"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

Friday, September 30, 2011

Ready, Fire, Aim: The Case for CoPayment Legislation in Florida in 2012


Florida needs passion in 2012.
  • Without passion we will not have legislative success.
  • Without passion, we will not have increased grassroots support.
  • Without passion, we will not have more donations to our Political Action Committee.
The three "hot topics" from the Austin, Texas APTA State Payment and Policy Forum on September 23-26, 2011 were these:
  1. Direct Access (Texas)
  2. POPTs (California)
  3. Co-payment legislation (Kentucky, New York and New Jersey) 
Texas raised $60,000 over-and-above it's typical level of PAC donations for its Direct Access PAC in a highly public and highly controversial legislative session packed with hot button issues crowding the media:
  • illegal immigration
  • concealed carry permits for Glocks on college campuses
  • innoculating 6th grade girls with HPV vaccine
The Texas Physical Therapy Association (TPTA) rose above these emotional issues with a carefully orchestrated public relations campaign that emphasized the Texas consumer.

The TPTA also excited over 500 physical therapists and physical therapist assistants to travel to the Texas capitol for Rally Day in support of Direct Access legislation.

Incidentally, Texas also excited the mainstream media (television) to broadcast news stories about direct access to physical therapists.

California lit up the physical therapy blogosphere in 2011.

California also lit up the print media in Los Angeles and, according to Paul Gaspar DPT, legislators' colorful language lit up the California capitol, Sacremento. (Incidentally, the original, Spanish name for Sacremento was "Sacred Mind". I wonder how sacred was the legislators' language? :)

California raised over $100,000 in direct POPTs PAC support from AROUND THE NATION. Not just California. That's passion.

Not only did California excite the nation, generate passion from physical therapists and raise buckets of money but THEY ALSO WON! POPTs are now illegal in California.

Now, California physical therapists just need enforcement of the new, anti-POPTs legislation.

Kentucky was a slam dunk! The Kentucky House voted 98-to-zero to approve physical therapy co-payment legislation.

Dave Pariser, PT, PhD was partying hard in New Orleans in February 2011 and he had to come home when he heard that a groundswell of public and legislative opinion had arisen in favor of CoPay.

Dave had to come home to shepherd SB 112 through the Senate. It squeaked through, 30-to-6, in favor. Thanks, Dave and to the KPTA.

The actuality was that the KPTA had NO INTENTION of Kentucky CoPay legislation winning ANY support in 2011. But, it did. Why? Passion.

This time the passion was from the Kentucky consumers. They wanted relief. They wanted relief from the gradual shift that insurance companies and employers had placed on employees' copays.

Kentucky voters wanted Co-payment legislation in 2011.

Florida needs passion in 2012.

The stated intent of the Florida Physical Therapy Association, from the FPTA Assembly on September 24th, 2011, is to move forward with Temporary Licensure for Physical Therapy Students. While Temporary Licensure is important, its definitely not passionate.

Without passion, the Florida Physical Therapy Association (FPTA) will get nowhere in 2012.

Temporary Licensure will not be effective in 2012 for the following reasons:
  • Student don't have money to donate to the FPTA PAC for Temporary Licensure .
  • No one else is going to donate to the PAC (above 2011 levels) for issues that they're not passionate about.
  • Controversy is necessary to raise physical therapists above the media fray - don't be afraid of controversy.
  • Controversy sells - PAC donations are driven by emotion, not logic.
  • Grassroots support will arise when physical therapists appeal to the consumer/patient
My pick for Florida in 2012 on a platform of Temporary License legislation:
  • Flat to negative Political Action Committee (PAC) donations over 2011
  • No rally in Tallahassee with 250 therapists supporting Temporary License legislation
  • No grassroots support for Temporary License legislation
  • Odds of successful passage of Temporary License legislation, 3-to-1 against, that is, 25% chance of passage.

Tuesday, September 27, 2011

Columbia U, Duke U and Washington U Students Can Make the Physical Therapists' Diagnosis

Direct Access to Physical Therapists has been in effect in the United States since the 1950's and NO state direct access law has EVER been overturned.

Watch the entire video. 13:01min.

Thanks to Ryan J. Grella, PT, DPT, OCS and Adam Geril, DPT at Medical Business Leaders Network

Sunday, September 25, 2011

The Kentucky Blueprint for Legislative Success

Building on the 2011 successful Kentucky Physical Therapy Association (KPTA) copayment legislation, Dave Pariser, PT, PhD KPTA Legislative Chair and Leigh Ann Thacker, Chapter Lobbyist gave a breakout demonstration at the American Physical Therapy Association (APTA) State Payment and Policy Forum in Austin, Texas on the process physical therapists can follow to successfully implement co-payment legislation in your state.

Here is the actual bill language that KPTA passed in the Kentucky Senate.
  1. An insurer shall not impose a copayment or coinsurance amount charged to the insured for services rendered for each date of service by an occupational therapist licensed under KRS Chapter 319A or a physical therapist licensed under KRS Chapter 327 that is greater than the copayment or coinsurance amount charged to the insured for the services of a physician or an osteopath licensed under KRS Chapter 311 for an office visit.
  2. An insurer shall state clearly the availability of occupational and physical therapy coverage under its plan and all related limitations, conditions, and exclusions.
Here is how the actual vote went down in Kenucky:

Feb. 23, 2011Kentucky Senate306
March 13,2011Kentucky House980

However, when you go to implement YOUR state physical therapy copayment bill the KPTA recommends this ideal language for your state's legislation: 

  1. An insurer shall not impose a copayment, coinsurance OR DEDUCTIBLE amount charged to the insured for services rendered for each date of service by an occupational therapist licensed under KRS Chapter 319A or a physical therapist licensed under KRS Chapter 327 that is greater than the copayment or coinsurance amount charged to the insured for the services of a PRIMARY CARE physician or an osteopath licensed under KRS Chapter 311 for an office visit.
  2. An insurer shall state clearly the availability of occupational and physical therapy coverage under its plan and all related limitations, conditions, and exclusions.
Physical therapists can help move their copayment legislation forward by doing the following:
  • Survey your state membership FIRST to see if MOST of the membership perceive copayment legislation important enough to get behind - believe it or not you may encounter opposition, either overt or covert.
  • Collecting copayment information for your patients' PT, MD and medical sub-specialty co-payments.
  • Collecting insurance company remisions, especially those amounts that are for $1 or $2.
  • Talking to patients and collecting stories about patient hardships related to difficulty accessing necessary physical therapy services due to high co-pays.
  • Talking to friends and neighbors about hardships related to difficulty accessing necessary physical therapy services due to high co-pays.

Physicians Cannot Control Physical Therapy Costs Under Medicare ACOs

Physician directed care cannot control costs under Medicare Accountable Care Organizations - that is the conclusion of a new report by Dr. Jane Pendergrast and presented by Dr. Pamela Duffy at the American Physical Therapy Association's State Payment and Policy Forum in Austin, Texas:
A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy
The professional best able to control costs for physical therapy services is likely the physical therapist, in collaboration with the patient.

Physical therapists can, and should, use this report to advocate for direct access by educating their payers and their state legislators.

Saturday, September 24, 2011

Are Physical Therapists Too Passive?

I heard the finest characterization of the political physical therapist from Juliana Koob, Legislative Advocate for the New Mexico chapter of the American Physical Therapy Association at the State Payment and Policy Forum in Austin, Texas today. Ms. Koob said:
"Physical therapists have the best work-life balance of all of my clients. They love their work but they generally love their private lives, too."
That's why grassroots action by state-level physical therapists often seems like all the work gets done by the same small group of people.

My conversation with Ms. Koob took place within the context of CEO Paul Hardin's discussion of the Texas Physical Therapy Association's (TPTA) attempt to secure physical therapy direct access legislation in 2011.

The Texas attempt enjoyed a broad support from leaders in the Texas private practice setting, a sophisticated social media campaign and grassroots activity from all over Texas and, perhaps, the United States.

The initiative for the Texas Direct Access legislation and much of the heavy lifting to ensure it's passage (it missed by only one vote!) was probably done, in my opinion, by three people:
  • Cynthia Fisher, PT, DPT, MS, PCS President of the TPTA 
  • Paul Hardin, CEO of the TPTA and 
  • Eric Wilson, PT Legislative Chair of the TPTA

I don't want to take away recognition of the effort of the 500 physical therapist who showed up on Legislative Day in Austin, Texas or of the genuine grassroots support as evidenced by the 2,906 people who signed the petition supporting direct access to physical therapists.

I also don't discount the people who donated over $60,000 to the Texas Political Action Committee in support of Direct Access.

Physical therapists have great jobs with huge potential to impact peoples' lives. When we support and initiate political action to improve our impact we have to spend our private time - the situation that Ms. Koob observed.

But, that private time can be spent in fulfilling advocacy activities that add balance to your life by improving your patients' access to physical therapy.

According to Ms. Koob, politics doesn't have to be negative or contentious. Done correctly, politics may be just about talking one-on-one with your friends and neighbors.

Physical therapists are not passive. But, we may need to shed our idea that seeking influence in politics doesn't square with our image of a happy work-life balance.

For more updates from the APTA State Payment and Policy Forum in Austin, Texas follow the Twitter feed at @APTAadvocacy.

State Payment and Policy Forum in Austin, Texas

The mainstream media would have you believe that Federal legislation has a greater impact on your practice than state law.

Notwithstanding the 2009 Patient Protection and Affordable Care Act (PPACA) in most years Federal law tends not to change much.

But, state law is much more volatile. Most laws that affect your daily practice are made at the state level.

That's why I'm posting from the American Physical Therapy Association's (APTA) State Policy and Payment Forum in Austin, Texas. I'm here representing the Orthopedic Section of the APTA.

APTA members from around the nation will be discussing the following:
  • Direct Access to Physical Therapists 
  • Health Care Reform 
  • Medicare Accountable Care Organizations (ACOs) 
  • Physical Therapist Co-payment legislation 
  • Physician Owned Physical Therapy clinics (POPTs)

Omni Hotel Downtown Austin

Follow events like this Forum at APTA's Moving Forward blog as well as my Twitter feed.

Friday, September 23, 2011

Yeah, There's A Code For That

These videos are for any physical therapist who has ever smacked their forehead in amazement at the incredible complexity, micromanagement and incoherence of our centrally-planned medical non-system in the United States. Enjoy.

Code Z72.820 Sleep Deprivation

Code V91.07xA Burn Due to Jet Ski on Fire

Code w22.02xA Walked into a Lamp Post

Thanks to Paul Martin, PT at Paul Martin's View

Tuesday, September 20, 2011

Physical Therapist Innovators Can Impact Population Health

My post yesterday had a fascinating video from TED about the origin of new ideas.

Ideas are often thought of as "Eureka!" moments but Steven Johnson describes a "network" of ideas that are resident within a group of like minded-individuals that "fade into view" over time until the value of the idea becomes evident to everyone paying attention. This "bubbling up" process is described as innovation but the innovative process depends on the network, not just the brilliance or the insight of one person.

One innovative approach to health that is becoming more and more obvious is the wellness approach to population health. Population health will be important to anyone trying to understand what the future of outpatient physical therapy practice will look like.

Engaging Populations Through Total Health Management from Healthways, Inc. describes some of the biggest cost drivers in treating chronic conditions, like painful musculoskeletal conditions. These drivers are patient self-reported measures like...
  • "Am I thriving in my current situation?"
  • "Am I struggling in my life to just get by?"
  • "Am I suffering in my life?"
People who were suffering spent 50% more on medical services than people who were thriving.

If physical therapists could identify "sufferers" early in the course of rehabilitation perhaps we could help direct appropriate care to alleviate their suffering.

Physical therapists are currently challenged to remain relevant in the changing US healthcare system and understanding how to impact population health seems important for our future.

Monday, September 19, 2011

How Can Physical Therapist Innovators Come Up with Good Ideas?

"Chance favors the connected mind..."

Steven Johnson on Where Good Ideas Come From (Hint: Coffee!)

Thanks to Todd Davenport, PT, DPT, OCS of PacificDPTweet and also on Facebook.

Wednesday, September 14, 2011

Will Screening for Pathology by Physical Therapists Lower Surgical Rates?

Direct access to physical therapy services is safe and effective for patients with musculoskeletal problems, like lower back pain.

Physical therapists can screen for ominous findings, such as cancer, with a predictive accuracy that meets rates by diagnostic imaging, such as x-rays, MRI or bone scans.
"Among patients who develop epidural spinal cord compression, those who are diagnosed early, while still able to ambulate, are the most likely to remain ambulatory following treatment.

The ideal diagnostic strategy would detect the few cases of cancer among primary care patients with low back pain, while minimizing unnecessary diagnostic testing."
Physical therapist early intervention may reduce unnecessary, expensive and risky back surgeries if two conditions are met:
  1. Over-diagnosis of pathology by physical therapists detected in the screening examination is not sent for unnecessary diagnostic imaging, and...
  2. Patients attitudes and choices regarding "risk free" surgical fixes do not continue to increase.
A recent study from Norway on the effect of population screening for breast cancer in 35,408 women found that screening increased that rate of surgical mastectomies in two of the three age groups.

According to the study authors:
"The objective of mammography screening is to improve the timing of breast cancer diagnosis, thereby reducing the number of associated deaths.

A potential additional benefit often stated in invitations to screening and on websites supported by governmental screening institutions is that screening reduces
the need for mastectomies and increases the potential for breast conserving treatment."
A corollary for physical therapist screening suggests that early detection of pathology and subsequent appropriate treatment should reduce unnecessary treatments, including hospitalizations, re-hospitalizations and death.

The recent meeting of the Florida Physical Therapists in Private Practice, attended by 81 private practice physical therapists, looked at physical therapist screening to reduce healthcare costs and improve outcomes under Medicare Accountable Care Organizations.

Diagnosis by physical therapists will be an important part of America's future healthcare system.

How much the physical therapists' diagnosis improves patients' lives and reduces system costs will determine the value physical therapists bring to this future system.

Sunday, September 11, 2011

Wellness Programs Are Not Poular Among Hopital CEOs

Hospital CEOs say that their wellness programs are "nice to have" but they are not getting paid for them.

As one hospital CEO puts it:
“I’m not getting paid for it so it goes to the bottom of my priorities.”

Hospital CEOs should pay attention to the practice of many physical therapist leaders who are positioning their organizations to impact patient health in a way that will impact population health.

Population health are the set of metrics that look at how physical therapists' interventions actually make a difference in peoples' lives:
  • Are patients happy with their physical therapist? (#4)
  • Can patients go back to work? Can they play with and lift their babies up? (#7)
  • Did the doctor/therapist ask about or measure the following:
    • their weight? (#31, #47)
    • their Blood Pressure? (#32, #41, #58)
    • their tobacco use? (#33, #38)
    • did the the PT screen them for depression? (#34)
  • Did their physical therapist screen for future falls risk and implement a plan of care? (#63)

As you can see, there are many of the 65 ACO Quality Measures that physical therapists can impact.

Payment may change as Medicare Accountable Care Organizations (ACO) begin in 2012 to pay providers based on outcome, not volume.

Wellness programs have great potential to impact some of the biggest, modifiable drivers of healthcare consumption:
  • obesity
  • smoking and alcohol consumption
  • activity avoidance
  • mood disorders.

Medicare Accountable Care Organizations have hospital CEOs fretting about their 2012 revenues since the new program gives hospitals the incentive to cut costs on some unnecessary procedures.

Medicare will reward hospitals that save from 2% to 3.8% of their prior year's revenues up to 7.5% of the "shared savings".

Forward-looking CEOs are aligning their organizations to achieve shared savings since the only alternative is steep, permanent cuts in Medicare and commercial reimbursement.

Forward-looking physical therapist leaders and clinic owners should also seek to align their organizations in a wellness model that impacts the biggest health care driver of them all:
Patient behavior
How can we help people who may not be able to help themselves?

Monday, September 5, 2011

New Slideshow from the FLPTPP Conference in Orlando

Free Tutorial

Get free stuff at BulletproofPT.com

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 .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

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Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.