Is Physical Therapy In The United States Heading In The Right Direction?

On April 24, physical therapists, physical therapist assistants, and students of physical therapy took part in a Federal Advocacy Forum on Capitol Hill. I for one applaud the efforts of this group in that they were able to present one small (yet at least united) voice to Congress. We certainly need a stronger voice in today’s health care world.

With that said, and with my annual APTA membership due for renewal, I am having my doubts about the direction that the profession is heading in this country these days, and the rate at which it is heading there.

I have now practiced in the United States for almost 22 years. The APTA’s Vision 2020 – the official vision statement for the profession – has now been in existence for 12 years. But when you look at the issues that are front and center with our Federal Advocacy Forum, you have to wonder where our priorities truly lie.

Here are the three primary issues that were being supported at the Federal Advocacy Forum:

1. Repeal of the Therapy Cap via the Medicare Access to Rehabilitation Services Act  (HR1546 / S829). This legislation repeals a provision from the Balanced Budget Act (BBA) that set an arbitrary annual financial limitation on Medicare beneficiaries’ rehabilitation services.

2. Adding physical therapists to the National Health Service Corps Program via the The Physical Therapist Student Loan Repayment Eligibility (HR1426 / S975). This legislation would provide for physical therapists’ participation in the National Health Service Corp’s Loan Repayment Program. This would help to address the rising debt of physical therapists by encouraging them to serve in rural and urban underserved communities.

3. The Traumatic Brain Injury Act of 2012 (HR4238). This legislation would help individuals and families gain access to the most appropriate community-based services for traumatic brain injuries.

First of all, I am not saying that these aren’t important issues to the profession. But when it is almost impossible to get a group of physical therapists together, in one place, to lobby for anything, should the profession not be using that time and effort to focus on bigger issues? Should that time not be spent pushing our role in health care reform, direct access and autonomous practice, and the like?

Perhaps we should be looking at the mechanisms underlying these issues, and address those mechanisms first.

For example, health care reform, with physical therapy front-and-center, could have a huge impact on the services available to all patients, Medicare and otherwise. If patients had direct access to physical therapy, the initial costs would drop and patients could make better use of that “arbitrary financial limitation” regardless of where it is set. Having a free marketplace, and not one dominated by the gatekeeper model, would bring costs down even further. He who provides the best outcome at the best price wins in the insurance company’s eyes, no?

Our professional association should have given consideration to the debt load long before it moved to a doctorate program. When a degree in physical therapy now costs about the same as a law degree, you have to debate the return on investment. Of course, the educational programs are making their money either way …

That is a topic to be discussed further in an upcoming post.

Maybe I am missing something here. Maybe there is greater strategic political planning than that which I am aware. Sure, I will grant you that possibility. But now that we are 12 years into Vision 2020 – and with very disputable progress towards direct access to physical therapy nationwide – I have to wonder if the Federal Advocacy issues  are really where our best efforts should be focused.

I think it may be time for an “Extreme Makeover” of sorts. Tune in over the next few weeks as I propose not only the big issues that need to be addressed in this makeover, but some solutions as well.

Photo credits: neuezukunft