NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (Full Version)

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jma -> NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 1, 2008 8:40:33 PM)

Just go this from the APTA. Please read:

"APTA Responds to NATA Lawsuit
The National Athletic Trainers' Association (NATA) on February 1, 2008, filed a lawsuit against APTA and the Orthopaedic Section, APTA, Inc. in the U.S. District Court in Dallas. The complaint alleges that the APTA and the Section have violated the antitrust laws by seeking to deny athletic trainers (ATCs) access to the market for manual therapy and by coercing physical therapists to refrain from educating ATCs in certain techniques. APTA's counsel is currently reviewing the complaint. APTA believes that the NATA lawsuit is wholly without merit.
Please click the links below to review documents relative to this action:

  • December 21, 2007 letter from NATA to APTA
  • Attachment to December 21, 2007 letter
  • January 25, 2008 letter from APTA to NATA
  • February 1, 2008 cover letter from NATA counsel
  • Copy of NATA complaint and application for injunctive relief "
    http://www.apta.org/AM/Template.cfm?Section=Home&Template=/CM/HTMLDisplay.cfm&ContentID=45981



    • TexasOrtho -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 1, 2008 9:03:12 PM)

    Thank you very much for posting this.  I will defintely get this up on the blog as well.  I really liked the APTA president's response. 



    Kaden -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 3, 2008 1:16:16 AM)

    Wow, a monopoly on manual therapy, really?  We have chiros, PT's, OT's and DO's all performing manual therapy every day and the NATA calls what PTs have as a monopoly on therapy.  Thats a good one.

    I have nothing against ATC's and have worked with some good ones but this lawsuit is just ridiculous. 



    ptdan23 -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 3, 2008 1:23:46 AM)

    I am sure that this lawsuit will get thrown out as it has not basis.  The letter that the NATA wrote to the APTA was absolutely absurd and I definitely enjoyed reading the response of Dr. Ward to the NATA letter. 

    Dan



    Tom Reeves DPT ATC -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 3, 2008 1:40:33 PM)

    Being both a PT and an ATC, I find the letter from the orthopedic section disturbing.  To tell a PT who they can and cannot teach a course to is a bit fascist.  I know as do you all probably, that ATCs are responsible for the rehabilitation of their athletes.  The good ones do a fantastic job and are better at it than the weak PTs.  The opposite is also true.  Good PTs are better than poorer ATCs.  The point is, that many of our professions overlap in scope.  PTs have some similar responsibilities and skills as ATCs ONLY with generally well athletic patients.  I often tell people that I look at patients very similarly to how mixer chiropractors do, we just have different methods of treating them.  (For the record, I think the subluxation concept is a religion and not based upon science.)  The DCs and PTs look at human motion much more similarly than do PTs and most MDs. 

    PTs and ATCs have different skill sets.  An ATC is a cross between a  PT and an EMT and a primary care doc, holding skills from each profession but not all of the skills from any one of the three, that's what makes them unique.  A PT is also unique but has a different set of skills coming from DC, DO, MD, and athletic trainer. 

    If someone wants to teach someone from another profession how to mobilize a joint, and mobilization fits in THAT person's scope of practice (and it certainly does for ATCs) then how is it the right of the APTA or anyone else to intimidate them out of doing so??  The APTA is now behaving like the Arkansas folks in the Teston case.  I am ashamed.



    SJBird55 -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 3, 2008 10:02:58 PM)

    Well, Tom... I'm a dually credentialed therapist too.  From my training and from a recent glance at athletic training/sports medicine program courses, athletic trainers do not have a huge chunk of their educational training in manual techniques.  I assume you received the same email blast from the NATA that I received.  I believe that the Ortho section president was right on in communicating to the two physical therapists that they should refrain from teaching the continuing education course on manual therapy directed to the cervical spine and ribs to the athletic trainers.  The general population that we treat as physical therapists can have quite the number of complexities.  Athletic trainers are not as well versed in understanding the various co-morbidities that we generally understand nor necessarily understand how those co-morbidities affect function.  I appreciated that the Ortho section president stood up and sent a letter to the 2 therapists that were scheduled to teach that course this January.  The athletic trainers don't have to learn mobilization skills from physical therapists unless we allow them to partake in courses.  Just a simple fact of life.  If physical therapists are teaching courses, they should probably limit the attendees to physical therapists and physical therapist assistants - the days of allowing massage therapists, respiratory therapists, athletic trainers, physicians, nurses... blah, blah, blah to attend so the course sponsor makes extra money should be disallowed.  If we can own the a special skill set of knowledge that will improve our political position and improve our value, in my opinion.

    The APTA and the Ortho section have every right to make their claims that certain courses should be for physical therapists and physical therapist assistants only.  We are the providers of physical therapy.  Technically, the ATCs only have 2 CPT codes directly allowable for them to use and that is the athletic training evaluation and re-evaluation.  All the physical medicine and rehabiliation CPT codes, according to the definition of them by the AMA, are strictly for physicians and therapists.  Athletic trainers can work under the direct supervision of a physician (although clinical reality is that for any third party payor that doesn't define the provider of care, athletic trainers will work under the supervision of physical therapists).  The other reality is that some third party payors follow CMS and do not allow athletic trainers to provide care to their subscribers.

    That whole letter the NATA president wrote to Scott Ward seemed very immature and very reactionary.  It is going to be a financial loss for both organizations and I have a feeling the NATA will lose.  The language of what the NATA wanted was too strong for the APTA who represents physical therapists to ever agree to AND half the crap will be a "he said, she said" kind of deal.  I also don't believe anything illegal transpired.  Politically, the NATA had to do something because they were left without 2 presenters for a major workshop....



    Tom Reeves DPT ATC -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 4, 2008 8:25:25 AM)

    I guess I was reacting more to someone's comment implying that PTAs were more qualified to deliver joint mobilization than athletic trainers.  That is rubbish.  The difference is political definition only and you know it.  NATA and APTA have been threatened by each other for more than 20 years.  I remember wondering if my ATC credential was going to help or hurt me when I was applying to PT school in 1988.  I do not believe that PTs should be precluded or intimidated by the APTA from teaching courses that are within our scope of practice.  If athletic trainers or optometrists want to attend, that is their right.  What if an ATC wanted to start a course on taping?  Would the NATA stop that? It is clearly within the scope of the ATC.  Joint mobilization is a universally accepted treatment for many disorders of the spine and of peripheral joints.  The ATCs may not be able to independently charge for that service/skill but they certainly will need to use it in the rehabilitation of their athletes. 

    A question that you don't have to answer, just ponder: Would you rather have a PTA or a good ATC work with your patients?  I too am a sort of control freak with my patients and do not delegate their treatment to others very often, however, the clinical maturity of a good ATC outpaces the maturity of a good PTA in my opinion.  I will probably get some nasty responses but that's where I stand.



    Shill -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 4, 2008 1:59:37 PM)

    This simply does not seem like a good use of our judicial system.  I found a nice definition of frivolous on Wikipedia.

    A claim or defense may be frivolous because it had no underlying justification in fact, or because it was not presented with an argument for a reasonable extension or reinterpretation of the law, or because laws are in place unequivocally prohibiting such a claim (see Good Samaritan law).
    In the United States, Rule 11 of the Federal Rules of Civil Procedure and similar state rules require that an attorney perform a due diligence investigation concerning the factual basis for any claim or defense. Jurisdictions differ on whether a claim or defense can be frivolous if the attorney acted in good faith. Because a frivolous defense or claim wastes the court's and the other parties' time, resources and legal fees, sanctions may be imposed by a court upon the party or the lawyer who presents the frivolous defense or claim. The law firm may also be sanctioned, or even held in contempt.
    Lawyer Daniel B. Evans writes:




    “
    [W]hen a judge calls an argument "ridiculous" or "frivolous," it is absolutely the worst thing the judge could say. It means that the person arguing the position has absolutely no idea of what he is doing, and has completely wasted everyone's time. It doesn't mean that the case wasn't well argued, or that judge simply decided for the other side, it means that there was no other side. The argument was absolutely, positively, incompetent. The judge is not telling you that you were "wrong." The judge is telling you that you are out of your mind.



    USAPT -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 4, 2008 2:10:07 PM)

    Tom,
    Being the third duel credentialed member on this thread I see points of both (yours and SJ). I do think ATs have a place in rehab; however, do I want an AT performing cervicothoracic mobs on my pts..No. I think that is going too far. I agree with SJ that some of our courses are too '$$ hungry' and allowing most any healthcare practioner to attend is not good for PT. I know that attending a weekend seminar I still have some trouble recalling the exact specifics of techniques but I also have a background that allows me to understand the premise/biomechanics behind them. An ATC taking a weekend seminar on C/T mobs with no prior background or fundamental understanding of arthrokinematics, despite 'learning' them OJT (on the job), is not going to touch my pts. Maybe that's just me.
      The lawsuit in of itself is another bad attempt of the NATA to cry out for 'more'.
    my 2 cents

    -Jason 



    TexasOrtho -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 4, 2008 2:45:28 PM)

    I'm not dual credentialled but I have seen a wide range of abilities for ATC's in the clinic.  Some I would trust with my wife, others I wouldn't let touch with a 10' pole.  I think it would be a case by case issue for me.  Since we can't legislate on a case by case basis, I think I have to stick with the Orthopedic Section's viewpoint on this one.  The lawsuit seems to be reaching.



    Tom Reeves DPT ATC -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 4, 2008 3:43:05 PM)

    Jason,
    I am not trying to say that I want an ATC working in my clinic, too much salary for what they can bill for.  I am saying that cervico-thoracic mobilization techniques on say, a gymnast who missed a dismount and landed on their head, would be a useful treatment technique for the ATC. 

    As far as the knowledge of the arthrokinimatics of the cervical facets, I used the same biomechanics book/author in undergrad AT classes as I did in Graduate PT classes so I can't say I agree with that particular premise.  Maybe I went to a uniquely scholarly AT program (I would like to think I did) but I know that othe ATCs who went to other programs did much of the same book lernin'.



    Tom Reeves DPT ATC -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 4, 2008 3:46:55 PM)

    Steve,

    I agree with you.  I am not really taking a side, I just thought that the letter from the Ortho section was a bit controlling and out of line.  We can battle the ATCs as much as we want in the clinic setting, in POPTs etc . . .  I just don't think we should limit what someone can learn at a seminar.  They may learn it but it doesn't mean we need to support their right to use it in our setting, they should be able to use it in their setting so long as it is not illegal or unethical.  I think that it is neither.



    SJBird55 -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 4, 2008 8:23:30 PM)

    This is the day of knowledge... it is in our best interest to keep our knowledege to ourselves to increase the need for others to seek out our knowledge.  What percentage of athletic trainers function solely in a high school setting?  Probably not many...  back in the day when I was in a high school setting, there wouldn't be time for any manual anything... tape, tape, tape... advise coaches... give exercise programs (but not really supervise) because being responsible for 6 concurrent teams with quite a few athletes never allowed me to do justice for the high school athletes.  Athletic trainers employed with a university/college or even in professional sports would definitely have the time to rehab an athlete optimally.  That being the case, I would be of the assumption that the majority of athletic trainers are being used in outpatient clinics and being supervised by physical therapists with claims billed out as physical therapy.  Reality is that athletic trainers aren't physical therapist assistants and reality is that we really should protect our knowledge and skill to maintain our role in outpatient settings.  That's just my opinion though. 



    SJBird55 -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 4, 2008 8:27:17 PM)

    Oh... the letter from the ortho section was to the therapists that were going to teach the course - NOT to the NATA.  The letter from the Ortho section president was just communicating the philosophy and the BOD guidelines.  The NATA could contract someone else willing to teach the course - the knowledge just wasn't going to come from physical therapists this time around.  The letter from the NATA to the APTA was very, very immature and childish - it had the town of an 8 and 10 year old bickering.  What a waste of money for our court system (the attorneys gotta love it!), but what a waste.  What occurred that was illegal?  The APTA didn't say the NATA couldn't offer the course.. the Ortho pres communicated to Ortho PT members and educated those members.  Those PT members decided to decline teaching.



    marptatc -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 5, 2008 10:01:16 AM)

    Something to ponder...have many of the techniques that PT's have learned and use, I.e manual therapy have been taught by other professions? Osteopathic and medical physicians taught much of the foundation for much of what we use(Cyriax, Mennell, Hartman, MacConaill, Basmajian just to name a few).  The physical therapy profession seems to have had no problem learning from these other healthcare providers. Much of the training that ATC's have in their education programs offer the foundation, anatomy and joint kinematics that qualify them to use and thus further learn joint mobilization techniques in their practice.  Seems like a strong stance that the APTA/Orthopaedic Section takes on PT's teaching mobilization and manual therapy skills to other healthcare professions.  Where does the Sports Section of the APTA stand on this? Oh what would Hippocrates think of all this???



    Shill -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 5, 2008 2:10:13 PM)

    Tom,
    That is a very good point, the one you made about what someone is allowed to learn.  It is similar to a store being able to sell drug paraphenalia.  Since it CAN be used for tobacco, it is not the device that is illegal, its the stuff that often goes into the device.  As you said, what someone learns may not need to be restricted, just what someone does with what he or she learned.
    Marc makes excellent points as well, that one really needs to digest in order to get to this heart of the matter.



    Rwantz -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 17, 2008 3:05:32 PM)

    I am an athletic trainer.  Maybe I will lose my ability to log in to the website after posting. 
    I would agree that the NATA seems to be reaching a little but, as an association protecting the rights of it's members, they are doing what is right and are bringing to light the "anti-trust" practices of the APTA.  Not of physical therapists.  The NATA and athletic trainers do not have a problem with physical therapists.  I have no problem with physical therapists practicing and doing what they are skilled and qualified to do.
    Athletic traienrs are trained and qualified to perform manual therapy in their practice.  The debate can continue through kingdom come if certain physical therapists believe that athletic trainers are qualified.  I would join in and say that I would not want some athletic trainers performing manual therapy on me.  I would also not want some physical therapists to perform manual therapy on me.
    That all being said, The lawsuit is between the NATA and the APTA and it's Orthopedic Section.  Although each represents us, it does not change that athletic trainers have been treated as second class healthcare professionals. 
    I think that a better use of topic would be on HR 1846.  Can someone please tell me why a physician should not have the ability to refer a patient to me and have that patient's insurance cover their treatment?  I am an atheltic trainer remember.  I would like to clarify what SJBird said concerning the CPT codes.  ATs have their own evaluation and re-evaluation codes (just like PTs).  ATs are qualified to use other CPT codes.  Those codes are not specific to physical therapy as you know.  I am qualified to provide therapeutic exercise and activities.  Now, why would the APTA misstate what HR 1846 says in the bill.  The APTA says that athletic trainers would be providing physical therapy with this bill.  Athletic trainers do not provide physical therapy.  Athletic trainers are fighting for the right to PRACTICE.  This seems "anti-trust" to claim that we are doing what they own (physical therapy).
    I personally think that it was in poor taste and judgement for the Orthopeic Section of the APTA to threaten dual credentialed practictioners who were willing to provide continuing education to healthcare providers who are qualified to perform the skills.  I will not disagree that the NATA went very far in their letter, but I do think that the NATA is right in serving the APTA.  Whether it is successful is not right for me to predict.  I am not in law and don't know enough about anti-trust lawsuits. 
    I would like to see the NATA and the APTA have civil conversation and the two work together in providing the public with the healthcare that is needed.  It seems wrong to work to restrict a profession from practicing as qualified at a time like this.



    SJBird55 -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 17, 2008 4:22:43 PM)

    Read the definition of the CPT codes again... the AMA prefaces the use of the physical medicine and rehabilitation codes to be used by the physician or the therapist.  (Athletic trainers are neither.)

    HR 1846 is directed toward patients with Medicare.  Athletic trainers are neither trained nor qualified to be the practitioners of choice with the elderly population, period.  Athletic trainers do not have or own a NPI.  Athletic trainers will always function "incident to" someone until that changes. 

    Some third party payors do not want athletic trainers providing any care either.  Some policies clearly state that care can only be provided by a physical therapist (not even a physical therapist assistant is allowed to provide care).

    Athletic trainers have created "gray" by taking the stance that employees of some companies are "athletes" based on the activities they do day in and day out. 

    The NATA has no grounds to stand on with their anti-trust lawsuit.  1) there are plenty of certification courses in the NATA BOC 2) the APTA nor the Ortho section have the clout to limit an athletic trainer's ability to earn a living.  The only objective statement with proof it acutally occurred was the letter from the pres of the ortho section to the speakers for the manual course.  (They weren't threatened at all, in my opinion... what was the threat?  The pres educated them as to the BOD stance on continuing education.)  Those speakers pulling out of teaching the course has nothing to do with limiting an athletic trainer's ability to earn a living.  How that action can be extrapolated to suggest anti-trust is beyond me. 

    Of course, the APTA should definitely be involved in any legislation occurring around the athletic trainers and should maintain, especially with federally funded programs, that a physical therapist would be the provider of choice for the elderly population. 

    The reason a physician would like to have an athletic trainer providing services, especially in the sports med population is simply due to finances.  It is cheaper to have an athletic trainer on staff providing all the care versus a physical therapist.  Another reason to have an athletic trainer on staff is to have the athletic trainer in the community providing athletic training services through a contract with high schools to then have the injured athletes filtered through the physician doors.  And yes... athletic trainers ARE providing physical therapy when they are working in a physician office OR an outpatient physical therapy office.  The referrals always state "physical therapy."  I have never, ever seen a referral that states "athletic training" is required.  The services are being billed as physical therapy services and they are being billed "incident to" a physical therapist or a physician.  All you'd have to do is look at the claims submitted to third party payors.  Let's not cloud the water and state that athletic trainers are not providing physical therapy services.  The modifier tagged to services on the claims will be a GP modifier... there is no athletic training modifier.

    For those of you who are athletic trainers, at what frequency are athletic trainer evaluations and re-evaluations reimbursed?  I hate to tell you this... but the codes were created to satisfy the politics of athletic trainers... there is no modifier to indicate an athletic trainer provided the services and athletic trainers provide services under the supervision of a physician or a physical therapist.  In fact, call up a few third party payors and ask if there are any benefits for athletic training services.  Third party payors do not care about whether a subscriber can participate in sporting events.  We all know when writing goals that a goal of return to golf or return to basketball just isn't going to be acceptable.  Real world... that's just the way it is.  The APTA isn't fully to blame either because the APTA can't fully control legislators, third party payors or benefits for services.



    TexasOrtho -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 17, 2008 4:29:26 PM)

    Remind me not to pick a fight with SJ.[sm=rolleyes.gif]



    blast7 -> RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08 (February 17, 2008 6:39:56 PM)

    quote:

    ORIGINAL: SJBird55

    Third party payors do not care about whether a subscriber can participate in sporting events.  We all know when writing goals that a goal of return to golf or return to basketball just isn't going to be acceptable.  Real world... that's just the way it is.  The APTA isn't fully to blame either because the APTA can't fully control legislators, third party payors or benefits for services.

    Not to head off topic, but do you mean that goal alone is unacceptable or even along with other measurable functional goals?



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