Reasons to Give Thanks

This year has certainly had its fair share of turmoil in the health care arena – from the H1N1 pandemic sweeping the globe to the battle over health care reform on Capitol Hill. So, it was heartening to read this column in yesterday’s Wall Street Journal – “20 Advances to be Thankful For.”

I think you’ll agree that we, as physical therapy professionals, have played – and can continue to play -- an important role in improving the health of patients worldwide. I, for one, am thankful to be part of a profession that helps empower people to take charge of their health and improve their quality of life. I am also thankful for the patients who allow me into their lives and who continually amaze and inspire me every day with their indomitable spirit, courage and focus on the future.

Happy Thanksgiving to all of you. What are you thankful for this year?

Could New Mammography Recommendations Impact Health Care Reform?

For weeks, the issue of health care reform has dominated the news. But over the past couple of days, another topic has given health care reform a run for its money – and it’s a topic that some say could potentially impact the future of health care reform.

By now we’ve all heard about – and most likely have a strong opinion on – new recommendations by an independent federal task force that women ages 40 to 49 should no longer receive routine screening mammograms or be encouraged to perform monthly breast self examinations. And there’s a reason we all feel so strongly – one way or another – about the recommendations. We all have mothers, sisters, daughters and other loved ones who have been – or may someday be – affected by breast cancer. It’s deeply personal to many of us.

As physical therapy professionals, it’s in our nature to empower patients to take charge of their own health. It’s what we do every day. So, in many ways the new recommendations seem counterintuitive.

On the other hand, our profession understands and embraces the importance of evidence-based decision-making. In fact, our very own “Vision 2020” underscores the importance of providing “evidence-based services throughout the continuum of care” and improving quality of life for society.

So, where do these new recommendations leave us? While some are urging calm and hoping the backlash of this federal report does not jeopardize the future of evidence-based medicine, others are denouncing the recommendations as a harbinger of things to come under health care reform and an example of the government’s focus on cutting costs at the expense of human lives.

What are your thoughts?

Going Global: To Direct Access and Beyond

These days, it’s almost just as easy to communicate with someone in the office next door as it is with a colleague half way around the world. Globalization has made our lives easier in so many ways, but it also reminds us that we need to be cognizant of the impact one country’s actions can have on the global community.

As such, during a meeting last week, APTA’s Board of Directors called for the appointment of a new APTA task force to explore opportunities for the association to engage in global activities. Recognizing the advantages of global collaboration as a means to address such issues as direct access, education, and workforce issues, the Board of Directors called for investigation into the benefits and responsibilities of global engagement, strategies for achieving global engagement, and the resources needed to be a part of the global physical therapy community.

A wonderful example of a successful global collaboration was the International Summit on Direct Access and Advanced Scope of Practice, held recently in Washington, DC. Leaders from 18 countries endorsed the results of research that demonstrate that patient self-referral to physical therapy is best for all health systems, whether public or private. The Summit was co-hosted by APTA, the World Confederation for Physical Therapy (WCPT), and the Canadian Physiotherapy Association (CPA).

From APTA’s perspective, we learned a great deal from our international colleagues -- hearing evidence from around the world that clearly demonstrates that direct patient access to physical therapists is appropriate for all Americans. The findings of this conference confirm that the legislation allowing patients to access physical therapists without a referral -- legislation that currently exists in 44 states -- is worth pursuing in all states and at the federal level. Those of us involved in the summit committed to encouraging legislators and health administrators around the world to consider these findings – for the benefit of patients everywhere.

In addition to learning a great deal from our international colleagues through global collaboration, it is important to note that many countries look to the US to be “at the table” for a variety of issues and discussions. The International Summit was a great way to kick off these global efforts and will serve as a wonderful model going forward as APTA’s new task force on global engagement begins its important work.

What are your thoughts on global activities such as the International Summit? Do you have suggestions for APTA’s new task force on global engagement regarding issues they should explore?

A New Streamlined Definition for Metabolic Syndrome?

As members of the physical therapy profession, we deal daily with patients who are at risk of developing heart disease and diabetes due to obesity, elevated cholesterol levels, high blood pressure and a host of other related factors. We’re also in a unique position to counsel them on the role physical activity can play in countering or preventing these problems.

For this reason, I read with interest a new joint statement that was released by a group of professional organizations – including the American Heart Association, the International Diabetes Federation and the National Heart, Lung and Blood Institute, among others – identifying specific criteria for the clinical diagnosis of metabolic syndrome. The statement is aimed at streamlining the definition of metabolic syndrome, which previously had differed from one organization to the next.

According to a news story from Heartwire, the American Diabetes Association was “notably absent” from the list of organizations signing on to the new definition due to “unresolved scientific issues” regarding metabolic syndrome.

“Specifically,” the article reads, “the ADA, as well as the European Association for the Study of Diabetes (EASD), objected to the manner in which the metabolic syndrome was characterized as a risk factor for heart disease or diabetes, arguing that there was no need to diagnose a patient with the syndrome because emphasis should be placed on aggressively treating the individual risk factors.”

What are your thoughts about the new definition, as well as ADA’s concerns about the characterization of metabolic syndrome?

Threat Escalates to Physical Therapy's Practice Expense Payment Increase

Members of APTA’s grassroots network, PTeam, were alerted this week to a threat to our profession’s expected Medicare practice expense (PE) payment increase. Because this threat is growing day by day, we are extending this alert beyond PTeam, in the hopes that you will join our grassroots efforts to protect the interests of our profession and our patients.

This threat is not coming from legislators or policymakers on Capitol Hill; it is coming from other health care professionals. Lobbyists for the oncology and cardiology professions are escalating an aggressive campaign to convince Congress to overturn the PE changes proposed in the 2010 Medicare Proposed Physician Fee Schedule rule that would give physical therapy a 10% payment increase effective Jan. 1.

The oncologists and cardiologists are building up momentum, circulating a congressional sign-on letter seeking to stop implementation of survey data that results in our justified payment increase. These efforts are unfair to physical therapy, our patients, and other health care provider specialties.

For most specialties, CMS is using practice costs from 1995 to 1999, which are clearly outdated. The use of the new PE survey data, which was collected uniformly and fairly, will improve payment accuracy and correct current inequities – and contribute to the ability of physical therapists to serve the rehabilitation needs of seniors and people with disabilities.

It is imperative that Congress knows that the PE survey is the most current and best available data on practice expenses. Contact your members of Congress and share your strong support today for acceptance and implementation of the PE survey data in the rule. It is critical that Health and Human Services Secretary Kathleen Sebelius hears from Congress on this important issue to counter the aggressive campaign to prevent the use of the new PE survey data.

Visit our Legislative Action Center today to send a letter to your members of Congress. And please join PTeam, so you can continue to receive important updates on this issue and many others.

Unfortunately, even if our justified 10% payment goes into effect, it will be offset by a 21% reduction in Medicare payments to providers also set to go into effect Jan. 1 – resulting in an aggregate impact of negative 11% on physical therapy payments -- unless congressional action is taken this year.

The Senate had a chance to rectify the situation this week by considering S. 1776, the Medicare Physicians Fairness Act of 2009. However, a motion to bring the legislation to the Senate floor for debate failed by a vote of 47 to 53. Though a 1-year fix of the SGR is included in the Senate Finance Committee's health care reform proposal, APTA is disappointed in the Senate’s actions and supports a long-term solution to the flawed formula. Congress should eliminate existing flawed Medicare payment policies that impede patient access to cost-effective outpatient rehabilitation services provided by physical therapists, including repeal of the SGR and the arbitrary outpatient therapy caps on services.

Please join PTeam and help us fight for our profession. When we stand together, we have the power to impact critical legislative and regulatory struggles that profoundly affect our ability to provide high-quality care and effectively serve our patients.

Oh, What a Month!

National Physical Therapy Month has already started off with a bang for the profession and APTA.

• This week, in conjunction with Breast Cancer Awareness Month, APTA rolled out a media initiative to shine the spotlight on groundbreaking research about the physical therapist's role in diagnosing, treating, and reducing both the risks and side effects of lymphedema. To support the campaign, APTA has created a members-only downloadable handout to distribute to patients who may have lymphedema or know someone who does. The information also has been added to the Move Forward consumer Web site.
  
• APTA members have been instrumental in securing provisions in health reform legislation that protect physical therapy patients and advance the profession. On Tuesday, the Senate Finance Committee passed its $829 billion health care reform bill. The legislation contains some important provisions for physical therapists, including a 2-year extension of the therapy cap exceptions process, a 1-year fix for the sustainable growth rate (SGR) at a .5 % increase, an extension of the 1.00 floor for geographic practice cost indices (GPCI) for an additional 2 years, a ban on specialty hospitals self-referral, increased transparency on disclosure of financial relationship between physicians and referred professional services, and a program in the Centers for Medicare and Medicaid Services' Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries in rural areas.
  
  
• Next week, on Oct. 21, tune in to the national morning shows to see your fellow colleagues and New York University physical therapy students promoting National Physical Therapy Month (NPTM) in front live television audiences at Good Morning America, The Early Show, and the TODAY show. If you don't currently follow APTA on twitter, simply click this link to follow our updates http://twitter.com/aptatweets.
  
  
• Last week, APTA member Jennifer Gamboa, PT, DPT, OCS, was featured in a CNNMoney.com article titled “Best Jobs in America,” which rates a career as a physical therapist as 7th in the nation for great pay and growth prospects. This article came on the heels of an equally positive report in BusinessWeek, titled “Looking for a New Career? Try Physical Therapy.”
  
  
• On top of all that, PT Magazine launched a fresh look, updated content, and a new name this month. The new PT in Motion will continue to offer need-to-know information about the physical therapy profession, but with a brighter look and fine-tuned content that members have told us they want to read.

What a month so far, and it’s only half over. How is National Physical Therapy Month going so far for you? What have you done – or what do you plan to do – to celebrate?

Positive Momentum for Physical Therapy

APTA took a small but significant step toward achieving direct access last week when the Senate Finance Committee unanimously passed an amendment by Sen. Blanche Lincoln (D-AR) that would authorize a program at a new “Innovation Center” to research the benefits of providing direct access to physical therapists for Medicare patients in rural areas.

The amendment was included in the committee’s “mark,” or its version of health care reform legislation called “America’s Healthy Future Act.” The Finance Committee mark requires the Secretary of Health and Human Services to create an Innovation Center under the Centers for Medicare and Medicaid Services (CMS). The Innovation Center will be authorized to test, evaluate, and expand different payment structures and methodologies which aim to foster patient-centered care, improve quality, and slow Medicare cost increases.

The program authorized by Sen. Lincoln’s amendment will study the impact of direct access and the ability of seniors and individuals with disabilities who reside in rural “primary care health professional shortage areas” to access the services of a physical therapist -- regardless of whether the individual is under the care of (or referred by) a physician or whether the services provided are under the supervision of a physician. A vote to report out this legislation is expected on October 6.

APTA will, of course, continue its long-term efforts to achieve direct access across all areas and practice settings, but this amendment – if included in the final health reform bill – could go a long way toward helping the profession reach its ultimate goal of direct access.

In addition to progress on the legislative front, the physical therapy profession continues to receive positive media coverage as the health care debate rages on. We certainly hope that legislators are taking note of these stories that support the notion that physical therapy is part of the solution to the health care crisis. In The Washington Post last week, a story focusing on fears of health care “rationing” points out that “often, people with generous insurance plans can run up large bills and face life-threatening complications from unnecessary care: back surgeries that result in wound infections, when physical therapy might have been a more effective treatment; imaging scans that expose patients to radiation; medication-caused side effects that must be treated.” And a story in the Capitol Hill newspaper, The Hill, quotes influential Blue Dog Democrat Allen Boyd (D-Fla.) complaining that his insurance company won’t cover physical therapy after his recent knee replacement surgery. “That doesn’t make any sense, does it?” he said. “They pay for the surgery, but not for the therapy you need for it.”

We are making progress on Capitol Hill, and public sentiment is leaning our way. As this unprecedented debate continues, your efforts are urgently needed to continue this momentum in the right direction. Please sign up today to become a member of APTA’s grassroots network, PTeam, to receive action alerts and important updates on health care reform and other legislative initiatives.