The Physical Therapist Assistant Profession Turns 50
While APTA's centennial may be a couple years away, there's another cause for celebration right here, right now: 2019 marks the 50th anniversary of the first physical therapist assistant (PTA) graduates.
Though a half-century may seem like a long time, the rise of the PTA from something that seemed like a good idea to a recognized, well-established, and in-demand profession integral to health care represents a remarkably short ascendance. Today, it's hard to imagine the delivery of physical therapy without PTAs on the team.
Here's a look at how the PTA profession came into being, and what's happened since.
The 1973 graduating class of PTAs from Greenville Technical College. Photo courtesy of APTA Library & Archive.
The Beginnings: A Clear Need, and a Creative Solution
The American Physical Therapy Association (APTA) first began to consider the idea of a physical therapist assistant in the 1940s, when physical therapists were treating soldiers injured in World War II, just as a new polio outbreak emerged. The United States had experienced 2 world wars, the Great Depression, and multiple polio outbreaks, resulting in high demand for the services of the approximately 2,500 physical therapists working at that time. Helen Blood, PT, FAPTA, a California Chapter member, introduced the House of Delegates (House) resolution to create a committee to consider a "physical therapy assistant occupation."
First PTA Programs Established
In 1967, the House adopted the policy statement "Training and Utilization of Physical Therapy Aides and Assistants" to establish educational standards, scope of practice, licensure, and eligibility for APTA membership. That same year, the first PTA education programs were established at Miami-Dade Community College in Florida and St Mary's Junior College in Minnesota (now St. Catherine University).
In 1968, Green River Community College in Washington admitted its first class of 26 students.
By 1971, APTA had approved 10 PTA education programs.
The number of PTA education programs grew steadily in the 1970s and 1980s, reaching the 100-program mark in the early 90s. After that, things really took off: today there are 393 accredited PTA programs across the United States.
The first graduating PTA class of St Mary's Junior College, Minnesota, in June 1969. Photo courtesy of APTA Library & Archive.
The PTA's Impact on APTA
PTAs were granted affiliate APTA membership in 1973. By 2018, PTA membership had grown from less than 100 to 7,736, along with 4,641 PTA students. APTA launched a #PTA10K initiative at the Component Leadership Meeting in June 2018 in an effort to reach 10,000 PTA members.
As PTA numbers and engagement in APTA continued to grow, so did a PTA sense of identity. In 1983, the Affiliate Special Interest Group (ASIG) was created, holding its first annual education conference in Topeka, Kansas, in 1987. Two years later, the House established the Affiliate Assembly, which succeeded the ASIG. In 1992, the House voted to give PTAs the opportunity to hold chapter and section officer positions.
To increase PTAs' knowledge and skills in a select area of physical therapy, in 2004 APTA established the Recognition of Advanced Proficiency for the Physical Therapist Assistant program, which was succeeded in 2016 by the PTA Advanced Proficiency Pathways (APP) program.
In 1974, APTA successfully petitioned the American Medical Association's Council on Medical Education to recognize the PTA as a health care occupation. That same year, "Physical Therapist Assistant" was added to the US Department of Labor's Employment and Training Administration's Dictionary of Occupational Titles, assigned the code 076.224-010s.
By the early 1980s, there was once again a shortage of PTs and PTAs, and federal funding for education assistance was reduced. In response, many potential employers began offering health coverage, continuing education, association dues, and licensure fees—and some even offered to pay for the last year of school in exchange for signing a 1- or 2-year employment contract.
A 1983 survey found that only 37 states and Puerto Rico included physical therapist assistants in their state practice acts, 32 of which required PTAs to take a special examination in order to practice. All 50 states, the District of Columbia, Puerto Rico, and the US Virgin Islands now include PTAs in their practice acts.
The Bureau of Labor Statistics projects that PTA employment will grow 31% between 2017 and 2026. The median PTA salary in 2017 was $57,430—a far cry from the median 1977 salary of $8,500–$9,999.
In June 2018, APTA successfully lobbied for federal legislation to include PTAs as authorized providers under TRICARE. (The rule is not yet in effect.)
First PTA to serve in the United States Peace Corps: Carol McClaugherty, PTA, served in Rio de Janeiro, Brazil, beginning in 1974.
First PTA program designed for PTA students who are blind or visually impaired: In 1977, St Mary's Junior College in Minneapolis became the only school in the country with special facilities for teaching physical therapy and occupational therapy to students with blindness or visual impairment.
First PTA student to receive APTA's Mary McMillan Scholarship: Melinda Hong, De Anza College, earned the scholarship in 1980.
First PTA students to receive APTA's Minority Scholarship Award: Karen Aitken-Douyon, Essex County College; James Lee Howlett, Wallace State College; and Mary Man, Tulsa Junior College, received scholarships in 1996.
PTA student Melinda Hong receives the Mary McMillan Scholarship in 1980. Photo courtesy of APTA Library & Archive.
First PTA to receive APTA's F. A. Davis Award for Outstanding Physical Therapist Assistant Educator: Barbara J. Behrens, PTA, received the award in 2000.
First recipients of the APTA Outstanding Physical Therapy/Physical Therapist Assistant Team Award: Edie Knowlton Benner, PT, PhD, and Juliana Robine, PTA, were recognized in 2006.
First recipient of the APTA Outstanding Physical Therapist Assistant Award: Roy Christopher Junkins, PTA, ATC, was awarded in 2007.
Lisa Finnegan, PTA, lead accreditation PTA programs specialist, became one of the first physical therapist assistants to work at APTA in 2006. "I've never believed that I'm ‘just a PTA,'" says Finnegan. "PTAs have many rewarding job opportunities—I've had the pleasure of treating patients in clinical settings, teaching in a PTA program, writing books for PTA students, and working for APTA and CAPTE. I'm proud to be a PTA and an APTA member."
For more on the history of the PTA, watch for PT in Motion magazine's special feature in the upcoming May issue.
Editor's Note: This post previously listed the current name of St. Mary's Junior College as St. Mary's Campus of the University of St. Catherine. The institution is currently called St. Catherine University.
Got MIPS Questions? We Have Answers.
The Merit-based Incentive Payment System (MIPS) is now in effect for many physical therapists. At a recent live webinar, APTA answered some of our members' most pressing questions. (In case you missed it, you can listen to the recorded webinar in its entirety.)
We've recapped some popular questions here. Not finding the question you need answered? You can email email@example.com. APTA members can also post questions, and review answers to other member questions on the Medicare MIPS Discussion Board on the Medicare Quality Reporting Hub.
What is the quickest way to find out if my practice is required to participate?
The Centers for Medicare and Medicaid Services (CMS) website has an easy lookup tool. Just type in your national provider identifier (NPI) number and you'll see whether you are required to participate as a practice, or as an individual.
APTA's MIPS resource page has a lot of information, including a decision tree to help you understand MIPS eligibility and required vs voluntary participation.
In brief, you must participate if you are an individual PT in private practice and exceed all 3 criteria for the "low-volume threshold":
- Receive more than $90,000 in Medicare part B payments each year
- Provide care for more than 200 Part B-enrolled Medicare beneficiaries annually
- Bill more than 200 professional services annually
My small practice is going to participate in MIPS. Because we have fewer than 15 PTs, we are allowed to report via claims instead of through a registry or QCDR. What are the business considerations for choosing one method or the other? Can we switch from claims to registry reporting later, or are we stuck with whatever choice we make?
If you report via claims, you can submit your quality data on your claim form. However, you will not get feedback on your performance until after the end of the reporting year, when it will be too late to make changes that could help your MIPS score. Even though you will incur a cost using a registry, it will provide you with feedback throughout the year. The type and frequency of feedback may vary by registry. You can switch data submission methods mid-year. CMS will base your score on your top 6 measures.
Does MIPS apply to hospital-based outpatient practices?
No. For 2019, if you practice in a facility-based setting such as a hospital outpatient department, skilled nursing facility (part B), or rehabilitation facility you are not able to participate in MIPS.
Our physical therapy clinic is part of a multispecialty practice in which the physicians already report as a group. The PTs do not meet the low-volume threshold as individuals. Do we need to report as part of the group?
It may depend on your specific multispecialty practice. You can contact us at firstname.lastname@example.org to address your questions.
We have 6 PTs in our practice, and none of them exceed the low-volume threshold individually. But as a group, we do. Do we have to report?
The group is not required to participate, since MIPS only mandates individual PT participation. However, because the practice as a whole exceeds the threshold, it can choose to participate in MIPS to take advantage of the potential 7% incentive payment.
Our practice exceeds the threshold, but only 1 of our PTs does individually. How does that work?
You have 2 options: The PT participates alone, or the practice can participate as a group. Only the PT who exceeds the threshold is required to participate. However, because the whole practice also exceeds the threshold, it can participate in MIPS. If you choose group participation, all therapists will be considered fully participating in the program.
What are my options for reporting improvement activities? Do you have recommendations?
CMS offers over 100 improvement activities, which can be found on the CMS QPP website. APTA has created a condensed list of activities that may appeal to PTs.
How can we follow our performance scores to tell if we are meeting expectations throughout the year?
This is a great question. If you report via claims, you will not know your score until the end of the reporting year. This is why APTA recommends using a vendor for reporting. It can help you improve your scores throughout the year. If you report using a "qualified registry," check with your vendor to see how frequently you will be able to get feedback. Some may only be quarterly or monthly.
As a qualified clinical data registry (QCDR), APTA's Physical Therapy Outcomes Registry gives you continual real-time feedback.
If you are attending CSM, Heather Smith, PT, MPH, APTA director of quality, and Kara Gainer, JD, director of regulatory affairs, will be presenting "Emerging Issues in Medicare: Quality Programs and Alternative Payment Models" on Friday at 11:00 am, where a CMS representative will be available to address attendees' questions. Heather Smith also will host a Q&A session at 2:00 pm on both Thursday and Friday at the Physical Therapy Outcomes Registry booth #1433 in the Exhibit Hall.