"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Monday, April 11, 2011

Can Florida Follow Kentucky's Co-Pay Legislative Success?

The Kentucky Physical Therapy Association (KPTA) recently advocated for and successfully passed a new law, SB 112, to prevent insurance companies from charging higher co-payments to physical therapy and occupational therapy patients than they pay for primary care doctor visits.

But, the bill was a surprise from the start...

Dave Pariser, PT, PhD, Legislative Chair of the KPTA, says...
"We had no illusions about getting this passed - we didn't think it would happen!
Our lobbyist called us when I was in New Orleans at the Combined Sections Meeting and told us this bill 'had legs' and that we needed to mobilize our Key Contacts to call our legislators"
E-mail blasts in Kentucky were used to generate and maintain a genuine grassroots effort among physical therapists and occupational therapists. Both the PT and the OT lobbyists were used to persuade legislators to support SB 112.
“This truly was a team effort,” said Mr. Pariser.
“Physical therapists, patients, and occupational therapists came together to advocate for this important legislation.
It just goes to show what we can accomplish when we put our patients first.”
The bill passed quickly in the Kentucky Senate and then unanimously, 98 - 0, in the Kentucky House.
"Be prepared to testify in front of your state legislative bodies" says Larry Benz, DPT and CEO of Evidence in Motion

"This bill is not a mandate, its a patient access bill".
How to Get Started in Your State
Many therapists are calling the KPTA to find out how they can obtain similar legislative relief in their states.

Before the bill was even written, the Kentucky leadership began by listening to their members to determine the needs of their organization.

The membership indicated "Reimbursement issues" were high on their priority list and patient co-pays were the single issue most amneable to change.

To obtain quantitative data on the extent of discrimination against outpatient PT and OT therapists, clinics should record the dollar difference between family physician co-pays and physical therapist co-pays.

Mr. Benz, recommends 20 patients each in six private practice physical therapy clinics. Put this data on a spreadsheet, he says. Do not count automobile (PIP) patients, do not count Medicare patients. Only count private insurance.

Try to find out if there is a big differential between outpatient physical therapist or occupational therapist co-pays - try to determine the extent that the large insurance companies are picking on the little guys.

Once the need for this legislation is determined, the next step is to find a legislative sponsor.

The legislative sponsor for Kentucky was State Senator Tom Buford (R).

Once the sponsor was found, the next step is to mobilize physical and occupational therapists statewide. This is done through your Key Contacts list and meetings in your district with legislators and their staff.

The Kentucky Physical Therapy Association is preparing a kit that will describe actions and strategies states can follow to repeat the Kentucky success.

President, Ramona Carper, PT, DPT:
“The Kentucky Physical Therapy Association pushed hard for this legislation because for too long we saw the detrimental effects that excessively high copays were having on patient care.
The financial implication of excessive copay amounts results in disincentives for patients to participate in physical therapy, contributing to a lack of compliance for their care.
This can result in significant recurrence and downstream costs including further surgery, imaging, and pharmacy.
We hope that SB 112 will provide the patients we serve with some financial relief for their copays and allow them to focus on their most important priority -- getting better, faster.”

Kentucky's new law, signed by Governor Steve Beshear on March 16th will go into effect June 8th, 2011.

Florida's legislative session will end May 6th, 2011 and we are hopeful that we can attach a new bill to current legislation already pending.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

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