Guest guest Posted December 2, 2004 Report Share Posted December 2, 2004 Ron: I suggest that you refer to the 11/16/04 edition of PT Bulletin Online, for more information on this issue. Link to this edition is included below. http://www.apta.org/Bulletin? & id[1]=70568 Ken Mailly, PT Mailly & Inglett Consulting, LLC Tel. 973 692-0033 Fax 973 633-9557 68 Seneca Trail Wayne, NJ, 07470 www.NJPTAid.biz Bridging the Gap! AOTA/APTA Dispute? Hello: I just received my " Advance for OT " E-newsletter. On the side bar is the following question/poll: ======================================================================= APTA recently announced it was reevaluating its relationship with AOTA after a dispute over PT direct access under Medicare. Should AOTA try to repair the relationship? ======================================================================== Does anyone know anything about this or have any additional information? Thanks, Ron C. Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 2, 2004 Report Share Posted December 2, 2004 It stems from a letter written to CMS from AOTA which indicated non support of Medicare direct access for rehabilitation professionals (PT/OT ST) Ron Barbato P.T. Corporate Director , Rehabilitation Ephraim McDowell Health Voice (859 )239-1515 Fax (859 )936-7249 rbarbato@... " PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. " AOTA/APTA Dispute? Hello: I just received my " Advance for OT " E-newsletter. On the side bar is the following question/poll: ======================================================================= APTA recently announced it was reevaluating its relationship with AOTA after a dispute over PT direct access under Medicare. Should AOTA try to repair the relationship? ======================================================================== Does anyone know anything about this or have any additional information? Thanks, Ron C. Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 2, 2004 Report Share Posted December 2, 2004 Ron, The issue at hand is that the APTA is upset that the AOTA is challenging the position of the APTA that Medicare should change its guidelines to allow for direct access for PT. As I understand it, the AOTA feels that if PT gets direct access, OT should too and if OT doesn't have direct access, they don't feel that PT should have it under Medicare. Botkin, MPT, PT Cardinal Home Care, Inc. 2999 E. Dublin-Granville Road, Ste #112 Columbus, OH 43231 rbotkin@... AOTA/APTA Dispute? Hello: I just received my " Advance for OT " E-newsletter. On the side bar is the following question/poll: ======================================================================= APTA recently announced it was reevaluating its relationship with AOTA after a dispute over PT direct access under Medicare. Should AOTA try to repair the relationship? ======================================================================== Does anyone know anything about this or have any additional information? Thanks, Ron C. Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 2, 2004 Report Share Posted December 2, 2004 Ron, This is in regards to a letter that AOTA sent out regarding direct access for PTs and the fact that if it is considered for PT, it should be considered for OT and ST as well, so as not to discriminate. For more information, go to the APTA website, PT online bulletin, archived article for Nov. 16th. L. AOTA/APTA Dispute? Hello: I just received my " Advance for OT " E-newsletter. On the side bar is the following question/poll: ======================================================================= APTA recently announced it was reevaluating its relationship with AOTA after a dispute over PT direct access under Medicare. Should AOTA try to repair the relationship? ======================================================================== Does anyone know anything about this or have any additional information? Thanks, Ron C. Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 2, 2004 Report Share Posted December 2, 2004 That's very, very sad that there's a rift between AOTA and APTA over the issue of direct access. If we invested the same effort to strengthen the relationship between our two professions that we have invested to drag each other down, incredible things could happen. It's time that we grow up and practice what we preach: teamwork. Instead of OT's whining about PT's moving toward direct access, why don't the OT's get off their tails and strengthen their own profession! The OT's and PT's where I work are a very cohesive unit worth bragging about. There is no reason why that level of cooperation cannot be achieved on a national level. Curtis Marti, OTR/L Inpatient Coordinator of Therapies Hillcrest Medical Center Tulsa, OK 74120 (office) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 2, 2004 Report Share Posted December 2, 2004 Interestingly enough, if you look at the OT's, they are already stronger than us as a profession, if only from point of view of direct access. Although this situation does make life more difficult for us, politically the AOTA could be considered irresponsible to their membership if they don't take this step. At any rate, the AOTA is not saying that PT's should not have direct access, they are making only the point that if PT is suitable for it, then OT should enjoy the same access to the market. I have seen no arguments, valid or otherwise, that would mitigate allowing PT's access, but not OT's. What concerns me is firstly, that the APTA did not see this coming - surely communications//negotiations at high levels in both associations could have prevented such a public letter being mailed. Secondly, I am concerned at what seems to be a knee-jerk reaction to the issue. Re-evaluating the entire relationship over this is poor politics and likely to be counter-productive in the end. Perhaps the OT points should be honestly evaluated and strategies can be devised to if not join forces to expand direct access work to all three disciplies, then to at least take steps to pre-emptively deal with these types of issues in ways that don't jeopardize long-term relationships. Brett Windsor, PT, OCS, COMT, FAAOMPT Re: AOTA/APTA Dispute? That's very, very sad that there's a rift between AOTA and APTA over the issue of direct access. If we invested the same effort to strengthen the relationship between our two professions that we have invested to drag each other down, incredible things could happen. It's time that we grow up and practice what we preach: teamwork. Instead of OT's whining about PT's moving toward direct access, why don't the OT's get off their tails and strengthen their own profession! The OT's and PT's where I work are a very cohesive unit worth bragging about. There is no reason why that level of cooperation cannot be achieved on a national level. Curtis Marti, OTR/L Inpatient Coordinator of Therapies Hillcrest Medical Center Tulsa, OK 74120 (office) Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 4, 2004 Report Share Posted December 4, 2004 BOth the APTA and AOTA are members of a group called the Tri Alliance. Along with ASHA, the presidents of these organizations meet to discuss issues of mutual interest, especially in the areas of regulation and reimbursement. I beleive that the AOTA had a mechanism for communicating this, namely picking up the phone as the communication lines have been open for years. Having said that, You can be sure that as soon as P.T. does acheive it, O.T. will be knocking at Medicare's door saying " me too, me too " , looking to be grandfathered in while the P.T. profession footed the costs to lobby to acheive direct access under Medicare. This actually has happened in a few states The APTA is correct to review it's relationship because what they thought was a good one appears, at least on the surface, to have been unilaterally altered by the AOTA action and position. I hope that the lines of communication continue to be open and that this is worked out positively by both organizations Jim Dunleavy PT, MS Adminstrative Director, Health and Rehabilitation Trinitas Hospital , NJ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 4, 2004 Report Share Posted December 4, 2004 I totally agree with you. I think what the President of the AOTA has done is inexcusable because the people who do not want us to achieve direct access will use that letter against us. We need this direct access regulation to go through in order for States like Missouri to get direct access.. Also, I live in a rural area where everything is referred to the hospital and direct access will help us brake that referral pattern by rural doctors and help those therapist in private practice. Sincerely, Greene Grand River Physical Therapy Albany, Missouri 64403 Re: AOTA/APTA Dispute? > > > BOth the APTA and AOTA are members of a group called the Tri Alliance. > Along > with ASHA, the presidents of these organizations meet to discuss issues of > mutual interest, especially in the areas of regulation and reimbursement. > > I beleive that the AOTA had a mechanism for communicating this, namely > picking up the phone as the communication lines have been open for years. > > Having said that, You can be sure that as soon as P.T. does acheive it, > O.T. > will be knocking at Medicare's door saying " me too, me too " , looking to be > grandfathered in while the P.T. profession footed the costs to lobby to > acheive > direct access under Medicare. This actually has happened in a few states > > The APTA is correct to review it's relationship because what they thought > was > a good one appears, at least on the surface, to have been unilaterally > altered by the AOTA action and position. > > I hope that the lines of communication continue to be open and that this > is > worked out positively by both organizations > > Jim Dunleavy PT, MS > Adminstrative Director, > Health and Rehabilitation > Trinitas Hospital > , NJ > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 4, 2004 Report Share Posted December 4, 2004 In the Nov 29th edition of Advance magazine, AOTA past president, Barbara Kornblau, indicates that in 2001, APTA president Bob Massey presented his organizations's decision to pursue direct access exclusive of other Tri Alliance members. According to Kornblau, " The alliance was founded on the idea that what is good for one is good for all " and that Massy's approach and goals violated the spirit of the Alliance. Based on the article, it doesn't appear that there ever has been " a line of communication " between APTA and AOTA on this issue. If you've read Fred Somer's letter to MedPac, I think you will agree that in no way does AOTA appear to be against PT having direct access. Mr's Somer's indicates that AOTA is still examing the issue of direct access and the letter identifies several areas of concern including equitable treatment for all rehab disciplines. While Mr. Somer's letter does identify some concerns about direct access, including licensure and therapist/physician collaboration, I do not believe that this is an attack against APTA's mission. Ron Carson ===============<Original Message>=============== On 12/4/2004, JIMDPT@... said: Jac> BOth the APTA and AOTA are members of a group called the Tri Alliance. Along Jac> with ASHA, the presidents of these organizations meet to discuss issues of Jac> mutual interest, especially in the areas of regulation and reimbursement. Jac> I beleive that the AOTA had a mechanism for communicating this, namely Jac> picking up the phone as the communication lines have been open for years. Jac> Having said that, You can be sure that as soon as P.T. does acheive it, O.T. Jac> will be knocking at Medicare's door saying " me too, me too " , looking to be Jac> grandfathered in while the P.T. profession footed the costs to lobby to acheive Jac> direct access under Medicare. This actually has happened in a few states Jac> The APTA is correct to review it's relationship because what they thought was Jac> a good one appears, at least on the surface, to have been unilaterally Jac> altered by the AOTA action and position. Jac> I hope that the lines of communication continue to be open and that this is Jac> worked out positively by both organizations Jac> Jim Dunleavy PT, MS Jac> Adminstrative Director, Jac> Health and Rehabilitation Jac> Trinitas Hospital Jac> , NJ Jac> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 2004 Report Share Posted December 6, 2004 There is a peripheral issue to this topic. Not all PTs and not all OTs are members of the respective professional associations. Some of those non-members have strong opinions on either side of this issue, be they PTs who do not support the APTA's position or OTs who do not support the AOTA's position on this matter of mutual interest. Thus, their voice is not being heard. Their voice is not part of the position of the association. So, use this as your catapult to JOIN and GET INVOLVED. Shake up the next meeting, take an office, and be part of the change... if you feel change is needed. Now, for my take on the PT-OT dispute: I am a PT, and believe direct access is important. I believe it is worthy of the time, effort, and funds being thrown at it. I am frustrated by all professional associations (OT, Orthos, etc) that oppose the measure. It is more interesting to view the reasons for opposition than to respect the opposition in and of itself. Hopefully, our lawmakers will see the opposition, on all sides, for what it is - TURF WAR. But, this ought to be a catalyst issue to get more people involved in the cause or to get involved in their professional associations. As you can see, what we do matters. Simonetti DPT land Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 2004 Report Share Posted December 6, 2004 As a rehab director with all disciplines under my responsibility and as an OT I would like to share my perspective on this. I think most importantly we need to differentiate between direct access to care and direct access to payment. This seems to come up frequently as a point of confusion and one that clouds the true discussion. I don't believe anyone within rehab is against the concept of direct access. This means that we as professionals do not require a physician's order to be able to treat a patient. It makes sense from a cost savings perspective and from a patient care perspective. I think we, for the most part, can recognize when it is appropriate to refer back to a physician for medical management or any other discipline who may be able to provide care that is beyond our scope and ability. So what this really comes down to is money. All the direct access in the world won't make any difference if we don't get paid when the payers require a physician referral. This is where the Medicare direct access issue comes in. In my opinion, this is less about getting direct access to Medicare patients and more about getting paid to see these patients when a physician is not involved in the care. So why would the OT's be against this? Should Medicare allow direct access to payment to physical therapists and not to other disciplines, this will create a significant professional differential between physical therapists and other allied health professionals. Take hand therapy as an example. Both PT's and OT's practice in this domain. Under direct access for PT's, a patient requiring hand therapy could go directly to a PT to receive treatment. The alternative would be to see their physician, be evaluated for their clinical needs, and referred to an OT. The OT would then evaluate the patient, develop a treatment plan and request a certification for care from the physician with subsequent followups for recerts as needed. I think anyone would look at this and see why the OT's would be against such legislation that didn't include all disciplines. Couple this with the expanded PT standards of practice and the writing is on the wall that such legislation could potentially eliminate outpatient occupational therapy as a discipline. I'll be one of many OT's to admit that we have a reputation of allowing the PT's to break the ground ahead of us and to then try to follow up to take advantage of the gains made. However I question how much this has been the reluctance of OT's to fight the good fight and how much has been the desire of PT's to go it alone to achieve the goals of their professional organization. To my understanding, the OT's have also been advocating for direct access along with the PT's but there has been little collaboration from APTA on joining together to achieve this. I would ask those PT's who are at the front of the direct access movement to discuss why OT should not have direct access as well, and why it isn't in the best interest of our patients to open all of ancillary care to direct access and payment for our services. Redge L MS OTR/L Director of Rehabilitation Services on Hospital Bremerton, WA 98310 Administrative Assistant: Wanda Kotte: wandakotte@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 2004 Report Share Posted December 6, 2004 You said: " So what this really comes down to is money. All the direct access in the world won't make any difference if we don't get paid when the payers require a physician referral. " This is exactly why we need Medicare direct access, and disagree with your statement. We will never be paid for our independent services unless we are recognized as a nation wide (government sponsored health plan) point of entry for healthcare. Albeit a factor I would suggest that money(payment) is a secondary gain. The PT profession (longevity) and patient (outcomes) are the focus of this initiative. State level direct access has helped our efforts, this is the logical next step. You said: " I would ask those PT's who are at the front of the direct access movement to discuss why OT should not have direct access as well, and why it isn't in the best interest of our patients to open all of ancillary care to direct access and payment for our services. " Before I respond I would be curious how you came to this understanding? Ron Barbato P.T. Corporate Director , Rehabilitation Ephraim McDowell Health Voice (859 )239-1515 Fax (859 )936-7249 rbarbato@... " PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. " Re: AOTA/APTA Dispute? As a rehab director with all disciplines under my responsibility and as an OT I would like to share my perspective on this. I think most importantly we need to differentiate between direct access to care and direct access to payment. This seems to come up frequently as a point of confusion and one that clouds the true discussion. I don't believe anyone within rehab is against the concept of direct access. This means that we as professionals do not require a physician's order to be able to treat a patient. It makes sense from a cost savings perspective and from a patient care perspective. I think we, for the most part, can recognize when it is appropriate to refer back to a physician for medical management or any other discipline who may be able to provide care that is beyond our scope and ability. So what this really comes down to is money. All the direct access in the world won't make any difference if we don't get paid when the payers require a physician referral. This is where the Medicare direct access issue comes in. In my opinion, this is less about getting direct access to Medicare patients and more about getting paid to see these patients when a physician is not involved in the care. So why would the OT's be against this? Should Medicare allow direct access to payment to physical therapists and not to other disciplines, this will create a significant professional differential between physical therapists and other allied health professionals. Take hand therapy as an example. Both PT's and OT's practice in this domain. Under direct access for PT's, a patient requiring hand therapy could go directly to a PT to receive treatment. The alternative would be to see their physician, be evaluated for their clinical needs, and referred to an OT. The OT would then evaluate the patient, develop a treatment plan and request a certification for care from the physician with subsequent followups for recerts as needed. I think anyone would look at this and see why the OT's would be against such legislation that didn't include all disciplines. Couple this with the expanded PT standards of practice and the writing is on the wall that such legislation could potentially eliminate outpatient occupational therapy as a discipline. I'll be one of many OT's to admit that we have a reputation of allowing the PT's to break the ground ahead of us and to then try to follow up to take advantage of the gains made. However I question how much this has been the reluctance of OT's to fight the good fight and how much has been the desire of PT's to go it alone to achieve the goals of their professional organization. To my understanding, the OT's have also been advocating for direct access along with the PT's but there has been little collaboration from APTA on joining together to achieve this. I would ask those PT's who are at the front of the direct access movement to discuss why OT should not have direct access as well, and why it isn't in the best interest of our patients to open all of ancillary care to direct access and payment for our services. Redge L MS OTR/L Director of Rehabilitation Services on Hospital Bremerton, WA 98310 Administrative Assistant: Wanda Kotte: wandakotte@... Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 2004 Report Share Posted December 6, 2004 Ron Why shouldn't OT's have nationwide direct access to all concsumers of healthcare? Why don't we let consumers decide who provides their care? Brett Windsor, PT, OCS, COMT, FAAOMPT Re: AOTA/APTA Dispute? As a rehab director with all disciplines under my responsibility and as an OT I would like to share my perspective on this. I think most importantly we need to differentiate between direct access to care and direct access to payment. This seems to come up frequently as a point of confusion and one that clouds the true discussion. I don't believe anyone within rehab is against the concept of direct access. This means that we as professionals do not require a physician's order to be able to treat a patient. It makes sense from a cost savings perspective and from a patient care perspective. I think we, for the most part, can recognize when it is appropriate to refer back to a physician for medical management or any other discipline who may be able to provide care that is beyond our scope and ability. So what this really comes down to is money. All the direct access in the world won't make any difference if we don't get paid when the payers require a physician referral. This is where the Medicare direct access issue comes in. In my opinion, this is less about getting direct access to Medicare patients and more about getting paid to see these patients when a physician is not involved in the care. So why would the OT's be against this? Should Medicare allow direct access to payment to physical therapists and not to other disciplines, this will create a significant professional differential between physical therapists and other allied health professionals. Take hand therapy as an example. Both PT's and OT's practice in this domain. Under direct access for PT's, a patient requiring hand therapy could go directly to a PT to receive treatment. The alternative would be to see their physician, be evaluated for their clinical needs, and referred to an OT. The OT would then evaluate the patient, develop a treatment plan and request a certification for care from the physician with subsequent followups for recerts as needed. I think anyone would look at this and see why the OT's would be against such legislation that didn't include all disciplines. Couple this with the expanded PT standards of practice and the writing is on the wall that such legislation could potentially eliminate outpatient occupational therapy as a discipline. I'll be one of many OT's to admit that we have a reputation of allowing the PT's to break the ground ahead of us and to then try to follow up to take advantage of the gains made. However I question how much this has been the reluctance of OT's to fight the good fight and how much has been the desire of PT's to go it alone to achieve the goals of their professional organization. To my understanding, the OT's have also been advocating for direct access along with the PT's but there has been little collaboration from APTA on joining together to achieve this. I would ask those PT's who are at the front of the direct access movement to discuss why OT should not have direct access as well, and why it isn't in the best interest of our patients to open all of ancillary care to direct access and payment for our services. Redge L MS OTR/L Director of Rehabilitation Services on Hospital Bremerton, WA 98310 Administrative Assistant: Wanda Kotte: wandakotte@... Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 2004 Report Share Posted December 6, 2004 Hi Ron, Not quite sure which statement you disagree with. I have no disagreement with you or anyone who is pursuing direct access. I believe it is in the best interest of our professions as well as in the best interest of patient care and cost control. However without changes in how our services are reimbursed from Medicare, other government agencies and from a great majority of insurance payers, legislative direct access will not result in significantly greater access to patients. We are a direct access state and probably less than 1% of our overall volume is seen without a physician referral. As for your second question, I have yet to see or hear any representative from APTA advocate for direct Medicare access for all ancillaries including OT. If I am incorrect in my understanding, I would be happy to retract my statement and join with my PT colleagues in lobbying for this change. Redge L MS OTR/L Director of Rehabilitation Services on Hospital Bremerton, WA 98310 Administrative Assistant: Wanda Kotte: wandakotte@... >>> rbarbato@... 12/6/2004 1:15:02 PM >>> You said: " So what this really comes down to is money. All the direct access in the world won't make any difference if we don't get paid when the payers require a physician referral. " This is exactly why we need Medicare direct access, and disagree with your statement. We will never be paid for our independent services unless we are recognized as a nation wide (government sponsored health plan) point of entry for healthcare. Albeit a factor I would suggest that money(payment) is a secondary gain. The PT profession (longevity) and patient (outcomes) are the focus of this initiative. State level direct access has helped our efforts, this is the logical next step. You said: " I would ask those PT's who are at the front of the direct access movement to discuss why OT should not have direct access as well, and why it isn't in the best interest of our patients to open all of ancillary care to direct access and payment for our services. " Before I respond I would be curious how you came to this understanding? Ron Barbato P.T. Corporate Director , Rehabilitation Ephraim McDowell Health Voice (859 )239-1515 Fax (859 )936-7249 rbarbato@... " PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. " Re: AOTA/APTA Dispute? As a rehab director with all disciplines under my responsibility and as an OT I would like to share my perspective on this. I think most importantly we need to differentiate between direct access to care and direct access to payment. This seems to come up frequently as a point of confusion and one that clouds the true discussion. I don't believe anyone within rehab is against the concept of direct access. This means that we as professionals do not require a physician's order to be able to treat a patient. It makes sense from a cost savings perspective and from a patient care perspective. I think we, for the most part, can recognize when it is appropriate to refer back to a physician for medical management or any other discipline who may be able to provide care that is beyond our scope and ability. So what this really comes down to is money. All the direct access in the world won't make any difference if we don't get paid when the payers require a physician referral. This is where the Medicare direct access issue comes in. In my opinion, this is less about getting direct access to Medicare patients and more about getting paid to see these patients when a physician is not involved in the care. So why would the OT's be against this? Should Medicare allow direct access to payment to physical therapists and not to other disciplines, this will create a significant professional differential between physical therapists and other allied health professionals. Take hand therapy as an example. Both PT's and OT's practice in this domain. Under direct access for PT's, a patient requiring hand therapy could go directly to a PT to receive treatment. The alternative would be to see their physician, be evaluated for their clinical needs, and referred to an OT. The OT would then evaluate the patient, develop a treatment plan and request a certification for care from the physician with subsequent followups for recerts as needed. I think anyone would look at this and see why the OT's would be against such legislation that didn't include all disciplines. Couple this with the expanded PT standards of practice and the writing is on the wall that such legislation could potentially eliminate outpatient occupational therapy as a discipline. I'll be one of many OT's to admit that we have a reputation of allowing the PT's to break the ground ahead of us and to then try to follow up to take advantage of the gains made. However I question how much this has been the reluctance of OT's to fight the good fight and how much has been the desire of PT's to go it alone to achieve the goals of their professional organization. To my understanding, the OT's have also been advocating for direct access along with the PT's but there has been little collaboration from APTA on joining together to achieve this. I would ask those PT's who are at the front of the direct access movement to discuss why OT should not have direct access as well, and why it isn't in the best interest of our patients to open all of ancillary care to direct access and payment for our services. Redge L MS OTR/L Director of Rehabilitation Services on Hospital Bremerton, WA 98310 Administrative Assistant: Wanda Kotte: wandakotte@... Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 2004 Report Share Posted December 6, 2004 " I would ask those PT's who are at the front of the direct access movement to discuss why OT should not have direct access as well, and why it isn't in the best interest of our patients to open all of ancillary care to direct access and payment for our services. " I don't have it before me, but believe that the AOTA letter to CMS basically said that " If you're not going to grant Medicare beneficiaries direct access to all rehab disciplines (meaning OT and SLP) then we do not think you should grant them access to physical therapy. " -- or words to that effect. Taking that position is an interesting strategy, prompting one to ponder about where it might lead. ...And it's not about the interests of patients. 'Way back in college, before and after doing my three years with the US Army Medical Department, I was actually a union firefighter (IAFF) running rescue squad in Rhode Island. At that time, there was always a wage issue called " parity " in which Police and Firefighters argued that they should either be paid better than the other guys, or at least get the same thing. Their areas of work were vastly different, but they each wanted to ride the back of the others' success, or at least not be isolated from the consideration. This discussion could head in the same direction, and I think that neither discipline would be well served. The discussion of Medicare direct access to PT is -- and should be -- a distinct and separate issue from direct access to OT or Speech. Combining the discussions could lead to claims that the fields are all " equal " . They are not the same. It's all that the PT community can do to handle its own vision and future, so there's no need for a PT to drift off and enter the discussion of what Medicare ought to do with occupational therapists, speech pathologists, podiatrists, physicians, audiologists, optometrists, DME stores, or other allied health providers. Especially, it would be unfruitful for a PT to enter into an attempt to argue why someone else should *not* do something. What do they gain if they " win " ? Each of those groups, however, should be strongly advocating for their own issues through their own professional organizations. OTs should be making their own case for their direct access, and they should be making it to CMS. Just a few Monday musings. Dick Hillyer, PT,MBA, MSM Hillyer Resources Cape Coral, Florida Re: AOTA/APTA Dispute? As a rehab director with all disciplines under my responsibility and as an OT I would like to share my perspective on this. I think most importantly we need to differentiate between direct access to care and direct access to payment. This seems to come up frequently as a point of confusion and one that clouds the true discussion. I don't believe anyone within rehab is against the concept of direct access. This means that we as professionals do not require a physician's order to be able to treat a patient. It makes sense from a cost savings perspective and from a patient care perspective. I think we, for the most part, can recognize when it is appropriate to refer back to a physician for medical management or any other discipline who may be able to provide care that is beyond our scope and ability. So what this really comes down to is money. All the direct access in the world won't make any difference if we don't get paid when the payers require a physician referral. This is where the Medicare direct access issue comes in. In my opinion, this is less about getting direct access to Medicare patients and more about getting paid to see these patients when a physician is not involved in the care. So why would the OT's be against this? Should Medicare allow direct access to payment to physical therapists and not to other disciplines, this will create a significant professional differential between physical therapists and other allied health professionals. Take hand therapy as an example. Both PT's and OT's practice in this domain. Under direct access for PT's, a patient requiring hand therapy could go directly to a PT to receive treatment. The alternative would be to see their physician, be evaluated for their clinical needs, and referred to an OT. The OT would then evaluate the patient, develop a treatment plan and request a certification for care from the physician with subsequent followups for recerts as needed. I think anyone would look at this and see why the OT's would be against such legislation that didn't include all disciplines. Couple this with the expanded PT standards of practice and the writing is on the wall that such legislation could potentially eliminate outpatient occupational therapy as a discipline. I'll be one of many OT's to admit that we have a reputation of allowing the PT's to break the ground ahead of us and to then try to follow up to take advantage of the gains made. However I question how much this has been the reluctance of OT's to fight the good fight and how much has been the desire of PT's to go it alone to achieve the goals of their professional organization. To my understanding, the OT's have also been advocating for direct access along with the PT's but there has been little collaboration from APTA on joining together to achieve this. I would ask those PT's who are at the front of the direct access movement to discuss why OT should not have direct access as well, and why it isn't in the best interest of our patients to open all of ancillary care to direct access and payment for our services. Redge L MS OTR/L Director of Rehabilitation Services on Hospital Bremerton, WA 98310 Administrative Assistant: Wanda Kotte: wandakotte@... Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 2004 Report Share Posted December 6, 2004 The PT/OT dispute: I feel that as PT's we need to strive for direct access under the scope of our practice acts. We are musculoskeletal experts and need to purport ourselves as such. We are striving for universal direct access across the country and need to set ourselves apart from OT's because the lines do become blurry at times. I feel that if the OT's want to lobby for direct access for their services than so be it. There is a place for both of us to exist without having a dispute over the territory of a PT and that of an OT. The reality is that PT's are musculoskeletal & movement impairment experts, where OT's are experts in ADL deficits. Let us have our place in the health care continum and allow the OT's there place as well. Mike Connors, PT Greater Therapy Centers Carrollton, TX Re: AOTA/APTA Dispute? > > > > There is a peripheral issue to this topic. > > Not all PTs and not all OTs are members of the respective > professional associations. Some of those non-members have strong > opinions on either side of this issue, be they PTs who do not support > the APTA's position or OTs who do not support the AOTA's position on > this matter of mutual interest. Thus, their voice is not being > heard. Their voice is not part of the position of the association. > So, use this as your catapult to JOIN and GET INVOLVED. Shake up the > next meeting, take an office, and be part of the change... if you > feel change is needed. > > Now, for my take on the PT-OT dispute: > I am a PT, and believe direct access is important. I believe it is > worthy of the time, effort, and funds being thrown at it. I am > frustrated by all professional associations (OT, Orthos, etc) that > oppose the measure. It is more interesting to view the reasons for > opposition than to respect the opposition in and of itself. > Hopefully, our lawmakers will see the opposition, on all sides, for > what it is - TURF WAR. > > But, this ought to be a catalyst issue to get more people involved in > the cause or to get involved in their professional associations. As > you can see, what we do matters. > > Simonetti > DPT > land > > > > > > > > > Looking to start your own Practice? > Visit www.InHomeRehab.com. > Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange > PTManager encourages participation in your professional association. Join and participate now! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 2004 Report Share Posted December 6, 2004 This topic has certainly stirred the pot. Allow me to add these thoughts to the soup: Therapists, as well as the entire community of health providers, have always struggled with third-party payers. The third-party system is, and will always be, adversarial in nature. What else should we expect when the customer (patient) is using the service, but the payer is not able to directly assess the service's value? Why we don't make real efforts to end this struggle is somewhat of a mystery to me. We all know that as long as third-parties exist the struggling will not go away, in fact the nation's population and economic demographics make it abundantly clear that fighting over money can only intensify in the future. (See how far we get if (when?) Medicare goes broke.) The solution is a system in which PATIENTS decide what services are worth spending their money on. The only way to do that is to allow medical savings accounts (with the initial capital investment by Uncle Sam) for our generally low-cost healthcare services, supplemented by catastrophic health insurance policies for those injuries and illnesses that would otherwise break the bank. So much good could come from this! The first positive change would be a lowering of service rates made artifically high by the various third-party systems (I'm speaking of the necessity of generalized rate inflation to cover things like losses from Medical Assistance and Medicare payments, non-covered or bundled services, and payments based on percentage-of-charge, let alone the human and technical costs of third-part billing). Another great good of MSAs is that our state boards would become the only significant determinant regarding the safety of direct access---the argument over Medicare payment for direct access blows away like so much paper in the wind. Dave Milano, PT Director of Rehabilitation Laurel Health System Re: AOTA/APTA Dispute? As a rehab director with all disciplines under my responsibility and as an OT I would like to share my perspective on this. I think most importantly we need to differentiate between direct access to care and direct access to payment. This seems to come up frequently as a point of confusion and one that clouds the true discussion. I don't believe anyone within rehab is against the concept of direct access. This means that we as professionals do not require a physician's order to be able to treat a patient. It makes sense from a cost savings perspective and from a patient care perspective. I think we, for the most part, can recognize when it is appropriate to refer back to a physician for medical management or any other discipline who may be able to provide care that is beyond our scope and ability. So what this really comes down to is money. All the direct access in the world won't make any difference if we don't get paid when the payers require a physician referral. This is where the Medicare direct access issue comes in. In my opinion, this is less about getting direct access to Medicare patients and more about getting paid to see these patients when a physician is not involved in the care. So why would the OT's be against this? Should Medicare allow direct access to payment to physical therapists and not to other disciplines, this will create a significant professional differential between physical therapists and other allied health professionals. Take hand therapy as an example. Both PT's and OT's practice in this domain. Under direct access for PT's, a patient requiring hand therapy could go directly to a PT to receive treatment. The alternative would be to see their physician, be evaluated for their clinical needs, and referred to an OT. The OT would then evaluate the patient, develop a treatment plan and request a certification for care from the physician with subsequent followups for recerts as needed. I think anyone would look at this and see why the OT's would be against such legislation that didn't include all disciplines. Couple this with the expanded PT standards of practice and the writing is on the wall that such legislation could potentially eliminate outpatient occupational therapy as a discipline. I'll be one of many OT's to admit that we have a reputation of allowing the PT's to break the ground ahead of us and to then try to follow up to take advantage of the gains made. However I question how much this has been the reluctance of OT's to fight the good fight and how much has been the desire of PT's to go it alone to achieve the goals of their professional organization. To my understanding, the OT's have also been advocating for direct access along with the PT's but there has been little collaboration from APTA on joining together to achieve this. I would ask those PT's who are at the front of the direct access movement to discuss why OT should not have direct access as well, and why it isn't in the best interest of our patients to open all of ancillary care to direct access and payment for our services. Redge L MS OTR/L Director of Rehabilitation Services on Hospital Bremerton, WA 98310 Administrative Assistant: Wanda Kotte: wandakotte@... Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2004 Report Share Posted December 7, 2004 Hello Dick: Your below quote is not even close to being accurate but the tone of your quote is 100% correct. I think APTA should be miffed at AOTA's letter. However, if I accept what Barbara Kornblau says about the way APTA presented their proposal to the Tri Alliance(see my previous post), APTA brought this on themselves. I agree with what someone has already stated: Essentially, at this point, APTA and AOTA are doing what's right for their members! Certainly, APTA is not looking our for OT nor is AOTA looking out for PT!! However, had the spirit of the Tri Alliance been upheld by APTA (and maybe it was), then this dispute might not even be occurring. I think that the dispute has merits because the organizations are acting in their best interest. However, I see signs that AOTA is backing down or sugar-coating their original stance, probably to appease APTA. I am disheartened to see this. For a long time, I've felt that as professions, OT and PT are in direct competition with each other! Do not confuse my statement as to mean that individual OT's and PT's are in competition, but only that the profession's compete for the same resources. I have had many 'PT friends', but at the organizational level, it's a dog-eat-dog world and the strongest dog is the best fed. Without question, PT is top dog. While that's good for PT, it isn't good for OT. As an OT, I believe and want my profession to be top dog. Now, I don't think that is ever going to happen but I certainly see it as a goal and the closer that I can help my profession move towards this goal the better my contribution to my profession. Ron Carson ===============<Original Message>=============== On 12/6/2004, RHillyer@... said: DH> I don't have it before me, but believe that the AOTA letter to CMS DH> basically said that " If you're not going to grant Medicare DH> beneficiaries direct access to all rehab disciplines (meaning OT and DH> SLP) then we do not think you should grant them access to physical DH> therapy. " -- or words to that effect. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2004 Report Share Posted December 7, 2004 Redge, Good discussion I will better clarify my first rambling. I disagree with your statement that this is all about money. For myself, as a PT, I see this movement to MC direct access as a stepping stone to full autonomous practice. We will never be able to address the issue of " payment " if we have to ask the physicians permission to do what we do. Your view has the " cart before the horse " In my view money (payment) is secondary to the primary purpose of gaining autonomy and recognition of our expertise. The APTA is quite active in this issue. Although globally supporting the issue of MC direct access for all rehabilitation specialists, it is not the duty or purpose to fight this fight for professions other than the PT's. I am sure however that a concerted and coordinated approach from all disciplines would be seen by CMS as a powerful catalyst to consider the legislation. I would behove all OT's and ST's suggest this initiative to their respective legislative bodies. Ron Barbato P.T. Corporate Director , Rehabilitation Ephraim McDowell Health Voice (859 )239-1515 Fax (859 )936-7249 rbarbato@... " PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. " Re: AOTA/APTA Dispute? As a rehab director with all disciplines under my responsibility and as an OT I would like to share my perspective on this. I think most importantly we need to differentiate between direct access to care and direct access to payment. This seems to come up frequently as a point of confusion and one that clouds the true discussion. I don't believe anyone within rehab is against the concept of direct access. This means that we as professionals do not require a physician's order to be able to treat a patient. It makes sense from a cost savings perspective and from a patient care perspective. I think we, for the most part, can recognize when it is appropriate to refer back to a physician for medical management or any other discipline who may be able to provide care that is beyond our scope and ability. So what this really comes down to is money. All the direct access in the world won't make any difference if we don't get paid when the payers require a physician referral. This is where the Medicare direct access issue comes in. In my opinion, this is less about getting direct access to Medicare patients and more about getting paid to see these patients when a physician is not involved in the care. So why would the OT's be against this? Should Medicare allow direct access to payment to physical therapists and not to other disciplines, this will create a significant professional differential between physical therapists and other allied health professionals. Take hand therapy as an example. Both PT's and OT's practice in this domain. Under direct access for PT's, a patient requiring hand therapy could go directly to a PT to receive treatment. The alternative would be to see their physician, be evaluated for their clinical needs, and referred to an OT. The OT would then evaluate the patient, develop a treatment plan and request a certification for care from the physician with subsequent followups for recerts as needed. I think anyone would look at this and see why the OT's would be against such legislation that didn't include all disciplines. Couple this with the expanded PT standards of practice and the writing is on the wall that such legislation could potentially eliminate outpatient occupational therapy as a discipline. I'll be one of many OT's to admit that we have a reputation of allowing the PT's to break the ground ahead of us and to then try to follow up to take advantage of the gains made. However I question how much this has been the reluctance of OT's to fight the good fight and how much has been the desire of PT's to go it alone to achieve the goals of their professional organization. To my understanding, the OT's have also been advocating for direct access along with the PT's but there has been little collaboration from APTA on joining together to achieve this. I would ask those PT's who are at the front of the direct access movement to discuss why OT should not have direct access as well, and why it isn't in the best interest of our patients to open all of ancillary care to direct access and payment for our services. Redge L MS OTR/L Director of Rehabilitation Services on Hospital Bremerton, WA 98310 Administrative Assistant: Wanda Kotte: wandakotte@... Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2004 Report Share Posted December 7, 2004 Hear Hear!! I agree completely! We are totally different disciplines, organizations, etc. We don't speak for each other and I don't know why anyone would think that we should. RSusickPT PPMC Portland, OR Re: AOTA/APTA Dispute? As a rehab director with all disciplines under my responsibility and as an OT I would like to share my perspective on this. I think most importantly we need to differentiate between direct access to care and direct access to payment. This seems to come up frequently as a point of confusion and one that clouds the true discussion. I don't believe anyone within rehab is against the concept of direct access. This means that we as professionals do not require a physician's order to be able to treat a patient. It makes sense from a cost savings perspective and from a patient care perspective. I think we, for the most part, can recognize when it is appropriate to refer back to a physician for medical management or any other discipline who may be able to provide care that is beyond our scope and ability. So what this really comes down to is money. All the direct access in the world won't make any difference if we don't get paid when the payers require a physician referral. This is where the Medicare direct access issue comes in. In my opinion, this is less about getting direct access to Medicare patients and more about getting paid to see these patients when a physician is not involved in the care. So why would the OT's be against this? Should Medicare allow direct access to payment to physical therapists and not to other disciplines, this will create a significant professional differential between physical therapists and other allied health professionals. Take hand therapy as an example. Both PT's and OT's practice in this domain. Under direct access for PT's, a patient requiring hand therapy could go directly to a PT to receive treatment. The alternative would be to see their physician, be evaluated for their clinical needs, and referred to an OT. The OT would then evaluate the patient, develop a treatment plan and request a certification for care from the physician with subsequent followups for recerts as needed. I think anyone would look at this and see why the OT's would be against such legislation that didn't include all disciplines. Couple this with the expanded PT standards of practice and the writing is on the wall that such legislation could potentially eliminate outpatient occupational therapy as a discipline. I'll be one of many OT's to admit that we have a reputation of allowing the PT's to break the ground ahead of us and to then try to follow up to take advantage of the gains made. However I question how much this has been the reluctance of OT's to fight the good fight and how much has been the desire of PT's to go it alone to achieve the goals of their professional organization. To my understanding, the OT's have also been advocating for direct access along with the PT's but there has been little collaboration from APTA on joining together to achieve this. I would ask those PT's who are at the front of the direct access movement to discuss why OT should not have direct access as well, and why it isn't in the best interest of our patients to open all of ancillary care to direct access and payment for our services. Redge L MS OTR/L Director of Rehabilitation Services on Hospital Bremerton, WA 98310 Administrative Assistant: Wanda Kotte: wandakotte@... Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2004 Report Share Posted December 7, 2004 Thank-you, Dick, for you very insightful Monday musings. Your experience as a firefighter demonstrates how broad experiences can broaden one's perspective. That -- and the College of Hard Knocks and Cold Experience. " Charity begins at home " -- it's hard enough fighting our own battles without taking on others' battles as well.. Lucy Buckley PT Re: AOTA/APTA Dispute? > > > > > As a rehab director with all disciplines under my responsibility and > as > an OT I would like to share my perspective on this. I think most > importantly we need to differentiate between direct access to care and > > direct access to payment. This seems to come up frequently as a point > of confusion and one that clouds the true discussion. I don't believe > anyone within rehab is against the concept of direct access. This > means > that we as professionals do not require a physician's order to be able > to treat a patient. It makes sense from a cost savings perspective > and > from a patient care perspective. I think we, for the most part, can > recognize when it is appropriate to refer back to a physician for > medical management or any other discipline who may be able to provide > care that is beyond our scope and ability. > > So what this really comes down to is money. All the direct access in > the world won't make any difference if we don't get paid when the > payers > require a physician referral. This is where the Medicare direct > access > issue comes in. In my opinion, this is less about getting direct > access > to Medicare patients and more about getting paid to see these patients > when a physician is not involved in the care. So why would the OT's > be > against this? > > Should Medicare allow direct access to payment to physical therapists > and not to other disciplines, this will create a significant > professional differential between physical therapists and other allied > health professionals. Take hand therapy as an example. Both PT's and > OT's practice in this domain. Under direct access for PT's, a > patient > requiring hand therapy could go directly to a PT to receive treatment. > > The alternative would be to see their physician, be evaluated for > their > clinical needs, and referred to an OT. The OT would then evaluate the > patient, develop a treatment plan and request a certification for care > from the physician with subsequent followups for recerts as needed. I > think anyone would look at this and see why the OT's would be against > such legislation that didn't include all disciplines. Couple this > with > the expanded PT standards of practice and the writing is on the wall > that such legislation could potentially eliminate outpatient > occupational therapy as a discipline. > > I'll be one of many OT's to admit that we have a reputation of > allowing > the PT's to break the ground ahead of us and to then try to follow up > to > take advantage of the gains made. However I question how much this > has > been the reluctance of OT's to fight the good fight and how much has > been the desire of PT's to go it alone to achieve the goals of their > professional organization. To my understanding, the OT's have also > been > advocating for direct access along with the PT's but there has been > little collaboration from APTA on joining together to achieve this. > > I would ask those PT's who are at the front of the direct access > movement to discuss why OT should not have direct access as well, and > why it isn't in the best interest of our patients to open all of > ancillary care to direct access and payment for our services. > > > > Redge L MS OTR/L > Director of Rehabilitation Services > on Hospital > Bremerton, WA 98310 > > > Administrative Assistant: > Wanda Kotte: wandakotte@... > > > > > > > Looking to start your own Practice? > Visit www.InHomeRehab.com. > Bring PTManager to your organization or State Association with a > professional workshop or course - call us at 313 884-8920 to arrange > PTManager encourages participation in your professional association. > Join > and participate now! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2004 Report Share Posted December 7, 2004 I don't think we have to speak for each other, or achieve each other's agendas. But if we communicate effectively in order to build support for each other's agendas and achieve mutual goals together, we will be farther ahead. If we keep blinders on and only work for what is good for the Physical Therapy profession then we as a profession lose. Kathy berger, P.T. Manager of Physical Therapy and Wound Care Services Mercy Medical Center Canton, Ohio Re: AOTA/APTA Dispute? As a rehab director with all disciplines under my responsibility and as an OT I would like to share my perspective on this. I think most importantly we need to differentiate between direct access to care and direct access to payment. This seems to come up frequently as a point of confusion and one that clouds the true discussion. I don't believe anyone within rehab is against the concept of direct access. This means that we as professionals do not require a physician's order to be able to treat a patient. It makes sense from a cost savings perspective and from a patient care perspective. I think we, for the most part, can recognize when it is appropriate to refer back to a physician for medical management or any other discipline who may be able to provide care that is beyond our scope and ability. So what this really comes down to is money. All the direct access in the world won't make any difference if we don't get paid when the payers require a physician referral. This is where the Medicare direct access issue comes in. In my opinion, this is less about getting direct access to Medicare patients and more about getting paid to see these patients when a physician is not involved in the care. So why would the OT's be against this? Should Medicare allow direct access to payment to physical therapists and not to other disciplines, this will create a significant professional differential between physical therapists and other allied health professionals. Take hand therapy as an example. Both PT's and OT's practice in this domain. Under direct access for PT's, a patient requiring hand therapy could go directly to a PT to receive treatment. The alternative would be to see their physician, be evaluated for their clinical needs, and referred to an OT. The OT would then evaluate the patient, develop a treatment plan and request a certification for care from the physician with subsequent followups for recerts as needed. I think anyone would look at this and see why the OT's would be against such legislation that didn't include all disciplines. Couple this with the expanded PT standards of practice and the writing is on the wall that such legislation could potentially eliminate outpatient occupational therapy as a discipline. I'll be one of many OT's to admit that we have a reputation of allowing the PT's to break the ground ahead of us and to then try to follow up to take advantage of the gains made. However I question how much this has been the reluctance of OT's to fight the good fight and how much has been the desire of PT's to go it alone to achieve the goals of their professional organization. To my understanding, the OT's have also been advocating for direct access along with the PT's but there has been little collaboration from APTA on joining together to achieve this. I would ask those PT's who are at the front of the direct access movement to discuss why OT should not have direct access as well, and why it isn't in the best interest of our patients to open all of ancillary care to direct access and payment for our services. Redge L MS OTR/L Director of Rehabilitation Services on Hospital Bremerton, WA 98310 Administrative Assistant: Wanda Kotte: wandakotte@... Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2004 Report Share Posted December 7, 2004 Kathy, You have a good point, but I feel that we have to respect the role of an OT in our health care community but not have to support their bid for direct access as well as our own. By this, I mean that as a professional association, the APTA does not represent the majority of PT's in this country. As an APTA member, it bothers me that other PT's don't take an active role in their professional organization. The reality is that more OT's belong to their professional organization than PT's. As PT's we need to continue to lobby for Medicare direct access for ourselves and respect the same outcome for OT's. Since we don't have universal participation in our professional organization, then we need to focus on our own efforts and leave the OT lobbying for direct access to the AOTA. Connors, MPT Greater Therapy Centers-Trinity Carrollton, TX Re: AOTA/APTA Dispute? > > > > > As a rehab director with all disciplines under my responsibility and > as > an OT I would like to share my perspective on this. I think most > importantly we need to differentiate between direct access to care and > > direct access to payment. This seems to come up frequently as a point > of confusion and one that clouds the true discussion. I don't believe > anyone within rehab is against the concept of direct access. This > means > that we as professionals do not require a physician's order to be able > to treat a patient. It makes sense from a cost savings perspective > and > from a patient care perspective. I think we, for the most part, can > recognize when it is appropriate to refer back to a physician for > medical management or any other discipline who may be able to provide > care that is beyond our scope and ability. > > So what this really comes down to is money. All the direct access in > the world won't make any difference if we don't get paid when the > payers > require a physician referral. This is where the Medicare direct > access > issue comes in. In my opinion, this is less about getting direct > access > to Medicare patients and more about getting paid to see these patients > when a physician is not involved in the care. So why would the OT's > be > against this? > > Should Medicare allow direct access to payment to physical therapists > and not to other disciplines, this will create a significant > professional differential between physical therapists and other allied > health professionals. Take hand therapy as an example. Both PT's and > OT's practice in this domain. Under direct access for PT's, a > patient > requiring hand therapy could go directly to a PT to receive treatment. > > The alternative would be to see their physician, be evaluated for > their > clinical needs, and referred to an OT. The OT would then evaluate the > patient, develop a treatment plan and request a certification for care > from the physician with subsequent followups for recerts as needed. I > think anyone would look at this and see why the OT's would be against > such legislation that didn't include all disciplines. Couple this > with > the expanded PT standards of practice and the writing is on the wall > that such legislation could potentially eliminate outpatient > occupational therapy as a discipline. > > I'll be one of many OT's to admit that we have a reputation of > allowing > the PT's to break the ground ahead of us and to then try to follow up > to > take advantage of the gains made. However I question how much this > has > been the reluctance of OT's to fight the good fight and how much has > been the desire of PT's to go it alone to achieve the goals of their > professional organization. To my understanding, the OT's have also > been > advocating for direct access along with the PT's but there has been > little collaboration from APTA on joining together to achieve this. > > I would ask those PT's who are at the front of the direct access > movement to discuss why OT should not have direct access as well, and > why it isn't in the best interest of our patients to open all of > ancillary care to direct access and payment for our services. > > > > Redge L MS OTR/L > Director of Rehabilitation Services > on Hospital > Bremerton, WA 98310 > > > Administrative Assistant: > Wanda Kotte: wandakotte@... > > > > > > > Looking to start your own Practice? > Visit www.InHomeRehab.com. > Bring PTManager to your organization or State Association with a > professional workshop or course - call us at 313 884-8920 to arrange > PTManager encourages participation in your professional association. > Join > and participate now! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 8, 2004 Report Share Posted December 8, 2004 This topic has certainly stirred the pot. I'd like to add some thoughts to the soup, especially regarding Ron's comment that " We will never be able to address the issue of payment if we have to ask the physicians permission to do what we do. " It appears to me at this point in the history of PT practice, that doctors telling us what to do is much less a problem than third-party payers telling us what we CAN'T do. Therapists, as well as the entire community of health providers, have always struggled with third-party payers. The third-party system is, and will always be, adversarial in nature. What else should we expect when the customer (patient) is using the service, but the payer is not able to directly assess the service's value? Now the practical success of direct access is hinging on another third-party struggle--for Medicare payment. I'd like to see us climb out of that box. We all know that as long as third-parties exist the struggling will not go away, in fact the nation's population and economic demographics make it abundantly clear that fighting over money can only intensify in the future. (See how far we get if (when?) Medicare goes broke.) The solution is a system in which PATIENTS decide what services are worth spending their money on. None of us can argue that it's unwise to let PATIENTS tell use what to do. The only way to accomplish that is to allow medical savings accounts (with the initial capital investment by Uncle Sam) for our generally low-cost healthcare services, supplemented by catastrophic health insurance policies for those injuries and illnesses that would otherwise break the bank. So much good could come from this! The first positive change would be a lowering of service rates made artificially high by the various third-party systems (I'm speaking of the necessity of generalized rate inflation to cover things like losses from Medical Assistance and Medicare payments, non-covered or bundled services, and payments based on percentage-of-charge, let alone the human and technical costs of third-part billing). Another great good of MSAs is that our state boards would become the only significant determinant regarding the safety of direct access---the argument over Medicare payment for direct access blows away like so much paper in the wind. Dave Milano, Director of Rehab Services Laurel Health System 32-36 Central Ave. Wellsboro, PA 16901 dmilano@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 8, 2004 Report Share Posted December 8, 2004 , I agree that we should not be lobbing for OT. My point is that if we communicate effectively, then OT and PT can support each other rather than work against each other. I would like to caution those on this list serve that question others about their involvement in the APTA. First let me say I am a member. Second, I may not be as active in the organization as others, but I maybe the one coaching your son or daughters sports team, I maybe very activity in MS society, American Heart Association, run a stroke group in the community, teach the bible study at your church. This allows you the time and energy to be active in the organization of your choice. I also maybe writing letters to my congressman, financially supporting the APTA, etc... So just because I am not involved in a committee, attending meetings, or chosen to join the APTA actively that I don't support my profession. Kathy Re: Re: AOTA/APTA Dispute? Kathy, You have a good point, but I feel that we have to respect the role of an OT in our health care community but not have to support their bid for direct access as well as our own. By this, I mean that as a professional association, the APTA does not represent the majority of PT's in this country. As an APTA member, it bothers me that other PT's don't take an active role in their professional organization. The reality is that more OT's belong to their professional organization than PT's. As PT's we need to continue to lobby for Medicare direct access for ourselves and respect the same outcome for OT's. Since we don't have universal participation in our professional organization, then we need to focus on our own efforts and leave the OT lobbying for direct access to the AOTA. Connors, MPT Greater Therapy Centers-Trinity Carrollton, TX Re: AOTA/APTA Dispute? > > > > > As a rehab director with all disciplines under my responsibility and > as > an OT I would like to share my perspective on this. I think most > importantly we need to differentiate between direct access to care and > > direct access to payment. This seems to come up frequently as a point > of confusion and one that clouds the true discussion. I don't believe > anyone within rehab is against the concept of direct access. This > means > that we as professionals do not require a physician's order to be able > to treat a patient. It makes sense from a cost savings perspective > and > from a patient care perspective. I think we, for the most part, can > recognize when it is appropriate to refer back to a physician for > medical management or any other discipline who may be able to provide > care that is beyond our scope and ability. > > So what this really comes down to is money. All the direct access in > the world won't make any difference if we don't get paid when the > payers > require a physician referral. This is where the Medicare direct > access > issue comes in. In my opinion, this is less about getting direct > access > to Medicare patients and more about getting paid to see these patients > when a physician is not involved in the care. So why would the OT's > be > against this? > > Should Medicare allow direct access to payment to physical therapists > and not to other disciplines, this will create a significant > professional differential between physical therapists and other allied > health professionals. Take hand therapy as an example. Both PT's and > OT's practice in this domain. Under direct access for PT's, a > patient > requiring hand therapy could go directly to a PT to receive treatment. > > The alternative would be to see their physician, be evaluated for > their > clinical needs, and referred to an OT. The OT would then evaluate the > patient, develop a treatment plan and request a certification for care > from the physician with subsequent followups for recerts as needed. I > think anyone would look at this and see why the OT's would be against > such legislation that didn't include all disciplines. Couple this > with > the expanded PT standards of practice and the writing is on the wall > that such legislation could potentially eliminate outpatient > occupational therapy as a discipline. > > I'll be one of many OT's to admit that we have a reputation of > allowing > the PT's to break the ground ahead of us and to then try to follow up > to > take advantage of the gains made. However I question how much this > has > been the reluctance of OT's to fight the good fight and how much has > been the desire of PT's to go it alone to achieve the goals of their > professional organization. To my understanding, the OT's have also > been > advocating for direct access along with the PT's but there has been > little collaboration from APTA on joining together to achieve this. > > I would ask those PT's who are at the front of the direct access > movement to discuss why OT should not have direct access as well, and > why it isn't in the best interest of our patients to open all of > ancillary care to direct access and payment for our services. > > > > Redge L MS OTR/L > Director of Rehabilitation Services > on Hospital > Bremerton, WA 98310 > > > Administrative Assistant: > Wanda Kotte: wandakotte@... > > > > > > > Looking to start your own Practice? > Visit www.InHomeRehab.com. > Bring PTManager to your organization or State Association with a > professional workshop or course - call us at 313 884-8920 to arrange > PTManager encourages participation in your professional association. > Join > and participate now! > Quote Link to comment Share on other sites More sharing options...
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