New Florida state legislation threatens Physical Therapist Assistant education

"Hi, my name is Tim and I'm in the Senator's district. I'm calling today to ask the Senator to oppose Florida House Bill 1071."

"Ok", said the voice on the other end of the line. "What's your zip code?"

"34222", I said.

"Ok, got it. Thanks for calling. I'll make sure the Senator gets this", said the voice.

"Ok, thank you."  I said and I hung up.

Well, that was easy.  I also sent an e-mail to my Senator asking him to oppose Florida House Bill 1071 (CS/HB 1071).

According to the Florida Physical Therapy Association (FPTA), HB 1071 is legislation originally intended to address a number of glitches in current law affecting the accrediting of healthcare providers and hospitals. HB 1071 has passed the Florida House of Representatives on April 24th, 2013. Unfortunately the legislation was amended on the House floor prior to passage and language was added to the bill that is problematic for the Physical Therapist profession. The legislation will now be considered by the Florida Senate.

The problematic amendment adds NEW language to the Florida Physical Therapy Practice Act (licensure law) that addresses physical therapist assistant education and licensing requirements. Specifically the new language could allow for individuals who have graduated from schools NOT accredited by Commission on Accreditation for Physical Therapy Education (CAPTE) to sit for the PTA licensure exam!

This language is extremely problematic for a number of reasons and was added without consultation from FPTA. The proposed change would undermine the CAPTE accreditation currently required for all U.S. PT and PTA schools offering education and training of students seeking examination and licensure. If enacted, this language could open the floodgates for entities who are not experts in physical therapy, nor meet the quality standards of CAPTE to offer “PTA educational degrees” in the state of Florida.

The Florida Physical Therapy Association is strongly OPPOSED to this amendment.

Accrediting agencies like CAPTE hold programs to high standards that have been informed by multiple stakeholders inside and outside of the profession that guide quality student training - this is in the best interest of the public safety and patient care. Relaxing accreditation requirements could diminish the current levels of care protecting Floridians requiring physical therapy rehabilitative and habilitative care.

URGENT ACTION NEEED NOW!

Please click on the following internet link to send an email to your state senator in Tallahassee on this important issue. It’s easy and only takes a couple of minutes – the email is already prepared for you. The message to your state senator will urge him or her to OPPOSE CS/HB 1071 unless this problematic language is deleted from the bill. In addition, the message will ask them to oppose any amendments to SB 594 and SB 966 changing PTA educational accreditation:

CLICK HERE

Please be sure to follow up with a phone call to your state senator as well.

Price, not More Visits, Drives Cost Increases in Healthcare

Why should you care?

Commercial health care costs are going up - does it matter whether price or patient volume is to blame?

Yes. The Town Hall meeting at the recent Florida Physical Therapy Association (FPTA) meeting included discussion about Copayment reform legislation in Florida.

Some voices in the Town Hall argued that Copayment reform legislation in Florida is not necessary since rising physical therapy utilization indicates there are no barriers to patient access to physical therapists.

Increasing health care costs, to employers via premiums and to employees in the form of rising Copayments, reduce access to physical therapist services.

Do we want to live in an America where only the rich or the employed have access to physical therapist services?

The findings of the Health Care Cost Institute from September 2012 found that

"... price growth for outpatient facilities and professional procedures remained higher than (patient volume) utilization growth.".

The prices paid were the primary drivers of health care spending in 2011.

According to a September 25th Washington Post article:

"Employers typically have tried to control costs by reducing the volume of care delivered, whether that means higher co-pays for doctor visits or using prevention to catch costly diseases earlier."

Copayment reform for physical therapy patients was a "slam dunk" in Kentucky, South Dakota and New Jersey in 2011 and 2012.

Other state physical therapy associations have not seen the same rapid success with Copayment reform. There is not even uniform agreement that Copayment reform is necessary for patients. Florida is one example where there is disagreement.

Some other opponents of Copayment reform at the recent Town Hall meeting in Daytona Beach spoke out and suggested that insurance companies would "get mad" at the FPTA if we, as an organization, supported Copayment reform.

These opponents, who are physical therapists, are supporting the insurance companies because the insurance companies support them.

When insurance companies set the political agenda for the FPTA we are allowing them to put profits before patients. We need Copayment reform to protect patients. From the Post article:

"Some economists have argued that government regulation is exactly what we need to slow price growth and ensure patient access.

Maryland is the only state in the USA where the government sets the rates that hospitals can charge insurance companies. 

Maryland's hospitals from 1977 to 2009 experienced the lowest cumulative increase in cost per adjusted admission of any state in the nation. And private insurers pay the same rates as public insurers.

All states except Maryland gravitated away from those models, as states have looked for more competition and less regulation in health-care markets."

Consumers will continue to need physical therapy services and employers will continue to buy lower priced health care with lower premiums for their employees. This means higher Copayments.

This problem wont go away and it can't be solved through "free market" methods.

States need legislative reform that lowers Copayments for patients.

Are Physical Therapy Students Risk Averse?

Do physical therapy students always choose the safe alternative?

Does $100,000 in debt cause students to vote for the status quo?

Do physical therapists and students feel so much anxiety over health care reform that they prefer to vote for short-run self-interests over long-run investments?

Outcomes measurement linked to physical therapist reimbursement was the subject of the 2012 Oxford Debate at the Florida Physical Therapy Association Meeting (FPTA) in Daytona Beach. The students and physical therapists in the room - about 400 - mainly voted against using these measures for payment.

I question if students, in these changing times, are prepared to put the interests of their patients and their profession ahead of their own interests. I can't really blame them. I was a student once, too. The future is uncertain and scary.

This student-led decision was reminiscent of the American Physical Therapy Association's (APTA) 2011 Annual Conference in Washington DC when a student-dominated audience voted against Clinical Decision Rules.

Oxford Debates pit two teams arguing contrary positions. Each team "wins" by persuading the audience to cheer, make noise or physically move from one side of the room to the other. The side with the most supporters wins the debate. Most Oxford Debates handle serious topics in a fun environment. Drinks are usually served.

This convention was well-attended by students, many of them from the University of St. Augustine. The student-dominated audience split about 60/40 against using patient outcomes to reward physical therapists.

Inadequate risk adjustment seemed to be the main reason outcome measures should not be used, according to the speakers and the audience. In other words, the measure would ONLY capture the outcome of care which might depend on factors other than the therapists' effort and skill.

For instance, if the patient does not do their home exercise program they will tend to have worse outcomes than if they do their exercises. Older people with multiple diseases will usually have worse outcome scores at baseline and at follow-up than younger people without disease.

We've recently heard similar arguments in the Chicago teachers' strike when school teachers objected to being paid based on the standardized test scores (outcomes) of their students. The teachers argued that many factors that affect test scores are beyond their control. Paying teachers based on test scores was unfair since many of the determinants of teacher performance happened outside of the classroom.

A physical therapy student at the Oxford Debate noted that the most important determinants of health also occur outside the physical therapy clinic. These determinants are things like the following:

• family and social support 
• a positive outlook 
• educational level 
• addictive behaviors, such as cigarette smoking 
• level of activity

Young people are typically more tolerant of risk, according to standard economic thought. They have more years to make up any financial loss so they're supposed to be more willing to accept risk.

However, I think these students' behavior is rational.

Instead of pushing physical therapists and students to accept a reimbursement system that puts us at risk let's design a system that lets us think about patient care rather than worry about money.

What do you think?

Tim Richardson Running for Secretary of the Florida Physical Therapy Association

Statement: I would be honored to serve my fellow physical therapists as Secretary of the Board of Directors of the Florida Physical Therapy Association (FPTA).

The FPTA Board of Directors is a responsibility I take very seriously since the FPTA is the largest organization representing physical therapists and physical therapist assistants in the State of Florida.

I believe our voice is strongest when we speak, not from our own self-interest, but from the perspective of our patients. I believe we should ask ourselves, when developing FPTA policy:

"What can I do, as an FPTA member, that can improve my ability to provide care or the ability of my patients to access my services?"

***

Online voting for FPTA offices began on Tuesday, August 14 at 9:00 am and will close on Friday, September 14 at 8:30 pm. FPTA will use the emails on file with APTA for contacting members regarding elections and voting procedures.

During the FPTA Annual Conference in Orlando, candidates will have the opportunity to speak during the Chapter Caucus.  Additionally, the Nominating Committee has scheduled a "Meet the Candidates: session during the Exhibit Reception. Members will have the opportunity to chat with candidates and ask any questions they feel necessary.

Biography: Tim Richardson graduated from the University of Florida in 1992 with a Bachelor's in Health Science (Physical Therapy).

Tim received Manual Therapy Certification from the University of St. Augustine in 2001. Since 1996 he has owned and managed private physical therapy clinics in Manatee County, Florida.

Tim is returning from a one-year sabbatical in Spain where he provided cash-based musculoskeletal and vestibular physical therapy services to Spanish-speaking people.

Tim just recently (June 2012) was elected to the North Central Florida Health Information Management Systems Society (HiMSS) Health Information Exchange Committee, which advises the HiMSS Board of Directors.

He is also a founding member of the Florida Physical Therapists in Private Practice (FLPTPP), serves on their Board of Directors and serves as their Legislative Chair.

Tim is serving his third year on the Florida Physical Therapy Association (FPTA) Government Affairs Committee and has served on the Web Site Task Force responsible for the FPTA logo. Tim also serves on the American Physical Therapy Association (APTA) Orthopedic Section Practice Committee and the Health Policy & Admin Section Technology Special Interest Group.

Tim advises the Florida Medicare Administrative Contractor, First Coast Service Options Inc., as a member of the Provider Outreach and Education Advisory Group.

Contact Information:
email: TimRichPT@MedicalArtsRehab.com
LinkedIn profile: http://linkd.in/zPc0EH
Twitter handle: https://twitter.com/#!/timrichpt
Skype name: TimRichPT
Facebook: http://www.facebook.com/timrichpt

Thank you for your consideration.

Remember, in a democracy its not "Majority Rules", but the majority of people WHO VOTE that make the rules.

Florida Physical Therapists Wanted to Speak to Legislators

The Key Contacts program of the Florida Physical Therapy Association (FPTA) is designed to put a physical therapist (PT) or physical therapist assistant (PTA) in every state legislator's office in Florida.

Each Florida legislator has an office in your district. Maybe your legislator has an office in your town.

We especially need therapists in the South Florida area.

The goal is to make politics personal so when the FPTA has an issue that needs support - such as the recently successful Temporary Licensure law - then we can reach out to the legislator.

But we need you to make that face-to-face contact.

The Florida Physical Therapy Association will be making strategic contributions to several legislators in anticipation of the 2013 legislative cycle.

You can set up a Practice Visit to meet you, your staff and your patients.

The FPTA may want to suport your legislator using FPTA Political Action Committee (PAC) funds.

Find out if your legislator in on the list by e-mailing Eric Chaconas, DPT.

Governor Scott signs Physical Therapist/PTA Temporary License Bill into Law

Physical Therapists and Physical Therapists Assistants graduating from Florida based PT and PTA programs will be able to obtain temporary licensure thanks to Governor Rick Scott signing HB 799 into law on Friday, April 6, 2012.

With Governor’s Scott’s signature HB 799 will become law effective June 1.

HB 799 was a major priority of the Florida Physical Therapy Association (FPTA) along with the state’s 11 Physical Therapy and 15 Physical Therapy Assistant schools.

Passage of the legislation can be attributed to the hard work of our PT and PTA students, faculty, and FPTA leadership and legislative counsel.

As a recap, HB 799 and its companion SB 1228 were heard in a total of six committees of reference and passed every single committee without objection. On final passage in the Florida House of Representatives HB 799 passed 114-0 and then passed 36-0 in the Florida Senate.

While process barriers were ever present during the 2012 session, the legislation steamed on toward final passage. However, it wasn’t until the final day, March 9 at 11:22 p.m. that HB 799 achieved final passage and was enrolled. On Friday, March 23, the Florida House of Representatives procedurally released HB 799 from its purview to be considered by Florida Governor Rick Scott.

As mentioned previously, Governor Scott signed the bill into law Friday, April 6. FPTA’s strategy was textbook advocacy for taking an idea and making it a law.

Thank you to the following legislative sponsors:

• Rep. Tom Goodson, R-Titusville
• Senator Bill Montford, D-Tallahassee

Florida Physical Therapy Bill Recieves Unanimous Support in Sub-Committee

Fourteen out of fourteen Florida House of Representatives in the Health Human Services Quality Subcommittee voted to adopt the Temprary License (HB 799) bill for new graduate physical therapists and physical therapist assistants without objection.

Congratulations to the Florida Physical Therapy Association (FPTA)!

Now, on to the House Education Committee and the House Health & Human Services Committe as detailed on the House Bill Tracker website.

Then, on to the Florida Senate.

If HB 799 passes this will be a significant victory for the Florida Physical Therapy Association.

Check the FPTA website for timely announcements to call your House members to ask for support of HB 799.

Florida Temporary Licensure - From a Ripple to a Wave

I got my first real taste of the less glorious side of politics when I spent 2009 and 2010 passing out flyers, attending fundraisers, and throwing candy for Chad Hays, my step father, now State Representative for the 104th district in Illinois.

Fast forward to January 16th, 2012—myself, some close peers, and colleagues in Physical Therapy are attending the Advocacy Forum put on by the Florida Physical Therapy Association (FPTA) in Tallahassee, Florida.

The 2012 FPTA Advocacy Forum was a success.

The forum allowed students and clinicians to learn more about the political process, how to advocate for our profession culminating with attendees having the opportunity to observe our own bill navigate a key House committee.

After our bill was introduced to the sub-committee by Representative Goodson, I joined other physical therapists in giving testimonials.

The bill passed unanimously in the Health and Human Services Quality sub-committee. The advancement of our bill that day has created a ripple effect. The result forwards the ultimate goal of allowing new graduates to practice while waiting to sit for board exams, but also splashes into important directions relating to the association’s future.

Equally important is the impact on the dozen physical therapy students in attendance at the capital in concert with the excitement from those students still in class on the home front who were kept notified through social media. Representing the future of the profession, we have truly seen democracy at work . . . .SO EXCITING.

Temporary licensure was re-exposed by a student this September to the FPTA in Orlando at a district caucus during the association’s annual conference. At the general assembly gathering the next day, University of St. Augustine students were recognized for raising $1000 for PT-PAC. Soon thereafter we each witnessed the organization quickly vote in support to pursue the legislature. Furthermore, not only did students witness their dollars at work, the receptiveness by the practicing clinicians to the idea served as justification and encouragement to students who do not think their voice could be heard. It further served as validation to those individuals who moan and grumble on the fees for FPTA/APTA membership they pay.

Here we are today, spearheaded by young professionals who juggle the rigors of doctoral education and sacrifice valuable study time (more importantly free time) to advocate for their trade. I felt as proud as when I had received my acceptance letter to PT school as the number of students at the advocacy forum exceeded the amount of practicing clinicians.

Thank you for making a difference.

The undulation of the Temporary Licensure stone thrown into the pool of politics is further seen in the development of the organization’s relationship with Tallahassee. We have made headway not only with our sponsors in the House (Rep. Tom Goodson) and in the Senate (Senator Bill Montford), but also with Doctor of Osteopathic Medicine Ronald Renuart, the vice chair of the Health and Human Services Quality Subcommittee. Eric Chaconas, PT, DPT, FAAOMPT and I were introduced to “Doc” Renuart in Jacksonville last fall.

The receptiveness from Representative Renuart that day left me feeling that the FPTA would have a tough road ahead of them.  However; Rep. Renuart was in full support of our bill on Tuesday arguing that Florida produces great physical therapists and we need to keep them here!

Anything is possible. We need to keep the swell that we have created this January 2012 session from turning into a tsunami headed in our own direction.

The day was a success. I am not looking at the glass optimistically as if it were half full. I am certainly not looking at the glass pessimistically as if it were half empty. I am however looking at the glass opportunistically; to drink it. Simply put, as a member of the FPTA, we need to evaluate and reflect our triumphs and mishaps. The organization, location, and presentations given during the advocacy training were terrific. Awesome hotel, food, excellent support information, and presentations that were interesting, helpful, and informative.

However, our sponsor in the House thought we were massage therapists. At one point, I had to explain to him that physical therapists were to bones and muscles as dentists were to gums and teeth so he would stop raving about the massages he has had before. He was good for a non-controversial issue, but what about direct access or dry needling? He clearly did not know the field.

There were many questions that could have been anticipated (dates, how it was before, why tests dates) but had to be answered by several different individuals because one could not fully articulate the nuances of our field. In fairness, legislators are bombarded with issues from hundreds of fields; the education of our elected officials is our job. The advancement of our bill that day has created a ripple effect that shouldn’t be left unrecognized.

I read a blog by Mike Reinold, a physical therapist that I hope to meet someday, and Head Athletic Trainer/Assistant Director of Medical Services for the Boston Red Sox. The article highlighted the common adage used in physical therapy called the “kinetic chain.” Dr. Reinold’s focal point was that far too often the body is more analogous to a ripple in the water with some parts not following the notion “a chain is only as strong as its weakest link”. He noted that the body follows a “kinetic ripple.”

My extreme love for Anatomy and Biomechanics was put on the back burner, for I found the ripple synonymous with our progress in the state capital on January 17th. I was intrigued in that the correlation heads in all directions. Perhaps we can all look further into Temporary licensure in that not only does the legislation create jobs for new graduates, but also lays the foundation for the future of young practitioners, their involvement, and the success for the organization at the Capital. FPTA staff, students and clinicians…stay diligent, because you never know what’s over the next wave.

Leighton Peavler, SPT, FPTA, GAC
Student Representative, University of St. Augustine for Health Sciences
For comments and questions, please do not hesitate to contact Leighton at LeightonPeavler@gmail.com

Why Politics Is Important to Physical Therapists

Congratulations to Eric Chaconas, DPT of the Florida Government Affairs Committee and and Scott Harp, PhD Vice President of the Florida Physical Therapy Association for hitting their attendance goals for the 2012 Florida State Advocacy Training program in Tallahassee on January 16 and 17, 2012.

Thirty five physical therapists and physical therapist assistants attended and the 2012 Advocacy Day was a HUGE success!

"FPTA members were treated to visits during the Advocacy Workshop by both Senator Montford and Rep. Goodson who offered praise and strong support for physical therapist and students taking time to travel to Tallahassee to advocate for their profession.

“The perfect lobbyist for the physical therapy profession is physical therapists and your students in training,” said Senator Montford.

Why is politics important for the physical therapist?

I highly recommend Charles Krauthhamer's excellent article in the Washington Post on December 30th which asks Are We Alone in the Universe?

Don't worry, its not science fiction - rather, Krauthhamer posits that politics is the driver of history and the organizer of our affairs:

"This is the work of politics — understood as the ordering of society and the regulation of power to permit human flourishing while simultaneously restraining the most Hobbesian human instincts.  

There could be no greater irony: For all the sublimity of art, physics, music, mathematics and other manifestations of human genius, everything depends on the mundane, frustrating, often debased vocation known as politics (and its most exacting subspecialty — statecraft).  

Because if we don’t get politics right, everything else risks extinction.  

We grow justly weary of our politics. But we must remember this: Politics — in all its grubby, grasping, corrupt, contemptible manifestations — is sovereign in human affairs. Everything ultimately rests upon it.  

Fairly or not, politics is the driver of history."

Physical Therapists Meet at the Beach

Special thanks to Blaire Burton, DPT for organizing the Florida West Central District spring meeting, Saturday, March 27th at America's #1 beach!



The meeting agenda promoted the update to the Florida Physical Therapy Practice Act (FS 486) during the 2010 legislative session.

The update is designed to do the following:


Some of the outstanding moments at the meeting were the following:

• A lucid and pointed rationale from Adele Carr, PT for why keeping statutory language affirming 'Physical Therapy Aides' in the practice act is a dangerous move for the profession.


• An even-handed narrative from Sheila Nicholson, PT, JD, FPTA President on how and why the practice act is being updated.


• Many, many passionate examples of members who care about their profession speaking up, voicing their ideas and trying to get involved.


• At least two private practice owners I spoke to telling me how ALL their marketing is now Direct-to-Consumer, instead of the physician.


• A lively fund-raising appeal for the FPTA Political Action Committee (PAC) that garnered several hundred dollars - we need to do more in this area since chiropractors and doctors still beat physical therapists 10-to-1 in donations.
  
  This year, our goal is $75,000 - about double last year's donations - and you can help us make it. Remember, patients can also be donors to the FPTA PAC - they want to help preserve their access to physical therapy, too!

These web links contain important, timely information for Florida physical therapists:

Florida PT PAC

The new, proposed PT practice act has been filed with the legislature: SB 2146.

Follow, in real-time, the process of SB 2146 as it makes its way through the legislative process.

What do YOU want to see in YOUR practice act?

Now's the time to speak up.

The Florida Physical Therapy Association's 2010 Legislative Advocacy Academy

They say you should never watch sausage or our state's laws being made - you may enjoy the final product but you won't enjoy the legislative process.

This year physical therapists will challenge ourselves to update and modernize the physical therapist practice act (FS. 486).

The 2010 FPTA Advocacy Academy in Tallahassee put the lie to that old chestnut - when you get involved in grassroots advocacy for physical therapy you challenge yourself in a way that is scary and thrilling at the same time - I know because I did it from January 31st-February 1st, 2010.

I sat in a class of about 15 physical therapists and the FPTA Chief Executive Officer, Craig Crosby, while we listened to lobbyists, media consultants, staff lawyers, legislative assistants and other folks familiar with sausage, er... I mean laws, being made.

The agenda was as follows:

• Ken Jacob, physical therapist and the legislative process


• Sheila Nicholson, FPTA president and attorney on grassroots advocacy


• Barry Monroe from the Florida Senate Health Care Staff


• John Van Gieson, media consultant


• Bob Rowe, physical therapist update on manipulation and chiropractic legislative intent.


• Gene Adams and Martha Edenfield, FPTA lobbyists in Tallahassee


• Lisa Weisman, House legislative aide in Tallahassee

The final result is an educated, motivated workforce that will help physical therapists introduce and pass a new practice act that will modernize our profession by, among other means:

1. protecting the designator, DPT, as the Doctor of Physical Therapy.
2. removing only specific designators (eg: practice acts 458, 460, et al) from referring to physical therapy.
   
   Anyone remember the issue with Advanced Registered Nurse Practitioners (ARNP)?
   
   They couldn't refer to PT because they weren't specifically designated. ARNP's receive their license under the nurse practice act (FS. 464) which is not specifically designated as being able to refer to PT. This issue will go away under the new practice act.

Direct Access is improved with this change although, for political reasons, the '21-day rule' will not be changed.

The new legislation can first be introduced on March 2nd, 2010 - the start of the 2010 legislative session in Tallahassee.

Physical therapists can help the process by calling your local, state legislator now, before March 2nd, and recommending support for an upcoming physical therapy bill.

A specific bill number will be available soon and updates are available at the FPTA website.