2019 APTA Federal Advocacy Forum – “Day on the Hill”

56610440_1121899427982296_3955834925961183232_n

Colorado members at the Forum representing and advocating for the #ChoosePT campaign.

Last week,  the APTA Federal Forum in Washington D.C. took place to advocate for important topics to physical therapists. The Forum brought together APTA members, speakers from the field, and stakeholders on the discussion of regulatory affairs and federal priorities that impact the physical therapy profession and its patients, as well as on learning about new information that comes with a new Congress. Attendees had the opportunity to speak with their representatives in person about issues facing their state and the profession as a whole. Among those in attendance were our very own Regis DPT students and faculty members. Second-year DPT student Hannah Clark reflects on her experience on the Hill and why it is crucial to not only advocate for our profession, but to be involved as a student, in her following essay:

“Issues Discussed at the Capital”

Hannah Clark, SPT – Regis University

To fundamentally agree with the policy positions held by the APTA is an exceptional feeling. As a DPT student who is hoping to delve headfirst into pain management and advocacy for marginalized communities in healthcare upon graduation, my decision to pursue this profession has been deeply validated by attending the Federal Advocacy Forum (FAF). Witnessing leaders within the APTA address topics related to population health, patient choice and access, value-based care and practice, and research and innovation helped me to fully recognize the crucial role the APTA has in influencing the policies that impact our ability to serve society. For these reasons, it felt important for me to join the GAC team advocating at the capital and I was deeply honored to be selected.

Due to the recent success regarding the removal of the Medicare cap, we were able to spend more time becoming educated and advocating for the field of physical therapy in a broader sense. On Monday, we spent the entire day learning about the current political climate in congress from Nation Gonzalez at CNN, the societal impact of healthcare policy from Sarah Kliff at Vox, and attended breakout sessions that detailed information regarding federal policy, payment, the ACA, Medicaid, and IDEA. One of the most emphasized topics throughout the day involved the #ChoosePT campaign. The APTA reminded those attending the FAF of the real impact physical therapists can have on the opioid epidemic through offering vulnerable populations access to non-pharmacological pain management. Clear objectives were presented that tackled this issue in addition to intra-professional issues such as student loan repayment. Several policy priorities were presented for every state to choose from when planning their congressional meetings.

The following topics were addressed by the Colorado GAC team when meeting with legislative assistants:

  • Our geriatric specialists spoke to the vital role in we play in exercise promotion and fall risk reduction in the community. Conversations were also had in the valuable perspective physical therapists can bring to park and recreational center design.
  • Our pediatric specialists asked congresspeople to consider expanding the budget for IDEA as they have witnessed the impact this program has on the lives of children.
  • Our outpatient clinicians provided examples of how they have successfully treated patients experiencing chronic pain and assisted them in weaning off opioids. These individuals also spoke to the measurable reduction in opioid use they have made in their local hospital system by implementing early access to physical therapy services.
  • Our students asked our congresspeople to cosponsor SB970 (and eventually the same bill when it is brought to the house) that would add physical therapists to the National Health Service Corps. This would allow graduates to serve rural populations, often most impacted by opioid addiction, and would offer student loan repayment as an incentive.
  • Our long-time advocates requested that physical therapists be added as community health center providers, as we are a vital element of the primary care team.

In addition to the invaluable time spent at the FAF learning about how physical therapists can impact healthcare quality and access in the U.S., one of the most important aspects of the weekend for my professional growth was getting to know the GAC members I accompanied. The people I spent time with exemplified everything I love and respect about our profession. They spoke with genuine care for their patients, integrity in leadership opportunities, intelligence in considering the complexity of pain, passion for their interventions, and commitment to social responsibility. Our conversations had a large impact on my personal development.

I returned to class following the Federal Advocacy Forum with a fresh perspective. I felt focused and calm as I approached coursework and simulation labs. Attending FAF granted me the opportunity to further shape who I aspire to be as a professional and world citizen. I am beyond grateful for this opportunity and truly believe that if any student were to have the chance to participate in this event, they would foster a deeper appreciation for the APTA and for healthcare advocacy at large.

56679436_596581000824361_6263839149833322496_n

Hannah (pictured second from right) was all smiles with fellow members of the Forum at the 2019 APTA Federal Forum in Washington D.C. 

Presenting At CSM 2019, Washington D.C.

It was a cold, rainy national Combined Sections Meeting (CSM) this year in Washington D.C., but that did not stop almost 17,000 people, including several from Regis University, to attend! Regis students and faculty not only learned the latest happenings from others in our field of physical therapy, but also took roles in presenting their research and/or speaking during educational sessions to inform our profession. Below are some highlights of their experiences.

 

 

50639474_2400110950030890_5336687128036245504_n

DPT students Amber Bolen and Grace-Marie Vega with Dr. Andrew Littmann

“Going to CSM as a student researcher was a wonderful experience! Discussing our narrative review with PTs, students, and other researchers who shared our passion for regenerative medicine will always stand out as a highlight of my time at Regis.” — Grace-Marie Vega

“I loved working as a team with my research partner on our narrative review (the PT’s role in stem cell research for spinal cord injury). Presenting research at CSM was something I never expected to do when I first entered PT school, but Regis faculty encouraged our class to submit for review. We decided to give it a shot and we made it! Being able to speak with people interested in our field of research was an amazing feeling. We even attended a lecture in which one of our cited authors was present. It was also humbling to see how many research posters and lectures came out of Regis and its faculty and students. I look forward to seeing more as a proud future alumni!” — Amber Bolen

 

50646895_2400111196697532_3858855440590831616_n

DPT students David Cummins and Katherine Heller with Dr. Andrew Smith and Dr. Denise O’Dell

“Attending CSM in Washington, D.C. was an amazing experience. I had the opportunity to share my team’s research, chat with leaders in the profession, and meet dozens of potential employers. The energy and passion at the conference was infectious and I left feeling reinvigorated and excited about the future of our profession.” — David Cummins

 

IMG_0712

IMG_0515

DPT students Hannah Clark, Vivian He, Felix Hill, and Erin Lemberger with Dr. Karla Bell, Dr. Melissa Hoffman, and Dr. Nancy Mulligan

“I think that getting to present an educational session at CSM is a fairly rare opportunity, and our team definitely bonded through the intimidating experience of presenting to almost 300 people! In presenting our research on LGBTQ+ related cultural competency, we were also able to identify barriers and build broader awareness of LGBTQ+ issues in our profession. I feel so grateful to our lead researcher, Dr. Melissa Hoffman, for getting me involved in research and making it possible for us all to have this experience!

In addition to the educational session, many members of our research team are involved in PT Proud, an LGBTQIA+ committee in the Health Policy Administration Section of the APTA. As part of that group, we held a membership meeting and happy hour event, which provided a powerful space for LGBTQ+ people and allies in our profession to come together.” — Felix Hill

51221450_2401821396526512_8523294897342513152_n

Pam Soto, a third year DPT student, presented a platform on “The Impact of Leadership Development Curriculum Through the Eyes of the Physical Therapy Student.”

 

51162324_2399835433391775_2582866922336944128_n

Class of 2018 graduate Dr. Amanda Rixey presented on preferred method of feedback after simulation experiences for DPT students.

 

And even more!

This slideshow requires JavaScript.

Farewell Marcia Smith!

Name: Marcia Smith, PT, Ph.D.

Picture1

As we sadly said farewell at the end of the summer to another beloved faculty member, Marcia Smith, who has been with us at Regis for 20 years, second-year student Meg Kates made sure to catch some of her words of wisdom before her retirement! Read the interview below for Marcia’s amazing journey as a PT, educator, and advocator.

How did your journey with physical therapy begin?

When I was 8 or 9 years old, I read a story in a Reader’s Digest publication called Karen, which was the story of a young woman growing up with cerebral palsy in the late 1930s. At the time in history, many of those individuals lived in group facilities for people with disabilities. I remember, in the story, Karen learning how to walk with the help of a physical therapist. My interest was further reinforced in 8th grade, when I saw a television show called Route 66. In the show, main character came down with an illness and had to be hospitalized, and, I remember, a physical therapist helped him get well. Lastly, the gentleman who became the head of the Rehabilitation Center in Grand Junction moved across the street from me. I had lots of opportunities to talk to him and watch him. So, I had lots of opportunities for physical therapy to be reinforced as the career I wanted to pursue.

I graduated with by Bachelor’s in physical therapy from CU, and then I moved to upstate New York, where my husband went to law school. A Bachelor’s degree was all that was really available at the time, unless a person wanted to teach, in which case he or she got a Master’s degree. I had never met a physical therapist with a Ph.D. at the time. I lived in Ithaca for 3 years, and then I moved back Colorado in 1972. There were zero positions open in the state, so I worked vacation relief at nursing homes. Colorado has been saturated a long time. Eventually I got a call from the head therapist at Denver Health, who had heard I was looking for a job and asked me if I would like to interview…I said yes! I was hired and it was the weird, the wild, and the wonderful. At Denver Health, therapists are assigned to teams, so I worked in the Amputee Brace Clinic for 6 months. Then, I did hand therapy. Then, I rotated onto the Neuro-/Neurosurgery team. After that, I told everyone they could rotate around me because I was not going to leave that team.

Starting out, did you always know that you wanted to pursue neuro-focused PT?

No, in fact, I thought I wanted to be a pediatric therapist. In New York, I worked at Tompkins County Hospital and Rehabilitation Center for 2 years. That was a wonderful opportunity. I would see a patient who had an acute stroke and I would get to follow them from acute care to rehab to outpatient. I had the opportunity to fill the spot of a physical therapist on maternity-leave at the Special Children’s Center, which was a freestanding outpatient school in Ithaca. Interestingly, the head of the Special Children’s Center had her Ph.D. in Education and her Master’s in Speech Language Pathology. And she had cerebral palsy. In fact, she was one of the people in the book “Karen.” It was a full circle moment for me. I worked with this woman in the pediatric setting for 8 months before I moved back to Denver where, like I said, there were no pediatric positions. There were hardly any positions, but it was at Denver Health where I decided neuro is what I really wanted to do.

 

Can you tell me more about your experience with Ranchos Los Amigos?

When I was at Denver Health, I felt like I needed to know so much more. I expressed these feeling to my husband and he encouraged me to apply to universities for a Master’s degree. I was admitted to a program for clinical specialization at Rancho Los Amigos, where I learned at a couple of years. The first year was mostly class work, and the second year was all clinical specialization. We rotated between specialties, and I chose traumatic brain injury, stroke, TBI children, GB, and it just goes on like that.

 

What advice would you to someone who want to get into a specific specialty of work?

When I was finishing my Master’s, I can remember a classmate saying to me, “If there are no openings, I will just go do anything.”

And I can remember saying, “I won’t. I refuse. If I can’t be a neuro therapist, I will flip burgers!

So, my advice is to find a place you want to be and stick with it. Secondly, try to pick your final clinical rotation in a setting where you know you would like to practice. Lastly, don’t disregard what you have learned based on the setting you are in. For example, I have used my musculoskeletal and cardiopulmonary skills in practice with my patients with stroke, multiple sclerosis, and Parkinson’s disease. Always be searching for opportunities to use a wide breadth of skills and never putting people into a “box.”

 

What do you think is the next step for the career of physical therapy?

I think that we will always need educators. So, if you’re interested in that route, be considering in what subject you would like to get your Ph.D.

There are other things I worry about. I worry about the cost of education, and the loans that people have to take out. I see how physical therapists are reimbursed in Colorado and nationwide, and it’s hideous. So, I see residency taking us to another level, but, ultimately, we need to be addressed as primary care providers.

Ultimately, we need to be our own advocates. That means writing up clinical studies, asking questions, and answering questions.

 

What is the first step in becoming an advocate? How did you get your start?

When I lived in New York, there were two physical therapists at Ithaca College who would regularly invite me and some others to attend district meetings, and everyone would go. Then, in 1970, New York had its first state conference: that night, everyone volunteered to participate on a committee of the APTA. When I moved back to Colorado, one of my mentors invited me to a picnic, where she asked me if I would become the secretary of the Colorado APTA Chapter.

I asked her, “Do you think I can?”

She said, “Of course you can.”

So, I became the secretary and did that for 4 years before I moved to California to pursue my Master’s, where I continued to follow through with my responsibilities until I came back.

 

What’s the next step for you? What’s in your future?

I am going to continue to do some research. I am going to continue to answer some questions about how we dose exercise for people with Parkinson’s Disease.

I will be doing some traveling. In September, my husband and I will be escorting some friends to Ireland. I am going to see Iceland next. We are going to go for Hawaii for a few weeks, and, then I thought, since we are halfway there, why not go to New Zealand? Why fly back to the mainland? Then we have friends that we will be joining on a river trip on the Rhine. I don’t know after that!

 

Thank youMarcia, for your work and dedication to both Regis and our profession! We are so grateful for all of your contributions and will miss you very dearly at Regis, and we wish you all the best in your new adventure in life! Congratulations!

How to Rock a CSM Conference

Name: Grace-Marie Vega

Undergrad: Arizona State University

Hometown: Placentia, CA

Fun Fact: I take pub trivia very seriously!

28536605_10213768225713302_781754182_n

CSM, or the Combined Sections Meeting of APTA, is a 4-day national conference held annually,  attracting thousands of students, practitioners, and researchers in the physical therapy field. These are some things I learned from CSM 2018 in New Orleans that I hope will help you navigate through future conferences:

  1. There are so many possibilities! CSM had over 300 educational sessions over the course of three days, not including poster presentations, platform presentations, and networking events. It was a whirlwind of people, places, and free giveaways. To get the experience that you want, and to avoid option paralysis, take some time beforehand to prioritize what you really want to see! In preparation for your own national conference, download the APTA conferences app so you can add programming to your own schedule. The WiFi in the conference halls can be unreliable, so I suggest that you make a plan before you get there, and glance at the map too.

IMG_6812 copy.jpg

  1. Do not underestimate your knowledge. On my first day of CSM, I chose programming with subject matter that I felt I knew well enough to discuss. It turns out that I did know it well, because I had already studied it in my coursework, and even read some of the referenced articles. Basically that program was review, and a reassurance that Regis DPT coursework incorporates current best evidence. But I could have learned new things and expanded my awareness of topics that may not get as much coverage in coursework. For the rest of the conference, I tried to pick topics that I was interested in, but not experienced in, and in doing so, I realized that I was not out of my depth. Challenge yourself, and trust that you probably know more than you think.

IMG_6851 copy.jpg

  1. Use public transit! Although less convenient, it’s cheaper and arguably more fun than taxis, ubers, and car rentals. I purchased a transit pass that allowed me to utilize all local buses and trolleys. For 3 dollars a day, I rode around New Orleans with locals and CSM attendees alike, and I felt like I was experiencing the city in a much more intimate capacity. Shoutout to the good people of New Orleans who always seem willing to make conversation and give restaurant recommendations while waiting for trolleys.

20180221_175522

  1. Network! As a self-proclaimed hater of all networking-related activity, I urge you to do this! Allow me to make a blanket statement and say that physical therapists are friendly, kind, and wonderful people who love talking to students, sharing their knowledge, and saving lives. Asking questions in educational sessions, talking to vendors in the exhibit hall, and even making small talk with the PT sitting next to you are all ways to get more out of your CSM experience. It’s also a way to dip your toes into the ocean of job hunting. I left with business cards, new aspirations to become a travel therapist, and more free t-shirts than I care to admit.

Picture2

  1. Quality over quantity! Strike a balance between conference time and exploration time. You could easily spend your time doing nothing but CSM from dawn to dusk, and that’s awesome! But, you don’t have to do that. You can get there a day early or take a later flight out if it means you have time to wander and be inspired by a new city, new friends, or live music. Your memory of this time will likely not only include the conference, but the people you were with and the place you were in. In my opinion, when you finally get home, your heart should be full, and your feet should be sore.

Picture1

 

 

Dry Needling…Not a Type of Craft that Your Grandmother Does

Name: Katherine Koch

Undergrad: The Ohio State University

Hometown: Cleveland, OH

Fun Fact: Last summer, I climbed six 14ers

pic

Dry needlingnot a type of craft that your grandmother does. This type of treatment uses thin filiform needles inserted by a physical therapist into myofascial trigger points, or a tight band of muscle that might be causing pain (1). Dry needling is based on physiological evidence supported by research that is usually part of a broader treatment plan (2). If this needling sounds familiar to you, you’re not alone. Acupuncturists use the same type of needle to adjust the flow of energy, or chi, throughout meridians in the body. Acupuncture is an ancient Chinese medicine and operates based on the belief that these thin needles can relieve tension, stress, and pain when inserted by an acupuncturist (3). While you won’t be getting an itchy sweater from this treatment, it can lead to pain relief for many people. 

However, there is still confusion and debate among physical therapists and acupuncturists concerning the rights and responsibilities of physical therapists in performing dry needling on their patients. This debate of dry needling by physical therapists was recently taken to a Denver district court when the Acupuncture Association of Colorado (AAC) challenged the Colorado State Physical Therapy Board (Board). The AAC claimed that physical therapists had not undergone enough training to perform dry needling and requested the Board reverse the rule that allows physical therapists to practice this method of treatment. The AAC argued that physical therapists only perform 46 hours of training to be certified to practice dry needling, while acupuncturists train for almost 2,000 hours. The association claimed this made dry needling by physical therapists an “unsafe practice of acupuncture” (4). However, this statement is strongly misleading due to the additional 3,400 hours of doctorate level schooling that physical therapists already have behind them before they complete those 46 hours specific to dry needling training. Physical therapists spend three years in graduate school learning how the human body works, what can go wrong with it, and how to fix it within the realm of physical therapy. Additionally, doctors of physical therapy are required to take continuing education courses throughout their careers.

Additionally, the AAC made the claim that dry needling is just a misnomer for acupuncture, while the two are fundamentally different practices. They may look similar to the untrained recipient, but physical therapists and acupuncturists perform their respective treatments with fundamental ideological differences between the two. This is not to say that one is better than the other, and patients may make the informed autonomous decision to receive either or both treatments. However, as the Denver District Court decided, there is no need to prevent members of one profession from performing treatments all together. In December 2017, the court recognized that physical therapists are acting within the Colorado Physical Therapy Practice Act when they perform dry needling.

As the Colorado Chapter of the APTA President Cameron MacDonald put so eloquently,

“this legal debate was brought forth by those who wished to restrict the practice of another profession from their own. This debate could have been about any intervention utilized by physical therapists, and not just dry needling. It is imperative to consider this legal challenge and the lawsuits brought against the Colorado PT Board through the lens of the Colorado consumer of healthcare. Consumers in Colorado are provided access to health care providers which have a defined scope of practice under which to deliver patient care. Health care professionals are expected to provide the best care they can, and to practice under a scope flexible enough to both protect the consumer and not limit the development of practice by health care providers.”

When physical therapists perform dry needling, they are practicing within their professional scope. When acupuncturists perform acupuncture, they are practicing within their professional scope. Both professions can live harmoniously alongside each other while helping patients within their respective realms.

Why does any of this matter? First, any judicial ruling or legislative rule concerning a profession as a whole likely has implications that affect many of its members. In this case, physical therapists that perform dry needling in Colorado were in danger of losing their legal right to treat patients in this way. Further, patients were in danger of losing out on a treatment that can benefit them. To be effective health care providers, it is imperative that physical therapists are informed practitioners in order to best advocate for their profession and best treat their patients. Denying to inform themselves and take positive action does a disservice to future physical therapists and patients who will benefit from the work done to advance the profession today. In order to practice as autonomous providers, physical therapists must continue to advocate for their profession and understand the issues surrounding it. It also stands to reason that since the American Physical Therapy Association participated in this case as an amicus party and presented information that no doubt helped sway the case, physical therapists should support and be members of the organization that advocates for them on this broad level.

This debate is not in Colorado alone; lawsuits in three states have gone the opposite way and the state boards have been forced to remove dry needling provisions from their practice acts.4 Since each state has their own physical therapy act, it is important that the Colorado practice act, which will be revised next year, continues to maintain its inclusive language that provides “for new developments in physical therapy practice, which includes dry needling” (Caplan and Earnest, LLC, personal communication, January 9, 2018). For the good of physical therapists, patients, and the future of physical therapy as a profession, this particular case is closed.


If you are a student physical therapist, like myself, who hopes to perform dry needling as a professional one day or if you simply would like to learn more about its practice, please refer to the references below.

  1. Dry Needling by a Physical Therapist: What You Should Know. American Physical Therapy Association. http://www.moveforwardpt.com/Resources/Detail/dry-needling-by-physical-therapist-what-you-should. Published December 25, 2017. Accessed January 28, 2018.
  2. Gattie E, Cleland JA, Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017;:1-41.
  3. Miller J. Physio Works – Physiotherapy Brisbane. Acupuncture and Dry Needling. https://physioworks.com.au/treatments-1/acupuncture-and-dry-needling. Accessed January 28, 2018.
  4. Migoya D. Acupuncturists sue Colorado’s physical therapy board over the very definition of their craft. The Denver Post. https://www.denverpost.com/2017/04/05/acupuncturists-sue-board/. Published April 7, 2017. Accessed January 28, 2018.

April Recap: National Advocacy Dinner

Name: Grace-Marie Vega, Class of 2019
Undergrad: Arizona State University
Hometown: Placentia, California
Fun Fact: One time, I drove a fire truck.

image1.JPGIf you were there on April 12, 2017, you hardly need me to recount the evening to you, but if you were not, here’s what you missed at this year’s Denver National Advocacy Dinner. First, allow me to set the scene. Room 210 of Claver hall, around dusk. As you walk into the room, you are immediately impressed by the free pizza AND La Croix. You look around and realize you are in the company of well-dressed professionals, esteemed professors, and the most promising physical therapy students in all of North America. You are here partially to avoid yet another night of diligent and thorough studying, but in a truer, more important sense, to get a handle on professional advocacy and how you as a student can become involved.

***

The evening opened with an introduction from Dr. Ira Gorman. “Politics: you can’t ignore it, because it won’t ignore you!” And of course, he is right. Advocacy is inherently and perhaps lamentably inextricable from policy. Dr. Gorman went on to explain that in physical therapy, advocacy happens on different levels: at the level of the patient, the professional, the professional organization, and the healthcare environment as a whole. All of these levels are effected by legislation, and legislation can be effected by you. Dr. Gorman outlined political advocacy in a sequence of steps to follow.

First, you must arm yourself with knowledge. This can mean simply being aware of your professional organization, local government officials, and media you can utilize or connect with. The next step is research. This involves investigation of the issue you’re interested in, typically in the form of reading into the specifics and history of proposed legislation, and knowing a little about allies and opponents of that legislation. Then comes implementation. This means taking political action, possibly in the form of writing letters to or visiting elected officials, getting patient testimony, or connecting with legislative staff. The last step is reflection. Ultimately, healthcare reform will not happen by itself. It is up to you to be part of the creation of a system that best serves you and your patients. Your vote and your participation in democracy absolutely matters.

After Dr. Gorman’s talk, Dr. Hope Yasbin, Federal Affairs Liaison for the Colorado chapter of the APTA, talked to us about her own experiences in advocacy. Dr. Yasmin gave us the run down on a few of the biggest issues currently effecting our profession, including:

  • Repeal of the Medicare Therapy Cap: an arbitrary dollar amount limiting outpatient physical therapy and speech therapy coverage.
  • The PT Workforce Bill: which would incentivize PTs to build careers in underserved areas by offering loan forgiveness.
  • The SAFE PLAY Act: which sets up school districts with concussion education for young athletes.
  • The #ChoosePT campaign: an initiative to combat the prescription opioid epidemic.

If you would like more information on any of these topics, you might consider checking out the APTA action center webpage, and downloading the APTA Action app.

Following Dr. Yasmin was Regis’ own Ryan Tollis, a second year student and government affairs committee member. Ryan was chosen to attend this year’s Federal Advocacy Forum, a 2-day adventure/visit to Washington DC during which students, physical therapists, and lobbyists represent our profession and meet with elected officials. By Ryan’s account, it was a whirlwind of networking, briefing, and nonstop political action. Attending events like this is an awesome way to get involved, but there are other ways too.  You can:

To wrap up what was, by all accounts, a thoroughly informative and enjoyable evening, Dr. Cameron MacDonald reminded us that advocacy that best serves the public is when professionals in every field are practicing at the top of their scope. It is our right and duty to be bold in the development of our profession, and to take ownership of the skills we work hard to learn in order to offer the best service we can to our patients. In summation, physical therapy has grown to be what it is today due to the efforts of our professional organization, and the advocacy of many therapists before us. The future of our profession will depend on the work we do to advance it.

***

By the end of the evening, you are very satisfied with the food (obviously), but even more so with yourself, for leaving as a more informed person than you were when you arrived. You tell yourself you will definitely be coming back next year, and you will be bringing all your friends.

Thanks to everyone who attended!

Special thanks to:

Speakers: Dr. Ira Gorman, Dr. Cameron MacDonald, and Dr. Hope Yasbin

Coordinators: Carol Passarelli and Ryan Tollis

Team: Kiki Anderton, Brianna Henggeler, Rachel Maass, Katie Ragle, Grace-Marie Vega

Funding: Dave Law and the Graduate Student Council, Dr. Mark Reinking and the Regis School of Physical Therapy

IMG_1304.jpeg

The Best Loss I’ve Ever Had

Blogger Katie Ragle, Class of 2018, writes about her experience at the National Student Conclave held in Miami, Florida over the October 27-29th weekend.  

DSC_0004

Let me tell you about my trip to Miami.

It all started with an email from a fellow Regis student that read, “Hey Katie! I just tagged you in a Twitter post about the Student Assembly Board of Directors. Take a look at the application :). Deadline 7/1.” This began my journey into a passion for the APTA. But first, a history lesson:

If you are a PT or PTA student and an APTA member, then you are in the Student Assembly. There are around 29,000 of us, and we’re all led by a board of 10 people—the Student Assembly Board of Directors (SABoD). This board is comprised of positions such as president, vice president, and other director positions that help to make the student APTA experience a great one.

aptayay.png

That aforementioned email referred to the Director of Communications position on the SABoD. This person creates content to engage the Student Assembly through emails, social media, and videos. You may not realize it, but you receive emails from the Director of Communications on a regular basis.

As a broadcasting major with a minor in editing and publishing, this position was right up my alley. After I was encouraged to apply, I decided that I wanted this position to get more involved in the APTA and to use my talents to further the profession of physical therapy by engaging students from across the county.

After an application and a Skype interview, I was chosen to run alongside three other candidates for the Director of Communications. The election occurs every year at the National Student Conclave (NSC), which is the annual national APTA meeting that is just for students. Two weeks ago, I packed my suitcase and headed to Miami for the final election.

katie1.png

The Regis representation at NSC.  I’m so glad they were there!

I arrived in Miami with nearly 1,000 PT and PTA students from around the country who gathered to learn how to be better practitioners and how to advocate for our profession. I was immediately blown away by the amount of enthusiasm and support for our field. Everyone eagerly engaged in meaningful conversations about their program and what they’re doing for the field of PT. Rather than simply clustering together with individuals from their schools, people branched out and met students from around the country. The excitement was palpable!

katie2

These are the incredible candidates I got to interact with all weekend.

Little did I know that I would receive a ribbon that read “Candidate” all weekend so that people could ask me about my slated position. I had the opportunity to meet so many amazing people in my field! These people inspired me to not only be the best PT that I can be, but also to advocate for our profession and to represent it well. The speakers empowered us with knowledge in entertaining ways and generated passion for the field.

katie3

This is one of my new friends, Alicia from MA

But more than passively attending, I got to actively participate in the conference. I participated in focus groups on how to make communication within the APTA better. I introduced a few speakers before their talks, and I met with the leaders of the Student Assembly to discuss the future of the organization. I also got to meet the president of the APTA, Dr. Sharon Dunn. She held an open Q&A for students to ask her any questions they had. She is both incredibly intelligent and personable. The APTA is fortunate to have her!

katie5

APTA President, Dr. Sharon Dunn, gave all of us candidates a pep talk.

Did I win the election? No. Am I upset? Absolutely not. I wouldn’t trade my experience at NSC for anything. I made connections that will last a lifetime. This conference opened doors that I otherwise would have never been able to encounter. I still receive emails and messages from other students and professionals asking to keep in touch and encouraging future connection at upcoming APTA events. Best of all, NSC lit a fire within me for my future profession and for the organization that represents us so well.

katie6.png

This is the amazing group of individuals with whom I ran for Director of Communications.  The one standing next to me (second from the left) was elected to the position.  His name is Cruz, and he will do great things for the Student Assembly!

In a future post, I will share some of the tips I learned at NSC about how to get plugged into the APTA;  for now, think about attending NSC 2017. It’s in Portland, Oregon, so how can you turn it down? You won’t regret it. We are the future of PT. Let’s be the best that we can be!

aptayay2.pngFollow NSC’s twitter to start counting down to next year!

Student Involvement in the Colorado APTA

The faculty at Regis strongly encourages leadership from its students because it knows that those who care enough to be the change they want to see move our profession forward. Rest assured that over the course of your time at Regis there are many opportunities, both formal and informal, to either try leadership for the first time or to grow your current skillset. One of those ways is to become involved in the Student Special Interest Group for the Colorado Chapter of the American Physical Therapy Association, (CO APTA sSIG for short).

I am the current 2016-2017 Chair of the CO APTA sSIG and a third year student in the Regis DPT program, and I would like to say something to those of you considering if the Regis DPT program is right for you, to the first years are who are about to embark on their first semester, and to the second years about to experience their first clinical rotation: you can do more than you think you can.

Running for a position on the CO APTA sSIG is an amazing way to broaden your perspective on what students of Physical Therapy, both Student Physical Therapists and Student Physical Therapist Assistants, are all about. The current board has 10 positions (http://coloradophysicaltherapists.org/student-sig/), and this year we are focusing on the following areas:

  • Creating a framework-for-action for the 2017-2018 sSIG
  • Growing student involvement with the APTA across the state through education and outreach
  • Building networking opportunities amongst students as well as between students and current professionals
  • Advocating for student issues at the state and federal level
  • Fundraising

With growing communication between APTA sSIGs across the nation, this is an exciting time to be involved. Aligning the sSIG with the CO APTA Chapter’s strategic plan provides a built in way to move forward, but there is plenty of room to grow new projects.

In the spring of 2017, we will be holding elections for the 2017-2018 CO APTA sSIG board. If you are interested in pushing yourself a little further, I encourage you to run for office, to use this as an opportunity to broaden your perspective beyond the next exam, and to begin shaping the future as a leader.

 

Engelsgjerd-Headshot

Blogger: Adam Engelsgjerd

 

 

What is it like to be in the military and PT school?

Name: Zach Taillie, Class of 2018

Hometown: Phoenix, NY

Undergrad: SUNY Cortland

Fun Fact: I’ve been in the Air Force for 6 years.
unspecified.jpg

You may not believe this, but NASCAR Technical Institute is a bit of a dead-end school.  You read that right—there is a school completely dedicated to folks who want to learn about race car maintenance and occasionally take them for a spin.  It is a one-year program outside Charlotte, NC, and was what I thought I wanted to do.  While the program set me up for an awesome career as a tire technician at Sears Auto while living out of my parents’ basement, I decided I wanted more out . I found myself over at the Air National Guard office, and in December of 2009, I enlisted.

IMG_0034

Once I was done with my training and learned that I could get school payed for while serving in the military, I was stoked to get started. Little did I know that when it comes to school and military duty, school usually doesn’t win. The biggest mission we undertake in the Air National Guard is state-level disaster response.  My first emergency response was to a winter storm, and to my surprise, I was told by my supervisor that school takes a backseat to duty.  I remember feeling frustrated at the situation, but once I showed up I realized how much of a positive impact we could have.  The feeling of helping out and giving back to those who needed it far outweighed any disappointment at missing classes or balancing class all day with working at night.  Luckily, I was blessed with great professors who would email me notes and allow me to reschedule tests if necessary.  This understanding and flexibility allowed me to respond whenever the call went out, and it allowed me to still excel in school.

IMG_20141207_172134

The military hasn’t been all rough, though.  During one of my winter breaks, I was sent to Germany for training.  I spent Christmas in Kaiserslauten, New Years in Berlin, and my birthday in Amsterdam.  Even when I wasn’t out exploring Europe, I was able to have fun at work coordinating air drops (think Humvees and supplies hopping out of planes) with the 86th Airlift Wing.  I’ve had the opportunity to deploy to the Middle East and serve with coalition troops from all over the world and make some lifelong friends.  Oh, and having part of school paid for is another perk!

IMG_9849207108340

Although I originally thought I wanted to make a career of the military as an officer once I graduated from college, I stumbled upon physical therapy during my junior year and fell in love.  Due to a shoulder injury, I was able to experience what it was like to go from injured back to working out and wanted to give that gift to others.  Fast-forward a couple of years, and here I am: at Regis fulfilling me dream!  Currently, I serve with the 153rd Airlift Wing up in Cheyenne, Wyoming.  I go up once a month and spend at least half of my breaks working.  Luckily, my drill schedule and our finals week seem to always coincide…so I get the opportunity to test how long I can stay awake and study.  Two semesters down, and I’m still here!!  While I listen to my classmates plan super rad trips for our summer break, I’m looking forward to two weeks of work connected by a drill weekend.  All things considered, though, I would do all the same given another chance.  I work with some great people and get to do things for my job that most people only see in movies: riding on C-130s, running through live shoot houses, firing some pretty awesome weapons, and watching live gun runs from planes overhead.  The military/civilian balance can be a challenge at times, but it’s one that’s well worth it!

20130814_143907

 

If you have any questions about balancing school with the military, please feel free to contact me at ztaillie@regis.edu.

The Physical Therapy Outcomes Registry

katie1

Blogger: Katie Baratta

My name is Katie Baratta and I just graduated from the Regis University School of Physical Therapy. I had the opportunity to spend two weeks at the APTA doing a student internship. I was able to talk to many different members of the APTA, attend the Federal Advocacy Forum, and learn more about what the APTA has been doing to move our profession forward. I’ve written a series of essays about my experiences here at the Association.

ptoucomes

Data… I love it! As a former engineer who analyzed a lot of data in my pre-PT life, I find it fascinating to see how lots of tiny bits of information, combined together, can provide us with a more comprehensive picture.

The PT Outcomes Registry is one of APTA’s current projects to create a centralized database for outcome data. The idea is to track a set of prioritized outcome measures (currently there are nine outcomes, but this may expand) across the country. Clinicians perform the outcome assessment with the patient at the initial evaluation and again at discharge to measure the patient’s progress and then input the information into the computerized system. The PT Outcomes Registry then compiles the data from all practitioners so that practitioners can see how they measure against a benchmark of other providers.

PTORInfographic.jpg

Timeline

The program is still in its pilot phase with 216 enrolled users (currently all practicing PTs, no PTAs) at 25 organizations. The most recent development is to include residents and fellows to compare their outcomes both during their residency/fellowship and again afterward to see how their outcomes change with time and experience. Later this year, APTA will collect feedback via user survey of pilot users regarding usability, pros/cons, glitches, and so forth. The team at APTA will then incorporate this feedback into the PT Outcomes Registry system.

The Registry will officially launch at the beginning of 2017, at which time any clinical site will be able to join. Clinicians will pay to enroll in the program, which will give them access to the aggregated data to see how their practice stacks up against national benchmarks. The service will not be limited to APTA members. Karen Chesbrough, the outcomes registry director, states that by the end of 2017 the APTA would love to have 1000 users, with the long-term goal of involving as many clinicians/sites as possible to get as accurate a picture of current practice as possible.

Which types of data are included?

The current outcomes include global measures, such as AM-PAC™ (Activity Measure for Post-Acute Care™), PROMIS (Patient Reported Outcomes Measurement Information System), and OPTIMAL (Outpatient Physical Therapy Improvement in Movement Assessment Log). There are also regional/body-specific outcome measures such as NDI and Oswestry. Other data includes clinician profiles, patient demographics, and pain ratings; practitioners have the ability to enter data at treatment visits along with at initial evaluations, reassessment, and discharge. The types of outcomes included are vetted through an independent group of clinicians and academics (including one Canadian!) called the Scientific Advisory Panel.

The Scientific Advisory Panel is working in conjunction with the SIGs (Special Interest Groups) to develop prioritized objective data that the clinician would also collect as part of the PT Outcomes Registry based on the patient’s diagnosis. These modules may be specific to cervical pain or to infant torticollis, for example, and would include relevant ROM or other objective data.

blogpic3

How does PT Outcomes Registry collect the data?

During the pilot program, enrollees are entering the data manually. Enrolled clinicians—or their clinic’s administrative support personnel—will log in to the system and select different tabs and boxes to enter the data, much like they do for electronic documentation of patient records.

However, manual data collection is time-consuming, so the current push within the project’s development is to build software “bridges” with all of the various EMR (electronic medical records) systems. These bridges would allow a computer program to connect the PT Outcomes Registry with each EMR system to pull the relevant pieces of data into the database. Each type of information (eg KOOS at initial eval, patient age, etc) will have an associated tag in the registry database, and each EMR will tag the same variable in their database so that the computer program will be able to match the data from the patient records to the PT Outcomes Registry. One EMR has already signed on to the project, and APTA is working to get more to participate. This will streamline the process significantly and will likely increase participation as less time and energy will be required for individual clinicians to enter the data by hand.

blogpic2

What does this mean for clinicians?

Being a part of the PT Outcomes Registry would allow clinicians to see how their practice stacks up against others throughout the country. If a particular clinic performed very favorably within the Registry, it would be able to advertise this fact to patients and to different entities that may want to contract with the clinic. Participation in the PT Outcomes Registry would also enable a clinic to pinpoint how to improve poor performance in a particular area that they may not have previously recognized without the aggregate data.

The PT Outcomes Registry will provide objective information to support the assertion that PT restores function. We can then use this information to demonstrate our value to different organizations, whether that is with a hospital, an insurance organization, or to the general public.

The outcomes registry director also sees this information as eventually being linked to reimbursement. Linking outcomes to reimbursement would continue the trend to move away from fee-for-service and toward a value-based payment structure. A value-based payment structure rewards effective clinical practice, rather than performing treatment units with the highest reimbursement rates. This would be a win-win for evidence-based practitioners, as well as for their patients.

Eventually, with enough data, there is potential for the information to be used for research as well; the Outcomes Registry represents the exciting future of our profession!

PT Outcomes Registry Site | More info from the APTA

 

Physical Therapy Classification and Payment System: a Discussion with Lindsay Still

 

katie1

Blogger: Katie Baratta

My name is Katie Baratta and I just graduated from the Regis University School of Physical Therapy. I had the opportunity to spend two weeks at the APTA doing a student internship. I was able to talk to many different members of the APTA, attend the Federal Advocacy Forum, and learn more about what the APTA has been doing to move our profession forward. I’ve written a series of essays about my experiences here at the Association.

Interview with Lindsay Still, Senior Payment Specialist

lindsaystill

I talked with Lindsay Still, a Senior Payment Specialist, and she explained the current state of the PTCPS.  Read a summary of our interview below!

Overview

The Physical Therapy Classification and Payment System (PTCPS) is an ongoing initiative that was developed as an alternative to the current, fee-for-service codes—ones that easily fail to capture the true value of what PTs do—and instead particularly account for the complexity and skill of clinical expertise required for patients with more involved presentations. It also incorporates the use of standardized outcome measures. PTCPS would include a single CPT (Current Procedural Technology) code for the entire treatment session versus the assortment of 15-minute unit codes that we’re used to today.

The system has gone through multiple iterations in the past several years, and was developed by the APTA in collaboration with a specialty work group within the AMA (American Medical Association) involving members from the professional organizations of OTs, massage therapists, athletic trainers, speech-language pathologists, chiropractors, psychologists, optometrists, podiatrists, physiatrists, neurologists, orthopedic surgeons, osteopathic physicians, and representatives of CMS (Centers for Medicare & Medicaid Services).

Structure of the new coding system

Under the new system, there would be three new evaluation codes that puts a patient into an initial category of lower, moderate, or higher complexity. Certain documentation criteria (e.g. under patient history, presentation, or plan of care) would determine which of the three eval codes you would select. For example, the number of comorbidities for a given patient would play a role in the eval code selection. There would also be a single code for any re-eval visit.

As currently structured, the proposed PTCPS would also incorporate five treatment codes, based on the overall complexity of the patient’s presentation and treatments. These codes, much like our current CPT code for evals (97001 Physical Therapy Evaluation), would not have a set time frame or number of units associated with it. However, treatment billed under the lowest complexity code would likely be much shorter than a treatment session under the highest complexity code, and the reimbursements would reflect this fact.

Implementation

In 2014, pilot testing of the new system was performed with PTs using the new system to code/bill for hypothetical patients, as well as using the new system to code the treatments of actual patients previously coded with the existing system. This testing occurred in various care settings. Overall, the clinicians were very consistent in their ability to categorize patients with the new initial eval codes. However, for the intervention codes, the pilot clinicians were only able to consistently categorize those patients with the least complex and most complex presentations. There was significant disagreement between PTs in regards to cases that fell within the different “moderate” treatment categories.

The definitions and valuation of the proposed eval codes were reviewed and approved by the RUC (Relative Value Scale Update Committee) and will now require CMS approval. Lindsay is hopeful that CMS will accept the new eval codes, as they will be budget-neutral. In August of 2016, CMS will release the 2017 Medicare Physician Fee Schedule Final Rule; this should include the new PT evaluation and reevaluation codes. The new codes will go live on January 1, 2017. PTs will have three brand-new CPT codes to replace the current 97001 Physical Therapy Evaluation. The APTA will provide training and support to clinicians during the time leading up to the release of the new eval codes.

Impediments to the impending treatment code change

The new treatment codes will require further review and refinement, given their inconsistency of use during the pilot testing. This will likely be an interactive process, and not without controversy from the perspective of payers (insurance companies). In the meantime, the RUC has requested a “backup plan” to address ten CPT codes commonly used by PTs which have been identified as “potentially misvalued codes,” most of which PTs probably use frequently:

  • 97032 attended electrical stimulation
  • 97035 ultrasound
  • 97110 therapeutic exercise
  • 97112 neuromuscular reeducation
  • 97113 aquatic therapy with therapeutic exercise
  • 97116 gait training
  • 97140 manual therapy
  • 97530 therapeutic activities
  • 97535 self care home management training
  • G0283 unattended electrical stimulation (non-wound)

These codes are flagged  because they represent a high reimbursement rate and have not been assessed since 1994.

As a result, the APTA is currently redirecting efforts to provide replacements to those 10 codes rather than waiting for the codes to be reevaluated for us. The new treatment codes the APTA envisions to replace them with would be procedure-based: you would still bill in 15-minute increments. However, they would be streamlined; there would be fewer codes, and the codes would reflect the types of treatment PTs currently perform in practice (as opposed to focusing on what treatments PTs may have historically performed).

Future of the proposed treatment codes

The more general patient- and value-based treatment codes initially envisioned by the APTA are still in the works, but Lindsay foresees a longer process before fruition: it will require all parties to agree on a coding system that accurately and cost-effectively describes the type of treatments that PTs perform for patients. This includes the third-party payers who generally prefer the current setup of treatment codes based on billable units. The current coding system is easy to monitor for abuse or overuse of treatments.

I asked Lindsay if she saw outcome measures as one way of giving insurance companies some power to track the value of treatments under the proposed system. While they wouldn’t be able to screen specific procedures in the same way that they are able to under the current system, they would be able to, for example, monitor whether the progress of a “low complexity” patient was lagging behind what would be expected given that patient’s presentation.

She agreed that this could work in theory, but felt that we still have a long way to go in terms of standardization of outcome data across the spectrum of patient presentation. This is one of the reasons the PT Outcomes Registry will be so important! These two issues truly are intertwined in the future of value-based billing for PT services.

For more information, visit: http://www.apta.org/PTCPS and check out the Timeline for payment reform.

From Practicing Clinician to APTA Employee: an Interview with Anne Reicherter

katie1

Blogger: Katie Baratta

My name is Katie Baratta and I just graduated from the Regis University School of Physical Therapy. I had the opportunity to spend two weeks at the APTA doing a student internship. I was able to talk to many different members of the APTA, attend the Federal Advocacy Forum, and learn more about what the APTA has been doing to move our profession forward. I’ve written a series of essays about my experiences here at the Association.

Interview with Anne Reicherter PT, DPT, PhD, OCS, CHES

blogkatie.png

What do you do at the APTA?

Anne was hired by the APTA last spring (2015) and works as a Senior Practice Specialist. In this position, she oversees the PTnow website, which provides practicing therapists with tools for evidence-based practice and includes access to current research and other clinical resources. A good portion of her workweek is dedicated to improving the services offered by PTnow* and working to facilitate access and utilization by APTA members.

Practice Specialists at the APTA are all licensed PTs and also work as consultants on whichever issues are current hot topics regarding our scope of practice. For example, dry needling is currently being discussed and spinal manipulation has been a historically important issue.  As one of the few PTs on staff at the APTA, Anne and her colleagues in the Practice Department review products created by the APTA marketing team or other departments prior to publication to ensure that they are accurate from a clinical and research perspective. She says she will sometimes look at a photo and say that “a PT wouldn’t perform that intervention,” or  that they “wouldn’t stand that far from the patient.” Another current project of Anne’s is a collaboration with APTA researchers on an article for the Journal of Health Policy and Administration about obesity. One of her other areas of focus is the importance of work-life balance within the profession.

How did you come to work at the APTA?

Anne graduated with a BS in Physical Therapy at University of Pittsburgh and then worked in a mixed inpatient and outpatient setting at a hospital. She describes that this was fairly common at the time, and that–with few exceptions–PTs were given a lot of autonomy from their referring providers, and that there was not yet a fee-for-service model at the HMO for which she worked. After ten years in that setting, she wanted to progress her career and knowledge, so she attended night school to obtain her Masters of Health Education. In subsequent years she held a variety of jobs in the educational setting (working for Howard University in DC and the University of Maryland, Baltimore) as well as in other clinical settings, including orthopedics and home health. During this time, she obtained her PhD in Educational Psychology, as well as her transitional DPT. She has also performed some educational consulting for various DPT programs.

The position at the APTA for a PT Practice Specialist opened up at the same time that Anne was searching for something more. She wanted a job that fit with her interests and values: the ability to participate in  writing and publishing, advancing the profession through APTA initiatives, and expanding her own knowledge made the job an excellent fit. She says that these meaningful components–including continuing education–were built into her practice as a new clinician (for example, if there was a “lunch and learn” on a given day, the clinicians would leave a bit early that day), as well as into her work as faculty. Today, however, there is an increased emphasis on productivity and fee-for-service; thus, there is limited time and resources allocated to the pursuit of continuing education that distinguish us as professionals. Anne described the difference between professionals and technicians: professionals design a plan of care and add value to the system with professional discernment, and technicians simply deliver a procedure. To maintain the high expectations set of PTs as professionals, most PTs today must spend time beyond their paid workweek to pursue continuing education, APTA involvement, and evidence-based practice.

Where do we plan to see change in the typical PT’s work-life balance?

Anne replied that one of the biggest initiatives currently is the push to change from a billing system with a procedural focus (for example, billing for “therapeutic exercises” x15 min or “therapeutic ultrasound” x15 min) to one based on value. Current reimbursement accounts merely for the delivery of a procedure or modality for a set unit of time, but it does not account for our clinical judgement as professionals. I’ll go more into this initiative in next week’s blog post.

Any advice for new clinicians starting out in their career?

Anne’s advice to new graduates is to consider whether a job or position allows for and encourages professional development: do they fund continuing education? Do they have on-site mentoring programs you can participate in? She also advises new graduates to not allow mentoring to be limited to colleagues within your particular clinical setting but to continue to seek out a supportive network of clinicians for support as you begin to navigate your professional career.

ptnow

*PTnow is a valuable resource for us, as new clinicians, to perform literature searches after graduation (as we’ll no longer have access to the school’s library search function) as well as to access clinical reviews, clinical practice guidelines, and clinical summaries prepared by respected experts within the field of physical therapy.

If you haven’t visited the website, you should definitely check it out: ptnow.org

 

Direct Access: Insight into Some of the Barriers and Current Initiatives

katie1

Blogger: Katie Baratta

My name is Katie Baratta and I just graduated from the Regis University School of Physical Therapy. I had the opportunity to spend two weeks at the APTA doing a student internship. I was able to talk to many different members of the APTA, attend the Federal Advocacy Forum, and learn more about what the APTA has been doing to move our profession forward. I’ve written a series of essays about my experiences here at the Association.

I met with Wanda Evans PT, MHS, CKTP (Senior Payment Specialist) and Elise Latawiec MPH, PT (Senior Specialist, Practice Management) who provided me with their insider understanding on this topic as well as directed me toward further resources.

Direct access physical therapy care means that a patient does not require a referral from a physician or other provider prior to a PT evaluation and/or treatment. All graduating Physical Therapists are required to have a DPT–a clinical doctorate–and, thus, they receive extensive training in the ability to recognize “red flags” and refer patients to the appropriate provider when it becomes apparent that the patient may be at risk for something more severe than musculoskeletal involvement.  Studies demonstrate that direct access decreases the time following an injury to the start of the patient’s PT care, reduces the number of visits of therapy needed and results in lower overall costs. Thus, PTs are not only appropriate for this role, but they can end up saving time, money, and patient suffering (as well as costs for the healthcare system overall).

Legislation

There are currently various types of direct access in all 50 states. Each state has jurisdiction over its own Practice Act, which is why there is some discrepancy from one state to another (state-by-state comparison). There are 18 states with unrestricted direct access—this includes Colorado! Some states require specific certification for a PT to provide direct access care, and others allow only an initial evaluation plus a set number of follow-up visits before the PT must contact the patient’s primary care provider. States with limitations in their practice act for direct access are fighting every day for legislative changes to eliminate these barriers; the APTA is aware of this and is actively assisting in these state-level legislative efforts.

However, the legal foundation is only the first step to getting patients the direct access care that we know would be beneficial. Common barriers to direct access that PTs reported in an APTA survey last year include reimbursement concerns, limitations in marketing, fear of alienating referral sources, restrictions by the PT’s employer, and lack of knowledge of state direct access laws.

Reimbursement                                      

Historically, third-party payers (ie insurance companies) have required a referral from a physician or other designated professional. Aside from Medicare/Medicaid and other federal programs like the VA or Armed Services (which have their own regulations on Direct Access), insurance policies vary by carrier and on a state-to-state basis. As the state legislation changes, the payers have been slowly adapting, with some payers more progressive than others in regards to reimbursement for direct access services. The APTA has been engaging with payers directly to eliminate the referral requirement at events such as the Insurance Forum, in comment letters, during in-person meetings, and in their day-to-day contacts. The APTA communicates this message to large employers who create their own insurance policies for their employees, as well, and are thus able to help employers set the terms of the insurance contract for their employees independently.

How can individual APTA members get involved on the reimbursement front? Each state chapter has a Reimbursement Chair.  The Chair’s responsibilities include learning as much as possible about trends with different payers in that state (and taking note if a lot of PTs have been reaching out with similar issues or complaints regarding the same payer) and assisting those therapists within their own state. The APTA nationally works in conjunction with the state chapters on payment/insurance issues and helps to connect states together when confronted with similar challenges. Patients and their advocates can also petition their Insurance Commissioner if they are inappropriately denied care or access to medically necessary services. The Insurance Commissioner advocates for consumers; s/he does not represent the insurance carrier.

Fear of alienating referral sources

Wanda and Elise described several studies in which direct access evidenced no negative impact on the physician-patient relationship. In fact, a key component of direct access is the necessity of PTs to refer patients to the appropriate provider when a patient’s symptoms and underlying pathologies are outside of our scope of practice. Given that PTs must make referrals back to other providers, it becomes a mutually beneficial relationship amongst different healthcare practitioners.

Education

A lot of concern stems from a a lack of education on the part of employers, insurers and potential patients. PTs need to demonstrate their clinical excellence to, essentially, prove that we are worthy of this responsibility, as well as to continue to educate all stakeholders on the importance and benefit of getting PT before medication/surgery. The first step for every PT is to become educated on what your state’s practice act specifically says about direct access and understand any limitations that may be in effect.  Educating patients, employers, and other healthcare practitioners is the next step. The APTA has developed many resources detailing the benefits and safety of direct access available online (more info).

Resistance to Change or Pushing for Progress?

There are some PTs who are more comfortable in the traditional referral arrangement than with unrestricted direct access. They may not want the additional responsibility, or they may simply prefer to do what they have always done.  That is okay!  Nobody is looking to force them to become direct access providers.

However, if you are one of the PTs who cares about the transition toward direct access and autonomy as a practitioner, make sure you’re an active member of the APTA! This is essential to better educate yourself, your patients, and other healthcare providers and to develop a strong voice with your state chapter and insurance agencies.

For more information on the current APTA involvement, as well as additional resources, check out its Direct Access page.

Federal Advocacy Forum: Regis DPT Student Katie Baratta Visits The Hill

federaladvocacy

The APTA Federal Advocacy Forum is a national conference for APTA members across the country to convene in DC.   Its purpose? To educate members of Congress on the role of physical therapy in our communities, with the specific goal of gaining their support for the various legislative initiatives* that are currently being debated in Congress.

A part of my experience during my two-week APTA internship through the Regis University DPT program included the opportunity to attend the Forum. We started out listening to several guest speakers in preparation for our visits on Capitol Hill with the senators and representatives. Brad Fitch from the Congressional Management Foundation (CMF) presented some of the results of a survey about what types of factors impact their decision-making process.  Constituents are the citizens that a member of Congress represents, and that includes both providers and their patients. So, it is important for them to know what matters to us! Ideas for getting in touch with them are listed below.

Robert Blizzard, a partner at Public Opinion Strategies, discussed the current political climate–including different scenarios for the presidential race and the outcomes’ implications. We also had the chance to listen to Senator Richard Burr from North Carolina speak. He has been a friend to PT initiatives for a long time. One of the things that has been most refreshing to me to see is that members of Congress really do care about the same issues we care about. Members on one side of the political spectrum may believe in different ways of solving those issues from their colleagues on the other side, but despite that, there is a lot of bipartisan support for the issues we care about. There were also break-out sessions that went into greater depth on key issues facing the profession from a legislative prospective.

On the third day, we embarked with fellow APTA members from Colorado to meet with staff from the offices of our senators and representatives to discuss current legislation. We thanked the members of Congress for their support on legislation they had already co-signed, and we asked for their support on further issues. The Colorado APTA members met with the offices of Colorado’s two Senators: Cory Gardner and Michael Bennet, and also the representatives from different districts. Diana DeGette is the representative from my district, but our group also had the opportunity to meet with representatives from many other CO districts, as well.

I’ll admit it–I was nervous, at first, to speak up in those meetings. It turns out, though, that the staff members are friendly and interested in what we have to say–even as students. It was reassuring to go as a group so that we could chime in and support one other. I felt more and more confident the more I did it! My advice to any PT or student interested in meeting with their elected official would be to review the facts of what you are going to say (and write down information you might not remember easily) so that you don’t have to waste time and energy trying to recall or look up information. Each meeting lasted approximately 10-15 minutes, and it’s surprising how quickly that time goes. Relax, be yourself, and know that nobody is going to bite your head off.   🙂

advocacy

What can I, as a student or clinician, do to support advocacy at the government level?

As a citizen in this country it is your right–and, arguably, your responsibility–to petition your lawmakers directly to share the personal impact that different legislation would have on you as a current (or future) provider on your patients’ day-to-day life. Start by downloading the APTA advocacy app which will let you know who your elected officials are and which legislative issues are currently relevant to your district/state. In terms of getting in touch with lawmakers, Brad Fitch shared with us some of the ways that we can connect with Congress on issues pertinent to the PT field:

  • write emails
  • make phone calls
  • attend town hall meetings
  • make an appointment to visit their local office in person with other PTs or on your own
  • follow your legislator on social media and respond to what they post

The more people to reach out, the more impact we can have.

If you are interested in getting more involved in the political and legislative process or have additional questions, feel free to reach out to me at kbaratta@regis.edu! 

*Key issues currently include:

  • Therapy Cap: Medicare Access to Rehabilitation Services Act (currently max out at $1940 for speech and PT combined) HR 775 / S 539  more info
  • PT Workforce Bill: Physical Therapist Workforce and Patient Access (includes PTs in loan forgiveness program for healthcare providers in underserved areas) HR 2342 / S 1426 more info
  • Locum Tenens: Prevent Interruptions in Physical Therapy Act (for Medicare providers to get short-term coverage for their patients when they must take a temporary leave of absence) HR 556/S 313  more info
  • Safe Play: Supporting Athletes, Families, and Educators to Protect the Lives of Athletic Youth Act / SAFE PLAY Act (include PTs in the discussion for developing standardized concussion management guidelines) HR 4829 / S 436 more info
  • Rehabilitation Research: Enhancing the Stature and Visibility of Medical Rehabilitation Research at the NICH Act (streamlines rehabilitation research, improves coordination between different organizations) HR1631 / S 800
  • PTs Travelling with Sports Teams: Sports Medicine Licensure Clarity Act (include PTs along with ATs and physicians in the existing legislation extending the state license of sports medicine providers who travel with a sports team across state lines to treat a traveling team) HR 921 / S 689
  • Self-Referral: Promoting Integrity in Medicare Act (proposes removing PT as an exception to the Stark Law, ie prevents Physicians from referring Medicare patients to entities in which they have a financial interest – eg a physician-owned PT service) HR 2914
katie4

Blogger: Katie Baratta

My name is Katie Baratta and I just graduated from Regis University School of Physical Therapy. I had the opportunity to spend two weeks at the APTA doing a student internship. I was able to talk to many different members of the APTA, attend the Federal Advocacy Forum, and learn more about what the APTA has been doing to move our profession forward. Check in next Tuesday for more!

APTA Tuesday: Interview with a Lobbyist

Learn more about the APTA and lobbying! Katie interviewed Michael Hurlbut, a lobbyist for the APTA.

katiepic1

Michael Hurlbut, Senior Congressional Affairs Specialist

Michael’s Background

Michael Hurlbut worked for several years on Capital Hill before he came to us at the American Physical Therapy Association in 2009 as a full-time Congressional Affairs Specialist. He previously worked as a staff assistant/systems administrator for Representative Jerrold Nadler (New York’s 10th district which comprises NYC); he then worked for Representative Robert Ernest  Andrews (for New Jersey’s 1st district, including Camden, NJ) and as a legislative assistant and for Representative Louise Slaughter (New York’s 25th district). Michael has a background in sports medicine and was interested in healthcare and policy. So, when the job opened at the APTA, he felt it was a good fit for his interests and strengths.

Michael was kind enough to explain to me some of the logistics of what goes on in Washington and what it looks like on the ground. I appreciated this perspective; as a PT, this whole world is pretty foreign to me!

Some Definitions

Each congressman or congresswoman has a chief of staff and multiple staff members who listen to issues presented by either individual constituents or lobbyists that represent groups of citizens.  For example, the APTA would count as a group of constituents with similar interests. The staff team then updates their member of Congress on important issues and perspectives.

What does a lobbyist do?

The APTA currently employs three lobbyists, each of whom focuses on different issues within the field of physical therapy. Michael’s areas of specialty include post-acute care, self-referral, workers comp, and Veterans Affairs/armed services. He monitors everything relating to those issues–including bills that are being proposed, progress on relevant ongoing legislative actions, and upcoming meetings which will be held on issues pertaining to his areas of specialty (for example, the congressional committee on Veterans Affairs). In his day-to-day work, he performs research to better understand the issues, he finds data surrounding each of them, he attends hearings and talks to constituents, and he matches up each issue with the correct APTA staff member.

katiepic2

Once he has all of his information, he prepares the APTA’s position on the topic. This could include creating a few talking points to be included in a conversation, or it could include a formal “Statement for the Record:” this is considered the formal stance of the APTA and must be approved by the APTA’s Executive Vice President for Public Affairs. He will set up meetings with members of the committee or other members of Congress to discuss the relevant issues.

Change in Legislation and Policy

Legislation can start in these committees and proceed out into the House or the Senate for a general vote if approved; legislation can also be proposed by the House or Senate Majority leader. Legislation with broad/bipartisan support in a committee may have a higher chance of being approved by Congress in general, but sometimes this is not the case.

Whether the bill starts in a committee or is proposed by the Majority Leader, Michael emphasizes that it is important to identify members of Congress who will be sympathetic to the issues that the APTA cares about. He notes that getting any bill through Congress is a slow process and it may take several congressional cycles to see any change. It is important to provide data, a convincing argument, and show a “grassroots” initiative–which, for us as PTs, would include individual practitioners and patients contacting our representatives and senators.  Change is typically incremental; as PTs, we can relate to that!  We are accustomed to slow, additive changes with a lot of our patients: even as patients make limited progress (or even have setbacks), we have to keep the bigger picture in mind and continue to work towards change.

Michael also points out that it is essential to recognize when it may be better to work directly with an agency (such as CMS for some of the Medicare/Medicaid issues).

How can we support legislative changes impacting our profession and our patients?

In addition to direct involvement with lawmakers (check in next week to read more about that!), we can support changes in legislation through continued APTA support with both membership dues and with donations to the PT-PAC (Physical Therapy Political Action Committee).katiepic3

PT-PAC pays for one of the Congressional Affairs Specialists (Michael or one of the other lobbyists) to attend the fundraising events for the re-election of members of Congress who have supported our initiatives in the past. Attending events is one of the most important ways to forge stronger contacts with members of Congress and their staff,  and it also increases interaction with other lobbyists who may support similar issues. APTA does not allocate PAC funds to individual candidates in hopes that they will support relevant issues. APTA member dues pay Michael’s and the other Congressional Affairs Specialists’ salaries, but the dues are not used for the PAC. So, when you pay your dues online to APTA, there’s a separate line item that asks you if you would like to donate to the PT-PAC.

The PT-PAC is among the top 10 political action committees of national health care organizations. If every APTA member donated $20, it would be the #1 healthcare PAC–that’s even bigger than the orthopedic surgeons’ organization!

If you are interested in further information or would like to donate to PT-PAC, click here.

Blogger: Katie Baratta

13116356_10100419212521716_5930412245204140005_o

My name is Katie Baratta, and I just graduated from Regis University’s School of Physical Therapy. I had the opportunity to spend two weeks at the APTA doing a student internship. I was able to talk to many different members of the APTA, attend the Federal Advocacy Forum, and learn so much about what the APTA has been doing to move our profession forward. I’ve written a series of posts about my experiences here at the Association.

Check in next Tuesday to learn more!