Right Time, Right Place

Physical therapy on Capitol Hill.

By Jerome Connolly, PT, CAE

April 4, 2015

The Private Practice Section (PPS) conducted its third successful Capitol Hill Lobby Day this past February. This year, our forces were fortified thanks to collaboration with the American Physical Therapy Association (APTA), which brought 25 additional physical therapists to Washington, D.C. Members of the APTA’s board of directors and the Payment Policy Advisory Committee joined the 72 PPS Key Contacts in walking the halls of Congress, conducting 185 meetings discussing the Medicare beneficiary therapy cap, payment rate, and locum tenens. Forty states and 105 unique House districts were covered by the total 97 attendees, many of whom met with their actual representative or senator.

The timing for this meeting, which was optimal, was established by the PPS board of directors and was heavily influenced by the looming March 31 deadline when the therapy cap would be fully implemented and Medicare reimbursement for outpatient services would be cut by more than 20 percent. The payment reduction is due to the expiration of the waiver of the sustainable growth rate (SGR) used to calculate the conversion factor for the Medicare physician fee schedule under which outpatient physical therapy services are paid.

Locum tenens is a provision in Medicare law that currently does not include physical therapists and, therefore, dramatically inconveniences solo and small practices when the clinician of record is called away on a short-term leave for a family emergency, vacation, professional development, maternity leave, jury duty, or the like. More importantly, since the practice is not able to readily bring in a qualified, Medicare-recognized substitute physical therapist and have the practice bill for these continued services, the patient is inconvenienced as the treatment plan is often interrupted resulting in setbacks. The Prevent Interruptions to Physical Therapy Act of 2015, which adds physical therapists to the list of professionals allowed to use this mechanism has been introduced in the U.S. House of Representatives by Rep. Gus Bilirakis (R-FL) and Rep. Ben Ray Lujan (D-NM) as H.R. 556. The companion bill in the Senate is S.313.

Attendees for the PPS/APTA Advocacy Conference were educated in the specifics of the three issues, provided exact “asks” to present to their members of congress, given talking points, and instructions how to respond to anticipated “pushback” from their legislators or congressional staff.

Conference attendees heard from Rep. Xavier Becerra (D-CA), who is a member of the House Democratic Leadership team and sits on the powerful Committee on Ways and Means that has jurisdiction over most of the issues important to private practice physical therapists and their patients. Becerra is an original cosponsor of H.R. 775, the Medicare Access to Rehabilitation Services Act of 2015, which will repeal the arbitrary and discriminatory annual, per-beneficiary caps for outpatient rehabilitation therapy. Rep. Becerra pledged to continue to work until the caps were repealed and the issue was resolved.

Attendees were also addressed by Senator Dean Heller (R-NV), who is a member of the influential Finance Committee, which—in the upper chamber—has jurisdiction over Medicare issues. Sen. Heller pledged to continue to work with the Finance Committee Chairman to find ways of paying for legislation that would repeal both the SGR and the therapy caps.

PPS members who were unable to travel to Washington, D.C., and join this effort could participate from home thanks to a coordinated grassroots campaign that used social media in addition to our traditional and conventional PTeam Alerts. APTA members received a targeted and informative call to action as the Washington meeting was convened. Then, throughout the two-day conference, tweets, photos, and other messages were broadcast via the various social media tools frequently used by APTA and PPS. The newest of these is the Twitter #PTTransforms.

For the past year, PPS has been putting time and resources into establishing and growing its Key Contact Program. Last September, over 80 Key Contacts were brought to Washington for comprehensive training in relationship building with their target legislators. In the near term, PPS seeks to have a Key Contact for every member of a committee of jurisdiction as well as for every member of congressional leadership; that is, both parties in both the House and the Senate. This training has already begun to produce dividends as Key Contacts lobbied their target legislators in meetings that were arranged by our advocacy contractor Soapbox Consulting. At least one Key Contact had a chance meeting when he encountered his target senator in a hotel elevator. Being well-trained and well-versed, PPS member Mark Anderson took advantage of the impromptu opportunity to renew his relationship with Sen. Orrin Hatch (R-UT), recite the issues, and request the assistance of the Finance Committee Chairman. Lobbying—advocating on behalf of our patients and ourselves—is an “on-call” job, and we all must be continuously vigilant and prepared.

Other notable meetings were conducted as scheduled in more conventional and expected settings. These included the Oregon delegation’s meeting with Sen. Ron Wyden, who is the lead Democrat on the Finance Committee; Nebraska Key Contact Jeffrey Zimmerman met with his Senator Deb Fischer (R); the Idaho delegation met with Sen. Jim Risch (R), who is chair of the Senate Small Business Committee, Ryan Lorenz of North Dakota met with Sen. Heidi Heitkamp (D) and our North Carolina delegation met with newly elected Sen. Thom Tillis (R).

Over on the House side, PPS members Peter Towne and Amanda Somers met in the ceremonial sitting room of Speaker John Boehner (R-OH) who assured them of his goal to repeal and replace the SGR and the therapy caps. The Speaker was also impressed by factual examples of the need for physical therapists to be added to the Medicare locum tenens provision conveyed by the PPS members. Other Key Contact House meetings were conducted with Oregon Representatives Schrader (D) and Walden (R), with Rep. Abraham (R-LA), and with Rep. Fincher (R-TN).

Numerous meetings were conducted with invaluable congressional staff, who advise the policymakers on the specifics of the issues. These meetings are important and instrumental as the staff members are experts on the issues, and have the ear and the confidence of the Member of Congress. They also have a better understanding of the nuances of the issues and the effects on our patients and practices. Meetings with staff members also usually last longer and get into more depth than a meeting with an elected member. All encounters are part of the political process which aims to make the conditions optimal for our desired goal to result.

Another highlight of the conference occurred on the second day of our Washington event when Senators Ben Cardin (D-MD) and Susan Collins (R-ME) introduced S. 539, the Senate version of HR 775, which repeals the Medicare cap on outpatient therapy.

Some of our goals were realized on the spot as Sen. Heitkamp agreed to cosponsor S.313 the Senate version of the Prevent Interruptions to Physical Therapy Act, which adds physical therapists to the list of professionals included in the locum tenens provision of the Medicare law. Sen. Heitkamp joins original cosponsors Grassley (R-ID) and Casey (D-PA) and other supporters who include Sen. Moran (R-KS), Durbin (D-IL) and Coons (D-DE). More sponsors are expected as examination of the legislation is accomplished in each office.

Over in the House, our efforts were rewarded as the list of cosponsors for H.R. 556 (the companion to S. 313) grew substantially as a result of our Pysical Therapy Lobby Day. But these efforts must not stop and continued contact with the offices of our federal legislators is essential to keep the focus on these important issues and their effects on our patients and our practices. (Please see side bar).

By all accounts and reports, the event was a success. One attendee praised the joint PPS and APTA conference saying it was “a great team effort!” It produced many appreciative and excited physical therapists.

One participant confessed he wasn’t sure he was prepared for his congressional office visits, but “once his meeting started, all the information flowed out and it was a successful meeting.” He capped it off by saying, “you all did such a great job of preparing me; it was all in there (pointing to his head).”

I mentioned that the PPS Key Contact program is nearing 130 members but our short-term goal is closer to 200. This program has been identified as a priority by the PPS Board and a formal Key Contact Task Force has been established and given the charge to expand this essential advocacy arm. The task force is being chaired by Kathleen Picard (MN), who—along with her several members—will be recruiting PPS members to join the ranks of our Key Contact team and agree to be trained and carry out the duties assigned to members of this critically important program. So, if Kathleen or another task force member contacts you, please step forward and agree to serve your Section, your fellow members, yourself, and your patients to advance meaningful federal policy that improves the environment for private practice physical therapy. 

Jerome Connolly, PT, CAE, is a registered federal lobbyist whose firm, Connolly Strategies & Initiatives, has been retained by PPS. A physical therapist by training, he is a former private practitioner who throughout his career has served in leadership roles of PPS and APTA. Connolly also served as APTA’s Senior Vice President for Health Policy from 1995–2001.