Advocacy in Action
Educate lawmakers and candidates
By Alpha Lillstrom Cheng, JD, MA
NOT YOUR STANDARD MID-TERM ELECTION
There are 435 seats in U.S. House of Representatives. Following the constitutionally mandated census every 10 years, these 435 seats are redistributed across the 50 states. As a result of the 2020 census and the shift of where Americans are living, seven states (California, Illinois, Michigan, New York, Ohio, Pennsylvania, and West Virginia) each lost a single congressional district, which meant that those seats were redistributed to states with increasing populations: Colorado, Florida, Montana, North Carolina, and Oregon each gained a seat, while Texas gained two.
In addition to the need to redraw the congressional district maps in these states, most other states with more than one representative updated their congressional district lines. This means that some current members of Congress are running for reelection in districts that have been combined or have reallocated swaths of former districts and are thus pitted against fellow representatives in their mutual quests to remain in office. In some freshly drawn maps, incumbent representatives are running in districts that are largely new territory and have to introduce themselves to a whole new electorate. Additionally, 49 (and counting) current members of Congress have announced that they will not seek reelection; this means that there are many open seats, where everyone running for that seat will be new to Congress. This turnover and change provide a rich opportunity for educating and engaging with candidates for elected office.
THE TIME IS NOW
This year, each seat in the House of Representatives is on the ballot, along with one-third of the seats in the Senate. The pressure to campaign and engage with voters really starts at the beginning of August and will build throughout the fall until Election Day on November 8, 2022.
As a crucial part of your local economy, your voice matters. Being an active advocate this election season will allow you to educate lawmakers about the issues that you want them to act upon. On the campaign trail, candidates deliver stump speeches about what they think you care about the most. If those seeking your vote aren’t talking about or considering the value of physical therapist services or the impact your small business has upon the local economy, be sure to speak up. Candidates are eager for clues on what voters care about. They spend significant money and time on polling and focus groups to help them craft their messages and talking points. Reach out to their campaign offices, attend campaign events and fundraisers, and share the PPS legislative issue one-pagers with their staff. When you provide them clear information on what matters to you and your community, they (and their staff) take notice.
You all have important stories to tell and perspectives to share with those who are seeking to represent you in Washington, D.C. As small business owners and essential healthcare providers throughout the pandemic, you can speak to many aspects of how patient care changed and how your business was impacted. You are uniquely positioned to share insights about how the policies that were enacted provided support as well as the challenges that remain unaddressed. Members of Congress and candidates are crisscrossing their districts, eager to talk to voters, and how you engage with them could change the makeup of the incoming Congress and impact the laws it passes.
WAYS TO ENGAGE
Your personal and business advocacy goals for August (through November) should include engaging with candidates for elected office. In order to find out when lawmakers and those vying to be lawmakers will be in your area, sign up for their campaign mailing lists and check out their campaign websites. In the case of incumbent lawmakers, you can stop by their official offices as well. If the candidate is coming through your community, jump at the chance to champion the value of physical therapy.
Identify Yourself as a Physical Therapist and Small Business Owner
Each time you meet a candidate, be sure to identify yourself as a private practice physical therapist and emphasize the importance of your roles in the community as a small business owner, employer, and healthcare provider who has contact with hundreds of constituents a year, or perhaps even each month. Also, describe where your practice is located and how many people work in your clinic. Make the most of any opportunity to tell them what matters to you, your patients, and your business.
Seeing your clinic in action can make a lasting impression on a politician. They will learn what a private practice physical therapy clinic looks like, who you serve, and where you are located. In order to set up a visit, reach out to the campaign — or, in the case of a sitting lawmaker, the district office — ask to talk to the scheduler, and offer to host the candidate for a site visit at your clinic. You should expect the tour to last around 30-45 minutes. Candidate schedules are often determined weeks in advance, so provide the scheduler options for dates and times that work for you. Check out the PPS’s “Connecting Congress to Your Clinic” webinar and Impact article (https://bit.ly/3zXvb7P) for more details on how to plan for the visit.
A site visit is also an ideal way to match a candidate’s desire for voter contact with your interest in increasing your local profile while building a relationship with those who hope to represent you in Congress. People running for election want the press to write stories about their interactions with voters and positively evaluate their ability to represent the district or state. This publicity produced by a third party is called “earned media.” A visit to your clinic, where they can be seen engaging with the community, learning about, and visiting a local small business, as well as responding to the needs of the voters, can play an important part in a candidate’s quest for earned media. When you are approaching a campaign office about a site visit, be sure to tell them if you are willing to have television, radio, or a newspaper cover the event.
Running for federal office is expensive. While it is common to attend free events like campaign rallies or town halls, those can be large gatherings where it is hard to have a conversation with the candidate. Providing financial support to a candidate provides an opportunity to have a more robust conversation with them and their staff. There are two options. If you have the resources, consider making a monetary donation of any amount directly to the candidates; this will likely get you invited to more intimate events. Another option is to volunteer on the campaign of a candidate you are eager to support. The time you spend volunteering with the campaign will provide many opportunities to build relationships with the candidate and his or her staff (as well as network with your fellow volunteers and become known as a valuable link to the community).
If you are able to expand the reach of your financial support to include candidates beyond your community who are champions of physical therapy, consider hosting a fundraiser or donating money to the political action committee (PTPAC) of the American Physical Therapy Association. PTPAC targets the donated funds so that APTA members can attend political fundraisers on behalf of PTPAC as a key way to solidify and enhance relationships between APTA members and elected officials. If your lawmaker has a history of standing up for the value of physical therapy and being responsive to the physical therapy profession’s goals and viewpoints, it may be possible to get monetary assistance to attend a fundraiser for them.
Use your professional social media accounts to engage with candidates on the issues, especially if you are able to attend a town hall or another public or private meeting with the candidate. Your social media post can be used to thank them for listening to your concerns or for coming to visit your clinic, and in the case of current members of Congress, you can thank them for the bills they have already cosponsored. If possible, have your picture taken with the candidate and post it on a social media platform, tagging the candidate and using #PPSAdvocacy.
As you know, PPS’s legislative priorities are renewed at the beginning of each Congress (https://bit.ly/3bf3xsu). In order to determine which issues to bring to a conversation with a sitting lawmaker or candidate at this time, a couple of factors are considered. We look at what types of issues are currently getting the attention of lawmakers, which issues have the most pressing economic impact on PPS members, and which priorities have the best chance of becoming law. Please focus on the following three issues when talking to candidates for federal office:
As a result of the success of using telehealth to provide services during the pandemic, there is genuine bipartisan interest in maintaining this form of access to care. The FY2022 Omnibus federal spending bill included an extension of the current COVID-19 Public Health Emergency (PHE)-related waiver which provides Medicare coverage for rehabilitation services provided by therapists and therapist assistants via telehealth. As a result, Medicare beneficiaries treated by private practice physical therapists, physical therapist assistants (PTAs), occupational therapists, occupational therapy assistants (OTAs), and speech language pathologists will retain coverage for care provided to them via telehealth for an additional 151 days (approximately 5 months) after the PHE expires.
However, a permanent legislative change is needed to ensure long-term coverage for care provided by rehabilitation therapists via telehealth. While a number of bills have been introduced, no single bill would address all of our priorities. An eventual telehealth package will likely include legislative text from a number of bills in an effort to be as comprehensive as possible while also being able to achieve passage. The bill which most directly addresses the needs of private practice therapists is the Expanded Telehealth Access Act (S.3193/H.R.2168), which would permanently add physical therapists, physical therapist assistants, and other rehabilitation therapists to the statutory list of “distant site providers” that Medicare pays for telehealth. When speaking to candidates and their staff, use PPS’s telehealth one-pager (https://bit.ly/3OiJOHh), which lays out our position on a number of telehealth bills and explains the need for including the language of the Expanded Telehealth Access Act in a comprehensive telehealth package.
Physical Therapist Supervision and Payment Differential
Since the beginning of the year, a 15% Medicare payment differential went into effect for care provided in whole or in part by a therapist assistant. As you know from the May 2022 Advocacy in Action article (https://bit.ly/3QJfcQK), we are attempting to reduce the impact of this policy with the passage of the bipartisan Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act (H.R.5536). Enactment of this bill would provide financial support for outpatient therapy clinics and protect Medicare beneficiary access to physical and occupational therapy by designating PTAs and OTAs working in rural and Medically Underserved Areas as exempt from the 15% payment differential. H.R.5536 would also change Medicare’s direct supervision requirements of therapy assistants in private practice settings to be “general supervision”; this change in Medicare policy would better align with state law and immediately result in a general supervision requirement for PTAs in 44 states.1 (Note: Occupational therapists are granted general supervision by 49 states.)
As a result of the PHE-related flexibilities granted by Congress, supervisors of PTAs and OTAs are currently able to “meet the immediate availability requirement for direct supervision through the use of real-time, audio/video technology” and do so “when use of such technology is indicated to reduce exposure risks for the beneficiary or health care provider.”2 This policy has provided therapists in outpatient settings an approximation of general supervision but is only in place until the end of the year in which the PHE ends. Policy change is necessary to permanently reduce this administrative burden and prohibit Medicare from requiring the increased level of direct supervision in outpatient therapy settings.
When you talk to lawmakers on the campaign trail, be sure to share with them how your clinic utilizes PTAs to ensure that the therapy needs of your community are met. They are probably unaware of how common it is for the PTAs providing care in these areas to also be long-term members of these same communities. It is crucial that you tell them if you will have to change staffing patterns, reduce hours, or potentially even close your clinic in order to survive these drastic payment cuts. Your input will help them realize that ultimately the differential will lead to delays in delivery of care, reduction in services provided, and an increased need for more costly interventions. Follow up on the conversation by emailing them the one-pager for the SMART Act.
If you need to be away from your practice, does your clinic have enough credentialed physical therapists on staff to be able to rearrange schedules so that all of your Medicare patients are able to be seen without delay? If not, then your practice and your patients would benefit if you were able to hire a locum tenens — a qualified substitute physical therapist — to fill in for the short time you are not able to be in the clinic.
Since 2017, physical therapists whose outpatient clinics are located in rural areas, health professional shortage areas, and medically underserved areas are able to hire a locum tenens on a short-term basis. The Prevent Interruptions in Physical Therapy Act (S. 2612/H.R. 1611) builds on that law and seeks to enable all private practice physical therapists in the United States to use a locum tenens to provide their Medicare patients continued access to services at their clinic.
When you get to talk to a lawmaker or a candidate for the House or Senate, point out the importance of continuity of treatment over the course of a plan of care, as well as the fact that physical therapists are the only providers whose use of locum tenens is limited geographically. Fundamentally, the crux of the issue is not the physical location of the practice—instead the need for a locum tenens hinges upon the number of therapists who regularly work at that clinic and that clinic’s Medicare patient mix. When a therapist is not be able to be at work, smaller clinics are unable to reshuffle the schedules of those therapists present to be able to absorb the full Medicare beneficiary caseload. Share the one-pager and ask your lawmakers to cosponsor the Prevent Interruptions in Physical Therapy Act so that any clinic in America could hire a locum tenens physical therapist to fill in for up to 60 days.
IMPACT OF ADVOCACY
The campaign season is ripe with occasions to connect with those who want to represent you in Congress. Take the opportunity to educate them about the role of a physical therapist and ask them how they will respond to PPS’s priorities — they need to earn your vote. We can make a real impact if all of you commit to taking time to champion your profession by engaging with candidates and asking them to support PPS’s top legislative priorities.
By speaking up for your patients, your businesses, and your employees, you are also honing your advocacy skills. These conversations improve the understanding members of Congress have of the value of private practice physical therapy for patients and for our national economy. Relationships built this summer and fall will impact how PPS’s legislative priorities are addressed—not just this year but for years to come. Federal advocacy is a long game and requires sustained engagement and education. When your senator, representative, or a candidate hears the words “physical therapy,” you want them to visualize you, your clinic, your patients, and your business. Together we can make a real difference.
1Federation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide. “Jurisdiction Licensure Reference Guide.” https://www.fsbpt.net/lrg/Home/SupervisionRequirementLevelsBySetting.
2Public Health Emergency. “PHE Declaration.” https://www.phe.gov/Preparedness/legal/Pages/phedeclaration.aspx
Alpha Lillstrom Cheng, JD, MA, is a registered federal lobbyist and the President of the firm Lillstrom Cheng Strategies which has been retained by PPS. An attorney by training, she provides guidance to member organizations, companies, non-profit organizations, and political campaigns. For six years, she served as Senior Policy Advisor and Counsel for Health, Judiciary, and Education issues for Senator Jon Tester (Montana) advising and contributing to the development of the Affordable Care Act, as well as working on issues of accountability, election law, privacy, and government transparency.