How Can the APTA Help Me?

Name: Lina Kleinschmidt

Undergrad: Pacific University

Hometown: Stuttgart, Germany

Fun fact: I was born and raised in Stuttgart, Germany

Picture1

As a physical therapy student and future physical therapist, the APTA is something you will hear about over and over again. With job opportunities, continuing education classes, research updates and legislation information, the APTA has endless amounts of information at the hands of students and professionals. However, the website and all the resources may seem a little overwhelming. Therefore, here is a little introduction into the APTA and how you can use it to further your education and career.

What is the APTA?

The APTA, or the American Physical Therapy Association, is a professional organization that represents physical therapy students, physical therapists and physical therapy assistants and has over 103,000 members. It is divided into state chapters each with a governing board. We at Regis University are fortunate to have Cameron MacDonald as an assistant professor, and he is the current president of the Colorado chapter which currently has 2,700 members. It is vital for each state to have a chapter since each state has different practice guidelines and thus must have individual legislation.

There are also sections within the APTA, which include: acute care, aquatics, cardiovascular and pulmonary, education, federal, geriatrics, hand and upper extremity, home health, pediatrics, private practice and quite a few others.  These sections allow you as a student or current PT to learn more information about different specialties. For example, I am part of the neurology section and as such, I get quarterly journals that inform me on the latest research and new updates in the realm of neurology and how it affects the physical therapy industry.

Districts are even smaller groups which are broken up by geographical location and each chapter has SIGs or special interest groups. Colorado has five statewide SIGs which include: Colorado Acute/Rehab SIG, Pediatric SIG, Private Practice SIG, PTA SIG and the Student SIG.

Continuing education (CE) classes happen often and allow students or PTs/PTAs to learn more about a specific topic and have hands on practice. I attended a vestibular and concussion CE class last fall and it completely opened my eyes to a world of physical therapy I had never heard of before. The APTA has a national conference called Combined Sections Meeting, or CSM, which is an incredible opportunity to learn about the profession and what new research developments are forthcoming. CSM is also a great way to network and get to know other practitioners in the physical therapy profession. The Colorado Chapter also has an annual convention called the Fall Convention & Expo.

How can I use the APTA?

Now that you have an introduction, it is important to know what you can do NOW. Depending on where you are in your journey, this may be different for each of you. If you are currently applying to PT school, the APTA website can help guide you in preparing for your interview questions, help you understand what is in your scope of practice depending on the state and school you apply to, and impress the faculty by understanding what is happening in the PT profession.

As you start your graduate school career, the first step is to become an APTA member! Some graduate programs require it, others do not. Either way, I highly recommend you become part of the association so you can reap the full benefits of the APTA and have your voice heard. Click here for joining the APTA. Attending state and national conventions will also give you a huge head start on understanding what the real world of physical therapy is like and they are a great chance to meet students from all over the US and also network!  The easiest step is to get involved with SIGs. Each university will have student special interest groups which hold meetings and special guest lecturers which allow students to connect and communicate about a specific PT specialty.

At Regis and CU Denver, we have multiple sSIGs that our students are involved in and I am lucky enough to be involved with the APTA sSIG this year. I will be working closely with the other sSIGs as well as the PTA schools to have a year of amazing events for our students. We hope to open their eyes to all the opportunities in Colorado. These include: panels about specialties and what to do after graduation, a kickball tournament, a national advocacy dinner and so much more!

Yes, this was a lot of information. No, I do not expect anyone to remember it all. But it is important that you get involved and find what you are passionate about. So now, go to www.apta.org and become a member today!

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.

APTA Tuesday: Meet Katie Baratta

Meet Katie Baratta, new Regis DPT graduate! Katie participated in an American Physical Therapy Association internship in Washington, D.C. during her final year at Regis.  Check in every Tuesday this summer to hear about her experience and to learn more about the legislation and politics behind all things physical therapy.

Name: Katherine “Katie” Baratta

Undergrad: Rensselaer Polytechnic Institute

Hometown: Boston/Belmont, MA

Fun Fact: I worked for 5 years as a transportation engineering consultant and am the second of six kids!

katie1

Where did you do your last two clinicals?

CE III at St Joseph’s hospital in Denver, acute care, ICU, cardiac care, and CF floors.

CE IV at Denver VA primarily outpatient ortho with emphasis on manual therapy

katie2.png

How did you get interested in advocacy and how has Regis furthered your interests?

I applied for the APTA internship for two reasons: one relating to learning to better serve patients I will serve as a Doctor of Physical Therapy, and the second pertaining to learning more about the role of Physical Therapy as a profession in the state in which I will practice.

In regards to my future patients, I foresee myself working a significant percentage of my caseload with patients who have considerable needs, vulnerabilities, and/or economic disadvantages—that is what motivates me to put 100% effort into what I’m doing. I know I’ll do everything within my power to provide the best care I possibly can for these patients. However, I also know that there are greater systemic forces at play which can limit any effort I make as an individual practitioner. In order to address these larger issues, I have a duty to advocate as a healthcare professional. Prior to the APTA internship, I didn’t possess a solid understanding of the ways the APTA, as an organization, interfaces with the government and how the political process can be a tool for large-scale change in the healthcare arena. This internship allowed me to observe and participate in this process. It gave me a more nuanced understanding of politics: I now both understand politics in terms of government and politics in terms of group and power dynamics and how these social factors relate to getting things accomplished. So now, as a new graduate, I can bring this understanding back to my individual patients as I push for large-scale changes in the realm of availability of care, funding, and specific physical therapy services.

The second reason I was interested in this internship had to do with the role of the APTA in Massachusetts. According to the APTA state rankings, my home state (and where I eventually see myself practicing) ranked last in APTA involvement in 2014. This is an area of opportunity for the profession. Massachusetts (and Boston) is a leader in many aspects of healthcare. I saw the APTA internship as preparation for increasing the presence of the APTA and the profession of physical therapy in Massachusetts.

katie3

Where are you heading with your career?

My path thus far in life has been winding and full of surprises, and I am sure my future will be as well!

I tremendously enjoyed my work during CE IV at the VA. I found a group of people I connected well with—both the patient population and the rehab team, overall. It was my first true manual/outpatient rotation. By the end of it, I really felt I was starting to get the hang of how to integrate manual skills with tailored exercise prescription for a patient’s short- and long-term function.

I find the role of the nervous system in pain—particularly persistent pain—to be fascinating, and I think that it’s an area that we as DPTs can serve, push the envelope, and dig deeper into understanding.  I see the solution to be very intertwined with integrating exercise, mental and emotional health, and our toolbox of manual skills.

Beyond the practice setting, I envision myself tying in some of the skills I developed in my prior career. I have an extensive background in data analysis, grant writing, and drafting reports on alternatives analysis; essentially, I have experience in demonstrating the “value” of something to decision-makers (including those who provide funding).

One of PT’s biggest issues is lack of PR. Nobody understands or sees our value. Word of mouth is clearly some of the greatest PR, particularly when attracting new patients to an outpatient clinic. But, when there are larger factors at play beyond an individual patient’s choice—when it comes down to hospital policy or insurance policy—we need to speak in the language that those controlling funding allocation understand: numbers (particularly numbers with dollar signs in front of them!).

So, I see utilizing the skills I’ve developed in my past career into my current practice and will be able to demonstrate the value of physical therapy for both patient outcomes and overall costs. There’s a tremendous need for widespread change to healthcare and to PT access and I am excited to be a part of that change!

katie4

Tune in next week to read Katie’s take on direct access barriers and initiatives to direct access.