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  • With Deadline Looming, APTA Members, Patients, Multiple Organizations Press on for Therapy Cap Repeal

    Congress has until February 8 to act on funding the federal government, and between then and now, APTA, its members, patients, and other organizations are making sure that legislators and their staff receive an earful on the need to include a permanent repeal of the Medicare therapy cap as a part of any agreement.

    Here's a quick rundown of what the association and others have been doing to call attention to therapy cap repeal and other crucial health care issues left unresolved by Congress.

    APTA members make a difference
    The association's members continue to deliver the kind of grassroots advocacy that can grab the attention of legislators, with more than 15,000 member emails sent to Capitol Hill, along with nearly that many sent by nonmembers who support repeal of the cap. In addition, more than 20,000 emails have been sent by patients and non-member supporters through APTA's Patient Action Center, a resource that makes it easy to take action on the cap.

    At the same time, members and their patients enthusiastically responded to APTA's call for patient videos urging Congress to repeal the cap. Those videos are being featured on APTA's Facebook page, and will be used as APTA staff and volunteers continue the push for repeal up to the February 8 deadline for congressional action.

    Multiple organizations, 1 voice
    In addition to its work with the Therapy Cap Coalition, which includes the American Occupational Therapy Association (AOTA) and the American Speech-Language Hearing Association (ASHA), APTA has joined forces with other organizations by signing on to 2 letters to members of Congress.

    On February 1, APTA announced that it has joined more than 70 national provider organizations in urging Congress to reauthorize and fund multiple health care programs and policies, including action on the therapy cap. Participating organizations include the American Nurses Association, the American Psychological Association, the Child Welfare League of America, and the National Association of County and City Health Officials.

    “These programs and policies are core to this country’s health care and essential to ensuring that patients have access to the care they need,” said APTA CEO Justin Moore, PT, DPT, in an APTA news release. “We are better together, and APTA did not hesitate to sign on to this letter in hopes that Congress will hear us and take swift and decisive action not only to provide a permanent fix to the therapy cap, but to also address these other critical issues impacting our health care system.”

    The association also joined 50 other organizations, including the Alzheimer's Foundation, the Brain Injury Association, MedStar Health, and the National Rural Health Association, in a letter to Congress urging action on multiple Medicare fronts.

    "We write on behalf of some of the most vulnerable Medicare seniors, disabled, and critically ill patients across America who are now facing serious health consequences if Congress does not pass a Medicare package soon," the letter states. "Now that we are well into 2018, Congress' inaction on these important Medicare policies could mean real harm to the vulnerable patients we serve."

    AARP and the Therapy Cap Coalition meet the press
    AARP, a longtime supporter of therapy cap repeal, joined representatives from APTA, AOTA, and ASHA to take the repeal message directly to the press.

    During a February 1 press conference, AARP spokespersons made the case that time is quickly running out for beneficiaries—many of whom are elderly—who are subject to the $2,010 cap on what AARP Executive Vice President and Chief Advocacy and Engagement Officer Nancy LeaMond described as "vital services."

    "Two thousand dollars doesn't go very far for these treatments," LeaMond said. "And seniors need them after a stroke or a fall to talk, walk, or do other everyday tasks."

    Justin Elliott, APTA's vice president of government affairs, added that access to therapy also allows patients to pursue nondrug approaches to treatment.

    "The caps impact a wide spectrum of patients needing rehabilitation services, from patients who are recovering from a stroke or traumatic brain injury, to those who are suffering from chronic and often painful conditions and would prefer to choose therapy to address their pain instead of taking opioids to mask it," Elliott said. "Patients cannot hit the pause button on their rehabilitation as they wait for Congress to fix this problem."

    From PT in Motion: PTs Should Cultivate Their Knowledge of Medical Marijuana

    Despite a lingering social stigma attached to marijuana use, there is a growing interest in medical marijuana (MMJ) among patients, researchers, and health care providers, including some PTs and PTAs. Medical marijuana is a potential alternative to opiates, muscle relaxers, and anti-inflammatory drugs. But is it always safe?

    This month in PT in Motion magazine: "A Growing Interest in Medical Marijuana" explores the complicated legal landscape regarding MMJ and how a patient’s use of MMJ may influence physical therapy care.

    While state laws regarding marijuana use are inconsistent, there is a trend toward legalization and decriminalization. However, the United States Drug Enforcement Agency (DEA) is still trying to shut down domestic cultivation of marijuana. Mike Pascoe, PhD, a neurophysiologist and assistant professor in the physical therapy program at University of Colorado, says he meets many physical therapists (PTs), physical therapist assistants (PTAs), and students who are "uninformed about federal and state laws and the process for researching marijuana."

    Charles Ciccone, PT, PhD, FAPTA, told PT in Motion that "many patients are ahead of the curve" compared with clinicians. While no PT or PTA should ever advise use of any medication, Ciccone says clinicians should be able to educate patients on the "reported benefits of marijuana as regards chronic pain, spasticity, and chemotherapy-induced nausea and vomiting"—as well as potential adverse effects.

    Laura Borgelt, PharmD, a pharmacology professor at University of Colorado, educates PT students about how cannabis works in the human body, and how it can be helpful or harmful to certain body systems. Because it is often used to treat pain symptoms, she says, marijuana is "very relevant for a PT." She encourages PTs to be on the lookout for side effects such as cardiovascular issues while exercising, and changes in mood or memory.

    Vivian Eisenstadt, PT, MA, is among PTs who are "very much in favor of legalizing" marijuana. "Marijuana helps many people I treat," she says, comparing it to Vicodin or "any other medication a physician has prescribed for management of physical or mental pain." That said, she observes that sometimes marijuana use can affect a patient’s response time or focus. In such cases, she counsels the patient about "not taking the drug before sessions if it’s going to lower the quality" of the therapy session—just as she would for someone taking Vicodin or OxyContin. "As a PT," she explains, "it is my job to navigate the situation with compassion and professionalism."

    The variety of forms of marijuana consumption is a concern, as dosage is often inaccurately labeled, says Pascoe. Pharmaceutical-grade marijuana extracts and topical creams differ from commercial products such as baked goods or candy. In addition, the different cannabinoids found in marijuana have varying effects on the body.

    When researching medical marijuana’s effects, Ciccone urges PTs to consider the source of the information to be able to provide patients with balanced and valid information. Clinicians "should be vigilant for any problems that may arise if patients are using cannabinoids during physical rehabilitation."

    "A Growing Interest in Medical Marijuana" is featured in the February issue of PT in Motion magazine, and is open to all viewers—pass it along to nonmember colleagues to show them one of the benefits of belonging to APTA. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.