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Don't get mad, get heard

Rehab Regs, March 11, 2004

How to influence government leaders about therapy

Round up a group of therapists and in no time they'll be discussing Medicare improvements, the merits of direct access, or other legislation that would help them better serve their patients.

Instead of just talking among themselves, there are ways for therapists to gather together to influence government leaders and make positive changes within the industry. "Numbers are your strength. If you can get an association behind your issue, you can make an impact," says Justin Moore, PT, associate director of federal legislative affairs at the American Physical Therapy Association (APTA) in Alexandria, VA.

Moore offers these examples of past industry success:

Therapy caps. Fought by the therapy industry, the caps were only implemented for four months and are now being held in moratoria through the end of 2005.

"The therapy cap is an example of a long-term advocacy effort," says Moore. "Over six years, the cap has only briefly been implemented."

Physician fee schedule. In the past two years, the therapy industry has lobbied for an increase to the conversion factor despite a proposed decrease each year. Therapists were given relief through the end of 2005 in the Medicare Prescription Drug Improvement and Modernization Act, passed in December 2003.

How did they do it?

Because the sound of a single voice is never as loud as the collective voice of many, therapists must lobby Congress as a cohesive body to be heard, just like any other group with a vested interest in the future of its industry.

But personal contact with your representatives is also a valuable part of the equation, says Christina Metzler, federal-affairs director with the American Occupational Therapy Association (AOTA). "One individual who is a constituent has as much power as an association-it's just a different kind of power," says Metzler. "When an individual calls a member of Congress, [he or she is] able to put a face and a local street address on the problem."

As a member of organizations such as APTA, AOTA, or the American Speech-Language-Hearing Association, a therapist can participate in the development of key lobbying issues and take part in the actual lobbying. APTA involves its members in these four ways, Moore says:

Establish critical issues. Each year, the organization develops 25-30 issues it plans to focus on. But Moore adds that these are not the only policy-development issues APTA addresses.

For 2004, critical issues include permanent removal of the therapy caps, direct access, Medicare payment policies, Medicare physician fee schedule methodology, fall prevention, legislation addressing pain management and strokes, federal funding for education, and research and legislation to reauthorize the Individuals with Disabilities Education Act.

AOTA's issues also include removal of the therapy cap and direct access, as well as home-health therapy, direct access, stroke treatment and prevention, fall treatment and prevention, and mental-health parity, says Metzler.

Get involved as an activist. If you are a PT and would like to influence policy decisions beyond brainstorming critical issues, APTA has created the P Team, an advisory group that includes about 25% of APTA's membership. Participants receive 10- 15 alerts from the group's government-affairs division, along with instructions on contacting government officials about the issue. In 2002, APTA and its members sent more than 20,000 e-mails to Capitol Hill.

Similarly, AOTA has an online Legislative Action Center where members can identify their Congressional representatives, obtain media contacts, get updates on AOTA issues and efforts, and send messages directly to lawmakers.

Volunteer to be a key contact. Some APTA members can choose to be linked with a member of Congress and develop a relationship with him or her. "We use this member to make contact and help us facilitate our lobbying effort," says Moore. "It's as productive as our member wants to make it." The two-pronged approach of group action and following up individual contact from members works for AOTA. "It is equally important that [associations] work to facilitate individual and collective contact," Metzler says. "Legislation is a dynamic process, and one dose is not enough."

Be a federal-affairs liaison. These members can advocate for government affairs that affect the therapy industry by organizing training sessions and going to Capitol Hill to lobby.

"I used to go to Capitol Hill and explain what a PT was. I don't have to do that anymore," says Moore. He believes that over the past year and a half, the visibility of the profession has increased.

What the future could bring

As organizations and individuals continue to work on behalf of clients' and the industry's best interests, Metzler encourages therapists to consider changes that could affect the entire industry-not just their individual facilities.

"Therapists need to pay attention to the status of the whole profession," says Metzler. "The [therapy] cap is an affront to the profession as a whole, even if you don't bill Medicare."

Case study in advocacy: MedPAC and direct access

One of the therapy industry's most recent advocacy efforts involved what became the Medicare Payment Advisory Commission (MedPAC)-conducted study on direct access. Included in the Medicare Prescription Drug Improvement and Modernization Act of 2003, the study is expected to determine both the feasibility and applicability of Medicare beneficiaries' direct access to outpatient therapy. MedPAC is required to deliver its recommendations to Congress by 2005.

Before the bill's passage in December 2003, the House of Representatives' version included a provision that would have provided a General Accounting Office (GAO) study on direct access. The Senate's version included a demonstration project that would have implemented direct access on a trial basis in five states for three years. Although 39 states currently have direct access in some form, it is currently unavailable to Medicare recipients.

Because the House and Senate approved different versions, it was up to the Congressional conference committee to merge the provisions into one bill. The American Physical Therapy Association (APTA) rallied for the demonstration project, but eventually the committee settled on a MedPAC study to make recommendations about direct access. "We spent most of the fall [in 2003] advocating for the demonstration," says Justin Moore, PT, associate director of federal legislative affairs at the APTA in Alexandria, VA. "We specifically targeted the 17 members of the committee and spoke to advocates in their states."

Although the demonstration won't occur, the MedPAC study could still be a success for the therapy industry, as it is expected to consider cost, access, patient choice, quality, and safety when compiling its report. The GAO would have heavily based its recommendations on economic issues. "This is still a victory because it's the first time in federal history that a statute on direct access is being addressed," says Moore. "If MedPAC has a positive report, it's a little like getting the Good Housekeeping Seal of Approval. Members of Congress will take [MedPAC's] advice very seriously."

APTA is focused on providing MedPAC with data that support the importance and need for direct access for Medicare beneficiaries. "Our challenge in 2004 will be to work with MedPAC and give them the data, research, and arguments to support the feasibility and applicability [of direct access] on the Part B side of Medicare," says Moore. "Ideally, we'll get a positive vote to springboard legislation on the issue."