The Promoting Integrity in Medicare Act was reintroduced again this year in the US House of Representatives. This bill seeks to exclude Physical therapy from the Inter Office Ancillary Service Exception on the Stark Law (IOAS). Although this bill is well intentioned, I feel it does little for Montana and other rural areas.

The Stark Law was written to stop referral for profit, and decrease overuse of medical services. The original Stark legislation was passed by congress in 1995. There were many exceptions to the original Stark law, including IOAS. This was created to allow for same day services to be provided in a physician office as a convenience for patients. In effect this allowed physicians to have ownership in physical therapy practices within the same facility as the physicians. While the intent may have been honorable, a GEOstudy found that only 3% of all scheduled physical therapy visits were on that same day as those of a referring physician visit.

The IOAS has lead to overutilization of treatments, not just in PT, but also in other ancillary services including clinical labs and imaging. The Alliance for Integrity in Medicare (AIM) coalition was formed by professional organizations to promote and support this legislation, and APTA is a member of this coalition.

Unfortunately, as important as this legislation is, the rural exception to the original Stark law was left intact. Section 2.(a) 17 states “the exception to the ownership or investment prohibition for rural providers in the “Stark” rule is not affected by this legislation.”

What this means is that the proposed legislation only effects metropolitan areas. So sorry Bozeman, Kalispell, Darby, and Havre. Integrity defined by this legislation is only for the big cities. The rural exception was initially intended to make sure that rural areas had ac-cess to medical services. This may have made sense in 1995, but I feel it is no longer practical. PT departments are thriving in areas outside of metropolitan areas. And alt-hough there are a numerous shortages of physical therapy services in some rural are-as, physician owned parties are not helping to fill the gap.

So why is the rural exception safe? No one has been able to answer this ques-tion. It is not mentioned in any of the APTA publications supporting this legislation. It is not mentioned in the AIM publications. When the question has been brought up, and it has been many times to the APTA , the response has been vague at best. “We’ll get back to you”, has been the battle cry, but my phone isn’t ringing. My best guess is that this is being left in place as a compromise to those legislative areas that are rural or micropolitan to garner more support.

Politics are full of this type of arrangement. But with this compromise, rural and micropolitan PT’s are being thrown under the bus in hopes that a watered down bill might pass. But if it is integrity that we want, then it needs to include all providers of ancillary services. We are physical therapists. We should not be defined by the popula-tion of a town we chose to live in, by our gender, sexual orientation, religion preference, or skin color. If it is good legislation, then it is good for all of us.

Let’s have a discussion on the merits of this legislation not for a few, but for all PTs. And let’s not allow national endorsements to hide the fact that this legislation is not for all PTs. This needs to be heard in all rural states and regions. Rural means small, but we are an important part of health care from border to border. And if APTA chooses to continue to support this legislation as it is written, I believe they need to get rid of the word integrity - it doesn’t fit.

As hard as it is to see the snow melting off the mountains, I’m happy to welcome spring in my garden. Last issue, I talked about assessing readiness for and supporting change. Gaining that “buy in” with assisting patients in moving forward with a healthy life decision felt comparable to talking to fellow physical therapists about getting involved with APTA and MAPTA to progress our profession. Following that branch, I wanted to remind readers of the many benefits of membership. As we work in the ever shifting field of healthcare, we need the power of our voices to guide local and national issues toward our vision.

APTA, including Montana members and legislators, advocates year after year at the national level on big issues including healthcare reform and the Medicare therapy cap. Check out the Legislative Action Center for a quick and easy way to stay in touch with our representatives on Capitol Hill including prewritten letters on current concerns. Website: http://www.apta.org/TakeAction

Everyone is rightfully anxious about reimbursement. Ensuring physical therapists receive proper payment is a major component of APTA’s Strategic Plan. The Payment section is a great place to stay up to date on critical payment topics.  http://www.apta.org/Payment.

MAPTA is also welcoming John Zakrzewski, PT, MT, OCS as our new resource for reimbursement questions and concerns.

The healthcare system is becoming more competitive every year. APTA offers marketing, public relations and branding ideas to communicate effectively with patients and other healthcare professionals.
http://www.apta.org/PRMarketing  and http://www.moveforwardpt.com

Sometimes you have to spend money to save money. Your membership gets you a discount on great conferences, publications and continuing education courses throughout the year. The APTA Learning Center also offers free courses. Also, MAPTA is now partnered with Medbridge for a discount on over 400 accredited online courses.
http://www.medbridgeeducation.com and http://www.learningcenter.apta.org

Locally, MAPTA is gearing up for grassroots efforts to protect and advance our practice. Contribute to the Montana Physical Therapy Pact, http://mapta.com/PAC, and contact Christian Appel on how you can get more involved.

I hope this fertilizes your understanding of the many reason to stay a member. All the more, pass this information onto a colleague to begin or reinitiate membership.

Greetings from the Flathead Valley Community College’s PTA program. This past February, Julie Robertson, ACCE and I ventured off to California to attend the Combined Sections Meeting in Anaheim. Anyone who has been to CSM knows that it has great energy, excitement and hype as part of its atmosphere. It is also a wonderful place to network with peers from around the country. Being a PTA educator, I was especially interested in a session titled: Transforming the Role of the PTA to Meet the Vision of the Physical Therapy Profession, presented by Jennifer Jewell, PT, DPT, Beverly Labosky, PTA, Gina Tarud, PT, DPT and Pamela Pologruto, PT, DPT from Penn State University.

They analyzed survey data from around the country from both approximately 50% each of PTA’s and PT’s, both APTA and non-APTA members. They sought data regarding: educational requirements for the PTA, work analysis for the PTA, scope of practice issues amongst states, CE requirements for the PTA, career advancement opportunities for the PTA, workplace and academic education on the PT/PTA relationship, and job satisfaction of the PTA, to name a few. I won’t go into each item but I encourage those of you who work with and educate PTA’s to keep a look out for this article in the next few months. I will however, provide a bit more depth of the topic of the PTA education.

The role of the PTA has evolved since the career began in 1967. Next year will be the 50th birthday of the first PTA class in the US…Happy Early Birthday PTA’s! The skill level and knowledge demands of the PTA have progressed with the advancement of the DPT degree, but the timeframes for PTA education have confined PTA educators to try and pack in as much information as they can in a short amount of time to meet the knowledge expectations of our profession as a whole. This can be a challenge both for the student and the educators. Personally thus far, I have found the high caliber students that we have had at FVCC, has minimized this obstacle for me as an educator. Most students have come in with a strong work ethic, entry level knowledge and experience that have made meeting the demands of PTA education a quite rewarding experience.

That being said, there are notable issues that will need to be addressed in the near future pertaining to PTA’s and PTA education. Here in Montana, I see a need to continue to educate on the value of the PTA and their role in the patient care continuum. Nationally, prominent issues are: strengthening the PT/PTA model to meet the changing healthcare needs, developing career paths to allow advancement of the PTA and reinforce the lifelong learning and passion for the field of physical therapy, continuing to assess the PTA education model to ensure our current model is meeting the needs of all stakeholders, and most importantly remembering that the most vital stakeholder in all of this are the patients we serve.

Please remember to email, call or stop on by FVCC with any feedback that you may have about the utilization of PTA’s in your area or PTA education.