Recently, Lauren Jarmusz - a Doctor of Physical Therapy Student at Northeastern University graduating in May 2016 - and I interviewed Justin Moore, PT, DPT. Dr. Moore is the Executive Vice President at the American Physical Therapy Association (APTA). He is focused on interdisciplinary innovation and public policy. He was awarded the R. Charles Harker Policymaker Award from APTA's Health Policy and Administration Section. Last year, I suffered from a serious knee injury and was seeking to understand how to innovate the physical therapy field insomuch that musculoskeletal injuries were prevented. Dr. Moore provided Lauren and I with an in-depth understanding of the challenges facing innovation in the physical therapy field, as well as the brights spots, all the while focusing on the ways to prevent musculoskeletal disorders. Here's our interview:
Marquis Cabrera: What do you believe are some persistent problems impeding innovation in the physical therapy field?
Justin Moore, PT, DPT: Innovation is something physical therapists (PTs) always have valued. Our profession began with the need to rehabilitate soldiers following World War I, and responded to a nationwide polio epidemic during the 1940s and 1950s. The demand for PTs' services grew during these times in history, prompting our profession to innovate to meet increasing demands.
Today, the profession continues to innovate, finding new roles for practitioners and new ways to improve patient care. Three major barriers restrict innovation, however. First, the regulatory burdens posed by traditional health care models, such as "fee for service" and "referral-based," in which physical therapists are commonly placed, box us in. Second, payment restrictions--such as the Medicare therapy cap, which places an annual cap on rehabilitation services and number of visits--limit access to and our ability to deliver quality patient care. Commercial payers or policies that diminish payment below the cost of providing the service impede access to care. Third, the current medical hierarchy is a culture of control over collaboration and care. We are beginning, however, to see increased collaboration between health care professionals and recognition of the valuable contributions PTs make to the health care team. Collaboration breeds innovation.
Lauren Jarmusz, sDPT: What initiatives are underway at the American Physical Therapy Association (APTA) to foster innovation in the profession?
Justin Moore, PT, DPT: The Affordable Care Act places a significant emphasis on the three pillars of health care: quality, access and cost. In order to contribute to the trend of innovation occurring in health care, APTA began to financially invest in it. In March 2013, APTA hosted its Innovation Summit: Collaborative Care Models, a groundbreaking event that brought together PTs, physicians, large health systems and policymakers to discuss the current and future role of physical therapy in integrated models of care. The Innovation Summit has evolved in ways that demonstrate the positive impact of physical therapy and the value PTs bring to health care. APTA has continued to invest in innovation through its Innovation 2.0 project, comprising four models that have the potential to be leveraged nationwide. In addition, in 2014, APTA announced its plans to develop the Physical Therapy Outcomes Registry, a data-collection system that will facilitate improved patient care and outcomes, inform payment decisions, and promote research. The registry will serve as an essential platform for data-based investigations, pilots, and decisions on innovative models of delivery and payment.
Marquis Cabrera: Can you explain the payment model?
Justin Moore, PT, DPT: Our current coding model does not account for patient management or condition. We need to be able to show the quality of our services through a reformed coding model, and we are working with other stakeholders to review current systems. Positive changes in health care are shifting the emphasis from volume-based to value-based services. APTA believes it has a responsibility to advance models that are patient-centric and accurately reflect the value PTs provide to health care.
Marquis Cabrera: PT Advocacy Day looked awesome! Was the APTA advocating for a specific piece of legislation?
Justin Moore, PT, DPT: APTA was, and still is, fighting to eliminate the therapy cap, which can prevent patients from receiving physical therapy under Medicare even when it's medically necessary. The arbitrary cap dates back to 1997, when it was added to the Balanced Budget Act. Other important legislation for which members were advocating on that day were: a bill on concussion management, legislation that incentivizes PTs to practice in underserved areas, and legislation aimed at bringing qualified PTs to facilities during absences of the regular PTs, so that patient care isn't impacted. These are just a few of APTA's legislative priorities. We're also involved in numerous public health initiatives, including falls prevention and addressing the national opioid epidemic.
Marquis Cabrera: Can you tell me about the Move Forward PT campaign? What is its role in advancing the Physical Therapy field?
Justin Moore, PT, DPT: Move Forward PT is a public education campaign designed to help patients and consumers understand who PTs are and how they can help improve function, restore movement, and relieve pain--often allowing patients to avoid surgery or long-term use of prescription pain medications. APTA launched the Move Forward campaign in 2009 and created MoveForwardPT.com, our consumer website that serves as the campaign's hub. Patients and consumers can look to MoveForwardPT.com to find a PT, learn more about their condition, and discover the ways in which a PT can help them. We strive to empower consumers to take control of their health and understand the important role of physical therapy in improving or maintaining movement and function. The campaign's success has led to opportunities such as partnering with the White House to address opioid abuse and promoting the use of non-pharmacologic approaches, including physical therapy, to treat pain.
Lauren Jarmusz, sDPT: What do you think of the move toward preventative, versus reactive, care in the physical therapy space?
Justin Moore, PT, DPT: PTs are movement experts, most notably in rehabilitation and habilitation. PTs have the knowledge, education, and unique opportunity to help individuals and populations of all ages improve their overall health and prevent the need for avoidable health care services. We are beginning to see a shift in the traditional paradigm. PTs now are more involved at the front end of a patient's care, in order to prevent injury or illness throughout their entire course of care. We will continue to see the PT's role evolve over time. This will include assessing patients, with and without chronic conditions, on a regular basis to help manage their overall health and wellness. PTs keep patients functioning at their highest level, and should be utilized for that purpose. I personally see a PT annually for a fitness assessment, to determine how my flexibility, strength and endurance are progressing.
Lauren Jarmusz, sDPT: Research shows that PTs can act as primary health care providers. Do you think PTs should serve as such? If so, why?
Justin Moore, PT, DPT: PTs' roles definitely are evolving. More patients are going directly to a PT without a physician's referral for an evaluation and some form of treatment. The US military has been at the forefront of innovation, with PTs serving as frontline providers and participating in collaborative care models to ensure soldiers are performing their best. Outside the military, PTs have expanded beyond their traditional responsive-based roles, providing proactive, first-line care in nations such as Great Britain, Canada, New Zealand and Australia. Unfortunately, due to some legal barriers in this country, PTs do not have the flexibility to practice in the same way as they can in the military and in several other developed countries.
As the US health care system transforms, PTs will be taking on more primary roles. They'll be more engaged, for example, in community-based health care models. The key is, we must get patients to the right providers at the right time, especially regarding musculoskeletal health. Early access to care by a PT can prevent costly and unnecessary medical procedures. PTs will also be part of teams in chronic care management.
Lauren Jarmusz, sDPT: Do you think an annual physical exam for muscles and bones would increase patient education and decrease the prevalence of musculoskeletal diseases?
Justin Moore, PT, DPT: Yes. There definitely is a role for PTs to play in identifying and treating health conditions that impair function. There's huge potential in patients working with PTs to better manage their health. When PTs actively participate with patients and other providers to manage conditions, the result will be reduced health care costs and better patient outcomes. Ideally, annual visits to a PT will one day be the norm. In the meantime, patients will continue to seek PTs for management of their health conditions and injuries.
Marquis Cabrera: Do you have a game-changing idea on how to go about decreasing the $170 billion spent on musculoskeletal disorders?
Justin Moore, PT, DPT: Treatment by PTs traditionally has been positioned at the back-end of the health care continuum. To reduce the amount spent on musculoskeletal disorders, physical therapy should be positioned at the front-end. This would go a long way toward preventing injury and unnecessary expenses. It also would expedite rehabilitation after surgery by strengthening a patient's musculoskeletal system pre-surgery--a growing trend referred to as prehabilitation.
To place physical therapy at the front of the health care continuum, incentives for early access to physical therapy would have to be put in place. For example, instead of allowing a low back injury to progressively worsen over time, insurers should incentivize patients to receive physical therapy to prevent low back pain, or to treat it within a few weeks of onset. Currently, incentives are misaligned. A realigned system would incentivize preventive, non-pharmacologic-based care.
In addition to improved positioning of physical therapy within the health care continuum, other positive steps for patients include better integrating PTs into work settings, accountable care organizations, and medical homes. The steps would reduce the timeframe for patient access to PTs' services and provide opportunities to collaborate with other health care professionals to improve population health and the health of our communities.
A decade ago, PTs were added to the care teams in many hospital emergency departments. There had been a high-degree of musculoskeletal disorders in those departments, and physical therapy was found to help reduce overall utilization of services and allow patients to return more quickly to functioning in sports, work, their homes and their communities. PTs didn't replace the essential services of emergency physicians and nurses, but complimented their overall care and efficiency by helping each provider be available to serve patients that needed their specific expertise. This model of role delineation and collaboration can be applied to other areas of health care.
Lauren Jarmusz, sDPT: What advice would you give to a doctor of physical therapy student seeking to do something nontraditional in the profession?
Justin Moore, PT, DPT: Over the last 100 years, PTs have been great innovators in the ways they practice. I would encourage students to explore the endless and inspiring possibilities our profession presents. This is a unique and entrepreneurial calling. Beyond patient care, we have seen PTs take on such unique roles as addressing patient needs in international crises and becoming an injury expert on ESPN.
Physical therapists have a fundamental understanding of human movement and how it affects one's well-being. This foundation of knowledge can be used in many sectors--from public health and policy work to not-for-profit international endeavors.
Marquis Cabrera: Why did you make the transition from clinical practice to policy?
Justin Moore, PT, DPT: I am passionate about health, sports and politics. A PT's education and skills that allows him or her to treat patients is foundational to our clinical practice and also a foundation to do many other pursuits such as public policy. Patients put their quality of life in our hands, and that role is so important to who we are as a profession. I personally am interested in trying to impact the system in which PTs practice. I look at public policy as a way to improve the practice environment, so that PTs can practice to the full extent of their licensure, skills, and education--to the optimal good of patients. Having a clinical foundation is key to success in our profession, but it also serves as a launching pad to many different career paths.