October 2019 PULSE

OCTOBER 2019

IN THIS ISSUE

Clinician’s Corner by Emily Searle Examination and Treatment of Diastasis Recti Documentation Updates

PTSMC’S ORTHOPAEDIC RESIDENCY A Journey to Clinical Excellence

When Mike Gans took on his current role as Director of Clinical Excellence, we knew he would have several opportunities to help improve clinical care in the organization. In my early conversations with Mike, it was clear that he had a vision for PTSMC and our scope of continuing education. His goal was to lead the charge to establish an orthopedic clinical residency.

It took Mike a few years of preparation to see the application become reality. In fact, the initial challenge challenging year. They all sacrificed personally and was convincing myself and PTSMC’s leadership that it professionally to succeed as residents, and we are proud would be worth it. to have witnessed them become the first graduating class of PTSMC’s Orthopaedic Residency Program!

We all recognized that the program supported our mission to improve the quality of people’s lives. We also As an organization, we are fortunate to have some understood that accomplishing this goal would require extraordinary physical therapists. My sincere thanks to a significant investment of human and financial Joe Allen, Nick Almonte, Danielle Dunn, Rebecca resources – it wouldn’t be easy and it wouldn’t be Petrosino, Tom Kassan, Ken Kosior, and Russ cheap.

Woodman for assisting Mike Gans. You’ve gone above and beyond to make us a better company!

Ultimately, improving the care all of our clinicians provide serves our tenets of unmatched experiences, I believe the PTSMC Orthopaedic Residency Program clinical excellence and lifelong relationships…so we reinforces our commitment to attract and grow great went for it! people. The program also sets us apart from many of our peers, as we are one of the few residency programs in After receiving a “conditional acceptance” from the New England specializing in orthopedics. We have made American Board of Physical Therapy Residency and a major financial and human investment in PT for Life.

Fellowship Education (ABPTRFE), we needed to prove Mike, thanks for challenging PTSMC to raise the bar. we could delivery a quality educational experience.

Thank you for your clinical excellence and congratulaPTSMC is fortunate that “three of our own” were willing tions on “cohort” number 1! to make a year-long commitment.

Thanks, I greatly appreciate John Galer, Channing Harwood, Alan and Erik Schmitt for the leadership and dedication required to successfully complete an extremely

Introducing #24 PTSMC Wethersfield!

We’re proud to be opening our 24th clinic in Wethersfield, CT under Kasey Adinolfi. Kasey has been with PTSMC since 2011 starting as a student in Guilford. Her roles have included: Clinical Instructor, CL&P Employee Assessment Clinician, Chart Auditor, and her current role as Assistant Director in Southington. Kasey’s specializations include vestibular and post-concussion rehabilitation, and she is a Pilates enthusiast and CrossFit athlete. Kasey is a resident of Wethersfield, and is excited to be opening a clinic in her hometown.

The clinic is scheduled to open on October 21st.

Congratulations Kasey!

Compliance Reminders HR Buzz Payroll@ptsmc.com Timesheet Reminders Thanksgiving Holiday Schedule Minimum Wage Increase Money Beat by Jim Hungerford Money Tips for Young Couples Wellness Program Upcoming Wellness Events Lifebeat - Healthy Apple Crisp Recipe

Congratulations!

Brian Greer, PT, DPT, physical therapist in Watertown passed his McKenzie Diplomat exam. The McKenzie Diplomat program provides clinicians with increased competence in mechanical diagnosis and therapy and involves a 10 week online theoretical component, 360 clinical hours with a McKenzie Institue Clinical Educator, and a pass in the final exam.

StriveHub Fab 5

“Lauren (Peladeau) is really terrific . She has been working with me all summer and I have to say the results have been outstanding and so much better than I thought it would be . She is very knowledgeable and was able to work around my limitations.”- Groton “The whole staff is welcoming and knowledgeable and the Physical Therapists have been wonderful as they help me meet my recovery goals. I can’t recommend them enough!” - Middletown “The entire staff is helpful and kind and truly care about the wellbeing of their patients. They all work together to help each other, thus creating an environment that feels safe, comfortable and welcoming to their patients.” - Avon “Very professional and inviting environment, and the exercises worked for targeted areas. Really nice facility! Making appointments was easy and convenient. We are very appreciative of the services provided for our son. THANK YOU!” - Windsor “The quality of the physical therapy is excellent.

The director of the program runs an excellent, professional program. In the 2 weeks I have been going to therapy, I can already see positive results.

All of the staff are very dedicated professionals and all work together to give all the patients very good physical therapy. It is apparent how dedicated they are to their profession.” - Essex

CLINICIAN’S CORNER

EXAMINATION AND TREATMENT OF DIASTASIS RECTI

By Emily Searle, PT, DPT PTSMC Branford

One of the biggest questions or concerns I get from postpartum patients is concerning diastasis recti. Their tone tends to be anxious and sometimes almost fearful. They are often unsure if they have it, and if they do, they are afraid of making it worse and therefore avoid strenuous exercise. It is important to be able to educate patients about this diagnosis.

Diastasis recti abdominis (DRA) is a separation of the linea alba that commonly occurs during second or third trimester of pregnancy, though it can also occur in men and women who have not given birth. While ultrasound is a very reliable method for measuring DRA (>.90), palpation is much more practical for the clinic and has been shown to have good reliability ( >.70).3 To do this, the head lift test is performed. The patient is hooklying while the therapist palpates with two fingers at midline and asked to perform a head and shoulder curl. Width, depth, and length of DRA, as well as tissue tension, should be noted. DRA of 2 cm or less are considered to be normal and do not require intervention.

Active Straight Leg Raise and SLS test can also be used in the evaluation to assess load transfer between the trunk and lower extremities.2 Poor load transfer indicates the need for stabilization of the core and pelvis.

DRA has been described as a symptom of excessive and unsupported intra-abdominal pressure.1 Treatment should therefore aim to restore and strengthen the entire core, which includes the pelvic floor, multifidi, and diaphragm. Research has shown that two-thirds of women have pelvic floor dysfunctions when they are diagnosed with DRA.4 Anecdotally, this rings true, whether it be pelvic pain, evidence of prolapse, or various levels of incontinence. Tightness in the diaphragm that can cause gas and constipation may also be evident.

ed in exercises that progressively load the linea alba, including TA exercises. Breathing and postural exercises are also usually involved. Typical progressions start in supine position and progress to standing followed by incorporating core strengthening and coordination into functional tasks.

Patients can progress exercises as long as they do not demonstrate compensation mechanisms such as doming. Patients can return to regular exercise but should avoid crunch or sit up type exercises and excessive twisting or bending backwards.1 Since treating more postpartum patients, this population has been very rewarding to work with. While there is still much to learn and more research to be done, it is a great feeling for both patient and therapist to get a patient’s strength and confidence back postpartum.

References: 1. “Diastasis Recti: The Muscles: MUTU System.” MUTUsystem, 7 Aug. 2019, https://mutusystem.com/mutu-system-blog/diastasis-recti-diagram-the-muscles-involved.

2. Lee, D.,& Lee, L.-J. (2011). The Pelvic Girdle: An Integration of Clinical Expertise and Research (4th ed.)

Edinburgh: Elsevier, Ltd. 3. Mota, P., Pascoal, A. G, Sancho, F., Carita, A. I.,&Bo, K. (2013). Reliability of the inter-rectus distance measured by palpation. Comparison of palpation and ultrasound measurements. Manual Therapy.

4. Spitznagle, Theresa M., et al. “Prevalence of Diastasis Recti Abdominis in a Urogynecological Patient Population.” International Urogynecology Journal, vol. 18, no. 3, 2006, pp. 321–328., doi:10.1007/s00192-006-0143-5.

Education is very important when treating this population. Since the linea alba is connective tissue and we are not just strengthening a muscle, healing can take 6 months to 2 years. Breastfeeding also keeps the level of the hormone relaxin higher, which can affect healing.

Patients should be educated that the goal is “not to close the diastasis but rather to generate tension through it.” 2 Patients should be instruct-

PTSMC Named Top Workplace for 9th Straight Year!

Thanks to employee participation and feedback, PTSMC was named a Top Workplace for the 9th consecutive year. We ranked 3rd in the Hartford Courant Region and 4th in the Hearst Region. In addition, in the Hartford Region we received the “Value Award.” This award is presented to the organization that scored the highest on the statement: “This company operates by strong values.”

From left to right, Janet Tarasuk, Joe Caligiuri, Drew Gallagher, Pete Catuccio, Erin Walsh, Alan Balavender, and Bryan O’Neill attended the Top Workplace Dinner.

Compliance Updates As we get closer to the end of the year, pleasebe sure you are keeping a close eye on the Medicare Threshold of $2040. If a patient requires continued care beyond this threshold, the KX modifier must be turned on in the patient chart prior to going over this amount.

The KX modifier indicates to Medicare that you are aware that you are going over the threshold and that you can justify why skilled therapy is required. In order to go beyond the Medicare Threshold, continued treatment must be justified and medically necessary.

The patient must require: • skilled physical therapy in the clinic because services being provided cannot yet be performed independently at home.

• those skilled services must be either making progress toward goals or avoiding significant regression.

There must be a justification statement in EVERY note and a progress note after the KX is added to billing. The justification statement should be typed in WebPT on the objective page, in the Precautions box so that it will carry over to every daily note going forward.

The justification statement includes: • information regarding why the patient needs continued skilled therapy beyond the Medicare Threshold.

• comorbidities, complicating factors and information regarding multiple courses of care in order to justify continued care.

Medicare has a second-tier threshold at $3000. At this point, Medicare will perform a post payment targeted medical review which means that the patient’s chart may be reviewed in its entirety at some point after payment is provided by Medicare. Again, documentation for medical necessity must be impeccable and fully justify the patient’s need for continued skilled therapy beyond these thresholds in order to stand up to a full Medicare targeted review.

Please contact Emily at Emily.hansen@ptsmc.com with any questions or concerns.

2019 Courses Email coned@ptsmc.com to attend October Email 12-14 coned@ptsmc.com to register Sacred Heart University Myopain TDN 3 Clinicians $1,095

November 14, 4pm - 8pm PTSMC Newington Vestibular/Concussion Internal Course

by Rick Purdy

Documentation Completion PTSMC is moving toward tighter compliance with documentation completion. For a long time we stated that documentation is to be completed within 48 hours of the date of service, however we allowed an end of month deadline for all documentation. At the start of 2019, we implemented consequences for documentation that was not completed by the end of month deadlines. There has been improved documentation timeliness.

At our mid year leadership meeting, all partners and directors agreed that our ultimate expectation will be that documentation is to be completed within 48 hours. With that standard articulated, it is also recognized that “life” happens. The “life” clause will allow a 7 day grace period when needed.

This means that the PTSMC standard for documentation is that documentation is to be completed within 48 hours of the date of service to be considered timely. Documentation must be completed within 7 days of the date of service to be considered acceptable and consequence free.

Beginning in October, each clinic front desk staff will be required to balance visits and new patients for the first 10 business days of the month within 7 days. Front desk staff cannot balance individual clinicians; they balance by the date of service.

STUDENT PROGRAM UPDATE This month, three of our students will be completing their PTSMC clinician affiliations. All will graduate from their DPT programs in 2020!

Amy Jo Sheketoff (Springfield) will present “Current Research Related to Quadriceps Tendon ACL Reconstruction” in Westbrook on October 1st at 11:30 am.

Linsay Yanaros (URI) will present “Trigger Points - Then & Now” in Plainville on October 28th at 12 pm.

Brooke Pawlack (Springfield) will conclude her time in Newington with a special project targeted at supporting the clinic.

Get in the

SPIRIT O Food Drive!

We are hosting our annual organization-wide food drive! Each clinic can choose to host a Thanksgiving or Christmas food drive and which local food bank they are donating to. Patients and employees are encouraged to participate in this event. Mallory will be checking in to see which holiday you are doing and if you need bins. Start thinking about your food drive!

Pumpkin Decorating Contest Does your clinic have what it takes to decorate the BEST pumpkin in the company? Admin will be bringing each office a pumpkin that you can decorate however you decide. We will post all the photos on social media, and whichever clinic’s pumpkin gets the most likes and Last year’s winner, Groton, proved that the Sanderson sisters look just as good 25 years later.

Money Tips for Young Couples

By Jim Hungerford, CPA

Life can be expensive – we all know that. Many of you are starting a family, making your first home purchase, as well as tackling student loan debt. If there was ever a time to keep a close eye on spending, now is the time. Let’s take a look at the opportunities to take advantage of and pitfalls to avoid while in the early part of your career.

Savings To cover life’s inevitable emergencies, many young people rely on credit cards to manage these expenses – but that only makes matters worse since credit cards charge high interest rates. Instead, you should create an emergency fund, preferably in a separate, high yield savings account. Most experts recommend having 3-6 months of your monthly expenses in this account. This will provide you quick access to money you will need to cover unexpected expenses.

The Baby Babies themselves aren’t the expense you need to worry about, it’s the health and care costs. If you are not contributing to our PTSMC Health Savings Account (HSA), now is the time to start. An HSA allows you to put money away, tax-free, to pay for medical expenses. Utilize PTSMC’s dependent care benefit to put away money tax-free (up to $5,000) for child care costs. You will also need to consider funding some of your child’s college education. Opening a CHET account when your child is young, and putting money in every month, even if it’s $50 per month, is a really smart move. It gives the account time to compound and grow. Every dollar you save is one less dollar of loan you need to take.

The House The financial crisis about ten years ago made it tougher to get a mortgage and there are a few things to think about before you apply. Banks highly rate credit scores, so be sure to check yours early in the process so you have some time to improve your score if need be. The rate you will be offered will depend on your credit score. Another thing to know is that if your deposit is less than 20 percent of the purchase price, you will be required to obtain Personal Mortgage Insurance (PMI). This can cost anywhere from 0.5% to 1% of the purchase price annually until you have at least 20% equity in your home.

Protection With so many new things in your life, you have to protect them. Be sure to consider term life insurance early in your life when it’s cheaper. The longer you wait the more expensive it becomes. Term life insurance protects your family with life insurance proceeds should something happen to you. Look at a policy with a 30-year term and try to get as much insurance as you can afford now. Also, think about disability insurance via either an agent or many professional memberships. PTSMC offers a $25,000 employer-paid life insurance policy and short-term disability plan. Employees working more than 20 hours are eligible to enroll for supplemental benefits with Colonial Life, including accident insurance, cancel insurance, disability insurance, hospital confinement indemnity insurance, and life insurance.

Retirement Finally, consider your savings and be sure to pay yourself first. You’re working hard today, but the goal is to make sure that you can retire with financial security.

Make sure you are contributing to your 401(k).

HUMAN RESOURCES Timesheet Reminders Be on the lookout for Timesheet completion reminders to come from payroll@ptsmc.com!

Payroll@ptsmc.com Effective October 1, 2019 All of the payroll related items listed below need to be emailed to Payroll@ptsmc.com:

• Direct Deposit adds or changes (Document must be password protected) • Tax Status changes • Address changes • HSA Contribution changes • ATC coverage in schools other than your home school • Employee coverage in clinics other than your home clinic • Questions regarding Audit, DOCS, Residency Program Teaching and Mentoring Hours • If manual entry is needed for vacation hours above the negative allowed. This will occur if vacation requests have been approved and not used yet.

Timesheet issues should be emailed to Sandra at Sandra.Boccialetti@ptsmc.com.

Thanksgiving Holiday Schedule All clinics will have the option of opening 7:00 am – 5:00 pm on either Wednesday, November 27th or Friday, November 29th.

Minimum Wage CT Minimum Wage is increasing to $11.00 an hour effective October 1, 2019.

CURRENT JOB OPPORTUNITIES AT PTSMC

Physical Therapy Aide Avon East Hampton Essex New Milford Orange Plainville Westbrook Windsor

Patient Services Coordinator East Hampton New Haven (part time) Newington West Hartford (part time) Wethersfield Windsor

Physical Therapist Naugatuck New Milford

Practice Liaison Admin - will cover the west and southwest region

Check PTSMC.com for our most up to date postings and feel free to share! We’re always interested in connecting with referrals of colleagues and friends. Call Jenn or email at jenn.detlefsen@ptsmc.com if you are interested in a PT Aide position. Call Karen or email at karen.havlicek@ptsmc.com if you are interested in a position other than PT Aide.

OCTOBER BIRTHDAYS Christine Boyd Meaghan Battige Sandra Balavender Rebecca Passante Emilee Wargo Jonna Tomasello Miranda Jasienowski Chris Wilkins Cindi Theriault Erin Carlson Fred Havlicek Sue Mantz Jessica Semmelrock Nicole Perin Arabella Goralski Erica Drake Gabe May Olivia Montesi Alyson Whelan Josh Ogunmwonyi Caty Halpin Justin Delgado

3 3 4 5 7 9 9 10 12 12 13 13 15 16 18 18 18 20 21 27 29 31

Groton Windsor Admin Guilford Guilford Westbrook Groton Middletown Southington Southbury New Haven Watertown East Hampton Southbury Newington Guilford Avon Guilford Essex Southbury Admin & Westbrook Guilford

ANNIVERSARIES Andrew Perazella Megan Burke Nicole Skirkanich Stephanie Brilla Zach Currie

Physical Therapist PT Aide Patient Services Coordinator PT Aide Physical Therapist

New Haven Westbrook Orange Southington Guilford

Laura Nicklis Nick Scott

Physical Therapist Physical Therapy Assistant

Avon Westbrook

Sue Ginsburg

Assistant Director

Guilford

Carol Corbo

PT Aide

Waterbury

EMPLOYEE NEWS

NEW EMPLOYEES Welcome to PTSMC. We’re so happy to have you!

Back row from left to right: Michelle Linicus, PT Aide New London Angela Alvarado, PT Aide Middletown Kirby Heffrin, PT Aide New London

Linda Lepeak, PSC Guilford

Front row from left to right: Cameron Szuch, PT Aide Southbury Katherine Chaber, PT Aide Naugatuck

From Left to Right: Miguel Santiago, PT West Hartford Dana Earle, PT Southington Rachel Beckmann, PT New London Shradha Rana, PT Middletown

Julianne Balavender, Admin Office Assistant

From Left to Right: Evan Jasek, PT Aide Wallingford Jaclyn Lomanno, PT Aide Wallingford Jordan Jud, PT Aide Wallingford Victoria Arlia, PT Aide Wallingford Nicola Ciccomancini, PT Aide Wallingford Gabrielle Alessi, PT Aide Fairfield

From Left to Right: Brook Stoodley, PT Aide New London Redmond Cahill, PT Aide Branford Dana Kriss, PT Aide East Hampton Bella Goralski, PT Aide Newington

to the following employees who have achieved advancement in the PT Aide Skill Base Levels

Brian Greer, PT Watertown, got engaged to Erin Dorsey.

Gabe May, PT Avon, got engaged to his girlfriend Taylor.

Tom Kirsch, PT Avon, got engaged to Sara Boudreau.

Joe Allen, Newington Partner & Director, and his wife Tracey welcomed their second daughter, Olivia Marie.

Tatjana Cvjetinovic Jessica Fontaine Madeline Lynch Samantha Seger Daniel Spaargaren Roslin Wilhelm

Waterbury Watertown New Haven Southington New London Waterbury

Nathan Gockel Mikayla Raffone Stephanie Brilla

Plainville New Haven Southington

Jen Catuccio

Watertown

PTSMC Happenings

- OUT IN THE COMMUNITY THIS MONTH -

Thursday, October 3rd at 11 am Stephen Strong presenting “Vertigo: It’s Enough to Make Your Head Spin” at the Groton Senior Center Sunday, October 6th at 9 am Fairfield at Sound Tigers 5k

Groton explored downtown Westerly together, with a special appearance from AT Bethany Grady’s newborn son.

Southbury celebrated their 5-year anniversary!

Pictured from left to right is Erin Walsh, Pete Catuccio, Drew Gallagher, and Alan Balavender.

New Milford wore flannel to celebrate the first day of fall.

Sunday, October 6th at 7 am Westbrook at Chamard Vineyard Half Marathon Monday, October 21st at 10 am Emily Searle presenting on women’s health at the Branford YMCA Thursday, October 24th at 12 pm Michael Antunes presenting on fall prevention at the Middletown YMCA Monday, October 28th at 10 am Joe Allen presenting “Vertigo: It’s Enough to Make Your Head Spin” at the Newington Senior Center

Essex hosted Patient Appreciation Day! Pictured is Kelly Cahill (right) with a patient.

Greg Schlossinger and Mallory Mason represented the West Hartford clinic at the West Hartford Chamber Health Fair.

SoCIAl Media Sensation Lauren Peladeau, PT Groton

Lauren is constantly sending the marketing department photos of what the Groton team is up to, inside and outside of the clinic. She sent this picture of her patient, Theresa, with a glowing testimonial.

The new residents Mike Krukiel, PT Plainville, and Tom Kirsch, PT Avon, started PTSMC’s Orthopaedic Residency Program with Mike Gans!

Watertown had a staff outing to Kinsmen Brewing Company.

Employee Spotlight

Rebecca Petrosino, Partner & Director of Fairfield, is this month’s Employee Spotlight! Get to know Rebecca and see the new Fairfield clinic at www.ptsmc.com/videos.

Life Beat

A Healthier Apple Crumble (Vegan, Gluten Free & Sugar Free Alternatives!)

INGREDIENTS Crust 1 1/3 cups spelt, white, oat, or gluten free all-purpose flour 1/4 cup sugar of choice, or erythritol for sugar free 1/4 tsp each: cinnamon and salt 1/4 cup oil or butter spread 2 tbsp water Filling 4 cups peeled apples, sliced thin 1 tbsp pure maple syrup, honey, or agave Spice it up with optional 1/2 cup raw diced walnuts, and optional 1/2 cup raisins

upcoming wellness Events Saturday, October 5th at 12 pm WELLNESS MEET UP Apple picking at Lyman Orchards RSVP to wellness@ptsmc.com!

All employees and family and friends are invited to join!

Saturday, October 12th PTSMC employees are running or walking the Hartford Marathon & Half Marathon events to support Healing Meals. To learn more about how you can join the team, email Emily Hansen at Emily.Hansen@ptsmc.com or visit ptsmc.com/fundraiser.

Crumble Topping 1/2 cup rolled oats 1/2 cup spelt, white, oat, or gluten free all-purpose flour 1/2 cup sugar, or erythritol for sugar free 1/4 cup oil, OR 1/4 applesauce for fat-free 1/8 tsp salt INSTRUCTIONS Use an 8-inch springform. A 9-inch springform will work if you double the entire recipe.

Preheat oven to 350 F. Toss the sliced apples and sweetener in a medium bowl to create the filling. Let it set for a few minutes to soak in.

Line the bottom of the springform with parchment paper and set aside. In a large mixing bowl, combine all dry crust ingredients, then stir in the oil and water to make a dough. Transfer to the prepared pan, press down hard, and bake 12 minutes on the center rack.

Next spread the sweetened apples evenly over the baked crust.

In a third bowl, combine all crumble ingredients. Sprinkle the crumble evenly over the apples.

Bake 50-60 minutes or until apples are soft and tender. Allow to cool 20 minutes before removing the springform.

#GETMOVING

Holiday Edition The PTSMC Wellness Program is excited to announce that we are doing a holiday-themed #GetMoving Challenge. An email will be going out from wellness@ptsmc.com with all of the details!

The #GetMoving Challenge encourages us all to get up and get moving with some good, old-fashioned friendly competition.