Having problems with message search?
Dear Brian –
Thank you for your response. I offer the following for the ongoing
debate and discussion.
First, in regard to the perceived timeline of events and
communications, I believe that there is certainly a difference in understanding
between the timing and events as you have described them and the perception of
the timing and events from the perspective of the VPTA Leadership. I am aware
that there have been many hours of discussion to try and resolve these
differences with you and others in your group. At this time, I suggest that we
all agree to disagree on these points. I do not believe that a veritable
‘he said / she said’ is either valuable or productive: the reality
for both parties is that the events occurred and, it is my belief, that it is
time to move forward.
I remain concerned that the description of the physician’s role
in the development of regulation may be misunderstood by those reading this
email discussion. I have included the language from the new law below for
reference.
“C.
In promulgating minimum education, training, and experience criteria, the Board
shall consult with an advisory committee comprised of three members selected by
the Medical Society of
The role of the three physicians, along with the three VPTA members,
(i.e. the advisory committee) in this process is limited to making
recommendations to the Board of PT on the development of regulations. The
Board of PT maintains the authority and right to accept or reject the recommendations
in whole or in part. The Board of PT has the right to make a decision that is
independent of the recommendations provided. This qualification was one that
the VPTA Leadership adamantly required during the negotiation process. Once the
regulations are developed, the physicians in no way play a role in making the
determination of which PT’s meet the requirements. The Board of PT is
solely responsible for making such determinations for the PT’s of the
state.
From my perspective, the issue that is most concerning to you and those
you represent is the agreement that was made with the MSV. Although the
agreement prevents legislative actions
(for the next five years) to approach the issue of Referral for Profit (RFP)
– it does not prevent all
actions. The reality is that there are many other ways to address the negative
effects of RFP. As you are aware, there is an RFP Task Force – both at
the national and state level - that is exploring any and all alternatives to
address the concerns related to RFP. I would suggest that our energies may be
best spent in formulating a strategic plan related to RFP and working
diligently to carry out the plan. I truly believe that options other than
legislative change may prove to be the most beneficial and influential. I am
excited about the potential to make real headway via these avenues versus
engaging in a long, expensive, and potentially unsuccessful legislative and/or
legal battle. My hope is that this debate will entice many members to
participate in the activities of the RFP Task Force, an outcome that has the
potential to greatly increase our chances of success.
In closing, my hope is that we can move from continual examination of
the past to developing a plan for the future. If we successfully leverage the
talents and skills of our members, we will be able to address the challenges we
face.
Respectfully,
Shawne E. Soper, PT, MBA
Shawne E.
Soper, PT, MBA
Director of Contract
Services
Sheltering Arms
804-342-4384 (o)
804-399-4633 (m)
804-261-2037 (p)
From:
vpta@yahoogroups.com [mailto:vpta@yahoogroups.com] On Behalf Of Brian D'Orazio
Sent: Saturday, March 31, 2007
12:25 PM
To: VPTA; Shawne Soper
Subject: Re: [vpta-listserv] post
Dear Shawne:
First, thank-you for becoming involved in the debate.
The value of your service to the VPTA, over your many years of service, is
incalculable. I am privileged to add to your knowledge base regarding
events leading up to our current legislation. Let me begin by addressing
your concerns in the order which you present them.
1) The request to share information with the
membership and the VPTA's response to my request vary from your understanding
of the situation. My request to the VPTA was as follows --
"In the interest of fairness in the debate, I request that the
e-mail I
attempted to send be sent to the membership. I clearly don't have the
capability of doing this without you, so all of us who are actively opposing
the bill would like you to send this through. Thanks."
(from an email to Lisa Shoaf dated January 31, 2007)
Lisa's response to my request (dated February 1) was --
"I and the other members of the Board have heard you.
At this point, I do not see using chapter resources/tools for this
purpose."
This was her complete response. After this response, I
exhausted all means possible of meaningfully communicating with the membership
as a whole. The listserv at this time was not accessible and would only
have reached a small percentage of the members.
You indicate that this is a "proprietary system",
but it seems evident that for a topic of this importance this system could have
been utilized by the board to express meaningful concern about the direct
access legislation.
2) In your second clarification, you indicate
"the new direct access law in no way decreases our Board's ability to
regulate our profession". My response to this is that we now have a
three physician panel, along with a panel of three physical therapists, who
will make the determination of which PT applicant will receive approval to
practice under the current legislation. As a result, the Board of
Physical Therapy clearly does not make an independent decision and therefore
this legislation abridges their current power.
I hope this helps you better understand both concerns.
In regard to your remaining commentary, the appropriateness of the VPTA's
leadership must be viewed with an eye toward the chronology of events leading
to this debate. The process of developing this legislation began in
August 2006. I, along with our lobbyist and many other VPTA leaders,
presented our views to the Medical Society of Virginia. The Medical
Society of Va's contingent was originally intended to include two orthopedic
surgeons, lobbyists and staff. When we arrived, we were told by the
lobbyist that both surgeons were unable to attend. We completed the
meeting and Damian Howell expressed concerns that while the meeting was
pleasant, we need the surgeons for a meaningful meeting. The lobbyist for
MSV agreed and we were told there would be a second meeting. Within two
weeks, we were informed that the surgeons were not interested in meeting with
the VPTA.
At this time, I approached Bill Howell, the Speaker of the
House. Speaker Howell is a personal friend and agreed to intervene with
the MSV as he is close friends, and a former colleague of MSV's chief
lobbyist. Speaker Howell is an attorney and suggested that we look at
what our legal options were surrounding all issues related to direct access and
POPTS. He offered that the stronger our legal case, the easier the
negotiations. I contacted a VA Appellate Court Judge who felt that we likely
had a case and forwarded that information to the VPTA and Speaker Howell.
After this time, I repeatedly made attempts to contact our legislative chair
and Lisa Shoaf. I was never recontacted until mid-November at which time
I was told that the Board was not going to follow-up with Speaker Howell's
offer. I remain amazed by this decision.
The next time I was contacted, was immediately before
Christmas with a request to review and comment on the proposed
legislation. I immediately objected to the legislation with specific
commentary related to concerns on the abridgement of the rights of physical
therapists secondary to both the legislation and our agreement with MSV.
I never heard back from VPTA on any of these issues. The next time I
heard anything about the bill, was through Speaker Howell at a social
event. He asked what I thought about the bill. I of course knew
nothing about it and expressed surprise that it had been introduced.
VPTA members must be the final arbiter of whether these
events constitute the level of leadership that we in
As to the bill, all physical therapists should read and
independently determine whether this functions in the best interest of the
profession. Aside from the bill itself, the VPTA's "deal" with
MSV is unprecedented in the history of our state organization. Although
current by-laws do not prohibit the Board from trading the rights of its
members, the leadership has discussed this in the past and its been everyone's
judgment that member rights must be upheld. The current VPTA leadership
contends that we couldn't create any changes inside of five years and therefore
the action was justifiable. This assumes however, that the negotiations
are taking place between equals. Two issues are striking in this
regard. First, orthopedic surgeons already have the right to own a PT
office. Therefore, their agreement not to pursue legislation becomes a
small concession. Secondly, one must ask what are the repercussions from
either side negating the deal. From the PT side, if we negate the deal in
less than five years, MSV would never support another bill that we propose.
If MSV negates the deal in less than five year, there are no
repercussions.
The United 4 A Change group is self-funded and comprised of
over thirty PTs and PTAs who remain concerned about the direction in which we
have been led by the VPTA. In addition to the listserv, we have also sent
correspondence to all licensed PTs and PTAs in VA. I hope many feel
compelled to engage in this debate as this bill affects the professional
autonomy of all PTs and PTAs. We must decide, as professionals, to be involved
in the process, or the process will control our destinies.
Respectfully,
Brian P. D'Orazio, DPT, MS, OCS
----- Original Message -----
From: Shawne Soper
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
, and that is not what we have. However, we are making progress and the new legislation provides for expanded access over our current law. Virginia
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
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] postPlease 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 legislature regarding treatment by a Physical Therapist without physician referral? Virginia 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
. 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. of Commonwealth Virginia 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
to be active members of the VPTA. All who practice Physical Therapy are affected by these regulatory changes. Virginia 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
. In addition, I ___ agree ___ disagree Virginia 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:
Physical Therapy Blue Ridge
728 N. Lee Highway
Lexington VA 24450
Send Email