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ADVANCE Perspective: Physical Therapy & Rehab Medicine

PT 2012: Politics of PT

Published June 7, 2012 4:28 PM by Lisa Lombardo

Tampa-June 7, 2012--The City of Tampa is becoming one of the most vital cities to decide what happens in nationwide politics in the upcoming election. Not only will the city be the site of the Republican National Convention in August, but here's a bit of political trivia: Tampa as a city has voted for the president in all but one of the past 20 presidential elections. I'd say their vote counts!

It's making a difference too in hosting PT 2012. One of the major themes of this year's conference is the upcoming elections, and what the results will mean for the PT profession and for the advocates who push therapy concerns to the forefront on the Hill.

Mandy Frohlich, senior director of government affairs, and Michael Hurlburt, senior specialist of Congressional affairs for APTA, led a thorough discussion about it on Thursday at the conference, touching on the most important issues related to current and future public policy.

Both acknowledged the political climate in Washington was "terrible" as Hurlburt pointed out, as partisanship has increased following a 20-percent flip in Congress, bringing in new freshman representatives who need to be educated on the issues that concern APTA most. "Both chambers are pretty split down the middle, and it's rare to get agreement on the issues," he said. "The budget environment overrides everything else. All are in agreement only that cutting the deficit and putting the U.S. on a better fiscal path to affect the economy is the most key issue."

Issue 1: The Cap

And though many think the PT profession is far removed from any budget wrangling, according to Hurlburt the big concern is Medicare cuts across the board for all providers, and costs associated with any cap repeal legislation-something APTA has been advocating for since 1997.  The cap remains at $1,880 for PT and speech therapy combined, and $1,880 for OT. "All this budget fighting is resulting in fewer members of Congress being willing to back repeal, as it carries a high cost; at this point any bills with budget impact are rarely considered. It's an uphill battle to get cosponsors."

Frohlich said the estimated cost of a total cap repeal would fall around $10 billion-obviously too large a number for any representative to want to get behind. "Right now we are working with a 3-month extension until Feb. 2013," he said.

Some good news that might bode well for the future once the elections are over and should the budget inch closer to balance: Congress did pass a 10-month revised exceptions process extension through Dec. 31, 2012-one of only very few Medicare extenders measures considered for legislation. "Congress does know how important this issue is to be addressed," Hurlburt said.

MedPAC continues to follow this process, preparing a report to Congress on how to improve the outpatient therapy benefit overall. Hurlburt added that there is some comfort: many of APTA's "champions", i.e., sponsors of the legislation, are considered "safe", but the proposal has 22 co-sponsors who might be in trouble come election time.

Issue 2: Direct Access

The Center for Medicare and Medicaid Services (CMS) have implemented a study on medical innovation to evaluate models of care that don't require a physician referral-and PT has been cited as a prime example for this study, Frohlich said. "We've sort of hit a wall with advancing Medicare direct access," she said, "so we are pushing for other ways to advance the issue. One is looking at a federal employees' health benefits plan, which is consumer-driven and serves 9 million federal employees, retirees and families." Around 250 private insurance plans participate and APTA is proposing to ask Congress to make direct access a benchmark to offering coverage, she said. "We're trying to get a sponsor to introduce it this year, but it is still and education process for Congress members unfamiliar with the issue. We expect this will come at a minimal cost which will help."

Remaining Visible

For these and other advocacy issue still dependent on Congressional support, now more than ever the PT profession needs a seat at the table. "If we don't continue to be engaged, we will lose momentum," Frohlich said. "We have a great presence on the Hill, and we rely on grass roots efforts from you, leaning on your representatives locally to push things forward-that's even more important than our presence in Washington."

She said physical therapists can learn how to get more involved through PTeam, at


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