Just finished my summer off the blog grid. Why physical therapy material to blog is no more lacking during the summer, a time to reflect on the profession and the healthcare environment is often better viewed when disconnecting for a bit.
Several years ago, there was a very noted difference between evidence and clinical practice. This “gap” often created a huge time lag between interventions that we had solid “proof” to be effective and the time for implementation. Such a delay compelled clinical practice to be heavily influenced by reimbursement. By way of example, if isokinetics was the highest reimbursed items (it was for awhile), every PT clinic stayed competitive by richly rewarding the manufacturers. Thankfully, the influence of improvement of science (e.g. meta-analysis and systematic reviews), funded research and replication on interventions, and when combined with an awareness of private practices that academics can and should collaborate with practitioners has largely closed that divide (and thankfully so). I think it is safe to say that if you have been practicing for many years that the patient encounters and look of the clinics have changed rather dramatically (side question: where is the modality and isokinetic morgue room or are they simply in landfills?). Without question, reimbursement trends in the form of relative value (not actual payments), mostly due to on-going practice surveys and validation studies have also changed considerably and rather favorably towards the best current evidence in interventions and therapeutic exercise. Challenges and laggards remain but kudos to the profession and innovative practices for embracing EBP.
Unfortunately, there exist at least two large divides or gaps in our profession as it relates to outpatient physical therapy. The first is the significant gap between our national association’ (APTA) and their governance, relevance, effectiveness, or understanding of day to day clinical practice under current healthcare pressures . The second divide is between third party payers and their view and perspective on physical therapy payment policy. This post will focus on this first divide.
This past June, The board of directors of APTA led a charge to rescind RC-3 or whatever number it was when it was eliminated. I have written extensively about this for years with all posts HERE. The Private Practice Sections, President Tom Diangelis has a terrific and must read commentary on the unfolding events including the use of misrepresentation and fear tactics. By reminder, with strong support, the HOD had adopted this position:
Resolved, That the American Physical Therapy Association (APTA) recognizes that physical therapy is provided by, or under direction and supervision of, a physical therapist. Evaluation remains the complete responsibility of the physical therapist.
The implementation date of the policy was definitely ambiguous but delivery of a comprehensive document of models of care was done in time and at great expense to meet an additional directive of a follow up RC. Tragically, the majority that originally passed the private practice sponsored motion several years ago and the support work behind it all got deep six’d.
It would be one thing for the HOD to put forth a motion in an attempt to kill this RC and argue against physical therapists being the provider of physical therapy but surprisingly the Board of Directors did it themselves by their own motion! Fundamentally, APTA’s BOD and HOD by their actions don’t believe PT’s should be given the right to delegate and direct tasks to any support personnel except a PTA (yet out of their same mouths believe PT’s should have direct access and be able to refer for imaging). APTA’s antiquated positions which work against outpatient practice remain and you can be assured that our national association will continue to advocate for medicare rules on all patients just like they have been doing for many years. Unfortunately, some 3rd party payers have listened and implemented. The crevace between healthcare reform where autonomous providers are mobilized to their best and highest use and value and our national association is further than ever. Thankfully, most state’s practice acts do not agree with APTA and real effectors of change-independent practices and the advocacy channels they form and participate will be more representative and more effective where it matters most-day to day clinical practice.
If this RC were an isolated case, evidence of a divide would be unfounded. Other examples include failed legislative strategies (direct access in medicare, “opt out” language for outpatient medicare patients, RFP), antiquated positions (excessive documentation requirements), and clinical practice prescriptive models (PT and PTA best practice). There is even an attempt to put forth productivity standards for outpatient PT! The bottom line is that governance at our national level and the day to day realities of clinical practice are completely misaligned.
APTA can serve vital roles in pivotal areas-just not any that impact clinical practice in a “real time” fashion given the pace of healthcare reform and the pressures and challenges of clinicians. We can and should still send them membership dues but clinical practices working collaboratively to make the right and transformative changes won’t occur at the association level (let RC-3 be the reminder). Just like the divide between evidence and practice, progressive change will occur through other networks sensitized to ground level realities working together outside formal and outdated governance structures.
Next up-the other divide.
Thoughts?
@physicaltherapy
