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    Signing of AB 1000 Concludes Busy Legislative Year for California Chapter

    California residents will have improved access to physical therapist services due to a bill that was signed into law by Gov Jerry Brown on October 7. The signing of the bill, known as Assembly Bill 1000, marks the end of a challenging legislative journey for physical therapists in the state in 2013.

    Under the previous law, patients could only be seen for an evaluation, fitness and wellness services, and treatment for a condition that had been the subject of a medical diagnosis. AB 1000, which goes into effect on January 1, 2014, expands patient access to physical therapist services for immediate treatment for up to 45 days or 12 visits, whichever comes first.

    "With the ability to evaluate and provide interventions to the direct access patient immediately, physical therapists in California can quickly address the needs of their patients," stated APTA President Paul A. Rockar Jr, PT, DPT, MS.

    While the end result of AB 1000 helps California physical therapists achieve the longstanding goal of direct access, the final version also includes language that allows physical therapists to be employed by medical professional corporations. This aspect of the bill was not without controversy, and created debate among some California chapter members, given that the legislation combined two significant and unrelated public policy issues. The provision of the law allowing medical professional corporations to employ physical therapists stipulates that a physician, surgeon, podiatrist, or other referring practitioner must inform patients that they may seek physical therapy treatment services by a practitioner of their own choice, and that the practitioner does not have to be employed by the medical corporation. The legislation also authorizes the organization of physical therapy professional corporations with majority ownership by physical therapists that, as well, may employ other health professionals.

    In addition to CPTA's work with AB 1000, the chapter successfully advocated against 2 other bills earlier this year: SB 381, which would prohibit physical therapists from performing manipulations; and AB 864, which would have licensed athletic trainers. Both SB 381 and AB 864 were defeated.


    Comments

    Hi, I am against MD's hiring PT's and making $ on referral for profit. Does AB 1000 address anything about PT's being paid for these services rendered under AB 1000 or was totally ignored? Thanks, Andrew R. Einhorn PT for 30-years
    Posted by Andrew Einhorn on 10/11/2013 4:11 PM
    The California Physical Therapy Association would like to thank all of the support we have received this year during our legislative endeavors this year. It was definitely a busy year. None of the issues we faced this year are unique to California, but to have all three concurrently in one legislative year does win the prize. CPTA is thankful for the overwhelming support from across the country regarding the manipulation issue. Many individuals provided resources and references for information that was used in defeating this bill. The athletic training issue was able to be dispensed because of CPTA's continued education of the legislators on this issue. With the passage of AB 1000 (which occurred without a single no vote from the 120 member California legislature), CPTA will move the profession forward with the member physical therapist now being able to initiate treatment based on their treatment plan that is established from their physical therapy diagnosis. Our work is now to educate the public that they have unrestricted access to physical therapists which includes the immediate treatment of their condition if indicated. No longer must a physical therapist's clinical impression need to be validated by another diagnostician. CPTA is already meeting with insurance companies to assist them in changing the language in their policies to reflect their coverage of direct access physical therapy services in their plans. Insurance companies have already reached out to CPTA to see that this occurs. Lastly, CPTA will continue to combat referral for profit (RFP) activities regardless if the RFP activity occurs in a setting owned by a physician, podiatrist, physical therapist, corporate, hospital, or any other type of clinic. RFP activities are not unique to any one type of employment arrangement and is bad for all in health care. AB 1000 has actually strengthened the anti-RFP laws by now requiring the physician to provide a written disclosure to the patient indicating their ownership/financial relationship with the referral for physical therapy services and that the patient may seek to receive their physical therapy from a service that is not a part of the physician's corporation. So thank you again to all of you for your overwhelming assistance in opposing SB 318 and AB 864 & support of AB 1000; from folks inside California and those of you outside of California, that contributed to the success of CPTA. Together, we all get to move the profession forward. Dr. James M. Syms PT, DSc, ATC, SCS President, California Physical Therapy Association
    Posted by James Syms on 10/11/2013 4:44 PM
    The CPTA and our president Dr. James Symes, PT will try and spin AB 1000 as a positive. In reality the CPTA is complicit in sponsoring legislation that has legalized Physician Owned Physical Therapy services. (POPTS). The CPTA did this despite a 25 year commitment fighting against POPTS including most recently defeating AB 783 and AB 1152. The reversal in policy and compromise was so egregious the CPTA had to call a special Assembly of Representative meeting to seek authorization to continue on this misguided course. The permission was granted after a 4 hour meeting that allowed for no member debate and was done with a SECRET BALLOT vote of the representatives. Repeating at hearings on the bill practicing physical therapists found themselves arguing that physical therapy is a valuable profession that should not be used by Medicine or any other profession for profit. To quote the APTA's referral for profit committee, “The purpose of rehabilitative care and services provided by physical therapists is to better the lives of our patients, not to be a revenue source for other health care providers.” Despite the efforts of practicing therapists and Private Practice Section of the APTA, we were unable to overcome the political power of the allied forces of the California Medical Association, The California Orthopedic Association, The California Podiatric Association and sadly, the California Physical Therapy Association. The CPTA did not have the confidence in the value that physical therapist offer to fight for our professional integrity and value in the marketplace. Instead they undercut practicing physical therapists and offered Doctoral trained, revenue generating, expert musculoskeletal care providers on a platter for exploitation by Orthopedic Surgeons, Physician Corporations and 15 other health care professions. They have set the stage for physical therapists to be a permanent employee profession like dental hygienists and medical assistants. For more information go to www.iptca.org. Jeffrey L. Fairley, PT, DPT, OCS, FAAOMPT
    Posted by Jeff Fairley on 10/11/2013 7:49 PM
    Practicing PT's in California are offended that our CPTA traded POPTS for a limited direct access. CPTA refused to fight for clean direct access and to combat referral for profit and instead partnered with the Orthopedic surgeons and the CMA to legalize employment of PT's by medical corporations. Truly a sad day for PT in California and the result of misguided leadership.
    Posted by Jeffrey Fairley on 10/11/2013 11:15 PM
    To the CPTA supporters and the iPT supporters in our State of California, The schism AB 1000 created generated a dynamic force that for better or worse advanced in some ways our professional rights here. Thank you for demonstating what true advocacy and professionalism means to you; I want to say that despite my shy nature your efforts have inspired me to be an advocate in my community. I think the PTs in California are really quite amazing and I hope forgiveness will soon trump rancor so that we can again share our talents and skills to form a more united front to better meet the challenges facing us in 2014.
    Posted by Lise McCarthy on 10/12/2013 11:58 AM
    Lise, The CPTA's historical mistake was self-serving, myopic and ego driven. They willing legalized the exploitation of our profession by greedy profiteers that provide substandard care to your community and mine, hire PTs to sign charts while aides deliver the care, and excessively refer to themselves, not for the patients' good but for their own profit. PTs have been demoted to pencil-pushing employees rather than autonomous decision makers. These aren't my opinions. The research supports this. Still don't believe? I predict the GAO report and yet another Jean Mitchell POPTS study, both to be published soon, will add to the reams of proof of the abuse that comes from POPTS. That's why CPTA used to be against referral for profit but did a 180 openly stating that working for a physician is NOT a conflict of interest. The future isn't great for PT in CA. You don't have to be a master economist to make any predictions. Simply look at what has gone on in other states. Reimbursement is drying up. The payers can't distinguish quality physical therapy from sham POPTS care. Even if they can, the legalization of exploitation and abuse of our profession by POPTS is a great excuse to cut payment for PT services like they have in NY, NJ, Ohio, etc. There was more than a rift or schism. Take a look at Political Action Committee (PAC) donations - down 75% this year. Do you think the membership really supported POPTS and patient abuse like Syms stated? Clearly they didn't with their money and with 15,000+ opposition letters to AB 1000, they let the legislators and governor know it too. To be clear iPT has been and always will be in support of direct access but not at the expense of legalizing POPTS. The CPTA missed again when they tried to convince its members that the iPT was against direct access. Moreover, the CPTA willingly opted out, through amendments of AB 1000, of allowing Work Comp patients direct access. Again, they galvanized fraud and abuse by POPTS in an already failing Work Comp system. Best of luck with advocating for PT in your community because you just endorsed the opening of the flood gates of competition. Now every health provider licensed in CA can open a POPTS. Furthermore, with the erosion of any perceived quality of care, again you've given the insurance companies an excuse to cut payment - they will respond with higher copays for your patients; therefore, disincentivizing the use of PT. Finally, it's unclear if PTs here in CA will even get paid for direct access. No one really knows. We do know that payers will do anything they can to delay or avoid payment for services rendered. So, if PTs can't get paid, then there's no ability to "quickly address the needs" of patients here in CA. Strike three - CA PTs and consumers are out. You may succeed, and I really hope you do, but the CPTA just killed hundreds of jobs of principled PTs here in CA and sent an indelible message to legislators and consumers that we care more about ourselves than patient care. Good luck.
    Posted by David Straight on 10/15/2013 2:17 AM
    David, This is what I know. Compromise is a hard pill for anyone to swallow, and absolute statements are almost never true. False inferences, bullish remarks and religious fervor create emotion-laden distractions that attempt to parcel truth. Reimbursement is not drying up--it's changing. The Medicare pendulum is swinging and knocking over those who are found to be fraudulent, abusive, wasteful, or non-compliant. Accelerated investigations and audits to correct poor performance are underway. It will take forceful effort from those of us with good intentions to ensure patient safety is not compromised during this turbulent reform of our healthcare system. In the meantime, the enforcement phase is a big headache for those of us already practicing within the law to the best of our abilities. We all need to help each other to stabilize this unsustainable and dysfunctional system. Please know I happen to hold Dr. Syms in high regard as well as respect the office of CPTA President. I also think Dr. Gaspar has the heart of a fearless warrior and admire him for this trait. I am hopeful that our shared passions for the health of our profession and the safety of our patients will direct us towards reconciliation and promote a second renaissance within the medical healthcare arena.
    Posted by Lise McCarthy on 10/15/2013 3:58 PM
    CPTA leadership clearly failed its members and the public. ... The special assembly meeting was a sham merely designed for CPTA to paint a picture so dire that they had no choice but to support AB 1000. A key statement was that we've used up our political capital and can't go back. There is always a choice to stick with the core values of the profession. AB 1000 is very bad public policy, will ultimately hurt consumers and will be even more harmful to our wonderful profession. Shame on CPTA.
    Posted by Chuck Felder on 10/16/2013 10:08 AM
    Editor's Note: The comment directly above was posted with the removal of two sentences that violate this site's terms and conditions. APTA encourages open discussion of all issues, including AB 1000, which, as the comments above indicate, has been the subject of considerable debate. However, name-calling and personal attacks will not be tolerated in this space.
    Posted by News Now Staff on 10/16/2013 10:09 AM
    What is wrong with the truth? We live in a Democracy do we not. Dr. Felder is a very respectable PT professional who has served his profession very well nearing 40 years or maybe over 40 years. The Truth is the Truth and if Dr. Felder felt it was necessary to draw attention to a group or an individual, while, it was principled and for good reason. There is a RIGHT AND a WRONG on many issues and such was the case with AB1000. It was not all shades of grey on AB1000 as some want to believe, it was very clear cut in fact, and easy to understand the implications that poor decision making would have. The Truth is that the CPTA failed their PT membership. To be more clear, the President of the CPTA and all those within the CPTA along with the Assembly members who supported AB1000 failed in their duty to protect the Professional of Physical Therapy in California. This not only has implications here in California but is far reaching throughout the Nation. Again, the TRUTH is the TRUTH and you cannot Censor the Facts from those that walked through the entire process this year such as Dr. Felder.
    Posted by Jeff C on 10/16/2013 5:31 PM
    Jeff C: The truth is that the terms and conditions of this site were violated. Simple as that. Readers are welcome to continue a respectful and professional dialogue here in accordance with the site's terms and conditions (see the link at the bottom of the website). Comments that can't meet that criteria won't be published here.
    Posted by News Now Staff on 10/16/2013 8:06 PM
    Gentlemen, I do not know if the bullying comments were directed at me or not, but I wish you could understand that the truth as you state it ("The Truth is that the CPTA failed their PT membership") is simply not my "truth" at this time. I, too, am a proud CPTA member and I do not think as you do...at least not yet. I acknowledge it is painful to stay calm amidst so much anger. Only time will tell if your predictions are right or wrong. If you are right I will offer you my help if you want it. If you are wrong perhaps you will consider coming back to the CPTA to help us; we all need your strength.
    Posted by Lise McCarthy -> >JVaDJ on 10/16/2013 8:56 PM
    My apologies if in your opinion I exceeded the sites terms and conditions. My goal was to raise people's awareness of the unprofessional and single sided actions of the CPTA Board. They chose to make a significant reversal in CPTA policy without the consent of the CPTA membership. For this they should be censored. This important of a change in policy deserved an open, honest and professional discussion rather than back room deals.
    Posted by Chuck Felder on 10/17/2013 11:40 AM
    Hi! I am applying to a DPT program right now. It is upsetting to see that the field which I believe to provide the highest form of health care is in such high disagreement on this very important issue. As a future PT, I look forward to helping the cause and purpose of this profession. However, as an outsider to this issue, I would only suggest that if ones own group does not agree, then it should be an indication that maybe a specific action needs to be analyzed by the whole group before making a decision. My question is, why was the bill pushed through if there are so many Physical Therapist that oppose it? Thank you for all that you do! - Shachar Peled Future DPT
    Posted by Shachar Peled on 11/15/2013 2:13 AM
    Does direct access in CA allow for PTs to work on the field at athletic events or just apply to clinics?
    Posted by R, PT on 3/17/2014 8:49 PM
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