In the past 24hrs I have received 3 emails concerning GA HB 1055, and the need for me as a PTAG member to take action in stopping this bill from passing. This bill removes any trace of a connection of the scope of practice of athletic trainers to athletes, making a general statement about participation in exercises or activities, and particularly adding the words, "without respect to where or how the injury occurs." The problem is, I am a certified athletic trainer as well as a student physical therapist, so part of me is glad that athletic trainers are winning in the fight to improve their marketability as professionals skilled in orthopedic rehabilitation. I can see, however, the concern from physical therapists that athletic trainers are infringing on PT's scope of practice. I feel though, that the passage of this bill could be advantageous to both parties if a little reason is used.
Thursday, March 13, 2008
Emergency or Opportunity?
Obviously the advantage for certified athletic trainers (ATC) is the ability to treat patients other than athletes and possibly receive 3rd party reimbursement for their services. This opens a lot of doors for ATCs in outpatient orthopedic clinics. Believe it or not, this isn't bad for physical therapists, and here are several reasons why. First of all, ATC own clinics are not going to spring up because of this bill. Third party reimbursement is still shaky, so oversight by a doctor or (gasp) a PT is most likely needed. This brings me to my second point. The goal of APTA's Vision 20/20, as I understand it, is to push physical therapist to autonomous practice with direct access for the general public. When this happens, as I feel it will, ATCs will be a great asset to the physical therapist. From 2003 survey results, the average salary for an ATC in a outpatient PT clinic was $40,000. This is similar to physical therapy assistants, but ATCs can offer much more than PTAs. For starters, ATCs do not need to have as much PT oversight, as do PTAs. The biggest advantage, however, is the ability for ATCs to be contracted out to local high schools, community events, etc. for medical coverage. This not only generates additional revenue for the clinic, it gets the clinic's name out to the public, which will be important for physical therapists when they are an autonomous profession.
Therefore, it is my opinion that PTAG and the APTA should stop and think before urging everyone to cry "foul" towards their congressman. A little competition can be a good thing, and in the end generally benefits the consumer, which should be our focus anyways.
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While I applaud your involvement in one of your chosen professions, I feel I must clarify some of the statements you made about HB1055 and athletic training in Georgia:
PTAG’s stance is that “This bill removes any trace of a connection of the scope of practice of athletic trainers to athletes…”. In reality, athletic trainers have been legally treating “non-athletes” since 1999. While in other states, AT’s are only allowed to treat members of an organized team or sports organization (ie—athletes), the Georgia practice act allows us to treat athletes as well as “comparable injuries” in other individuals, meaning a construction worker who suffers from epicondylitis from swinging a hammer can be treated by an AT because that injury is “comparable" to the epicondylitis suffered by a baseball player throwing curve balls. Insurance companies, including Blue Cross/Blue Shield and many others, have reimbursed for athletic training services for nearly a decade. Note the phrase is “comparable injury”, and NOT “comparable setting”. Athletic trainer-owned clinics already exist in many parts of Georgia and have for quite some time.
Secondly, you refer to “infringing on the PT’s scope of practice”. The current athletic training practice act, and the proposed amendment in HB1055 will do nothing to affect the practice of PT in Georgia. One discipline’s board cannot regulate the members of another discipline. Where there is overlap, both disciplines are allowed to practice those skills. A governing board’s jurisdiction is over the title and practice of a single profession. Just at the nursing board cannot regulate PA’s, and the speech therapy board cannot regulate OT’s, the board of AT and the board of PT can only regulate their respective members. However, if one professional chooses to bill for something and call it by the wrong name, then the practice would be encroached and the offended board would have every right to be enraged and seek legal action. Athletic trainers are not, and should not, be charging for “physical therapy”. Only a PT can charge for PT, just as an OT is the only legal professional licensed to bill for occupational therapy, and an athletic trainer is the only individual licensed to bill for athletic training services. CPT codes (“Common Procedural Terminology”, not “Codes for Physical Therapy” as some refer to them) exist for PT, OT, ST, AND AT. Some CPT codes are used by all of us (and others), but the eval and re-eval codes are discipline-specific and readily recognized by insurance companies.
I do partially agree with one of your points: “Third party reimbursement is still shaky, so oversight by a doctor or (gasp) a PT is most likely needed.” Reimbursement is down for all healthcare disciplines today, in spite of what discipline files the charge. However, reimbursement is more consistent when physician oversight/supervision/referral is involved and our current practice act requires that athletic trainers act “upon the advice and consent of a physician”. Our act does NOT require PT oversight. You state “ATCs do not need to have as much PT oversight, as do PTAs”, when in reality, our current practice act does not require ANY oversight by a PT. “Supervision by a PT is only necessary when billing for PT services. We bill for athletic training services and do not require this supervision any more than an OT would require PT supervision when charging for OT. Both PT and OT have direct access in Georgia, but we would rather act under physician supervision. This physician oversight means that athletic trainers cannot and will not see “inappropriate patients” as feared by some if HB1055 passes. Our referrals are governed by the physician. To say we will suddenly begin seeing the wrong types of patients is to say the physicians will inappropriately refer them to us.
Incidentally, when approached by PTAG, the Georgia Athletic Trainers’ Association chose to be neutral on the recent PT Direct Access Bill, as it did not directly impact our profession or our scope of practice. Although some had personal reservations about the direct access issue, it was simply not an issue with us professionally because it did not impact our day-to-day practice. When it came to the Governor’s desk for signature, his one question was whether or not any other discipline was opposed to it, specifically athletic trainers. Barring any open opposition to the bill from other healthcare providers, Governor Perdue signed the bill into law. We are asking the same neutrality on this housekeeping measure that should have absolutely no impact on the practice of physical therapy in Georgia. (From your post and the reference to 20/20, it is not clear if you knew PT’s had direct access in Georgia. You have it, but I do not know of any insurance companies in Georgia that will reimburse for those services which are not supervised by a referring physician.)
Some oppose HB1055 because they feel it is an expansion of scope of athletic training. This argument is easily refuted by reading the part of the bill which states “Nothing in this paragraph shall be construed to expand the scope of practice of an athletic trainer”. We are simply trying to clear up some of the confusion about the “what” and “where” of athletic training. I do not know of any other discipline in Georgia that is limited by setting. We have been treating “comparable” injuries—“without respect to where or how the injury occurs”--for nearly a decade and that is in keeping with the legislative intent of the 1991 and 1998 athletic training practice act changes. Physicians have referred their patients to us and insurance companies have paid for our services for nearly a decade. The very confusion illustrated by this conflict is what we are trying to avoid by clarifying the existing practice act. We will not be able to do anything new the day after the bill passes than we did the day before it passes, but all parties (employers, insurance companies, and practitioners) will be on the same page and we will spend more time treating patients and less time explaining semantics.
HB 1055 is a housekeeping/cleanup bill for several other licensed professions (geologists, massage therapists, architects, vet techs, and even physical therapists). This bill will affect many other boards, yet the only group objecting to our amendment is PTAG. Our amendment did nothing to change the original intent of the bill, as it did nothing to change any of the original wording of the bill that passed the House. (The email you received from PTAG stated that the amendment was “not in keeping with the original intent of HB 1055”).
Finally, two thoughts related to the overall misunderstandings between the disciplines of PT and AT. 1) Do not get hung up on the “athletic” part of your title. We treat far more than athletic injuries. Consider how “physical” therapists now treat far more than “physical” problems—i.e. the cognitive and even social deficits of a CVA are very challenging problems, but not entirely “physical” in nature. Does an “occupational” therapist only treat injuries that prevent individuals from returning to an “occupation”? Speech therapists do much more than retrain speech patterns, but now treat swallowing and other disorders. Neither the name nor the setting should entirely dictate the profession of athletic training. 2) Since PTAG is the Georgia affiliate of the APTA, and not an independent organization, is it any surprise that the weblink to “take action” in PTAG emails recently sent to their members opens a page on the APTA website with a pre-written letter explaining opposition to HB1055? How does this APTA action refute the claims made by the NATA against the APTA regarding anti-competition and unfair business practices when many of the arguments are simply not true and protectionist stands?
Again, I applaud you for getting involved and hope these opposing viewpoints are helpful. I wholeheartedly agree with your statement “Therefore, it is my opinion that PTAG and the APTA should stop and think before urging everyone to cry "foul" towards their congressman.” For every PT/ATC that PTAG finds to oppose the bill, we have an ATC/PT who reads it and finds nothing offending. Usually, with an open mind, reading the bill provides all of the information needed to understand that it is simply a housekeeping bill and will clarify current practice and not expand the scope of any field or encroach on any other field. I am amazed that PTAG is willing to kill the entire bill—including their own beneficial language in sections 8-10 –and hinder the improvements other boards are trying to make to benefit the citizens of Georgia. Your blog can be a valuable tool for promoting change, but have you voiced your concerns to PTAG?
For more information about athletic training and reimbursement in Georgia, check the GATA website at www.athletictraining.org .
Paul Higgs ATC, LAT, CSCS
GATA President
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