Federal Advocacy Forum Wrap-Up

So I’ve had a couple weeks to digest the whirlwind trip to the Federal Advocacy Forum earlier this month. While the timing is different every year, I can say it is always an exciting time. There’s really nothing like having the opportunity to sit down with our country’s leaders to speak about issues personal to myself and my profession. And seeing so many students there really made me happy that our profession is growing stronger by the day!

So many students!

For those who have not been involved with federal advocacy in the past, there were some big pieces of legislation we lobbied for specifically this year. Perhaps the biggest in terms of impact on physical therapy is legislation that would repeal the Medicare Therapy Cap. You know, that arbitrary dollar amount placed on rehab services that helped balance the budget in 1997? It’s so helpful these days.

We also spoke to lawmakers about a bill that would establish a locum tenens allowance for physical therapists, whereby PTs could hire a temporary PT to fill in for themselves or an employee in the event of prolonged sickness, maternity leave, etc., instead of completing a whole hiring process. Other legislation included adding physical therapists to the National Health Service Corps, and including PTs in concussion management and return-to-play clearance.

It would be great if we had all this freedom in our scope of practice, wouldn’t it? Well the only to make that happen is if you take part in advocating for yourself and your career. The Federal Advocacy Forum is an excellent avenue to get our names in the heads of Congress. Lawmakers respond to facts, statistics, and repetition. The brightest minds in physical therapy have found the statistics and researched the facts. It’s now on ALL of us to be repetitive and constantly remind our legislators that physical therapy needs a lot of attention from them!

On the day we set off to the Capitol to talk with Senators and House Representatives, you could feel a certain sense of excitement permeate through all 250 participants. Everyone, LITERALLY everyone, was dedicated to the same cause. Despite being in Washington D.C., politics were largely put to the wayside so we could achieve a common goal. That goal being advancing the physical therapy profession!

Tennessee came prepared!

I like to think we were all successful in our goal. Politics takes a long time, and asking lawmakers to throw their support behind legislation immediately is not likely to happen. However, the Colorado staff I spoke to were all very receptive to our cause. After we got out the first time jitters, legislative aides were very interested in what we had to say. Unfortunately, the House was on recess, so we essentially traded places with our House Reps. However, their legislative aides are a huge part of each legislator’s policymaking and support/opposition of legislation. Getting the ear of the aide is much easier than a sit down with your Congress(wo)man, but they speak to their legislator (boss) on the daily.

There was an excellent speaker this year who really hit the nail on the head regarding advocacy. Brandon Fitch spoke for two hours on tips and tricks to make the most of your lobbying efforts. While certain things seemed pretty common sense (use your name, present facts, give a bill number), his take on developing relationships with legislative aides was great. Since lawmakers are so difficult to reach as an individual (even though we elected them), their aides are usually the first line of communication about specific legislation. If we can develop a good relationship with their aides, that person would also likely talk to your legislator about all these physical therapists that keep telling them to support these bills!

I would highly recommend everyone go to this event at least once. It really is an amazing experience, and it will open your eyes to the extensive process in getting a single piece of legislation passed. You can even start advocating today in your state! It’s really the same process, but there are several more issues that have yet to be dealt with at the state level. Term protection, imaging authority, direct access, and dry needling are just some of the issues physical therapists face in several states.

As someone who loves helping others get involved in politics and advocacy, shoot me a tweet @tylerDPT, or you can find me on Facebook!

 

 

 

Advertisement

Five Things About Advocacy You Need to Know

Think about this scenario for a minute. Imagine there is a bill that would outlaw anybody under the age of 30 to drive a car. For one reason or another, this bill in your state has gained some traction, and is about to be brought up in a committee. Being 26 years old, if this bill passed, you would no longer have transportation to your job. Ridiculous, right?!

You look up ways to stop this bill from moving forward, and discover your state senator is on the committee about to discuss this bill. Since this person was elected to represent you, they need to hear what you have to say, right? Well how does that work? Can you just walk into their office and demand they stop this bill? Probably not. But there are plenty other ways to get your legislator’s attention, you just need to know where to look. This list will give you a jumpstart on your advocacy efforts, and will hopefully allow you to get your opinion heard!

1. Know Your Legislator’s Background

Most politicians are normal people (despite what the media tells you). They were raised in various areas of the country, have expertise in different topics, and probably have a passion for making your state or the country better for their constituents. These interests and backgrounds certainly play into how your legislator’s may vote on a certain topic. Take the scenario above for example.

Say your legislator studied environmental science in college, and she is a huge advocate for decreasing pollution in cities. Based on what we know, this bill would likely decrease the number of drivers on the road at any given time. Theoretically, this would decrease pollution over 5-10 years. Your legislator is likely a strong supporter of this bill.

But what if this same legislator has also been dealing with poor public transportation systems and infrastructure in major cities in their district? Knowing that, she may be less inclined to support this bill, as that would just make her constituent’s current problems worse.

This is why researching your legislator is SO important. They typically don’t respond to pre-written drafts with generic writing on a certain topic. By relating your opinion to their background, and helping them understand your situation from their perspective, your chances of a positive reaction increases substantially.

2. Ballotpedia is Your Best Friend

     Believe it or not, there are people out there that do nothing but research politicians and have information on all elected officials on a convenient website. No that’s not this website (yet), but there are several out there. My personal favorite is Ballotpedia. This website allows you to look up your legislator, find out their background, and the committees and leadership positions they currently hold. SO HELPFUL.

This website is designed much like Wikipedia. It seems to be very well moderated, and provides information in a non-partisan manner. Ballotpedia also gives information on how this legislator voted on key issues. I highly recommend you check it out before talking to your legislator.

3. Politicians are Not Experts on Everything

No matter how much research you do on your legislator, take note that they do not know everything about every issue presented to them. Bear this in mind when writing or speaking to them. The best way to approach this issue is assuming your legislator knows nothing about your issue. In the scenario above, maybe your legislator grew up in downtown New York, and has never driven a car. She probably doesn’t know the impact of having that mode of transportation taken away from you.

Chris Christie: Confused

In my experience, the best way to gain your legislator’s interest is to talk to them with facts and data, without using jargon, and asking them engaging questions. Questions like, “How often do you drive your car?” can get a response from them that furthers your conversation. Also, present your opinion in a way that earns their respect. Using well documented facts and quotes from experts in your topic can really go a long way. Just make sure YOU know what you’re presenting, because hopefully they will be asking you questions!

 

4. Countable can Help Develop Your Opinion

I have always been an introvert. Being an only child, my social/public speaking skills are not super sharp. That’s why I take all the help I can get when I need to relay important information in a meaningful way. Countable is great at helping you think about a certain issue, examine it from both sides, and learn how to argue in support/opposition of a bill or ideology.

Since most of you reading this are healthcare providers, or in healthcare, public speaking may not be a natural gift. That’s totally fine! In fact, legislators may like you more for your candid tone, as they hear from a TON of lobbyists and professional speakers all day long. Using Countable can help you figure out what you want to say, how to support your position, and reach a logical decision on whether your legislator should support/oppose a bill.

5. Use Twitter!

This may seem obvious to most of you, but Twitter really is a great tool to learn. You can follow your legislators directly, though federal legislators mostly have an aide control their social media. However, on a state level, most legislators remark on things candidly, just like you or me.

Source: blog.investis.com

There are also tons of people on Twitter that have the experience and knowledge to help you if you have specific questions. While I’m certainly not an expert (SHAMELESS PLUG INCOMING), you can often find me tweeting about current issues in physical therapy, and engaging in discussion with other leaders in our field.

So that’s it! These quick tips are easy to work on, and can get you a leg up on your competition for your legislator’s attention. It’s a never ending battle with politics, so remember if you do not hear anything from them at first, keep trying! The more your name shows up on their emails/voicemails, the more likely you will get their attention.

Speaking of Twitter, you can always follow me there @tylerDPT. You can also sign up to receive emails whenever I post a new blog. I appreciate all comments and feedback as well! Let me know what you think about this post, and how I can improve my blog to fit your needs better.

Federal Concussion Law: What’s the Point?

The fact concussions have gained some much attention is both good and bad. On one hand, more focus on traumatic brain injuries (TBI) allows for further research and legislation. However, the fact concussions are so prevalent raises concern on how our children can play sports safely. Obviously, concussions encompass many more individuals than young athletes, however my focus is on this population, as legislation for safe concussion protocols varies by a huge amount in each state. So, since every state has some form of concussion legislation, what’s the point of pushing for federal standards?

State laws protecting children from concussions are nothing particularly new. In 2009, the hallmark Zackery Lystedt Law was passed in Washington. Zackery was injured in a football game after receiving a suspected concussion. After a timeout, he returned to the game. However, he soon collapsed after the game, and had to be airlifted to a local hospital. Zackery was in a coma for 3 months, and had to relearn how to talk, eat, and walk. Even 10 years after his injury, Zackery still has limited control of his left side.

Being the first state to pass a comprehensive protocol for children with concussions, many other states quickly followed suit. There are four major pillars in this law which many states have since used as the backbone of their legislation:

• Guidelines/Education – Requires school districts and corresponding state activities associations to develop a concussion guidelines, with education for coaches and parents.
• Consent – The athlete participating in a sport AND a parent/guarding must sign a concussion information sheet every year, prior to participating in any sport activities.
• Immediate Removal – This portion has been adopted by the NFL as part of their concussion protocol (as we all know too well). This requires any athlete suspected of a concussion to be removed from play, AND:
• Written Clearance to Return to Play – Prior to returning to a game or practice, athletes must first:
  1. Be evaluated by a health care professional (different by state) with training in concussion management, AND:
  2. Receive written clearance to play from that same provider

Source: www.momsteam.com

The problem is, not all states have adopted such stringent requirements for young athlete concussion protocols. For example, Wyoming doesn’t specify guidelines to follow on handling suspected concussions, or education regarding concussions. On the Wyoming High School Athletic Association website, there are position statements and “suggested” reading for parents to look at. There is no mandate on what exactly to do when an athlete has a suspected concussion. In fact, this is only recommended information, and parents don’t even have to sign the form!

Compare that information to the forms found on the Washington Interscholastic Activities Association website. On this site, there is a form with concussion information for parents/student athletes to read. Both parties must sign the form prior to beginning any sport. Seems like a big difference concussion management, right?

Obviously, everyone wants what is best for the athletes in their states. We also want to decrease the incidence of concussions, and improve immediate management after a concussion, but I believe we need a more nationwide standard that all states must follow. If every state can follow all the requirements of the Zackery Lystedt Law, then we can truly begin our fight to prevent concussions.

What would this blog be without talking about real legislation? Let’s look at a current bill that aims to tackle the issue of federal regulation of concussion management.

Senate bill S-988, known as the “Protecting Student Athletes from Concussions Act of 2015,” was introduced by Sen. Dick Durbin (D-IL) in April 2015. Being a ranking member on the Democratic side of the aisle (Majority Whip), this bill already has some weight behind it. It was referred to the Committee on Health, Education, Labor, and Pensions, where it currently sits awaiting a committee hearing. *Interestingly enough, this commitee has TWO presidential candidates on it, Bernie Sanders and Rand Paul!

The bill itself is grounded in four major pillars. Those pillars are described below:

• Education – Requires each state to train sports personnel, coaches, athletic trainers on signs/symptoms of concussions, and management of concussions. Also requires release forms for parents and athletes with up-to-date information on concussion risk and management
• Posting Concussion Information – Requires all middle and high schools to post information about concussions at school and on their website. This information is based on current peer-reviewed evidence, and also includes risk, immediate management, signs/symptoms, and the effects of concussion on academic performance.
• Response – Requires all schools to have a designated healthcare provider to detect possible concussions. These providers will immediately remove the athlete from play, keep them out for at least one day, and requires written release from a healthcare provider prior to returning to any sports activities.
• Return to Play – Requires a written release from a healthcare provider that states the athlete is capable of resuming sports, and may include a treatment plan to reintegrate sport activities.

These requirements seem very fair, and are more strict that what many states currently have in place. Another piece of this bill addresses penalties for noncompliance with these requirements, which is lacking in many, many states. If a state were found to be noncompliant with this concussion regulation, the Secretary of Education will reduce federal funding to the state by FIVE PERCENT the following year. WOW. Further noncompliance the following year decreases federal funding by ten percent. That’s a real incentive to follow the rules!

If this bill were to pass, I think one major change needs to happen. Under “Healthcare Providers,” only MDs and DOs are currently listed as trained providers. As a physiotherapist, I strongly support an amendment that would include physiotherapists to this list. The NFL already has PTs on the sidelines, why not in high school too?

With this in mind, I think the APTA and all physiotherapists should strongly support this legislation. Without federal standards for concussion management, I’m afraid many young athletes will not get the care they need, or their symptoms may be overlooked entirely.

What do you think about this bill? Have any points you would like to discuss? Sign up for my email list today, and follow me on twitter @tylerDPT!

 

Pain Management: Changes Coming Soon?

Physical therapists work with pain and its many forms every single day. There are still many theories on what pain is, why it exists, and what we can do about it. However, we know that most pain is treated with medication. Whether it is from a recent injury, or chronic pain from a variety of factors, most everyone tries medication as the first treatment to manage pain.

A new bill introduced in the U.S. House aims to change how pain is managed with the “heavy hitters”: opioids, narcotics, benzodiazepines, etc. This bill, H.R. 4641, would create a task force to identify what research shows is best practice for pain management. After being introduced on February 22, 2016, it was sent to the House Committee on Energy and Commerce. The bill’s cosponsors, Susan Brooks (R-IN-5) and Joseph Kennedy (D-MA-4), are both members of this Committee’s Subcommittee on Health.

So, what exactly does this bill entail? Well, the makeup of the task force initiated by this bill is certainly interesting. While there would be representatives from major bureaucratic agencies (DEA, CDC, VA, etc), there would be other seats filled by healthcare providers who deal with pain. Named in the bill are seats for physicians, dentists, pharmacists, “experts in fields of pain and addiction research,” as well as seats for representatives of pain advocacy groups, addiction treatment groups, and a person with chronic pain. The problem is, that’s as specific as it gets for seat assignment. We do not know how many total seats are available, how many each group will get, or how these individuals will be selected.

The purpose of the task force makes more sense later on in the bill. Once the task force is created, they then meet to modify or update current best practice for pain management. According to the bill language, this task force must take into account “existing pain management resources…recommendations from relevant conferences…as well as pharmacological and medical device alternatives to opioids.”

Another interesting wrinkle is the requirement of this task force to ask the public on their opinion of the changes they make to pain management practice. This may be a way for physical therapists to get involved, since we do not seem to have a seat on the task force. You probably already know, but #PTAdvocacy is a very effective tool for just this purpose. What would YOU say about current pain management practice?

The final piece of this bill, after taking all new research on pain and plans to decrease opioid usage, is a feasibility study on how effective these new changes would be. As of right now, there is no requirement to actually implement these changes. But what if the changes have a negative financial impact on medical groups and hospitals? Will insurance companies chime in to kill this bill?

For now, it looks like we’ll have to wait to find out.

Much Ado About Term Protection

So what’s the biggest issue facing physical therapy today? Insurance payments? Medicare Therapy Cap? Direct access? These are absolutely the most prominent topics our profession has discussed and faced recently. However, the issue of term protection remains something left entirely to each individual state. I believe we need to make term protection a federal issue. Wouldn’t that be awesome?

Let’s see how the APTA is tackling the term protection issue. This statement explains how the terms “physical therapy,” “physiotherapy,” “PT,” and “DPT” should be protected titles used only by those licensed in the field. That sounds fair, right? As physical therapists, we cannot use “MD” after our name, or say we practice chiropractic. Yet, many physicians and chiropractors claim they can practice physical therapy. This seems like a huge disconnect from the rest of the healthcare world.

By allowing other providers to use “physical therapy” as part of their offered treatments, we are allowing our profession to be lowered to nothing more than a service. With the already prominent issue of branding our profession, this certainly creates a negative perception of who we are and what we do. For example, look at this screenshot from a chiropractic website. They place physiotherapy under “Chiropractic Treatment” they provide! 

Now, I am not at all insinuating chiropractors cannot educate their patients on appropriate treatments for their condition. However, this image shows that PTs are seen as providers of a service, as opposed to a well-respected profession. To put it simply, we are allowing ourselves to be misrepresented to patients by the healthcare complex as a whole. This is the exact reason why I believe term protection needs to be brought to the forefront of our federal advocacy campaign.

So what’s the best way to tackle this issue, since legislators likely have little knowledge on this problem? Aside from calling and speaking to them directly (which you should absolutely do), the APTA distributed a clever advertisement that is clear and easy to understand. These solutions apply on a federal as well as a state level. We have to start somewhere right?

If you are not confident this would be successful in your state, check out what’s been done in Virginia and Massachusetts. It can be done! In fact, many states already have some form of term/title protection in place. Here’s a convenient chart that shows the breakdown by state (updated 2014). Even the World Confederation of Physical Therapy has policies that recognize the need for worldwide term protection for physical therapists.

Should We Have a Super-PAC?

Have you seen any campaign commercials on TV or online, often showing a certain candidate’s terrible political decisions and their hatred of America? Of course you have. Chances are, those ads you saw were created and distributed by a Political Action Committee, or PAC. These groups have been around since 1947, when Congress prohibited labor unions and corporations from spending money on elections and candidates. Since they could no longer directly influence elections, unions and big businesses ultimately created a separate fund, which pooled individual contributions, and labeled it a political action committee.

So who can establish a PAC, and, more importantly, how are they used in politics today? In previous years, large businesses and corporations created PACs in order to best represent the needs and interests of their employees. This idea has expanded to allow any group of people with a common interest or ideology to start a PAC. The idea behind starting a PAC is to more easily gather funds from many people and use their pooled money for a single purpose.

PACs are highly regulated entities, as they have direct control of how voluntary contributions are spent. A typical political action committee can contribute $5,000 to a single candidate or his/her campaign in one calendar year, and can contribute up to $15,000 towards a federal campaign. However, individual contributions to the PAC itself cannot exceed $5,000, though there is no cap on how much money the PAC can receive in total. Sounds pretty easy, right? PACs can solicit donations from their interested constituents, pool that money together, and contribute to candidates who represent their best interests. With high regulations on PACs, the use of limited funds on candidate elections was not as controversial. Now, however, the rise of Super PACs has created a much bigger rift between those who want to freely express themselves financially, and those who want money in politics to remain regulated.

The term “Super PAC” first began in 2010, following the controversial Citizens United v. Federal Election Commission ruling in 2010. This case, ultimately favoring Citizens United by the Supreme Court, determined corporations could fund “electioneering campaigns,” as this is an expression of free speech under the First Amendment. A separate ruling, SpeechNow.org v. Federal Election Commission, led to a ruling that it is unconstitutional to limited the amount of money an individual can contribute to “independent expenditure groups,” aka Super PACs.

Perhaps the most significant difference between a PAC and Super PAC is where they can legally contribute politically. As described above, a typical PAC can contribute a maximum amount of money directly to a candidate and their campaign. However, a Super PAC cannot contribute funds to any candidate or campaign. Instead, they can create commercials, distribute information, or donate to other PACs in order to influence the public’s decision making. All well and good, until you realize Super PACs have no limit on how much money they can contribute. None at all. In theory (and in reality), this means PACs with affluent individual donors can then distribute thousands, hundreds of thousands, even MILLIONS of dollars, in order to influence our decisions when Voting Day arrives. If you have heard of Super PACs on the news, you probably heard about the Koch Brothers in the same story. These brothers, both worth billions, are huge donors to Republican causes. In fact, for the 2016 Presidential elections, the Koch’s are budgeting $889,000,000 for political ads and electioneering activities. Unless you’re a billionaire (and if you’re a PT you probably are not), this is just an absurd amount of money. But that’s the name of the game in our current political climate when Super PACs are involved.

So what does all of this have to do with physical therapy? Well, if you know me or have read my blog in the past, I have a lot of strong opinions in regards to politics. However, I think this topic needs to be looked at from a broad perspective, rather than getting buried in partisanship, numbers and data.

Right now, physical therapy has one political action committee, the PTPAC, which raises funds and promotes PT legislation on our behalf. In 2014, the PT PAC contributed $1,261,590 to candidates running in midterm elections. Where did that money come from? Well, over $1,259,000 came from other PACs, meaning individual donations to the PTPAC totaled $1,250. If we really want meaningful changes to the Medicare Therapy Cap, increased reimbursement from insurance companies, and more autonomy in practice, we need to contribute MUCH more to the PAC. However, one issue limiting money flowing in from individual donors is the fact that the PTPAC only accepts money from current APTA members. Why? If the PAC represents our entire profession, should it really matter if we are members of the APTA? Considering the current levels of membership, the PAC is severely limiting potential donor sources within our own physical therapy crowd.

Based on all this information, should we form a Physical Therapy Super PAC? This would allow physical therapists to contribute any amount of money, regardless of APTA membership, towards efforts to get PT-friendly candidates into office. This can be on a state and/or federal level. Those states that are very restricted in what they can practice (Gr V mobilizations, dry needling, direct access, etc), a Super PAC can focus money on commercials and electioneering materials for that state, in an effort to change these restricting practice acts.

Unfortunately, money is the oil that runs the political machine, so why not join in and maximize our presence and influence in politics at all levels? Many state APTA chapters hold several fundraisers to increase spending ability on lobbying efforts and political influence in their respective Capitol, but with a Super PAC supporting these states, they would potentially have exponentially more funds to help with their efforts. Granted, this money could not be directly contributed to candidates the way our PTPAC can. But, having less restrictions on where and how much money a Super PAC receives can easily dwarf the current PTPAC spending, truly making physical therapy a force in the political sphere.

Of course, the current PTPAC can remove their restriction on funding sources by including non-APTA member physical therapists. Honestly, this restriction doesn’t make sense to me in the first place. Having more money flowing to the PTPAC may be better for physical therapy efforts, at least until PT becomes more “mainstream” in political healthcare talks. For now though, I believe we need to have a serious discussion on the current capacity of the PTPAC, and consider starting a Super PAC to make physical therapy a large, influential political force in healthcare talks that are sure to come in the future.

What do you think? This would have to be a large undertaking by the vast majority of physical therapists, but I think we can all come together if it means benefiting the profession we all love. If you want to talk more, find me on twitter @tylerspt, or comment here!