When I heard that the California legislature not only passed AB 1000, but did so by a landslide vote of 72-0, I was more than a little upset. In fact, I am downright angry—and as a member of the rehab therapy community, you should be, too.
Sponsored by the California Physical Therapy Association, this bill essentially trades small gains in direct access for legalization of physician-owned physical therapy services (POPTs).
Specifically, it allows patients to independently seek therapy treatment for a period of 45 days and 12 visits. After that, patients are required to undergo a physician evaluation and plan of care approval.
I think we can all agree that direct access to physical therapy services is good; it can decrease healthcare costs by eliminating unnecessary medical office visits while simultaneously offering patients the quickest, most efficient route to receiving therapy treatment. I am happy that CAPTA leaders recognize the value of direct access enough to push legislation that permits it, but I do not believe those leaders were serving our best interests when they agreed to make concessions in other areas—namely, POPTs—to make a little bit of headway in the fight for direct access. I would not be as frustrated if the bill had passed without quid pro quo.
By legalizing POPTs, the California Assembly has essentially allowed physicians to, in a very literal sense, take ownership of rehab therapy. Giving the green light to POPTs ultimately will result in fewer referrals for independent therapy clinics because physicians will begin referring exclusively to their own therapists—thereby ramping up their own revenue. This is not acceptable. We are not physicians’ musculoskeletal sidekicks, or, in the language of AB 1000, “healing arts professionals.” We’re fully competent, doctorate-level therapists capable of making our own clinical decisions. While I’m sure there are some effective physician-therapist partnerships out there (and I’d be willing to bet those therapists enjoy a high degree of autonomy), overall, I believe this sort of arrangement negatively impacts the therapy industry.
What good is direct access if these POPTs end up running you out of business? How do you expect to get paid for the 12 direct access visits when most payers require diagnosis from a medical professional who is authorized to complete a claim form? (PTs currently don’t fall into that category in most states—we’re fighting that battle with slow, minimal progress.) Considering that physicians can now own PT practices, does it not seem rather coincidental that after a patient reaches the maximum of 12 therapy visits, a PT must refer back to a physician to continue treatment? This only perpetuates the vicious cycle. Plus, POPTs take away therapists’ power to treat as they see fit by forcing them to work under someone else’s control, and that’s detrimental to our ultimate goal of gaining autonomy with direct access. It also undermines our efforts to raise brand awareness for physical therapy as a whole; the brand now becomes even more muddled.
If the implications of this law don’t alarm you—or worse yet, if you are apathetic toward them or have never even heard of AB1000—then we have serious work to do. Changing the way the general public thinks about rehab therapy—i.e., its value as effective stand-alone treatment—starts with changing the way we think about ourselves and our willingness to be outspoken and fight for our beliefs.
As I read through the forums and posts for and against AB1000, it became increasingly clear that by supporting this bill, the CPTA blatantly misrepresented the interests of its constituency. But who was really out there on the front lines fighting for our profession? There are 26,000 registered PTs in California. However, according to the APTA, only 5,439 of them were CAPTA members as of June 3, 2013. Does that mean that only 20% of PTs in California actually care about what happens in their state? Or perhaps it’s just that California PTs see no reason to waste money paying dues to an organization that doesn’t represent their interests anyway. And honestly, the numbers are not that much different on a national level.
Things are moving fast with national health care reform and the Affordable Care Act set in motion; now, more than ever, is a time to unite and stand our ground before losing more of what we have fought so hard for in years past. We are a diverse group that needs to unite behind a common professional brand that effectively represents all PTs. Together, we can drive our profession forward in a way that promotes our value, relevancy, and the amazing patient outcomes we achieve every day. There is strength in numbers; our voice is louder when everyone shouts at once.