February/March 2008 PTThe Official Magazine of thePriority Illinois Physical Therapy Association Inside: PT Priority has a NEW LOOK! DIRECT ACCESS 2008 Workers Comp Medical Fee Schedule Ethics Today ...and more! PRST STD US POSTAGE PAID PERMIT #419 FT MYERS FL PT Prior.Feb-Mar.08.indd 1 1/30/08 4:00:49 PM Honored as the “Best Physical Therapy Practice in the Nation” by ADVANCE Rehabilitation Magazine Physical Therapy ō Sports Medicine ō Industrial Rehabilitation ō Aquatic Therapy ō Hand Therapy Why ATI? One-to-One Care Mentorship Program Competitive Salary Career Development Performance-Based Bonuses Company Growth Opportunities In-House Research Department Evidence-Based Medicine State-of-the-Art Facilities Dedication to Continuing Education Clinical Management & Leadership Training ATI Foundation Outstanding Benefits To Join ATI’s Team of Professionals E-Mail Resumes to [email protected] www.ATIPT.com PT Prior.Feb-Mar.08.indd 2 1/30/08 4:00:52 PM Illinois Physical Therapy Association • www.ipta.org President’s Message “Such stories are proof By Peter McMenamin, PT, MS, OCS positive that physical therapists are ready for Direct Access!” irect public access to physical therapists remains a top prior- professionals, and there is every evidence that we have honored those ity of the Illinois Physical Therapy Association. Sometimes, obligations as well as the other professionals. Dgood and just things do not come quickly and do not come without lots of work. That is clearly the case with direct access. But A few other things need to the fact that a good and proper change does not come as fast as we be said about direct access: want, does not mean we give up. 1. The intent of direct access is not to separate physical therapists from A few months ago a physician (internist) referred to me a 42 year old the mainstream medical model of healthcare but to enhance our effec- male who had injured his back at work. The referral specified a diag- tiveness within healthcare, and bring added value to the public. nosis of “back strain” and requested I treat the patient for a week or two 2. Very simply, the intent of direct access is to give the public a new and then send him back to the doctor for probable return to work. The port of entry to the healthcare system, and to the PT skill-set. patient, despite having significant spasm, wanted even more than the 3. Omitting the legal requirement of a physician referral will not doctor to get back to work quickly, concerned about losing the overtime reduce the need for referrals to physical therapy. In states where pay which helped him keep his two daughters in private colleges. direct access has been in place for years, the great majority of I took the patient’s unremarkable history. But only a few minutes patients still come to a physical therapist by physician referral. into the physical examination it became apparent this was no simple back strain. I tested toe-walking and heel walking. Heel walking was 4. In-hospital care of patients will still be under physician medical awkward due to pain, but otherwise normal. Toe walking was clearly management. Physical therapy services for in-patients will not occur problematic. He wanted so hard to prove he could do it that he kept without collaboration with attending and consulting physicians. using nervous and clever adaptive strategies. But the bottom line was: 5. In out-patient settings, physical therapists, who are educated and his calf strength was rated only 1/5, and the weakness was clearly not due ethically bound to refer to physicians any patient whose condition to pain or guarding. I had the patient wait in the room while I contacted lies outside their scope of practice, will still be legally bound by the the referring internist, suggesting that this patient had physical signs practice act to refer such patients to physicians for medical diagnos- consistent with severe radiculopathy including pathological weakness tic work-up. of the left calf. I recommended the patient be referred ASAP to a spine 6. The most surprising thing about direct access, initially, may be how specialist (orthopaedic surgeon) for further workup. More phone calls little physical therapy practice will change. were made. The next day he had an MRI showing massive HNP; three days later he saw the orthopaedic surgeon; a week later he was in surgery 7. If initial changes in physical therapy practice are expected to be for discectomy. A month post-op he returned to physical therapy able to small, why bother with direct access at all? Direct access is of walk on his toes. Luckily, because intervention occurred so quickly, he critical importance because the healthcare system for the coming will have no residual loss of calf strength. age of dramatic demographic shifts, needs physical therapy to be The fact that this patient was referred with a diagnosis of “back an autonomous profession, no longer hampered by artificial legal strain” is not the point. The point is that the initial physician referral constraints which make our professional knowledge, insight, judg- was irrelevant to my course of action. My education, training, and ment, and intervention accessible to the public only after being experience were the basis of my evaluation and dictated my course filtered through the lens of other professions. The public is harmed of action: get this patient ASAP to a spine specialist, preferably when it is robbed of this choice. with MRI in-hand! Had this patient come to me — or to any of you 8. Physical therapists offer physical solutions to health problems — under direct access, he would have been handled in similar fashion, related to physical movement and function. Consumers must have because this is what we are trained to do! the choice to access such solutions, both when their physician sug- Similar events occur every day in the work of Illinois physical gests it, and when they exercise their own judgment and know that therapists. Such stories are proof positive that physical therapists are they need this service. Any other policy is paternalistic, a vestige ready for Direct Access! Physical therapists have proven time and of a bygone era! again that we identify signs and symptoms of pathology, that we refer In 2008, there is simply no legitimate reason why it should be ille- cases to physicians when the need arises (as in the example above), gal for a consumer to seek and receive treatment from their physical and that we are no more likely than any physician, dentist, podiatrist, therapist of choice. or attorney, to provide services beyond our scope of practice or our capabilities. Our professional education, our ethics, and our legal Peter McMenamin, PT, MS, OCS liability impose the same obligations on us as are imposed on other President, IPTA 3 PT Prior.Feb-Mar.08.indd 3 1/30/08 4:00:53 PM PT Priority • February/March 2008 CONTENTS From the Editor Features: By Jennifer Ryan, PT, MS, DPT, CCS Direct Access 5 APTA Your Washington Advocate: Focus on Reimbursement 7 Did you recognize the How do they do that? A look inside the creation of CPT codes... publication when it and why it matters to physical therapy 8 Take Action! Making a compelling came in the mail? phone call to your state legislators 10 News Flash: ere you wondering what new, polished and well-designed publication put you 2008 Workers Comp Medical Fee on their mailing list? Despite the new cover and opportunity for color adver- Schedule 10 Wtisements it is the same “PT Priority” that you have grown to know over your years of “You never know when you IPTA to hold insurer forum 10 membership. We are always looking at ways to New Professional Liaison named 10 improve and this is the latest in the ongoing pro- are going to find a unique Medicare announces new cess. Please let us know what you think by writing connection in life, often NPI requirement 10 a letter to the editor or posting your opinion on Assembly Meeting slated 10 the IPTA listserve. they sprout up in the least You never know when you are going to find Columns and Departments: a unique connection in life, often they sprout up likely of places.” in the least likely of places. I wanted to write this President’s Message 3 letter to you all before I left on my amazing journey, but failed to meet my own self- From the Editor 4 assigned deadline. So now I am on the plane, returning from Ireland and actually happy Bookshelf 12 that I waited. The relevance of Illinois physical therapists seeking unrestricted direct Ethics Today 14 access is more similar than I could ever imagine to the aspirations of my grandparents Lobbyists Report 16 emigrating from Ireland in the mid 1920’s. Though they left after the Irish won the Sinn Fein rebellion to make most of Ireland sovereign to its own government, they still had Community: great economic limits on what they could achieve in Ireland and sought a new life in IPTA Calendar 17 Chicago. They sought a change from the no-so-glass ceiling that was obvious to the Irish Lobby Day 2008 18 who sought control and opportunity in their lives much in the way that we as therapists Dateline 20 want our freedom to practice independently within the auspices of our practice act. Awards Nominations 23 Our legislative effort is incremental, making it sometimes hard to understand how Welcome new members 23 all of the steps will lead to the outcome that we seek.