APTA HHS Quarterly Report, Vol. 54, No. 2

A Publication of the Home Health Section Spring 2019 | Vol. 54 | No. 2

The

Quarterly Report

What the Patient Driven Groupings Model (PDGM)
Means to the Individual Clinician

By Chris Childers, PT, BSc (Hons), Ph.D., and Chris Chimenti, MSPT

Are you ready for the new world? more therapy services. This change was based on the
cost associated with delivery of therapy services and was
Where are we now? accounted for in the Service score, based on the number
The Balance Budget Act (Public Law 105-33) of 1997 of therapy visits delivered (Figure 1). 1 As a result, home
compelled changes to reimbursement for home health health therapists have at times been viewed as ‘revenue
care services. The resultant Medicare Prospective Pay- generators’ across the industry. Over the last 19 years,
ment System (PPS) was implemented on October 1, the home health industry has seen a steady increase in
2000. Among the many changes, PPS extended higher the amount of therapy services delivered in the home2.
episodic payments associated with patients who required

Continued on page 3 »

Official publication of the Home Health Section of the American Physical Therapy Association

The

Quarterly Report

Table of Contents Published by the Home Health Section - APTA

1 What the Patient Driven a component of the American Physical Therapy Association
Groupings Model (PDGM)
Means to the Individual Editor
Clinician
Dawn Widmer-Greaves, PT, DPT
6 Physical Therapists Can Play a
Role in Identifying Sepsis Managing Editor/Design

9 An Interview with the Section Don Knox
Vice President: Chris Chimenti,
MSPT Publications Committee

11 Government Affairs Happenings: Julie Colaw, PT; Zachary Hampshire, PTA; Julie Hardy, PT, MS; Mary Marchetti,
S. 433 - The Home Health PT, PhD; Olaide Sangoseni, PT, DPT, MSc, PhD; Aban Singh, PT

Payment Innovations Act Section Officers:

13 Evidence-Based Practice Can President Diana Kornetti, PT, MA
Enhance Care PTAs Provide To
Patients Vice President Chris Chimenti, MSPT

15 The Importance of Test and Secretary Matt Janes, PT, DPT
Measures for the Home Health
Therapist: Allowing the Evidence Treasurer Philip Goldsmith, PT, DScPT
to Support Your Selection
Executive Director Don Knox


The Home Health Section Quarterly Report is the official publication of the Home

Health Section of the American Physical Therapy Association. It is published four

times per calendar year (Winter, Spring, Summer, Fall). Statements of fact and

opinion are the responsibility of the authors alone and do not imply an opinion on

the part of the officers or the members of the Home Health Section.

Article & Content Contributions

Guidelines for contributions are available from the Home Health Section website.
If you have materials you would like considered for publication, please email
them via attachment to the Home Health Section Executive Director: rlchilders@
homehealthsection.org.

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2 - Home Health Section • APTA

...continued from page 1

The development of rehabilitation programs in home day to our patients, as
health has likely contributed to this trend. Over that well as our employers.
same time period, overall agency outcomes have trended We must strive to be
up as well.3 Is this in part due to the enhanced provision the physical therapist
of physical, occupational, and speech therapy services? and physical therapist
assistants our agency
Where are we going? simply cannot live
In 2020 the home health industry will be entering the without. The advanced
new payment concept called the Patient Driven Group- skills we possess must
ings Model or PDGM4. In this new model, home health drive functional
physical therapy service provision will no longer be a improvements and
part of the case mix calculation that determines reim- mitigate the risk for
bursement. What is the potential impact of PDGM on hospital admission
the profession of physical therapy? Will our professional among our patients.
service be simplistically viewed as a cost of doing busi-
ness? Will our home health agencies decide to retain our What does it mean for
services at current levels, or will we possibly be viewed a home health physical Chris Childers, PT, BSc (Hons), Ph.D.
as a financial liability? A recent survey conducted by De- therapist to practice at
cision Health suggests that 22.3% of agencies will “spend the top of license? This
considerably less” on therapy staff in 2019.5 Will this term can be defined
intention continue into 2020? A quick scan of blogs as providing com-
and articles reveals the concern of various home health prehensive service to
stakeholders, but also captures the essence of the change patients to the fullest
through remarks such as: extent possible relative
to training, clinical
“We hope the clinical incentive remains there to deliver practice guidelines,
therapy services”3, “It is imperative that you are able to and state practice act
understand and demonstrate the value your services bring regulations. 10 These
to your facility or agency—and, of course, to your patient6, skills include dif-
“PDGM aims to drastically alter how and when therapy ferential diagnosis,
services are provided”.7 pharmacology, wound
evaluation, assessment,
Therapy costs were a part of the analysis for the cost of clinical reasoning,
care calculations utilized to develop the PDGM model.8 musculoskeletal reha-
And CMS has been clear in its communications that bilitation, neurologi-
the intent is not to value or devalue one profession over cal rehabilitation and
another in the provision of services.2 Further examina- education on disease
tion of the model indicates that up to 28% of all 30-day management. Our Chris Chimenti, MSPT
periods will be made up from the musculoskeletal and
neuro/stroke groups, with wounds adding another 9%. care should support
motivation, education and behavior change among the
Within the medication management, teaching and as- patients we serve. Physical therapists will then need to
sessment categories (MMTA), cardiac and respiratory provide appropriate, relevant, and validated interven-
add an additional 25.5% and surgical aftercare a further tions. Finally, they document all the above in a manner
3%9. Quick addition demonstrates that there could be that fully justifies their presence in the home and the
an anticipated 65.5% of all patients in home health 30- interventions provided.
day periods that would benefit, and could be justified,
by home health physical therapists. The question that The advent of version D of the Outcome and Assess-
needs be answered is how does the profession ensure ment Information Set (OASIS-D) earlier this year has
that physical therapists are a critically necessary part of made it clearer the depth of focus on function will
these groups? continue and that is evident in items such as GG0130
and GG0170. The decision-makers at the Centers for
Are you ready? Medicare and Medicaid Services appear to believe in
As clinicians committed to the quality and experience of the importance of functional mobility. In fact, evidence
our care, we must demonstrate our value each and every is beginning to surface linking function to the rising
costs of health care, including hospital readmission,11
To demonstrate our merit and relevance during this

Spring 2019 - 3

Figure 1 . Where are we now Back in 2017 when PDGM was a blip
on the horizon, the founding co-directors
dramatic shift from volume to value, home health and faculty of the Advanced Competency
physical therapists must strive to practice at the top of in Home Health (ACHH) determined
license. that the certificate program should
Physical therapists must perform at the highest levels promote clinical competence and push
of clinical expertise. They must be willing and able therapists to deliver assessment, interven-
to render all the skills they learned during the formal tion, and documentation at a higher level,
education process in PT school, but now beyond thereby providing outstanding care for
entry level. Interestingly, there is little recent research their patients and employers. The vi-
regarding physical therapists and clinical expertise or sion statement developed in 2017 as the
specialization. In 2003, Resnik and Jensen indicated program was born stated:
that experts demonstrated improved self-reflection, The Advanced Competency in Home Health
patient education, and based on a strong knowledge Program will be the differentiating factor
foundation, offered more individualized treatments12. in the clinical performance of the Home
To be successful moving into the next decade, physical Health physical therapist. The program
therapists in the home setting must be able to demon- will focus on synthesizing current evidence-
strate expert level skills. based practice and tailoring it to the unique
physical therapy setting: the client’s home.
The Advanced Competency in Home Health
Program will provide the physical therapist
with the ability to enhance efficacy and
efficiency of treatment of the home health
client.
The live skills component of the ACHH
program instructs physical therapists
in assessment of blood pressure/pulse,
auscultation of heart and lung sounds,
and evaluation of their findings, with
respect to starting or stopping exercise
based on current guidelines. Review of
cardiopulmonary interventions alongside
medication issues and quality assessments
supports identification and justification of
appropriate interventions.
There are many ways to enhance clinical knowledge,
practice and skills. Continuing education, journal
review, peer to peer interaction and development of a
case study process within your agency are just a few ex-
amples. In addition, the Home Health Section provides
many resources that can help you to develop and refine
your practice.
The next two issues of the Home Health Section Quar-
terly Report will highlight ways that physical therapists
and physical therapist assistants can prepare for PDGM.
Our skill set is much more robust and inclusive than
exercise prescription and walking programs. When we
practice at the top of license, our interdisciplinary teams
can achieve the triple aim of optimizing patient satis-
faction, advancing outcomes, and reducing the cost of
service delivery.13

4 - Home Health Section • APTA

Admission Source and Timing (From Claims) 2. Federal Register. CMS–1689–FC. https://www.fed-
eralregister.gov/public-inspection. Accessed 3/10/19 
Community Community Institutional Institutional
Early Late Early Late 3. Holly, R. Home Health Care News. NAHCS Dom-
bi: Threat of payment cuts can’t be ignored. https://
Cliinical Grouping (From Principal Diagnosis Reported on Claim) homehealthcarenews.com/2019/01/nahcs-dombi-
threat-of-payment-cuts-cant-be-ignored/. Accessed
Neuro Wounds Complex MS Behavorial MMTA- March 20th, 2019
Rehab Nursing Rehab Health Other
MMTA- Interventions MMTA- 4. Centers for Medicare and Medicaid Services. Cen-
Surgical GI/GU1 ters for Medicare & Medicaid Services Patient-
Aftercare MMTA- MMTA- MMTA_ MMTA- Driven Groupings Model. https://www.cms.gov/
Cardiac and Endocrine Infectious Respiratory Medicare/Medicare-Fee-for-Service-Payment/Home-
Circulatory Disease2 HealthPPS/Downloads/Overview-of-the-Patient-
Driven-Groupings-Model.pdf Accessed 3/10/19
Functional Impairment Level (From OASIS Items)
5. Childers A. How much will agencies spend on
Low Medium High staff in 2019? Home Health Line - DecisionHealth.
2019;44(3):5
Cormorbidity Adjustment (From Secondary Diagnoses
Reported on Claims) 6. APTA. The New Skilled Nursing Facility and Home
Health Payment Models. http://www.apta.org/Pay-
Low Medium High ment/Medicare/NewPaymentModels/. Accessed
March 20th, 2019.
HHRG
7. https://homehealthcarenews.com/2019/02/home-
(Home Health Resource Group) health-revenue-down-as-brookdale-shifts-case-mix-
for-pdgm/
Figure 2. The future payment model
8. Abt Associates. Summary of the Home Health
Chris Chimenti is the Senior Director of Clinical Inno- Expert Panel Meeting. https://www.cms.gov/
vation at HCR Home Care, a Rochester-based certified/ Medicare/Medicare-Fee-for-Service-Payment/
licensed home health care agency operating across 25 coun- HomeHealthPPS/Downloads/Summary-of-the-
ties in Upstate New York. He previously served the Home Home-Health-Technical-Expert-Panel-Meeting-.
Health Section as Research Committee Chair and Trea- pdf Accessed 3/10/19 
surer. Currently, Chris serves as the Vice President of the
Section and Executive Committee Member. 9. Attaya C. CMS releases Home Health Final Rule:
Chris Childers, PT, BSc (Hons), Ph.D. Assistant program PDGM starts in CY 2020. https://www.shpdata.
director, University of St. Augustine, San Marcos. Flex com/blog/hh-2019-final-rule-pdgm/. Accessed
DPT program. Director Advanced Competency in Home March 10th, 2019
Health. Chris gained her entry level PT degree at the Uni-
versity of East Anglia, Norwich, England prior to moving 10. Advisory Board. What is Top of License Nurs-
to the US where she became licensed to practice in 1999. ing Practice? https://www.advisory.com/research/
She gained her MS in Gerontology from the University of nursing-executive-center/multimedia/video/2014/
Utah, in 2005, the same year she became a board certified defining-top-of-license-practice?wt.mc_id=email.
Geriatric Clinical Specialist. Chris worked in skilled nurs- Accessed March 28th, 2019.
ing for 15 year prior to moving into academia and home
health to maintain her clinical skills. She is honored to be 11. Fisher S, Kuo Y, Sharma G, et al. Mobility After
the director for the ACHH certification. Hospital Discharge as a Marker for 30-Day Read-
References mission. J Gerontol A Biol Sci Med Sci. 2013; 68(7):
1. Med Pac. Home Health Care Services Payment Sys- 805-810

tem. http://www.medpac.gov/docs/default-source/ 12. Resnik L, Jensen GM. Using Clinical Outcomes
payment-basics/home-health-care-services-payment- to Explore the Theory of Expert Practice in Physi-
system-15.pdf. Accessed 3/10/19  cal Therapy. Phys Ther 2003;83(12):1090-106 doi:
10.1093/ptj/83.12.1090

13. Institute for Healthcare Improvement. An Overview
of the IHI Triple Aim. http://www.ihi.org/Engage/
Initiatives/TripleAim/Pages/default.aspx. Accessed
March 28th, 2019.

Spring 2019 - 5

Physical Therapists Can Play a Role in
Identifying Sepsis

By Marijke Vroomen Durning, RN, Director of Content, Sepsis Alliance

It wasn’t that long ago that the word sepsis was rarely do lead to sepsis. But
mentioned in mainstream media. Now, a quick Google most cases – as many as
search will bring up stories from news outlets such as 92% - occur in the community, before hospitalization.6
The Washington Post and The Los Angeles Times on the Because a high number of people in the community de-
dangers of sepsis. A Washington Post article credited the velop sepsis, physical therapists may come into contact
deaths of Patty Duke and Muhammed Ali in 2016 with with them in the early stages of their illness. Mortality
increased awareness of sepsis.1 In real life, more facilities from sepsis increases by as much as 8% every hour treat-
are working to raise sepsis awareness among their staff ment is delayed, and as many as 80% of sepsis deaths
and patients. However, although awareness is rising, could be prevented with rapid diagnosis and treatment.
many people still either don’t know what sepsis is or do Physical therapists can play a significant role in saving
not understand the significant impact sepsis can have on lives and reducing the risk of serious complications if
their life.2 they can recognize sepsis risk and presentation.7
Estimates suggest there are 31 million sepsis cases with Sepsis
6 million deaths worldwide.3 Given the frequency that Sepsis is a medical emergency, not unlike strokes and
sepsis strikes, physical therapists are likely to come in cardiac arrests. Time is of the essence in treating sepsis
contact with patients who are either developing sepsis or to save lives and limbs. Sepsis Alliance started the “It’s
suffering life altering complications post-sepsis. About TIME™ campaign” in 2018 to help bring the
What sepsis is and what it isn’t message in a simple, easy-to-remember format:8
Based on anecdotal evidence, there appears to be a
misconception among many in the general public that • T- temperature, which may be higher or lower
sepsis is a blood infection. This is likely the result of than normal
generations calling it “blood poisoning.” Sepsis is the
body’s inflammatory reaction to an infection, not an • infection. There may be signs or a procedure
infection itself.4 Sepsis can affect anyone, even the that may have caused an infection.
strongest and healthiest individuals but some groups of
people are at higher risk of developing it. • M- mental status. The patient becomes drowsy,
The groups at higher risk of developing sepsis include:5 confused, or difficult to rouse.

• People over age 65 • E- extremely ill, “I feel like I might die.”
• Infants and children under 2 In addition to the basic signs outlined with TIMETM,
• People with chronic illnesses like diabetes physical therapists should also watch for rapid heart
• People with impaired immune systems rate, shortness of breath, shivering, and sweaty or
clammy skin.9 Given the unique relationship between
Another misconception the Sepsis Alliance encounters is physical therapists in the home health setting and their
the belief that most patients get sepsis while in the hos- one-on-one contact with patients, physical therapists are
pital. Certainly, healthcare-acquired infections can and well-placed to talk to their patients or caregivers about
the signs and symptoms of sepsis. In addition, they are
able to observe the patients’ overall state of health from
one visit to another. This can lead to the physical thera-
pists seeing changes that others may not notice.

6 - Home Health Section • APTA

The two most common infections that trigger sepsis are after they have been discharged from the hospital, com-
respiratory, such as pneumonia, and urinary tract infec- pared with patients who were hospitalized for infection
tions (UTIs).10. However, it’s not unusual, especially but did not have sepsis.14 Researchers don’t know why
among seniors, that there are no obvious signs of infec- this is the case, however the sepsis survivors do tend
tion. Many times, the first hint that something is wrong to have more co-occurring comorbidities, which could
is a change in their mentation.11 Thus, if a patient seems contribute to the increased risk of death.16
“off,” or seems to be deteriorating with no obvious The picture for children is also grim. Almost one-third
cause, some detective work may be in order: (31%) of pediatric sepsis survivors leave the hospital
with some disability, including cognitive or physical
• Did your patient recently have an invasive impairments, skin graft, amputation, or hearing loss.17
procedure, including an intravenous or urinary Nearly half (47%) of child sepsis survivors need to be
catheter insertion? readmitted to the hospital at least once for additional
care.18 Children who were treated in a pediatric ICU for
• Does your patient have any skin wounds, in- severe sepsis also experience post-traumatic stress disor-
cluding skin tears or pressure sores? der (PTSD) more often than children who were treated
on a general hospital ward.19
• Does your patient swallow well, or could there Even survivors who don’t have obvious health issues
be an aspiration pneumonia? following sepsis, such as amputations or organ dys-
function, often report problems such as chronic pain,
• Has the patient been in contact with someone chronic fatigue, post-traumatic stress disorder, and even
who may carry a viral or bacterial infection, hair loss.20 One recent study reported that 36% of sepsis
especially a child? and septic shock survivors experienced alopecia, a dis-
tressing development for many, especially women.20 All
• Did your patient have sepsis within the previous these issues lumped together are considered to be part of
few months? post-sepsis syndrome (PSS).21
Working with sepsis survivors may be challenging,
These are just a few examples of how someone could however, physical therapists who understand that PSS is
have an infection that has not yet been detected. If your real can help their patients feel less alone. Understand-
patient shows signs of sepsis, this is a medical emer- ing why their post-sepsis patients may be more fatigued
gency. Call 911, or have your patient transported to or complain of more pain than they may expect, can
the closest emergency room as quickly as possible. The help physical therapists formulate appropriate treatment
CDC advises the public to use the word sepsis when plans. This can allow them to help their patients reach
talking with their healthcare providers about concerns.12 their previous level of functioning. Or optimize their
When the patient arrives at the hospital, the word level of functioning with consideration for any new
“sepsis” should be used by the patient or caregiver as in limitations.
“we suspect sepsis.” This puts sepsis on the triage nurse’s
radar. Suggested reading: Faces of Sepsis – a collection of
The typical treatment for sepsis is antibiotics and the ad- over 1,000 stories from survivors and tributes from
ministration of fluids.13 The sooner this treatment starts, loved ones.
the better the chances of sepsis not progressing to severe Editor’s Note: The CDC has noted sepsis as a medical
sepsis or septic shock. emergency and has educational materials available for both
Post-sepsis consumers and healthcare providers. These can be accessed
Many sepsis survivors fully recover and resume their at: https://www.cdc.gov/sepsis/
previous levels of activity.14 However, 59% of survivors
aged 50 years or older experience new cognitive or
physical limitations – or both – after discharge.14 And
patients over the age of 65 experience, on average, one
to two new limitations on activities of daily living after
hospitalization.14
Younger adults also face challenges. They have an
increased risk of stroke and myocardial infarction (MI)
within the first month after hospital discharge. In addi-
tion, patients between the ages of 20 and 45 seem to be
at a higher risk for stroke and MI compared to patients
over age 75.15 Adult survivors who are younger than 45
also have a higher risk of death for the first two years

Spring 2019 - 7

References 14. Prescott HC, Angus DC. Enhancing recovery
1. The Washington Post. Sepsis is a medical emer- from sepsis: a review. JAMA. 2018;319(1):62–75.
doi:10.1001/jama.2017.17687
gency, CDC say. It can be stopped if caught
in time. https://www.washingtonpost.com/ 15. Lai C-C, Lee MG, Lee W-C, Chao CC, et
national/health-science/sepsis-is-fast-moving- al. Susceptible period for cardiovascular com-
and-deadly-but-there-are-ways-to-stop-it-cdc- plications in patients recovering from sepsis.
says/2016/08/23/8a0febca-6940-11e6-99bf-f0c- CMAJ.2018;190:E1062-1069.
f3a6449a6_story.html?utm_term=.3fa60a718681.
Accessed March 24th, 2019 16. Abu-Kaf H, Mizrakli Y, Novack V, Dreiher J.
2. Sepsis Alliance. 2018 Sepsis Awareness Survey Long-term survival of young patients surviving
Results. https://www.sepsis.org/2018-sepsis-aware- ICU admission with severe sepsis. Crit Care Med.
ness-survey/ Accessed March 7, 2019. 2018;46(8):1269-1275.
3. Fleischmann C, Scherag A, Adhikari NK, et
al. Assessment of global incidence and mor- 17. Boeddha NP, Schlapbach LJ, Driessen GJ, et al.
tality of hospital-treated sepsis. Current esti- Mortality and morbidity in community-acquired
mates and limitations. Am J Respir Crit Care sepsis in European pediatric intensive care units:
Med. 2016;193(3):259–72. doi: 10.1164/ a prospective cohort study from the European
rccm.201504-0781OC Childhood Life-threatening Infectious Disease
4. Centers for Disease Control and Prevention. Study (EUCLIDS). Crit Care. 2018;22(1):143
What is sepsis? https://www.cdc.gov/sepsis/what-
is-sepsis.html Accessed March 7, 2019. 18. Czaja A, Zimmerman JJ, Nathens AB. Readmis-
5. Sepsis Alliance. Risk Factors. https://www.sepsis. sion and late mortality after pediatric severe sepsis.
org/sepsis/risk-factors/ Accessed March 7, 2019. Pediatrics 2009;123(3)849-857; doi: 10.1542/
6. Liu V, Escobar GJ, Greene JD, et al. Hospital peds.2008-0856
deaths in patients with sepsis from 2 independent
cohorts. JAMA. 2014;312(1):90–92. doi:10.1001/ 19. Syngal P, Giuliano JS. Health-related quality of
jama.2014.5804 life after pediatric severe sepsis. Healthcare (Ba-
7. Kumar A, Roberts D, Wood K, et al. Dura- sel). 2018;6(3).
tion of hypotension before initiation of effective
antimicrobial therapy is the critical determinant 20. Battle CE, Lynch C, Thorpe C, et al. Incidence
of survival in human septic shock. Critl Care and risk factors for alopecia in survivors of critical
Med. 2006;34(6):1589-1596. DOI: 10.1097/01. illness: A multi-centre observational study. Jl Critl
CCM.0000217961.75225.E9 Care. 2019;50:31-5. https://doi.org/10.1016/j.
8. Sepsis Alliance. It’s About TIME. https://www. jcrc.2018.11.015
sepsis.org/itsabouttime/ Accessed March 7, 2009.
9. https://www.cdc.gov/sepsis/signs-symptoms.html. 21. Sepsis Alliance. Post-Sepsis Syndrome – PSS.
Accessed March 24th, 2019 https://www.sepsis.org/life-after-sepsis/post-sepsis-
10. https://www.cdc.gov/vitalsigns/sepsis/. Accessed syndrome/ Accessed March 7, 2019.
March 24th, 2019
11. Girard TD, Opal SM, Ely EW. Insights into
severe sepsis in older patients: from epidemiol-
ogy to evidence-based management. Clin Infect
Dis. 2005;40:719–727
12. https://www.cdc.gov/sepsis/pdfs/Consumer_con-
versation-starter_start-the-conversation-sepsis-P.
pdf. Accessed March 24th 2019.
13. Seymour CW, Gesten F, Prescott HC, et al.
Time to Treatment and Mortality during Man-
dated Emergency Care for Sepsis. N Engl J Med.
2017;376:2235-2244 DOI: 10.1056

8 - Home Health Section • APTA

An Interview with the Section Vice President:
Chris Chimenti, MSPT

Interviewed by Julie Hardy, PT, MS

Chris Chimenti, MSPT

What motivated you to enter the profession of Physi- What is your favorite part of your role within the
cal Therapy? section?
I have always known that I wanted to be in health care. It has to be the ability to network with therapists from
My sister, who is 8 years older than I am, is a registered other organizations of different sizes, patient popula-
dietician and initially sparked my interest in the medical tions, and geography. Sharing ideas to advance individu-
field. When I was in high school, I had aspirations of al and global practice is very stimulating for me. Bounc-
being a dentist. In college, it was an orthopedic surgeon. ing ideas off APTA colleagues such as Ken Miller, Dan
While I was studying for the MCAT, I was encouraged Kevorkian, and Matt James, just to name a few – makes
by a college counselor to shadow a PT in an outpatient me a better therapist and leader. My involvement in the
ortho clinic. I suddenly discovered a profession that APTA and the section has made these connections pos-
combined my intrigue for anatomy and physiology with sible. One of the biggest advantages I find is that it gets
my interest in physical fitness. I immediately fell in love you outside your own isolated sphere of influence. This
with PT and have never looked back. is an open, collegial organization where sharing of ideas
is facilitated.
Tell us about your current job and your role in the
Home Health Section. What does the section most need from the member-
I serve as the Senior Director of Clinical Innovation ship?
for my organization, HCR Home Care. I have been in Involvement. Volunteer for a task force, a committee;
home health care for 19 years, and in various manage- on any level that is possible. This is not only a way to
ment roles for the last 16. I oversee new hire orienta- give back to your profession, but it may expose oppor-
tion, develop continuing education programs, and tunities that may not have presented themselves other-
direct clinical innovation initiatives. As an example of wise.
this, we have incorporated an evidence-based sepsis
screening tool into our EMR and launched agency-wide What do you think home health looks like in the
education to advance our clinical practice in managing future? What looks different? What stays the same?
patients with infection. Grant funding has been secured I believe we all agree that home health is the most cost-
to further explore optimal screening and facilitate early effective setting for health care. The biggest challenge is
treatment intervention for sepsis. making it more efficient. With 10,000 Baby Boomers
turning 65 every day, and a new payment model on the
For the section, I serve as Vice President. Roger Herr horizon, we clearly are facing challenges that can only
(former Section President) strongly urged me to accept be met only with innovation. Clinical video telecon-
the Research Chair position after seeing my platform ferencing and tele-rehabilitation will become crucial in
presentation involving recovery from TKR surgery at meeting these challenges. The patient’s own technology
CSM in 2006. After that, and before being elected VP, I devices (Bring Your Own Device, or BYOD) will likely
also served the section as Treasurer. advance our partnerships in providing efficient, quality
services.

Spring 2019 - 9

What changes have you seen within the profession Tell us a little bit about Chris the human – your life
and how have they impacted you as a home care outside PT and the APTA, and how you find work/
therapist? life balance?
The two things that stand out the most to me (in no My wife and I live in upstate New York, near Lake
particular order) are: a) Growth in the therapist’s re- Ontario. We have a son who is 15 and a daughter who
sponsibility in documentation and regulatory compli- is 13. We made a decision early on that family is pri-
ance and b) The advancing medical and social com- ority. Being a husband and dad is my No. 1 role. Of
plexity of the patients we see, including the number of course, my dedication to my full-time employer keeps
co-morbidities and increasing longevity. Nineteen years me plenty busy. I fill in the gaps around these important
ago, we would have never dreamed of caring for joint responsibilities with volunteerism. On a practical level,
replacement patients without opioids in home health I have learned to prioritize. I have my “A list” priorities
one day post op! that I work on every day, and I prioritize other tasks on
my “B” and “C” lists, and get to them as I can. As far
Whenever I have the opportunity to talk with PT as hobbies, I love anything outdoors. Whenever pos-
students, I challenge them to identify any other practice sible, and as the weather allows, I take advantage of our
setting that uses almost every aspect of their skill set. proximity to Lake Ontario to spend time boating and
As patient complexity continues to evolve, the sophis- fishing with my family.
tication of services we provide must evolve along with
it. To meet this challenge, therapists must embrace the Thank you, Chris, for sharing your life with us, and for
concept of practicing at top of our license every day to your service to the APTA Home Health Section!
meet the demands of our patients.
Julie Hardy has many years’ experience working in the
“One of best compliments to our profession is for a PT fields of home health care, acute care, and physical therapy
to be mistaken for a nurse. Think about all that you education. She is currently using her skills to educate home
must do in addition to developing and overseeing their health and hospice clinicians of all disciplines in her role
exercise/mobility program: ongoing assessment and as Clinical Education Consultant with Encompass Home
interpretation of vitals, auscultation of lung sounds, Health and Hospice, one of the largest home health pro-
wound care, med reconciliation, and disease manage- viders in the United States. She has been a presenter at
ment education. The therapist of 2020 and beyond the Combined Sections Meeting of the American Physical
must harmonize the autonomy and flexibility of home Therapy Association and has been published in the Home
care with the challenge of caring for the numerous Health Section’s Quarterly Report, and the Academy of Ge-
medical needs of complex patients.” riatric Physical Therapy’s Geri-Notes. She has been instru-
mental in developing the current Memory Care Program
for Encompass Home Health and Hospice.

CSM 2020 WILL BE FEB. 12-15 IN DENVER, COLORADO

CSM brings together more than 15,000 innovative and dedicated professionals for the largest conference on
physical therapy in the country. With programming designed by all 18 of APTA's specialty sections, including
the Home Health Section, you will not want to miss this upbeat conference!
yy Registration will open Sept. 18
yy Exhibitor registration for CSM 2020 opens in early June

10 - Home Health Section • APTA

Government Affairs Happenings:
S. 433 - The Home Health Payment
Innovations Act

by Carol Zehnacker, PT, DPT, CEEAA

On Feb. 11, 2019 Senator Susan Collins (R-ME) intro- connect.com/pqr4iw0o9bax/>
duced The Home Health Payment Innovations Act with • Question and Answer Session 1 via Adobe Connect
a bipartisan group of her colleagues including Senators
Debbie Stabenow (D-MI), John Kennedy (R-LA), Bill – 3/5/2019<http://apta.adobeconnect.com/p2hkh-
Cassidy (R-LA), Rand Paul (R-KY), Doug Jones (D- 1boas8l/>
AL) and Jeanne Shaheen (D-NH). S. 433 represents a • Question and Answer Session 2 via Adobe Con-
revised version of S. 3458 and S. 3545 from the 115th nect – 3/6/2019<http://apta.adobeconnect.com/
Congress and is intended to ensure full budget neutral- pa40ewj3qllg/>
ity in the Patient Driven Groupings Model (PDGM).
This bipartisan legislation is endorsed by the National Over the next few issues the Quarterly Report will
Association of Home Care and Hospice, as well as by include select questions posed to the panelists on the
the Partnership for Quality Home Healthcare. Q&A webinars. Here are the Q&A for this quarter:
This bill will refine payments in the new home health
payment system to ensure behavioral-based payment What is the importance of coding under PDGM?
adjustments are based on evidence and observed data, The primary diagnosis will be used to determine the
not on assumptions of provider behavior. It would limit clinical grouping to which patients are assigned. It’s an
the risk of disruption in care by providing a phase-in for important construct under the model. I would encour-
any necessary rate increases or decreases. This phase-in age PTs who have shied from clinical taxonomy to
is critical for home health providers, as CMS has already fully embrace coding. We should be responsible for
proposed cutting Medicare payment rates in 2020 by body structure and body impairments that are derived
more than $1 billion in the first year alone, based purely from the health conditions, and we should be more
on assumptions of changes in behavior. The phase – in responsible for identifying the primary condition that
would operate to ensure full budget neutrality by 2029. is driving reimbursement for that particular condition
S. 433 would also provide flexibility on waiving the for that 30-day period. Additionally, in PDGM there
“homebound requirement” when a Medicare Advantage is a new construct called the questionable encounter.
plan determines that providing care to the patient in the CMS has assigned certain ICD-10 codes into a category
home would improve outcomes and reduce spending on called “questionable encounters,” and it believes these
patient care. are not appropriate for a primary condition. It is affect-
Please support S. 433 by going to the APTA website ing codes typically used for rehabilitation significantly
and Take Action to contact you Senators. A companion because codes like abnormality of gait are designated as
bill at the House should be coming out at the end of questionable encounters and claims won’t proceed with
March. these codes in the questionable encounter slot. We need
PDGM to educate ourselves as to what those codes are and how
The second webinar on PDGM was recorded on to get at the primary etiology.
2/19/2019 followed by Q&As on 3/5/2019 and
3/6/2019. Special thanks to Kara Gainer APTA Direc- There are concerns that patient populations that need
tor of Regulatory Affairs and GAC members Bud Lang- therapy services but that do not fall exclusively into 1
ham and Ellen Strunk. The links to these informative of the 2 rehabilitation clinical groupings will receive
and timely webinars are: less therapy. Is it a strategy to code more patients to
ensure they are categorized into a “rehabilitation”
• Overview of PDGM – 2/19/19<http://apta.adobe- grouping?
It is not a strategy. You must code appropriately. Under
PDGM, just because someone is not in the musculo-

Spring 2019 - 11

skeletal rehabilitation or neurological rehabilitation • Supervise PTAs
clinical groupings does not mean they are ineligible to • Perform medication management
receive rehabilitation. If patients in Medication Man- • Perform an OASIS admission assessment
agement, Teaching, and Assessment (MMTA), complex • Assess vital signs and ADLs, etc.
nursing, behavioral health, and wounds have rehabilita- Driving value means – taking extra steps to keep pa-
tion needs, then agencies and their therapy professionals tients out of the hospital or ER and ensuring patients
must satisfy those needs. are highly satisfied with services they are receiving.
Rehabilitation services are not confined to the neuro Additionally:
rehab and musculoskeletal rehab groupings. Many agen- • Track data, show your outcomes and what you do for
cies do not understand this; this is where therapy profes-
sionals must stand up and inform the agencies about the patients and families. Focus the therapist on a few
right way to do things. metrics, not all home health compare metrics, be-
As far as strategy, the strategy is for rehabilitation profes- cause they aren’t all equal.
sionals to understand how to accurately code patients • Medicare Spending Per Beneficiary: Ratio of spend-
for the episodes in which PTs and PTAs are involved. ing.
We must strive for accuracy. Patients who fall into the • Discharge to community – the more discharges to
musculoskeletal rehabilitation or neurological rehabili- community, the better.
tation clinical groupings need rehab services. A myth • Acute care hospitalization rates for patients you en-
exists that the patient in one of the other four clinical counter.
groupings will not need rehabilitation. However, re- • Think about patient satisfaction (HCAHPS). Claims
habilitation needs are not driven by clinical grouping. based metrics and metrics where families provide
Many types of patients may need rehabilitation services; feedback are crucial.
we should not allow anyone to exclude access to reha- • Look at how you determine number of visits.
bilitation just because of the clinical grouping. • Look at effectiveness of your exercises.
CMS reiterated this same sentiment during a Feb. 12, • Are you connecting with the upstream provider, to
2019, PDGM webinar, stating: “While there are Clini- find out what they’ve already done?
cal Groups where the primary reason for Home Health • Examine how you bring discharge to community
services is for therapy, and others where the primary rea- down to your individual practice level; examine how
son for Home Health is for nursing, these groups reflect you are preparing patients for discharge, whether
the primary reason for Home Health services during the you have aligned your plan of care with the patient’s
period of care - but not the only reason. goals, whether you are helping them achieve what
Home Health remains a multi-disciplinary benefit, and they want to achieve instead of just PT goals.
payment is bundled to cover all necessary services iden- • When supervising assistants, examine if they are
tified on the individualized Home Health plan of care. specifically addressing the metrics; examine what the
So, for example, if a period of care is grouped under the physical therapist needs to do to drive certain types of
complex nursing interventions group because the pri- therapeutic exercises?
mary reason the patient needs Home Health services is • Starting immediately, conduct a self-determination of
for nursing care, therapy services could also be provided where you’re at in your practice and how individual-
if those therapy services are reasonable and necessary ized you should make the plan of care.
and ordered on a Home Health plan of care.” • All 4 PAC settings are collecting Section GG, and
(See: https://www.cms.gov/Outreach-and-Education/ will be using the data to look at what’s happening to
Outreach/NPC/Downloads/2019-02-12-PDGM-Tran- a beneficiary across the care setting.
script.pdf ). Finally, be an advocate for your patient and coordinate
Volunteers needed with other health care professionals. PDGM will make
The Government Affairs Committee continues to seek rehabilitation professionals more aware of other services
input from the members of the Home Health Section and how you relate to others.
and also seeks volunteers for the committee and the li-
aison program. Help us to help you by getting involved Carol Hamilton Zehnacker PT, DPT, CEEAA is the owner
and serving your profession. of Physical Therapy Consults. LLC and contracts with
What are strategies for therapists to demonstrate Bayada Home Health. She is the Chair of the Govern-
their value?  ment Affairs Committee and may be reached at doctorz@
comcast.net.
Practice at the top of your license; be a total and com-
plete clinician. Demonstrate that you are willing to:

12 - Home Health Section • APTA

Evidence-Based Practice Can Enhance Care PTAs
Provide To Patients

By Kandy Ortgies, PTA

As the role of the physical therapist assistant (PTA) has by using this model, you can get a “cookbook” approach
changed and evolved over the years, the use of evidence- to treatment.1 However, if you consider your personal
based practice (EBP) has experience, evidence from research
become more important. and take into account the patients
The PTA, especially in values, you should be able to tailor a
home care, has become plan for your specific patient.1 If you
more autonomous.1 The rely solely on research, you may feel
PTA is one half of the as though you are applying the same
physical therapist/PTA intervention to all patients with the
team and therefore has an same diagnosis.
important role in deliver-
ing high quality patient To use evidence-based practice ef-
care. The use of EBP will fectively, you need to be aware of
allow the PTA to be able some broad categories of research.
to deliver quality patient Scientific research can be broadly
care. The American Physi- categorized as either basic research
cal Therapy Association or applied research.4 Basic research
(APTA) supports the de- is also called “pure,” or fundamen-
velopment and utilization tal, research.5 Its scientific research
of evidence-based physical aim is to improve scientific theories
therapy services by PTAs. or improved understanding.5 Ap-
The APTA Vision 2020 plied research uses scientific theories
Statement described the to develop techniques to intervene
expectation that “physi- and alter natural or other phenom-
cal therapist and physical ena. 5 One must also take into ac-
therapist assistants will ren- Figure 1: Incorporating patient values, best evidence and count clinical practice guidelines. Ac-
der evidence-based services clinician’s expertise to get EBP. Source: Gresham BB. Con- cording to APTA, “Clinical Practice
cepts of Evidence Based Practice for the Physical Therapist
through the continuum of Assistant. Philadelphia, PA: F.A. Davis Company; (2016) Guidelines (CPGs) enable PT’s and
care.2 PTA’s to understand the state of evi-
dence as it stands. They are the key to decreasing unwar-
What is Evidence-Based Practice? ranted variations in practice, decreasing the knowledge
The most common definition of EBP comes from Dr. translation gap, and optimizing movement.” 6
David Sackett. Evidenced-based practice is “the con-
scientious, explicit and judicious use of current best All PTA programs are required to be accredited by the
evidence in making decisions about the care of the in- Commission on Accreditation in Physical Therapy Edu-
dividual patient.”3 EBP is the integration of your own cation (CAPTE). Currently, CAPTE does have standards
personal experience with external clinical evidence from and required elements for accreditation stating that, to
systematic research.3 Not only does EBP integrate your receive accreditation, a PTA program needs to “identify
clinical experience and research evidence, it also takes and integrate appropriate evidence-based resources to
into account patient values (Fig 1).1 For EBP to be ef- support clinical decision-making for progression of the
fective, all three aspects need to be addressed, and each patient within the plan of care established by the physical
plays an equal key role. Many critics have stated that, therapist” 7

Spring 2019 - 13

Is Evidence-Based Practice important? ing knowledgeable about outcome measures. This will
Over the past few decades, EBP has become a frequent help ensure that the patient is meeting the goals and the
topic for continuing education. It is being used to im- plan of care the physical therapist has developed. This
prove the quality of patient care and standardize aspects can help determine if the patient is progressing. Being
of care emphasizing the best possible outcomes for the competent in using outcome measures not only gives in-
patient.1 In addition, patients have more access to media, formation on whether the patient is progressing towards
so they are better informed on their health care needs and established goals, but also helps the patient see his/her
have higher expectations of the service they are receiv- level of progression. This can help motivate the patient
ing.8 That doesn’t mean that everything they have access to participate to his/her full potential.
to is correct. As PTAs, we need to be able to assist them The PTA needs to read the literature to update their
to understand the information they receive is accurate, or knowledge of physical therapy interventions. There also
we need to be able to decipher if the information is not needs to be open communication between the PT and
relevant to their specific situation. With PDGM (Patient the PTA. Working together will make this task, which
Driven Groupings Model) being implemented in 2020 may seem daunting at times, easier and more beneficial
by The Centers for Medicare and Medicaid Services, the for the patient.
need for EBP will be much more important and neces- PTAs need to seek out continuing education to improve
sary to justify treatment interventions. their EBP skills. This knowledge can then be shared with
their colleagues. Also, the PTA can make suggestions to
How does the PTA fit into the idea of using EBP? the PT to identify an article that pertains to a patient they
The role of the PTA is primarily with the intervention are seeing, and then discuss the article. This can provide
aspect of care.1 PTAs are unable to perform the exami- an opportunity to share information, ideas and problem
nation/evaluation, but they can competently perform solve as a collaborative team. In order to utilize EBP with
selected data collection related to outcomes measures our patients, there needs to be an understanding that
uniquely selected for their patients.1 Also important is this is the correct way to practice. Intuitively, using EBP
understanding reliability and validity of the test and be- should enhance the care we provide our patients.
...continue on page 17

Responsibility

It can be difficult to think there is a sufficient amount of time to read research and review literature related to the patients you are
currently seeing. As with any task, having a process or framework to follow can help make the task less daunting. The process of
EBP includes five commonly identified steps1

Step 1: Formulate a Focused Clinical Question A clinical question provides the basis for a literature search to find information
relevant to a particular patient situation.

Step 2: Locate the Evidence Use a search engine and use key words or phrases related to your clinical question. Also limit your
research to a certain time frame.

Step 3: Critically Appraise the Evidence You need to determine if the article is relevant to the clinical question, and if it is a high
quality article. It is important to know if it is an abstract, which is a research summary; a systematic review, which is a literature re-
view and summary of existing research; or a research report, which is a subjective summary of evidence provided from an author’s
perspective.

Step 4: Apply the Evidence to Patient Care Combine the relevant evidence with the clinician’s clinical experience and the patient’s
specific circumstances.

Step 5: Evaluate the Process Ask yourself- Was it helpful? Decide what you could do differently the next time and, most impor-
tantly what was the patient’s outcome?

Evidence Based Practice. Is it a term that we should use only when taking a continuing education course or when talking to our
colleagues? Or is a framework on how we should be practicing every day to give our patients the best possible outcomes they can
accomplish? The PTA plays an important role in patient management, areas of intervention, outcomes and tests and measures.
With changes in healthcare, not to mention the increased knowledge of our patients, we as PTA’s need to embrace the fact that we
can, and should, use evidence based practice so we too can practice at the top of our license.

14 - Home Health Section • APTA

The Importance of Test and Measures for the
Home Health Therapist: Allowing the Evidence to
Support Your Selection

By Nick Panaro, PT, DPT
Board Certified Geriatric Clinical Specialist
Certified in Advanced Competency in Home Health

Home Health agencies are in the process of Figure 1 – Patient Client Management Model from the APTA Guide
transitioning into one of the more fascinat- to Physical Therapy Practice
ing times in the history of Home Health
services with the coming Patient Driven more relevant in the home health setting as supported
Grouping Model (PDGM) set to begin in by research and evidence-based studies.
2020. With this change, more than ever, As any home health physical therapist can attest, the
Physical Therapy as a profession has the range of clinical conditions that we observe in our
opportunity to demonstrate our worth and patient referrals is quite vast. Knowledge and confi-
value in the home health setting. dence in choosing the right assessment tools or outcome
Valuable home health physical therapists measures allows the therapist to provide a valuable and
(HHPT) need to be well-rounded. They specific evaluation of the patient’s problem, while also
must be prepared to challenge themselves in allowing for thorough plan of care development (POC).
areas where they may have a lack of experi-
ence or knowledge. Physical therapists
must approach each patient in a holistic
manner that considers ALL things that can
affect the patient’s current health condition,
as well as potential barriers or opportunities,
that a therapist must address to meet the
needs of the patient. Therapists, both expe-
rienced and less tenured, can develop tunnel
vision, or bias, toward specific interventions,
preferences, and methods of assessment.
In the Advanced Competency for Home
Health program, one of the objectives is to
present a challenge to physical therapists to
find what makes them uncomfortable, and
to give them an opportunity to develop this
area by allowing the maximum amount of
clinical growth. This is a question any practitioner can
ask of him/herself. The end result of a question of this
nature should be seeking out the additional informa-
tion or support needed to improve competence in the
identified area. This will permit physical therapists to
be broader in their approach to their patients, as well as
to the profession moving forward.
One specific area that could be a focus is the selection
of tests and measures. More specifically, what test &
measures, as well as other sources of outcomes, may be

Spring 2019 - 15

According to the APTA Guide for Physical Therapy,1 results to demonstrate the skilled benefit of the inter-
the Patient Client management Model is an ongoing, ventions provided, or the need for further home physi-
ever changing, dynamic process that requires a concen- cal therapy services in order to produce a true clinical
tration and emphasis on the evolving needs for each of difference and functional change.
our patients. All the components of this model play
important and specific roles in the care of a home health For instance, a physical therapist may be selecting
patient.1 among a group of tests for his/her patient to focus on
the assessment of balance due to a history of frequent
The examination, which includes patient health his- falls. These may include tests such as the Timed Up &
tory, review of systems, and test and measures, begins Go, Berg Balance Scale, Five Times Sit to Stand, and
to frame our patient assessment.2 It then allows us to BESTest test to assess balance on a patient with frequent
start to decide how this patient may benefit from skilled falls.4 The skill is not in choosing just any test, but in
in-home physical therapy as well as assisting in the choosing the most appropriate test.
development of a proper and attainable POC. Through Are you more concerned with the static or dynamic bal-
a thorough review, we systematically screen all major ance?
body systems and functions including, but not limited
to, cardiovascular, pulmonary, neuromuscular, mus- • Do you want to assess his/her balance while also
culoskeletal, and integumentary systems.2 From these assessing mobility?
results, as well as the information gathered from the
patient history, the HHPT then decides what specific • Or are you looking for a balance test that can also
tests & measures are going to give the best description give you a measure on other impairments such as
of this patient’s limitations, as well as opportunities for strength or coordination?
improvement. As noted in the “Principles of Physi-
cal Therapist Patient and Client Management” in The • Also, are you going to select a performance-based
Guide,2 “Physical therapists use tests and measures to measures such as the ones just listed or would a
rule in or rule out causes of impairment in body struc- self-report measure be more appropriate such as
tures and functions, activity limitations, and participa- the ABC scale or Falls Efficacy Scale (FES).
tion restrictions.”
In the example above, a HHPT who is aware that psy-
As part of our patient evaluation, we then analyze and chological factors can be more predictive of falls than
interpret the results and findings of the exam. Thera- physical tests and measures would have the ability to
pists should utilize the evaluation to also consider con- paint a clearer picture to the patient of his/her fall risk.5
textual factors that we often encounter in home health, Many physical therapists certainly have their “go to” test
including living arrangement, social environment, moti- for balance, however that one test may not be the most
vation, and patient desired goals. Further, our findings appropriate to utilize in a given situation or patient
from our selected tests and measures can help formulate scenario. When performing a test ask yourself:
differential diagnoses and the implementation of spe-
cific interventions and patient education to promote an • Does your selected test or measure find what you
improved quality of life. are looking for?

Clinical decision making • Does it benefit the patient?
“The appropriate selection of tests and measures for • What are the functional tie-ins associated with this
a specific individual depends on the established psy-
chometric properties of the measurements and on the test or measure, and will it allow an opportunity
clinical utility of the test and measures.”1 Being familiar to reassess later to determine true clinical change?
with psychometric concepts such as reliability, valid-
ity, predictability, and clinical meaningful change in tests The decision of which tests and measures are chosen
and measures allows the HHPT to be equipped with a does not have to be limited to only one or two tests.
knowledge of the most appropriate and beneficial tools Evidence continues to show that utilizing clusters of
for that specific patient.2 Interpreting the results of the tests and measures may provide greater detail into
selected test and measure requires a better understand- levels of impairments and provide predictive criteria.6
ing of clinically significant difference, also known as The results of these test clusters can allow the HHPT
minimal detectable change (MDC) or minimal clinical- to provide a quantitative description of the limitations
ly important difference (MCID).3 By becoming familiar present in the patient’s functional status. The proper
with clinical differences, the HHPT is able to utilize the selection of tests & measures will provide a context to
the limitations of our patients, support goal writing and
development, and promotion of objective measures used
in reassessments, recertifications, and payor authoriza-
tion requests.

16 - Home Health Section • APTA

Enhancing your skill in the areas of selection and appli- ...continued from page 14
cation of tests and measures will help you to choose the References
most appropriate test & measures based on patient char-
acteristics, the parameters for the chosen test, and the 1. Gresham BB. Concepts of Evidence Based Practice
most recent evidence that links specific tests to specific for the Physical Therapist Assistant. Philadelphia,
outcomes and patient populations. Not only is it criti- PA: F.A. Davis Company; (2016)
cal for the HHPT to be confident in the selection of the
best tests and outcome measures, but also in utilizing 2. American Physical Therapy Association. Vision
the results of the test and re-test, through the assistance 2020. http://www.apta.org/vision2020/. Accessed
of the literature, to determine if the observed change via March 28th, 2019
test and measures results is truly clinical in nature and
beneficial to the patient. In turn, you will be able to 3. Sackett DL, Rosenberg WM, Gray JA, Haynes
provide yet another strong statement into your value as RB, Richardson WS. Evidence based medi-
a Physical Therapist in our evolving and exciting land- cine: what it is and what it isn't. BMJ 1996 Jan
scape of Home Health Physical Therapy. 13;312(7023):71-2

Nick Panaro, PT, DPT is a Board Certified Geriatric 4. Portney LG, Watkins MP. Foundations of Clinical
Clinical Specialist and Certified in Advanced Compe- Research: Applications to Practice. Upper Saddle
tency in Home Health. He is a Clinical Supervisor with River, NJ: Pearson; (2008)
UPMC Home Health of Central Pennsylvania. With ex-
pertise in Musculoskeletal and Geriatric Physical Therapy, 5. Berkley Lab. Basic vs. Applied Research (from
he authored and co-authored modules for the Advanced Lawrence Berkeley National Laboratory). http://
Competency in Home Health (ACHH) and is a current www.sjsu.edu/people/fred.prochaska/courses/
faculty member of the ACHH Live courses. He can be ScWk170/s0/Basic-vs.-Applied-Research.pdf. Ac-
reached at [email protected]. cessed March 28th, 2019

References 6. American Physical Therapy Association. Clinical
1. Principles of Physical Therapist Patient and Client Practice Guidelines. http://www.apta.org/Eviden-
Management. Guide to Physical Therapist Practice ceResearch/EBPTools/CPGs/. Accessed March
3.0. Alexandria, VA: American Physical Therapy 28th, 2019
Association; 2014. Available at: http://guidetopt-
practice.apta.org/content/1/SEC1.body. Accessed 7. Commission on Accreditation in Physical Therapy
2/13/19. Education. Standards and Required Elements
2. Measurements and Outcomes. Guide to Physical for Accreditation of Physical Therapist Assistant
Therapist Practice 3.0. Alexandria, VA: American Education. http://www.capteonline.org/upload-
Physical Therapy Association; 2014. Available at: edfiles/capteorg/about_capte/resources/accredita-
http://guidetoptpractice.apta.org/content/1/SEC3. tion_handbook/capte_ptastandardsevidence.pdf.
body. Accessed 2/13/19. Accessed March 28th, 2019.
3. Haley SM, Fragala-Pinkham MA. Interpreting
change scores of test and measures used in physical 8. Landers S, Madigan E, Leff B, et al. The future
therapy. Phys Ther. 2006;86: 735-743. of home health care: A strategic framework for
4. Huang WW; Perera S, et al. Performance mea- optimizing value. Home Health Care Manag Pract.
sures predict onset of activity of daily living dif- 2016;28(4):262–278
ficulty in community-dwelling older adults. J Am
Geriatr Soc. 2010;58:844-852. Spring 2019 - 17
5. Landers, MR, Oscar, S, Sasaoka, J, Vaughn, K.
Balance Confidence and Fear of Falling Avoidance
Behavior are Most Predictive of Falling in Older
Adults: Prospective Analysis. Phys Ther. 2016; 96:
433-442.
6. Lusardi MM et al. Determining Risk of Falls in
Community Dwelling Older Adults: A Systematic
Review and Meta-analysis Using Posttest Probabil-
ity. J Geriatr Phys Ther 2017;40:1-36.

ACHH FACE-TO-FACE COURSE IN PITTSBURGH NOW
OPEN FOR REGISTRATION

When: Sept. 7-8, 2019; 7:30 a.m. - 5:30 p.m.
Where: Chatham University Eastside Physical Therapy Dept.

6585 Penn Avenue, Pittsburgh, Pennsylvania  15206

This 2-day live course is a part of the Advanced Competency in Home Health
program. This course has four online pre-requisite courses. You must have
successfully completed the pre-requisite courses prior to attending this course.
Sorry, no exceptions. Review the program requirements here: https://www.
homehealthsection.org/page/AdvCompetencyHH
This is a course for Physical Therapists and Physical Therapist Assistants.
The Advanced Competency in Home Health program is a hybrid program
consisting of core and elective on line modules and a 2-day live face to face
course. This 2 day, 15 hour course is designed to complement and build on
the core modules of the Advanced Competency in Home Health program.
During the two day program, participants will revisit and practice skills required
for quality cardiopulmonary, orthopedic and balance assessments that will be
integrated into clinical vignettes. Participants will use these skills to support
a thorough but efficient OASIS start of care or physical therapy evaluation
in the home setting. Throughout the 2 day program, ethical and regulatory
issues, as well as documentation will be incorporated into clinical case studies.
Participants should be able to take the skills covered back to their home health
settings and incorporate them immediately into patient care.
Save $40 by registering at the early bird rate. Rates increase on August 3, so
register soon!
For more information and to register, go to https://www.homehealthsection.org
> Calendar > 9/7/2019 » 9/8/2019 Advanced Competency in Home Health Live
Training East
Questions? [email protected]

Spring 2019 - 19

P.O. Box 3406 Presorted
Englewood, CO 80155 Standard
www.homehealthsection.org U.S. Postage

PAID
Missoula, MT
Permit No. 569