Minnesota Chapter APTA

Amid the aroma of deep fried everything-on-a-stick, the noise of hundreds of thousands of people, and the heat of late summer in Minnesota, 114 physical therapists, physical therapist assistants and students volunteered to promote our profession by staffing a booth at the KARE-11 Health Fair Building during the 12 days of the Minnesota State Fair. KARE-11 estimates we had over 350,000 people walk through the Health Fair this year—a new record! After adding the 250,000 viewers for our two on-air spots, it is easy to see how this event helps promote recognition of physical therapy by offering timely and helpful information to consumers.

This year, the MN APTA booth provided consumer information on how to fit a backpack and how to prevent ‘gamer's thumb.’ Booth handouts included general information and literature about PT and how to access PT. In addition, fellow Health Fair exhibitors North Memorial Hospital, which gave away 350 bicycle helmets each day, agreed to hand out an APTA-developed flyer on how to fit a bicycle. Due to the heat, MN APTA paper fans were a huge hit and attracted fairgoers from all over the fairground to the booth. MN APTA gave out over 9,000 fans, as well as 6,000 pencils and 8,000 handouts—another big success! (Jackie Petersen-Morehead, pictured, displays the MN APTA booth goodies.)

MN APTA established a booth sponsorship system this year, rather than charging a fee to fairgoers. MN APTA thanks the prime sponsors donating $500 or more: Bethesda Hospital; BODYWORKS Physical Therapy; Excel Physical Therapy; Fairview Rehabilitation Services; Ham Lake Physical Therapy; Institute for Athletic Medicine; In Touch Physical Therapy; MultiCenter Physical Therapy; Jon Nordrum, PT; Regions Rehabilitation Institute; Ridgeview Rehab Specialties; Sister Kenny Sports & Physical Therapy Centers; and Soderberg Physical Therapy. Other sponsors included DSI Work Solutions, St. Mary’s Duluth Clinic, Northern Star Therapy, and Capernaum Physical Therapy. All our sponsors helped make this event successful!

MN APTA would also like to thank Anne Lamb, PT, and Craig Johnson, PT, for their on-camera representation of the physical therapy profession; NovaCare, In Touch Physical Therapy and Orthopaedic Sports Inc., for booth equipment; Margot Miller, PT, and the APTA Marketing Department for booth handouts; North Memorial for adding APTA handouts to its booth activity; the terrific MN APTA chapter office staff for all their work; the State Fair Workgroup for organization, planning, and execution; and all the volunteers for their flexibility, professionalism, caring, and responsiveness as they interacted with fairgoers.

We have already been invited back for 2008, so mark your calendars now: August 21 through September 1, 2008! Sign-up starts in April!

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MN APTA Strategic Plan: 2008–2010

By Craig Johnson, PT, MN APTA Vice President

APTA Member since 1978

In September, the MN APTA Board of Directors adopted a new strategic plan for 2008-2010. The chapter went through a review of its strategic plan during the past summer at the Coordinating Council meeting and the chapter board meetings. The process of getting leaders within the chapter to discuss the mission and vision of the chapter for the next few years was again a significant event for the life of our association. Why? The strategic plan provides the focus for the growth and activities of our association. The consensus process used allows the leaders within the association to give the Board its views of where they want the chapter to go. The plan is then used to drive the agenda and the budget for our association.

I would like to highlight three items in the strategic plan: The vision now states that the services provided by physical therapists and physical therapist assistants will “reflect the Core Values of the Physical Therapy Profession.” You will also see our goal includes the terms “values-driven” and the phrase “optimal professional environment.” Moving down to the objectives, our legislative objective remains a primary focus.

To illustrate the importance that professionalism and the legislative objectives have for the future of our profession I mention two actions by our Board that will help ensure we reach our objectives and move closer to reaching our goal. Recently the Board voted to make changes to the staff at the chapter office. Equally important the Board established the Quality Improvement/Professional Practice Task Force.

The changes to our staff came about because of the need to focus our staff on the objectives of our strategic plan. In the past, the Executive Director (ED) has had to divide her time between legislative activities, chapter activities, and the day to day operations of the office. Having our ED representing us at the legislature, with other associations, and other healthcare organizations is a significant benefit to the chapter. Through the establishment of these relationships, our leader/members are then able to step in and work to help move our profession forward. The newly added Office Manager sees to the day to day operations of the office and supervises the Administrative Assistant, which frees up the ED to be more strategically focused.

The Quality Improvement/Professional Practice Task Force is leading both a visionary function and a transitional function in the association. The vision that established our peer review process almost two decades ago is being renewed by this task force. The efforts in peer review have been key in upholding our profession’s Standards of Practice and consistency in quality of physical therapy in the state and throughout the country. This task force will lead our members into a future in which we act responsibly for our own professional standards and have safe and appropriate practices which will support our efforts for direct access. These two interdependent initiatives are rightly tied together, as we move forward with legislation we need to provide sound, safe practices. Likewise, as our professional practice advances we will want more autonomy in the clinic and with the healthcare consumer. Our strategic plan focuses our efforts towards the advancement of our profession.

MN APTA Strategic Plan: 2008–2010

MN APTA Mission: As a member driven and volunteer-led organization, the Minnesota Chapter of the American Physical Therapy Association (APTA) advocates for securing the future of the profession of physical therapy.

MN APTA Vision: Consumers will choose and directly access physical therapy for the prevention, diagnosis, and management of movement dysfunction. Physical therapists and physical therapist assistants are the only providers of physical therapy services, and will reflect the core values of the physical therapy profession.

MN APTA Goal: By 2010, the physical therapy profession will be values-driven and will be supported by an optimal professional environment.

Objectives to Meet This Goal	Board Champions
1a. Pass legislation that removes 30-day referral requirement	K. Picard, C. Johnson
1b. Pass legislation that places supervision of first-year licensees under physical therapists	K. Picard, C. Johnson
1c. Pass legislation that allows physical therapists to provide prevention and health and wellness services without a referral requirement	K. Picard, C. Johnson
2. Pass legislation that recognizes physical therapists as professionals	C. Johnson, K. Picard
3. Professionalism is understood by members and integrated into all chapter activities	P. Polga, D. Sellheim
4. Physical therapists will be part of the ‘medical home’ health care team in the management of chronic disease	P. Polga

Adopted by MN APTA Board of Directors 09/25/07

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Volunteering in the Pacific

By Vickie Meade, PT

APTA Member Since 1974

My mother always used to say “be careful of what you wish for” and, of course, she was right. After graduating from the University of Iowa with my physical therapy degree, I wanted to work in a developing country. My opportunity to do so came when my husband and I left Minnesota and moved to Kosrae (pictured below), where my husband had accepted a job offer. Kosrae is a little island in the middle of the Pacific Ocean between Hawaii and Guam and is one of the four island states of Micronesia.

After a few months on Kosrae, I saw a big banner across the one road in the main town that said ‘Disability Awareness Days.’ I investigated and met the staff from the hospital, as well as a gentleman who was with the Rehabilitation Services Assistants (RSA) under the Department of Education. He handily spoke English and was interested to learn that I was a PT, particularly since there were no PTs on the island. He wondered if I would be willing to “help out” when I had time, and time was exactly what I had to offer. The next week he called, and we were off to see some children the RSA team had been working with.

I learned that the RSAs were a group of six people who have had extensive training since 2000 from a program led by Katherine Radcliff, PT, PhD, at the University of Hawaii Affiliated Programs. All of the island states in Micronesia have access to this training since Micronesia has a special relationship with the United States which is similar to protected territory status (in Micronesia, this status is called the Compact). The RSAs had an initial six-month course of training followed by short courses on a yearly basis. Services provided by the RSAs were the first rehabilitation that the children on the island had ever had.

Since the initial invitation to assist the RSAs, I have accompanied them on home visits seeing children from 10 months to 16 years old. Most of the children with severe disabilities have never been to school, and the biggest challenge we face is obtaining wheelchairs and equipment that is the right size for the children. Our biggest success so far has been to integrate a six-year-old young lady with severe spastic quadriplegia into a typical first grade classroom. Her parents were too scared to let her go to school by herself, but after our visit, the parents agreed to a trial period of 30 minutes, twice per week. Her home is high in the mountains and the terrain is very rough, so her parents carried her everywhere. Our next challenge was finding a wheelchair. We were able to borrow one so that she would have a place to sit in the classroom. One of the RSAs and her father go with her each of the two days she is in school.

The education department provides RSA services to children starting at age three, but allows RSAs to assist with infants who have a care plan. Infants are primarily followed through the hospital maternal and child health services (MCH) from birth through two years old, but very few have been identified as needing a care plan. This past April, all the hospital and education staff joined together to offer an all island survey (screen) for children from birth through age five. The staff traveled to each of the five villages to provide the screening clinics. The clinics included MCH, a pediatrician, nutrition counseling, the RSAs, early childhood education and dental services. In addition to screens by each group, the children had immunizations, height and weight measurements, and flouride treatment for their teeth. There are an estimated 1,000 children in this age group on the island and 354 children were screened at the clinics, 44 of whom needed further evaluation.

My experience on Kosrae has been a great learning experience so far. I have been delighted and surprised that the people who live on the island are so willing to include me in their activities and welcome me and my interpreter into their homes. I am slowly getting used to the local customs and have picked up a bit of the language. I thoroughly enjoy applying all my creativity to the challenges I encounter here on Kosrae!

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Addendum: New Certified Clinical Specialists in 2007

In the last issue of Soundwaves, MN APTA recognized Minnesota physical therapists who became APTA Board Certified Clinical Specialists this year. Laura Sanford, PT, Pediatric Clinical Specialist, was inadvertently omitted from that listing. Our apologies and congratulations to Laura!

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Change in Workers’ Comp Provider Fee Levels Effective October 2007

By Barbara Baum, PT, Workers’ Compensation Workgroup Lead

APTA Member since 1961

As noted in an earlier edition of Soundwaves, the mechanism for reimbursement in the Minnesota Workers’ Comp system changed as of October 1, 2005. The system is still based on Medicare’s RVRBS system, which assigns a relative value unit (RVU) to each treatment procedure or modality. Maximum fees are based on the multiplication of the assigned RVU and the conversion factor.

“The Minnesota statutes 176.136, subd.1a, as amended during the 2005 legislative special session, requires the conversion factor for chiropractic services be increased to 72 percent of the medical/ surgical conversion factor on Oct. 1, 2006. The law also provides that the annual adjustment of the conversion factors for four categories of health care provider may be adjusted (by no less than zero) to offset the increase in payments resulting from the increase in the chiropractic conversion factor.”¹

“Pursuant to M.S. 176.136, subd. 1a, which provides for annual adjustments of the medical fee schedule conversion factor by no more than the change in the statewide average weekly wage, the commissioner is adjusting the 2006 conversion factors by 0.9 percent, which is the percent change in the producer price index for offices of physicians (PPI-P) developed by the U.S. Department of Labor, Bureau of Labor Statistics.”²

Subject to the approval of an administrative law judge at the Office of Administrative Hearings, effective October 1, 2007, (for dates of service from October 1, 2007 through September 30, 2008) the new conversion factors will be:

-- Medical/surgical services $77.56 (2006 factor was $76.87)

-- Pathology/laboratory services $64.77 (2006 factor was $64.19)

-- PM & R services $67.24 (2006 factor was $66.64)

-- Chiropractic services $55.85 (2006 factor was $55.35)”¹

Reimbursement for physical therapy services will now be calculated with the relative value of a modality or service multiplied by $67.24. It should be noted, that although the RVU system is used, the Minnesota Department of Labor & Industry (DOLI) medical fee schedule does not use the current relative values used by other reimbursement systems.

For additional information regarding the DOLI medical fee schedule, contact the Workers’ Compensation Division of the Minnesota Department of Labor & Industry at 651-284-5005 or 1-800-DIAL-DLI (1-800-342-5354) or via e-mail (DLI.Workcomp@state.mn.us). See also the State Register for an official notice of the medical fee schedule conversion factors.

Questions? Please contact Barbara Baum, PT, at bbaum1@fairview.org

1. Minnesota Department of labor & Industry COMPACT publication August 2006, page 5 (For a copy go to COMPACT at http://www.doli.state.mn.us/pubwkcp )

2. Minnesota Department of labor & Industry COMPACT publication August 2007, page 3 (For a copy go to COMPACT at http://www.doli.state.mn.us/pubwkcp )

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Consumer Access Bill Update

By Kathleen Picard, PT, MN APTA Board of Directors

APTA Member Since 1977

The Consumer Access Bill workgroup is continuing to promote the Consumer Access Bill during the 2008 Minnesota legislative session. Over the summer and fall months, MN APTA members have been meeting with legislators to discuss the merits of the bill and to provide supportive evidence. The workgroup is looking forward to the start of session on February 12.

What can members do before the Minnesota legislature convenes in February?

1. Talk to your friends and colleagues about direct access to physical therapy. Explore the benefits to patients and consider the long term benefit to the profession. If you are interested in having someone from the CAB workgroup come and talk to you and your peers, call the MN APTA Chapter Office at 651-635-0902.

2. Join the effort to support legislators who understand and agree with direct access to physical therapy. If you want to know more about how to go about this, contact Stephanie Vandover at stephaniemarie80@yahoo.com.

3. Mark your calendar and plan to attend MN APTA Legislative Day [PDF] on March 4, 2008. It’s not too early to sign up!

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MN APTA Takes Position on Athletic Trainers’ Bill

By Kathleen Picard, PT, MN APTA Board of Directors

APTA Member Since 1977

The MN APTA Board of Directors has voted unanimously to strongly oppose the scope expansion bill that was introduced by the Minnesota Athletic Trainers’ Association (HF 2399/ SF 2336).

The decision is based on safety concerns. MN APTA President Joan Purrington notes:

“Increasing the scope of practice for athletic training without requiring an increase in education, training, and supervision would pose a risk to public safety. Entry level requirement for athletic trainers to practice in Minnesota is a bachelor’s degree in athletic training. Academic preparation centers on young, healthy, athletic individuals that make up a distinct population and not on the complicated patient with coexisting medical conditions and pathologies.”

Joan explains, “It is concerning that a state-registered group called ‘athletic trainers’ would not have any reference to ‘athlete’ or ‘athletic’ in their practice act.”

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LEGISLATIVE DAY 2008

TUESDAY, MARCH 8, 2008 - - - KELLY INN, ST. PAUL

MN APTA’s sixth annual Legislative Day will provide an opportunity for consumers to join physical therapy professionals at the Minnesota Capitol. Together, we will learn about and build support for the

Consumer Access to Physical Therapy Bill.

TO REGISTER: DOWNLOAD REGISTRATION & MAIL/FAX TO MN APTA

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Evidence in Action

Reviewed by Katherine Ites, PT, and the MN APTA Research Committee

APTA Member Since 2004

Clinical Question: Can overweight children gain lasting benefits from a high-intensity, structured exercise program?

Evidence: Childhood obesity, type 2 diabetes, hyperlipidemia, and hypertension are increasing at a significant rate. Many overweight children become overweight adults, increasing their risk for diabetes, heart disease, and stroke. Physical therapists are in a unique position to promote overall wellness in this population by encouraging physical activity. Low to moderate intensity aerobic exercise has traditionally been used for weight loss programs. Two recent studies examined the effects of a biweekly high intensity exercise program lasting 3-6 months. These studies reported significant reductions in BMI and total cholesterol, and increased leisure time physical activity in groups of overweight children participating in structured high intensity exercise programs. In both studies, the positive results were maintained at a 1-year follow-up as the participants continued with physical activity independently.

Clinical Decision: Supervised exercise is an important component of a multidisciplinary approach to minimize the impact of childhood obesity. Physical therapists can play a central role by developing structured exercise programs and teaching children how to exercise in order to maintain a healthy lifestyle.

References:

Nemet D, Barkan S, Epstein Y, Friedland O, Kowen G, Eliakim O. Short- and long-term beneficial effects of a combined dietary-behavioral-physical activity intervention for the treatment of childhood obesity. Pediatrics. 2005;115(4):443-449.

Savoye M, Shaw M, Dziura J, et al. Effects of a weight management program on body composition and metabolic parameters in overweight children: A randomized controlled trial. JAMA. 2007;297:2697-2704.

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Quality Improvement Taskforce Update

By Debra Sellheim, PT

APTA Member Since 1975

For the past few months, the MN APTA Quality Improvement (QI) Taskforce, appointed by the MN APTA Board of Directors (BOD) has been shaping and promoting a renewed chapter vision and structure. Building on the excellent work of the chapter’s leadership taskforce, the BOD has given its nod of support for the chapter to start working on bylaw changes that will reorganize our chapter to allow focus on professionalism and quality in practice to occur, including adding a second Vice President (VP) to the chapter. This structure would allow one VP to focus on regulatory affairs and the second VP to oversee professional affairs and quality. In January 2008, the QI task force will be bringing forth a further revision to the organizational structure for BOD approval within a newly created “professional practice division.” The most recent work of the QI taskforce has been in visioning a chapter structure that can support members in continuing competence, professionalism, and quality in practice. This structure includes (1) Building vibrant quality improvement work groups; (2) Redefining the role of the peer review coordinator (to be called quality improvement coordinator) to continue oversight of the MN APTA peer review process while also including a broader focus on quality practice; and (3) Strengthening the linking and coordination of the work of the ethics, education, research, and QI committees/workgroups. It is anticipated that these changes will be finalized and implemented over the next two years.

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Save the Date!

MN APTA Spring Conference 2008

April 18-20, 2008

Earle Brown Heritage Center, Brooklyn Center, MN

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Upcoming MN APTA-Sponsored CE courses

A full calendar of MN APTA courses is available on the MN APTA CE webpage, and will be mailed to your home in the December MN APTA CE flyer

January 19-20, 2008

PEDIATRIC KINESIOTAPING

(Option to become kinesiotaping practitioner upon completion of a third day of class on Saturday, March 1, 2008)

Presented by Deanna M. Wanzek, PT, CTKI

Location: University of Minnesota Medical Center—Fairview Riverside Campus

MN APTA Course Coordinator: Jocelyn Lian, PT

February 1-3, 2008

STRAIN AND COUNTER STRAIN FOR THE EXTREMITIES

Presented by Randall S. Kusunose, PT, OCS, JSCCI

Location: University of Minnesota—Twin Cities

MN APTA Course Coordinator: Terry Cherner, PT

February 16, 2008

GERIATRIC STRENGTH BUILDING

Presented by Mark Richards, PT, MS

Location: College of St. Catherine—Minneapolis Campus

MN APTA Course Coordinator: Laura Franco, PT

March 8, 2008

DOCUMENTATION: COMMUNICATION PROGRESS AND THE VALUE OF PHYSICAL THERAPY

Presented by the MN APTA Quality Improvement Committee

Location: Twin Cities (TBA)

MN APTA Course Coordinator: Judy Hawley, PT

March 13, 2008

PHYSICAL THERAPY INTERVENTIONS FOR SELECTED CONDITIONS OF THE LOWER EXTREMITY

A LOOK AT THE EVIDENCE

Presented by JW Matheson, PT, MS, SCS, OCS, CSCS

Location: Mayo Clinic, Rochester

MN APTA Course Coordinators: Kathy Cieslak, PT & Scott Bandel, PT

Date TBA (March/April)

BALANCE & FALLS IN THE ELDERLY

Presented by Lori Danzl, PT, GCS; Kristin Johnson, PT, NCS; Becky Olson-Kellogg, PT, DPT, GCS; Michelle Peterson, PT, DPT, NCS