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  • Proposed Legislation Would Allow PTs to Bring In Another Licensed PT to Continue Care During Absences

    Physical therapists (PTs) in private practice may be able to provide Medicare patients the continuity of care they deserve if a recently introduced bill is successful. The federal Prevent Interruptions in Physical Therapy Act of 2013 (HR 3426) would make it possible for PTs to bring in other licensed physical therapists during absences to avoid gaps in care and costs to practice.

    The bill was introduced October 30 by Reps Ben Ray Lujan (D-NM) and Gus Billirakis (R-FL), and seeks to expand so-called locum tenens arrangements to include PTs. This arrangement would allow a physical therapist to bring in another licensed physical therapist to treat Medicare patients and bill Medicare through the practice provider number when he or she is temporarily absent due to illness, pregnancy, vacation, or continuing medical education. Current law only extends locum tenens to doctors of medicine, osteopathy, dental surgery, podiatric medicine, optometry, and chiropractic.

    Because locum tenens arrangements are not granted to PTs under current law, PTs in private practice are forced to risk gaps in patient care should they be absent, or must avoid such absences altogether. The need for locum tenens for PTs in rural areas is particularly great, where a small private practice may be the only source for physical therapy for miles. Should a PT in such a setting need to be absent, the entire practice could be forced to shut down temporarily, leaving Medicare patients with limited choices for nearby care.

    This legislation came from a collaborative effort between APTA and the Private Practice Section of the American Physical Therapy Association (PPS) to provide relief for private practitioners and continuity of service for Medicare beneficiaries. APTA President Paul Rockar Jr, PT, DPT, MS, sees HR 3426 as another example of what can be accomplished when PTs work together. "This legislative collaboration between APTA and PPS reconfirms our commitment to advocate for sensible solutions to challenges seen by physical therapists in private practice," said Rockar. "We look forward to working with PPS on the hill to move this bill forward."

    PPS President Tom DiAngelis, PT, DPT, describes the bill as legislation that "seeks to eliminate an unnecessary limitation on our ability to practice and provide excellent continuous care. We commend congressmen Lujan and Bilirakis for taking an important step to ensure a patient’s access to uninterrupted physical therapy."

    APTA has advocated for this issue to be linked to larger Medicare reforms that may be moving through Congress, particularly the efforts to find a solution to the flawed sustainable growth rate (SGR) formula (.pdf) that determines Medicare payment rates. Congress has until December 31 to act to avoid a 24.4% decrease in Medicare reimbursement, though it is possible it will continue to address these reforms in 2014.

    APTA will monitor the progress of the bill and will post updates to its locum tenens webpage. Resources on the website include a podcast on the importance of this legislation and information on how PTs can get involved in advocating for its passage.

    'Culture of Resistance' Complicates Concussion Reporting in Youth Sports

    As youth sports programs have grown, so has a "culture of resistance" around concussion reporting and treatment compliance, according to a major study released October 30 by the National Institute of Medicine and National Research Council. The report addresses this culture, as well as a wide range of topics including rates of concussion by sport, effectiveness of protective gear, and the lack of research around concussions in youth.

    The 340-page report, titled Sports-Related Concussions in Youth: Improving the Science, Changing the Culture is available for free download (1-time registration required) or online viewing, and contains several key findings. Among them:

    • Male high school and college athletes report the highest rates of concussions in football, ice hockey, lacrosse, wrestling, and soccer; for females, the highest rates occur in soccer, lacrosse, and basketball.
    • Researchers found "little evidence" that the latest helmet designs reduce the risk of concussions, even though they do reduce the risk of other injuries.
    • Recent sports program efforts to put limits on the number of head contact incidents for a given player are "fundamentally sound" but "without a scientific basis."

    The report acknowledges that while there has been an increase in awareness of the signs and risks of concussion in youth sports culture, "there are indications that the culture shift is not complete. Athletes profess that the game and the team are more important than their individual health and that they may play through a concussion in order to avoid letting down their teammates, coaches, schools, and parents."

    Physical therapists (PTs) and physical therapist assistants (PTAs) play an important role in the recognition and management of concussions, and the findings in the federal study echo the work APTA has done over several years to promote greater awareness of the dangers of concussions in youth sports and the need for policy changes and guidelines on the state and federal level. Along with legislative efforts, APTA has worked with the Centers for Disease Control and Prevention (CDC) on the issue of concussions and two APTA members have been appointed to the CDC Pediatric Traumatic Brain Injury Guideline Workgroup. APTA online concussion resources include a series of podcasts, and a PT's guide to concussions.