"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, October 17, 2011

"Safe" Legislation in Florida in 2012

There were, from my perspective, three "big" issues discussed by the physical therapy community at the American Physical Therapy Association's 2011 State Policy and Payment Forum in Austin, Texas:

  • Co-payment legislation (Kentucky, New York, New Jersey)
  • Direct Access legislation (Texas)
  • Anti-POPTs legislation (California)

Each of these states successfully implemented legislation that improves access for patients to physical therapists and physical therapist assistants. Each of these state had a unique story and a strategy for accomplishing their mission. Each state was able to accomplish their mission through a sustained grassroots movement and by substantial financial support from the membership, both within the state and from members in other states.

Web-based advocacy, fundraising, consciousness-raising, public relations, social media and communications were a significant factor in California, Texas and New Yorks’ legislative strategies.

Each of these states’ legislative strategies (which were all successful, by various measures) met with significant opposition from physician groups. The California opposition was particularly vociferous, even resorting to name-calling and punitive actions.

There was also a very important piece of research presented in Austin by Pendergrass et al that showed self-referred PT episodes used 14% fewer visits and cost 13% less than physician directed episodes of care. I mention this because it is a landmark study but I view this within the context of Direct Access legislation.

I provide extensive details in these blog posts, written during the presentations and the breakout sessions. Since this is a summary document, I will just provide the links:

How should the physical therapist community respond to this new information?

Each state must make its own choice based on its members’ needs, available resources and unique legislative situation. Before embarking on any course of action, it is essential that a plurality of the membership support the decision.

From my perspective, there are two general approaches state leadership could choose:
  1. The “safe” alternative as proposed by Florida
  2. A more controversial alternative, such as pursued by California and Texas.
Two of my assumptions should be made clear here:
  1. Most states desire a broad-based “grassroots” support from their PT and PTA membership both to assure that the collective needs are being addressed and to distribute the workload on moving forward a legislative agenda.
  2. Most states desire and need ongoing, substantial financial donations to the physical therapist Political Action Committee (PAC) to support lobbying efforts.
I define “successful” legislation as having met these goals, rather than mere passage by the state legislature.

To illustrate one course of action, I will describe the choice made by Florida (3rd largest state by population) and contrast that with the choices made by California (1st largest state) in choosing a legislative strategy.

Immediately following the 2011 State Policy and Payment Forum, to which Florida sent two representatives, the Florida leadership elected to pursue a “safe” legislative agenda in 2012. This agenda will attempt to open the Florida Practice Act (FS 486) to improve language offering Temporary Licenses to new graduate PT and PTAs.

The Florida Physical Therapy Association (FPTA) lobbyists feel that Temporary License legislation is unlikely to be opposed by physician or specialty groups seeking to defend their turf. Therefore, in their opinion, Temporary License legislation is “safe”. It seems unlikely that Temporary License legislation, however worthy it is on its own merits, will deliver that same benefits gained by California, Texas and Kentucky.

Evidence offered by California and Texas showed that Anti-POPTs and Direct Access legislation, respectively, earned ADDITIONAL donations to the state PAC of $100,000 and $60,000, respectively. Also, California gained over 3,000 signatures on a petition supporting anti-POPTs legislation. Over 400 Texas physical came to San Antonio in 2011 to rally in support of Direct Access legislation. California enjoyed extensive and favorable nationally syndicated television and print media exposure in support of their anti-POPTs effort.

In both California and Texas, their respective legislative efforts were anything but “safe”.

I provide additional supporting documentation on “safe” legislation in a previous post.

State leadership needs to understand the risk/reward exchange they face each year among competing legislative priorities and rank the various issues that could be (and have been) addressed through legislative means and assign an explicit risk, dichotomized as high/low, and an explicit reward.

That way, individual leaders from each state could use the document to better understand the rewards they might expect from a well-planned “controversial” legislative strategy. Also, they might better understand the risks they face from so-called “safe” legislation.

Like hiding your money in your mattress to make sure that it is “safe”, failing to pursue an aggressive legislative agenda in this era of health care change just might prevent physical therapists from reaching our goals.

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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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