Integrating Picmonic for Nursing into the nursing program at Northeast Alabama Community College meant embracing change. Making big changes, like to how nursing educators interact with and teach their students, isn’t usually something people are eager to do. But as Magan Edwards, Nursing Faculty at Northeast Alabama Community College shares, it is more than worth […]
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In response to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) will offer flexibilities to clinicians who chose (or were mandated) to participate in MIPS during the 2020 performance year.
The Merit-Based Incentive Payment System (MIPS) is a Medicare payment program that rewards clinicians with financial incentives for improving the quality of care in their clinics—as per the standards of the program. Last year, 2019, was the first year that PTs, OTs, and SLPs could participate. While MIPS participation was optional for a large majority of rehab therapists, many chose to opt into the program in an effort to improve Medicare reimbursements for their clinics.
However, with the rapid spread of COVID-19 and its impact on the healthcare industry, CMS recognized that many MIPS participants may struggle to successfully report in 2020. So, on June 24, 2020, CMS announced that it would give 2020 MIPS participants some reporting flexibility.
CMS has opened up access to its Extreme and Uncontrollable Circumstances Application for MIPS participants. Through this application, participants (including individuals, groups, and virtual groups), can “request reweighting of one or more MIPS performance categories to 0%” due to hardship from extreme and uncontrollable circumstances—a pandemic, for example.
Essentially, what this means is that, upon application approval, reweighted categories will not contribute to a final MIPS score. So, because PTs, OTs, and SLPs are currently only eligible to participate in two of the four MIPS categories (quality and improvement activities), they could ask to reweight one or both of these categories.
CMS will review applications “on a case-by-case basis,” and the deadline to apply is December 31, 2020. Also, keep in mind that if you end up submitting performance data to CMS, it will void approved applications on a category-by-category basis.
MIPS participants can submit an Extreme and Uncontrollable Circumstances Application through the QPP website (linked below) by following these instructions from CMS:
For clinicians and groups that would like to continue participating in MIPS, CMS has added one new high-weighted improvement activity to the pool “to provide an opportunity for clinicians to receive credit in MIPS for the important work they are doing across the country.”
MIPS participants can receive credit for this activity in one of two ways:
Please note that while rehab therapists can theoretically report this activity, many will not meet the activity’s logistics criteria. Therapists who work in physician practices are the most likely candidates to be eligible to report this activity.
MIPS participation always comes with a degree of risk—and, all things considered, this might be a good time to assess how much risk your clinic can assume. Have questions about MIPS or the flexibility that CMS is offering? Feel free to leave a question below!
2020 has been one hell of a year. We kicked off the new year with a news cycle about fraught international tensions—followed shortly by all-encompassing coverage of the Australian bushfires. In February and early March, news about COVID-19 began picking up steam, and the economy started to feel the effects of the pandemic in April. Early May heralded the arrival of the murder hornets, and the month ended with the tragic death of George Floyd. June was defined by social unrest and the BLM movement (which still continues to this day), and it’s beginning to look like July will be the month of the sun-blocking Saharan dust cloud and the resurgence of COVID-19. (Then comes hurricane season and a presidential election!)
Needless to say, the American public has a lot on its mind, and I think it’s safe to assume that more than a few therapists (myself included) are struggling to stay present at work. It certainly doesn’t help that many providers are spending part of their day in front of a screen delivering remote care; telehealth has some wonderful benefits, but it distances us from the personal connection that we love.
So, what are therapists to do? How do we focus on treating patients when we’re consumed by everything that’s going on in the outside world?
Meaningful interpersonal connection is like a psychological balm. Studies show that strong social connections can help improve a person’s mental and emotional wellbeing. Unfortunately, with the country in various stages of lockdown, those all-too-important interpersonal connections are in short supply. That’s why we have to make a dedicated effort to connect with the people around us—in our personal lives and at work.
Video conferencing may not be the perfect way to connect with friends and family from a distance, but it’s better than nothing—and it’s definitely a step up from your run-of-the-mill phone call. So, schedule regular check-ins with your loved ones at a cadence that works for you (e.g., weekly or biweekly). If you live in the same city as those loved ones, try to plan safe meetups with one or two people at a time—like masked morning neighborhood walks (six feet apart, of course).
If you don’t have many opportunities to connect with your family and friends (or if you just want more connection opportunities), you can forge meaningful relationships at work. This might be the perfect time to get to know your coworkers better. You don’t have to relegate yourselves to talking about patients or your commute—it’s far more rewarding on a personal level to talk about hobbies and recipes. Regular check-ins with clinic compadres (or comadres) who live alone or are new to the clinic can also go a long way to create camaraderie—and even build new friendships.
We are being bombarded with bad (or less-than-ideal) news on a daily basis—so much so that there’s a name for it now: doomscrolling. Some people might process these stressors by talking about them, but others—maybe even you—might need a reprieve from the news sometimes. There’s no right or wrong way to process the latest current events, but you definitely need to establish some hard-and-fast conversation boundaries. Whether you decide you don’t want to talk about the news before your morning cup of coffee, or you want a personal media-blackout Friday, you’re well within your rights to kindly ask your social circles to respect your boundaries. Just be careful not to completely bury your head in the sand. The pandemic and BLM have both generated a lot of conversations about public health and diversity, and those discussions are worth having—even if you take a break now and then.
Socially, we’ve progressed leaps and bounds when it comes to discussing mental health problems. But there’s still a stigma around mental illness that discourages many from seeking help or taking the steps they need to ensure their psychological well being. Luckily, there are some simple things you can do to help keep your mental health in tip-top shape.
This suggestion goes hand-in-hand with knowing when to set conversation boundaries with your peers. The reality of our modern digital world is that we have constant access to (and are constantly barraged with) news updates. It’s all too easy to become oversaturated with doom-and-gloom health forecasts and stories of violence and unrest. I don’t want to discourage anyone from staying up to date, but moderation is key. There’s a lot to be said for unplugging from all media (social included).
Try scheduling specific blocks of time where you catch up on the news for the day—maybe after dinner or once a week on Sundays. Do your best to seek information from reputable sources. Misinformation can cause unnecessary tension and stress for you and your peers.
I’m sure you’ve heard it 100 times by now, but these are unprecedented times, and we’re all trying to muddle our way through. You don’t have to continue functioning like the world is completely normal. If you’re not working at your full capacity, if you’ve had to withdraw from commitments, or if you’ve started replacing some of your home-cooked meals with take-out—that’s okay. We are all coping as best we can, and if you’ve found something that helps you relax (and it’s not harmful to yourself or others), then go for it. There’s no need to beat yourself up.
Part of being kind to yourself is staying active in any way you can. Gyms and other public recreation areas might be closed in some states (in Arizona, certainly), but we’re physical therapists. We’re masters of creating home gyms and adapting exercises to safely keep people active and moving. We should absolutely take advantage of that for ourselves—especially because so many therapists are providing more telehealth services, which limits the amount of activity they do at work.
It’s hard to know when you need to seek additional mental health counseling, but there’s absolutely nothing wrong with doing so. As Mental Health America says here, “you don’t have to be in crisis to seek help.” In fact, it’s better to reach out to a mental health professional before your mental health deteriorates too much. Trained professionals can give you the tools you need to manage your stress and help you process the collective trauma that we’re all experiencing.
Another way to manage the all-consuming need to stay on top of the latest news is to set aside time in your personal and professional life to take action. When I feel like something is very wrong, I have a burning need to focus on it. That feeling of urgency only subsides when I take an action to fix what I perceive as wrong. Perhaps taking action in your professional and personal life will help quench that fire.
Some of the latest major news stories (e.g., the pandemic and BLM movement) are bleeding into our professional lives because of the nature of what we do. We are healthcare professionals, so of course patient safety, public health, and care quality are all top of mind. So, in many cases, it’s actually very appropriate to bring up these current events in the workplace—and addressing them might actually help you take your mind off them.
Take the COVID-19 pandemic, for example. If you’re glued to the updates in your city—and you’re worried about contracting the virus or spreading it to your patients—then revisit your clinic’s infection control policies. You should always follow CDC best practices to ensure the safety of staff and patients. And if you discover an overlooked safety precaution, then bring it up to the clinic manager or director. Don’t sit in fear—take action. Try to fix the problem.
Or, let’s say the BLM movement and the drive for diversity and equality is eating at your every thought. Set aside some time to learn the National Culturally and Linguistically Appropriate Services (CLAS) Standards, and try to recognize and address any implicit biases in your clinic and/or treatment methods. Advocate for diversity, equity, and inclusion (DEI) in your clinic, and speak out against any policies that may inadvertently affect one group of patients more than another. Become an advocate for the people who need your help most, and know that you’re doing your part to aid in the movement.
Finally, if you have the time or resources to do so in your personal life, try to give back to your community and advocate for what you believe in. If you’re concerned about the pandemic, advocate for universal mask-wearing and speak out against rampant misinformation. If you feel comfortable doing so, you can volunteer at pop-up COVID-19 testing sites, or you can donate hygiene and sanitation supplies to homeless shelters and local non-profits. If you want to contribute to the BLM movement, continue learning and (again) speaking out against misinformation. Volunteer at local nonprofits (they have digital tasks, too!), sign petitions, support black-owned businesses, donate to humanitarian centers—the list goes on.
You can make a difference in your community, and sometimes being proactive can help you find a modicum of inner peace—which could help you focus on patient treatment.
I’m not going to say that these suggestions are a stressor cure-all, but forging genuine human connections and taking time to care for yourself and your community is a great place to start. We’re all in this together, and we will make it through the muck and the mire to a better day.
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In light of the ongoing civil unrest in the United States, I wanted to use this month’s Founder Letter as a way to engage with the physical therapy community—a group that includes peers, colleagues, and friends—about the topic of diversity. My hope is to spark meaningful, productive conversations surrounding racial disparity in rehab. As someone with a platform, I feel it is my duty—as well as my privilege—to promote and model a more equitable and inclusive environment for practice leaders, clinical staff, non-clinical staff, and patients alike.
I realize that in writing about this topic, I am inviting an opportunity for heated—and potentially uncomfortable—discourse. All it takes is a simple scroll through the comments beneath any recent article covering race and inequality to know that this topic incites strong reactions—both positive and negative. Still, I believe I have an obligation as a healthcare provider—and a business leader—to (1) think critically about issues surrounding systemic racism, (2) examine the ways it impacts patient health and access to care, and (3) discuss strategies to improve treatment delivery by promoting diversity, equity, and inclusion in the physical therapy industry. It is my hope that you will read this with an open heart and an open mind.
Fostering diversity and creating a more inclusive practice is not an overnight transition. And just like any massive undertaking, the work starts at home. As I mentioned before, I believe it is our moral imperative as physical therapists to do everything in our power to improve patient health and well being—and part of that is cultivating an environment of understanding, empathy, and inclusion. To accomplish this, PTs can start by making minor adjustments to their own interactions with patients and colleagues—something that is bound to create a ripple effect.
One of the best things individual therapists can do to cultivate diversity and mitigate potential unconscious bias is to self-educate and listen. There are plenty of resources available to those who wish to learn—from books and research papers to podcasts and documentaries—and many are available online free of charge. It’s a massive topic, so if you’re not sure where to start, I’d suggest familiarizing yourself with definitions of words that are now commonplace (e.g., systemic racism, racist, anti-racist, etc.). It’s not enough to simply acknowledge that systemic racism exists in the PT community; we must also educate ourselves on why it exists in the first place. As you do your research, I encourage you to vary your sources and specifically seek out educational materials that come directly from voices in marginalized communities. A great example is Justice in June, which I am proud to say some WebPTers helped to make available to the public. As you start consuming information, share your findings with people who are open to thoughtful discussion. These types of conversations are just as beneficial for you as they are for the people to whom you speak.
I also recommend taking part in any formal educational opportunities available to you. Many educational institutions—including Yale, Columbia, and Harvard—are offering free online courses on the topics of race and diversity. And when you participate in PT industry conferences—online or in-person—make it a point to attend sessions focused on diversity in our profession. What better way to educate yourself than in a room full of your peers?
Something we can all do right now is examine the language we use when communicating with—or referring to—individuals from minority groups. (For reference, this resource has a robust list of terms and guidelines for using inclusive language in the workplace.) Certain words or phrases—even when spoken without malicious intent—still communicate a sense of “otherness” to people of minority backgrounds. An example would be referring to an individual as your “______ patient” or “______ coworker,” wherein the blank is filled by that person’s ethnicity, skin color, sexual orientation, or religion—specifically, in cases where that descriptor is irrelevant to the conversation. Often, this reinforces embedded stereotypes, expectations, and the sense that society will always view that individual as a “______ person” instead of simply a person.
Furthermore, it’s important to maintain an open mind and a willingness to listen if you are ever corrected on your word choice—particularly if the person correcting you is from the community you referenced. Missteps are inevitable on the road to change, and terminologies can evolve over time. The important thing is that you’re open to learning.
You’ve likely heard the term “implicit bias” before, but if not, here’s the quick definition: implicit biases are the unconscious beliefs every person has based on stereotypes and societal norms. You’ll note that I said every person—not just some people. For this reason, broaching the topic of implicit bias can be touchy. Most of us don’t want to think of ourselves as having biases—particularly when it comes to minorities or underserved communities. But unlike explicit bias, implicit bias isn’t a conscious choice. Rather, it’s the result of a lifetime of social conditioning that causes us to tie specific qualities to a given demographic. Having implicit biases doesn’t make someone a bad person—it’s simply part of the human condition. However, implicit biases can lead us to make unconscious assumptions about a person based solely on appearances. And as physical therapists, it’s critical that we understand how those assumptions can impact patient treatment. In 2003, the Institute of Medicine in Washington, DC, conducted a report on unconscious bias in healthcare settings that “concluded that unrecognized bias against members of a social group, such as racial or ethnic minorities, may affect communication or the care offered to those individuals.”
While some studies have implied a correlation between implicit bias and patient outcomes, it’s a topic that warrants further exploration. However, we do know that implicit biases can alter the way we communicate with each other—whether that be communication between PTs and patients or PTs and their colleagues.
Recognizing and deconditioning unconscious bias takes a concerted effort, but here are a few actions PTs can take to identify biases and address them:
If you’re a leader in your practice, you have the means and the authority to shape the culture and values of your team. While each staff member is ultimately responsible for self-educating and addressing individual biases and behaviors, your leadership can have a major impact on your team’s journey toward prioritizing diversity and inclusivity. There may be bumps in the road, but if you create an environment of learning and self-reflection, you’ll eventually find yourself surrounded by a team that values those same goals.
If you’ve attended any WebPT webinars, you know I believe that achieving greatness in practice starts with education. That’s why WebPT has joined an organized nationwide effort to advance diversity, equity, and inclusion in the workplace: CEO Action. I strongly encourage you to consider joining this movement with us. It focuses on inclusion via the elimination of blind spots.
I mentioned before that unconscious bias can significantly impact how you communicate with your patients, but the importance of addressing biases doesn’t stop there. Implicit and similarity bias can also significantly affect employment practices. A 2016 study by the University of Toronto and Stanford University found that job applicants with anglicized names (i.e., caucasion-sounding names) were the most likely to receive a call back from potential employers. During the study, 25% of resumes for black applicants with caucasian-sounding names received a call back, while only 10% of applicants with traditionally black-sounding names received a call—despite both resumes being otherwise identical. For Asian applicants, 21% of resumes with anglicized names earned a call from the potential employer, while only 11.5% were contacted when their names indicated their ethnicity. Again, the education, credentials, and experience were identical on both versions of the resumes.
This isn’t to say that those employers or hiring managers were explicitly racially biased. In fact, the study had similar results when applications were specifically sent to employers who claimed to be pro-diversity and thus, actively sought applicants of color.
So, what does this mean? To me, it says that even the most well-intentioned employers are prone to unconscious racial bias. It also tells me that we must make a concerted effort to recognize, educate, and negate implicit bias in our recruitment practices. This starts with scrutinizing current hiring practices and ideally, enacting a blind recruitment process—meaning demographic information that may imply an applicant’s race, gender, age, or economic class is removed from resumes before they reach your desk.
Additionally, practices can regularly check their screening processes for discrimination by weighing the percentage of minority applicants against the percentage of those applicants who made the initial cut.
Let’s face it: discussions around race and inequality are often uncomfortable. I think in most cases, our knee-jerk reaction is to reject racism and any role we might play in it, because of course we don’t want to think of ourselves as racist. These discussions challenge our sense of self, and they ask us to question our own actions—even the unconscious ones. They also force us to re-examine seemingly innocuous tendencies and beliefs we’ve held our entire lives.
Whether the topic is race, religion, or politics, finding yourself in a situation where you’re asked to question a deeply-held belief is like asking your arm to bend in the opposite direction. So, it stands to reason that an individual’s initial reaction to such situations may not be a receptive one. However, with a little patience and encouragement, people often change their minds. So, if you find yourself interacting with someone who doesn’t immediately “get it,” it’s okay. But more importantly, you should promote an environment of learning that allows these individuals to come back later if they’ve had a change of heart—without fear of ridicule or belittlement.
This is one of those potential knee-jerk moments, but I hope you’ll keep an open mind to what you’re about to read: nearly every modern system in the United States has been impacted by racial inequity in some way, and unfortunately, health care—including physical therapy—is no exception. I won’t delve too deep into the roots of this disparity—there are many—but I encourage you to do your own research on the subject, as I believe it can help us come up with ways to better address it.
Historical data on the number of black providers in the United States sheds a harsh light on the very real racial disparity across all areas of health care. Around the year 1900, about 2% of medical professionals were black—a number that did not budge until the 1980s, despite the growing black population in the country. Today, about 5% of physicians in the US self-identify as black, according to the Association of American Medical Colleges. Compare that to the 13.4% of Americans who identify as black, and the disparity is easy to see.
With that historical data in mind, let’s shift the focus back to PT. In 2019, WebPT conducted our third-annual State of Rehab Therapy industry survey. Of the 6,000 individuals who responded to our survey—including occupational therapists and speech-language pathologists—a mere 2.2% self-identified as black or African-American. That’s nearly identical to the percentage of black medical doctors who practiced during the era of Jim Crow and segregation. This number aligns with the APTA’s most recent demographic analysis of its member population: as of 2017, only 1.5% of APTA members identified themselves as black or African American.
The black community is not the only one that experiences disparity. Our 2019 industry survey found that 4% of rehab therapy professionals identify as Hispanic or Latino, while the APTA reported that a mere 2.5% of its members identify the same way. However, 2019 US census data tells us that Hispanic and Latino individuals make up about 18.5% of the population.
You might be wondering about the implications of this data when it comes to treating patients. After all, a talented PT can provide excellent care to any individual regardless of the patient’s race or ethnicity, right? While that may be true, a lack of diversity can often impede patients from seeking care in the first place. A recent study from the National Bureau of Economic Research found that black men seen by black doctors agreed to undergo more preventive services—as well as more invasive treatments—than those seen by non-black doctors, an effect that was said to be “driven by better communication and more trust.”
This revelation is especially prudent for physical therapists. Quality health care—and physical therapy, in particular—is driven by human connection, and patients can more easily connect with providers when their relationship is built on mutual understanding and trust. Conversely, if patients don’t trust their providers or feel misunderstood by them, it gives those patients a reason to not return for care—or to not seek it at all. And considering that only 10% of patients who could benefit from physical therapy actually receive it, this is a missed opportunity to solve the so-called “90% problem.” But more importantly, health outcomes and life expectancy are significantly lower for people of color compared to the white population, and we should be striving toward any solution that can help mitigate that trend.
As we face these discouraging numbers, we must ask ourselves why there is such a massive disparity between the number of white PTs and the number of PTs of color; then, we must come up with ways to address that disparity. To me, one very obvious place to start is with PT education.
In 2018, faculty from the University of Colorado’s School of Medicine hosted a session at the APTA’s Combined Sessions Meeting (CSM) that addressed this very issue. During the session, the presenters discussed their experience with restructuring the admissions processes for DPT programs in order to cultivate a more diverse workforce. The speakers presented findings they collected after employing tools in their own admission process that:
They noted that an applicant’s test-taking ability or cumulative GPA was not necessarily an accurate representation of the kind of PT he or she would become. (They did, however, note that academic performance in math and sciences is highly valuable when assessing an applicant’s potential for success as a physical therapist.) So, in addition to test scores and GPA, the admissions staff also considered non-cognitive assessment methods such as emotional intelligence and grit score.
This session spurred a lot of discussion around the need for a more diverse applicant pool. One commenter—a faculty member at Northern Illinois University—mentioned that it’s hard for diversity initiatives to be successful when you’re pulling from the same pool every year. She recommended working with local professional chapters to assist in recruitment efforts. Another commenter from the University of Arkansas said we must get adolescents in the PT pipeline from the moment they become interested in health care (as early as high school, middle school, or even elementary school). Far too often, when high school students speak with guidance counselors about a career in health care, those students are funneled into a physician path—unless they specifically express an interest in PT.
The presenters also noted the need for inclusivity across all stages of the PT career, not just during the school admissions process. According to Lara Canham, a faculty member from the University of Colorado, “[Diversity] can’t be a program-level effort. It needs to be a national effort; a societal effort, if we want to see change.”
Still, once we have greater diversity in the PT education system, we must continue supporting these clinicians beyond graduation day by ensuring they have equal opportunities for success. Diversity can be metrics-driven and measured, but inclusion is a choice. I believe one very important component of ensuring continued success is to endorse and advocate for organizations that support these future PTs. Two organizations that come to mind are the National Association of Black Physical Therapists, Inc. and PT Proud, an advocacy group supporting patients and providers in the LGBTQ+ community. By reaching out to these groups, we can learn how to be better leaders, better colleagues, and better PTs—as well as better allies.
As we discuss ways to cultivate inclusivity with our patients and within our practices and profession, we cannot forget about our healthcare peers outside of physical therapy. As PTs, we must hold ourselves accountable for the systemic effect of inequality within not only our own profession, but also the healthcare industry at large. After all, as we strive to work with physicians and other rehab therapists as part of integrated care teams, we must first be the change we wish to see.
Just as we should push for greater inclusivity in physical therapy education, the entire medical community could benefit from re-examining their education practices. I believe medical programs—as well as other healthcare professional programs—should consider ways they can foster diversity during the admissions process.
That said, simply leveling the playing field isn’t enough. Historically, people of color have had less access to higher education, which is part of a much larger issue within our society. For that reason, universities must find opportunities to reach adolescents within these communities and provide pathways to students who wish to pursue healthcare careers.
With that in mind, the acceptance rate for medical students from minority communities isn’t the only area of higher education that warrants further review. In 2017, a collaborative study examined the admittance rate of medical students to one of the most prestigious medical honor societies. Upon review, black and Asian applicants were far less likely to be admitted than white applicants. Considering the impact such awards have on future employment and grant funding opportunities, this disparity could end up putting minority students at a disadvantage.
As a PT in technology, I would be remiss to overlook the role tech systems can play in fostering greater inclusivity in health care. A challenge that many who use EMRs and EHRs run into—and one that has been brought to my attention personally—is the lack of gender-inclusive terminology in electronic patient charts. While changing gender terms seems like an easy back-end fix, the lack of cohesion among various EMR/EHR products and other platforms (e.g., billing software) means adding more nuanced gender options creates an interoperability dilemma. Namely, if the payer recipient is not also updated with those same terms, it could lead to incomplete data transmission and denied claims. Correcting this issue at scale will require cooperation and a united commitment to diversity across the entire health IT community—not just one or two companies. However, the WebPT team is currently testing ways to make this change within our platform—an effort we hope will lead the charge for transformation within the industry at large.
2020 has been a year for the books, and I don’t think it’s controversial to say that we’re witnessing history in the making. The message behind the Black Lives Matter movement—and the voices spreading that message—has forced every community to think critically about their role in systemic racism and the actions they can take to create lasting, meaningful change. Granted, that change won’t happen overnight; we have a lot of work to do with ourselves, our businesses, and our communities. But as long as we listen, maintain empathy, and stand in solidarity with those who speak out against inequality and injustice, I believe we will see a better tomorrow—for everyone.
The post Founder Letter: 10 Actions You Can Take Now to Support Diversity in Your PT Practice appeared first on WebPT.