From the President

Michael Horsfield
By Mike Horsfield, PT, MBA


Author Parker Palmer calls on us as leaders to stand in the space between “what is” and “what might be.” Acting productively in this uncomfortable “tragic gap” requires us to avoid falling prey to corrosive cynicism or irrelevant idealism. There is no greater tragic gap in our profession than payment. For years we have been dreaming of a day when patient access is unfettered and payment is fair, while simultaneously being beaten with blunt instruments that question our professional ethics and our worth. Please join us and stop complaining or dreaming and rather take meaningful action to move closer to “what should be.”


Mounting deficits in DC, escalating health care costs, and opposing powerful special interests are not going to make the fight for federal payment dollars any easier. As I pen this, we are awaiting the release of the proposed 2022 Medicare Fee Schedule. We are expecting this to contain the second of three rounds of cuts to offset the raise given to primary care services last year.

On the state level, the commercial payers who range from collaborative to disingenuous are exposing themselves. There are some exciting wins occurring with payers who share our patient centered values but also disappointing implementation of arbitrary policies by others whose sole concern appears to be their bottom line.

We have some amazing colleagues doing extraordinary things. We also must acknowledge that we have too much unwarranted variation in the care we provide as a profession. Some payers have been honest enough to share that they pay us what they do “because they can” and apply utilization management “because they have to.”


On the federal level, we must unite around strategy and leverage our limited resources to have maximum impact. Opposing outside interests are too strong for us to have multiple factions within our profession fighting this battle independently. The communication within our profession must be clear, concise, and unifying. Improving payment makes everything else we want to do as a profession easier or unnecessary. It is for this reason that we are working alongside APTA and other components in creating a short-term strategy to fight the cuts and a long-term solution that makes it easier for us to take care of more people. We have also reached out and welcomed influential organizations outside our association into the conversation. It is exciting to see the new strategies that are emerging from this unprecedented level of collaboration.

Regional and national payers are waging multi-state battles against our under-resourced troops. We recognize the rules of engagement have changed and therefore so must our structure and strategy. Quickly identifying payers as friend or foe and then implementing the appropriate coercive or collaborative strategies for success with our unified coalition is essential. We must collaborate within and outside our association to ensure we have the appropriate troops on the ground to advocate for our patients and our profession. Accomplishing this will require us to overlay current infrastructure with a system that will learn quickly and act intentionally. Executing this plan will require focus, collective effort, and efficient use of all of our resources. Wins amplified across state lines and payer policies that reflect our true impact on society are how ultimate success will be defined.

The difficult reality is that our association cannot help us if we are not willing to join them in the tragic gap. Why should payers value our services at a higher rate than we are willing to accept? Who should manage our variation in care if we are unwilling to do so? When enough of us are willing to let go of “what is” and push uncomfortably toward “what should be” then true change will occur. Ethical billing, adherence to care guidelines, and refusing poor payer contracts are all within our control and great first steps.

Your courageous Board invites you to join us on this ambitious, challenging, and worthwhile crusade for meaningful change. We look forward to providing you with more details on the path forward when we see you in Dallas!

Together, we got this! 

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