Determining that this is not the right time for a more “permissive” policy on the individuals that should be permitted to perform physical therapist (PT) interventions under the direction and supervision of the PT, the APTA House of Delegates (House) rescinded a 2011 position statement, not yet implemented, that would have supported the expansion of support personnel available to the PT. At the same time, a new House position affirms that APTA can best help PTs and physical therapist assistants (PTAs) navigate the changing health care landscape by encouraging diverse creative approaches to the provision of patient-centered physical therapist delivery of care through consultation, referral, direction and supervision, and interprofessional collaboration. The House reached this agreement after extensive executive session discussion, closed to outside observers and not recorded, at the 2014 House session June 8-10 in Charlotte, North Carolina.
The newly adopted policy states that APTA positions and policies are "intended to communicate best practice for physical therapist practice," and are "not intended to limit the development of innovative approaches to physical therapist practice in the evolving health care system."
The related motions and discussion were the result of proposals to refine the position statement, titled "Physical Therapist Responsibility and Accountability for the Delivery of Care," first adopted at the 2011 House and amended in 2012. The position had confirmed that physical therapy is provided by, or under the direction and supervision of, a physical therapist (PT), and that evaluation remains the complete responsibility of the PT. Additionally, the position acknowledged how the changing health care system and the needs of the patient based on the PT’s clinical decision making could have an effect on which personnel the PT may use in treatment, and the nature of those relationships. The actual implementation date had been delayed to allow the association to explore the potential impacts; implement necessary initiatives in education, practice, payment, regulation, and research; and adopt positions, standards, guidelines, policies, and procedures that were consistent with the new position.
As part of the run-up to implementation, a task force was created to carefully examine how APTA might best reflect the position in its policies and other documents. That task force’s report, delivered to the APTA Board of Directors in December of 2013, sparked the Board to ask for a third-party policy analysis. Meanwhile, amendments to the position were readied for 2014 that could have moved the position ahead.
In the end, however, the proposal that won favor with delegates was a new motion to rescind the position altogether and return to the position that the PTA is the only individual permitted to assist a PT in selected interventions, under the PT's direction and supervision. APTA will continue to be responsive to how new models of care and accountability are affecting physical therapy, and the association has reemphasized the importance of member ability to develop innovative practice models that best meet the needs of patients and clients. [RC-3, RC-4, RC-22, RC-23]
APTA members can view videos of all open sessions of the 2014 House of Delegates online. Final language for all actions taken by the House will be available by September after the minutes have been approved.
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