On Dec 19th , our national association wrote a letter to U.S Senator Max Baucus on the
Call To Action
Health Care Reform 2009 which proposes a framework to address access and achieve affordable
health care coverage for Americans. On Dec 18th,a short letter was
written to President-elect Obama. For those of you who are members, you can
access the letters here. For those of
you who aren’t member, you should join.
While we respect our national
association and agree with a few of the items in the letter, much of it is far
off the mark – see details below.
Overall, the
problem is that the APTA seems to be advocating for the wrong
audience.
Healthcare
reform is supposed to be about addressing societal needs, whereas, these letters
primarily are focused on ‘we the physical therapists”:
– Defining our
qualifications
– Giving stature
to PTAs
– Getting payers
to “recognize” us
– Suggesting that
we can improve access to care and reduce costs by mandating that “….physical
therapist services will be provide only by physical therapists and by PTAs under
the direction of PTs.”
A statement we
find at best mystifying.
– And all those
references to our “vision”….please, who in with world CARES about our vision of
us? Or cares that “physical therapists will be practitioners of choice in
health networks, and will hold all privileges of autonomous physical therapy
practice…..etc….etc….
The Baucus
letter touches on many key
points which we support.
On the other hand, under the header
“Improving Value by Reforming the Health Care Delivery System”
1. One gets the strong impression that
our national association represents the primary care physician
association. While the real issue here is that reimbursement undervalues
primary care which has resulted in a massive exodus of physicians from primary
care to better paying specialties. While we support revising the reimbursement
methodology to better recognize the value of primary care services (INCLUDING
physical medicine and rehabilitation) PTs offer an immediate solution to the
primary care manpower shortage.
And to that end we should be trumpeting
PT’s as direct access providers, treating musculoskeletal conditions as key
members of the medical team
2. Few PT’s work in day to day wellness
and prevention and the recommendation is to enhance coverage of these services
although politically correct is not defensible in a system that is broke. How
about paying us for the things we do on a daily basis?
3. I have yet to meet a PT who has
“embraced the PQRI” as represented. All find it a pain in the arse and many
aren’t doing it simply because the cost of complying is greater than the cost of
reimbursement and many that have painstakingly done it have yet to receive their
check!
4. Seeking to make the exceptions process
permanent?
Update, Update Fortunately, John Ensign
(R-NV) and other Senators have thankfully submitted 546/HR43 which would
eliminate the Cap. This is THE position to take by all PT’s. Extending the
exceptions process is not a good option-it only makes day to day practice
burdensome and does not work-this analysis
explains why.
5. Seeking to provide incentives for the
wide-adoption of health information technology? Moving medicine into the
electronics age certainly makes sense. But the claim that our national
association has developed an electronic health care record and national outcomes
database would make one believe that there is widespread adoption of OPTIMAL and
CONNECT-this couldn’t be further from the truth.
6. Pay for Performance (P4P) is a great
idea. But we’ve not seen the concept translated to practice. And that’s why we
see scant support of P4P . Kind of hard to believe when you have a guideline put out
that is so restrictive that it virtually eliminates the whole notion of P4P
including the notion that the program has to be “voluntary” and can’t
disadvantage a provider-the whole proviso behind P4P (side note: I am against
P4P because it has yet to be demonstrated to be effective and almost all tests
for this are really P4C-pay for compliance).
The letter to President-Elect
Obama is clumsier than
a wobble board. If you can get past the 5x mentions of PT’s and PTA’s so
closely linked that you have no idea that there really is a difference, you are
left with the impression that PT’s (and PTA’s under direction and supervision of
PT’s!) are in the wellness and prevention field. I am sure this letter will
be file in the “failed to impress section” of the shredder. (side question: do
you think AMA would mention PA’s 5x or ANA mentioning nurse’s aids 5x in a
letter to the new administration)?
Can letters from our advocacy please
stand up to some review process before hitting the send button?
Rick@physicaltherapist.com
