The Physical Therapist Workforce & Patient Access Act has been introduced in Congress for the past five legislative sessions and, this spring, was finally referred to committee.
The act authorizes physical therapists to participate in the National Health Service Corps (NHSC) Loan Repayment Program, thereby including rehabilitative care in the federal program.
According to Monica Herr, senior congressional affairs specialist for the American Physical Therapy Association (APTA), the last time the NHSC was reorganized in 2008, its committee language introduced the possibility of extending benefits to other providers, including physical therapists.
If signed into law, more than 10 million underserved individuals in rural and underserved urban areas would have improved access to physical therapy care, Herr explained. At the same time, physical therapists would be incentivized for their two-year commitment with a $60,000 student loan forgiveness stipend. After working in a federal health service corps site for six years, participants may apply for $140,000 in loan forgiveness.
Clearly, the loan forgiveness would take a huge financial burden off the shoulders of physical therapists. The average student loan debt is $83,138, according to a 2011 survey by APTA. Repayment options for medical students' service in inner cities or rural areas have historically lessened both the student burden and the access gap. Proponents are hoping the same formula can be applied for PT, simultaneously elevating the profession's stature.
"Based on current trends in the physical therapy workforce, the shortage could reach 400,000 by 2020 when you account for the Affordable Care Act," stated Herr. "This program is just a first step in increasing our workforce. If physical therapists are deemed part of the primary care team, it goes to show that more funding should be allocated to physical therapy."
Primary Care Leadership
Adding PTs to the list of covered providers would address a growing community need. Physical therapists in underserved communities often find themselves as their patients' gateway to the health system.
James Spencer, PT, DPT, OCS, CSCS, encounters patients with access issues every day in his work as a traveling PT in Colorado. He recalled one 80-year old man who had been "kicked around the system for two years with tests before being referred to a PT" to slow his decline in balance and motor skills. In just six weeks with Spencer, the patient eliminated the cane.
"I think the real success story of this man's care was my ability, as a therapist, to observe him over time, realize he was having progressive difficulties in swallowing safely, and make a referral to a speech-language pathologist," Spencer recalled.
Assisting in the collaboration of care between therapists, doctors and case managers is one of the most challenging and humbling parts of the job for Colleen Sullivan, PT, DPT, at Magee Riverfront, an outpatient center of Magee Rehabilitation in Philadelphia.
"When you have a post-stroke patient with high risk factors, we're constantly monitoring blood pressure," she said. "If it's elevating and they're showing symptoms of another stroke, we refer them out. We have patients who come in with a change in speech, weakness in one side or a headache. We instantly send them along to the ED rather than back to their doctor and then to the ED. It takes a step out of the long bureaucratic process."
Because of the move toward doctorate-level entry for PTs, it's logical that they should be used as a primary care point of access, rationalized Sullivan. Additionally, employing PTs in the gatekeeper role can hold insurance costs down, as they can often spot potential problems early on, she said.
Sicker Patient Populations
Though the demographics are different, patients' health issues in rural and urban underserved communities are remarkably similar.
For Colleen Sullivan, PT, DPT (pictured above with patient Dane Walker Sr. of New Jersey), including physical therapists in the National Health Service Corps would go a long way toward reaching inner-city patients with diabetes, stroke, spinal cord injury and TBI. "The bill makes sense," said Sullivan, physical therapist at Magee Rehabilitation in Philadelphia, since many students would like to treat in urban and rural areas after graduation, but are often forced to take more lucrative offers elsewhere in order to pay down hefty tuition debt.
"In rural areas, there's an access issue created by lack of practitioners," explained Spencer. "An access issue is also present in inner cities because of an excess of patients. "
In rural areas, where logistics prevent patients from visiting the doctor very frequently, Spencer encounters a large contingent of patients with diabetes. Diabetes is prevalent in cities as well, as are other neurological chronic conditions such as stroke, spinal cord injury, and traumatic brain injury.
For Sullivan, complications lie not in the diagnosis, but in the correlating social conditions in her facility in Philadelphia.
"Patients may not have a home caregiver or the financial means to procure a wheelchair or assistive device," she explained. "Their medication management has been poor up until now, and there's a lot of bureaucratic hoopla in terms of transportation to a doctor's office. They're not safe at home because their equipment isn't right and, if their meds aren't properly managed, it can be exemplified in their functional capacity."
The issue of inadequate medical equipment prompted Magee to offer a free care service for patients with limited means for safe care and walking devices. Former patients donate used equipment, and the state's Office of Vocational Rehabilitation provides funding for walkers and other equipment to approximately 10-15% of Magee's patient population.
Spencer likened his work to home care, in which he served a stint. "You go into their home without the support of other disciplines," he said.
Reversal of 'Brain Drain'
Many PTs who find themselves in remote areas or inner cities after graduation become attached to the care coordination role. Sullivan often encounters PT students enthusiastic about their work in student-run or pro bono clinics in Philadelphia.
"With the wave of pop-up pro bono clinics and the insurgence of urban-based PT schools, the bill makes sense," she said. "These students want to stay in urban areas, but can't always afford to because they have to take more lucrative offers to pay down their debt from PT programs."
One of the aims of the PT Workforce and Patient Care Act is to connect the idealism of young professionals with the needs of at-risk communities. According to Herr, the short-term (less than 10-year) retention rate for other disciplines in the National Health Service Corps was 82% in 2012.
Passage of the act could reverse the infamous "brain drain," whereby the best and brightest youngsters leave their hometown to pursue higher-paying positions in large metro areas.
In her position on the APTA student assembly board of directors from 2010-2012, Sullivan met many Midwestern students hoping to return to practice in their hometown. When one of them explained the bill and its implications to his Iowa senator, the senator mentioned his own mother's 3-hour commute to her PT sessions and immediately endorsed the measure.
Similar hospital-based loan repayment programs in Alaska have met with success, said Spencer. While some students only stay for the required 2 years, many have remained in the state for decades.
But patients benefit most of all, said Sullivan. She speculates that more PTs would help handle the current influx of highly complex patients and allow more one-on-one time during patient visits.
"I'll always remember a patient with a spinal cord injury who couldn't explain what happened to her," she said. "Nobody had ever explained the anatomy of a spinal cord injury to her. All it took was 15 minutes to describe the spine model and why she couldn't walk. I felt so empowered to be the one to educate somebody who'd been so defeated by the current system."
Robin Hocevar is senior regional editor at ADVANCE. Contact: http://firstname.lastname@example.org
OTs in the National Health Service Corps
On March 7, 2013, the Occupational Therapy in Mental Health Act (H.R. 1037) was re-introduced to the 113th Congress. The act would "Amend the Public Health Service Act to include Occupational Therapists as Behavioral and Mental Health Professionals for purposes of the National Health Service Corps."
The National Health Service Corps was established in 1972 to bring health care to the underserved and people with limited access to healthcare, such as those in inner cities and rural areas. Members of the NHSC include primary medical care, dental, and behavioral and mental health practitioners who provide services to those in need. Through the NHSC, providers receive scholarships and loan forgiveness benefits in return for a commitment to serve in the Corps for at least two years.
If this bill were to pass, occupational therapists would be eligible for loan forgiveness in return for practicing at least two years in mental health with the underserved.
The aim of H.R. 1037 is to include occupational therapy under the definition of "behavioral and mental health professional" for the NHSC. H.R. 1037 would increase occupational therapy's visibility and recognition through participation in this federal program as a behavioral and mental health profession, and would encourage more OTs to pursue mental health practice.
The original bill (H.R. 3762) presented in December 2011 did not pass at the close of Congress. On March 7, 2013, Rep. Paul Tonko (D-N.Y.) re-introduced the bill as H.R. 1037. The bill was referred to the Committee on Energy and Commerce.
OTs need advocacy for the bill to pass. Visit http://capwiz.com/aota/issues/alert/?alertid=62482651 to learn more about the bill and how to support it.
Lisa Ann Olsen, OTR/L, is a practicing OT in California and an OTD student at Creighton University.