ADVANCE Perspective: Physical Therapy : Conference

Maley Lecture Emphasizes Health Care Reform

Elizabeth Puliti — Mon, 15 Jun 2009 14:12:00 GMT

BALTIMORE--On Friday, June 12, Helene M. Fearon, PT, was honored with the 14 th annual Maley Lecture. Since 1996, this lecture has been an integral part of APTA's annual conference. Fearon, a graduate of Marquette University's physical therapy program...(read more)

Identity Heft: What About all Those Credentials?

Lisa Lombardo — Sat, 13 Jun 2009 13:40:00 GMT

BALTIMORE--The promoters of the PT 2009 Second Annual Oxford Debate promised a rocking argumentative good time-and they delivered on Friday June 12 to a packed room of conference attendees who happily hooted and hollered approval or disapproval for their...(read more)

Regulations: Are They a Necessary ‘Evil’?

Lisa Lombardo — Fri, 12 Jun 2009 19:40:00 GMT

BALTIMORE--Do we really need all of the regulations Medicare and the physician fee schedule places on the PT profession-or do the regulations just make practicing PT more cumbersome and confusing? Likely a little bit of both, according to the panelists...(read more)

Female Athletes and the ACL

Elizabeth Puliti — Fri, 12 Jun 2009 19:13:00 GMT

BALTIMORE--In their session this morning, Timothy E. Hewett, PhD, FACSM and Terry Malone, PT, EdD, ATC, FAPTA, discussed how and why female athletes who participate in jumping and pivoting sports are 4 to 6 times more likely to sustain a knee ligament...(read more)

Gingrich Speaks of ‘Challenge for America’

Lisa Lombardo — Thu, 11 Jun 2009 13:48:00 GMT

BALTIMORE--What's the difference 20 years can make? As former Speaker of the House Newt Gingrich pointed out Wednesday night while making the keynote address at PT 2009, one need only look at the Baltimore Inner Harbor. "The area's growth over the past...(read more)

APTA President Challenges PTs and PTAs to ‘See Possibilities’

Lisa Lombardo — Thu, 11 Jun 2009 13:28:00 GMT

BALTIMORE--On Wednesday, June 10, R. Scott Ward, PT, PhD, addressed attendees of PT 2009, welcoming them to the city of Baltimore. "We can look forward to all this historic city has to offer. It is experiencing a true renaissance and APTA is proud to...(read more)

Off to Baltimore!

Lisa Lombardo — Tue, 09 Jun 2009 19:41:00 GMT

The last time I was in Baltimore I was struck by how open and inviting the city was, especially the Inner Harbor area. There was a lot to explore but since I was on a business trip at the time I didn't have a lot of free opportunity to see the town outside...(read more)

Make the Most of PT 2009!

Elizabeth Puliti — Mon, 08 Jun 2009 16:51:00 GMT

Heading to the conference this week? Here are a few don't-miss events from ADVANCE's PT 2009 at-a-glance calendar : Wednesday, June 10, 5:30-7 p.m. Opening Ceremonies PT 2009 kicks off with APTA President R. Scott Ward, PT, PhD, highlighting the advances...(read more)

Don’t Miss the Debates!

Lisa Lombardo — Fri, 05 Jun 2009 14:07:00 GMT

To quote French writer Joseph Joubert, "It is better to debate a question without settling it than to settle a question without debating it." That is definitely the spirit of the two debates held each year at APTA's annual conference. I have had the opportunity...(read more)

Strategies on Combating POPTS

Lisa Lombardo — Wed, 18 Feb 2009 15:09:00 GMT

CSM 2009 Wrap-up: The APTA keeps a watchful eye on the legislative strategies states can use to fight encroachment of physician-owned physical therapy practices (POPTS). But there are other ways to stop what many therapists see as a major cause thwarting the autonomy of the PT profession.

Peter J. McMenamin, PT, MS, OCS, and Brian J. Tovin, PT, DPT, presented "Combating POPTS: Legislative and Non-Legislative Strategies for Every PT" on Wednesday, Feb. 11 at CSM 2009 in Las Vegas.

While the session was well-attended, both speakers expressed concern that it wasn't packed. The profession's ability to combat POPTS through legislative and legal means is directly related to its survival as an autonomous profession, McMenamin said.

"Can PTs have a viable and independent business model as part of Vision 2020?" he asked. "The interest is there-within 8 years we have seen a complete reversal of educational programs in this direction, from 20 percent of programs offering the DPT to 93 percent today. So it is market-driven. Direct access is also making progress, with full direct access in 14 states and provisional DA in 31," he said.

Strategies states are attempting to use to ban POPTS include laws against referral-for-profit (RFP); fee-splitting provisions for owners of practices, and professional corporation law, which is still a theory to deal with POPTS, McMenamin said.

POPTS are banned in South Carolina, Delaware and Missouri. All three states have language in their state practice acts that effectively bans POPTS; in SC, it is illegal for PTs to work for a POPTS. On the other hand, POPTS are deemed legal in Alabama, Tennessee and Rhode Island. McMenamin said in some of these cases, POPTS earned the right to exist in a state's practice act by essentially bartering direct access-physicians in the state backed direct access language in the PT practice act in exchange for the right to own PT practices if they chose.

"Many physicians assume that in states where they are allowed to own a POPTS, it will at some point become illegal, but they are willing to continue owning until that risk becomes reality," he said.

State chapters should never attempt to "go it alone" when developing a plan to eliminate RFPs.

"It has to be a chapter-wide effort, and you have to have your full board committed to it," McMenamin stressed. "Everyone involved must fully understand their practice act implications, and have a war chest to fight with." Other important steps include:

Establishing a POPTS task force;
Developing an educational mission for the chapter to inform about POPTS;
Developing a legal team with a lawyer to work for the chapter;
Creating a lobbying team for the chapter;
Conducting a SWOT analysis on PT autonomy to determine where support against POPTS lies;
Scrutinizing the language in the state practice act on fee-splitting prohibitions, direct access and licensure rules;
Building a base of state private practice PTs who can campaign on fighting POPTS.

The important thing to remember is that the profession still controls its own success, said Dr. Tovin. "Eliminating POPTS would have more of an effect on the profession's control than direct access does," he said.

Driving the Consumer Marketplace for PT

Lisa Lombardo — Wed, 11 Feb 2009 23:33:00 GMT

LAS VEGAS-- As part of the session "Emerging Issues in Medicare, Medicaid and Private Insurance presented Tuesday at CSM 2009, Carmen Elliott, MS, outlined trends in private insurance reimbursement and what PT can do to help itself not lose out in an ever-narrowing window of payment opportunities.

"Consumers are beginning to assume a huge share of the risk for their own health care and providers know it," Elliott said. "They are becoming savvy shoppers for insurance, and they are looking for competitively priced services and quality outcomes."

Conversely, employers are shifting more risks to their employees. More than 60 percent of workers are still covered by health benefits offered by the firm they work for, she said.

Payers are now more likely to raise premiums and reduce medical claims costs where they can. Payers also are emphasizing more consumer-driven products such as high deductible health plans and health savings accounts, she said.

National industry trends show employer-sponsored health insurance is decreasing and that underinsured and uninsured groups are growing.

The result? "The power of consumerism is driving the health care market, especially in this economy," Elliott said. Since they are being asked to pay more out of pocket for their health insurance, consumers will comparison-shop for those who offer the best outcomes for the lowest cost.

There is an impact on physical therapy that the profession must recognize, she said. Opportunities for PT in this economic climate include educating patients on lifestyle changes, contracting directly with employer groups, decreasing reliability with third-party payers if possible, tracking market trend data and payer activity, and stepping up advertising and good marketing.

"Health care is a business whether we like it or not," Elliott said.

Assessing PT Market Demand

Elizabeth Puliti — Wed, 11 Feb 2009 23:30:00 GMT

LAS VEGAS-- In PT - Who Needs It? Exposing & Forecasting Market Demand for Physical Therapy Services, Lynn Steffes, PT, and Bridget Morehouse, MPT, MBA, spoke with PTs on how to accurately assess the market.

"We are facing tremendous economic uncertainty. Fear of the unknown is the greatest fear businesses and the greater population faces," said Steffes.

In this new economy, uninsured people will become insured through government plans. PTs need to think about what that means to their business, she added.

"Suddenly, the way we practice clinically is affected by the economy. What can we do to be proactive?" Steffes asked the audience.

Responses consisted of: having sales on services, extending practice hours, advertising businesses and bundling services. Some practices that are really struggling are getting by through contracting their services to another area, such as outpatient services.

Steffes advised PTs to look at market demographics and ask themselves what these demographics say. "Census data is available to you and you should be looking at it."

Morehouse stated that private practices have an advantage in this current economy. There's change in the market and private practices are agile, she noted.

It's a good idea to collect competitor information and market trends. One way PTs can do this is through identifying all "alternatives" to physical therapy. "PTs tend to look at competitors as only other PT practices," said Steffes, "but people who are paying out of pocket might use massage therapy because they understand what massage therapy is, it's it has a perception of being less expensive and they can control how many times they go."

Literature shows that the quicker patients have access to physical therapy, the quicker they get better. Therefore, "we have to stop clinging to the past and start thinking of proactive solutions," to get patients in the door, Steffes said.

Leading the Way

Brian Ferrie — Wed, 11 Feb 2009 19:12:00 GMT

LAS VEGAS--As this profession seeks to enhance its recognition in the health care field, it is important for PTs and PTAs nationwide to step to the forefront and spread the word about why physical therapy matters and is effective. So "Revving Your Leadership Engine" represented one of the more intriguing educational sessions offered here in Sin City on Tuesday.

Presented by Janet Beznar, PT, PhD, Z. Annette Iglarsh, PT, PhD, and Jennifer Wilson, PT, MBA, the session drew a full crowd of PT professionals, including many who already held some type of leadership position at their respective clinics or facilities. To open the presentation, Wilson stated, "We'd really like to talk to you about the differences between management and leadership."

One of the main distinctions is that managers tend to focus their efforts inward, while leaders often focus outward, she noted. Leaders need to retain core values while constantly questioning the methods by which those values are achieved, added Dr. Beznar.

"It's not always easy to question fundamental things about our organizations, but it is necessary," she explained.

Furthermore, leadership is an ongoing and evolving process, related Dr. Iglarsh.

"Leadership has to take place every day," she said. "You are constantly growing as a leader.'

Full coverage of this educational session so pertinent to the future of the profession will be provided in a future issue of ADVANCE!

Medicare and Private Insurance: They’ve Got Issues

Lisa Lombardo — Wed, 11 Feb 2009 15:31:00 GMT

LAS VEGAS--It was a lot of ground to cover in just an hour and 45 minutes. Gayle Lee, JD, Roshunda Drummond-Dye, Esq., and Carmen Elliott, MS, presented "Emerging Issues in Medicare, Medicaid and Private Insurance on Tuesday at CSM 2009 in Las Vegas.

Lee first addressed the pending changes to the Centers for Medicare and Medicaid Services, which are somewhat on hold due to leadership issues. "Activities at CMS and HHS are obviously suspended because we still do not have a Secretary of Health chosen," Lee said, referring to the recent withdrawal of former Senator Tom Dashle from consideration for the position.
"It has been determined that the current payment system for health care is just not sustainable," she said. "According to new projections Medicare will now become insolvent by the year 2016, not 2019 as previously predicted. So it is clear CMS is looking at payment systems with an eye for change."

Lee noted that of the $4.07 billion paid out in outpatient therapy services in CY 2006, PT services accounted for 75 percent of that amount. In fact, after a low of outpatient PT expenditures in 1999 following the institution of the cap on outpatient therapy, PT payouts rebounded with gains each year up until 2006, she pointed out.

"CY 2000 also saw a major growth in PTs in private practice according to payments," Lee said. "That is why it is important for us to explain our importance to policy makers in this area."

One thing that has helped is a marked decrease in paid claims in error rates to Medicare. The reduction is largely due to more education on the matter, she said. The biggest problem was insufficient documentation on timed codes and missing certifications when PTs billed Medicare. The drop in errors has helped keep costs down and successful claims going up.

Lee also touched on the status of the fee schedule, and feels Congressional action will take place to keep the physician fee schedule from enduring more cuts. "We can't imagine such a drastic amount would be allowed to take effect," she said. At the current rate, by 2015 Medicare would see a 40 percent drop in payments if action is not taken on the Sustainable Growth Rate formula used to calculate the fee schedule.

On the therapy cap, Lee noted that APTA is involved with two studies, one short-term and one long-term, on how CMS can identify alternatives to the Medicare cap on outpatient therapy. Data has yet to be gathered on either study but Lee said that depending on the results, "we could see something radically different from what we have now." Currently the cap is set at $1,840 for OT services and $1,840 for PT and speech therapy combined.

For more information on where the cap stands, the physician fee schedule and what APTA is doing to lobby Congress on both issues check our coverage of the current political topics forum during our CSM conference coverage.

Medicaid is facing its own challenges to implement changes, Drummond-Dye said. She touched on some actions that would improve PT coverage and reimbursement under Medicaid, including establishing PT as a mandated health benefit under the Medicaid and State Children's health Insurance Program (s-CHIP); creating minimum documentation requirements for PT services; mandating federal definitions of "qualified providers of PT services;" and ensuring proper reimbursement rates for PT services in each state.

Generational Diversity: Year 2020 Is Coming

Lisa Lombardo — Wed, 11 Feb 2009 01:38:00 GMT

LAS VEGAS--Do PTs comprehend the times as they are a'changin?

Sooner or later the change hits every clinician with a job in PT: There is a big difference in how therapists of different generations see their values and goals on the job.

Heidi Dunfee, PT, DScPT, CCCE, explored strategies and solutions to promoting generational diversity in the workplace. She and a panel of PTs presented "How Are You Leveraging Your Generational Diversity for the Year 2020? on Tuesday at CSM.

Dr. Dunfee shared the panel with Peggy Blake Gleeson, PT, PhD, Teri Stumbo, PT, MS, Alecia Helbing Thiele, PT, DPT, MSEd, ATC/L.

"PTs need to consider what their own core values are, what their top three generic abilities are and what skills and personal traits are most important in guiding them in the workplace," Dr. Dunfee said. "Generational differences often [yield] differing views of generic abilities and values on the job."

The first step is for many PT managers to ask themselves three simple questions: What do we do here? What is your job? What is our mission?

PTs should recognize that those of an older age range could see the core values and necessary abilities in a different light than younger counterparts, she said. This applies to both the clinical environment and at the educational level.

With such a broad range of ages among professional clinical PTs, educators will soon realize how outlooks on the way newer PTs approach their careers can affect how clinics operate.

The topic was interesting to this PT outsider because it would seem this kind of generational gap occurs in most fields. But I have noticed that physical therapy, to its credit, spans a wide swath of age ranges; many are young yes, but there are a lot of baby boomer-age PTs and PTAs still working at the clinical level, many at non-managerial positions. They are often the ones working alongside the "new" generation of clinicians. No matter how tightly honed a staff, conflicts among traditional workers and novices to the profession are bound to happen.

So what do PTs think? Do changing outlooks toward managerial skills and on-the-job values affect how PTs are educated today? How will changing approaches impact Vision 202 for educators and current managers?