Dating back to last year, APTA has provided crucial information about these upcoming cuts in all-member e-mails, News Now articles, social media messages, and via the APTA.org homepage. Still, we know that some physical therapists are unaware of what's ahead.

That's why I'm urging you to share this information with your colleagues, which can be as simple as forwarding the link to this blog post.

These cuts will impact physical therapists financially and may affect the access to care our patients receive. Additionally, as health care providers continue to bear the brunt of payment reductions, there is also an emotional toll to these changes, and it's important that we support one another in these challenging times.

I've talked with many physical therapists from across the country, and I know that these challenges are real. I see and feel it in my own practice as we work as a management team to continue to provide the patient care needed by so many with resources that continue to shrink. It is becoming more and more evident that from a financial and reimbursement aspect we are facing a "new normal" that is often hard to understand.

Those familiar with our national advocacy efforts know that APTA works year-round to protect payment for physical therapy services - advocating intensely to repeal the therapy cap and to prevent the MPPR and other cuts from going into effect. Unfortunately, despite successes in many legislative and regulatory areas, physical therapists are not immune to the repeated changes affecting all Medicare providers.

Although APTA alone cannot change the course of sequestration, the association will continue to look for opportunities to fight the MPPR cuts. However, with or without congressional action on these items, these challenges necessitate our consideration of payment reform. It is becoming increasingly clear that we cannot sustain the current payment system - not for ourselves, and not for our patients.

That's why APTA is developing an alternative payment system - the physical therapy classification and payment system (PTCPS) - for outpatient services. The need for reform is clear, and we want the opportunity to help shape payment reform to reward the clinical expertise physical therapists bring to the health care system, rather than having payment reform imposed on us.

Payment in the future will be based on data that demonstrates value, patient engagement, and quality outcomes. The proposed PTCPS embraces that model with the goal of not just improving payment but also quality of care.

No proposed system will be perfect, and while many have embraced this change, other physical therapists have expressed their concern. But with the challenges facing payment in health care, change is essential.

I encourage you to read about APTA's alternative payment system, PTCPS, and consider its impact for the future. But more importantly I urge you to spend 5 minutes sharing the resources at APTA.org with your colleagues to prepare for these challenges in our present.

Since then, the task force developed a new proposed vision statement and supporting vision elements, which the Board will propose to the House in June.

To generate conversation about the proposed vision, the Vision Task Force invites comments at the bottom of this post. Additionally, individuals attending the Combined Sections Meeting (CSM) in San Diego are welcome to attend the Beyond Vision 2020 Member Forum (also open to nonmembers) on Wednesday, January 23, 6:00 pm-7:00 pm PT, in Ballroom 6C of the San Diego Convention Center.

The new proposed vision statement and vision elements, and background about their development, can be found on the Beyond Vision 2020 webpage. In seeking your feedback, we feel it is appropriate to briefly highlight where we are and how we got here:

From the beginning of our work, the Vision Task Force was guided by a few very broad themes, inspired by the information we collected early on and the charge from the House. We wanted this new vision to be "outward looking" (focused on our role in society and our obligation to meet society's needs) and to reflect the evolution of a physical therapist's role (beyond treating people who are having problems and then discharging them, not to see them again until another serious problem generates a referral).

Those themes might be best captured in the phrase "my physical therapist," which evokes consumers seeing their physical therapist on a regular basis to maintain a healthy, high quality of life so they move efficiently at their highest personal ability level, whatever that means for them. That kind of streamlined, habitual relationship between the consumer and physical therapist would be direct access at its best.

Guided by these themes, the task force decided to aim high and be bold, which was one of the tips provided to us by our visioning consultant, Marsha Rhea, CAE. The proposed vision that will be submitted to the House reads: "The physical therapy profession will transform society by optimizing movement for all people of all ages to improve the human experience."

As many have pointed out, this is a lofty vision. But that's what we believe a vision should be, providing statements of identity (who we aspire to be) and desired outcome (what we aspire to change), while speaking to the public (not "the choir") in language that those within and beyond the profession would understand.

To realize its vision, APTA would of course repeatedly establish specific strategic priorities and objectives, which would be timed and measurable. A vision can and should be something greater, and we hope this proposed statement reflects that.

As you consider your response to this proposed vision, we encourage you to read (or reread) Mary McMillan lectures by Ruth Purtilo, PT, PhD, FAPTA (2000), Andrew Guccione, PT, DPT, PhD, FAPTA (2010), and Alan Jette, PT, PhD, FAPTA (2012), which are available through PTJ. (In particular, note Purtilo's comments on periods of identity and Jette's comments on systems thinking and positive deviants.)

The Vision Task Force believes that the physical therapist's role in transforming society goes beyond our already familiar, traditional image of physical therapy. There is a leadership role within the public sphere that needs to be embraced, such as advocating for walkable communities and physical education in schools, for example.

We shouldn't sell ourselves or our profession short: improving movement of individuals within society has the power to transform society itself.

We look forward to hearing your thoughts on the proposed vision statement.

Vision Task Force
William McGehee, PT, MHS, Chair and Board of Directors Member
Patricia Brick, PT, MS, GCS
E. Scott Euype, PT, DPT, OCS
Edelle Field-Fote, PT, PhD
Pauline Flesch, PT, MPS
Charles Gulas, PT, PhD, GCS
Colleen Kigin, PT, DPT, MS, MPA, FAPTA
Tasha MacIlveen, PT, DPT, CSCS
Lisa Saladin, PT, PhD

The campaign will launch October 1, at the start of National Physical Therapy Month, with “50 Days, 50 Ways,” a daily series of 50 tips for Baby Boomers from APTA member physical therapists on how to prevent injury and maintain mobility by staying active and fit. The tips will be published via Twitter and Facebook, and on the consumer information page at www.moveforwardpt.com/FitAfter50. To encourage the public to share these tips with their social networks, APTA will give away prizes throughout "50 Days, 50 Ways."

As a Baby Boomer who understands how healthy aging can improve quality of life, I am really excited about the launch of Fit After 50. Our goal with this campaign is to educate people about the importance of staying fit as they age to achieve long-term quality of life. Physical therapists can help people remain active and fit by providing individualized fitness programs that improve balance, increase mobility, and reduce the risk of injury.

APTA also will launch its "Fit After 50 Member Challenge" to allow APTA members to nominate member colleagues ages 50 and older who are committed to being fit, active, and mobile as they age. From March 1, 2013, through April 5, 2013, APTA members and the public can vote for their 1st, 2nd, and 3rd place favorites on www.moveforwardpt.com. Winners will be announced at APTA's Conference & Exposition in 2013.

In recognition of National Physical Therapy Month, I hope you will join us in celebrating and promoting the important work that physical therapists do to help people restore and maintain health as they age. You can learn more about the Fit After 50 campaign in this video. As always, please feel free to post your thoughts about the topics covered on this blog.

We also held our fiduciary session that included an excellent presentation on the status of our association management services. We will continue our discussions on the direction of this area of association business as we consider how to best serve the needs of our components. I encourage you to read and comment on the News Now articles on the Strategic Plan updates and the discussion surrounding APTA's association management services.

In an effort to keep members more up to date on Board activities, I hope to use this blog to communicate the Board's actions and the various issues it discusses throughout the year. As always, please feel free to post your thoughts about the topics covered on this blog.

Watch the prerecorded video tribute below, and leave any thanks or memories in the comments.

Comments are published after moderator approval. 

A report submitted to the Board of Directors on updating APTA's governance structures and processes gave Board members a platform for several hours of engaged discussion April 20-21. This report was the result of comprehensive work done by APTA members as part of a number of volunteer groups that began in 2009 to collect and assess data representing APTA's multiple interests and needs. More than 3,000 APTA members also provided their input and feedback as part of this process.

The report now will be forwarded to the House of Delegates so it can consider the recommendations that require a change to our bylaws (bylaws decisions are scheduled for 2013). The report also will be forwarded to our chapters and sections for their consideration.

APTA will provide a summary of the Board proposals and background on their development by May 4. More about the governance review initiative, designed to ensure the association is effective, nimble, responsive, and inclusive in today's environment, is available at www.apta.org/GovernanceReview.

I hope you will take the time to learn about the proposals and the opportunities we have to reformat our structures and processes to best position APTA and the profession to meet the challenges we are facing now, and those challenges that are sure to come.

The Board also held a session on visioning that stemmed from a 2011 House motion calling for APTA to revise its Vision Sentence for Physical Therapy and Vision Statement for Physical Therapy. The objective is to look beyond 2020 and clearly articulate the profession's commitment to society. During this session we discussed the current persona of the physical therapist (PT), skills and competencies of the PT, the profession's culture, and important initiatives the profession will face in the next 10 years. We also identified top priorities and design principles of APTA that the Vision Task Force will use as it continues its work over the next few months conducting focus groups with members, interviews with thought leaders, and an environmental scan.

Later this year the task force will submit a draft of the new vision to the Board for its review. The new vision will go to the 2013 House for its consideration.

One of the most debated motions in last year's House resulted in the creation of a task force to review the current model of the PT, physical therapist assistant (PTA), and physical therapy aide (PT aide) as the only participants involved in the delivery of physical therapist services. The task force was also asked to identify potential new models of delivery of these services. A report from the task force was presented to the Board that, among other things, identified 4 models of service delivery that include using support personnel in selected elements of the PT plan of care. Following much rich discussion—which focused on our ability to best meet the needs of our patients/clients now and in the future, and the barriers to accessing physical therapist services—the Board voted to continue the exploration of a new practice model based on the scenarios in the task force report. Because the House will be considering motions this year on this topic, the Board will not take action on the motion it adopted until the House discusses the motions on its agenda in June. Background material to help inform House discussion on this topic will be posted for the delegates on the House of Delegates community.

On the topic of research, I'm happy to report that a workers' compensation study from APTA's health services research pipeline is wrapping up, and the results will soon be disseminated to association members, policymakers, payers, and other stakeholders. APTA will use a communication strategy similar to that of the direct access study last year in which the results were distributed through webinars, an audio conference, press materials, social media, talking points, and a toolkit for chapters and sections.

In addition to getting study results out to members on a regular basis, the goal of the research pipeline is to equip payers with data so that they can make informed decisions rather than indiscriminately reducing payments. Other projects currently in the pipeline include an investigation into home health care readmissions and a clinical education study.

With each Board meeting, recurring themes emerge and connect the various issues we discuss. Whether our conversation focused on payment, practice models, or APTA's vision, the phrases "raise the floor," "demonstrate the value of physical therapy services," "focus on patient-centered care," and "collaborate with other health care providers" surfaced again and again. These are all positive endeavors, and I challenge you to incorporate them in your practice.

Following the conclusion of the Board meeting, a town hall was held on APTA's alternative payment system (APS). Still in a draft format, this new payment model will be pushed to members in the near future through News Now and other communication channels for their review and comments. This proposed payment system is rooted in the severity-intensity concept described in PTJ in October 2011. Under APS, payment for physical therapy services would reflect why a PT performed an intervention, not what intervention was performed. Some have described the model as being "as much about what you do in your head as it is with your hands."

Updates on APS will be provided to members as they become available.

While much work was accomplished during the April Board meeting, much lies ahead. Your Board remains committed to moving forward the association's initiatives that empower and position each and every PT and PTA to better serve our patients and clients.

Yesterday, a message was sent to association members regarding the recent Board of Directors meeting that references the "Triple Aim" of health care and its influence on policy. We'd like to take this opportunity to further explain the Triple Aim and discuss physical therapy's role in what has become a major focus in the post-health care reform debate.

The Triple Aim originates from the Institute for Healthcare Improvement, a think tank founded by Donald Berwick, MD, in Cambridge, Massachusetts. This philosophy permeated the Centers for Medicare and Medicaid Services (CMS) during Berwick's tenure as its administrator, and is now linked to implementation efforts associated with taking the more than 2,400 pages of health care reform legislation and turning them into volumes of new regulations, programs and federal efforts required to operationalize the Triple Aim. Berwick's tenure ended on December 2, but the Triple Aim is now part of his legacy to reform our health care system.

What is the Triple Aim? To start, it is a proposed solution to our health system's ills. It is well documented that the United States' health care system is the most expensive in the world, disparate in its access, and often doesn't impact or improve one's health status. On November 4, CMS announced that US health care spending growth was 4.0% in 2009, reaching $2.5 trillion in expenditures, or $8,086 per person or 17.6% of the nation's Gross Domestic Product, up from 16.6% in 2008.¹ The Triple Aim was outlined in Health Affairs in 2008 as an effort to reverse this trend and simultaneously pursue the 3 objectives of:

• (1) improving the experience of care;
• (2) improving the health of populations; and
• (3) reducing per capita costs of health care.² 

The Triple Aim builds upon the 3 goals of the "iron triangle" of health policy, which call for enhanced quality of care, improved access to the right provider at the right time, and reduced health care costs to manage a person's health status.

Can physical therapy achieve the Triple Aim and, if so, how? We believe that we can because the Triple Aim is connected to what we do as physical therapists. The task before us now is delivering this message to policy makers. APTA continues to position and align its organization and priorities to meet the demands of the changing health care landscape, achieve the Triple Aim or contribute our proper role to the Triple Aim for delivery systems, and to demonstrate the essential value of our profession and the services we provide to the public. Connecting these to the health policy environment with which we interact is essential to move the profession forward as a leader in health care delivery. As 2011 comes to a close, there are several critical initiatives ongoing to leverage physical therapists as essential to achieving the Triple Aim.

To improve access, APTA is working to secure a commitment from the new Center for Medicare and Medicaid Innovation (CMMI) to invest in the early access or direct access to physical therapists for musculoskeletal conditions as part of its search for more efficient and effective models of care delivery. APTA's proposal has been submitted and is under consideration by CMMI at this time. Also in this area, APTA saw the completion of a multi-year project on direct access with the publication of an article published in the journal Health Services Research that suggests that "the role of the physician gatekeeper in regard to physical therapy may be unnecessary in many cases." This work by Jane Pendergast, PhD, Stephanie A. Kliethermes, MS, Janet K. Freburger, PT, PhD, and Pamela A. Duffy, PT, PhD, OCS, CPC, should help our state and federal efforts prove the value of direct access to physical therapy in the coming years. APTA also has assembled an issue team led by Roshunda Drummond-Dye, JD, APTA's regulatory and payment counsel, to spearhead our role in integrated models of care delivery. These models, ranging from Accountable Care Organizations (ACOs) to patient centered medical homes, will have key access issues as they become part of our reformed health care system. APTA's work is to demonstrate the value of physical therapy and our role in these models.

To improve quality, APTA hired a full-time policy expert in 2011 to lead the development of a quality work plan and focus on the policy efforts that the federal government is involved in to enhance quality care. This has resulted in a coordinated and consistent approach to position APTA in the quality area and incorporate quality into areas such as a reformed model for payment, the development of a national registry, and health information technology in physical therapy. Just last week, CMS released the updated measures specifications for the Physician Quality Reporting System for the 2012 reporting year, allowing physical therapists to report for an additional individual measure in the 2012-Measure #182: Functional Outcome Assessment. Our work with CMS in this area can be seen each year as physical therapists are included in reporting on new measures.

To reduce costs, APTA continues to seek needed reforms to physical therapy services. As mentioned in yesterday's message to members, APTA is exploring a reformed payment system model, which could include direct billing for physical therapists, and embarking on a regional payment pilot project in the New England area. Also essential to this objective is establishing strong term protection for physical therapy and title protection for the physical therapist. APTA will submit its review of the current status of term and title protection to the 2012 House of Delegates and begin an action plan to improve term and title protection where gaps lie. In addition, we continue to seek policy support through the health service research pipeline to advance our public policy priorities. Work in 2011 began on referral for profit, billing patterns of health care professionals who use the 97000 CPT series (physical medicine and rehabilitation), and bundled payments and the role of physical therapists.

These are just a few of the areas where APTA is working for you and with you to achieve a Triple Aim that advances physical therapy. The key words in health care today are "integration" and "innovation." We are reminded of this daily with announcements such as the following from CMS:

News Alert: The Department of Health and Human Services recently announced the Health Care Innovation Challenge from the CMS Innovation Center, a new initiative designed to test creative ways to deliver high quality medical care and reduce costs across the country. The Challenge will award up to $1 billion in total grants to applicants who can rapidly implement the most compelling new ideas to deliver better health, improved care and lower costs to people enrolled in Medicare, Medicaid and CHIP, particularly those with the highest health care needs. 

APTA is a key messenger in this transformation from independent and often fragmented care to more interdependent models. The key message will be the work that physical therapists do daily, our record of compliance, and our value to the health care system in reducing costs while raising the bar on quality. We can have a positive impact on the nation's health-and do so already. Illustrating this by adapting to the current realities of health care and accepting the challenge of innovation and integration will best convey our message.

2011 was a year in which we saw the start of the transformation of our health care system through rules on ACOs, a proposal on the essential benefits program, and payment innovations such as the CMMI bundling project. 2012 promises more transition to a health care system where transparency, accountability, and integration are valued. To deliver the message of physical therapy's role in this transformed health care system that meets the Triple Aim, we need you to participate and build on the successful grassroots efforts and Capitol Hill activities we demonstrated in 2011. It was just 6 months ago when almost 1,000 physical therapists, physical therapist assistants, and students stood in the heat on Capitol Hill ready to share the Triple Aim value proposition that physical therapy is prepared to accept and deliver. We look forward to continuing the momentum in 2012.

Have you thought about your role in achieving the goals of the Triple Aim? Do you see opportunities and challenges to implementing programs in your practice that can improve access and quality and decrease costs? How can APTA's initiatives help support your efforts?

References

1. Centers for Medicare and Medicaid Services. Historical National Health Expenditure Data. https://www.cms.gov/nationalhealthexpenddata/02_nationalhealthaccountshistorical.asp. Accessed December 12, 2011.

2. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff. 2008;27(3):759-769.

Media organizations such as UPI and the Bend Bulletin in Oregon, among others, have published stories on the study. We've also seen APTA members across the country promoting the research on their web sites, blogs and social media channels.

Word about this study is definitely spreading, and we want to continue that trend, so we've developed an online toolkit to assist you in your outreach efforts. The kit contains the resources and information you'll need to get the word out to your local media, legislators, and other important players in health care. Join us in sending a strong message to decision makers that direct access to physical therapists could go a long way toward helping to make health care more affordable and accessible for all.

Jayne Snyder, PT, DPT, FAPTA 

Jayne Snyder, PT, DPT, MA, FAPTA died on October 5 of pancreatic cancer.

Jane was an active APTA member since 1969. She served APTA as vice president, on the Board of Directors, and as president of the Foundation for Physical Therapy. In 2004, she received APTA's Federal Government Affairs Leadership Award for her efforts at the federal level to preserve and promote the profession of physical therapy.

Jayne owned and operated Snyder Physical Therapy in Lincoln, Nebraska. She was elected a councilwoman on the City Council of Lincoln in May 2009. She also served as a member of the Lincoln-Lancaster County Board of Health. Jayne served in a consulting role for President Clinton's Economic Package and the Democratic National Committee's Retreat on Health Care Reform.

She began her career in the Lincoln public school system as a physical education and health teacher. Past posts include co-owner of Total Fitness Consultants and director of rehabilitation for Tabitha Inc, both in Lincoln, as well as physical therapist at the University of Nebraska Athletic Department and assistant professor for the university's Division of Physical Therapy Education. A lifetime runner, Jayne completed 50 marathons in 27 separate states.

Her advocacy efforts included the development of the Clinical Research Network and support for the APTA Hooked on Evidence campaign. She worked for health policy reform at multiple levels, including significant contributions to the Guide to Physical Therapist Practice.

Jane Walter Venzke, PT, EdD, FAPTA 

Jane Walter Venzke, PT, EdD, FAPTA, passed away on October 8 after a long illness. Jane was a long time APTA member, serving on state, regional, and national levels including president of the New Hampshire chapter, president of the Section for Education, Board of Directors, and vice president.

Jane attended the University of Connecticut where she received her degree in physical therapy. She was the administrative director of physical therapy, occupational therapy and speech pathology at Mary Hitchcock Memorial Hospital for 12 years before obtaining her MEd degree and becoming the associate director of the Arthritis Center at Dartmouth-Hitchcock Medical Center. After earning her EdD degree, she moved to the University of Alabama at Birmingham where she continued her research in rheumatology. In 1993 she became the director of the physical therapy program at Wayne State University in Detroit.

Wishing to fulfill her dream of bringing a physical therapy education program to New Hampshire, Jane returned to New Hampshire to become dean of science and director of the physical therapy program at Notre Dame College in Manchester. After upgrading and revamping the science programs, she went on to become Dean of Health Sciences and established programs in physical therapy and physician assistant studies. When Notre Dame closed, Franklin Pierce University acquired the physical therapy program. Jane ultimately joined the university as associate dean of graduate studies and director of the physical therapy program.

Jane became the dean of Franklin Pierce's College of Graduate and Professional Studies in 2007 where she launched the first doctoral programs at the university and added several new master's level programs.

In 1981 she was appointed by President Reagan to the White House Conference on Aging and to membership of the National Arthritis Advisory Board. She credited these 2 national appointments to her introduction to the politics of public policy.

Leadership Beyond the Association 

APTA will miss both of these remarkable leaders. But what I found particularly revealing was that both shared their leadership skills and sense of responsibility far beyond APTA.

Jayne served on her city council and on the county board of health, and as a national consultant on health care policy. Jane served on 2 national presidentially appointed organizations. Both were active in working to shape public policy.

Both were intimately involved in research-Jayne in her role with the Foundation for Physical Therapy and Jane having written a remarkable collection of research articles, presented numerous poster and podium presentations, and written many book chapters, manuals, and monographs. Although the research efforts of both of these remarkable women will be visible within the profession of physical therapy, the lasting benefits will be experienced by countless patients and clients worldwide.

Although APTA honored both with its highest honor-having named them Catherine Worthingham Fellows-the highest honor that those in the profession can bestow upon them is to emulate their models of dedication, purpose, and leadership.

Case in point: On August 22, the Chairman of the Health Subcommittee of the House Ways and Means Committee, Rep Wally Herger (R-CA), visited a practice in his home district -- Butte Premier Physical Therapy in Chico, California. This was the first clinic visit for the chairman, whose committee is 1 of 2 key health policy committees in the House of Representatives that play an important role in APTA's legislative issues, including repeal of the therapy cap. Clinic owner Leigh Langerwerf, PT, DPT, led the tour with Herger, who was able to observe the care of 2 patients, while clinic staff described the scope of PT services and discussed APTA's legislative priorities. This grassroots effort represents the importance of a strong collaborative effort between APTA and individual members. Thanks to Leigh Langerwerf for helping to coordinate this important event.

Throughout the August recess, APTA made a concerted effort to increase the number of home district meetings and site visits, and we had an excellent response from our membership and components. We've had 8 sites visits (either completed or scheduled in the near future) and 15 regular visits in congressional offices. It can't be stressed enough how important these visits are for our legislative advocacy efforts.

Thanks to all of our members who opened their clinics and practices to members of Congress in support of APTA's legislative initiatives. We'd love to hear about your experiences on this blog.

Rep Wally Herger (R-CA) (left) with Leigh Langerwerf, PT, DPT. 

Do nice patients get better care than others? That's a complicated question. As physical therapists we are on the front lines of patient care. Interpersonal relationships and close, one-on-one interactions with our patients are simply a part of what we do. Everyone is unique; we're all products of our own backgrounds and distinct experiences.

Now, I know we've all dedicated ourselves to delivering the highest quality care to our patients without regard for the variables that are part and parcel to individual personalities. The fact is, however, that we're only human and it is in our nature to respond to hostile or grumpy folks. The authors of the JAMA piece agree and conclude that "clinicians are human and subject to the influence of bias." They go on to suggest the development of methods for addressing the existence of bias to ensure that professional standards are consistently met.

The good news here is that we're ahead of the game with our Move Forward branding initiative. You've probably heard this before, but the brand is about more than just educating consumers and other health care professionals about who PTs are and what and how they treat. It's about providing patients a 'total experience' that includes not only excellent health care, but also a higher level of professionalism, organization, workplace cleanliness, efficiency, and overall quality. Once they’ve learned about us and decided that a physical therapist is the right person to see, we want them to have an outstanding experience - every time. Call it the 'Starbucks Effect.' When you go to Starbucks, you know you're going to get a consistently good cup of coffee whether you're in New York or Shanghai; large city or small town.

Based on consumer research, APTA has developed the core professional behaviors that make the Move Forward physical therapist. They are basic, simple and can be found on pages 8 and 9 of the Users Guide to the Brand located on the www.apta.org/brandbeat site, which is the place where all members-only information and tools related to the branding campaign are kept. These brand behaviors serve as a perfect guide to help us prevent personal biases and opinions from creeping in and affecting the way we handle one patient or another.

I suggest to you that if we all take a moment to learn more about the brand and adhere to the core behaviors, messages, and principles then we will be much more likely to deliver that consistent 'total experience' to all patients, regardless of who they are or how they behave.

Let me know - what do you think?

For those not acquainted with APTA's House of Delegates, I describe it as the physical therapy profession's Congress but without the whole "bicameral" thing. While it is exceedingly difficult to summarize the work of such a complex political body, I'm not one to back down from a challenge! The House of Delegates, or the House, as it is known, is the highest governing body of our association. It is the only event that brings all states, specialty groups, and membership categories (PT, PTA, SPT, SPTA) together to debate, discuss, and dictate the policy and direction of our organization. It's a big event! And the 2011 House was exceptional for several reasons.

The topics on the table included everything from philosophical and practical debates about PT extenders and the PT/PTA relationship to national issues regarding payment, advocacy, and policy, to the appropriateness or inappropriateness of establishing a new vision for our profession. The 401-member group also took time out to elect new APTA leaders, dive into the ongoing APTA governance review process, and set the stage for a large rally on Capitol Hill. National Harbor was a fantastic sampling of all that APTA does for our profession. It will undoubtedly be one of the most memorable conferences of my career!

Though it was my sixth time in attendance (3 as a student, 3 as a delegate from Georgia), this year was different in many regards. I would propose that 1 theme of this year's House was "Emergence." We saw it in House business, as debate divided delegates between keeping Vision 2020 and creating a new vision for our association. We also saw it reflected in the candidates for national office, as a variety of new leaders were brought forward for possible service on the national stage. These 2 examples, along with the tone of several debates, inspire enthusiasm and pride in my expectations for physical therapy's future. I believe that our profession is beginning to move to a place of higher importance in the health care field. And now our debates and strategies are beginning to move along with our potential. Can we continue to pursue 1 vision while broadening our horizons for the next? The House voted yes!  

The second major theme could be "Policy Players." While the concept is tied to PTs being emerging leaders in health, a focus on policy demonstrates where we intend to lead. Multiple items of business sought to influence how physical therapy fits in a multidimensional world, the world outside of APTA. We discussed statements regarding the ethics of copays, the politics of payment for PT vs PTA services, the importance of physical therapy as a prominent voice in the rehabilitation technology realm, and the benefit of having a PT as a recognized partner in end-of-life and hospice care. Physical therapy is moving beyond some of our more traditional settings. As we do, so we are seeing more and more places our voice can be, should be, and need to be heard. Should APTA be positioning itself to influence national politics or making statements on cultural and ethical viewpoints? Again the House voted yes.  

The third major theme I propose for the 2011 House is "Evolution." Two new technologies appeared in this year's House: remote control voting and the first-ever videotaped candidate interviews. Additionally, APTA's governance review process was repeatedly discussed, and delegates provided realtime feedback regarding the process and their expectations thereof. Last, a delegation asked if delegates should be supported by local or national funding. Each new element attested to the fact that our association is not static but willing to question itself and explore alternatives to established ways of doing business. Has APTA "perfected" its way of doing business? The House gave a clear yet supportive no." 

For those who do not believe this type of event has relevance or could be inspiring, let me share my favorite personal anecdote. In June of 2003 I sat in a classroom learning about APTA's Code of Ethics. In June of 2010, I sat in the House of Delegates and voted to change it. The House is an inspiring place filled with amazing people. I hope I have given you a peek into the world at work behind the scenes.

I encourage every PT and PTA to know a delegate. Let your voice be heard through them.

I encourage every delegate and representative to reach out to members and nonmembers alike. By expanding our reach we strengthen our collective voice. The House is where that voice echoes loudest.

Ben Braxley, PT, DPT, NCS, is a member of the APTA Nominating Committee, a Georgia delegate, and the manager of "Move It: The New Professional Collaboration Blog." 

It's the bottom of the ninth and the bases are loaded. Are we, the profession of physical therapy, going to step up to the plate to be heard? The answer is a resounding YES! YES to the hope of hitting a home run! YES to being heard!

Approximately 1,000 PTs and PTAs said yes to PT Day on Capitol Hill. The event started with a rally on the lawn; all of us facing the Capitol and listening to the National Anthem. Professionals in our association for over 50 and 60 years were recognized. I spoke with those around me and was amazed to find many physical therapy students there to represent our profession. The specific issues at hand are bills that relate to: (1) the balanced budget act of 1997 (repealing the Medicare cap - an arbitrary limit on financial services to PT/OT care without consideration of pathology); (2) adding PT students to the loan forgiveness act if they choose to enter underserved communities via the National Health Services Corps; and (3) the concussion bill that includes PTs in the team of professionals surrounding head injuries to determine safety and timing in return to activity.

As APTA President Scott Ward, PT, PhD, spoke on the first issue I was flooded with emotions remembering back to 1997. Tears streamed down my cheeks as I recalled my own graduation. At the time the balanced budget act of 1997 was implemented, I was a graduating from Old Dominion University's master of physical therapy program. Not only did it rock our profession with a "knee jerk" reaction of laying off PTs, it made it nearly impossible for new grads to get a foot in the door. After searching and interviewing at clinics and hospitals in my area I realized there was a hiring freeze. All I could think was, "ARE YOU KIDDING ME?" I was eager to work and full of excitement only to find I would wait 6 months after graduation to secure a job-and with $35,000 in loans deferred for 6 months (a far cry from the $100,000+ that burden those committed to answering a call today).

During that transition I went to Florida to help my grandparents: my grandfather couldn't drive, and my grandmother was in an acute care facility with a fractured right tibial plateau (NWB for 3-6 months) and a fractured right distal radius, and recently recovering from a left rotator cuff repair a month and a half out. The state-of-the-art facility, which employed 25 professionals (PT, OT, and speech therapists), was preparing to lay off 12 professionals due to the financial burden of the balanced budget act. The need to care for patients in this facility was unchanged. The workforce to do it, however, was obliterated! How could we allow this to occur for the well-being of the patients we serve? This flashback prepared me for the work ahead. We marched as 1,000 strong carrying a message to the legislative body of our nation.

Along with Ryan Johnson, PT, DPT, a new addition to our profession having graduated 3 weeks ago from UCSF, I had the opportunity to meet with Kristen Glenn, who is California Congressman Tom McClintock's health advisor. We spent over 30 minutes discussing health care concerns specific to our profession and the patients we serve. She listened intently and added her thoughts and concerns. We shared stories of our professional experiences and were grateful for her genuine concern. I learned that Ryan followed in the footsteps of his father, a PT for over 30 years. He made it clear as a member of the Board of Directors for the Student Assembly that his voice represented the 15,000 students in our profession. In fact, we represent the field of 210,000 PTs and PTAs in our profession and, more important, the patients in our care.

I believe we hit a home run! We were heard! We fostered a new relationship with our congressmen out of the concern for the PT profession and the patients we serve. Many physical therapy professionals concluded the same experience. As Katherine Sullivan, an APTA House of Delegates representative for the Neurology Section, noted of the final motion brought before the House, "PTs are committed to a society where people of all ages live healthy, active, and productive lives with optimal function." As a first-time delegate of the House of Delegates, I felt that this final day of a 5-day stint was a life-changing experience in my career. It was the "cardiac paddles" I needed to erect a spirit of hope and a commitment to change. We can no longer proceed along the same path if the path is not the one that will allow us to arrive at our final destination! Please rise to be heard! At any level - city, state, or national - one voice can be the catalyst to change.

Karen K. Swisher, PT, MPT, DPT (right), with Ryan Johnson, PT, DPT, and Kristen Glenn 

As I stood on the lawn in front of the Capitol listening to a beautiful trio sing "The Star-Spangled Banner" I was filled with excitement and a sense of purpose mixed with a little trepidation about the day to come. I am a middle-aged member who attended the national legislative rally for my first time Thursday, and the whole experience exceeded my expectations. What made me do it? The encouragement of my association and a sense that health care is at a pivotal point. APTA President Scott Ward put it well when he said that we do not have a government run by representation, we have a government run by those who participate in the representative process. That rang true for me because I have always felt that what we learn in PT school and in continuing education is not enough; if we don't take care to have a voice and exert a presence then we will be legislated out of the ability to be effective and use the knowledge and skills that we have.

My saga started back in my local chapter (Washington) where I was recruited for our Legislative Committee and then became legislative chair several years ago. I had planned and attended many local legislative days at my state capitol but never flew across the country to attend the national rally. I changed jobs and then re-established my commitment to chapter governance by getting elected as the Practice Panel director, but there was still this thing called House of Delegates and the national scene that would take a bigger commitment of time and resources. Last fall I took the step and ran for a delegate position to bring my personal education and involvement to a different level. That brought me to the right place at the right time for my first national rally.

Issues around Medicare, health care reform, and reimbursement changes have been moving at a faster pace, and I realized that our profession stood at a crossroads. My nonmember PT friends back home didn't seem to see the same train on the tracks that I was watching. I saw the ACOs coming, the RACs coming, and Medicare's sky falling! I felt that we could either choose to mutely stand by and accept whatever happens or we could take some control and shape our destiny into one with exciting possibilities. After being one of the thousand APTA representatives standing shoulder-to-shoulder in the intense humid heat of Washington, DC, I now feel certain that we have a lot of good people who do see the train and are working hard to keep the train on the best track for our profession and our patients. A PTA friend of mine encouraged me, saying I would find rich debate in the House of Delegates, and the experience at the Capitol would live up to my expectations. She was right (thank you, Cathleen).

Since Washington is so far from the Capitol it really takes a commitment to attend our national legislative day. I did not realize how much support I would get from my colleagues and association. APTA rolled into action, and my national staff turned a daunting task into a few e-mail clicks beyond my ordinary travel plans. The APTA staff had training for us the night before, maps, written instructions, glossy handouts, and pre-scheduled appointments. Although the heat was stifling at times we were able to get out of the sun because there were rest areas and strategies that kept us inside as much as possible. I saw a lot of APTA staff standing outside in the heat organizing the bus drop-off/pick-up process with smiles, clear instructions, and encouragement. More than once I heard staff telling groups of us how important the mission was; one of them told me that the way we connected as individual constituents was more powerful than a whole year's work for our staffers.

When we got into the meeting rooms I noticed that each one of the legislative assistants that I saw was interested in our story. The level of expertise varied and I found myself speaking to one legislative assistant on topics that seemed new to him. He took notes, took my card, and asked if he could e-mail me for more information in the future. He really meant it!

At my senators' offices, larger groups coordinated who could best tell stories that connected with our legislative agenda: repeal the Medicare cap, add physical therapists to the list for loan forgiveness via the National Health Services Corps, and support national legislation on concussion management that recognized physical therapists amongst qualified practitioners in this arena. Each visit we were asked to individually identify ourselves, our hometown, and practice locations. The senators had legislative assistants who knew about past participation as co-sponsors. One expressed that the senator had simply been so busy last year that she did not prioritize it and did not sign on, but our presence indicated that the cap is still a big issue. They took copious notes and seemed to gain a new understanding of the student loan repayment situation as a result of our visit. Yes, we can open doors and we can be heard at the national level. The future will tell us how successful we have been, but at least I know that I lived up to Scott Ward's call to participate. We will not go down silently.

Before I traveled to Washington, DC, I read a lot of posts from colleagues claiming that the only issue before us was reimbursement. After this trip I know that the debate is about far more than reimbursement, AND it is about reimbursement. We are at a pivotal point for physical therapy, and I think about the pioneers who came before us. By participating in our national legislative efforts I feel that I am joining in historical times. The future of our profession is in our hands and I am more positive about all the issues that we face because we face them together and with a united voice. Tonight I will sleep well, knowing that I participated-finally.

Of course, nothing can take the place of an in-person meeting and the palpable sense of excitement you feel during opening ceremonies, the satisfaction you experience during an educational session when you learn a new technique you know will help your patients, or the camaraderie that is evident during a casual drink at the bar after an incredible day of learning. But through Twitter, Facebook, and blogs today, conference participants can share their experiences not only with fellow attendees but also with those who are following along from home -- and they can continue the conversation long after the final session closes or the last exhibit booth is packed up and shipped away.

This year at PT 2011, we'd like to help facilitate those important connections and conversations in a new way by recruiting attendees to use this blog to discuss their experiences during Annual Conference. We want you to share your perceptions and personal experiences during sessions, events, and other social activities while you're there, with the goal of expanding the impact of PT 2011, continuing that valuable exchange of ideas and knowledge that will help you and your colleagues grow as professionals.

I'd love to share this blog space with you, if you will in turn share your experiences with us. Guidelines for bloggers can be found here. If you're interested in participating, please let us know by e-mailing us at publications@apta.org.

We look forward to hearing from you -- now and during PT 2011.

Approximately 300 physical therapists, physical therapist assistants and students had converged on the Alabama state legislature in Montgomery to rally in support of SB 361 and the House's version of the legislation, HB 202. Before the rally, participants met personally with their statehouse representatives and state senators – educating them the on the importance of direct access for state residents. Many of the physical therapy students explained to their legislators that they would potentially leave the state following graduation given that Alabama is 1 of only 2 states left that has no form of direct access.

These personal visits really do make a difference, which is why we need you to come to Washington, DC, next month to advocate for your profession with members of the U.S. Congress. This year, PT Day on Capitol Hill replaces APTA's annual Federal Advocacy Forum to run in conjunction with APTA's Annual Conference & Exposition (PT 2011). PT Day on Capitol Hill takes place over two days, with events at National Harbor, MD, and on Capitol Hill in Washington, DC.

Let's look to our Alabama colleagues as an example. Together, we can make a difference. As your colleagues who were interviewed for the video below have said, "If we don't speak up for ourselves on Capitol Hill, who will?"

Hope to see you next month!

These are all major steps in the right direction - not only for the players themselves, but also for the millions of student athletes across the country who look toward professional players as role models. But more needs to be done to protect our young athletes from the often devastating effects of head injuries, and the state of Iowa recently made one giant leap toward making athletic activity safer for our children.

A new groundbreaking law permits student athletes in Iowa to be evaluated by physical therapists to determine when it is safe to 'return to play' following a hit, fall, or other incident in order to reduce the risk of a concussion or other brain injuries. Signed April 7 by Gov Terry Branstad, SF 367 requires that a student be immediately removed from participation in an activity when a concussion is suspected, and must be evaluated by a physical therapist or other licensed health care provider trained in the evaluation and management of concussions and other brain injuries. The health care provider must provide written clearance for the student to return to activity.

Kudos to Iowa Physical Therapy Association (IPTA) President Blake A. Hardy, PT, DPT, OCS, and IPTA members whose grassroots lobbying efforts helped ensure that student athletes with head injuries will continue to have access to physical therapists. So far, similar legislation has been introduced in more than 35 states and enacted in 15 in an effort to reduce the risk of concussions or other brain injuries sustained in community and school sports or other extracurricular interscholastic activities. The Iowa law is the first to specifically allow student athletes to receive clearance to return to activity from a licensed physical therapist. Legislation in Vermont also includes physical therapists as health care providers who can make similar decisions, but the bill is awaiting passage. As we know, physical therapists are well trained in evaluation and treatment of balance and vestibular disorders and are appropriate participants in return-to-play decisions.

APTA is working to make certain that physical therapists and other qualified health care providers are included in similar legislation in other states to ensure that there is access and collaboration across a broad range of providers on this important public safety issue.

What are your thoughts on this issue? How might physical therapists best help ameliorate this public health concern? How is this issue being addressed in your state?

With the recent news that the Medicare Fraud Strike Force had charged 111 individuals - including four physical therapists - with fraud, the issue and its unfortunate consequences to patients and the health care system really hit home.

While all of these defendants are presumed innocent until proven guilty, news of physical therapy services being part of any fraud scheme is deeply troubling to APTA. We're not familiar with, and cannot comment, on the specific charges against the individuals cited in the lawsuits, but we have zero tolerance for the type of behavior alleged. APTA promotes only the highest standards of practice to its members. It is important that individuals receive physical therapy services that are of high quality and medically necessary, furnished by licensed physical therapists or physical therapist assistants under the direct supervision of a physical therapist.

APTA stands ready to work with government and private payers to bring an end to fraudulent activity within the health care system.

What are your thoughts regarding these recent Medicare fraud cases? Why do they seem to be increasing? And what can we, as health care professionals, do to help put an end to this behavior?

Last week, APTA introduced a new publication titled "Today's Physical Therapist: A Comprehensive Review of a 21st Century Health Care Profession" that we hope will assist our chapters and sections in proactively educating policymakers, payers, prospective students and the public about the physical therapy profession - before other professions attempt to define us.

The new publication pulls together various subject matters and issues about the physical therapy profession: from licensure and specialization to education and research, to the role of the PTA and payment for physical therapist services. This new publication provides readers with a 'one-stop' location to learn in depth about where we are as a profession, and where we are going in the 21st century.

Please let us know what you think of the publication. Are there other tools you would find helpful for your outreach efforts?

The Web site will now serve as a hub for not only this blog, but also the latest news from APTA and the profession, our social media platforms for members and the public, and a host of information on careers and education, practice and patient care, payment, advocacy, and more.

For the moment there will be growing pains. Almost all inbound links to the old site, including any bookmarks on your computer, broke as a result of the new design and need to be updated. Meanwhile, APTA is still working to improve the overall performance of the site, so that pages will load quickly and consistently. This will take time and patience.

But already there have been so many changes for the better! (If you haven't yet, take a brief video tour of the changes.)

What do you especially like? Do you have suggestions for future improvements? Please browse the site and let us know what you think. Please report errors here.

In Texas, about 500 physical therapists, physical therapist assistants and students attended the 2011 Texas Physical Therapy Association (TPTA) Legislative Day in the state capital, where they advocated for passage of HB 637, legislation that would allow direct access to physical therapists. Their efforts resulted in two excellent news stories in the Austin area – one on Fox News affiliate KTBC, and the other on ABC News affiliate KVUE-TV. Mentioned in the ABC interview is a website TPTA has developed to raise awareness of the legislation and the importance of direct access – http://www.accessyourphysicaltherapist.com/. The Texas chapter has also set up a Facebook page to promote the issue.

In California, members of the California Chapter’s Private Practice Special Interest Group are fighting a bill that would repeal the state’s anti-referral for profit law. In a press release, the Private Practice Group warns of the consequences to patients when physicians employ physical therapists and send patients to their own physical therapy clinics for treatment. A Web site has also been set up to educate consumers on the referral for profit issue – http://stoppopts.org/. In addition, a Facebook page on the issue has been developed.

The California and Texas chapter efforts follow on the heels of a recent PT advocacy day hosted by our Indiana Chapter. Approximately 500 PTs, PTAs and students gathered in the Indiana capitol building (pictured above) at the end of January in support of direct access legislation and to combat efforts to restrict physical therapists from performing spinal manipulation.

And just this week, the South Carolina Chapter hosted its PT Day at the statehouse in Columbia to advocate against cuts in Medicaid and the ongoing attempt to repeal its current anti-POPTS law.

Congratulations to our members in Texas and California for their excellent public education and media outreach efforts and to all our state chapters on their growing grassroots and lobbying efforts!