----- Original Message -----

From: Shawne Soper

To: vpta@yahoogroups.com

Sent: Thursday, March 29, 2007 4:59 PM

Subject: RE: [vpta-listserv] post

To My Fellow VPTA Members:

As a long time member of the Association and Chapter – I commend the professional dialogue and debate surrounding this issue.  We are all well aware of the analogy that equates regulatory change to the making of sausage - unfortunately, it is at times very messy.

I am compelled to provide some comment and clarification for the sake of the discussion.  I will start with the clarification.

I found two comments in the original post to be concerning because they were in conflict with my prior understanding of the course of events and resultant outcome related to the change in our direct access law.  Investigation into my concerns has revealed the following:

 1) In regards to the statement that “A request to present an opposing viewpoint to the membership on this legislation, prior to its passing, was denied” I learned that one of the original communications that was sent out regarding the legislation was sent through the Association’s proprietary blast email system.  An individual from ‘united4achange’ inquired about the ability to use this email communication system to offer a response.  Because of the nature of the proprietary system, this was not an option.  The member was informed of this limitation and the group was informed that they were welcome to use the list serve – which is the established mechanism for member communication.

2) In regard to the statement that reads:

“The criteria for this certification will be decided by three members of the VPTA and three physicians from the Medical Society of Virginia.  After 7 years of an independent PT Board, we are again putting our profession under further "referral and direction" constraints of physicians.”

I found this concerning because it could be interpreted as a loss of our independent Board of Physical Therapy.  In obtaining clarification, I learned that the new direct access law in no way decreases our Board’s ability to regulate our profession.  The reference to the input by the members of the Medical Society relates to their participation in an advisory committee, (that will be convened by the Board of Physical Therapy), to provide suggestions to the Board of Physical Therapy on the criteria for certification.  The advisory committee’s recommendations are non-binding – a detail that the VPTA leadership ensured during the development of the regulatory language.  Therefore, the Board of Physical Therapy retains all of the power and ability to establish the regulations, including the criteria for certification.  

I offer the following comments on the concerns voiced by ‘united4achange.’  I believe that the VPTA leadership acted appropriately in the development and negotiation of the new direct access statute.  The Chapter has been in discussion with the Medical Society on this very topic, with varying degrees of success, for many years.  Having been personally involved in the negotiations in the late 1990’s, I am actually impressed that we were able to negotiate this position.  The unfortunate truth of the matter is that as long as we were fighting against the Medical Society, we were making little (if any) progress in changing our direct access legislation.  It was imperative that we come to the table ready to negotiate, and our leadership was charged to do just that.  Obviously, we would all like to see unencumbered direct access legislation in Virginia, and that is not what we have.  However, we are making progress and the new legislation provides for expanded access over our current law.

In regard to the concern related to the negotiated moratorium on legislation to prohibit physician owned physical therapy services (POPTS) for five years, I offer the following.  First, as a part of the negotiation, the Medical Society has also agreed that they will not pursue actions to ensure that POPTS remain legal in the state.  Second, pursuit of legal alternatives to prohibit POPTS will be incredibly difficult and costly.  Our Chapter is not, and likely will not, be in a position to pursue this option for at least five years.  Third, the Chapter leadership sought advice and council form APTA prior to making this agreement.  APTA staff and leaders are well versed in the options and alternatives related to dealing with POPTS, and the sage advice provided was that this limitation was acceptable to us because it would not be feasible or wise to pursue a legal option for resolution to this issue within the next five years.  Third, based on the comment offered above, I must respectfully disagree with my colleagues who believe that “The actions of the Virginia Chapter are in direct opposition to the directive of the APTA House of Delegates Resolution to seek legislative prohibition of physician ownership of physical   therapy services (RC  06-02-24-48).”  Should the proposed actions have been in conflict with the referenced RC, the APTA staff and leadership would have readily pointed that out to our Board, and directed us to pursue action of another course.

I am also concerned that the comment in the post that reads “When specifics of the bill became available many concerned VPTA members contacted the Board, but the Board elected to “stay the course” in the face of these weighty concerns” might be interpreted by some that the Board denied these members the right to fully express their views.  However, the dissenting views were actually fully explored, both in individual conversations and at the January Board of Directors meeting.  As a participant in the January discussion and observer of the Board’s final action, I assure you that the concerns voiced were respectfully heard and discussed by all present.  The Board debated options in light of the concerns and then, and only then, made the decision to “stay the course.”

Finally, I offer a comment regarding the process of negotiation and decision making during the General Assembly.  The reality is that the process of negotiating for a change to our statue requires a willingness to concede in order to gain; an ability to be able to act quickly; and trust in those who we have elected.  Having been at the recent Board of Director’s meeting and understanding the process of negotiating with the Medical Society, I for one believe that the VPTA Board of Directors did protect our best interests, sought sage advice and counsel, made wise decisions with the information and opinions available to them, and developed a workable solution that moves us in the ultimate direction that we all desire.  I applaud their courage and dedication.

Respectfully,

Shawne E. Soper, PT, MBA

ssoper@shelteringarms.com

From: vpta@yahoogroups.com [mailto:vpta@yahoogroups.com] On Behalf Of Bill Whiteford
Sent: Tuesday, March 27, 2007 4:16 PM
To: vpta@yahoogroups.com
Cc: Bill Whiteford
Subject: [vpta-listserv] post

Please post the following information.

Thank you.

Bill

Recent Changes to the Laws Governing Physical Therapy in Virginia

Information for Licensed Physical Therapists and Physical Therapist Assistants

A Message From:

Rachel Amidon, PT,  Christina Curran, PT,  Brian D’Orazio, PT,  Kash Eagleton, PT,  Melissa Eagleton, PT, Barbara Ehman, PT, Gayle Garnett, PT,  Brian Hoke, PT,  Ginger Houck, PT,  Pat Huston, PT,  Scott Hyldahl, PT,  Samuel Jamison, PT,  Bill Melchione, PT, Judy Jenkins, PT,  Marshall Rennie, PT,  Beth Rennie, PT, Bill Whiteford, PT,  Colleen Whiteford, PT,  Mary Wooten, PT,  Heidi Zander, PT

What are some of the privileges and limitations recently passed by the  Virginia legislature regarding treatment by a Physical Therapist without physician referral?

PT’s must obtain a certificate of authority to evaluate and treat patients without referral. This certification will separate how different therapists are allowed to practice, and require additional expense to Virginia Physical Therapists in the form of fees and continuing education. 

The criteria for this certification will be decided by three members of the VPTA and three physicians from the Medical Society of Virginia.  After 7 years of an independent PT Board, we are again putting our profession under further "referral and direction" constraints of physicians.

Once a PT has gone through all of  the required certification, limitations still apply for treatment without referral:

• You may NOT treat a patient if they are already under the care of a physician/referring practitioner for the problem. The patient must attest to this in writing.
• At the time of evaluation, the patient must identify a physician/referring    practitioner that they will see if care is desired beyond the 14 day limit and they must release their information to be sent to that provider.  
• You must send your evaluation to the designated provider within 3 days.
• Physical therapy treatment without referral cannot exceed a period of 14 business days.
• A PT may not evaluate and treat a patient without referral if they were evaluated within the previous 3 months

What is wrong with this picture?

    To get support of the Virginia Orthopaedic   Society and the Medical Society of Virginia, the VPTA Board of Directors made binding promises to these physician organizations that for five years the VPTA WILL NOT:

  Introduce any legislation that prohibits physician ownership of physical therapy

   Introduce any legislation expanding the scope of practice of physical therapy

     The political climate as it relates to referral for profit is shifting, and public opinion on conflict of interest is generally negative.  The physicians’ groups wanted assurances we would not bring this into the legislature for debate and discussion (and hence, the newspapers).  Our ability to bring forth any legislation to address this problem was negotiated away for “new freedoms” for PT that appear to be crafted with protection of the physicians’ interest first and foremost.  While we gained treatment subject to the conditions noted, the physicians gained further advantage and     control of Physical Therapy in Virginia.

      The recent action of the VPTA Board has profoundly affected the practice of EVERY PT and PTA in the Commonwealth of Virginia.  Prior to doing so, they failed to survey the membership, enlist the full membership in discussion on the negotiations with the physicians, or communicate the details of the bill to Virginia PT’s and PTA’s before support was solicited.  When specifics of the bill became available many concerned VPTA members contacted the Board, but the Board elected to “stay the course” in the face of these weighty concerns.  A request to present an opposing viewpoint to the membership on this legislation, prior to its passing, was denied.

     The actions of the Virginia Chapter are in direct opposition to the directive of the APTA House of Delegates Resolution to seek legislative prohibition of physician ownership of physical   therapy services (RC  06-02-24-48).

Now what?

Every PT and PTA should take the time to read the specifics of the new physical therapy practice act. It is our opinion that VPTA/ APTA communications have only highlighted those aspects which cast the changes in a positive light,  neglecting to mention new restrictions on practice.  The regulations can be accessed at the following link: http://leg1.state.va.us/cgi-bin/legp504.exe?071+ful+SB1305ER

If you read the full legislation and AGREE the new law is a worthwhile and less confusing improvement and you agree with the way this was handled by the VPTA, let us know.

If you DO NOT AGREE with the way this was handled, and would have preferred alternative actions, make your feelings known to the VPTA Board of Directors.  You may do so individually, AND you may join us in conveying the following message at the next meeting of the Board:

• The VPTA failed to properly represent the membership in crafting the recent             legislation and negotiating with physician’s groups
• It is in the best interest of the membership to require the VPTA to survey its members and engage in meaningful discussion to assure that the majority support any legislation that alters the laws governing Physical Therapy practice in Virginia.

We encourage all PTs and PTAs in Virginia to be active members of the VPTA.  All who practice Physical Therapy are affected by these regulatory changes.

Let your voice be heard!

• Send us your opinion via fax, e-mail, or mail and/or
• Attend the Issues Forum on 4/13 or the Board of Directors meeting on 4/15 at the VPTA Annual Retreat (details at www.vpta.org).

IT IS IMPERATIVE THAT THE VPTA BOARD OF DIRECTORS IS PROVIDED FEEDBACK ON THEIR ROLE IN THE  RECENT LEGISLATIVE CHANGES

Physical Therapists and Physical Therapist Assistants, who would like to express their opinion about the manner in which the VPTA advanced recent PT legislation, may do so by sending an e-mail to:   united4achange@comcast.net     

PTs and PTAs may also send their opinions on this topic by completing the following:

========================================================================

I am a   ___ Physical Therapist       ___ Physical Therapist Assistant

and it is my opinion that the VPTA acted     ___  appropriately  ___  inappropriately

in the recent introduction and advancement of laws changing the practice of physical therapy in Virginia. In addition, I   ___ agree        ___ disagree

that future VPTA actions which alter the Virginia PT /PTA practice act should be more fully disclosed to the membership (including dissenting opinions), and the VPTA should establish specific guidelines for member notification and majority approval when advocating such changes.

Additional comments:  ___________________________________________________

______________________________________________________________________

Name: _____________________________

City: _______________________________

You can fax this by 4/4 to:  (540) 901-8773 (Attn: Colleen Whiteford)

You may also mail this to:    

    Blue Ridge Physical Therapy

    728 N. Lee Highway

    Lexington VA   24450