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2002 APTA Presidential Address |
BF Massey Jr, PT, is Executive Director, North Carolina Board of Physical Therapy Examiners, 18 West Colony Place, Ste 140, Durham, NC 27705-5582 (bfmassey{at}mindspring.com)
 | Introduction |
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I greet you today—and I didn't think this was possible—with even more pride and passion for this profession than I had 1 year ago, when I delivered my first Presidential Address.
It has been clear to me for months that I wanted to use this special occasion to talk about something that is near and dear to our hearts. It is one of the keys to fulfilling our vision for the profession, and one of the most critical issues involving patients' rights during the last several decades. I'm talking about direct access.
Direct access is not a new topic. We've been fighting for the rights of patients to see physical therapists without having to obtain a physician referral for 2 decades now.
We've waged the battle for direct access state by state. Most recently, we celebrated along with Virginia and Pennsylvania as these 2 states were added to the ever-growing list of direct-access states.
Each state's battle has been fought with a passion and dedication that is difficult to describe unless you've lived it. My state of North Carolina was the seventh in the country—and the first in the South—to pass direct-access legislation. Our bill was signed into law on July 4, 1985, and it was quite a celebration of independence that year! We had worked on the legislation for 3 years. During that time, I served as chapter president. I was so proud of the incredible grassroots lobbying effort by our members.
Each state has its own special story of how victory was achieved. In North Carolina, for example, we were on the brink of victory but almost pulled our bill because chiropractors were working to add language restricting us from spinal manipulation. After negotiation, our bill moved forward without major restrictions.... A very close call.
As a profession, we've celebrated each state's passage of direct access, and the news of each victory has been celebrated with the same enthusiasm as if it were the first. Today, 35 states have direct access to physical therapist services. Forty-eight states allow physical therapists to conduct an initial examination without a physician's referral.
Until late last year, the quest for direct access has been a state legislation issue. But in November 2001, something extraordinary happened: We took the fight for our patients to the federal level. Because of the high regard and the respect that policy makers have for us as health care professionals, Congress listened—and acted.
In November, the Medicare Patient Access to Physical Therapists Act [HR 3363] was introduced in the US House of Representatives, and, in April 2002, a companion bill [S2386] was introduced in the US Senate.
This legislation is monumental! In fact, I believe it is the most important legislation with which we've been involved during the past 20 years.
The Direct Access bill would allow Medicare payment for the services of physical therapists provided without a physician's referral. It also makes technical corrections that would separate physical therapy and speech-language pathology services once and for all, to avoid situations such as the current shared cap under Medicare.
Our formal position on the direct access bill states: "The physician referral is unnecessary and limits access to timely and medically necessary physical therapist services. Such access for beneficiaries is critical as Congress looks to reform the Medicare program."1
Another important benefit of this legislation is its potential for setting a precedent. Medicare is the largest health care insurer in the country. Imagine the possibilities once the Medicare program puts its stamp of approval on direct access to physical therapy! This is exactly the kind of example that private insurers are likely to follow.
As a profession, we've set a clear goal of truly autonomous practice for all physical therapists by the year 2020. In order for that to happen, direct access has to be achieved in 2 ways:
We all know that the burden of referral weighs heaviest on those who are economically disadvantaged. They may not have the transportation to get to the physician for the referral. They may not be able to afford time away from work for the physician visit and then for the appointment with the physical therapist. They may, in fact, be intimidated by the idea of having to visit the physician to ask for a referral to the physical therapist.
Direct access is truly about access to needed health care for all citizens. And this is why the Medicare Patient Access to Physical Therapists Act is so, so important.
The push for direct access under Medicare and the fight for the legality of direct access in every state are much more than just legislative issues or just practice issues. These efforts have everything to do with realizing our dreams for our patients and for ourselves as a profession, and they cut across the 3 prongs of physical therapy—practice, research, and education.
Unified as a profession, we have embraced a common vision for our future. We know where we are going, and we know how to get there. In fact, we are well on our way. We have a Vision. We have a landmark description of physical therapy in the Guide to Physical Therapist Practice.2,3 We have a Clinical Research Agenda. And we have a commitment to the clinical doctorate as the preferred professional degree.
We are ready. The time has come for full and complete autonomy!
The quest for autonomy did not start with direct-access legislation. Generations of physical therapists before laid the bricks in what is now this strong foundation on which we stand poised to realize full professional autonomy.
Recently, I read a draft copy of a PT Magazine article in which one of our distinguished Catherine Worthingham Fellows, Sam Feitelberg, PT, MA, was quoted on the topic of autonomy. He said, "I remember my first job as a physical therapist in September of 1953. I sat at the end of a long table and waited for a nurse to come into the room and give me the prescription from the physician for the patient that I was about to see. I was not allowed to talk with the patient about the evaluation, the diagnosis, or prognosis. I was simply to follow the order for treatment. And the only time I might have the opportunity to speak with the doctor would be if HE had a problem with ME."
Sam went on to say that he knew early on that he would not be content to practice this way.
Sam, and hundreds like him, worked diligently throughout the years to change things.
One of our most beloved and esteemed colleagues, Florence Kendall, along with her husband, Henry O Kendall, played a major role in drafting the original state practice act in Maryland in 1947. She has called it "a labor of love, with the only compensation being the satisfaction of helping attain standards for the quality of physical therapy in the health field."
Throughout our history, we have been on a quest for independence. And what has always set us apart on this journey, I believe, is our spirit of cooperation—our desire to work within, not apart from, the larger medical community.
Almost 50 years ago, another of our revered Catherine Worthingham Fellows, Helen Hislop, PT, PhD, addressed this desire in a Physical Therapy editorial, stating, "We seek stronger, not weaker, ties with medicine. We seek cooperation, coordination, and communication with all branches of medicine. (But) we still affirm the basic right to govern our own affairs."4
Throughout our history, we can be grateful that our predecessors had the foresight to fight for that basic right.
I have talked about our future in the framework of our Vision. And I've talked about our past, as the generations before us fought so valiantly on the early road to autonomy. What about the present?
When I see what today's physical therapists are accomplishing, I couldn't be more proud or excited. We have achieved an advanced level of education, scholarship, and clinical skill that is clearly synonymous with autonomous practice. And this has been achieved by all of us—including those who continue to fight for direct access in their states.
We have defined our scope of practice, and our ability to evaluate, diagnose, and treat is without question. In private practices, in hospitals, in rehabilitation facilities, in skilled nursing facilities, and in patients' homes, we have the unmatched ability to return our patients to meaningful function. For one patient, that may mean returning at 100% performance to the professional playing field; for another, it may mean returning to the backyard garden.
I believe this may be the most promising time ever for physical therapy.
In addition to our continued dedication to the more traditional rehabilitation settings, we are moving into more and more new markets, including prevention and wellness, exercise and fitness, balance and falls prevention, women's health, and ergonomics. Direct access makes it possible for so many to avail themselves of these kinds of programs—and, in effect, prevent future injury, disease, and disability.
We have the potential to dramatically enhance the quality of life for countless Americans, with just as dramatic an effect on health care cost containment. We have already begun to do this. Direct access makes it that much easier.
In addition to our achievements in the clinical arena, I also see physical therapists with a sophisticated political understanding. Back in the 1960s, it was just a handful of physical therapists who worked day and night for months to ensure the specific inclusion of physical therapist services into the original Medicare legislation.
Today, we have hundreds (thousands?) of you and your patients working to secure sponsorship of our Medicare direct access bill. You understand the importance of your political activism. And this activism has paid off. We now have 34 sponsors of HR 3363, as we move toward our goal of 50 to 100 sponsors by the end of this year!
Recently, APTA put out a call to many of our members asking for patients' stories to aid in this lobbying effort. It probably won't surprise any of you when I tell you that the stories are there, and they began coming in immediately. Consider this one, typical of so many:
As a senior and World War II veteran, I had a bout with shingles last autumn. After several doctors' visits and repeated MRIs [magnetic resonance imaging scans] and diagnoses, I finally received treatment from a physical therapist for my frozen shoulder due to shingles. In between, I had doctors' appointments weeks apart before I finally had some help. All that time I was in severe pain and required pain-killing drugs to tolerate it. The delay in seeing a physical therapist not only prolonged my condition but entailed many extra visits, and I believe added costs to an already overburdened health care system.I believe I could have been helped earlier, less expensively, and more efficiently, and [could have] had significant improvement without delay, if I had been allowed prompt access to a physical therapist.
If this story sounds familiar to you, I'm sure you and your patients have countless more to add to this cause. We need to hear from every one of you!
To ensure passage of the Medicare Patient Access to Physical Therapists Act, every voice in this profession must be heard!
We need you to urge your Members of Congress to become co-sponsors. If they already are, send them a letter of thanks.
Educate your patients about the importance of this bill. Ask them to write in support of its passage—and thank them when they do.
Become involved in APTA's Federal Government Affairs Liaison Program.
Get all of your colleagues involved!
Before you leave the conference this week, please stop by our Government Affairs tables in the registration area and the Exhibit Hall to see just how easy it can be to get involved.
In closing—
We are so close to seeing our dreams for this profession become a reality. Each of you here today—and the thousands more back in your clinics, and classrooms, and offices, and labs—must believe in our ability to make a difference.
Our practice options are nearly limitless. And our potential to improve the health, fitness, and function of all Americans can be beyond our dreams ... if YOU get involved NOW!
| Footnotes |
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| References |
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 TopIntroduction References |
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This article has been cited by other articles:
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  C. J Leemrijse, I. C. Swinkels, and C. Veenhof Direct Access to Physical Therapy in the Netherlands: Results From the First Year in Community-Based Physical Therapy Physical Therapy, August 1, 2008; 88(8): 936 - 946. [Abstract] [Full Text] [PDF]
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L. L Swisher, J. W Beckstead, and M. J Bebeau Factor Analysis as a Tool for Survey Analysis Using a Professional Role Orientation Inventory as an Example Physical Therapy, September 1, 2004; 84(9): 784 - 799. [Abstract] [Full Text] [PDF]
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