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Culture Map Series: An Introduction to Transgender Health and Related PT Service (Part 2)

Posted on: August 10th, 2016 by Aika Barzhaxynova No Comments

Uchenna OssaiBy Uchenna Ossai, PT, DPT, WCS, CLT

In my previous post, I introduced the history and culture of transgender patients. Here, I offer some steps to begin creating an inclusive environment for your transgender patients:

Investigate your implicit bias. Taking an honest and realistic inventory of your personal bias toward members of the LGBTQ community can be profoundly informative, allowing you to recognize the potential impact on your patient’s experience. As extensive research has shown, the implicit bias of medical providers harms the quality of care minority patients receive.

Understand and recognize that gender is a social construct, and sex is a biological status (chromosomes and genitals). Just like sexual orientation, gender identity is on a spectrum and is quite variable. Recognize that gender identity and expression are not the same thing.

Implement an anti-discrimination policy in your department or your private practice that includes sexual orientation, gender identity, and expression.

Have a basic awareness of discrimination laws in your state and/or city. This will help inform you about both the micro-aggressions and macro-aggressions that your patients are up against on a daily basis that can be a barrier to participating in and responding to healthcare interventions and prevention. Check your local ACLU chapter or The National Center for Transgender Equality (www.transequality.org).

Build a network of providers who have experience working with transgender clients. Lack of physical and emotional safety is a common barrier to accessing healthcare for transgender individuals.  Many patients have had negative experiences with their healthcare providers, which discourages regular healthcare visits.

Formally collect data about sexual orientation and gender identity (recommended by the National Institute of Health and Joint Commissions). Adjust your forms and clinic environment. On your forms, differentiate between “sex” and “gender.”  Under “gender,” include a space for “other” or “gender non-conforming.” Train your front desk staff to ask about preferred name and adjust patient greetings to exclude gender.

Do not accidentally “out” your patients. Be careful how you address this patient population in public and in your documentation. Even if you have forms that are gender-inclusive, your patients may not feel safe enough to answer honestly, and/or they may not be “out” to family, friends, or employer.

Ask. If you are not sure how to address your patient or handle certain situations, simply ask.

Do not assume that your patients are gay or straight. Sexual orientation and gender identity do not necessarily go hand-in-hand.

Do not ignore the underlying anatomy. Continue to do a thorough past medical and surgical history for effective preventative healthcare screening.

  • UC’s Top 5 Transgender Care Resources
  • (1) World Professional Association for Transgender Health (WPATH) – wpath.org
  • (2) National LBGT Health Education Center: A Program of the Fenway Institute – lgbthealtheducation.org
  • (3) The Center of Excellence for Transgender Health – transhealth.ucsf.edu
  • (4) The Gay and Lesbian Medical Association – glma.org
  • (5) National Center for Transgender Equality – transequality.org

References for Parts 1 and 2

  • Safer, J.D., et al. Barriers to healthcare for transgender individuals. Curr Opin Endocrinol Diabetes Obesity. 23(2): 168-171.
  • Unger, C. Care of the transgender patient: A survey of gynecologists’ current knowledge and practice. J of Women’s Health. 2015. 24(2): 114-118.
  • Makadon H.J.; Mayer, K.M.; Potter, J.; Goldhammer, H., editors. The Fenway guide to lesbian, gay, bisexual, and transgender health. 2nd ed. Philadelphia, PA: ACP Press; 2015.
  • Frost, D.M.; Lehavot, K.; Meyer, I.H. Minority stress and physical health among sexual minority individuals. J Behav Med. 2013. 9523-8.
  • Grant, J.; Mottet, L.A.; Tanis, J., et al. Injustice at every turn: a report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011. Available at thetaskforce.org/downloads/reports/reports/ntds_full.pdf.
  • Mayer, K.; Garofalo, R.; and Makadon, H.J. Promoting the successful development of sexual and gender minority youths. Am J of Public Health. 2014. 104:976-981.
  • Reisner, S., et al. Comprehensive transgender healthcare: the gender-affirming clinical and public health model of Fenway health. J of Urban Health. 92 (3): 584-92.

Author: Uchenna Ossai is treasurer of the Section on Women’s Health-APTA. She can be reached at [email protected]

 

 


 

 

 

Reimbursement Q & A: Billing for Electrodes

Posted on: June 28th, 2016 by Aika Barzhaxynova No Comments

By Kelly Huestis, PT, MPT

The Section on Women’s Health receives many payment reimbursement questions from physical therapists providing a range of services. Here is one of the most common, according to the SOWH ReimburseKelly Huestis, chair of the SOWH Reimbursement Committee, addresses a common question on electrode reimbursement codes. ment Committee:

Question:  Our physical therapists do internal vaginal biofeedback and/or electrical stimulation. The electrode probes we use are $40 each, and we want to ensure we are using the most appropriate CPT codes to charge for this intervention. Do you have any advice for us? “90911” seems like an appropriate code. Is anyone else using it?

Answer: The Reimbursement Committee regularly receives questions regarding proper billing for incontinence patients and how to maximize payment to cover the cost of equipment, probes, and electrodes. Recapturing the cost of the intra-vaginal probes can be a huge expense issue for many outpatient clinics.

Regarding this question, yes, some clinics are still using the “90911” CPT code (biofeedback services and procedures) for biofeedback. However, I would caution you since many payers do not reimburse for that code, and coverage determinations can vary by state. Talk to each individual payer about what they allow. Several stipulations and criteria must still be met for billing Medicare, and you also should look at your state’s local coverage determinations as related to biofeedback billing.

See the following link for Medicare guidelines and National Coverage Determinations (section 30.1.1 and section 230.8): https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r10ncd.pdf.

Other clinics use EMG feedback as a tool to assist with neuromuscular re-education or therapeutic exercise and to document and bill as such. If a clinic believes these charges are not adequate to compensate for the cost of the probe, here are other options:

  1. Have the patient purchase their own electrodes.
  2. Consider the use of surface electrodes, when possible, rather than intra-vaginal probes. These are significantly less expensive and can be just as effective for many patients.
  3. Check out corporate deals. For instance, cmtmedical.com will let you set up an account where patients go to purchase electrodes at a discount.
  4. Buy the electrodes and sell them to patients but consider DME licensing and sales tax.

Stay tuned this year to the Section on Women’s Health’s Payment, Policy, and Advocacy webpage for regular updates on billing for pelvic floor muscle dysfunction. For more payment questions, email the Reimbursement Committee at [email protected].

AUTHOR: Kelly Huestis, PT, MPT, is chair of the Section on Women’s Health Reimbursement Committee. She can be reached at [email protected]

 

 


 

 

 

APTA Federal Forum: A Report from Capitol Hill

Posted on: June 21st, 2016 by Aika Barzhaxynova No Comments
SOWH Federal Affairs Chair GailZitterkopf (left) and Director of Programming Sandy Hilton are among the hundreds of APTA physical therapists participating in the 2016 Federal Forum to create and support stronger PT-related legislation.

SOWH Federal Affairs Chair Gail Zitterkopf (left) and Director of Programming Sandy Hilton are among the hundreds of APTA physical therapists participating in the 2016 Federal Forum to create and support stronger PT-related legislation.

By Gail Zitterkopf, PT,DPT, CLT, CKTP

The American Physical Therapy Association holds an annual Federal Advocacy Forum to update physical therapists on Medicare and Medicaid billing, train them in lobbying skills, and learn new technologies.

The 2016 forum drew nearly 260 therapists to Washington, DC, April 3-5 to learn about and educate legislators and Capitol Hill staff on three main issues: (1) a Therapy Cap Repeal; (2) the Physical Therapy Workforce and Patient Access Act (including student loan forgiveness); and (3) Medicare Locum Tenens  (allowing a therapist to cover the work of a therapist out on family or medical leave, vacation, or other reasons in a private practice). The following are highlights of each. More specifics can be located in the APTA Advocacy app (downloadable from www.apta.org/advocacy) or on APTA’s Advocacy website at www.apta.org/advocacy

Medicare Access to Rehabilitation Services Act (S. 539/H.R. 775)

On April 15, 2015, the U.S. Senate passed the Medicare Access and CHIP Reauthorization Act (H.R. 2) legislation to repeal and reform the Sustainable Growth Rate (SGR) formula. The act extends the Medicare therapy cap exceptions process through December 31, 2017, with provisions to allow CMS to better target manual medical reviews.

Last year, 58 Senators supported the Cardin/Vitter Amendment to the SGR legislation to fully repeal the Medicare therapy cap ; this would permanently remove the arbitrary $1,920 therapy max on Medicare patients.  Despite falling short by two votes, the effort showed the broad bipartisan support for this patient access issue.

Although we made the greatest progress in the last 18 years, APTA believes this was a missed opportunity for a long-term solution and puts beneficiaries at further risk when the extension expires December 31, 2017. Thus, therapists asked representatives to co-sponsor legislation to repeal the Medicare therapy cap, since the therapy cap is arbitrary and does not take clinical condition into account. Sadly, the therapy cap affects those who need therapy the most.

Prior to the forum, there were 223 co-sponsors in the U.S. House of Representatives. APTA members’ legislative visit to Capitol Hill resulted in positive movement, with 22 new cosponsors added to the three main bills: therapy cap, locum tenens, and student loan  repayment.

Please communicate your support for this bill to your elected officials! Form letters can be found on the PTaction app (on your mobile device) or online in the Legislative Action Center, http://www.apta.org/TakeAction/.

Physical Therapist Workforce and Patient Access Act (H.R. 2342/S. 1426)

This bill would include physical therapists in the National Health Service Corps (NHSC) and is legislation that matches the corps’ goals and mission . Basically, it would help alleviate demand on other primary care providers to increase those served by providing greater patient access to rehabilitation, which is currently not part of the program.

The NHSC allows medical service providers to apply to work in an underserved rural area; in exchange, the corps will provide up to two years of loan forgiveness. The NHSC has an 82% retention rate (PTs who go to work in these areas often remain in these areas), which would help meet the workforce needs of underserved areas. Demand for physical therapy continues to grow faster than other primary care disciplines. Most importantly, this legislation is budget- neutral, e.g., it does not cost the government nor taxpayers any money!

Prevent Interruptions in Physical Therapy Act (H.R. 556/S. 313)

This legislation allows physical therapists to enter into locum tenens arrangements under Medicare . Under current law, private practice PTs participating in the Medicare program are not able to bring in another licensed physical therapist to their professional practices when they are temporarily absent due to illness, pregnancy, vacation, or continuing medical education.

Currently, physicians are able to bring a provider who is certified by Medicare in their practice to cover for them during such absences. Without this agreement the therapist must choose between providing free care to the patient or placing the patient’s care on hold during the absence.

Locum tenens arrangements benefit both patients and providers, since care is continued short-term by another licensed qualified provider. Because rural areas have a greater density of private practices, local tenens disproportionately affects rural areas, where there are greater shortages of providers . An interruption in PT care can lead to patient regression and higher costs to the health care system over time.

AUTHOR: Gail Zitterkopf, PT,DPT,CLT, CKTP, is the Section’s Federal Government Affairs Chair.

 

 


 

 

 

$10,000 SOWH Grant Awarded for Research on Techniques to Reduce Chronic Caesarian Section Scar Pain

Posted on: June 7th, 2016 by Aika Barzhaxynova No Comments

FOR IMMEDIATE RELEASE: June 7, 2016

CONTACTS: Meryl Alappattu, director of research, Section on Women’s Health-APTA, [email protected]

Kristin Clarke, CAE, executive director, Section on Women’s Health, 571-344-5422, [email protected]

 

$10,000 SOWH Grant Awarded for Research on Manual Therapy Techniques to Reduce Chronic Caesarian Section Scar Pain

McLean, Va.: Jennifer Wasserman, DPT, MS, Ph.D. candidate, is the 2016 recipient of the Section on Women’s Health $10,000 Research Grant for her proposal titled “Fascial Scar Mobilization Techniques in Treating Chronic Caesarian Section Scar Pain: A Randomized Clinical Trial.” The Section on Women’s Health, a professional organization affiliated with the American Physical Therapy Association, awards the grant annually to advance research on bettering men’s and women’s health through physical therapy.

Drs. Karen Abraham, Mary Massery, and Beth Marcoux will serve as Wasserman’s team of co-investigators. The grant funding and project length run August 1, 2016, to July 30, 2017.

“The Section on Women’s Health is pleased to continue its long tradition of financially supporting evidence-based physical therapy research in the areas of women’s and men’s health,” says Meryl Alappattu, PT, DPT, Ph.D. “We congratulate Dr. Wasserman and her team for their vision and commitment to reducing pain in women post-partum. We also thank the other grant candidates and encourage their continued efforts to expand much-needed research in this important specialized physical therapy area of women’s and men’s health.”

Wasserman also will receive an award plaque at the 2017 SOWH Business Meeting in San Antonio, Texas, in February. Photos are available below for use by media.

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The Section on Women’s Health-American Physical Therapy Association (SOWH) is a professional membership association of nearly 3,000 physical therapists treating patients across the life span and around the globe. Members provide the latest evidence-based physical therapy services to everyone from young athletes and childbearing women to peri-menopausal mothers and men with pelvic health complications. In addition to a major focus on providing top-quality continuing education, the Section provides networking opportunities, access to its peer-reviewed journal, inclusion in a PT Locator directory, and more. For information on membership, products, or services, go to http://www.womenshealthapta.org.Credentials:

photo 5Jennifer B. Wasserman, DPT, MS, PhD candidate
Principal Investigator
Rocky Mountain University of Health Professions
Franklin Pierce University
Manchester, New Hampshire

 

 

Karen Abraham

Karen Abraham, PT, PHD
Co-investigator
Director, Physical Therapy Department
Shenandoah University
Winchester, Virginia

 

photo 4

 

Mary Massery, DPT, DSC
Co-investigator
Massery Physical Therapy
Glennview Illinois

 

12td

Beth C. Marcoux, DPT, PhD
Co-investigator
Franklin Pierce University
Manchester, New Hampshire

 

 


 

 

 

Protecting Women’s and Men’s Health in Beirut: A Personal Story

Posted on: May 6th, 2016 by Aika Barzhaxynova No Comments

By Lea El Feghali

“Get comfortable being outside your comfort zone because that is the only way to grow.”

Lebanese physical therapist and entrepreneur Lea El Feghali (third from left) joins instructors at an SOWH course.

Lebanese physical therapist and entrepreneur Lea El Feghali (second from left) joins instructors at an SOWH course.

I am a 24-year-old Lebanese physical therapist who was working in a sports rehabilitation clinic in Beirut when I decided to stop working for someone else’s dream and build my own.

Most Lebanese physical therapists treat patients who have joint pain (knee, hip, ankle etc.) or those who have low back or neck pain. What is not common is working with the muscles that we don’t usually talk about: pelvic floor muscles.

Talking about muscles “down there,” painful intercourse, or urine leakage while laughing, coughing, or running is kind of a taboo subject. Unfortunately, an alarming number of Lebanese women and men struggle silently with pelvic floor dysfunction and live with the pain because they are embarrassed to talk about it or simply do not know they can seek help.

Conservative treatment of pelvic floor disorders has proven effective for many years, but no appropriate training was available in my country. Therefore, I conducted an online search and found out about the Section on Women’s Health and its dedication to providing great educational resources for physical therapists treating patients throughout their lifetime.

I applied for the CAPP-OBF and CAPP-OBA courses through the American Physical Therapy Association and received the opportunity to gain experience by shadowing several women’s health therapists in the U.S., specifically Vanda Szekely and Suzan Giglio. These women first helped me enter the world of pelvic floor physical therapy.

I was the only international physical therapy student in class who had to make the journey to a foreign country I had never been to before. Despite my initial hesitation, I jumped at the chance to participate in the program and have never looked back. It was a big, interesting–yet scary–jump for me, but I believe the fear of regret of never trying is so much worse than the fear of failure.

I knew that this once-in-a-lifetime opportunity would help me deepen my knowledge and education in this field and, therefore, help patients live, work, and have sexual relationships without embarrassment or pain.

I was originally educated that pelvic floor therapy was all about Kegels exercise. But after going through my internship and courses, I realized pelvic floor physical therapy goes way beyond Kegels. I have to admit that the intravaginal /rectal manual exam was weird at first, but when you start practicing and gain the patient’s confidence, you notice how easy and important the assessment of these muscles is in order to develop an individualized treatment plan.

Now that I am a member of the International Organization of Physical Therapists in Women’s Health (IOPTWH), I am ready to face the greatest challenge by going back to my country and actually starting my practice. I am impassioned to highlight the importance of pelvic floor physical therapy in the Middle East and to break down barriers for patients and practitioners to begin to appreciate the power of this muscle group and its multi-function capability!

I believe we have greater need in my community not only for proper conservative care of treatment, but also for information about pelvic health to be shared more publicly among men and women.

I am convinced the experience I gained in the United States will help me make a difference by giving Lebanese children, women, and men a service they deserve and require in order to improve their overall health.

“In the end we only regret the chances we didn’t take”

Author: Lea El Feghali recently opened her own women’s health practice in Beirut, Lebanon. She can be reached at [email protected].

 

 

 


 

 

 

An Insider’s Guide to the SOWH Board Nominations Process

Posted on: May 3rd, 2016 by Aika Barzhaxynova No Comments

By Blair Green, PT2[1]

The 2016 SOWH Board of Directors elections have opened and run through May 31! All members and student members qualify to vote, so the Nominating Committee invites you to carefully consider the highly qualified slate of candidates it has put together for these four important leadership positions.

Many members, especially new ones, do not understand how SOWH generates the list of candidates, so in the spirit of transparency and democracy, I’d like to provide a behind-the-scenes view of the process.

Each fall the Nominating Committee starts its search for new candidates. We email and call members who we think have potential to be strong leaders. We receive recommendations from current board members. We distribute an open call for nominations to the membership. All of this culminates in the “official” nomination process that happens at the Section Business Meeting at APTA’s Combined Section Meeting.

What most members do not see is the hours of work that precedes the final release of names and tallying of ballots. The electoral process starts long before the fall, even well in advance of the previous year’s election. It is a continual, year-round process of working to identify potential leaders in the Section, so when the time comes for creating a highly qualified slate, we already have a list of potential nominees.

The goals of the Nominating Committee are to form a robust, contested slate of candidates each election cycle, to encourage participation in all elements of SOWH, and to help members connect with volunteer opportunities. We also work to maximize voter turn-out at each election, so members can choose the professionals who best represent them and their interests.

While the Section’s Board of Directors may recommend members it believes would be capable and interested in running, it has no role in the nominations and slating process. The Nominating Committee communicates with committee chairs and state representatives to receive recommendations. The committee communicates directly with all interested members and helps match them with a position that best fits their skill set.

This begins over the phone and continues in person at CSM. Running for a board position requires signing a “consent to serve” document and committing to attend board meetings, both at conference calls and two yearly face-to-face meetings.
The Nominating Committee helps candidates understand the job description and the dedication required. The months between October and April are very busy piecing together the final slate of candidates. Those who choose not to run, or who do not win the election, become part of our database or pool of members whom we may reach out to in the following election cycles.

What does this mean for you?

It means there is a place for you and everyone to play a part in Section leadership. If you think you would be interested next year or even in five years, let us know! Talk to your state representative and get involved locally. Join a committee or a task force. Talk to Karen Connor, the SOWH volunteer coordinator, about other opportunities to engage in the Section work of educating physical therapists and promoting women’s and men’s health globally. When the next election cycle picks up, you could be the next candidate on the election slate.

Author: SOWH Nominating Committee Chair Blair Green, PT, OPT, CSCS, is a physical therapist and partner at One on One Physical Therapy and Back 2 Motion Physical Therapy in Atlanta, GA.

 

 


 

 

 

Clinical Education Survey

Posted on: April 13th, 2016 by Aika Barzhaxynova No Comments

Several women’s health clinicians have asked for assistance in creating clinical education programs – it seems many clinicians do not feel they have the resources to establish such programs in their clinics. At the same time, student interest in the practice of women’s health physical therapy is growing – and clinical education sites are in high demand.

To address these needs in our membership, the Section on Women’s Health has formed the Clinical Education Task Force.

The goals of the task force are twofold:

  1.  to write a position statement on the role of students in clinical affiliations in women’s health physical therapy, and
  2.  to compile and distribute resources to assist women’s health PTs in creating clinical affiliations at their clinics.

To accomplish these aims, we need your input. We need to know what current practices are in women’s health clinical education and what resources you have found helpful for student education. We also need to know what clinician resources would be helpful to assist our members to become clinical instructors.

We have created a survey to help us gather that information. Please consider sharing your experience and your insight in clinical education in women’s health with us.

TAKE SURVEY

This survey should take about 20-25 minutes to complete. It should be completed in one sitting in order for the information to be recorded correctly. The link is live, and the survey will be available until April 30, 2016. Please complete the survey before then. Thank you in advance for your time and for you commitment to excellence in clinical education in women’s health!

 

 


 

 

 

SoWH Clinical Education Survey​

Posted on: April 13th, 2016 by Aika Barzhaxynova No Comments

Several women’s health clinicians have asked for assistance in creating clinical education programs – it seems many clinicians do not feel they have the resources to establish such programs in their clinics. At the same time, student interest in the practice of women’s health physical therapy is growing – and clinical education sites are in high demand.

To address these needs in our membership, the Section on Women’s Health has formed the Clinical Education Task Force.

The goals of the task force are twofold:

  1.  to write a position statement on the role of students in clinical affiliations in women’s health physical therapy, and
  2.  to compile and distribute resources to assist women’s health PTs in creating clinical affiliations at their clinics.

To accomplish these aims, we need your input. We need to know what current practices are in women’s health clinical education and what resources you have found helpful for student education. We also need to know what clinician resources would be helpful to assist our members to become clinical instructors.

We have created a survey to help us gather that information. Please consider sharing your experience and your insight in clinical education in women’s health with us.

TAKE SURVEY

This survey should take about 20-25 minutes to complete. It should be completed in one sitting in order for the information to be recorded correctly. The link is live, and the survey will be available until April 30, 2016. Please complete the survey before then. Thank you in advance for your time and for you commitment to excellence in clinical education in women’s health!

 

 


 

 

 

Interested in hosting SoWH courses in 2017?

Posted on: December 29th, 2015 by Aika Barzhaxynova No Comments

Screenshot 2015-12-29 15.14.51

Screenshot 2015-12-29 15.15.06

 

 

 


 

 

 

Protected: Membership Statistics

Posted on: November 10th, 2015 by Aika Barzhaxynova Enter your password to view comments.

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