health care providersthe car-diologist, the PTvia their phones, hesays. Supplied with this information,well know patients predispositions tocertain chronic diseases and have valu-able insights into which physical inter-ventions might be most effective withthat individual.

Advised of Goldbergs far-fetchedscenario, Wolf responded confidentlyand imploringly, Thats not specula-tion. Thats the future. And we needto be ready for it.

Eric Riesis associate editor. He can be reached

at [email protected].

References1 Vision 2020. www.apta.org/Vision2020. Accessed March19, 2012.

2 Physical Therapy and Society Summit (PASS). www.apta.org/PASS. Accessed March 19, 2012.


26/72P T i n M o t i o n m a g . o r g24 J u n e 2 0 1 2

Sometimes its intentional. Sometimes its not.Either way, fraud and abuse are bad for the profession,patients, and the nation.

Afew years back, Matthew Goodemote, PT, nearly losthis business. It was rough, he recalls. And every stepof the way, it just got worse.

Right before his professional world fell apart,Goodemotewho owns Community Physical Therapy &Wellness in Gloversville, New Yorkthought everything wasgood. Hed started the clinic in his hometown and we just gotreal busy real quick. It took off.

He began with 2 physical therapists (PTs) on staff. Beforelong, he had 12. He had 45 employees, a constant supplyof patients, andin a town he describes as economicallydepressed, with high unemploymenthe was doing whathed always wanted to do: helping the people who needed itmost. Business, says Goodemote, was great.

And then I received a phone call.On the other end of the line, he recalls, was a representative

from the Centers for Medicare and Medicaid Services (CMS).The people at CMS had been reviewing the practices recordsand questioned how 2 physical therapists could possibly beseeing so many patients. I told the gentleman there must besome kind of misunderstanding, says Goodemote. I had 12therapists working for me, not 2. The CMS representativeasked Goodemote to fax him their licenses and a variety ofother relevant information. We did it that day. I thought thatwould be the end of it.

Unfortunately for Goodemote, that wasntthe end of it.It was only the beginning.

After that initial phone call, Goodemote received a letterfrom SafeGuard Services, a Program Safeguard Contractor(PSC)/Zone Program Integrity Contractor (ZPIC) hired byCMS to help it in its fight against fraud, waste, and abuse inthe Medicare and Medicaid programs.

I didnt know it at the time, but its the last letter you everwant to get, explains Goodemote. His credentialing errorhad cost him. Now, in addition to the fine imposed on himas business owner, hed have to pay fines for those 10 PTs whohad been billing CMS.

Goodemote accepts responsibility: As the owner, I droppedthe ball. I assumed the person I had on staff who did the cre-dentialing for the first 2 did the same for the rest.

By Chris Hayhurst

Fighting Fraud and AbuseIn Physical Therapy


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Community Physical Therapy& Wellness was about to besubjected to an audit. CMSrequested 5 of our charts, which I

didnt think was a big deal, saysGoodemote. If anything, I fig-ured we were under-billing.

Goodemote was wrong again.

Coping With aChanging World

Well return to Goodemotesstory a bit later in this article.But first, consider the world in

which Goodemote found himselfengulfed. In 2008, a year beforeCMS contacted him, a report bythe U.S. Office of Managementand Budget estimated that dur-ing a 12-month period endingin late 2007, Medicare andMedicaid made $23.7 billion inpayments for health care servicesthat did not comply with one ormore coverage, coding, billing,or other rules.1

Later, in 2010, the Wall StreetJournalpublished 2 articles detail-ing fraudulent practices related tophysical therapy services at severallarge home health companies.That led to a federal investiga-

tion. In 2011 the Senate FinanceCommittee issued a report accus-ing those companies of gamingMedicarethat is, intentionally

increasing their home health visitsto increase their profits.2

According to the report, Thehome health therapy practicesidentifiedat best represent abus-es of the Medicare home healthprogram. At worst, they may beexamples of for-profit companiesdefrauding the [program] at theexpense of taxpayers.

The Departments of Justice

(DOJ) and Health and HumanServices (HHS), meanwhile, withhelp from the FBI and state andlocal law enforcement agencies,spent much of 2011 combat-ing a variety of health care fraudschemes that sometimes includedbilling for physical therapy. (Ahighlight: Last September, ajoint DOJ-HHS Medicare FraudStrike Force operation uncoveredcoordinated fraudulent activi-tiesagain, just a few of whichincluded physical therapyto thetune of $295 million in 8 citiesaround the country.3)

Not surprisingly, in 2012,federal efforts to contain costs

and fight fraud, abuse, andwaste in the health care systemhave continued. For the vastmajority of PTs, these measures

are most visible in the form ofincreased regulations and audits.For example, notes Gayle Lee,JD, APTAs senior director ofhealth finance and quality, forabout a year physical therapistsin private practice have beensubjected to a higher-levelscreening categorymoderateinstead of limited.

Its a result of these few

highly publicized cases involv-ing physical therapy services,explains Lee. For PTs in privatepractice, this means that whenthey enroll with Medicare, theymust have a site visit.

The same revised provider-enrollment rules raise the screen-ing levels for both new andexisting home health agenciesand other providers, notes Lee.Clearly, the more we hear aboutfraud, the more we see thesecases in which the Departmentof Justice is getting involvedin which peopleand mostof them arent even PTsaremanipulating the number of vis-its or billing for therapy servicesthat the facility never provided.And so the more difficult thingsbecome for physical therapists,the vast majority of whom are

billing services appropriately.Even most PTs who do have

problems, Lee adamantly pointsout, are not committing truefraud. Some are non-compliantwith regulations that they didntknow existed. Some are makingbilling mistakes or documenta-tion errors. And others, likeGoodemotewell, many haveno idea whats coming when theyreceive that first letter.

Krafft

Ravnikar

Kirsch

Matthew Goodemote, PT,working with a patient.

Levine


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I was so nave about the wholething, he says. I thought I could justfocus on my patients. But in the eyesof the government, things just didnt

add up.

An Ethical CompassFirst things first, says Cindy Krafft,

MSPT, COS-C, president of APTAsHome Health Section and director ofrehabilitation consulting services forMassachusetts-based Fazzi Associates.Its unfortunate that we keep seeingthese stories in the news because theyre

leading people to believe that theres ram-pant fraud, especially in home health.Were definitely not seeing rampantfraud, and were tired of looking bad.

From the perspective of the HomeHealth Section, Krafft says, the discus-sion of fraud and abuse is not a new one.Especially when it comes to abuse, whichshe says includes tactics like over-provid-ing therapy to increase reimbursement,weve been a strong advocate for ethicalpractice for years.

Fraud, on the other hand, is analtogether different sort of challengemainly, she says, because if Im willingto do things like intentionally bill ondead people, Im not going to stop basedon what the section says or because anew regulation is issued. Getting arrestedis what will stop me. The recently pub-licized crackdowns, Krafft asserts, are astep in the right direction. She says sheonly wishes Medicare would spend even

more time on enforcement, and resistthe urge to make more rules, which justmakes it harder for the people who arealready doing the right things.

As far as combating abuse, Krafftsays, PTs and physical therapist assistants(PTAs) first must understand the regula-tions that already are in place. Towardthat end, the Home Health Sectionoffers free podcasts and other resourcesfor anyonenon-members as well asmemberswho wants to reference them.

Were trying to empower PTs and PTAsto know the rules, and not just say,Well, my agency says were supposedto do this, so Ill just believe them. Its

important for us as professionals to takeresponsibility and be informed so we dowhat is right.

That leads to her final appeal: Thosewho encounter either fraud or abuse

should stand up and report it. Im notsaying when you have a bad day, quit orgo tell on people, explains Krafft. Butwhen you see something that shouldnt

be occurring, you attempt to address it,and the response is, Well, this is howwe do it here, you cant just turn a blindeye. At the end of the day, if youreworking for somebody who abuses the


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system, you have to ask yourself: Is mysilence agreement? We need to makesure we keep our practice where it needsto be. In some cases, that may require

making tough decisions.Diana Kornetti, PT, MA, who owns

Integrity Home Health Care in Ocala,Florida, and is co-chair of the HomeHealth Sections Practice Committee,agrees. Unfortunately, physical thera-pists historically have not really ownedthe rules and regulations of home care,she says. Agencies certainly should beheld accountable, but therapists need toknow that they can be prosecuted, too.

Ignorance is not bliss.Kornettis suggestion? Learn the ropes.Take on agency leadership roles wher-ever possible. And document everything.Thorough documentationdefensivedocumentationis critical, she says.

If you know the regulations, Kornetticontinues, and the details that arerequired to ensure that your work islegitimate, its very easy to put on paper,or on an electronic medical record,everything you needto say, Yes, I

need to be here to see this patient, at thistime, for this visit, to do this interven-tion or this standardized test, becauseonly a skilled therapist can do it. Its

reasonable and necessary, its related tothe individuals function, and there isevidence behind it.

Therapists in home care, Kornettisays, really only need to follow the samepractices as do PTs in other settings.You have to make sure that each andevery visit you make is a necessary visitand a reimbursable visit. Then you haveto put it in the record. If you dont, shecautions, you have nothing to go on

in the event of an audit.

Resisting PressureFrom Above

Of course, its almost impossible todocument effectively if you dont havethe time. That, at least, was the experi-ence of Patricia Crean, PT, MSnot inhome health, where she works now asan independent contractor in Prescott,Arizona, but in skilled nursing, an arena

in which she vows shell never workagain. In her 40 years as a physical thera-pist, says Crean, shes seen more fraudand unnecessary treatment in SNFs than

in any other setting.In 2002, she recalls, she was rejected

for a position for voicing her view onthe facilitys policies requiring you seeeverybody every day, twice a day, nomatter what. In 2004, she landed afull-time job at a skilled nursing facili-tya large, national companyandwhat I found was, again, the paymentper bed received for a patient is basedon the number of minutes of therapy,

so it behooves [the employer] to putpatients at a higher level of minutes,whether its justifiable therapeuticallyor not.

Her supervisor would push her totreat even when she recommended thather patients be discharged, says Crean.They would say, Arent there more goalsthat can be met? And a social workerwould look at the patient and say some-thing like, Well, he doesnt have goodjudgment, and override my decision todischarge. Ensuring a strong continuumof care (by, for example, returning thepatients to their homes to begin a homehealth program), Crean says, generallywas not part of the plan. Theyd end upholding these patients just so they couldget payment for the bed.

She left that facility after 8 months,Crean sayspaid back my sign-onbonus without another job to go to.I kept thinking, I can do something

about this, but it just kept gettingworse. Throughout her time in SNFs,Crean says, she routinely rejectedrequests by her employer to add visitsto her records, and always made sureto document everything: Id workedwith the state board. I knew that thepeople going before it were mainly therebecause of inappropriate documenta-tion. They were being pushed to theirlimit to do more and more, and theyjust didnt have time to keep good

Fraud or Abuse: Whats the Difference?

Fraud, says practice management and compliance consultant Stephen

Levine, PT, DPT, MSHA, involves knowingly and willfully trying to get any

money that belongs to a health care benefit program. The litmus test for

fraud, he says, is not only that the provider had actual knowledge of the

information, but also whether the provider acted in deliberate ignorance

of the truth or in reckless disregard of the truth.

Abuse, which is much more common, involves payment for items or

services when theres no legal entitlement to that payment or service, but

the provider has not knowingly or intentionally misrepresented the facts toobtain payment.

Waste, which often is mentioned in conjunction with fraud and abuse,

can include inefficient claims processing and health administration, defensive

medicine, medical errors, hospital-acquired infections, and money spend on

preventable conditions.10

Whats the best answer for physical therapists who want nothing to do

with either fraud or abuse? Know and stay up to date and in compliance

with the rules related to coding, billing, and documentation, and especially the

requirements related to medical necessity, Levine says. If you bill a program

for services it says are not medically necessary or reasonable, he adds, that

could constitute fraud.

28 J u n e 2 0 1 2 P T i n M o t i o n m a g . o r g


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ticing inappropriately should be reportedto their state licensure boards.4

A Need for ChangeIn her position on the New Jersey

Board of Physical Therapy, says NancyKirsch, PT, DPT, PhD, she sees a lot ofwhat she describes as petty fraud. Itsphysical therapists, says Kirsch, who,for example, honestly think theyredoing pro-bono work when they waivea co-pay and just accept what the insur-ance company pays. The fact is, thatsillegal. PTs do it because the practices

ownership says its OK with thembecause doing pro-bono work is in ourcode of ethics.

Kirsch is director of the Doctorof Physical Therapy Program at theUniversity of Medicine and Dentistryof New Jersey and also works in privatepractice in a school-based setting. Shesays that 99% of physical therapistsare not doing anything wrong. Still,she continues, the frequency of fraudin the profession is very disconcert-ing. Fraud is more obvious in certainpractice areas, she says, but it happenseverywhere. Its even happening inschools, and theres really no reason togame the system there.

Kirsch tells of recently receiving a callfrom a PT working in a school district.The PT told Kirsch about a colleaguewho was blatantly lying about the work

she did. She wasnt even seeing thechildren she said she was. Or she wasdocumenting that she was seeing themfor a certain amount of time when shewas only seeing them half that time.Even when children were ill and not inschool, she was documenting visits. Itwas fraud.

The state board, says Kirsch, may seesuch providers either before or after theygo through the courts (if they are pros-

ecuted for fraud). The board deals withthem in a variety of ways. It can rangefrom a letter of sanction to action againsttheir license. It depends on how egre-gious the offense is, Kirsch says.

As a teacher, Kirsch says, she asks herstudents to look for ethical issues duringtheir clinical experiences and then discusstheir findings when they return. Theyused to say they didnt see anything, butnow that almost never happens. Now Imhearing about things such as documenta-tion fraud to get patients into a sub-acutefacility. Or putting patients at a higherRUG level than is appropriate. Theyrebeing asked to do things that they knoware wrong.

The justification offered by theirsupervisors is If we send them home,its dangerous. So we have to lie. But itsnot really a lie, its playing the system

because the systems not right. Thesetherapists think theyre doing whatsright, says Kirsch, but clearly theyre not.Unfortunately, theyre not fixing any-thing by buying into whats wrong withthe system.

Kirsch admits that she has been insituations that could have been interpret-ed as fraudulentif she hadnt correctedthem. Once we received a payment thatwas part of a bundled check, and we

realized it included a patient who wasntours. But wed already cashed the check.It was a hassle, Kirsch recalls, but thefacility knew it had to repay the moneyto the insurance company.

You would have thought that Iwanted to go into Fort Knox and takethe gold bullion out myself and bring ithome. We ended up having to pay theentire check back to the insurance com-pany, and then wait months to get repaidfor each of the patients who were actual-ly ours, Kirsch explains. Time-wise, shesays, we lost money. It would have beenmuch easierbut wrongto just ignoretheir mistake. It makes you understandhow some fraudulent acts take place.

Climbing Out of the HoleWhich brings us back to Matthew

Goodemote. In the midst of his ordealwith Medicare, Goodemote decided to

bring in practice management and com-pliance consultant Stephen Levine, PT,DPT, MSHA, for help. When SafeGuardServices, the government contractor,looked at his charts, they found a99% error rate on our documentation,Goodemote recalls. Steve said it was theworst hed ever seen.

To make a long story short,Goodemote was asked to pay $30,000back to Medicare for those 5 errone-ous charts. Next, SafeGuard Services

APTA on Fraud and Abuse

APTA has made the following points in public statements and in congressional

testimony:

APTA is committed to working with the federal government, state licensure

boards, and enforcement agencies to address and prevent fraud and abusethat may occur within the profession. APTA vehemently condemns this

unethical behavior.

APTAsCode of Ethics for the Physical Therapist delineates the ethical

obligations of all physical therapists.

The vast majority of physical therapist services are billed appropriately.

Millions of individuals rely on and benefit from these services.

Any physical therapists who are committing fraud and abuse should

be reported immediately to their state licensure boards and to any other

relevant authorities.

More info: http://www.apta.org/prmarketing/media/fraudeabuse



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recommended CMS conduct post-payment reviews on all documentationgoing forward.

I thought: Fine. If we make mis-

takes, well learn and fix them and justmove on, says Goodemote. Well,thats not how it works. Medicare, heexplains, is supposed to review a claimwithin 60 days of its submission. Butthey never did anythingin 60 days.It took nearly 6 months for them torespond to our first batch.

His new claimshundreds perweekwere piling up, and old claims

were returned, in no apparent order, withrequests for explanations. It was a never-ending cycle, with no Medicare moneycoming in and no obvious way out.

The pressure really was building,says Goodemote. We were trying tochange our documentation, but wedidnt even know if our new documen-tation was good because they wouldntlook at it. Meanwhile, we were mov-ing ahead hoping that it was good. Bythen, I had 6 months worth of billingand all of it could have been worth-less. I honestly considered just closing

down and stopping providing therapyaltogether.

In the end, with Medicare providingnearly 35% of his revenue, Goodemote

had no choice but to reduce costs anddownsize. He cut the number of employ-ees from 45 to 15. Meanwhile, he says,he took it upon himself, at Levines urg-ing, to learn everything he could aboutdocumentation through continuing edu-cation, Webinars, and other resources.He had his staff do the same.

Before, he says, I never cared. Idget these flyers from APTA about the

ResourcesPresented below is a sampling of fraud and abuse resources

available from APTA and from government agencies.

Government

Medicare.gov site on fraud and abuse

http://www.medicare.gov/navigation/help-and-support/

fraud-and-abuse/fraud-and-abuse-overview.aspx

StopMedicareFraud.gov

http://www.stopmedicarefraud.gov/

Stop Medicare Fraud Website Widget

http://www.stopmedicarefraud.gov/widget.html

HEAT (Health Care Fraud Prevention and

Enforcement Action Team) blog

http://blogs.justice.gov/main/archives/1157

The National Consumer Protection

Technical Resource Center:

The Center of Service & Information for SMPs.

http://www.smpresource.org/AM/Template.

cfm?Section=Health_Care_Fraud

APTA

FAQ: Fraud & Abuse

http://www.apta.org/Compliance/FraudAbuse/FAQ/

Reporting Suspected Fraud and Abuse

http://www.apta.org/Compliance/FraudAbuse/Reporting/

Crandall D. RACs Redux: An update on the work of Recovery

Audit Contractors, and what PTs need to know. PT in Motion.

20113(6):41-44. http://www.apta.org/PTinMotion/2011/7/

ComplianceMatters/

Drummond-Dye R. Matters of Integrity.PT in Motion.

2011;3(4):37-40. http://www.apta.org/PTinMotion/2011/5/

ComplianceMatters/

Karker-Jennings K, Levine S. Medicare Audits and

Physical Therapy: Mitigate Your Risk. Audioconference.

http://www.apta.org/Courses/TheSource/2011/10/19/

Kass J, Drummond-Dye R. Julie Kass Audioconference:

Hear It From the Source: Remaining Compliant: What PTs

Need to Know. http://iweb.apta.org/Purchase/ProductDetail.aspx?product_code=AV-52VP&LI=0

Lee G. Medicare AuditsReducing Risk: The importance of

knowledge and preparation. PT in Motion. 2012;4(1):46-48.

Russell G. Advantageous Counsel: What you should

know about Medicare Part C health plans. PT in Motion.

2011;3(9):45-46. http://www.apta.org/PTinMotion/2011/10/

ComplianceMatters/

For additional resources, go to www.apta.org and search for fraud and abuse.



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changes in Medicare. I thought, Whosgoing to bother me up in this littletown? I just wanted to work withmy patients.

To straighten out his processesandto keep them compliantGoodemotepaid for Levine to conduct on-sitetraining. The firm has paid for its staffto attend APTA-sponsored courses inperson and on-line. Hes also hired aLevine-trained consultant to reviewevery note that goes to Medicare.

The fine, he says, was penniescompared to what I invested into train-ing and dealing with Medicare. My

message to fellow PTs is: Do the train-ing before Medicare shows up. Take itvery seriously.

Goodemotes facility has transi-tioned from hand-writing notes to elec-tronic recordkeeping, and the practices

documentation is sound. Thanksto Levines help, Goodemote says,Medicares post-payment reviews foundan error rate of less than 10%. Medicare

doesnt reveal how much less than 10%.Goodemote says, We like to think 1%.And going from 99% bad to 99% goodis a complete turnaround.

Chris Hayhurstis a freelance writer.

References1 Coalition Against Insurance Fraud. Fraud Data. www.insur-

ancefraud.org/medicarefraud.htm2 Staff Report on Home Health and the Medicare Therapy

Threshhold. Committee on Finance, United States Senate.

SPrt 112-24. September 2011. http://finance.senate.gov/imo/media/doc/Home_Health_Report_Final.pdf

3 http://www.justice.gov/opa/pr/2011/September/11-ag-1148.html

4 APTA Re-affirms Commitment to Elminating Fraudand Abuse. October 2011. http://www.apta.org/Media/Releases/Legislative/2011/10/7/

5 King K. Medicare program remains at high risk because ofcontinuing management challenges. Testimony before theSubcommittee on Oversight and Investigations, Committeeon Energy and Commerce, House of Representatives.GAO-11-430T. March 2, 2011.

6 The NHCAA Fraud Fighters Handbook: A Guide toHealth Care Fraud Investigations & SIU Operations.

National Health Care Anti-Fraud Association. 2007.7 ABC News. Medicare Fraud Costs Americans $90 Billion

a Year. February 17, 2011. http://abcnews.go.com/WNT/video/medicare-fraud-costs-americans-90-billon-year-entitlement-program-biggest-criticisms-health-12945081

8 Kelley R. Where can $700 billion in waste be cut annu-ally from the U.S. healthcare system? Thomson Reuters.October 2009. http://factsforhealthcare.com/reduce

9 The price of excess: Identifying waste in healthcare spend-ing. PricewaterhouseCoopers Health Research Institute.2010. http://www.pwc.com/hri

10 Aldrich N. Medicare fraud estimates: A moving target?The National Consumer Protection Technical ResourceCenter: The Center of Service & Information for SMPs.http://www.smpresource.org/Content/NavigationMenu/

AboutSMPs/MedicareFraudEstimatesAMovingTarget/Medicare_Fraud_Estimates.pdf

11 Karker-Jennings K, Levine S. Medicare Audits and Physical

Therapy: Mitigate Your Risk. Audioconference. http://www.apta.org/Courses/TheSource/2011/10/19/12 Lee G. Medicare AuditsReducing Risk: The impor-

tance of knowledge and preparation. PT in Motion.2012;4(1):46-48.

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36/7234 J u n e 2 0 1 2

When Lindsay Farmer was in the sixthgrade, her career goal was to becomea chef. Actually, I was torn between

being a chef or a physician. Then I went to aSTEM event.

The acronym STEMwhich stands for science,technology, engineering, and mathusually refersto programs to attract more students to those fields.

Presidents Barack Obama, George W. Bush, andothers all have addressed the importance of STEM-related education and its importance in keeping theUnited States globally competitive. [See Presidentson STEM.]

But lets catch up to Lindsay Farmer, PT, DPT.Today shes a physical therapist with Elite Physical

Therapy in Chicago.

What happened to her aspirations to become achef? There happened to be a chef at the event,says Farmer, and she told me she didnt even likecooking anymore. She said that I should just cookfor my family. Take cooking classes for fun, notmake it my job. She said I should pick a career thatwas a little more stable.

At the time, Farmer was in middle school. Shedbeen attending an annual STEM eventGirls+ Math + Science = SUCCESS!ever since sheshowed an aptitude for math and science in thirdgrade. It was a county-sponsored program, sheexplains, in Prince William County, Virginia.Theyd invite girls who were getting As in mathand science and try to encourage them to stay with

those subjects.

By Chris Hayhurst

Generation STEMTheres a national effort to encourage more studentsespecially femalesto study science, technology, engineering,and math. How will this affect physical therapy? And what rolesare PTs playing?


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The event included presentationsand interactive workshops led by adultsfrom a variety of STEM-related fields,but Farmer always spent the day learning

about health care jobs. I remember see-ing physicians, dentists, and nurses, shesays. However, back then, I never didsee a physical therapist. Shed eventuallyfix that oversight.

Promoting the ProfessionToday, Farmer, well established in a

career of her own, has come full circle.Three years ago, she says, the direc-

tor of SUCCESS! tracked her down.Since then, as other professionals haveintroduced kids to fields such as spacescience and audiology, shes led the pro-grams new physical therapy workshop.Last March, the event drew 225 girls(and 150 parents, who cycled throughworkshops of their own). Every year,says Farmer, the kids are so animatedand so excited. Still, she acknowledges,None of them really knows anythingabout physical therapy. They associ-

ate it with massage, or doing a wholebunch of exercises.

Her workshops, she says, covervarious aspects of physical therapy,

from acute care to outpatient orthope-dics to neurological rehab, and I reallytry to show them what they can do andthat there are so many options withinthe field.

At the acute care station, studentslearn to take vital signs. At a skilled nurs-ing station, they dress wounds. And atthe orthopedics station, they see how afirm grasp of anatomy is critical to effec-tive treatment. Hopefully, that gets the

ball rolling, says Farmer, and maybefrom there theyll even educate their par-ents about the field, and more peoplenot just the studentswill know whatphysical therapists actually do.

A few girls, Farmer says, havereturned to her workshop year after year,and some have followed up with e-mailsasking what they should do as highschool students to prepare for PT school.The responses Ive received have beengreat, she says. Its really encouraging.

Why Girls?STEM educationand their many

related eventsisnt limited to girls.Theres a need for more scientists, engi-

neers, and mathematicians regardless ofsex. But the comparatively few femalesentering STEM professions coupled withthe underrepresentation of women inmany of those fields have led to manyprograms focused on attracting femalesto those careers.

The lack of women in computer sci-ences, engineering, and physics is espe-cially pronounced.1In the workforce,only 24% of jobs in science and engi-

neering are held by women.2

To better understand this dispar-ity, the National Science Foundation(NSF) annually awards millions ofdollars in grants for studies examiningboth the barriers to entry that womenface and the potential facilitators thatmight encourage them to enter the var-ious STEM fields. NSF-funded studieshave found that 1 reason women shyaway from STEM subjects is a lack ofconfidence, which begins to surface in

A Matter of DegreeThe National Science Foundation has

been tracking the number of degrees

earned in science and engineering

fields by males and females since

1966. With the help of initiatives to

involve girls in STEM subjects and

careers, the number of females

awarded science and engineering

degrees has increased over the years.

% of females awarded bachelors degrees in 1966 2008

science and engineering 24.8% 50.3%

math or computer science 33.2% 25.3%

engineering alone 0.4% 18.5%

physical sciences 14.0% 41.3%

% of females awarded doctoral degrees in

science and engineering 8.0% 39.5%

math or computer science 6.1% 26.1%

engineering alone 0.3% 21.5%

physical sciences 4.5% 27.5%

National Science Foundation, National Center for Science and Engineering Statistics. 2011.

Science and Engineering Degrees: 19662008. Detailed Statistical Tables NSF 11-316.

Arlington, VA. http://www.nsf.gov/statistics/nsf11316/. Accessed June 23, 2011.



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37

the middle school years. Other studieshave shown that providing female rolemodels who are successful in STEMfields can encourage young girls in

these subjects.3

Why Physical Therapy?Most people would agree that getting

more girls involved in science, technol-ogy, engineering, and math is good forthe nations workforce, good for theeconomy, and good for society. But in aprofession in which nearly 70% of prac-titioners already are women, is STEM

education goodor even relevantforphysical therapy?4

Absolutely, says Laurie Hack, PT,DPT, MBA, PhD, FAPTA, profes-sor emeritus at Temple University andimmediate past chair of the APTAs

Starting a STEM Event

If there are no STEM events cur-

rently in your area, and youd like to

start one, you can contact a local or

regional chapter of the Girl Scouts,Girls Inc, the American Association

of University Women, or the Society

of Women Engineers.

Youd be surprised how many

groups out there would be inter-

ested in these sorts of programs,

says physical therapist student

Alison Barnard of the University of

Alabama Birmingham, who started

that schools Girls in Science and

Engineering Day in part by modeling

it on a successful STEM event held at

another university. And as a student,

I was impressed by how almost every

professor we contacted was inter-

ested in getting involved.

A few resources:

Expanding Your Horizons

www.expandingyourhorizons.org

A nonprofit national organization that

holds STEM conferences in moststates and internationally.

National Science Foundation

www.nsf.gov

The foundation offers a number

of funding opportunities

and programs related to STEM.

STEM Education Coalition

www.stemedcoalition.org

The coalition works to support STEM

programs for teachers and students at

the US Department of Education, the

NSF (see above), and other agencies.


40/7238 J u n e 2 0 1 2 P T i n M o t i o n m a g . o r g n

Womens Initiatives Task Force.Because the majority of thosein our profession are women,what happens to the women inthe profession then has a power-

ful influence on what happenstothe profession. And so, byimproving the ability of womento functionnot excluding men,but by focusing on those thingsin which women by traditionare perhaps not as strong as wedlike them to bewere going toraise the whole profession. Thisisnt a womens issue. This is aprofessional issue.

The way Hack sees it, theearlier girls are encouraged topursue STEM subjects, themore the professional gendergap in related careers will bereduced. That is what theresearch says to me. Thats whatmakes a difference. [Girls] needto get excited about it early. Ifthey demonstrate that excite-ment and interest, they need tobe supported throughout theirgrade school and high schoolyears and then into college.

The fact is that more U.S.college studentsboth maleand femaleneed to major inSTEM subjects, says Hack. Andsince the majority of college

entrants these days are women,we need more women to choosethese majors. If these girlsthen choose to become physicaltherapists, Hack notes, theyll bebetter prepared to do the workin science and research that theprofession needs.

Jennifer Braswell Christy, PT,PhD, agrees. If we want newclinicians to practice evidence-

based medicine, its importantthat they appreciate the scienceand research that is part of theprofession. Last May, Christy,an assistant professor in the doc-tor of physical therapy programat the University of Alabama atBirmingham (UAB), led a neu-roscience workshop as part ofUABs first ever Girls in Scienceand Engineering Day.

The event, says UAB physi-cal therapist student AlisonBarnardwho conceived the idea

and then planned and co-directedthe program with a student fromUABs medical schoolbroughttogether more than 70 middleschool girls for a day of STEM-

related learning through hands-on activities. Some kids dissectedsheep hearts. Others extractedDNA. Still others built waterrockets or learned about reptilianbiology by observing turtles.

Christys session includedmodels of the brain, a vestibulo-ocular reflex demonstration inwhich girls were spun around ina chair while wearing goggles that

displayed their eye movements ona TV screen, and an interactiveplay in which students acted outthe neural pathways for light-touch sensation.

I tried to get them excitedabout neuroscience, she explains.I showed them how, as a physi-cal therapist, not only can youhelp your patients by workingwith them directly, but alsoyou can become a scientist anda researcher and work to findthe best interventions for those

Jennifer BraswellChristy, PT, PhD,leads a neurosci-

ence workshop at aGirls in Science andEngineering Day.


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patients. I taught them about setting upa research study. We did a little mockstudy and saw how important it is toknow the basic science and physiologyof components of the body such as the

brain and spinal cord.Many of these girls think of a sci-

entist as someone in a laboratory witha microscope looking at cells. Althoughthat kind of bench science is important,I wanted to show them that research canbe fun. That they also can be involvedin clinical research and become physicaltherapists who perform science-basedresearch working with patients in theclinic, Christy says.

Big ReturnsWhile its impossible to know for

sure how many communities are offer-ing STEM programs such as the one

organized by Barnard at the Universityof Alabama Birmingham, this much isclear: The reaction to those that havebeen held has been overwhelmingly posi-tive, and many, including TechGYRLS

IT Empowerment Daya program atChicagos Rosalind Franklin Universityof Medicine and Sciencehave becomeannual events.

TechGYRLS, a YWCA-run after-school program for girls ages 5-14, hasbeen an educational staple throughoutthe country since 1997. Local YWCAchapters find sponsors in their commu-nities willing to host the technology andengineering event. Then women profes-

sionals from numerous STEM-relatedfields volunteer their time to show girlswhat they do.

Last year at Rosalind Franklin, KellyHawthorne, PT, DPT, GCS, led a physi-cal therapy workshop that emphasized

the use of math and measurements inphysical therapist practice. (Hawthornethen was the director of clinical educa-tion and an assistant professor in theschools physical therapy program. She

now is an assistant professor at St LouisUniversity.) We had the students gofrom station to station and performhands-on tasks that physical therapistswould do. One thing they used was agoniometer. It was a perfect applicationof their math skillsacute angles, obtuseanglesto real-life practice.

In another activity, the girls tooksit-and-reach test measurements andthen compared their scores to national

averages.Finally, Hawthorne explained to thegirls exactly what it takes to become aphysical therapist. First, I showed themthe APTA You Can Be Me video.Then, during a Q&A session at the end


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Make a gift today!

The Presidents Sustaining Fund

The Presidents Sustaining Fund provides vital unrestricted funding to the

Foundations operations, helping to facilitate more physical therapy research.

1111 N. Fairfax Street Alexandria, VA 22314 800/875-1378 foundation4pt.org


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are womenwell, that was actually thepoint. I think its good for physicaltherapists to be involvednot so muchto try to get more girls into physical ther-

apy, she says, but as a way to promotephysical therapy as a profession thathas lots of science in it and is becomingmuch more science- and research-based.Its important to show girls who mayconsider becoming PTs that science is animportant foundation for them to haveas theyre entering the profession.

In addition, says Barnard, exposingthe girls to physical therapy ultimatelymay lead to enhanced collaboration

between other disciplines and physicaltherapy. If a young girl who is intro-duced to physical therapy eventuallydecides to pursue mechanical engineer-ing in college, she also might develop thenext generation of locomotion-trainingrobots for use in physical therapy.

Furthermore, Barnard notes, its thecomputer scientists who develop the soft-ware used in gait analysis, and materialsengineers who create the latest high-techwound dressings and bandages. If thegirls who attended her STEM program

become computer scientists or engineers,then theyre that more likely to focustheir work on advancements that ulti-mately may benefit the profession of

physical therapy and its patients.Barnard was on a math team in

middle school and high school inBirmingham. She recalls, It was kindof dorky, but it was a big part of mylife. I never did a real STEM event, butI just loved math. Because I was on thismath team I was exposed to more of theengineering and physics and science stuffthroughout school.

Barnard eventually went to the

Massachusetts Institute of Technology(MIT) for her undergraduate degree.Shed sometimes hear the men in herclass say she must have been acceptedbecause she was a woman, and notbecause she was exceptionally good inscience or math. Theyd be like, Weneed more girls in these fields, so thatsthe only reason youre here.

Barnard persevered and ultimatelydecided to become a physical therapist.Even as shes going through rotations,learning firsthand exactly what will

be required of her the day she finishesschool, she also has been thinking abouta second UAB Girls in Science andEngineering Daywhat it would take

and when to have it. Last year wewerent really sure how many peoplewould show up, she says. We triedto keep it really simple.

Now, says Barnard, having seen howexcited the girls were to learn, hav-ing seen the volunteers so eager to beinvolved, and, most important, havingseen that a STEM event can be createdfrom scratch and prove a wonderfulsuccess, shes not so sure. Maybe theyll

change a few things. Make things evenbetter. Ive already been asked by girlswho were there this year whether wellbe doing it again next year, she says.

Her answer? Definitely.

Chris Hayhurst is a freelance writer.

Original material and story concept

provided byAlison Barnard.

References1. National Science Foundation. Women, minorities, and

persons with disabilities in science and engineering.http://www.nsf.gov/statistics/wmpd/. Accessed May 3,2012.

2. National Science Foundation. Science and engineeringindicators 2006. http://www.nsf.gov/statistics/seind02/c3/c3s1.htm. Accessed May 3, 2012.

3. Halpern D, Aronson J, Reimer N, Simpkins S, StarJ, Wentzel K. Encouraging Girls in Math and Science(NCER 2007-2003). Washington, DC: National Centerfor Education Research, Institute of Education Sciences,U.S. Department of Education. http://www.ies.ed.gov/ncee/wwc/pdf/practiceguides/20072003.pdf. AccessedJune 16, 2011.

4. American Physical Therapy Association. Physicaltherapist member demographic profile 2010.May 2011. http://www.apta.org/WorkforceData/DemographicProfile/PTMember. Accessed April 9,

2012.5. Obama B. Remarks by the President in State of theUnion Address. January 25, 2011. http://www.white-house.gov/the-press-office/2011/01/25/remarks-presi-dent-state-union-address Accessed September 19, 2011.

6. Bush GW. Address Before a Joint Session of the Congresson the State of the Union January 31, 2006. http://frwe-bgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=2006_presidential_documents&docid=pd06fe06_txt-11Accessed September 19, 2011.

U.S. Presidents on the Importance of STEM

Recently, President Obama made STEM education a priority as part of his

$4 billion Race to the Top competition, in which states may receive federal funds

to reform and improve their education programs. In his 2011 State of the Union

address, Obama said, The quality of our math and science education lags

behind many other nations . . . We need to teach our kids that its not just the

winner of the Super Bowl who deserves to be celebrated but the winner of the

science fair.5(A few months earlier, in fact, in October 2010, he had done just

that, hosting a White House event at which many of the countrys best students

showed off their winning STEM-related innovations.)

However, President Obama is only the most recent president to support

additional resources for STEM education. President George W. Bush in his 2006

State of the Union Address said, [T]o keep America competitive, one com-

mitment is necessary above all: We must continue to lead the world in human

talent and creativity. . . . And were going to keep that edge. Tonight I announce

an American Competitiveness Initiative, to encourage innovation throughout our

economy and to give our nations children a firm grounding in math and science.

. . . [W]e need to encourage children to take more math and science, and to

make sure those courses are rigorous enough to compete with other nations.6



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http://www.shopingenix.com/APTA


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ComplianceMatters

The enforcement deadline of July 1

is fast approaching for implementationof Version 5010 of the Health InsurancePortability and Accountability Act of1996 (HIPAA)a new set of standardsregulating electronic transmission of spe-cific health care transactions, includingeligibility determinations, claim status,referrals, claims, and remittances.

Thus, there is no time to lose forproviders not yet in full compliance.

BackgroundHIPAA requires that the secretary of

the Department of Health and HumanServices (HHS) adopt standards thatcovered entitieshealth plans, healthcare clearinghouses, and certain healthcare providers such as physical therapists(PTs)must use when electronicallyconducting administrative transactions.

The laws section on administrativesimplification was designed to streamline

and make uniform requirements forelectronic transactions and code setstandards, privacy, security, and nationalidentifiers. Currently, electronic transac-tions are submitted on HIPAA ASC X12Version 4010 or 4010A1 (Version 4010saddenda), but this iteration is outdated.HIPAA ASC X12 Version 5010 (Version5010) was finalized through regulationon January 16, 2009. The standardswere to have gone into effect on April 1,but in March the Centers for Medicare

and Medicaid Services (CMS) granted a

3-month extension.Version 5010required for Medicare,Medicaid, and commercial payer elec-tronic transactionsoffers improvementover the existing version in terms oftechnical, structural, and data content.The new version standardizes businessinformation related to each transactionand is more specific in defining whatdata must be collected and transmitted.

The new version also was willaccommodate reporting of clinical datathrough ICD-10 (International StatisticalClassification of Diseases and RelatedHealth Problems) code sets, and it distin-guishes between codes for principal diag-nosis, admitting diagnosis, external causeof injury, and patient reason for visit.

Furthermore, Version 5010 supportsmonitoring of certain illness mortalityrates, outcomes for specific treatmentoptions, some hospital lengths of stay,

and clinical reasons for care. The new

standards use new technical reportguidelinesTechnical Reports Type 3,or TR3that present data in a consis-tent fashion and with less potential forconfusion. Version 5010 addresses unmetbusiness needs by, for example, allowinginstitutions to indicate a condition waspresent on [patient] admission.

One note: CMS has delayed thepreviously scheduled implementationdate of October 1, 2013, for mandatoryICD-10-CM (clinical modification) andICD-10-PCS (procedural coding system)diagnosis and procedure code sets. At thiswriting, a new implementation date hasnot been announced.

TipsIf your organization or system ven-

dor is not ready by July 1 to transmitall electronic claims at Version 5010

Version 5010:A New Standard for Electronic BillingReadiness assistance for the impending transition.

by Gillian Russell, JD

ResourcesVersion 5010 Electronic Administrative Transactions page:

www.apta.org/5010/

HIPAA Version 5010/D.0 Implementation Overview and Updates:

www.cms.gov/Versions5010andD0/

CMS ICD-10 Overview: www.cms.gov/ICD10/

Electronic Data Interchange (EDI) Standards: Transition to Versions 5010 and D.0:

www.cms.gov/Versions5010andD0/Downloads/w5010PvdrActionChklst.pdf


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ComplianceMatters

standards, you face costly disruptionsto transaction processing and paymentreceipt. Following are some suggestions

for successful transition.Assess the impact of changes to

transaction standards. Version 5010features a number of reporting changesthat may affect your practice or facilitysbusiness functions and must be consid-ered. These include: Post office boxes and lock boxes no

longer can be used as billing provideraddresses. They still can be used,however, in the pay-to address field.

Providers must submit a full 9-digitZIP code in the billing provider andservice facility location address fields.

Dependents of a subscriber to a healthplan or other patients on the sub-scribers health plan who have uniquehealth plan member ID now reporttheir information as the subscriber.

Previously, the subscribers ID wasused and the patients informationwas reported separately.

Upgrade practice management andelectronic health record systems.Workwith your system vendor to ensure thatnecessary system upgrades are made.Budget for them, as they can be costly.Test the upgrades to ensure your systemcan generate Version 5010 transactions.

Your vendor may do this internal testingfor you, so ask about it before initiatingthe testing process.

Identify any needed workflow modi-

fications.These may be required in orderto accommodate data-reporting changes.Updating your system for collecting andreporting transaction data may requireyou to update the way you manuallyrecord data.

Identify staff training needs.Appropriate train

Documents

PT in Motion