Joe Black's Physical Therapy Blog

More on Referral-for-Profit Situations

2006-02-14T08:32:00.000-05:00

DISCLAIMER: The opinions expressed in this blog belong to me, Joe Black, and no one else. I do not speak for any group, practice, or organization. I am a Physical Therapist and an Athletic Trainer, first and foremost. I also serve several roles in our professional associations, most notably as President of the Tennessee Chapter of the American Physical Therapy Association, also known as the Tennessee Physical Therapy Association. As such, I write this blog with great concern and caution. It can be difficult to separate my roles. I would insist that I have a right and, in some respects, an obligation to voice my opinion. In doing so, I am doing so as an individual.

I’ve never put as much effort and thought into any blog I’ve witten, but if you don’t want my opinion and/or cannot see it as separate from other hats I might wear, please stop reading now. Otherwise…

They’re now known as “Referral-for-profit” situations. POPTS is no longer the descriptive phrase of choice.

For most Physical Therapists, anti-POPTS sentiment has always been easy to sustain. Most PT professionals have a horror story about this or that doc that refused to let a patient see them for all the wrong reasons. Those that don’t work in referral-for-profit situations seem to have more than their share of those.

We forget, sometimes, that folks working in those clinics are Physical Therapists and Physical Therapist Assistants just like us.

They are not often, however, active members of APTA.

But if you want to be brutally honest about it, neither are most of the Physical Therapy professionals in the country.

Only about 43% of Physical Therapy professionals (PT’s and PTA’s) are members of APTA. In Tennessee, that figure is about 27%.

And less than that are what could generously be described as active members.

The referral-for-profit issue seems to get bigger by the day. Legislation, lawsuits, and appeals in South Carolina. Rhetoric and arguments. I have written here in the past about the conflicts.

The net result is that Physical Therapy professionals in RFP situations question the value of their membership in an organization that opposes their practice setting.

Put most bluntly, the whole issue begs a couple of questions:
1. Should PT professionals working in referral-for-profit situations belong to APTA and
2. How does an association that opposes their work situation, recruit and retain referral-for-profit therapists?

For me, the answer to the first question is yes.

There are many more issues in our profession than dealing with referral-for-profit situations.

Reimbursement, respect, our practice acts, Direct Access, autonomous practice, all the many things that are encompassed in the Vision 2020 statement.

Huge agenda items on our plate that make dealing with referral-for-profit situations somewhat secondary.

So yes, PT professionals working in referral-for-profit situations should most definitely be members of APTA, the only professional association that we have and the one that is fighting to protect your rights as a Physical Therapist or a Physical Therapist Assistant.

Fighting to make sure you get paid for what you do at a rate at which you can make a reasonable living. Fighting to both enact legislation to protect you and defeat legislation that would hurt you.

It is that simple.

As a commercial we’re hearing around here says, “the biggest no-brainer on the face of the earth.”

But the second question is much tougher. So, what are we to do?

I would suggest that the problem is really far less about the Physical Therapy professionals in referral-for-profit situations and far more about the physicians that employ them.

Let’s face it, if the playing field were level, this probably wouldn’t be an issue.

If physicians would offer their patients the option of obtaining Physical Therapy services at any appropriate provider, without attempting to influence those patients to visit a facility in which they have a financial involvement, we would not have the conflicts that we now face!

It would still be an issue but would cease to be an ethical dilemma and would certainly not be as contentious an issue as we now face.

Do not take this to imply that Direct Access is not an essential component of the future of this profession: It most certainly is.

And please do not ignore the stumbling block that referral-for-profit creates to achieving autonomous practice.

But without abuse of the referral system, and surely insisting on a single provider with whom that referral source has a financial interest can and should be classified as abuse, this issue would not be addressed with such passion and vigor.

Unfortunately, depending on physicians to self-regulate this one basic issue is highly unlikely.

So that brings us to our stumbling block: We cannot expect physicians to level the playing field, so what options do we have?

That is why there are attempts all across the country to legislate against a situation in which any physician profits from referral to any Physical Therapist.

It is perhaps the only mechanism we have to level that playing field.

I would ask the question of Physical Therapy professionals in referral-for-profit situations (not rhetorically): What would you have us do as a profession?

Any Physical Therapist should prefer that patients choose their services because of what they have to offer the patient, not how much the referring physician needs to supplement their income.

And if you don’t think that is how too many physicians see your services, then you haven’t had a frank discussion with one yet or you haven’t seen one of the many advertised services that offer the opportunity to physicians to establish this “ancillary source of income.”

Physical Therapy professionals should refuse to be an integral part of a system in which the physician demands that the patient go to “their” clinic. If there is any clinician out there that insists that this could never happen at their clinic, give me two weeks to talk to the other clinics in the area and I believe I will find evidence to the contrary.

I would ask that any PT professional ask themselves those same two questions in light of the information provided and then tell me how you would answer them.

But in the meantime, all Physical Therapy professionals need to be active members of our professional association (APTA), working toward those objectives that are common and important to all of us.

jb

Another question from the field

2005-12-30T07:47:00.000-05:00

This came in from a soldier in Iraq. I admit that I'm a bit stumped. If you've got any ideas, either e-mail them to me or post them as a comment.

"I ran a 6 miler when I first felt it. I hadn’t run in months and then I just jumped right into it, all through college I was a long distance runner so I thought it would be alright. I started feeling a tightness towards the end of the run but it went away. A week later I did a 10 miler and I felt it almost as soon as I started running, but after a couple of miles it went away and I did not feel it anymore. A week later I did an hour long hill workout on my bike (keeping in mind I had been biking pretty religiously over the past couple of months). I didn’t feel anything during the workout but about an hour after the workout it hit me gradually and I have been feeling it ever since. I have been stretching (with a bent leg, to focus on the soleus) and doing bent leg calf raises at the advice of my physical therapist back in the states. I have tried to ramp up my running slowly 3 times now and I have not been able to break 2 miles without enough discomfort for me to think I should stop. I always feel the most pain when there is physical pressure on the tendon i.e. a boot that covers my ankle or the back of a tennis shoe. I can not create pain or soreness by poking around with my fingers neither can any physical therapist that I have seen. I do not have any pain or discomfort doing calf raises. I do not have weak calf muscles and my hurt Achilles is definitely more flexible now than my good one. I have tried ultrasound therapy (1 month) deep tissue massage (2 weeks) and active release (1 month). While all of them helped my ankle feel good immediately after the procedure it was less than an hour before I was right back where I started. I have not noticed any significant improvement or it getting worse in the 8 months that I have had it. There doesn’t seem to be anything I can do to really get it moving one way or the other. I should also say that I was stupid and after I hurt it, I did quite a good bit of strenuous hiking and then tried to climb Mt. Rainer all within 2 weeks of when I hurt it (it should be noted that none of these activities really made it feel any worse). After I initially hurt it in May I did not ice it or do anything else significant to try and help it except rest it when I wasn’t hiking. It was probably a little over a month before I saw a physical therapist for the first time. I probably deserve this for how stupid I was in addressing this initially, but now I am at the point where I am seriously thinking that a prosthesis might help me live the active life that I once did before this happened. Currently where I work I have to climb quite a lot of stairs. I do my best to climb and descend the stairs flat footed as opposed to pushing off with my toes like you normally would. I have also cut out the back of my combat boots at the advice of another physical therapist to help relieve some of the pressure, it definitely helps a lot as far as pain goes. It should also be noted that my Achilles passes the Thompson test (squeezing the calf muscle and watching for the foot flexing) no problem. Anything you can do to help me would be greatly appreciated. "

And in response to my request for further information (where specifically does it hurt), I got the following:

"I could never pinpoint a focal area of the pain, it kind of jumps around. I can tell you that I’m pretty sure it’s not the muscle. The pain is definitely centralized up and down my left Achilles tendon. If I had to give you an area that hurt the most I would have to say it is the middle to upper Achilles. Upper being where the Tendon inserts into the muscle and middle being maybe two inches above where the tendon inserts in the calcaneus. But definitely more in the body of the tendon than anywhere else, I think. I know that doesn’t really help too much, but I’m definitely going to stick with in the body of the tendon. Thanks for any insight you can provide."

Thanks!

Happy New Year!

jb

A Clinical Question

2005-12-22T16:07:00.000-05:00

A friend and colleague sent me the following question today. It seems quite appropriate to put it on this blog and see how others see the situation. Just go to the "comments" section and post your reply.

I have a friend/colleague/fellow triathlete that has a 6mm X 10mm OCD on lateral aspect of talus secondary to lateral ankle sprain. She is scheduled for surgery, however the surgeon told her that she recommends no more running distances above 10 miles. She was signed up for an Ironman in Idaho and usually does 1-2 half Ironman races/year, as well as several Olympic and sprint distance races.

This friend is also a PT so knows enough about the injury to be worried, but is questioning if the recommendations are too conservative.

I have my opinions, but was wondering if anyone else out there could weigh in on this based on experience.

Merry Christmas (yes, I still say that).

Joe B

News from Maryville

2005-10-27T15:51:00.000-05:00

On October 12th, Pam White resigned as President of the Tennessee Physical Therapy Association. Since I was Vice-President, I then became President, just before the 2005 TPTA Fall Meeting.

That means that I have a whole new set of responsibilities and priorities. One of my very best friends called my wife that same week and asked "can you believe he's doing this?" My wife replied "of course."

I must admit that I once aspired to the TPTA presidency, but Pam was so much more qualified than I am, I was very satisfied serving as her vice-president. At 52, I had long since decided that I would finish this term as VP (it is up in 2007) and then fade into the fabric of TPTA, always serving but certainly in a minor capacity.

All that got swiftly changed.

I look forward to the challenges before me. I have embraced the office and have dedicated myself to succeeding.

I believe that we are called to service. My leadership mantra is as the "servant leader."

I am passionate about the art and science of Physical Therapy and am convinced that the practice of Physical Therapy is inextricably linked to the actions of our professional association.

There is no other answer beyond a simple "of course."

jb

NATA Speaks Up

2005-09-28T09:59:00.000-05:00

September 27, 2005

Dear NATA Member:

Last April, the NATA released a chart review study that is intended as a marketing tool to promote the athletic training profession to patients, physicians, insurance company personnel, and others. Subsequent to its release, there has been no discussion regarding the authenticity or facts found as a result of the study. There has, however, been discussion related to the methods. It is my hope that the focus will be on the results as it demonstrated that when doing rotator cuff rehab in one practice, athletic trainers were found to do better, in less time, and at less expense than other allied health care providers. As an athletic trainer, I celebrate these findings and am confident a more in-depth and broader based outcomes study will find similar results.

As I am sure you know, in the past year many within the NATA and I have worked to develop and improve the relationship with the American Physical Therapy Association and its Sports Section. Last February, I was welcomed and treated very well at the Sports Section Annual Meeting and had a productive meeting with President Ben Massey of the APTA. As a result, President Massey addressed our members at a General Session in Indianapolis. In August, representatives from the NATA and APTA met in Dallas. The meeting was cordial and, in my opinion, productive. We agreed to future collaborations and I looked forward to continued discussions.

With this as background, President Massey recently called to express his concerns related to this NATA marketing tool. He respectfully asked that it be withdrawn and I declined to act on this request. Due to his and the APTA's strong opposition to this chart review, President Massey informed me that any and all future collaborations would be cancelled. Although I regret that the APTA has chosen not to continue with future collaborations, I do not believe that the study is erroneous or its findings untrue. I also believe that it is the NATA's duty to market our profession and its practitioners in whatever legal, moral, and legitimate way it can. I believe this chart review meets these standards.

It is my opinion that other associations have sought and will continue to seek ways to prevent athletic trainers from becoming eligible for CMS approval as well as other national and state initiatives. It is our responsibility to counter these inaccurate portrayals of our practitioners with information that is legal, moral and legitimate and this is what we have done. We will continue to portray accurately athletic trainers and the unique set of skills we bring to health care regardless of what our opposition may wish.

In spite of recent events, I remain committed to making friends where possible and supporting common causes to benefit the public to whatever degree we can. We will continue to represent our members and profession in as aggressive a way as is dictated by our opposition as well as our desire to reach our goals while maintaining the dignity of the profession and its practitioners. We have not, nor will we, represent our members in any way that is less than honest. It is our hope that our competitors will some day recognize and support our efforts to offer aid to a public that can benefit from our unique set of skills. Until that day, we will be required to choose athletic trainers first and we will do just that.

Sincerely,

Chuck Kimmel, ATC
President NATA

APTA Speaks Up

2005-09-26T09:11:00.000-05:00

The following can be found at http://www.apta.org/AM/Template.cfm?Section=Current_Issue&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=25128

I print it here in the interests of objectivity:

APTA Dismisses NATA "Study" Promotion

Once again, the National Athletic Trainers' Association (NATA) has vainly attempted to find some justification for its expansive view of athletic trainer services in its efforts to secure athletic trainer parity with physical therapists.

This time the "evidence" is found in a retrospective "study" (that would probably be better categorized as an "infomercial") conducted by an orthopaedic surgeon, a physician assistant, and two athletic trainers. The "study" purports to show that athletic trainer services are cheaper than the services of physical therapists; that the utilization of athletic training is lower than that of physical therapy; and that comparable outcomes are achieved by the provision of both services. (For a copy of the report on the "study," see www.scottgudemanmd.com/programs/atc.cfm

Because of the lack of any citation, it appears that the report of the "study" was not published in any peer review journal. Likewise, there is no mention of an Institutional Review Board (IRB) approval.

Among the "study's" many failings are the following:

Small "Study" Size: The "study" looked at only 36 patients-16 of whom were workers compensation patients with half of those reportedly treated under a physician extender model (involving an athletic trainer) and the other half under a physical therapy model. Twenty non-workers compensation patients were likewise treated under the same models. In all instances, the treatment followed rotator cuff surgery.

Lack of Random Assignment: Although the patients' charts were reportedly picked at random, there is no indication that the assignment to treatment models was also randomized. Likewise, there were no criteria listed for the assignment of patients to the physical therapy model or to the physician/athletic trainer model.

Lack of Patient Comparability: There is no reported evidence that patients in the different treatment models were matched for age, sex, previous functional level, etc. Nor is there mention of even the most basic demographic information.

No Actual Physical Therapy Costs: None of the cited physical therapy charges were actual charges. An estimated "average" treatment charge of $130 was provided by physical therapists from 5 facilities with no mention of whether or not the patients in the "study" were treated in those facilities. There is also no indication of whether these were "billed charges" or "paid charges" or whether they were comparable with the calculation of the "costs" for athletic training.

Orthopaedic Bias: As the report on the "study" itself notes, "because patient satisfaction was based on subjectivity measured by the orthopedic surgeon who operate on the patient, some level of bias cannot be excluded."

Outcomes Impacted By Orthopaedic Bias: The report refers to "comparable subjective outcomes." These subjective outcomes were subject to the same bias as noted above because the measure of outcomes was based on "patient satisfaction," as determined, not by the patient, but by the surgeon.

Questionable "Findings:" It is difficult to confidently determine the meaning of most of the data. Without appropriate statistical testing, what is the real meaning of three tenths of a point difference in satisfaction ratings-which did not even come from the patients themselves? Workers compensation patients received fewer visits from the athletic trainers than did the non-workers comp patients. Yet the average costs for the workers comp patients were higher, thereby implying that these patients received less care at higher costs. However, the reverse is true for the physical therapy patients, who appear to have received more care at slightly lower costs. So, which group of workers comp patients received the care with the better value?

NATA's promotion of this extremely questionable "study" is but another example of its willingness to grasp at any straw in support of its ongoing opposition to the recent Medicare decision that excludes athletic trainers from reimbursement under Medicare's "incident to" provision. APTA will continue to monitor information disseminated by NATA relative to physical therapists and the practice of physical therapy, and respond as appropriate.

UNBELIEVABLE!!!

2005-09-14T15:30:00.000-05:00

You've got to check this one out.

Look at www.nata.org/committees/indocc/ComparaAnalysis.pdf.

See what I mean?

Unbelievable!

To see the "research" that this summary sheet was based on, look at www.scottgudemanmd.com/programs/atc.cfm.

You might notice that I put "research" in parentheses. Reliable resources well versed in research techniques have raised huge questions about the research process with regards to this "study."

I have always been very proud to be an Athletic Trainer and proud of the organization that represents that profession. But this one really bothers me.

Why this? Why now?

The past 7 months have been filled with cooperation and discourse between APTA and NATA. I'd be willing to bet the farm that those days ended with the publication of this document.

Bewildered. Betrayed. Distressed. Increasingly angry.

Those are the words to describe what I am feeling right now.

What do you think? Share your comments with me so I can then, in turn, share them with anyone else. If you want to remain anonymous, I will respect that.

And please send this blog to every Physical Therapist and Athletic Trainer you know. This could be bad and reasonable heads everywhere need to get involved.

APTA and POPTS-II

2005-08-19T12:48:00.000-05:00

Let me start by stating that this is my opinion. Nothing more; nothing less. I hold some positions in our professional associations that might serve to discourage me from expressing my opinion freely, but then I am reminded by several good friends in the profession that I actually have an obligation to express those opinions.

There are apparently several of you out there that want to hear them.

If you don't want my opinion, you should stop right now. Maybe morbid curiosity will compel you to keep reading but be forewarned: you might have your own ideas tweaked a bit. And you might hear some truths that you aren't ready to acknowledge.

So, here goes.

Last week was a bad week for me (not that it should concern you). I had a huge fight with a dear friend over my stance on the POPTS issue and then a patient told me a long story about her physician (the owner of a POPTS) that insisted that she see "his" physical therapist (non-caps intentional).

I was frustrated, angry, disturbed, and defeated. I was ready to quit.

So I wrote a long blog about all that and sent out a note that there was a new blog on my site. After mowing my yard Friday evening, an event that always gives me time to think things through, I decided to pull that blog. Some of you read it before I held it out for further editing this morning. That's OK. Some of you wondered out loud what happened.

In any case, let me make a couple of things really clear.

I am against POPTS situations. I realize that certain of you feel compelled to stay in those work situations because of finances and/or practice opportunities. Let's face it: if you want to see orthopedic patients, your only choice in some areas seems to be to work in a POPTS.

I also acknowledge and will shout from the mountaintops that we are all Physical Therapy professionals. Period.

I will state for the record that I want every Physical Therapy professional in the country to be an involved member of APTA. Every single one of us.

Membership should not be predicated by a work situation that I find favorable, not that you were asking anyway.

But, as an association, it is my personal opinion as a dues-paying member of APTA that we should, as an association, pursue an agenda that eliminates POPTS from the list of practice opportunities.

And that is nothing new, for, as you will see, APTA agrees.

To wit:

APTA's official position:

Opposition to Physician Ownership of Physical Therapy Services

Whereas, The American Physical Therapy Association Vision for Physical Therapy 2020 supports autonomy of physical therapist practice and judgment;

Whereas, Financial relationships and incentives between a patient’s/client’s physician and physical therapist represent an avoidable conflict of interest, reduce consumer choice, and diminish professional autonomy;

Whereas, There is evidence that such avoidable conflicts of interest affect delivery of care, utilization of services, and aggregate cost of treatment, and that patients/clients and payers would benefit from the elimination of such conflicts;

Whereas, In recent years, ownership of physical therapy services has been marketed to physicians as a means to recover revenues lost as a result of managed care, which has led to an accelerating trend of physician ownership of physical therapy services and referral of patients/clients to these services;

Whereas, The American Physical Therapy Association (APTA) opposes physical therapy services provided in practice settings in which the physician profits as a results of the referral;
Whereas, Numerous professions have successfully regulated ownership of their professional services through state legislative provisions; and

Whereas, The APTA, through its Goals and Objectives and other documents, has identified and implemented comprehensive legislative strategies to ensure the public’s right to direct access to physical therapy;

Resolved, That the American Physical Therapy Association supports the development of strategies to secure enactment of federal and state laws and regulations that prohibit physician ownership of physical therapy services. [RC 30-03, RC 31-03]

Seems pretty clear to me.

And from the "APTA Guide for Professional Conduct" section on "Interpreting Ethical Principles:"

PRINCIPLE 9
A physical therapist shall protect the public and the profession from unethical, incompetent, and illegal acts.
9.1 Consumer Protection
D. A physical therapist may not participate in any arrangements in which patients are exploited due to the referring sources’ enhancing their personal incomes as a result of referring for, prescribing, or recommending physical therapy. See Sections 2.1.B, 4, and 7.

Again, pretty darn clear.

Fran Welk, PT, DPT, MEd reported on an APTA "White Paper" position statement on POPTS:

"APTA opposed the ownership of physical therapy services by physicians and supported federal and state laws and regulations that prohibit physician ownership of physical therapy services. That was unanimously passed by the House of Delegates, made up of more than 400 people. A unanimous passage of any resolution in a body that size is pretty remarkable."

Dave Mason, APTA Vice President of Government Affairs says that, in a nutshell, APTA believes that POPTS are just wrong.

"There was a law passed that was supposed to prevent [POPTS]. To the extent that it is not preventing the situation, folks are just plain getting it wrong," says Mason. [See "The Stark Laws."] "Combined with the Medicare mandatory referral requirement, this is an unbalanced playing field-even for physician offices that are set up for appropriate purposes and have legitimate concerns about patient access.

"It is impossible for there to be another solution. The [medical] doctor controls the referral, and the doctor has a financial interest in where that patient goes. So it is inherently anti-competitive," Mason says.

APTA's policy on POPTS Job listing:

APTA is opposed, as a matter of health care policy, to arrangements under which sources of referral (including physicians) stand to profit from referring patients for physical therapy. The policy, adopted by the House of Delegates, states: "The American Physical Therapy Association opposes ... participation in services that is in any way linked to the financial gain of the referral source." Financial Considerations in Practice (HOD 06-99-13-17).

Because of this policy, PT Bulletin Online does not accept job listings for positions in a practice if any physician has a financial interest in the practice and refers patients to an employed physical therapist or to a physical therapist who supervises an employed physical therapist assistant.

Draw your own conclusions, but APTA's position seems crystal clear to this member.

If the future of the profession is important to you, then eliminating POPTS situations should be on your agenda too.

And for that position, I can't apologize.

Joe B

The PTA and APTA

2005-07-08T07:58:00.000-05:00

At the most recently completed session of APTA's House of Delegates, an RC had been forwarded that would give PTA's a full vote in APTA affairs (they currently have a half vote). It was definitely the topic of the HOD, with a rare entire afternoon devoted to the discussion.

One concern that was voiced was that as the profession moves toward the DPT as the entry level degree, granting a full vote in our professional association to PTA's would not place our profession for the position in the health care continuum that was part of the reason for switching to the DPT in the first place. Another opinion forwarded was that scope of practice decisions are best made by PT's, not PTA's.

PTA's, on the other hand, want full representation in what is their professional association as well.

I'll not get further into the argument for either side, but the vote was actually about 50/50, so the HOD was obviously evenly divided on the debate. The RC failed because it required a 2/3rds majority for passage.

Unfortunately, a lot of PTA's left the meeting quite unhappy with the outcome. One influential PTA forwarded a note afterwards that said "(this action) has made a very huge impact on my opinion of the APTA and the PT profession as a whole.... I foresee a more difficult task ahead to gather new members as well as retaining current ones. My membership expires on 6/30/05. I have a lot of thinking to do."

For someone that truly loves this profession and the association that represents it, those are indeed disturbing words.

Other actions at this HOD that affect the PTA: The RBNA has been dissolved and, in its place, the PTA's acquired representation in the HOD.

PTA's are an important part of the profession of Physical Therapy. I prefer to use the term "Physical Therapy Professional" when referring to both PT's and PTA's. In Tennessee, we long ago realized the importance of the PTA both to our profession and to our professional association. PTA's serve in a wide variety of positions in TPTA, including district officers and an automatic position on every standing committee.

I would also like to think that we have a model relationship between our PT's and PTA's here at Appalachian Therapy Center. Our PT's and PTA's work as a team, often blurring the lines of responsibility (but remaining true to all rules and regulations under which we fall). Recently, I asked a student after his first day at our clinic who were the PT's and who were the PTA's. Since he had witnessed meaningful professional discourse and true teamwork, he had difficulty in deciding which was which.

Still, this issue threatens to erode our membership initiatives. Already at an alarmingly low 7% in Tennessee, PTA membership in APTA remains a huge issue for us. We cannot ignore the importance of the PTA to the profession nor can we ignore the potential value to our association from their membership.

To the PT's, I would encourage you to embrace your fellow Physical Therapy professionals. We are all part of the same profession.

To the PTA's, I would ask that you not see negatives in this situation: We/You have indeed come a long way. Please see this instead as an impetus for greater involvement, not as a reason to drop your membership. If our HOD is truly representative of the membership, then half the PT's in this country were ready to grant you full voting privileges. Remember how far you've already come.

Joe Black, PT, SCS, ATC

The Physical Therapist Assistant

2005-06-14T12:47:00.000-05:00

I have been waiting to write another blog on ______________________ (fill in the blank).

Unfortunately, inspiration never came. Oh, there are lots of topics that I'm passionate about but none that I really wanted to bother you with.

This one has been one of those "back burner" topics for a couple of weeks. I was going to combine it with another one. I've waited too long so here goes. This one is brief.

Recently APTA announced the list of the first recipients of the APTA Certificate of Recognition of Advanced Proficiency for the Physical Therapist Assistant.

This is a tremendous accomplishment, both for the profession and the individuals. I was particularly pleased to see the name of several Tennesseeans on the list. The complete list, with the Tennesseeans in orange (go figure) follows:

Janet Lynn Adams, PTA, Memphis, TN (Neuromuscular)
Shirley Barnum, PTA, Benoit, WI (Musculoskeletal)
Allison Bolt, PTA, Seymour, TN (Musculoskeletal)
George Carrasco, PA, Live Oak, TX (Musculoskeletal)
Veronica Doughtie, PTA, Wilson, NC (Musculoskeletal)
Carol Ann Everett, PTA, Bolingbrook, IL (Musculoskeletal)
Andrea Gildar, PTA, Sarasota, FL (Musculoskeletal)
Sanaz Armand Holcomb, PTA, Westlake, OH (Musculoskeletal)
Michael Huszcza, PTA, Scotch Plains, NJ (Musculoskeletal)
Kari Jones, PTA, Murfreesboro, TN (Musculoskeletal)
Roy Christopher Junkins, PTA, ATC, Easley, SC (Musculoskeletal)
Angela Keir, PTA, Westerville, OH (Musculoskeletal)
Brenda Law, PTA, Maryville, TN (Musculoskeletal)
Janet Claire Lehoullier, PTA, Hooksett, NH (Musculoskeletal)
Ginadoria Martins-Brown, PTA, Seattle, WA (Musculoskeletal)
Julie Lyn Meseck, PTA, Charter Oaks, IA (Musculoskeletal)
Jennifer Jo Nave, PTA, Martinsville, IL (Musculoskeletal)
Jackie Osborn, PTA, Lubbock, TX (Neuromuscular)
Debra Perry, PTA, Herndon, VA (Musculoskeletal)
Carolyn Jeanine Reppy, PTA, Carbondale, IL (Integumentary)
Juliana Robine, PTA, Mantua, OH (Musculoskeletal)
Nathan Rosel, PTA, Belmont, MI (Musculoskeletal)
Katherin Ryan, PTA, Atalissa, IA (Musculoskeletal)
Gary Allen Shankman, PTA, ATC, Knoxville, TN (Musculoskeletal)
Susan Snow, PTA, Bangor, ME (Neuromuscular)
Valecia Snyder, PTA, Amarillo, TX (Integumentary)
Jodi Steiner, PTA, Palantine, IL (Neuromuscular)
Krista Marie Swanson, PTA, Seattle, WA (Musculoskeletal)
Terry Trundle, PTA, ATC, Powder Springs, GA (Musculoskeletal)
Davis Varduny, PTA, Riverview, MI (Musculoskeletal)
Michele Voight, PTA, Corpus Christi, TX (Musculoskeletal)
Rose Wehnau, PTA, Troy, NY (Musculoskeletal)
Mary Beth Zendzian, PTA, Avon, CT (Neuromuscular)

I also just learned that the recently completed APTA House of Delegates did NOT approve a full vote for PTA's. Apparently it was a hot issue.

In Tennessee, PTA's are an active part of chapter activities at many levels. I would like to think that we are among the best in the country as far as relationships and responsibilities of the PTA in associational activities.

I'll find out more about the HOD and let you know what I find out.

Take care.

jb

Guest Blog: Bob DuVall

2005-05-26T14:26:00.000-05:00

In response to my last blog ("What will happen to the orthopedic Physical Therapist?), I received the reply you will find below from Dr. Robert DuVall, PT, OCS, DHSc, MMSc, ATC, FAAOMPT, CSCS. He is an APTA Credentialed Manual Therapy Fellowship Program Director and Primary Contact Residency Program Director for Sports Medicine of Atlanta.

Dr. DuVall present a compelling case that I think most of you will find quite interesting and informative. He also teaches a seminar on how to survive in this most difficult of arenas.

I repeat the reply in its entirity, with the qualifier that you pay particular attention to how Dr. Duvall proposes that we deal with the dilemma found in those states that do not have full, unlimited Direct Access.

Dr. Duvall:

You ask, "Think about it....if every orthopedic group in the country had their own PT clinic, where would that orthopedic PT go to work if not at the POPTS?" I ask you, will "Direct Access PTs work in a POPTS? Think about it for a moment. PT "direct access" in a POPTS? It's an oxymoron. Given your scenario that orthopaedic surgeons could be 100% POPTS, you imply that there would not be a place for Orthopaedic PTs to practice if not in a POPTS. We as politically active PTs need to keep abreast and integrate the PT professions recent moves toward autonomous practice, direct access and the "Doctor" of Physical Therapy degree into empowering reality. The APTA's defined initiatives need to be consider and integrated into reality as a solution to problems that PTs encounter in contemporary practice. These initiatives are timely and very relevant to your POPTS concerns, especially with regard to grassroots consumer needs.

Being a PT private practitioner since 1984, I was faced with an ultimatum to either "physician fee-split" and pay referring orthopaedists for their "Medical Directorship" of my practice or loose their referrals to a PT down the street who was ready, willing and able. In spite of being heavily in dept from my new practice's start-up costs, I made the ethical decision to not fee-split. Yes, I lost my major orthopaedic referral sources. However, I started educating potential patients (consumers) as to Georgia law that permitted the patient to first consult with the PT prior to the physician. Georgia is one of 49 states that permit patients to be consulted by PTs prior to physician intervention. Almost all of my "direct access" patients appreciated our initial PT consultation and especially appreciated and logically understood the PT's movement impairment based diagnosis that identified the etiological variables needing PT intervention that would often sometimes prevent surgery. Our PT consulted patients then would willingly carry our PT referrals (see attached referral form and example) to preferred physicians to get the "medical necessity for PT" approved in writing. Thus, the patient had insurance coverage medically approved. To this day, we have consulted with greater than 15000 patients prior to physician intervention. Both there patients and physicians are highly satisfied. Due to our efforts, the surgeons we refer to have less clinic time and more OR time. The fee-splitting orthopaedic surgery group's practice volume actually dropped, especially with regard to the educated and active/athletic patient population. Our PT's have become this community's "preferred practitioner", facilitating an open medical marketplace where the neuromusculoskeletal care consumer has more choices. In response to slow down my success, the fee-splitting orthopaedic group eventually started their own PT practice (POPTS) but consumers saw a significant difference in our approach to care and frequently demanded (consumer rights) choice to come to our practice. The fee-splitting physicians eventually sold their PT enterprise to a large, well known PT corporation. Over the years, the fee-splitting orthopaedic surgery group has disintegrated and all but one of their original partners has left my area. The large, well know PT corporation is still existing and accepting physician referrals.

So, I can tell you that the POPTS scenario you describe may ironically facilitate and motivate some PTs to actually assume accountability for their own professional destiny. In stead of waiting for anti-POPTS laws to develop, I assume that tomorrow's DPTs will be more inclined to assume the necessary responsibility and control for their professional destiny. Maybe this is why the fastest growing section in the APTA is the Private Practice Section. Based on the merits of the clinical science and evidence that deems PT to be of unique value to consumers/society, I encourage autonomous and direct access practice to be a viable and effective solution to control POPTS, now. Given my practice scenarios, PTs can secure reimbursement by third parties so there is no reason why PTs can't start direct access now. Proliferation of POPTS actually can present a wonderful opportunity for PTs to take greater control of their professional destiny and educate consumers as to the type neuromusculoskeletal care they desperately are seeking and need. The comfort found in traditional referral based PT practice temps the PT to hinge their professional destiny on judges' and lawmakers' regulation of POPTS instead of grassroots consumer demand. When physician referrals account for the majority of a PT's business, few PTs see the consumer who did not get referred to PT as substantial enough reason to make the transition to direct access practice. I have found that the fear of retribution from the majority of a PT practice's referring physicians as the main reason that prohibits PTs from practicing direct access.

POPTS could ironically facilitate PTs move toward direct access and professional autonomy. Looking at POPTS from a different angle, if PTs earn the right to be professionally autonomous by offering an evidenced based service that is unique and valuable to society, then they will control POPTs with or without law makers stopping it. PTs have the capability to control POPTS without legislation stopping it. How long will it take for PTs to realize that they truly have a unique body of knowledge that commands autonomy beyond the scope of physicians' practice. Due to the breadth of PTs scope of practice, consumers and PTs can no longer assume that physicians will make referral of everyone in society who needs PT. Likewise, due to the PT's scope of practice boundaries, PTs must make collaborative referrals to medicine as necessary. This is how PT's "ancillary" perception will change and mutually respectful and "collaborative" practice should evolve to better serve and advocate for the consumers' needs.

Robert E DuVall, PT, DHSc, MMSc, ATC, OCS, FAAOMPT, CSCS

Thank you, Dr. DuVall.

jb

What will happen to the Orthopedic Physical Therapist?

2005-04-29T15:56:00.000-05:00

The day is rapidly approaching in which a good orthopedic physical therapist has two undesirable options: either go to work for a group of orthopedic surgeons in a POPTS situation or get out of orthopedics.

Think about it....if every orthopedic group in the country had their own PT clinic, where would that orthopedic PT go to work if not at the POPTS? That's not as far-fetched as you might think.

In nearby Knoxville, there are 59 orthopedic surgeons. Of those, 54 work in practices that have their own PT clinic. 92% of the orthopedic surgeons in Knoxville have Physician Owned Physical Therapy Services!!!

John Doe (not his real name) with credentials a mile long, is one of the best Physical Therapists I have ever known, yet, he works in Knoxville for a POPTS. He doesn't like it and would definitely prefer to get out of the POPTS, but he's stuck. He is an orthopedic Physical Therapist in every sense of the phrase and if he's going to work in Knoxville, his options are very, very limited.

Why are we in this sad state?

Physician salaries have dropped considerably in recent years and physicians have grown increasingly dependent upon ancillary sources of income. Unfortunately, Physical Therapy has fallen into that category.

"The playing field ain't level."

The fact that many of us have spent years building good, responsible, accountable practices doesn't matter. If the orthopedic group that refers a substantial number of patients to us wants to open their own practice, we're toast. Kaput. Close the doors. Find a new job.

The problem is compounded because many orthopods insist that patients go to "their" PT clinic. One notorious yet very prominent orthopedist in Knoxville has, on several occasions, literally torn up a PT order when the patient refused to go to their clinic and instead wanted to come to mine, which just happened to be in the town where the patient lived. And it is not like we're a shabby, second-rate clinic.

A colleague just today related a story of a local (rural) physician insisting that a patient that she was seeing travel 25 miles to "his" clinic.

We might even be able to live with even that if this were an isolated incident, but virtually every P.T. in the country can relate similar scenarios. No, the playing field ain't level.

How much money are these POPTS practices making? How much profit can a 20+ person orthopedic group expect from their "ancillary sources of income?"

I must be an idiot. I've been in private practice for 24 years and I'm sure not making the kind of money that could supplement even one physician's salary.

The only way to generate profits in the business of physical therapy is to increase income and cut costs.

Simple enough, right?

Part of the problem with POPTS is that we're talking about substantial profits, not a nice little bonus check.

How do you increase income? Increase prices. Increase the number of visits per referral. That's about it.

And increasing prices isn't often practical, since most third party payors are going to pay what they darn well want to anyway, regardless of what you bill.

So that means increasing the number of visits, disregarding the needs of the patient and definitely ignoring the impact on health care in this country. I don't know about you, but if I did that, I couldn't sleep at night. That's screwing the patient, our system of health care delivery, and our profession.

How do you cut costs? Reduce salaries. Ooooh....nobody wants to hear that. So lets hire folks that cost less. New graduates. Professionals without advanced competencies and credentials. You can't afford to hire the best, most experienced clinicians.

Reduce expenses, which means making do with less. Like keeping older equipment. It definitely means you don't do as much for the community.

I'm sorry, but there is no other way to look at it. Your quality of care is going to go down if profitability drives your practice. Any practice, PT owned or physician owned.

Period.

You can talk about patient rights and free trade and the PT's right to work in the setting of their choice all you want to, but this is, at its essence, all about the money. And I'm not talking about money that goes into the pockets of the Physical Therapist, but money that is going into the pockets of those that are making the decision about whether the patient needs Physical Therapy or not. And for how long.

We've got a great system in place here: a physician makes the decision that Physical Therapy can be of benefit to their patient (and I don't have any problem at all referring to that patient as "their" patient), and refers them to a Physical Therapist. There is no financial incentive to make that referral and there is definitely not any financial incentive to perpetuate the referral beyond reasonable outcomes. The physician is free, nay COMPELLED, to use the best available Physical Therapist. The Physical Therapist must do good work at a reasonable price. The patient wins (they got the best care). The system of health care delivery we have in this country wins (costs are inherently and without exception reduced). And the physician wins, because their patients get better.

My friend and colleague, Baron Johnson, PT, put it this way:

The Physical Therapist is not the bad guy here. The POPTS P.T. has a job and is doing his best to feed his family. The problem is the perception that if you work in a physician's office, you are unethical. That's not necessarily true. But I must question the P.T. that continues to work in a POPTS owned by doctors who insist that all their patients go to "their" P.T. That is unethical and the P.T. is implicitly part of that unethical practice.

If we are going to move forward as a profession, I think we quit making the P.T.'s the bad guys and put the blame where it belongs: on the shoulders of those that would exploit our profession for financial gain.

Our job is to educate the P.T.'s that the profession is at stake, not the job. A student did a clinical here a year ago and was taking a job with a POPTS and his statement to me was that it was a job, nothing more. HE had to pay his education loans. To me that suggests that we are not training professionals but college graduates who are only looking for a job, not a career. Where are we failing that student? By failing to educate him that he was a professional, not just some college graduate looking for work.

I don't advocate having the P.T. in a POPTS declare the unethical nature of their employer. Let's take the high road on this one and unite P.T.'s, not self-destruct the profession. All the fighting among P.T.'s needs to stop yet all of us across the country need to understand the consequences of taking jobs in POPTS. If no one took that job, what do you think would happen to POPTS?

Amen.

This is more than a job. When you decided to become a Physical Therapist, you chose a life, a career dedicated to helping others.

Joe Black, PT, SCS, ATC

A Not So Simple Question

2005-04-01T08:48:00.000-05:00

But, short and sweet.

Which would you prefer to have: Fully reimbursed Direct Access or the elimination of POPTS?

Let me hear from you (and both isn't an acceptable answer-although it is definitely preferable).

jb

TPTA Spring Meeting

2005-03-31T13:56:00.000-05:00

If you haven't registered yet, it's not too late. You can download a registration form at www.tptaonline.org and attend the TPTA spring meeting next week in Nashville.

Even if you don't attend any of the excellent educational sessions, you should attend the chapter business meeting on Saturday. It starts at 1:00 and will be over by 2:30. If you are only coming for the business meeting, you might also be interested in attending the Student SIG meeting at 11:30 or the Affiliate SIG meeting at 12:00. Those will last only a half hour but are great meetings for students and PTA's, respectively.

On a personal note, I would like to encourage you to sign up for the "EMT First Responder Course" taught by our esteemed colleague, Danny Smith, DHSc, PT, SCS, OCS, ATC. This is an super course that we are very fortunate to have. Danny teaches this course internationally and it is in great demand. It is an essential course in preparation for taking the Sports Clinical Specialist exam. In my opinion, it is a necessary course for those Physical Therapists that want to work the sidelines of an athletic event.

Pre-registration has been quite slow, especially considering the quality of the course. I would speculate that the cost might seem a bit high, but it a great value for what you are getting. The cost is $400 for members and $500 for non-members, plus there is a $65 charge for a textbook and a workbook. Danny would like for everyone to get the workbook early and bring it completed.

If you're interested in sports, this course is for you.

But if you can't attend any of the courses, be sure and be at the Saturday Business Meeting: some really great things are going on in Tennessee and you will definitely want to be a part of those.

One of my colleagues related a really poignant story this morning. It seems that he was at church recently and another Physical Therapist (in private practice locally) stopped him and asked him how Appalachian Therapy Center could afford to have so many employees stay so active in APTA. You can find ATC employees at all levels of TPTA functions, from the district to the BOD to the Executive Committee. He said he was so busy that there was never enough time to attend meetings let alone head up a committee or hold an office.

My colleague's answer to him was simple: "It's all our company's attitude. We are committed to the profession. It's also about your priorities. When some orthopedist opens a clinic up across the street and is treating your patients, you won't have to worry about being so busy and might have the time to get involved again."

Well said.

I hope to see you next weekend.

Joe B

TPTA Candidacy Statement

2005-03-31T10:32:00.000-05:00

My candidacy statement did not make it into Volunteer Voice. For the record, I am running for the office of Vice-President of the Tennessee Physical Therapy Association. My candidacy statement, as submitted on March 9th, is as follows:

A lot has happened since I got elected Vice-President of TPTA.

I am older, maybe wiser, definitely more politically correct. Some would say subdued.

I would insist that I’m more excited (if less excitable)—excited about Physical Therapy. Excited about the things that are happening in Tennessee. Excited about the young clinicians of today, coming out of school with their DPT’s and oh so much more ready to take on the world than I was some 27+ years ago.

Excited about what we have become as a profession. Really excited about our potential and our future. And excited about TPTA, which is financially solvent, fiscally responsible, politically active, and moving forward.

But being vice-president has changed me. Don’t get me wrong; I’m still hell-bent-for-leather on fulfilling our potential. My obligation to identify mistakes we make and the shortcomings that we find ourselves with remains steadfast. I remain committed to those agenda items that I see as vital to our future.

Unrestricted direct access.

Professional autonomy.

Freedom to choose the best provider.

Adequate reimbursement for our services.

A TPTA where every Physical Therapy professional in the state is an active member.

I’ve just changed my personal concept on how I can best serve the profession. That’s where that “subdued” comment came from. It used to be that I did a lot of “finger-pointing.” Now, that finger is pointing more at me.

I used to express my opinions freely, disregarding personal feelings.

Not any more. That is not a lack of backbone but merely intellectual honesty. To quote Rudy Guiliani from his book Leadership, “people should be ready to admit when there is evidence to make them change their minds.”

In my case, change my methods. It is important for me to be a mediator and a peacemaker, yet still a broker for change. It is essential that I reconcile those roles. The small part I’ve played in the ongoing conflict between APTA and NATA has convinced me of the value of mediation and reconciliation.

I ask for your vote for Vice-President of TPTA, not because I’m good at the “business” of TPTA (which I’m not), but because I can see things the way they should be and have a pretty good idea about how to get there.

Student Responsibilities

2005-03-23T11:17:00.000-05:00

I don’t remember the exact year, but I know it was one of the times that CSM was in New Orleans. I had been visiting friends at Tulane Sports Medicine and was talking to John Guido, one of the Physical Therapists on staff there.

I’m not sure why, but the conversation turned to our obligation to our students.

Now, keep in mind that my approach to dealing with students at that time was much like a buffet table: Here it is. Take as much as you like. If you’re not hungry (interested), no problem. What you take away from the table has nothing to do with me.

Guido (he’s rarely called John) was telling me that he wants his students to be ready to treat his mother before they were through with him.

Let me repeat that core philosophy. Before they were through with their clinicals under Guido’s supervision, they were sufficiently competent that he would be comfortable sending his mother to them for care.

Wow!

From a clinical education standpoint, it was an epiphanous moment, changing forever the way I approached my students.

I had heard it before, but sitting on the steps outside Tulane Sports Medicine, talking to this young man, it finally hit home.

I guess if you hit a stubborn mule across the head with a 2x4 enough times, you’ll get your message across.

Unfortunately for one PT student, I was a man invigorated by newfound knowledge.
What a frightening proposition!

David Bright was a last semester student in the Masters PT program at the University of Tennessee-Chattanooga. He was also the son of one of my best friends and a young man that I had watched grow up (and someone that I had probably influenced to enter this profession in the first place).

David was my next student.

If he had known what was in store for him, he might have changed professions.

He was about to enter the clinical from hell.

I had never seen a new graduate that was competent to treat my mother, and if David Bright was going to be ready to treat my mother, welllllll, he better be ready.

Keep in mind that when I graduated from PT school, I was extremely confident of my abilities. Some probably called me cocky. I was ready to take on the world (or so I thought).

Several years later I was blessed with the wisdom of knowing how much I really didn’t know and hopeful that in my ignorance I hadn’t hurt anyone.

So I had about six weeks to get this next student to a level that I didn’t think possible.

David was in trouble.

David was also bored with PT school. Call it senioritis if you want to but David had grown as a student to the point where school wasn’t that challenging anymore.

That was about to change.

With me as his Clinical Instructor, David had exhaustive homework assignments every night, multiple special projects, and several presentations. He designed treatment protocols, carried a heavy patient load, and suffered from intense critique of everything he did. The papers he turned in had more red marks on them than my 8th grade English paper.

Fortunately for the profession, David took fire. He met every challenge and responded appropriately to every criticism.

He became an excellent clinician and is now a Senior Staff Physical Therapist and a valuable team member with Skip Hunter’s main clinic in Clemson, South Carolina.

I had dinner with he and his wife while at CSM and it is easy to see that he is a top-notch clinician.

And he can take care of my mom any day of the week.

LEADERSHIP

2005-03-09T15:41:00.000-05:00

Having a wide range of leadership responsibilities, I spend a fair amount of time studying about leadership.

Our best lessons in leadership come from studying effective leaders and from studying history.

Good books about leadership include Stephen Ambrose’s books on Eisenhower, Donald T. Phillip’s Lincoln on Leadership, and most anything on Churchill.

My own lessons in leadership probably started in Boy Scouts. I didn’t have to be the strongest or run the fastest but if I could get my small group, known in Boy Scouts as a patrol, to work together, we could accomplish great things.

Isn’t that the essence of leadership?

I watched as my good friend Tab Blackburn get surprised by the 1st SPTS Lifetime Achievement Award that he received at CSM and then shared a tear with him as that same award was permanently named the Turner A. Blackburn Lifetime Achievement Award.

If you have anything to do with Sports Physical Therapy, you know who Tab Blackburn is.

And you probably know that this honor was well-deserved.

Tab is most definitely a leader.

He leads by example. He leads by teaching. He leads by mentoring. He leads by giving substance and quality and structure to this great profession of ours.

And he leads by being a friend. He makes you feel important. You would go to war following this man.

What do great leaders seem to have in common?

One of the best lessons my father taught me was that I should never ask anyone to do a job I wasn’t willing to do myself. This was a smart yet uneducated man who never went beyond a routine production job in a factory.

If there is a mess in the floor, you should never be too good to clean it up.

If the dishes need washing, maybe the fact that you take care of that menial task means that others learn that their responsibilities are broader than they thought.

If there is a job that no one wants to do, you take care of it.

Great leaders all seem to have the courage of their convictions.

Great leaders all seem to be flexible, adapting to changes both current and predicted.

John Kerry was accused of being “wishy-washy” for changing his position on several issues. I would suggest that the latitude to change our opinion is a necessity for an effective leader.

In his book, Leadership, Rudy Giuliani offers the following: “The notion that changing your mind about an issue shows weakness is ridiculous. People should be ready to admit when there is evidence to make them change their mind. That’s an indication of intellectual honesty, not of a lack of backbone.”

Great leaders are decisive. Ineffective leaders just can’t seem to make the tough calls. They agonize over details and seek more and more input and just procrastinate making the difficult decision.

It is far more effective to gather sufficient information and then make a decision, right or wrong. Good leaders also admit their mistakes but haven’t allowed the fear of making a mistake keep them from making decisions.

Great leaders motivate and inspire others.

A great leader knows their strengths and weaknesses. Great leaders surround themselves with good people. To be truly effective, you need to find those that complement your strengths and compensate for your weaknesses.

A great leader is humble and honest, with themselves and with others.

It seems simplistic, but great leaders lead.

My high school football coach was a great leader. When it came time to take the field, I would have run through a brick wall if he had asked me to. Not because I followed him blindly but because he would have run through it first and because I was convinced that there wasn’t a wall that could stop the sheer force of our convictions.

I’ll follow Tab anywhere.

Congratulations on a well-deserved honor.

2005 CSM

2005-03-02T13:16:00.000-05:00

Almost as soon as I arrived in New Orleans for CSM, a friend shouted across a crowded room, “I can hardly wait to read your blog when this meeting is over.”

So, I’m making mental notes the whole time and asking myself “what will I write?”

Then, on Friday afternoon, I sat in a circle of chairs while a summit of sorts was held between the president of APTA, Ben Massey, and Chuck Kimmel, president of NATA.

And when I walked out, I knew I had my blog.

If you didn’t know it, APTA and NATA have been quite at odds lately.

Well, no, it was more than that.

The two organizations were on the brink of war.

In a nutshell, APTA has opposed the “incident to” clause in the CMS reimbursement guidelines which allows physician offices to bill for services. Physical Therapists consider that billing for physical therapy services should be strictly the domain of the physical therapists.

A lot of athletic trainers work in physicians’ offices without a physical therapist, billing for their services under this “incident to” clause. Without the “incident to” reimbursement, those same athletic trainers would be out of a job.

If you expect the NATA to work to protect the interests of its members (a logical expectation), then the NATA’s opposition to this ruling is easy to understand.

So, APTA opposes the “incident to” billings and NATA needs them to support their membership.
The whole situation digressed from there but I’ll just leave those for now.

For me personally, the event that galvanized me to action was when two close friends, who were involved with the process and incensed by NATA’s actions, declared that they would no longer use the “ATC” after their name.

Keep in mind that I wear both hats: I am both a physical therapist and an athletic trainer.

I felt much like the baby in the Biblical story of Solomon.

Mike Voight, President of the Sports Physical Therapy Section, is one of my very best friends. SPTS was particularly upset about this situation.

Chuck Kimmel, NATA President, is a fellow Tennesseean and a friend.

These are good men and effective leaders. I feel that I know them both well. They are sincere and dedicated.

And a bit at odds.

So I sent an e-mail to Chuck, voicing my objections to NATA’s stance on the “incident to” ruling, on direct access for physical therapists, and on other issues. I expected a cursory response because I know how busy Chuck is. It was more about me expressing my own opinion than seeking answers.

What I got back was a carefully worded, very personal response from Chuck. This wasn’t a standardized, prepared statement from NATA—this was real response from my friend Chuck. I was overwhelmed.

I didn’t agree with everything he said so I fired off another e-mail.

Thus began an ongoing dialogue.

Flash forward now to CSM.

Chuck had been invited to CSM to visit with President Massey as well as with the membership of the SPTS.

Having played some small part in this visit, I was asked to be Chuck’s host in New Orleans. Keep in mind that Chuck might have been stepping into a hostile environment.

We joked that I might be more bodyguard than host.

Chuck was scheduled to make a short presentation to the SPTS membership at a “town hall meeting” to immediately follow the Section business meeting.

Some from NATA probably thought that Chuck would be entering the devil’s lair.

A few from APTA might have thought that Chuck was more than the Trojan horse.

Mike Voight and I were determined to keep this a collegial affair.

But before that, came a private meeting between Chuck and Ben Massey, APTA’s President.

Scheduled to be present were those two plus APTA’s CEO, Frank Mallon, and APTA Board member Barney Poole. Mike Voight and Mark DeCarlo (immediate past president of SPTS) were going to sit off to the side while I was going to go hide in the corner.

When we arrived at the top floor suite in the Hilton, there were six chairs in a circle. Frank Mallon did a quick head count and added a seventh chair for me. I told him I was there just as Chuck’s host and offered to stand in the closet.

When Ben Massey came, I again offered to step to the side but he wouldn’t hear of it.

So here I was, in the inner sanctum.

That meeting was diplomatic, cordial, and very productive.

At the risk of sounding condescending (an apology I’ve already made to both men) I was extremely proud of both my Presidents; Ben of APTA and Chuck of NATA.

Both are effective, determined leaders, genuinely nice fellows, and definitely folks that you can be proud of too.

Chuck went on to address the SPTS membership with such sincerity and effectiveness that what might have once been a hostile environment became the welcoming of a brother.

A brother who we might disagree with but with whom we don’t have to be disagreeable. A brother with whom we have much more in common than we have in difference. A brother with whom we have history!

A lot of work is yet to be done, but there is now a foundation of dialogue and acquaintance upon which success can be pursued.

And I can tell you that I’ve never been prouder to be a Physical Therapist and an Athletic Trainer.

Parenting 101

2005-02-04T13:37:00.000-05:00

OK. Maybe this doesn't have much to do with Physical Therapy.

But being a parent is also an important part of who many of us are. In many ways, the two things DEFINE us.

I've started writing for another column in the local newspaper (my sports medicine column has been printed for over 20 years!). This one is on parenting. I wrote what follows on an airplane ride late last night. It's pretty personal for me so bear with me.

Hey dad.

Did I do it right?

Was I the father to my children that I needed to be?

The father that you tried to prepare me to be?

You may have thought I wasn't paying attention.

After all, I was a teen in the 60's when it seemed the normal thing to question everything your parents told you.

But I was definitely listening.

I was listening when you made me straighten the nails when I built my tree house.

I learned there was a right way and a wrong way to do most things.

I was watching you in your 50's studying math and economics despite not attending school past the sixth grade.

I learned that you never stop learning.

I listened when you told me that even though I might disagree with the war in Vietnam, sometimes you have to do your duty.

I've since become very, very proud that you served our country in World War II.

I listened when you taught me that NOT going to college was not an option.

Being the first in my family to even attend college, I wish I knew how you taught that lesson so incredibly well so that I could teach others.

I imagined you listening to the radio broadcast of my football games. The doctors wouldn't let you go because your heart wasn't strong enough.

You didn't know it, but I always thought you were there with me anyway.

I listened when you told me that marriage was never 50-50 but it probably took me too many years to truly learn that one (or are those first few years always supposed to be hard?).

I listened when you taught me to always be there for my kids by always being there for me.

And now that my kids are grown and I don't always know how to deal with them and I find myself wishing that I could just sit down and ask you some really important questions about being a dad and I can't cause you're not around anymore, I stop and realize...

that if I'm still listening, the lessons are still there.

Love,

Joe

APTA/FSBPT

2005-01-19T16:15:00.000-05:00

I had heard the rumors of a riff.

But I had no idea.

A little background: The Federation of State Boards of Physical Therapy, commonly called The Federation, is an entity you probably know little about. Yet, it is one of the most important organizations in the profession.

Tennessee's own Debbie Ingram, Ed.D., P.T., has been one the principals of The Federation for years, although she has not been active in The Federation for 6 years.

Now, apparently, there is a serious conflict between the American Physical Therapy Association and The Federation. Serious.

You can probably guess that, in my opinion, the APTA goes beyond important to the essential stage. So when two organizations that I so deeply revere are in an obvious conflict, I want to know more.

So I did what 99.99% of America does: I looked it up on the internet. Both organization have position statements in cyberspace.

Rather than espouse my own take on the situation (which is still in diapers), I will simply direct you to sites where you can read more.

I would recommend that you check out the following:

www.fsbpt.org/download/Volume_7_No_1_Newsflash1.pdf

and

www.apta.org/news/news_release/response

I think you will be surprised by the rhetoric.

If you have insight on this issue, let me know. I will print it, refer to it, and/or publish it. Respectful dialogue may not solve all our problems but it is necessary to moving forward on successfully dealing with our problems.

Joe Black, PT, SCS, ATC

New Blog Site Up and Running!

2005-01-18T14:58:00.000-05:00

It finally happend....

I learned enough about a computer to create my on weblog or "blog."

Well, actually, I didn't learn enough about how to use one; I just found a way to create one that even I could do.

Some of you may have read my internet newsletter Rants & Raves. Before that it was Rantings of a Mad Man.

A lot of people didn't get it.

When I started writing Rantings of a Mad Man, I had just returned from a state physical therapy meeting that was a disaster. Terrible attendance. Poor participation. I was, in a word, MAD.

Since I write a lot, I did what came naturally to me: write.

For 20 years, I have written a sports medicine column in the local newspaper. From time to time, I will knock out an article for one of the non-peer reviewed journals/publications.

Rantings of a Mad Man was born. It was wildly popular (if I do say so myself). People all across the great state of Tennessee responded favorably.

We fixed a lot of problems in the state, particularly our state meetings and then it was hard for me to simply be the "angry man," so, at the urging of a friend, I changed the name to Rants & Raves.

Then I got myself elected to the post of Vice President of the Tennessee Physical Therapy Association and a couple of people that I respect asked me to discontinue Rants & Raves.
Big mistake.

People all across the state called to ask what happened to it. It had apparently been a source of great inspiration for some, a source of great discussion in others, and a rallying cry for a few.
Still, I made a promise and Rants & Raves stayed dead.

This is different.

I won't be sending it out unsolicited (actually, I won't be sending it out at all). If you want to see it, you've got to look it up.

I'll have something on here just about every week (oh, I'm not so dedicated that I will be doing it from the Carribean, but I'm pretty dedicated to it). It is my hope that caring Physical Therapists all across the state of Tennessee will put this website on their "favorites" list and check it from time to time.

I don't understand much about it but I do know that a blog has the ability to be updated, changed, and responded to. Responsible responses will be repeated. Garbage will be deep sixed.
I know that not everybody will agree and not everybody will like it but just like its predecessors, I hope this blog will stimulate folks to action.

So, that's it. No meat today but by the end of the week, I'll add some substance. Thoughts that come to mind are the fight between NATA and APTA, the fight between the Federation and APTA, should PT's be on the sidelines of games, what the CMS ruling really means, and where we seem to be heading with regards to direct access in Tennessee.

Stay tuned.

Joe Black, PT, SCS, ATC