Chapter News

Corporate Practice of Medicine

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Update on Corporate Practice of Medicine

by Ellen Caruso, Executive Director

The Executive Director of the Colorado Department of Regulatory Agencies (DORA) issued a directive late last year to the state’s health professional licensing boards and advisory committees stating that Colorado statutes concerning the corporate practice of medicine will be “evenly and strictly” enforced.

“As your know, the corporate practice of medicine doctrine prohibits in most cases the corporate commercial ownership of health care practices or the employment of health care practitioners by corporations,” Rick O’Donnell said in his memo. The memo begins with an acknowledgement that there may have been uneven enforcement of violations of the corporate practice of medicine doctrine by the various boards.

O’Donnell’s directive followed his meeting with representatives of professional associations representing physical therapists, optometrists, dentists, medical doctors, mental health professionals, podiatrists and chiropractors. The meeting was convened by the associations in an effort to clarify the department’s stance and consistency in regards to the state’s corporate practice statutes in light of a disciplinary warning / action by DORA against a small rural Colorado rehab clinic and its owners and employees. 

See September 16, 2003, issue of Colorado PT e-bulletin at http://www.aptaco.org/practice/bulletin_0903.htm

O’Donnell reminds board members and DORA staff in the memo that “our task is to enforce the law as promulgated by the General Assembly. While some board members and health care practitioners may believe that the corporate practice of medicine doctrine hinders consumer choice and restricts accessibility to affordable care in the modern economy, until the General Assembly changes the law we are required to strictly enforce the corporate practice prohibition.”

DORA staff later told the Colorado Chapter that if a complaint was received, there would be no exceptions or exemptions made for hospitals or other types of facilities, regardless of licensure, certification or oversight by the state.

Following receipt of this memo and after a thorough investigation and discussion of the PT and corporate practice of medicine statutes in Colorado and numerous other states, the APTA / Colorado Chapter Government Affairs Committee recommended to the Board of Directors that the Chapter not initiate legislation on this issue at this time. The Chapter will continue to monitor carefully any other groups’ legislative proposals related to Corporate Practice. The committee advises Chapter members so interested to review their own corporate status and if necessary clarify compliance with state law by obtaining legal advice from a health care attorney familiar with the corporate organization of health care facilities and organizations.

Members wanting to learn more about this issue and other corporate compliance issues should tune in to the Lunch & Learn audio-conference on Wednesday, March 24^th, presented by Greg Smith, Esq., who serves as general counsel to the Colorado Chapter and numerous PT and medical practices in Colorado

Click here to link to the Colorado PT Practice Act (Corporate Practice Section 12-41-124, C.R.S. at http://www.dora.state.co.us/physical-therapy/PTact.html,

Click here to link to the Colorado statute that addresses Provider Networks, Section 6-18-301 to 304, CRS at http://198.187.128.12/colorado/lpext.dll?f=templates&fn=fs-main.htm&2.0  

9Health Fair is PT's Best PR Opportunity!

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The 9Health Fair is the Physical Therapist's best public relations opportunity!

The Colorado Chapter’s longest standing state-wide PR project is scheduled for April 17-25, 2004. Over the past 20 years, APTA members have volunteered their time to provide the Body in Balance© screen to thousands of visitors to the very popular and successful

9Health Fair. APTA was one of the first health care organizations to develop a screen and protocol and is now one of 11 official 9Health Care partners that receive recognition in 9Health Fair publicity and publications and by 9News.

In encouraging APTA members to volunteer for the 9Health Fair, APTA Colorado Chapter President Audrey Waldron, PT, said “With health care changing faster than at any time in history, physical therapists and our physical therapy facilities need to be out front educating the public on what physical therapy is and what we do. If we want to keep our profession, our careers and our jobs, WE must let people know how and where we, as physical therapy professionals, fit in the emerging and ever-changing health care system.”

One great way to accomplish this is to volunteer!
For details and to sign-up, click:
http://www.aptaco.org/events/9health.htm

Denver Metro area PTs who interesting in educating 9Health Fair participants about urinary incontinence should indicate this interest on their volunteer form. Your interest will be forwarded to the organizing committee.  

Plan to Attend!   www.aptaco.org

April 17

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 Education Programs on Tap:

“Diagnosis and Treatment of Movement Impairment Syndromes, Level II and III, Lower Quarter” on February 21 &22, 2004, at CU PT School presented by Suzy L., Cornbleet, PT, MA, PT Program, Washington University School of Medicine, St. Louis, Mo.   
http://www.aptaco.org/events/2004/MSB_level2.htm

“Insurance Laws and Regulations Have Changed” Audio-Conference on February 25, 2004, presented by Doug Dean, Colorado Insurance Commissioner  http://www.aptaco.org/events/2004/insurance_audio.htm 

“Corporate Compliance” Audio-Conference on March 24, 2004, presented by Gregory J. Smith, Esq., Colorado Chapter General Counsel.
(registration form to be posted) 

APTA/Colorado Chapter 34^th Annual Spring Convention & PT Exhibition, April 17, 2004, Regis University 

(registration form to be posted)

 http://www.aptaco.org/events/2004/convention_schedule.htm

“Integrating High Velocity Techniques in Patients with Chronic Low Back Pain” presented by Timothy W. Flynn, PT, PhD, OCS, FAAOMPT and Tim Noteboom, PT, PhD, SCS, ATC, Associate Professors, Dept. of Physical Therapy, Regis University, Denver

“How to Appeal Denied Claims and Other Reimbursement Issues” presented by Susan Villageliu, PT, JD, American Physical Therapy Association, Alexandria, Va.

“Outstanding Physical Therapist Lecture” by Elizabeth (Libby) Pettit, PT, Roaring Fork Physical Therapy, Basalt

Order These
Items
Today

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Two Important Forms Now Available

http://www.aptaco.org/products/consent-payinfo.pdf

“Consent to Physical Therapy Treatment” (recently revised)
 

“Payment Information” (developed since auto insurance changed from No-Fault to Tort)

Two Important Recordings in Tape or CD Format:

http://www.aptaco.org/products/products.htm

“Auto Insurance Has Changed from No-Fault to Fault-Based, Tort System” – June 11, 2004
 

“Medicare News for the PT Professional” by Nancy Garland, former Director of Government Relations, APTA – August 28, 2003

National
News 

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Congress Approves Study on Medicare Direct Access, Suspends Therapy Cap and Increases Payment Rates to PTs

As part of the Medicare Prescription Drug and Improvement Act (HR 1) passed by Congress on November 25^th, the Medicare Payment Advisory Committee (MedPAC) will conduct a study in 2004 to determine the feasibility and advisability of providing Medicare beneficiaries with direct access to physical therapists. MedPAC’s report to Congress could boost APTA’s ongoing efforts to enact the Medicare Patient Access to Physical Therapists Act (HR 792/S 493). Visit www.apta.org for more information about the Medicare direct access legislation, which is currently endorsed by 131 congressional representatives and 12 senators. Colorado Rep. Marilyn Musgrave (R-4) and Rep. Tom Tancredo (R-6) have signed on as sponsors of HR 792.

Also as a result of HR 1, the Centers for Medicare and Medicaid Services (CMS) issued a program transmittal instructing Medicare contractors to immediately suspend enforcement of the $1,590 Medicare therapy cap. Under the provisions of the Medicare legislation signed into law last year, the cap was lifted upon enactment of the bill, and the moratorium blocking enforcement will remain in place through December 31, 2005

HR 1 brought more good news to Physical therapists and other providers paid under the Medicare Part B fee schedule who will receive a 1.5% increase in 2004 under revised final regulations released December 31 by the Centers for Medicare and Medicaid Services (CMS). The new payment rates became effective January 1. Thanks to provisions advocated by APTA and other provider associations, the final rule reflects action taken by Congress in passing the Medicare Prescription Drug, Improvement, and Modernization Act (HR 1) to prevent a scheduled 4.5% cut in 2004 payments.

Medicare
Fee
Calculator

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Medicare Fee Calculator Updated for 2004

Keep current with APTA. The Medicare Fee Calculator at http://www.apta.org/Govt_Affairs/regulatory/Medicare/Medicare_Fee_
Calculator on APTA's Web site reflects the final Medicare fee schedule rule that was released following the enactment of the Medicare Prescription Drug, Improvement, and Modernization Act (HR 1). The legislation not only increased the conversion factor but made a number of changes in geographic practice cost indices and other values. The calculator is for members only. APTA is the first to have this updated calculator available. Questions or comments about the calculator or the fee schedule can be address to Dave Mason at davemason@apta.org or at ext 3160.

Chapter Focuses

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COAPTA News . . . President’s Report

Chapter Focuses
On the Future of PT and 
Its Unique Body of Knowledge
By Audrey Waldron, PT

The end of the year always seems to be a time of reflection.  As I look back upon this past year, I am proud of what has been accomplished in the Colorado Chapter APTA, as well as what is being done on a National level to promote the profession of physical therapy and to meet the needs of the members of the American Physical Therapy Association. 

First and foremost our attention needs to focus on what has occurred here in Colorado.  We embarked upon the year in hopes of redesigning our vision for the future of the physical therapy profession in Colorado and by establishing a strategic plan to reach our vision. This was an exciting process as this is an exciting time for our profession.   

As life evolves, so does the profession of physical therapy. The Colorado Chapter has been establishing and revising strategic plans for our state since 1987 when we held our first Strategic Planning session in Silver Creek. This year we were able to build from past visionary plans for Colorado and the National APTA’s Vision 2020.

During the past six months and throughout the next six years the Colorado Chapter APTA will focus on the following areas:

PROVIDING DIRECTION: (will provide clear direction for PT in Colorado; facilitate discussions and strategies related to APTA Vision 2020; capitalize on and promote the APTA vision 2020, as well as its own, and will motivate PT’s to be aware that “PT is rising!.”)

PARTICIPATING IN GOVERNMENTAL AFFAIRS:  (will be strong, proactive and present in all legislative and regulatory arenas within Colorado; maintain an extensive legislative network, with members assigned to liaison with their legislators on behalf of PT, and will mentor and encourage more PT professionals to be involved in the political process)

PROVIDING AND MAINTAINING A RAPID INFORMATION SYSTEM: (will develop a progressive and rapid information management system;       maintain a website that is the best resource for our member, provides information, promotes the profession, provides links to  research and sources for clinical trials, and educates the public about PT)

LEADING IN EMBRACING EVIDENCE: (will be the leader in embracing and endorsing evidence as the basis for clinical decisions; promote evidence-based research; make access to evidence-based research; make access to evidenced-based research easy through its web site and linking tools, and will coordinate and participate in specific research projects)

GUIDING ALL IN AUTONOMOUS PRACTICE: (will guide members in understanding and implementing autonomous PT practice; bring PTs together for instruction and the creation of a PT community; point the way to venue options or pathways to advanced education, and will make strides in the achievement of chapter-approved, mandatory CEUs)

CULTIVATING LEADERSHIP: (will promote leadership and will develop its leaders; allow opportunities for older members to mentor the young and its younger members will be encouraged to mentor the old)

SPREADING THE WORD: (will encourage all to spread the word!; all PTs will work together to promote direct access and the value of PT; PTs in institutional settings will consider themselves a specialty department, ensuring PT controlled patient care)

ENSURING PT’S ARE PRESENT AND VISIBLE: (will be present at health fairs and any venue that provides exposure to the profession and will increase the perceived value of physical therapy services)

It will be imperative that each and every PT assist the Chapter in accomplishing this vision. It is imperative that PTs feel good about their contributions and communicate their value to the public.

We have always been a profession with a unique body of knowledge: 

     unique because we have extensive knowledge in the neuromusculoskeletal system;

     unique because we choose how we want to specialize in the use of this body of knowledge. 

This body of knowledge enables us to evaluate a condition, develop a plan of care and carry out a treatment regime to assist individuals in reaching their highest level of physical potential.  Today, that uniqueness is so very important.  There are many individuals who claim they do things similar to a physical therapist.  If we think about our extensive body of knowledge being the entire alphabet from A-Z, those other individuals may do A-C or H-J. It is the physical therapist who has the body of knowledge for the rehabilitation of neuromusculoskeletal conditions from A-Z. As such individuals, we have the ability to be “autonomous practitioners.” 

This does not mean we work alone or in private practice.  This means we have the knowledge and the ability to evaluate a client’s condition, not just physically, but through review of diagnostic studies and other practitioners’ care and make independent decisions on how an individual should be treated or not be treated with physical therapy interventions. Through this unique body of knowledge, it is important to realize that there are other types of care that can assist individuals in recovery from neuromusculoskeletal dysfunction and if physical therapy interventions are not working then an alternative approach needs to be considered whether it is within our profession or in another profession. In this way, we are being responsible and ethical practitioners with the patient’s best interest in the forefront of our decision making process and maintaining our strong position within the healthcare community.

Just as the tide rises in the ocean so is the tide of our profession rising. We will all move upward and onward with the tide. How far we, and our profession rises, will be largely up to each and every one of us. We will all play a part, whether we individually pursue a doctoral degree, or we continue to practice as always. By being the best we can at any given time and with even a modest commitment to volunteerism, we can all help the Colorado Chapter APTA bring the profession of physical therapy to the forefront of the Colorado healthcare community ……… which benefits each and every physical therapist as well as our patients and prospective patients!

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What, Exactly, Is Autonomous Practice?

(Ed. Note: Members of the APTA/ Colorado Chapter Board of Directors were asked how they would describe Autonomous Practice. Here are perspectives from three different PTs practicing from 10 to 30 years in different settings.)

#1 – “Independent and Self Determined” by Amy Stone, PT, PRO Physical Therapy, Boulder

The APTA has set high expectations for the growth of the profession of physical therapy.  In the Vision Statement 2020, physical therapists are envisioned to be autonomous in the practice of physical therapy. This means that by 2020 the profession should grow to include doctorate level educated physical therapists that have direct access to patients in order to diagnose, intervene, manage, and prevent injury and illness. The autonomous practitioner will use the DPT education, experience, and expertise in specialized areas of study to become the practitioner of choice for movement and functional health related issues.    

As an independent practitioner, I hold some of the qualities of an autonomous physical therapist as defined by the APTA. I do not work under a corporate structure. Therefore, I am independent and “self determined” in my professional judgments and actions on a daily basis. I currently work under a model that allows for and forces almost complete responsibility on my own judgment.

It is evident that the physical therapist of 2020 will be much closer to the needed ideals and attributes of an autonomous practitioner if the trends in physical therapy education and practice continue to support higher levels of education and expertise.

#2 – “Independent organisms” by Kathy Voss, PT, Hand Specialists, PC, Littleton

One of Webster's definitions for "Autonomous" is "existing as an independent organism and not as a mere form or state of development of an organism." When we speak of "Autonomous Practice" we are not necessarily defining it as "self-employed." The goal of this statement is that all therapists take responsibility for their professionalism, their education and their ethics as they practice. The setting of the practice matters not. If we all strive to be "independent organisms" within the whole we will attain "Autonomous Practice."

#3 – “Taking Responsibility for Professional Behavior” by Greg McCall, PT, All Pro Physical Therapy PC, Littleton

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DPT Programs

By Amy Stone, PT

Director at Large, APTA/Colorado Chapter Board of Directors

As the physical therapy profession transitions to professional (entry-level) DPT programs, this educational level will more accurately reflect the scope, depth, breadth of education preparation needed for current and future practice of physical therapy. The Doctoral program will better prepare the graduate to enter clinical practice able to examine, evaluate, diagnose, prognose, and intervene in the management of impairments, functional limitations, and disabilities of the cardiopulmonary, musculoskeletal, neuromuscular, and integumentary systems.

In addition, the DPT degree will better facilitate the consumer's recognition of the physical therapist as a fully autonomous health care practitioner who is a point of entry into the health care system. In the process, the advanced skills and education will better facilitate interactions with medical colleagues on an equal basis. Education of the medical and consumer community still needs to be pursued to prevent the DPT degree adding to the confusion of patients, employers, and other health care providers about physical therapists and physical therapy services.   

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Colorado Physical Therapy Students 
Make a Showing at the National Student Conclave
By Noelle Natale, SPT
Colorado Student SIG Chair

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PTAs in the State of Colorado
By Mary Chavez, PTA
Affiliate SIG Chair

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Colorado Physical Therapy Political Action Committee

By Kim Bozich, PT

Colorado PT-PAC Chair

The Colorado Physical Therapy Political Action Committee (PT-PAC) is asking for your contributions. The State Legislature is back in session and we all know money talks!

Let the Colorado PT-PAC do the “talking” for you by working with the Governmental Affairs Committee to represent the physical therapists of Colorado. 

Most PTs are not aware of a candidate’s position on issues of importance to physical therapists. The PAC contributions allow us to educate the elected officials before a decision is made that will influence how we, as PTs, practice.

If you have any questions about contributing to the PAC or joining the committee, please contact Kim Bozich, PT-PAC chair, at kbozich_dpt@yahoo.com or (303) 425-9925.

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CO/APTA Research Committee "Hooked on Evidence"
by Michael A. Keirns, PT, PhD
Research Committee Co-Chair

Greetings Everyone and Happy New Year!!  I hope your holidays were good ones and the new year plans include continued efforts in advancing research efforts in our State. The Colorado APTA Research Committee's next meeting will be February 16th from 6 – 7 p.m. at Regis University in the PT Department's laboratory: ALC A203. (email Mike at mkeirns@regis.edu or call 303-458-4982 for directions.)

At this meeting we will be reviewing an article from the January 2004 PT Journal titled: “Identification of Individuals With Patellofemoral Pain Whose Symptoms Improved After a Combined Program of Foot Orthosis Use and Modified Activity: A Preliminary Investigation”

by Thomas G Sutlive, Scott D Mitchell, Stephanie N Maxfield, Cynthia L McLean, Jon C Neumann, Christine R Swiecki, Robert C Hall, Anthony C Bare, and Timothy W Flynn

Not only does this article have good clinical implications, but is a good review of using statistical power to implement evidenced based practice. At our February meeting, we will be preparing this article for entry into the APTA's "Hooked on Evidence" Web Site. Look for our meeting at the Colorado/APTA Spring Convention where the Research Committee will be reviewing the process of using the "Hooked on Evidence" Web Site.

http://www.ptjournal.org/PTJournal/Jan2004/v84n1p49.cfm

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Mile High District News

By Steve Kangior, PT

Mile High District Chair

As attendance to Mile High District Evening Series events and meetings incorporates only a small number of our total members, please read e-mails of news and notes as related to our District. The Mile High District will be working closely with the Chapter’s Professional Development Committee to offer quality educational opportunities. Starting in 2004, the Mile High District’s goals are to hold an Evening Series Event every other month. A tentative schedule of upcoming Mile High District Evening Series is as follows:

            March 24: Women’s Health

            May 13: Evidence Based Practice

            July 21: APTA promotion and social gathering

            Sept 16: Gerontology

All members our encouraged to be involved in making our association strong !