Friday, July 25, 2014

US Virgin Islands Gets Direct Access, Improved PT Practice Act

Virgin Islanders will now have improved access to physical therapist (PT) services—and a much more effective physical therapy practice act—thanks to a new law signed by Governor John P. de Jongh Jr, on July 11.

The new law, Act No. 760, allows for direct access to evaluation and treatment by a PT without a physician’s referral, and includes changes to the licensing law that protect the term "physical therapy" as an activity that can only be engaged in by a PT, among other improvements.

Prior to the act's passage a physician referral was required for all PT services. The new law, which takes effect on October 9, 2014, allows for treatment without a referral for 45 days or 12 treatment visits.

"It’s been a long time coming, but consumers will now have greater access to quality health care provided by physical therapists," said Virgin Islands APTA member Jerry Smith, PT, DPT, ATC. "These changes could not have happened without the work of the physical therapy community here."

In addition to direct access, Act. No. 7620 also makes significant updates to the physical therapy practice act. Besides the protection of "physical therapy" as a term that can only describe the activities of PTs, the new law provides title protection for "DPT" and "doctor of physical therapy,” an updated definition for the practice of physical therapy, an expanded board of physical therapy, and revised qualifications for licensure.

"APTA commends the work of the dedicated physical therapists in the US Virgin Islands who worked for many years to bring about these legislative changes," said APTA President Paul Rockar Jr, PT, DPT, MS. "Improved patient access to PT services continues to be a high priority for the profession and APTA."

Earlier this year both Oklahoma and Michigan enacted direct access legislation. The new Oklahoma law goes into effect on November 1, and the Michigan law on January 1, 2015. All 50 states, DC, and now the US Virgin Islands have enacted laws allowing for direct access to evaluation and some level of treatment without a physician referral.

Comments

I applaud VI for their success! I take exception with your final comment that all 50 states now have DA and "some level of treatment". Texas is evaluation only. Thanks for the thought though, we could use a little support from APTA in our efforts; we're working on it, hopefully 2015 is the time for treatment too.

Posted by James Lewis on 7/25/2014 4:50 PM
Well done VI !!! With that said, I don't understand why the statement continues to be made that All 50 states allow for evaluation and "some level of treatment without a physician referral." ... I'm in Texas and the only way I can provide any treatment is if it's considered an "emergency." This is a misleading statement. We can't treat without referral in Texas.

Posted by Jarod Carter on 7/25/2014 5:59 PM
IS DPT IS OR tDPT IS REQUIRED TO HAVE DA??

Posted by ELANGO KALIAMOORTHY on 7/25/2014 7:40 PM
Actually you can treat patients without a referral in Texas. It's fairly limited though, the patient has to have been subject of a prior physician referral, so it's pretty much direct access just for folks who have chronic or reoccurring condition that was previously diagnosed. But when we got it passed back in the 90's it was a huge effort!

Posted by Mike on 7/25/2014 7:51 PM
I just want to say thank you for the positive comments. This process really wasn't easy. Our law was in place since originally enacted in 1969 and stayed pretty much unchanged since then. Thanks to the efforts of many VI PTs who emailed, texted, and attended hearings. VI PT Board Members Schuster and Short for their dedication and services of over 20 years. The APTA 's State & Govt Affairs Division and the FSBPT for their guidance throughout the process. To Senator Clifford Graham who sponsored the bill in his freshman year and pushed it like a veteran Senator. Senior Senator Craig Barshinger who showed his strong support and legislative prowess from the beginning and helped us to avoid some pitt falls along the way. Senator Clarence Payne and staff who through his Chairmanship of the Health & Hospitals Committee allowed the bill's introduction and rallied the support of his colleagues needed to get through the committee process and continued his support through the remaining legislative process. Finally, the remaining 12 Senators who voted favorably and provided a unanimous show of support for Physical Therapy, and Gov. John P. de Jongh for his support and confirmation that it is a good thing for the people of the VI to have direct access to the capable care of a Physical Therapist. It was truly a team effort and I thank everyone involved!

Posted by Jerry R Smith on 7/26/2014 7:13 AM
Great accomplishment and congratulations to the VI. We should all learn from their monumental achievement that professional unity and proactive persistence can be well rewarded. I am trying to get involved in protecting our profession to become full first line autonomous practitioners in Florida as well. We can use the help of the apta to guide us. I am open to suggestions on how we can also protect the term physical therapy/therapist to only be a term used and rendered by a licensed physical therapist and assistant. How can we make this happen? Sincerely, Matthew St.Aimee, PT, DPT

Posted by Matthew St.Aimee, PT, DPT on 7/26/2014 8:17 AM
Since all of the wording reads PT and physical therapists, does this exclude PTAs from practicing under a PT in the USVI? Victoria Anglin, PTA, BS

Posted by Victoria on 7/29/2014 5:44 AM
Wow, you guys think you got a good deal. Here in California our lame CPTA managed to get us 12 visits or 45 days and handed over the keys to 15 other health professionals that can now own a PT clinic in California. Remember how those Orth Surgeons like to make money. Well now they get to send the patient to their own clinic and make money in a resolving circle. PT's cannot diagnosis the patient in California. That is how great our California Physical Therapy Association and Lobbyist are. We no longer give them any money. All our money goes to IPT in California who have an interest in private PT practice in California.

Posted by Fred on 7/29/2014 3:37 PM
Matthew - I hope I'm not being insulting or offering an over simplification but to achieve exclusive use of the term your PT law has to directly state that only persons with PT/PTA credentials can use the term. Victoria - Actually the VI language specifically includes PTA in it's terms for the expressed purpose of including PTAs. Before this document PTAs were not recognized by statue and although PTAs have been practicing within the territory they couldn't qualify for local licensure nor liability insurance. Fred - we actually used California as a starting point of negotiation for the final details that we now have. I can only imagine the level of opposition your board had. I'm sure tgere will be improvements with time.

Posted by Jerry R Smith on 7/29/2014 7:58 PM
I totally respect you Jerry. I do want to point out that the deal the CPTA worked out was against the larger part of the membership. Our Association did so many things incorrectly, that our profession was steamrolled. It will not change with the CPTA in California. The only group that made a HUGE difference and cared enough to confront a horrible deal for Californian PT's was IPT. They are an awesome group of men and women who are not afraid of making waves. What the CPTA did will take 10 years to undo because they were very unschooled and were willing to listen to a Lobbyist that unfortunately has quite a poor reputation. We also had a first hand view of the dirtiness of politics in California. I would encourage the other States to NOT FOLLOW THE LEAD OF CALIFORNIA, because it was not the correct way, nor is it a good DIRECT ACCESS LAW. Presently we have direct access for 12 visits or 45 days. We cannot legally diagnosis the patient. So in order to be paid by a carrier, a PT either has to break the law by assigning an ICD9 code and sending to insurance or get a diagnosis from a professional licensed to diagnosis in California. What that added up to is honestly no better than what we had. At the same time, 15 other professionals, some of which can diagnosis the patient, can now monopolize the care in all speciality areas including PT. Social workers, dental hygiensts, psychologist's, Dentists, Chiro',s Physicians of all types etc. can own a PT clinic, some just to make MONEY. The CPTA refused to do their homework and thought nothing of private practice PT's. There are many members who have no respect for the CPTA and are unwilling to fund their activities. Hard to believe, but that is what happened. I saw it with my own eyes, read a ton and was present at some of the meetings. It was shameful and unprofessional with concern to the CPTA. The APTA claimed their hands were tied. Well, that is their position but it is not believable as they all rub shoulders on tons of issues. This was one of the biggest issues in the Nation. Some of us never want to see others use California as their model for Direct Access as it is very poor.

Posted by Fred on 7/30/2014 12:38 PM

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