APTA gathers in Philadelphia for annual meeting

By Lauren Fritsky

Philadelphia. It's home to Independence Hall, the Liberty Bell and the National Constitution Center. It's the place where American government took root centuries ago. So it was fitting the American Physical Therapy Association chose to host its annual State Policy and Payment Forum in Philadelphia, Sept. 21-23. Members from each state gathered to discuss legislative issues, professional challenges and plans for moving the profession forward.

The event started with a general picture of the current state of government, painted by Dave Mason, APTA's vice president of government and payment advocacy. The fact that it's a presidential election year means Congress probably won't move to pass much legislation in the remaining months of 2008, Mason explained. Whichever candidate wins the election, the APTA believes health care reform will remain at the forefront well into the next administration.

"The threat of gridlock that we've seen over the last few sessions will still be there," Mason said. "The need for bipartisan support is really going to be essential in moving our agenda forward."

The APTA has spent the last 18 months restructuring its advocacy unit. Changes include keeping state government affairs and grassroots advocacy as separate components and adding federal agencies not directly related to payment policy to the federal government affairs section. The association also adopted its strategic plan in July. It aims to focus on access to and payment for services, education, public identity and recognition, research and standards for practice.

State Payment and Policy Updates

In addition to the presidential election, 44 state legislatures are holding competitions this fall and how each one is decided may ultimately affect how the APTA proceeds in its agenda.

"Changes in political party control could mean new leadership on committees that are responsible for legislation impacting physical therapists," said Angela Chasteen, assistant director, APTA state government affairs.

APTA's mission in the state house remains focused on limitations related to direct access; referral for profit/POPTS; protection from infringement; practice act modernization and payment issues. There are resources available to chapters regarding these issues, including direct access grants, which allot a group up to $7,500, and tools for grassroots campaigns.

Roshunda Drummond-Dye, associate director of federal regulatory affairs, gave updates on the Centers for Medicare and Medicaid Services. Current CMS efforts related to therapy focus on:

• Developing an alternative payment system for outpatient therapy;

• Creating a post-acute care assessment tool (called CARE) to identify whether patients should be placed in skilled nursing facilities, home health or inpatient rehabilitation facilities;

• Identifying quality measures for pay-for-performance;

• Establishing more uniform policies for Medicare Part A and B services;

• Changing the SNF PPS system;

• Looking at recently granted exemptions for PTs from Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) accreditation requirements;

• Exploring rulemaking regarding orthotics and prosthetics.

Carmen Elliott, associate director of private payment policy and advocacy, gave updates on private payment initiatives. APTA's mission in payment policy and advocacy involves focusing on payment policies developed and implemented by commercial payers.

APTA is currently generating reconsideration requests on payment and coverage policies that negatively impact physical therapy services. There are resources available to chapters regarding payment issues, including state insurance forum grants, which encourage individual state chapters to meet with payers on a local level and advocate for services provided by physical therapists.

Life After Direct Access

In addition to providing general issue updates, the forum also included presentations on how chapters can achieve certain goals. For instance, Anthony DiFilippo, PT, of the Ohio chapter, discussed how chapters can educate PTs, consumers and other groups about direct access.

"We work so hard to get direct access. It's sort of the end goal," he said. "I think it's really the first step."

Ohio got direct access in 2004. Afterward, the chapter focused on educating physical therapists on how to use it while remaining legal. They reached out in three ways: a blast e-mail campaign, semi-annual conference programming and a road show. Through the e-mail campaign, the chapter included parts of the legislation addressing the five-day rule, prior diagnosis, fitness and other areas. At the semi-annual conference, members went over the legislation line by line and gave scenarios on how to apply it in different practice settings. The road shows involved going to all six state districts and rehashing information from the semi-annual conference.

DiFilippo's chapter hired a public relations firm to get the message on television and in newspapers and formed its own PR committee to funnel information on direct access to consumers. The chapter set up a separate page on the Website with a "find a PT" link, established a booth and sponsored a race at the Ohio State Fair and created community event kits.

Other populations they connected with included third-party payers, with whom they set up face-to-face meetings; facilities and PT students. Tools for other chapters looking to get the word out about direct access can consider APTA's component community awareness grant, news release template and branding campaign tools.

Continued Competence in the States

Marilyn Phillips, MS, PT, CAE, director of APTA professional development, quoted the Josiah Macy Foundation report on Continuing Education in the Health Professions: "Continuing education of health professionals is essential, yet continuing education is in disarray."

"We truly are in disarray in terms of the systems that are used, the terminology used, the number of hours required," she added. "I understand the need for states to have their own rules and prerogatives. But the underlying goal for all is the same."

That goal, to assure the public of competent PTs and PTAs, requires health care professionals to have access to diverse options for life-learning. CE offerings should be based on evidence and include some form of learner assessment, the speaker said.

The Macy report emphasizes the need to collaborate and to simplify and unify the CE reporting and tracking processes, while expanding the needed research base and use of technology. The APTA recently launched a learning center in September that includes a content and learning management system providing access to continuing education offerings 24 hours a day, seven days a week.

New CE offerings on professionalism and documentation are available as well as 30 other online courses. This new system provides on-demand CEU certificates after successful completion of a test and a transcript of APTA-provided online courses.

The association next plans to expand CE offerings to blended learning formats, including distance learning and live courses with social networking. APTA also offers other professional development options including the credentialing of residency and fellowship programs, specialist certification, Advanced Clinical Practice (ACP) courses, CD-ROMs on current topics and the awarding of PTA Recognition for Advanced Proficiency.

Susan Layton, vice president of the Federation of State Boards of Physical Therapy, said her organization has begun implementing several tools to assess competence. One is the practice review tool, launched in July, which lets therapists compare themselves to entry-level PTs. By answering 125 questions, therapists get feedback in 10 categories. The general practice questionnaire is currently live, with pediatric, orthopedic, geriatrics, acute care and neurology to be added in the next four years.

"You can get data and plan your continuing education to meet those objectives," Layton said.

The federation is also offering jurisprudence exams and establishing a portal to solicit input from licensees, employers and vendors.

Geraldine M. Gryzbek, PT, GCS, president of the Pennsylvania chapter, and Paul J. Welk, JD, PT, PA APTA legal counsel/lobbyist, explained how they managed to change their state practice act for the first time since 1985. Starting the process involved both short- and long-term preparation.

Part of the short-term efforts the PA APTA undertook included forming a task force and reviewing the former practice act to make recommendations to the chapter's board of directors. The task force wanted to stress that the aim of updating the document centered on administrative changes, not scope of practice. Long-term preparation included reviewing legislative process, figuring out how much money and time was needed and identifying key state legislators who could support the chapter's cause.

"Identify those leaders you're going to have to deal with, and build relationships with them," Welk said.

Other things the Pennsylvania chapter considered included identifying other parties of interest, such as the state medical society, and evaluating the legislative environment of the state. For instance, Pennsylvania's governor had introduced a provision calling for health care professionals to be able to do everything in their scope of practice. "That was sort of the overlying umbrella we went into," Welk said.

Gryzbek and Welk gave these tips for revising your state's practice act:

• Familiarize your chapter with the APTA's resources;

• Be aware of chapter and APTA policies and positions;

• Work with the Federation of State Boards of Physical Therapy;

• Bargain in good faith with outside interest groups;

• Choose lobbyists that share a passion for the profession;

• Assist legislators with issues important to them, as well as to your chapter.

For more information on the issues discussed at the forum, visit www.apta.org

Lauren Fritsky is assistant editor at ADVANCE and can be reached at lfritsky@advanceweb.com