Chapter News

President’s Report  

by 
Audrey 
Waldron, PT

President, APTA/Colorado Chapter

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2002 has been a very exciting year for the APTA and 2003 may be even more exciting. As you may recall, in 2001 the House of Delegates adopted a Vision statement:  “The vision for the physical therapy profession by the year 2020 is that physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health.” In order to achieve this goal one of the first steps is to have physical therapists being trained at the doctoral level.  There are presently 64 DPT programs already accredited and at least 5 developing.  Another important step is to obtain direct access, not only legally as we have in our state, but to have it recognized and payable by third party payors.  APTA is working hard to achieve this goal. At APTA’s urging, and with widespread grassroots support by APTA members, 44 representatives and 3 senators endorsed the “Patient Access to Physical Therapists Act,” which would allow Medicare Part B beneficiaries direct access to physical therapists. The push to build support continues in 2003.  On February 13, 2003 Congress re-introduced HR 792 and on February 27 S 493 was introduced in the Senate.  These 2 bills are companion bills that would allow Medicare beneficiaries to directly access physical therapists as authorized by state law for outpatient services.  This legislation had 51 House co-sponsors and 5 Senate co-sponsors in the 107^th Congress.  Anyone involved in politics knows that it takes a great deal of time and work to get a bill sponsored.  It will take a significant amount of effort by national APTA and all of us on the grassroots level to ensure these bills are passed.  Your membership dollars help to fund all this work.  Your phone call to your Congressman & Senator in support of this bill is imperative to helping it pass through the House & Senate.  Please refer to www.apta.org for further information on what you and your patients can do to help get HR792 and S493 passed.

Additionally, your dues dollars have assisted our National APTA staff in accomplishing the following activities:

• Politically supporting the “Medicare Access to Rehabilitation Services Act,” which would repeal the $1,500 cap on Medicare outpatient physical therapy services.
• Advocated to increase the practice expense component in the Physician Fee Schedule, resulting in $23.5 million more in reimbursement to physical therapists in 2002
• Achieved Medicare coverage for biofeedback and electrical stimulation for the treatment of urinary incontinence.
• Achieved Medicare coverage for electrical stimulation for the treatment of stage III and IV pressure, arterial, diabetic, and venous stasis ulcers.
• Monitored the literature and the positions of other organizations to ensure that the role of PTs was accurately represented.
• Retained a new public relations firm to help increase the awareness of PTs among consumers.
• Prevented chiropractors’ efforts to prohibit physical therapists from performing manual manipulation of the spine.
• Governmental Affairs department monitored 2500 pieces of legislation.
• Participated in 4 major national conferences
• National Black Caucus of State Legislators
• National Conference of State legislators (Held right here in Colorado and assisted by members of the Colorado Chapter)
• American Legislative Exchange Council
• Council of State Governments
• Launched “Hooked on Evidence,” APTA’s Web based review of research literature that can be used by clinicians to enhance clinical decision-making and practice. Reviews have been entered and a search engine has been developed.
• Developed the Physical Therapist Evaluation Tool (PTET), a mechanism for documenting the knowledge and experience of licensed physical therapists that are applying to transition DPT programs.
• Changed the scope of the Commission on Accreditation in Physical Therapy Education to include only PT programs at the post-baccalaureate degree level and PTA programs at the associate degree level.
• The American Board of Physical Therapy Specialties certified 508 new clinical specialists— a 20% increase over the number of physical therapists certified in 2001. 
• Provided all members free copies of the “For Your Health” supplement to PT Magazine to help educate consumers about physical therapy.
• The Foundation for Physical Therapy funded a 3-year, $1.5 million Clinical Research Network that will assess the effects of strengthening exercises.
• Pennsylvania became the 35th state to achieve direct access in 2002.  New Jersey and Wyoming were next in line to achieve direct access in 2003.
• Interactive Guide to Physical Therapist Practice, With Catalog of Tests and Measures CD).
• Three home-study continuing education courses designed to give you the latest information on evaluation and intervention strategies: Topics in Pediatrics, Topics in Neurology, and Business Skills: Legal Issues.
• Advanced Clinical Practice Seminars, a new course series based on evidence and focused on helping you secure your future.
• APTA’s online audio/video CEU library, with 19 courses on current clinical topics and business management. There’s sure to be something of interest to you!
• APTA worked with Lands’ End on the company’s Back to School Campaign, providing backpack safety tips that were incorporated into a press kit made available to media outlets nationwide. And APTA worked with Lands' End to produce a video news release on backpack safety and tips for selecting an appropriate backpack.
• Advocated for the increase of the practice expense component in the Physician Fee Schedule, resulting in $11.5 million more in payments to physical therapists in 2001.
• Published the 740-page second edition of the landmark Guide to Physical Therapist Practice.
• Ensured that PTs can continue to provide orthotics/prosthetics within the scope of PT practice in Alabama, Georgia, Louisiana, New Jersey, and Oklahoma.
• APTA was one of the leading non-physician organization groups represented in the AMA’s Physician Fee Schedule Update Work Group.

As you can see YOUR DUES DOLLARS have been utilized well!  Believe it or not, I have not listed ALL of APTA’s activities and accomplishments.  Please take the time to visit the APTA web site (www.apta.org) and see for yourself what your dues dollars are doing.  Please consider encouraging those PTs/PTAs you know who are not members yet are reaping the benefits of YOUR DUES DOLLARS to become members. 

APTA Takes Lead in Auto Insurance Reform Debate

by
Ellen Caruso
Executive Director, APTA/Colorado Chapter

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According to Colorado Chapter President Audrey Waldron, PT, Boulder, the chapter and other health care providers tried unsuccessfully to give input into an insurance-industry driven bill that was more than four months in the making. After reading the bill just days prior to its introduction on January 30^th. Waldron said the chapter’s Governmental Affairs Committee decided to join a coalition of providers to oppose the bill, primarily because it made major changes to auto insurance coverage and reimbursement procedures with very little savings for consumers.

House Bill 03-1225, sponsored by Rep. Tambor Williams (R-Greeley) and supported heavily by Gov. Bill Owens, set up a strict medical model for treating auto insurance accident victims. The new system named the medical doctor as the gatekeeper; used the Workers Comp medical guidelines for auto accident injuries; eliminated the consumer friendly Personal Injury Protection (PIP) review panel by like health care professionals and replaced it with review by an MD directed peer review organization. Under HB 1225, auto insurance policies that would allow alternative treatments such as chiropractic and massage therapy would either not be offered or would be more expensive than other options. The bill was defeated by a narrow bi-partisan vote on March 6th.

Alternative Bill Offered
While HB 1225 was being debated in the halls of the state legislature, APTA and a group of providers and trial lawyers helped write an alternative bill. HB 03-1321, sponsored by Rep. Tom Wiens (R-Castle Rock). In her testimony before the House Business Affairs & Labor Committee, APTA Executive Director Ellen Caruso said, "Our member physical therapists work in many settings - hospitals, private practice, home health, nursing homes and schools. In these settings, PTs are very familiar with various 3rd party payors besides auto insurance: Medicare, Medicaid, lots of Workers Comp and much commercial insurance and managed care. They are used to a variety of insurance dictates and benefit limits. PTs have many ideas on how to reduce costs while getting the patient back to health and function. One year ago, we offered to join any group that was formed to study and make recommendations on how to lower costs of auto insurance in Colorado." 

The complete testimony can be found at http://www.assnoffice.com/apta/practice/auto_reform_2003.htm

The bill passed out of the committee but due to a large fiscal note the bill died in the House Appropriations Committee on March 14th.

What next?
APTA’s contract lobbyist Betsy Clark Murray is currently facilitating meetings among providers, insurance companies and consumer organizations. Each group has offered its best ideas for reforming auto insurance and saving consumers money. The Colorado Chapter’s ideas were the first to be presented:

Goal: Auto reform that retains PIP No-Fault system, saves consumer money and gives choice of treatment for injuries after auto accident.

1. Purchaser's choice on length of treatment (Medical: 3 years; Rehab: 5 years)

2. Purchaser's choice of $50 med/$50 rehab or $40 med/ $40 rehab

3. Health providers to establish practice guidelines for their own specialty

4. Retain appeal/review panel by like profession

5. Prompt payment for clean claims enforced

6. Providers either licensed in Colorado or accredited/certified by nationally recognized accrediting body

7. Insurance Commissioner must review cost savings and ensure that premium savings follow

8. Enforce inappropriate (over or under) utilization through practice acts and national certification standards

9. Insurers SHALL offer low-income policies (rather than MAY)

Additional Reforms
1. No one will be automatically defaulted (slammed) into a policy with lesser or limited coverage (or managed care)

2. Allow consumer to choose various co-pay / deductible levels

3. Raise threshold from current $2,500 for pain and suffering.

With less than 25 days remaining in this session, the General Assembly, providers, consumers and the insurance industry will be working until the final hours to complete the daunting task of reforming auto insurance in Colorado.

www.state.co.us/gov_dir/stateleg.html

Upcoming Events

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Mark your calendars and plan to participate in these upcoming APTA events!

April 5 to April 13, 2003
9Health Fair
At locations throughout Denver metro area
To volunteer, please visit our web site http://www.assnoffice.com/apta/events/9health.htm

April 27-29, 2003
Federal Government Affairs Forum, Washington, DC

June 14-18, 2003
APTA House of Delegates

June 18-21, 2003
PT 2003: APTA Annual Conference, Washington, DC

June 19, 2003
PT 2003: Rally on Capitol Hill to Support Direct Access, Washington, DC

September 7, 2003
APTA/Colorado Chapter Bob Doctor Golf Tournament
Green Valley Golf Club, Northeast Denver

September 27-28, 2003
APTA/Colorado Chapter Fall Symposium, Denver
Assessment & Treatment of Traumatic Injuries
Featured Speaker: James Meadows BSc PT, MCPA, FCAMT
The Acute Motor Vehicle Accident Patient

October 2003
Physical Therapy Month

See what took place on March 29-30, 2003
APTA/Colorado Chapter's 33rd Annual Spring Convention & Physical Therapy Exhibition
Integrating Ortho and Neuro in Your Practice of Physical Therapy
Arvada Center for the Arts & Humanities, Denver

Mile High District

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Attention Mile High District members!
As stated in the last flyer, postcards will no longer be sent as notification of meetings.  Please visit the Colorado Chapter’s website and click on Mile High District for district meeting times, places and topics.  The District will make every effort to send email notification to those whose email addresses we know. If you have an email address or your email address changes, please remember to notify the Chapter office at apta@assnoffice.com

Medicare Q&A

by
Ira Gorman, PT, MSPH
Colorado Chapter Governmental Affairs Committee

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Answer: 
As a Medicare provider you must: 

1) Bill Medicare for anything that would be covered such as the eval for orthotics. You can charge the patient for DME (if you are not a Medicare DME provider) but the patient must sign a non-coverage waiver for supplies. Otherwise you need to bill Medicare and receive a denial before you can charge the patient. 

2) You must be consistent with charges for all patients, Medicare and others. You must charge all the same. Why would you want to give a Medicare patient a larger cash discount than any one else? Medicare is not a charity program and not tied to income. 

APTA Membership

is a Privilege

by
Anne Slack, PT

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I have always thought membership in my organization, the American Physical Therapy Association, was a privilege, not a burden.  This organization works for me, ensuring the quality of my profession and representing my concerns on a district, state, and national level. I cannot always donate my time; but I can always donate some amount of money to the APTA.  And it is the diligence and efforts of those who do donate time that ensure the size of my paycheck and my ability to practice my skills.  The APTA facilitates my learning with its website.  But more than anything else, for me, the APTA provides me a network with my colleagues. When I moved to Colorado last year I really struggled. Moving can be so exhausting physically and emotionally. I sought out the Colorado/APTA for some semblance of my life in Texas. When I came to the Fall Conference last year it was like coming home. There at last, were the people of my profession who shared the same ethics and goals. It was a wonderful experience. I thank everyone who gets involved with the Colorado Chapter for helping me make the transition from to here. It really made the difference for me and allowed me to settle into this state. 

Member Tips

Evidence Based Practice

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I have experimented with the effect of kinesiotape on functional test scores of individuals with anterior knee pain, usually ACL or P/F clients. I have measured up to 10% increases in balance/reach and step tests using the tape to support the patella & tendon. It's an easy test to do. Just do the functional tests like we do with and without the tape. We need to vary which one we do first. I have been taping them if they report pain during the testing. I would like to try taping first, then retesting without. These have all been done on the same day.
Dean Walker, PT  

Ultrasound

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Curious whether ultrasound for an acute ankle sprain was worth my time I did a literature search on PubMed. I found three articles that influenced me to spend my time or my assistant’s time doing other interventions. Randomized controlled study of ultrasound therapy in the management of acute lateral ligament sprains of the ankle joint, Nyanzi et al of the Rehabilitation Research Unit, reported no statistically significant difference between placebo group and treatment group in any outcome measure. This is not to say that I will never use ultrasound for an acute ankle sprain, but it did remind me not to practice without THINKING.  
Kelly Martin, PT