FROM THE PRESIDENT 

Advocacy is an individual or group whose aim is to influence public policy and resource allocation decisions within political, economic and social systems and institutions.[i]APTA and NMAPTA are by this definition an advocacy group and we all have an opportunity to be advocates for our profession and to protect and preserve our livelihood. Some people don't like politics or don't feel that they know enough about public policy to actively participate. Others site other obligations and lack of free time. Others admit to not knowing what the Association does. Advocacy for our profession is not something that we should turn over to a small group. In this busy day and age, none of us have "extra time". There are many ways to have your voice be heard and together as a strong association we can have one larger and more effective voice.  

Key functions of advocacy include: Assisting in the development of better public policy, ensuring government's accountability to its citizens; giving a voice to citizen's interests; mobilizing citizens to participate in the democratic process and supporting a culture of democracy. [ii] We are all able to participate albeit at different levels in each of these areas. 

Membership would be the most obvious way to support your profession as it pursues fulfilling these key advocacy functions. We need a strong membership to have a strong voice. We need to be able to tell legislators and policy makers that we represent most of the licensed therapists in our profession. Numbers do matter and membership dollars are important to us getting the job done. Many of you probably wonder - "where do my dues dollars go?" Almost one quarter of your national dues go to professional services and government affairs. In New Mexico two thirds of the state dues go to hire our lobbyist for legislative advocacy.

Lobbying is only one form of advocacy and our own lobbyist, Julianna Koob, has spoken and will continue to speak to us about our role in bringing our collective voice to the state legislative level. Existing research notes that health professionals are widely viewed as persuasive by legislators, and that policy makers would like more contact with them. [iii]  Meeting and helping your state legislators to know and understand our profession is one way that you can be an advocate. 

APTA is representing your professional interests daily on Capitol Hill and it provides representation on legislation and regulatory issues that affect the way you practice every day. I have been able to meet with and work with several members of the APTA Legislative Affairs department and can tell you that they are a hard working team. APTA is the go-to organization for most members of Congress when they want information on anything having to do with rehabilitation issues.

Although APTA did not take a position on the 2010 health care reform bills debate they were present and active throughout the debate in looking out for the interests of our profession. PT/As and student PT/As have a range of opinions and thoughts about the Patient Protection and Affordable Care Act (PPAC) that was signed into law by President Obama. Most all agree that, regardless of support or opposition to this law, the law opens a new chapter in health care delivery in our country.

The new law provides a paradigm shift in health care from a model of treating sickness to a basic idea of wellness and prevention. APTA was active in getting the new law to explicitly include both rehabilitation and habilitation services as a required category in the mandatory benefits package. There also is provision for coverage of preventive services without cost-sharing. Physical therapy stands to be a critical piece of the prevention puzzle that health care reform attempts to assemble. This affords us many opportunities to put our expertise forward in new ways to help our patients and clients reach their best possible level of function and for us to get reimbursed fairly.

APTA will be there to be our advocate for changes to improve access, lower costs, enhance quality and reduce the disparities as rules and regulations of the PPAC are issued by the Centers for Medicare and Medicaid Services (CMS), the Office of Consumer Information and Insurance Oversight, and other federal agencies.  The APTA website now has an Issues in Focus series, which is a resource to help you understand how certain health care issues or practice settings may be affected by the Health Care Reform bill. There are currently 15 of 41 planned issue briefs covering practice settings and issues. More will be rolled out in the next several months.

There are of course, many details that are yet to be worked out with the new law and necessary changes are needed to problematic provisions. For example we need to be sure that PT is included as a front line provider in prevention initiatives. We are also faced with challenges in payment policy. Those of you who are members of the NMAPTA list-serve recently received an urgent alert for action to stop CMS from implementing a devastating payment policy. Action on this rule on multiple procedure payment reduction (MPPR) policy would result in significant reductions in payment of outpatient services. CMS needs to hear from you to understand the implications the MPPR policy will have on your practice and your patients.

At the state level, NMAPTA has been playing a greater role in state legislative efforts and health care policy. This summer we had a very productive meeting with Human Services Department (HSD) Secretary Katie Falls to discuss the importance of PT services under Medicaid. We all know that therapy services are not a mandated benefit under Medicaid and that Medicaid is in deep trouble financially. Secretary Falls was very receptive to our comments and as a result we were invited to submit an application to participate in the HSD Health Care Delivery Work Group that will be looking at restructuring of the state Medicaid program. We submitted two applicants and anticipate hearing soon on the selection.

Given the state's budget crisis, one area that the Governor's Restructuring Taskforce has recommended for potential saving is to do away with or combine all state licensure boards and commissions. This is an issue that we have been fighting for years in the legislature which we know as the "super board" issue. We continue to oppose this along with many allies on other professional boards and we have good legislative support. We are getting our message to the taskforce on the need to maintain separate professional boards for regulation of each profession.

A recent public hearing of the NM Board of Physical Therapy looked at changes in how physical therapy techs were utilized and practices allowed by physical therapy assistants.  These are areas where we are not all in agreement and the turnout to testify on the changes spoke to this. Those who supported continuing to utilize PT techs as extenders of the physical therapist were successful in holding back any change in this area. This was also a hot topic at this year's APTA House of Delegates meeting and we heard from many of you on this issue. No action was taken in this HOD session, but it will be an issue that returns for more discussion. Our state rules and regulations contained language that limited, albeit not in a direct and clear manner, PTAs from doing sharp debridement and certain types of manual therapy. This part of the regulation was changed to allow PTs to delegate interventions to PTAs that are competent and trained in these interventions. As of the date of this writing the changes have not been posted on the Licensing Board's website.

These changes in rules and regulations have no effect on requirements as contained within the Practice Act. Some changes cannot be made without making changes through the legislative process and the Practice Act. This would also be the case in the area of direct access.  The Licensing Board has no authority to expand current direct access beyond what is stated in the Practice Act. New Mexico is one of 45 states that allow treatment without a referral from a physician and we have had this since 1989. There are many pros and cons to entering the legislative arena with further changes, discussion of which is beyond the scope of this article.  

As an APTA member you have access to more in-depth information on this topic and others, such as referral for profit, that are important to our profession as we move closer to achieving APTA's Vision 2020:

By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health.

As a member of NMAPTA I hope that you will appreciate all the hard work of this Board and past Boards and officers in doing their very best to represent our profession.  You  see current evidence of this in the new website that you are viewing this newsletter on for the first time as a statement of our commitment to represent our profession in the most professional, comprehensive and effective way possible. We hope to add more information that will be accessible to members on some of these hot button issues.

To those of you who are members I offer you heartfelt thanks for your support. For those that have never been members or who have let your membership lapse I ask that you re-examine your reasons and see if they support justification for letting a smaller group carry the burden for our profession in a rapidly changing health care environment. As you look at the new website you will see the work of many people whose efforts are not always recognized.  All current Board members, our Delegates, PTA Caucus Rep and Nominating Committee members have contributed in some way and have done it on the foundation laid by volunteers that came before us. Please let us know what you think.

If you have questions or comments on any of the issues referred to in Advocacy 101, please contact Pat Bartels at 505-256-0816 or pbartels8@comcast.net.

Pat Bartels, PT, OCS

Pat is the President of NMAPTA and has been an advocate on health care issues since 1992.

2010 SLATE OF CANDIDATES ANNOUNCED

• Develop an education campaign and deliver it through the media.
• Provide materials to Senior Centers and other community agencies who might want to participate in National Awareness Day.
• Identify older adults who can speak about their fall experience and what preventative measures they are taking to reduce their risk. 
• Provide fall risk screenings and handouts on Fall Prevention and Home Modification.

The spring and early summer have been very busy for the Pima Medical Institute PTA program. The second cohort of students was admitted in early April and started classes on April 19, 2010. Twenty one students successfully completed the first semester and will begin the second semester on August 9^th . While the second cohort was adjusting to the rigors of the PTA program, the first cohort was in the clinic for their first 7 week clinical affiliation. Several of the students communicated with us via email sharing enthusiastic stories of their experiences. Visits to the clinical sites reinforced their reports. The students benefitted tremendously from the dedication of their clinical instructors and other staff at their clinical sites. Eighteen students will progress to their fifth and final semester in the PTA program. We are grateful for the support in the physical therapy community.

Simultaneous with the classroom, lab, and clinical activities, Pima Medical Institute has relocated. Our new address is 4400 Cutler Avenue, Albuquerque, NM. The PTA program has a dedicated classroom and a well equipped lab. Our Open House is August 25^th during the afternoon.  Please stop by to visit.

Therese M Tomkie, PT, MBA, BS

Physical Therapist Assistant Program Director

Pima Medical Institute - Albuquerque

4400 Cutler Avenue NE

Albuquerque, NM  87110

505/881-1234

Fax:  505/884-8371

ttomkie@pmi.edu

• Medicare home payments for 2011 - in the proposed rule, there would  be a 4.75% decrease in Medicare payments to home health agencies (HHAs) for calendar year (CY) 2011. According to APTA, "the proposed rule contains clarifying policies regarding the coverage of therapy services in the home health setting. These new coverage requirements would set forth clarifications for what the PT should be documenting in the patient's record to justify the furnishing of skilled therapy. CMS also proposes changes in ownership requirements of HHAs and quality reporting.
• Skilled nursing facilities - in a notice with comment period, skilled nursing facilities will receive a 1.7% increase in payments for fiscal year (FY) 2011. In addition, CMS discusses a self-implementing provision contained in section 10325 of the PPACA. This provision modifies the FY 2011 implementation schedule for the Resource Utilization Groups version 4 (RUG-IV) case-mix classification system that CMS announced last year. CMS plans to delay implementation of the provision until system modifications are completed. Legislation is pending that would approve the use of RUGs IV on a permanent basis. Comments will be accepted on the proposed changes until September 14.
• Inpatient rehabilitation facilities (IRFs) - in another notice, payments in FY 2011 will increase by a market basket of 2.5% and will be offset by 0.25% per the PPACA. The IRF update contains no policy changes.  

• Establishment of an internet web portal that allows people to search for information related to health insurance products available in their state
• Creation of an early retiree reinsurance program to provide financial assistance to employers who establish a retiree insurance program
• Implementation of a maximum 12-month period for submission of claims to the Medicare program
• Expansion of coverage to adult children (up to age 26) under a parent's health insurance plan
• Development of high risk pools at the state level to help people considered "high risk" obtain insurance coverage
• Creation of an Office of Consumer Information and Insurance within HHS
• Establishment of the Consumer Operated and Oriented Plan (CO-OP) Advisory Board
• Elimination of lifetime limits under health insurance plans