Contentious Physical Therapy Legislation Approved by Committee

by David Gorn

TOPIC ALERT:

The Senate Committee on Business, Professions and Economic Development on Monday finally approved a contentious bill to allow professional corporations to directly employ physical therapists. Monday's intense and multifaceted discussion followed a hearing in the same committee just a week before, a hearing which went on so long, it had to be carried over to this week. 

AB 1000 by Assembly member Bob Wieckowski (D-Fremont) came up last session, as well. This year, it passed the Assembly and now heads to Senate Appropriations for hearing after the summer recess.

The heart of the proposed measure is simple, said Tim Shannon of the California Orthopaedic Association, which sponsored the bill.

"We think this a good bill for patient care in a couple of aspects. It puts California among the list of states that gives direct access to physical therapists, and in these changing times of health care we think that's important," Shannon said. "It has important protections for the patient … and it solved an issue that has vexed us for years. It clarifies that a professional corporation can hire physical therapists [and certain other health professionals]."

The latter provision of the bill irked Paul Gaspar, a trustee at the American Physical Therapists Association.

"I'm here to talk about the elephant in the room," Gaspar said, "and that's referral for profit."

Gaspar said the bill positions itself as a patient service and a boon to physical therapists, but that it is neither. He said the real issue is providers forming professional corporations to hire physical therapists and make a profit from them.

"Nobody thinks referral for profit is a good idea, it's just a horrible idea," Gaspar said. "It will spell the end of our independent physical therapists in California."

Many of the witnesses talked about the compromises within the bill between physical therapists and physicians, including Juan Thomas, legislative advocate for the California Medical Association.

"We do have problems with direct access," Thomas said, "but we have a lot of members who have chosen to be organized as professional corporations." In 2010, he said, a different regulatory interpretation of the rules governing those business practices changed, and that left the medical world with an ambiguity regarding the right of physicians to hire physical therapists. This bill clarifies that issue, he said.

"So, for us, do we continue to let this build up, or is there an appropriate amount of direct access? And if so, then what can we do to protect patients?" Thomas said. "Getting clarification on this is important to us. We're in a democracy … we had to give something. To the physical therapists' credit, they gave something, too."

All of the back-and-forth over the bill bothered committee member Sen. Marty Block (D-San Diego).

"In all the political machinations over this bill, people wanting to include their professions [in the bill], expand their scope," Block said, "I just hope patient safety is not being compromised here."

The bill, approved 8-0 by the business and professions committee, will be presented to the Senate Committee on Appropriations after summer recess.

Robert Weiss
In my opinion as a lymphedema patient advocate, a California resident and author of a California bill for the treatment of lymphedema patients according to current treatment protocols, this bill is a disaster for the 200,000 lymphedema patients in California. The bill is counter to the current concept of "patient-centered medicine". Briefly I contend that: 1) The accepted protocol for treatment of lymphedema, "complex decongestive therapy" includes manual lymph drainage, compression bandaging, garment fitting, decongestive exercises and home self-treatment protocols are not part of a PT curriculum and are not tested for in the licensing process; 2) Any licensed PT or OT in California, trained & certified or not in the specialized lymphedema treatment protocols can legally treat a lymphedema patient; 3) Self-referred treatment of self-diagnosed lymphedema is dangerous absent a physician's determination that certain co-morbidities do not exist. AB1000 offers no LE patient protection.

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