The Role of Social Determinants of Health

The Role of Social Determinants of Health

Nick Blonski, SPT

As a student physical therapist at the university of New Mexico I have had the opportunity to work in a pro bono lab and volunteer at an adult men’s homeless shelter. Having these chances to work with an underserved population and having to problem solving ways to modify home exercise programs to fit with their daily lives has developed a deeper sense of just how impactful social determinants of health can be on an individuals access to healthcare. 

Social determinants of health can be broken into two broad concepts: structural and intermediary, these two concepts play a role in determining an individual’s social determinants of health. The structural concept refers to socio-economic status, politics in the area, ethnic group, etc., whereas, the intermediary concept consists of factors such as money for food, living environment, access to food. These two concepts can affect an individual’s health exclusively but can also begin to affect an individual’s health together through social cohesion and social capital when others are willing to make sacrifices to help these individuals out in lower socio-economic environments.1 

Individuals that are raised lower socio-economic living environments are at an increased risk of having poor development, lower education achievement, and lower levels jobs when they are older. This can be tied into their intermediary concepts as some of these individuals are raised in environments that use lead paint in the walls and this can lead to permanent changes within a child’s brain.2 This can biologically condition this child to remain in the lower socioeconomic class where health care and healthy lifestyles are harder to come by.2 This stood out to me as an area that I didn’t even realize was playing a role in the disparity that faces many individuals in our country. Coming from a background where I never experienced these situations it was hard for me to conceptualize how much of an impact that lifestyle can have on an individual not just socially but also biologically. As a health care provider it becomes our responsibility to bring these types of living environment situations up to our legislators and representatives, and to provide these individuals with factual and scientific evidence about how this is affecting these children’s health and long-term quality of life.

Looking at the APTAs stance on health, wellness, and fitness physical therapists have a unique opportunity to educate the community, provide direct intervention to individuals, participate in research, advocate for health care changes and policy changes, and to collaboratively consult with other individuals in these areas.5 Another area that we can provide input in health, wellness, and fitness is by adding our knowledge on adapting community environments, such as parks and community centers, to be accessible for all individuals.5

As physical therapist and physical therapy students we can play a major role in reducing health care disparities. One way is by providing pro-bono clinics for individuals that are unable to afford convention for profit physical therapy clinic models.3 For many this may seem like a stretch when you start to think about the financial burden this can place on a clinic but it can be made realistic by having new pro bono programs join the Pro Bono Incubator program put on by Move Together. This program works to help initially support the development of these new programs. We can also bridge the gaps between ethnic groups by having the patient take control of their care and by us as therapists asking simple questions like “Who supports you and helps you make decisions?”3 We can also bridge this gap by translating our screening guidelines and early intervention recommendations into forms that work for different cultures and ethnicities.3 

Social determinants of health add another level of complexity to the patients that we treat and the members of society that could benefit from therapy but are unable to access therapy services. By taking a role as an advocate for these patients and the community as a whole we can have an impact at the legislative level and among community organizations to provide safe and affordable options for individuals to participate in physical activity or areas that individuals can go to complete home exercise programs. It isn’t necessary to completely change your practice to solely focus on changing the landscape of the social determinants of health, but if all therapists and student therapists could take minor action we could see a large scale change that benefits our patients and society as a whole access to health care.

References

Social Determinants of Health- an introduction. YouTube. http://www.youtube.com/watch?v=8PH4JYfF4Ns. Published 2017 Jun 25. Accessed 2020 Feb 25.

Braveman PA, Egerter SA, Mockenhaupt RE. Broadening the Focus The Need to Address the Social Determinants of Health. Am J Prev Med. 2011;40(1S1):S4-S18.

Lehmann C. Addressing Social Determinants of Health. PT in Motion. 2019. www.apta.org/PTinMotion/2019/7/Feature/SocialDeterminants/. Published 2019 Jul. Accessed 2020 Feb 25.

Social Determinants of Health: Know What Affects Health. Centers for Disease Control and Prevention. http://www.cdc.gov/socialdeterminants/. Updated 2018 Jan 29. Accessed 2020 Feb 25.

Physical Therapists’ Role in Prevention, Wellness, Fitness, Health Promotion, and Management of Disease and Disability. American Physical Therapy Association.

http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Practice/PTRoleAdvocacy.pdf​. Updated 2019 Sep 20. Accessed 2020 Feb 25.

Let’s Talk About Food

Let’s Talk About Food

Nick Blonski, UNM DPT ’21

As physical therapists in the world of direct access many times we are the first people to welcome physical therapists into the world of health care. One of our main jobs as physical therapists is to do a comprehensive systems screen and provide a full evaluation comprised of a subjective and objective examination. Undoubtedly at some point during your time as a physical therapist or even a student physical therapist you have been confronted with a patient that asks about nutrition or you feel would benefit from discussing nutrition. This can be an incredibly awkward situation, as it seems like something we should be able to discuss due to the effects it has on physical abilities. So the questions become what are we allowed to discuss with our patient, when should we refer a patient, and whom should we refer a patient to? 

According to the American Physical Therapy Association nutrition is within our professional scope of practice as physical therapists. Our role as physical therapist in regards to nutrition allows us to screen and provide information about diet and nutritional issues to patients.1 It is also important to remember to check both the physical therapy practice act for your state, along with practice acts for nutritionists and dieticians within your state. A good rule of thumb for providing information about nutrition is using information that can be publically found. One good resource that you can refer patients to is https://www.choosemyplate.gov/. The My Plate website can help you as a clinician explain a healthy diet and also has many resources including printable free documents you can provide to patients.

When trying to figure out if you should refer a patient for further nutritional consultation a few criteria can point you in a referral direction. If you feel uncomfortable trying to provide nutritional education it is better to refer to a specialist to maintain high quality of patient care. It is also essential to refer a patient for nutritional education if the patient needs help with meal planning, or needs to talk about specific macronutrients and micronutrients. Lastly, it is important to refer a patient that has special nutritional needs. This can qualify for athletes trying to plan a nutritional plan to improve performance or a patient with diabetes that needs nutritional modification to maintain quality of life. 

When choosing whom to refer to it is important to know the difference between a nutritionist and a registered dietician. A registered dietician is someone in the United States that is required to become registered with the Commission on Dietetic Registration (CDR), where as a nutritionist does not. Dieticians are regulated by government regulations whereas a nutritionist who choses to not go by dietitian or registered dietitian are typically free from government regulation.2 This again is dependent on the state you practice in and should be researched when referring a patient for nutritional consultation.

When working with patient it is important to provide the highest quality of education and service. This includes the education we provide on nutrition as it can play such a huge role in a patient’s health. Taking time to review websites such as My Plate and familiarizing ourselves with basic nutritional facts and preparing printable handouts can improve our ability to answer patients’ basic nutritional questions. Knowing when to refer a patient and who to refer to can also greatly improve the quality of care a patient receives and can improve our patients’ quality of life.

References

1. “Role Of PT Diet Nutrition.” APTA, www.apta.org/apta-and-you/leadership-and-governance/policies/role-of-pt-diet-nutrition.

2. “Distinguishing Between Dietitian vs Nutritionist.” Dietitian vs Nutritionist, www.nutritioned.org/dietitian-vs-nutritionist.html.

COVID-19 Telehealth Program.

COVID-19 Telehealth Program Purpose The COVID-19 Telehealth Program will provide $200 million in funding, appropriated by Congress as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, to help health care providers provide connected care services to patients at their homes or mobile locations in response to the novel Coronavirus 2019 disease (COVID-19) pandemic.On April…

Therapy specific telehealth services that Cigna will cover during COVID-19 pandemic.

Therapy specific telehealth services that Cigna will cover during COVID-19 pandemic.

 

It has been reported that Cigna will allow providers to bill standard in-person visits for all telehealth visits, including those not related to COVID-19, through May 31.

Here are the therapy services, and their respective codes, that Cigna will cover when provided via telehealth through May 31.

Virtual care for physical, occupational and speech therapy services:

  • 97161: physical therapy evaluation, complex, 20 minutes
  • 97162: physical therapy evaluation, moderate complex, 30 minutes
  • 97110: therapeutic exercises, two unit limit
  • 97165: occupational therapy evaluation, low complexity, 30 minutes
  • 97166: occupational therapy evaluation, moderate complexity, 45 minutes
  • 97110: therapeutic exercises, two unit limit
  • 92507: speech/hearing therapy
  • 92565: oral function therapy

*source: https://www.beckershospitalreview.com/telehealth/28-telehealth-services-cigna-will-cover-during-covid-19-pandemic-their-codes.html

Physical Therapy Futurology

by Hannah Mullaney, SPT


Me: “What kind of exercise should I do?”

Also me: “Mmmm, it’s too complicated.”

“But I know it’s important for me.”

“Probably costs lots of money. I don’t know.”

“Just do anything, some push ups, planks, squats, jumping jacks!”

“Oh look, I’m out of time.”

These internal conversations abound when it comes to exercise. It is easy to become frustrated and overwhelmed. And the question often begins with, “what kind of exercise do I do?”

The simple answer is this: whatever you will actually do!

Strengthening the heart, building up the bones, balancing the chemicals messengers of the body and brain – a few of the direct benefits of exercise – these powerful outcomes blossom for doing things that challenge and move the body. Every person has distinct and individual interests, and effective, sustainable exercise training comes from doing something that matches someone’s interests with movement.

Guidelines start simple – move more! Take the stairs, park far away, stand on one leg while talking of the phone. But many people want to take that next step. Once people have experienced the relief of finishing a workout, the satisfaction of pushing their limits, or the sense of calm from endorphin release, they are ready for more. Officially, adults are recommended to do moderate to vigorous physical activity for 30-60 minutes, 5 days a week (HHS.gov).

At this point, the options may feel endless – gym membership, Zumba classes, rock climbing, running, biking, swimming, weight lifting, team sports league, golf….the list goes on an on. The volume of opportunities can be overwhelming. Some of these options are more expensive than others, and people need to think about their priorities and budget. Sometimes there are forms of exercise that may be easily overlooked, like roller blading, coaching a child’s soccer team, fishing (especially fishing someplace that can only be reached by hiking), a quick 10 minute circuit of squats, pushups, and planks, and dancing.

All of these things are valid forms of exercise. The trick is to pick something that is fun and interesting and puts a smile on the exerciser’s face.

“I HATE running!” Common sentiment. Solution…don’t run! Yes, it’s important to push oneself past the comfort zone, but, if it really is such a drag, maybe find something that is more interesting. Would running or biking to the movies to meet with friends make a difference? (Then, don’t eat the entire bag of popcorn.) Maybe if running doesn’t jive well, what about dancing? What about 3 v 3 basketball games on lunch break? All of these activities will still increase the heart rate and help make the body happy and healthy.

People talk about SMART goals, and someone who is motivated to move their body more can use these techniques to make their own game-plan. Here is the breakdown of moving more SMART-ly, using the example of someone who wants to swim 800 meters on an upcoming triathlon relay. For this individual, their spouse is doing running while another friend is doing the biking.

 

Specific – set a narrow goal. “I will go to West Side Pool.

Measurable – set a goal with something concrete to measure. “I will go to West Side Pool for 45 minutes.”

Achievable – set at goal that can actually be reached. “I will go to West Side Pool for 45 minutes on Wednesday and Friday afternoons, when I have a shorter work day. Also, I own goggles and know a little bit about swimming, so this is a realistic goal.”

Relevant – set a goal that matters to you personally. In this example, the individual is doing swimming, so swimming is the relevant activity.

Time-based – set a goal that has a clear start and end time. “The triathlon is in 6 weeks.”

 

Therefore, the whole goal is would look like this. “In order to prepared for my part of the triathlon relay, I will go to West Side Pool for 45 minutes on Wednesday and Friday afternoons for the next 6 weeks in order to swim 800 meters without stopping.”

Finally, accountability takes goal-making to goal-attaining. If someone is asking us how we are doing, bugging us about going to the gym, waiting for us at the trailhead at 7am, or trying to workout 5 days a week with us, we are that much more likely to follow through with our good intentions. In the example above, perhaps the spouse can run while the swimmer does laps.

Therefore, if you are thinking about exercising more, my encouragement is to dive right in! Find something enjoyable that you actually want to do. Set a SMART goal. And, very importantly, ask someone to hold you accountable. No need to wait – let’s get moving today!

Physical Therapy Futurology

by Rachel Granzow, SPT

As “rehabilitation” professionals, physical therapists are often considered to be mechanics of sort. Something goes “wrong” with the body and, as a result, movement is impaired, and, often, there is pain.  A PT can improve how the body moves in a variety of ways and as a result, the pain improves.

This process — from symptom, to treatment, then relief — is the typical medical model of intervention. But I wouldn’t call this “health care.” It’s more like “sick care,” because people don’t seek the services of a PT until something is amiss. The job of the PT, in this paradigm, is to help set things right again, to “fix” patients.

At least that’s how things are now. But with medical costs rising along with rates of chronic disease, something has to change. The PT profession is poised in a prime position to make a significant contribution towards preventive care. That is, helping people improve their health BEFORE issues arise and, whenever possible, avoid problems altogether. Here are some ways that the future may look for PT.

Annual checkups

Much like you see a dentist, optometrist, or other specialist provider on a regular basis, you could see a PT for a yearly screening of your “movement system.” Doing so will identify ways to identify risk factors before they turn into major concerns. Having a “PT for life” allows higher quality of care if or when the need for PT arises. 

Click here to read more about annual checkups

On-going disease management

PTs can play a vital role on an interprofessional team for managing many of the most prevalent and costly conditions, including obesity, diabetes, and back pain. Choosing PT as the first-line treatment for these diseases saves money in the long run. As the experts in physical activity, PTs are the best providers to address many of the lifestyle factors that contribute to chronic health conditions.

Click here to read more about PT for pain management

With an aging population, there are increased risks for a variety of health concerns, such as frailty and falls. Improving how seniors are able to move and function in their day-to-day lives is well within the PT wheelhouse. As the “silver tsunami” of the Baby Boomer generation continues to enter this demographic, PTs can work to keep them healthy and active for as long as possible.

Click here to read more about falls

Prenatal and postpartum care

Did you know there’s a PT specialty that focuses on pelvic health? For pregnant women, enlisting a PT in the care team can help with both delivery and recovery after their babies are born. The period of time known as the “4th trimester” is a critical place where PTs can provide support and expertise to mothers. 

Click here to read more about exercise after pregnancy

To be clear, there are many PTs who already provide these services. But as the medical system evolves, demand will increase for this kind of approach. It’s an exciting time to be a PT!

The Five Best Investments You Can Make In Your Business This Year

As we start the new year, we’re all looking for ways to continue to grow and develop our business.  How well were you goals from last year achieved?  And when setting goals for this year, will your goals cost you or will it pay in the long term?

Here are five investments that clinics working with coach Erika Trimble are planning to make in their practice this year:

Reminder: Changes to CPT Code Guidelines for 2017

Beginning January 1, 2017, there will be eight new CPT codes that physical therapist and occupational therapists will be required to use.  These codes, 97161-97168, will be replacing codes 97001, 97002, 97003, and 97004.

Medicare and all private payers are requiring this change effective January 1, 2017.  The new codes will be used to reflect the level of complexity of each patient’s evaluation with three possible levels, low, moderate, and high.  At present time, you will not receive higher payments based on complexity.

Current CPTReplaced by
97001PT Eval97161Physical therapy evaluation: low complexity
97162Physical therapy evaluation: moderate complexity
97163Physical therapy evaluation: high complexity
97003OT Eval97165Occupational therapy evaluation: low complexity
97166Occupational therapy evaluation: moderate complexity
97167Occupational therapy evaluation: high complexity
97002

97004

PT Re-eval

OT Re-Eval

97164Re-evaluation of physical therapy established plan of care requiring:

An examination (including a review of history and use of standardized tests and measures) A revised plan of care (based on use of a standardized patient assessment instrument and/or measurable assessment of functional outcome)

97168Re-evaluation of occupational therapy established plan of care requiring:

An assessment of changes in patient functional or medical status, along with a revised plan of care An update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals A revised plan of care (a formal re-evaluation is performed when there is a documented change in functional status or a significant change to the plan of care is required)


Along with the coding changes, CMS has  increased the therapy cap to $1,980 for occupational and $1,980 for physical and speech-language therapy services combined.

BestPT has been updated to meet the changes put forth by CMS and the AMA.   Before the end of the year, we suggest you add these new CPT codes to your fee schedule to avoid any disruption in your billing.  If you’re unsure how to do this, please let us know and we are ready to help.  

For more information:

APTA New Eval/Reeval CPT Codes/

APTA New Evaluation Codes Quick Guide

3 Steps to Losing a Referring Physician

A physician usually has a very good reason when they stop referring patients. A recent survey found that most physicians do NOT fully read their therapist reports. Communication, clarity, and customer feedback are critical components when it comes to maintaining your relationship with referring physicians. Erika hopes to help you avoid this possibility all together by discussing the three reasons why your reports aren’t being read:

3 STeps to Losing a Referring Physician