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Open Letter to Physical Therapists
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Open Letter to Physical Therapists - February 18, 2000 5:54:00 PM
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jc137
Posts: 6
Joined: February 17, 2000
From: Santee, CA, USA
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I came upon this letter on the internet. To all who are interested.
Legislative Issues
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Open Letter to Physical Therapists
by James Dagostino
October 1, 1999
Memo: To my PT Colleagues:
The time has come to initiate the legislation needed to allow physical therapists to make a physical therapy diagnosis. We all know that California is considered a direct access state. However, due to idiosyncrasies of California law we must rely on the diagnosis of a physician before implementing care. As times and moods change in the medical community, physical therapists can no longer solely rely on the referrals of physicians for their livelihood. Autonomy of practice means the ability to openly compete in the marketplace, so patients have the ability to seek our services directly. How can physical therapists survive this current dilemma without this right?
Physical therapy has been effective and productive for many of us who have been in the profession in the past. Consequently in these changing times the status quo of the physical therapy profession is no longer adequate to support established practitioners and new colleagues entering the field, who will be impacted even more negatively. It is believed that our profession will continue to provide what is deserved, if we all are prepare to fight for our rights.
The California Chapter of the American Physical Therapy Association (CCPATA) has been planning for well over 5 years, so that in the year 2000, legislation will be introduced to provide Physical Therapy Diagnosis. CCAPTA has proposed a change to the Practice Act, which will allow patients the right to see PTs directly. Physical therapists are skilled and educated to provide basic medical screening. We already perform independent PT evaluations, set treatment programs and refer back to the physician when dangerous conditions are found. Physical therapists should be paid for this direct access.
As with all legislative ventures, fine-tuning of the political process is necessary. CCAPTA has greatly contributed to the legislative process and has established excellent contacts with many legislators. To guarantee our success with this undertaking we need to hire a professional public relations firm to help us deliver the message. Legislative efforts, public relations firms, testimony from patients and other health care professionals will be costly. It is estimated that the cost of the legislative effort will be $250,000 or more, with the public relations portion being about $100,000.
I have convinced the California Chapter that I can raise the money. I have spoken with many of you in the past about the needs of this legislative effort and many of you have concurred. Now is the time for you to become involved. We need your financial support. Strides in our profession have been made primarily by the dedication of private practices. I come to you with hat in hand to ask for a large donation to help implement this legislation. The chapter has set up a special fund for this effort. It is my recommendation that practices grossing $2,000,000 + annually should contribute $5,000, while practices grossing between $2,000,000 and $1,000,000 should contribute $2,500 and practices grossing below $500,000 should contribute $1,000.
Your contributions should be made out to: CCAPTA DX-FUND
And sent to: CCAPTA
2520 Venture Oaks Way, Suite 150
Sacramento, CA 958333
Please feel free to contact me regarding contributions, as I would like to speak with each and every one of you. I am proud to be a physical therapist and I know that you share that same pride. Let us move forward and take our rightful autonomous position. Our persistence will get our goals recognized by the law.
James J. Dagostino, DPT
Dagostino Physical Therapy
3520 College Blvd, Suite 101
Oceanside, CA 92056
Tel: (760) 941-2630
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Re: Open Letter to Physical Therapists - February 21, 2000 12:03:00 AM
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Rose
Posts: 122
Joined: September 19, 1999
From: Ohio
Status: offline
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AS you stated, Physical Therapist's are qualified to do "basic medical screening". I continue to prefer the presence of a physician in my work. Yes, we DO find things the physician has "missed"....but I feel that "in the big picture" we, as therapy clinicians, stand to miss a heck of a lot more if we are left to direct access. I, for one, do not care for that responsibility or liability. Direct access knocks out any Medicare recipients we may have and probably most of the insurance companies whop want physician referral. So where is the benefit ??
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Re: Open Letter to Physical Therapists - February 21, 2000 4:48:00 PM
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jc137
Posts: 6
Joined: February 17, 2000
From: Santee, CA, USA
Status: offline
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Rose:
I understand that some PTs may not have the diagnostic skills to become first care providers or do not want the burden of the liability. DPT programs have begun incorporating differential diagnosis, clinical imaging, and patient management courses in order to resolve this issue. For the individuals who desire to see physical therapists as specialists in movement pathology (with the ability to directly provide services to patients), this is a necessary step in advancing the profession and educating the public about our services.
Are chiropractics any better at rehabilitation than physical therapists? Some might say "yes", but I for one do not think so. However, they are primary care providers. They are in that position because they took the initial step in forming their identity by lobbying and educating the public. If we do not take our step now, then we can start to see more and more patients acquiring chiropractic or other services for their rehab. The chiropractors are now starting to call it "Physiotherapeutics". Sounds great, does it? Pretty soon, there WILL be no demand for PT. They have seen that we are relectant to do anything about. They are laughing all the way to the bank at the expense of patients and physical therapists.
For the individuals that do have the diagnostic skills, the benefits will come after they can evaluate, diagnosis and treatment without limitations. We are selling ourselves short and the patients are paying the price. That's my opinion. I am FOR physical therapists (especially DPTs) in diagnosing and treating without a physician referral.
JC
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Re: Open Letter to Physical Therapists - February 23, 2000 8:20:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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Rose:
I understand and share some of your concerns. The thought of some PTs I know having primary care responsibilities is a little scary!!!
However - we should be moving towards direct access anyway. You can see a massage therapist off the street, so why not a PT. Chiropractors are NOT as qualified in my opinion to have direct access. How many primary care physicians know more about muskuloskeletal problems than a good, experienced physical therapist.
What are the benefits???? Tbat is a difficult question. Medicare will not pay for a PT without referral and neither will most HMOs. Direct access patients will likely serve as a small portion of your overall patient population. I don't think it can hurt however. If you like your current group of physicians so much think what could happen if you were able to send a few patients their way when additional evaluation was necessary. this would strengthen your provider relationships!!
I am not sure of how to work out the details or how to ensure that PTs were qualified. Perhaps you could require board certification. But I don't think it is a bad thing.
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Re: Open Letter to Physical Therapists - February 23, 2000 12:12:00 PM
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Rose
Posts: 122
Joined: September 19, 1999
From: Ohio
Status: offline
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In these days of litigation for EVERYTHING under the sun, I personally don't want to ask to place myself in the position of being MORE of a target than I already am. I understand your comments and I respect them. As I said, "personally" I don't want the added liability Direct Access would give me. In my career I have been sued because a patient on the SECOND floor fell and fractured her ankle while I was in the BASEMENT. I was to blame, according to the family, because I took this lady on the stairs the day before (and I had to almost RUN to keep up with her !!)I feel "Direct Access" would only bring more wild dogs to my end of the forest. :-)
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Re: Open Letter to Physical Therapists - February 24, 2000 4:29:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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Rose:
Thats a scary story!!!!!!!!!!! None of us like to hear things like that. Totally not your fault.
Direct access might increase your exposure....true. But as you discovered, there may be no preventing someone who wants to sue.....regardless. When you see a patient who is suing the referring physician many times you get sued as well. Furthermore, I have been in situations where I feel that specialist intervention is needed but I can't get the primary to go along or I had to be careful not to insult him/her. With DA you have more control.
Still.....I definitely appreciate your apprehension.
-Marc
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