At the end of March, almost 300 PTs, PTAs, DPT students, and rehab therapy supporters gathered on Capitol Hill to meet with legislators and staff members and discuss how the APTA’s public policy priorities could benefit US health care in general. This served as the capstone to this year’s Federal Advocacy Forum (FAF), and the energy we brought to the Hill in support of the physical therapy profession, our colleagues, and our patients was palpable. According to Ken Sprague—APTA senior congressional affairs and grassroots specialist—“there was a high level of energy, and a lot of focus. The participants who went to Capitol Hill were excellent representatives for the profession, and kept commitment to best possible patient care front-and-center at all times. Those kinds of messages have an impact on legislators.” Prior to this visit, we gathered together as a group to discuss the issues that matter most to private practice PTs well as how we can optimize our advocacy efforts to make the greatest impact.
The Private Practice Section (PPS) of the APTA identified five major categories of initiatives to prioritize over the next two years (unsurprisingly, the “Medicare Issues” category contained the most line items). Here’s what PPS has committed to working toward:
We all know that Medicare is ripe for disruption—at the very least, there are some rather important initiatives that it’s high time Medicare revised. To that end, PPS will focus on:
- Enabling physical therapists to opt out of Medicare and/or privately contract with Medicare patients. This initiative is hugely important, because as it stands now, PTs cannot opt out of Medicare like other medical professionals can—nor can they provide Medicare-covered services to Medicare beneficiaries on a self-pay basis. This takes away Medicare patients’ freedom to choose the providers they want, and, in some cases, may prevent those patients from getting the care they need. Essentially, the legislation as it stands now puts therapists in a tough spot because they can’t see certain patients—even if those patients are willing to pay cash.
- Repealing or replacing the therapy cap. The APTA is heavily pushing for the Medicare Access to Rehabilitation Services Act—legislation that would effectively repeal the problem-laden therapy cap. This isn’t a new issue. In fact, it’s been on our agenda for the last 18 years. We got very close—the closest we’ve ever come—to successfully repealing the cap last year, but we lost by two votes. So, once again, an extension of the cap went into effect (it expires December 31, 2017).
- Expanding Medicare’s locum tenens provision to include physical therapists in all settings. Without locum tenens, therapists cannot use substitute therapists when they need to be absent from their practices. This threatens care continuity—especially when a PT needs to be away for an extended period of time (due to pregnancy or illness, for example).
- Allowing physical therapists to receive payment for telehealth services. By and large, the current rules around telehealth practice are vague and inconsistent—especially for rehab therapists. That could prevent some of the most vulnerable populations—including people who are homebound or live in remote, rural, or geographically isolated areas—from accessing and receiving the care they need. Telehealth represents a huge opportunity for improving the health of entire populations, which is an integral piece of the Triple Aim—and PTs should be capitalizing on that opportunity. But, they need laws that allow them to do that.
- Mitigating the negative effects of physician self-referral. This is the physician-owned-physical therapy services (POPTs) issue. It threatens independent private practitioners and may be detrimental to patients whose specific diagnoses and conditions would be better addressed by a different specialist.
Additional Medicare-related priorities are:
- Pushing for fair and equitable Medicare reimbursements.
- Opposing Medicare’s increased privatization.
- Monitoring the new evaluation code implementation—and identifying appropriate reimbursement values.
- Achieving consistent supervision standards for support personnel across practice settings.
- Advocating for private practice PTs to serve as quality-of-life evaluators and managers for patients with chronic conditions.
- Opposing the decision to increase the Medicare eligibility age.
- Removing barriers currently preventing patients from accessing physical therapists.
- Achieving a “streamlined, responsive, and transparent process for [Medicare’s] manual medical review.”
- Repealing the Independent Payment Advisory Board (IPAB).
- Promoting ACO adoption of quality measures that include functional health status.
Affordable Care Act (ACA) reform has been a hot-button topic for the past year. As such, PPS is working to ensure that any and all reform efforts take into consideration the needs of physical therapists—and their patients. Specifically, PPS is prioritizing:
- the inclusion of physical therapy as an essential health benefit in all insurance plans;
- guaranteed insurance access for patients with preexisting conditions;
- improved healthcare provider price transparency; and
- the ability for children under the age of 26 to remain on their parents’ insurance plans.
Commercial insurers could stand for a little shake-up as well, which is why PPS is aiming to:
- Achieve process standardization for coverage eligibility and service authorization.
- Mitigate the negative effects of market control—read: monopolization—of insurance companies on PTs and patients.
- Ensure that provider networks have the “size, scope, geography, and…expertise necessary to increase patient choice.”
- Minimize policies that unreasonably prevent patients from accessing and/or choosing physical therapists.
- Eliminate “arbitrary limits and denials for services provided by physical therapists in private practice in accordance with evidence of value.”
Small Business Issues
Small business issues for private practice PTs are near and dear to my heart, which is why I am very pleased PPS is working toward:
- Enabling small PT businesses to form groups in order to purchase health insurance for themselves and their employees.
- Pursuing federal student loan repayment programs in underserved locations to improve private practice recruitment efforts. (On the topic of student loans, the APTA is also heavily supporting the Physical Therapist Workforce and Patient Access Act, which would authorize PTs to participate in the National Health Service Corps Loan Repayment Program).
- Bolstering tax reform efforts that benefit private practice PTs.
PPS has also included the following as priorities:
- Increasing opportunities for Veterans to receive outpatient physical therapy services in a private PT setting (see the Advocacy in Action section below).
- Ensuring that private practice PTs are included in medical teams providing concussion management services. (The APTA supports the Safe Play Act, which not only recognizes PTs as professionals who are qualified to make return-to-play decisions, but also calls for “education, awareness, action plans, training, and further research related to health issues associated with sports—including cardiac conditions, concussions, and heat advisories—in which PTs play a role.”)
The APTA is also strongly advocating for the adoption of the Sports Medicine Licensure Clarity Act of 2017, which would provide licensure clarifications and legal protections for physicians, PTs, and athletic trainers who practice across state lines when traveling with professional and collegiate athletic teams.
Advocacy in Action
As an example of advocacy in action, here’s a personal win from my day on the Hill. First, a bit of background: Under TRICARE, physical therapist assistants (PTAs) are not recognized providers of physical therapy services. Therefore, TRICARE does not provide reimbursement for PTA-rendered services—regardless of where those services are provided (e.g., in private practices, rehab agencies, CORFs, or skilled nursing facilities). As a result, TRICARE beneficiaries have less access to the physical therapy services they need.
Now, Congressman Ruben Gallego is the District 7 Representative—where WebPT is located—and he’s been a raving fan of ours for many years. In fact, he jumped at the opportunity to cosponsor the Medicare therapy cap bill during his first year in office. With his past experience as a military officer—and his proven track record of advocating on behalf of veterans—he was a natural choice for us to approach. We asked him to not only initiate a Congressional bill to get the language changed, but also strategize with us to see it go through. And he was totally on board.
As a result, Mike Matlack—the Director of the APTA’s Political Action Committee (PT-PAC)—and the APTA government affairs committees are working with Congressman Gallego to craft the language necessary to get this regulatory constraint removed. That way, more veterans will be able to access physical therapy treatment outside of VA hospitals. It’s immensely exciting to know we can all effect this kind of change on behalf of our profession—and our patients. And all it took was some relationship-building, education, and perseverance.
While all 300 of us who attended this year’s FAF are bound and determined to work toward achieving these goals—for ourselves, our colleagues, our profession, and, most importantly, our patients—we can’t do it without you. As I said at last year’s Ascend conference, “The APTA is only as good as the voices they can hear.” Again, it’s all about building personal relationships. That’s why you absolutely must get involved in your state and national organizations, follow legislative changes, support the PT-PAC, and fight for your rightful place in health care. To make a difference—a real difference for our industry—we need all hands on deck, all voices speaking up for the changes we want to see. So, check out the APTA’s advocacy tools page today to see how you can get involved. Then, get your tickets for this year’s Ascend event—the ultimate business summit for rehab therapists. We’re more powerful when we’re united. And where better to unite than at an event designed specifically to advance our profession?
About the Author
Heidi Jannenga PT, DPT, ATC/L is the president and co-founder of WebPT, the leading practice management solution for physical, occupational, and speech therapists. Heidi leads WebPT’s product vision, company culture, and branding efforts, while advocating for the physical therapy profession on a national scale. She co-founded WebPT after recognizing the need for a more sophisticated industry-specific EMR platform and has since guided the company through exponential growth, while garnering national recognition. Heidi brings with her more than 15 years of experience as a physical therapist and multi-clinic site director as well as a passion for healthcare innovation, entrepreneurship, and leadership.
An active member of the sports and private practice sections of the APTA, Heidi advocates for independent rehab therapy businesses, speaks as a subject-matter expert at industry conferences and events, and participates in local and national technology, entrepreneurship, and women-in-leadership seminars. In 2014, Heidi was appointed to the PT-PAC Board of Trustees. She also serves as a mentor to physical therapy students and local entrepreneurs and leverages her platform to promote the importance of diversity, company culture, and overall business acumen for private practice rehab therapy professionals.
Heidi was a collegiate basketball player at the University of California, Davis, and remains a lifelong fan of the Aggies. She graduated with a bachelor’s degree in biological sciences and exercise physiology, went on to earn her master’s degree in physical therapy at the Institute of Physical Therapy in St. Augustine, Florida, and obtained her doctorate of physical therapy through Evidence in Motion. When she’s not enjoying time with her daughter Ava, Heidi is perfecting her Spanish, practicing yoga, or hiking one of her favorite Phoenix trails.