TPTA Synergy Fall 2017

Page 1

SYNERGY

PT

Official Publication of the Texas Physical Therapy Association

Protecting the Practice of Physical Therapy

Legislative Recap


TPTA would like to thank the following sponsors and exhibitors of the 2017 Annual Conference* Affiliated Therapy Group/Functional Foot Fitness Cariant Health Partners Cedaron Medical Centre for Neuro Skills Century Rehabilitation Christus Health System Deanna Stuart Allstate Agency *SPONSOR* Dynatronics Ensign Services Hanger Clinic Health Pro/Heritage

HPSO Kids Care Therapy Medcare Pediatric Group Mobility Research, Inc. - LiteGait Products Pediatrics Plus Rehab Synergies Rehabcare *SPONSOR* Reliant Rehabilitation RiverKids Pediatric Home Health Sage Care Therapy Services Select Physical Therapy & Baylor Rehab Senior Rehab Solutions

Tekscan, Inc. Tenet Health Texas Tech University Health Science Center-School of Health Professions Therapy 2000 Therapy Staff Memorial Hermann Touchstone Rehabilitation University of St. Augustine for Health Sciences VIVA Pediatrics Vonco Medical, Rehab & Fitness

Interested in being a sponsor or exhibitor? Please visit the TPTA website (TPTA.org) or contact the TPTA office for more information. *List is current as of 8/25/17; please refer to the TPTA website for a list of current sponsors and exhibitors.

OFFICERS: Michael Connors, PT, DPT, OCS, President Denise Gobert, PT, PhD, NCS, CEEAA, Vice-President Lois Stickley, PT, PhD, Speaker of the Assembly Jennifer Frerich, PT, DPT, OCS, Secretary Lynne Hughes, PT, PhD, OCS, Treasurer

TPTA DISTRICT CHAIRS:

COMMITTEE CHAIRS:

Capitol Area: Central: Coastal Bend: East Texas: Greater El Paso: Heart of Texas: Midwest: Midwest: North Texas: Panhandle: Permian Basin: South Plains: Southeastern:

Nominating Committee: AC Committee: Bylaws Committee: Ethics Committee: Government Affairs Co-Chairs: Membership Co-Chairs: Practice Co-Chairs: Professional Dev. Co-Chairs: Public Relations Committee: Payment Policy Committee:

Fall 2017

Mark Mililgan, PT, DPT, OCS, FAAOMPT Robert Sandoval, PT, PhD Luke Markert, PTA Laurie Hurst, PT, DPT, CLT-LANA Bryan Boyea, PT Kristi Trammell, PT, DPT Mary Lou Garrett, PT, DPT, C/NDT, PCS (Co-Chair) Regina Hartnett, PT (Co-Chair) Seth Watson, PT, DPT, Cert. DN, CSCS Marla Ehly, PT (Co-Chair) Misty Miller, PT, DPT (Co-Chair) Vacant Brad Allen, PT, ScD, COMT Gail Zitterkopf, PT, DPT, CLT, CKTP

page 2

Barbara Gresham, PT, PhD, GCS Kristi Trammell, PT, DPT Martha Sneary, PT, DPT, MSCPM Robert Sandoval, PT, PhD Brant Capps, PT, DPT, MS Cynthia Fisher, PT, DPT, MS, PCS Marcos Lopez, PT, DPT, OCS Janna McGaugh, PT, ScD, OCS Ann Newstead, PT, PhD, GCS, NCS, CEEAA Jon Anderson, PT Kristi Trammell, PT, DPT Michele Voight, PTA, MPA Katherine Reyes-Brooks, PT, DPT William "Bill" Lewis, PT, DPT


CONTENTS FALL 2017

PT Synergy is published for Texas Physical Therapy Association 900 Congress Avenue, Suite 410 Austin, TX 78701 512.477.1818 www.tpta.org EDITOR IN CHIEF Craig Tounget, CAE Executive Director ctounget@tpta.org MANAGING EDITOR Stacey Mather, CAE Deputy Executive Director smather@tpta.org PT SYNERGY is published quarterly by the Texas Physical Therapy Association.

6 7 16 20

Building the Practice of PT: Practice Committee PoP Quiz Questions

7

Getting Social

8

Annual Conference 2017

12

All About Specialization

How to get involved Licensure Compact

12

Legislative Recap

IN EVERY ISSUE 4 TPTA Member Updates 5 Executive Director's Report 22 TPTA Calendar page 3

Fall 2017


MEMBER UPDATES TPTA 2017 LEADERSHIP ELECTIONS

APTA AWARDS

Several TPTA members were recipients of APTA awards this year. Congratulations to the following TPTA members on their The following members have consented to run accomplishments. for the following TPTA offices: Janet Bezner, PT, DPT, PhD, FAPTA

CANDIDATES ANNOUNCED

Vice President Michael Geelhoed, PT, DPT, MTC, OCS Colette Pientok, PT, DPT, OCS

Catherine Worthington Fellow of APTA Jennifer Frerich, PT, DPT, OCS, FAAOMPT Emerging Leader Award

Chief Delegate Janet Bezner, PT, DPT, PhD, FAPTA

Venita Lovelace-Chandler, PT, PhD Lucy Blair Service Award

PTA Caucus Representative Deborah Nicole Volek, PTA

Myla Claire Quiben, PT, DPT, PhD, MS Dorothy E. Baethke - Eleanor J. Carlin Award for Excellence in Academic Teaching

Nominating Committee Member Mitchell Guberman, PT, DPT, CMTPT, Cert DN Lauren Szot, PT, DPT, NCS

Texas Addition to the APTA Nominating Committee

Delegates-at-Large Kimberly Broderick, PT, SCS, OCS, ATC, CFMT, MS Michael Geelhoed, PT, DPT, MTC, OCS Denise Gobert, PT, PhD, CEEAA, NCS Jennifer Hale, PT, DPT, NCS Venita Lovelace-Chandler, PT, PhD, PCS Rupal Patel, PT, PhD Colette Pientok, PT, DPT, OCS Robert Sandoval, PT, PhD Allison Smith, PT, DPT, OCS, FAAOMPT Jessica West, PT, DPT Gail Zitterkopf, PT, DPT, CLT

Congratulations to Rupal Patel, PT, PhD for being elected to the APTA Nominating Committee and thank you for your service.

The online ballot will open on September 1st. Thank you to all who have consented to run for TPTA leadership! Fall 2017

page 4


THE

EXECUTIVE DIRECTOR'S REPORT CRAIG TOUNGET, CAE

H

ello, my name is Craig Tounget (tongue-gĂŠt) and I am your new Executive Director. I am excited about this new opportunity and am confident that you are going to see some changes here at TPTA in the coming months that are going make this an even better association of which to be a member. I am a Lubbock native and a Texas Tech grad. I started my career working on political campaigns and as a staff member in the Texas Legislature. I then spent a couple of years in Washington, D.C. with the American Medical Association. I returned to Austin where I was the Executive Director of an association of vocational education teachers, counselors and administrators. I later served as the Government Relations Director and then the Executive Director of the 650,000 member Texas Parent Teacher Association. For the past twelve years I have had my own association management company and have worked with a variety of small associations and non-profit organizations providing management services, government relations and meeting other needs. These groups have ranged from a six-state regional association, to a coalition on the winning side of one of the biggest legislative battles in the past two decades, to a small local non-profit. It is my pledge to you that you will see an improvement in communication from this office. We will get back on track with our regular publications (such as this issue of Synergy) and there will be an increased social media presence as well. I look forward to meeting as

many of you as I possibly can in the coming months. I am already scheduled to be at the Southeast District Meeting on September 19th and in Amarillo for the Panhandle District Meeting on October 5th. Hopefully I will be able to make several other district meetings in the coming months and I hope to see many of you in Corpus Christi October 26-29th for TPTA Annual Conference. Associations must be a little like the shark, constantly moving forward or at risk of dying from a lack of oxygen. We will be moving forward here at TPTA and I think you will like the changes you see. We have a fairly new staff, only one person has been here more than a year, but they are enthusiastic and up for the challenge. We will be approaching the Board, and eventually the membership, with some ideas to do things a little differently. But every change we seek to make will be with you, our members, in mind. We want to make you proud of your membership in TPTA and we want to provide you with the education, services and opportunities that you need to succeed in your work as a PT or PTA. Please feel free to contact me anytime you have ideas to improve TPTA or if you have any complaints of which I need to be aware. This is your association and it is our goal for it to serve your needs. See You in Corpus!

page 5

Fall 2017


Building the Practice of PT: TPTA's Practice Committee

T

he TPTA Practice Committee serves as a resource and provides support to the membership in understanding and utilizing the Texas Physical Therapy Act. Led by co-chairs Ann Newstead, PT, DPT, PhD and Jon Anderson, PT, the practice committee is composed of a talented and experienced group of TPTA PT and PTA colleagues from a variety of settings and specialty areas. Committee members are actively engaged in building and promoting continuing education programs and resources to support clinical practice development of all PTs and PTAs.

health and wellness and prevention, general and specialization.” Please contact the TPTA office for more information and to learn how to get involved!

The Practice Committee produces highly successful education webinars including the Journal Club Series: “Management of Falls in Community-Dwelling Older Adults” and “Venous Thromboembolism and Physical Therapy – A Review of Clinical Practice Guidelines”. The committee expects to announce their fall webinar and Journal Club education sessions soon. Please watch your email for upcoming announcements! In addition, the Practice Committee assists with a variety of practice-based initiatives, ranging from drafting recommendations on telehealth for physical therapy to creating position papers on topics such as concussion management and dry needling. These resources play a critical role in physical therapy advocacy efforts involving legislators, regulatory agencies and the public. The Practice Committee is currently seeking volunteers to serve on the committee. Ann Newstead, PT, DPT, PhD, Practice Co-Chair encourages member involvement. “We are seeking members to join the committee who can offer current practice information for PTs and PTAs through webinars, special task groups and answer questions and disseminate current information related to physical therapy for best practice in all areas – Summer 2017 Fall 2017

page 6

PRACTICE COMMITTEE Co-Chairs Ann Newstead, PT, PhD, GCS, NCS, CEEAA Jon Anderson, PT Members Kirsten Harper, PT, DPT, OCS, FAAOMPT Herman "Harry" Koster, PT Jackie Underwood, PTA Aaron Cantu William "Bill" Lewis, PT, DPT


S

ocial media has become an absolute in the digital age that we live in. While being constantly connected can have its downfalls, there are also great opportunities. Access to information is now instant, and we can order pizza, read a book, look at medical records, and do countless other activities, all from the convenience of a hand-held device. In that vein, TPTA is working towards a better social media presence. In this digital age, it's imperative to get information and updates out to our membership in quick and efficient ways. In order to enhance our members' experience, we have just launched a brand new TPTA Facebook page. The page will be updated frequently, and will include such information as member updates, current news, legislative initiatives, upcoming events, and general

1 2 3

getting social

updates from within the association. Communication is important to us, and we are always looking for ways to improve communications with our members, and create value within the membership. The new Facebook page will also be a way to engage and encourage non-member PTs & PTAs to join TPTA. We will also look to you, our members, to get input and content submissions for the new Facebook page. If you have ideas for content and posts, please feel free to contact Lindsey Green in our office through the new page, or TPTA directly at (512) 477-1818 or projectsupport@tpta.org. As the Facebook page gets rolling, we will also look into additional forms of social media that can enhance and drive the membership experience.

PoP Quiz - Questions How long should I keep medical records? Can a nurse supervise physical therapy treatment by a PTA or Aide? Is the Primary Care Provider NPI number a required field for BCBS of Texas claim submissions? If so, where can I find this information?

Summer 2017

4 5

Regarding Medicare, what is the frequency a physical therapist evaluation can be billed to Medicare for returning patients with the same condition? May I collect upfront payment from a patient when providing a service that is NOT covered by Medicare?

*Answers are on page 22

page page10 7

Fall 2017


2017

TPTA's ANNUAL CORPUS CHRISTI OCTOBER 27-30

T

he TPTA Annual Conference Committee and committee co-chairs Kristi Trammell, PT, DPT and Michele Voight, PTA, MPA are pleased to invite you to attend the 2017 Annual Conference, October 27-30, in Corpus Christi. New this year, the conference will open with the Barb Melzer Lecture. Speakers Myla Quiben, PT, PhD, DPT, Janet Bezner, PT, DPT, PhD, FAPTA, and Laura Wiggs, PT will introduce the efforts of the APTA on promoting the movement system and how it relates to the identity of the physical therapist. The current state of practice and the human movement system as central to physical therapist practice will be discussed.

has attempted provide a range of courses to excite and challenge current and future clinicians in a variety of practice areas," Steven Spivey, PT, DPT. In addition to the courses, more than 40 research posters will be presented at the conference and exhibitors will be in attendance to meet with you regarding products to enhance your practice, career changes, and more. Be sure to register by September 8th to take advantage of early bird discounted registration rates!

The conference will offer more than 30 sessions over three days on a wide-range of topics, including courses on pediatrics, orthopedics, neurology, acute care, women’s health, and payment. In addition, several courses will include demonstrations or hands-on labs to apply the skills learned in the course. "The Education Committee

Winter 2017 Fall 2017 Summer 2017

page 8


AC17 Details

HOTEL

CONVENTION CENTER

OMNI CORPUS CHRISTI 900 N. Shoreline Blvd. Corpus Christi, TX 78401 (361) 887-1600

AMERICAN BANK CENTER 1901 N. Shoreline Blvd. Corpus Christi, TX 78401

HOTEL ROOM BLOCK INFORMATION

8:00AM to 1:00PM

Board of Director's Meeting

5:30PM to 7:30PM Registration Open to Pre-Registered Attendees No On-Site Registration

Book online Visit the link: TPTA Room Block Enter your dates Enter the group code: 14500814365

5:30PM to 8:30PM Tom Waugh Leadership Program - Orientation Meeting

RATES $153 $163 $173 $183

THURSDAY, OCTOBER 26, 2017 1:00PM to 5:00PM Consortium & Program Directors Meeting

Book over the phone (800) 843-6444 Reference "TPTA Annual Conference 2017"

Single (1 guest) Double (2 guests) Triple (3 guests) Quad (4 guests)

AC17 Schedule

Self Parking $5 Valet Parking $22

FRIDAY, OCTOBER 27, 2017 7:00AM to 3:00PM

Registration Open

8:00AM to 10:00AM Opening Session: Barb Melzer Keynote Lecture

*Please note that the Omni room block is valid until October 4th.

8:00AM to 1:30PM

IMPORTANT DEADLINES

10:00AM to 11:00AM TPTA Awards Ceremony 11:00AM to 2:00PM

Exhibit Hall & Lunch

Sept. 8, 2017 Oct. 4, 2017 Oct. 6, 2017 Oct. 26-29, 2017

1:00PM to 4:00PM

Courses

4:00PM to 7:00PM

TPTA Assembly

Early Registration Ends Omni Room Block Rate Ends Regular Registration Ends On-site Registration Available

SATURDAY, OCTOBER 28, 2017

BIG EVENTS Friday, Oct. 27, 2017 Saturday, Oct. 28, 2017 Friday, Oct. 27, 2017 Saturday, Oct. 28, 2017

On-Site Voting - Professionals

Texas Assembly Student Assembly Exhibit Hall Open Exhibit Hall Open

7:00AM to 2:00PM

Registration Open

8:00AM to 11:00AM

Courses

11:00AM to 12:00PM Research Poster Presentations 11:00AM to 2:00PM

Exhibit Hall & Lunch

12:30PM to 2:00PM

Student Assembly

2:00PM to 6:30PM

Courses

4:30PM to 6:30PM

Student Bowl

SUNDAY, OCTOBER 29, 2017 8:00 AM to 12:00 PM Courses

page 9

Winter Fall 2017 Summer


Legislative T

Protecting and Advancing the

he Texas Legislative Session occurs for only 140 days each biennium (not counting special sessions), which means that every day counts. During the 85th Legislative Session, TPTA introduced three bills and responded to countless others. Our members were engaged with their legislators in targeted outreach efforts, and we held a successful Legislative Day. Together, we continued to protect and advance the practice of physical therapy and help ensure access for our patients.

SUNSET Recap

The Texas Board of Physical Therapy Examiners (TBPTE) and Executive Council of Physical Therapy and Occupational Therapy Examiners (ECPTOTE) were scheduled for Sunset Review in 2017. During the Sunset Review process, the Sunset Advisory Commission (“Sunset”) staff and members review the board or agency to determine whether it is still necessary. If so, they then review the board’s functions and activities to determine whether changes should be recommended.

The Sunset Review process began 14 months before the start of the 85th Legislative Session, in November 2015, when TPTA members and staff began providing feedback to the Sunset staff regarding the TBPTE’s functions and effectiveness in regulating physical therapy. TPTA began meeting with the Sunset staff in December to learn more about the TPTA’s interactions with the TBPTE, and how the Continuing Competence Approval Program (CCAP) was administered on behalf of the TBPTE. Multiple discussions, along with meetings with legislators sitting on the Sunset Advisory Commission, were held prior to the release of the Sunset staff report on April 6th. The first version of the Sunset staff report recommended that the TBPTE remain an independent licensure agency through 2029. However, the Sunset staff also made a recommendation in their report calling for changes Fall 2017

in the way that the Continuing Competency Approval Program (CCAP) is administered. Their recommendation would “…remove the authority of the PT and OT boards to authorize external organizations to operate as the sole approval authorities for continuing competence or continuing education activities.” The Sunset report also raised the issue of the board’s authority to delegate the responsibility for approving continuing education and continuing competency to “outside” entities. We felt strongly that the TPTA CCAP program has done an outstanding job of the review and approval process of continuing competency activities for Physical Therapists in Texas, and that the state’s best interests are well served by maintaining the current CCAP program. Once the report was released, TPTA members and staff were engaged in advocacy efforts. Hundreds of members responded to more than two dozen callsto-action, providing crucial feedback to legislators and their staff. In June 2016, TPTA President Michael Connors, PT, DPT, PhD and staff testified before the Sunset Advisory Commission in support of the continuation of an independent licensure board and the continuation of the CCAP program. During the August Sunset Advisory Commission meeting, we learned that an effort was underway to consolidate the TBPTE with the Texas Department of Licensing and Regulation (TDLR), which

page 12


2017 Recap

e Practice of Physical Therapy would eliminate our independent licensing board and replace it with an advisory committee. TPTA members and staff quickly responded, and this recommendation was presented at a later Sunset Advisory Commission. Based on key testimony from TPTA members and staff at the December 8th Sunset Advisory Commission hearing, this recommendation was pulled from the final recommendations published on January 6th and approved by the Commission on January 11th. The Senate Bill, SB 317, was carried by Senator Robert Nichols, and the House Bill, HB 3210, was carried by Representative Cindy Burkett. The Senate version of the

bill was successfully passed during legislative session, and was signed by Governor Abbott on June 9th. How does this impact the profession? Thanks to efforts by TPTA members and staff, the Texas Board of Physical Therapy Examiners and the Executive Council for Physical Therapy and Occupational Therapy Examiners were renewed as independent boards for 12 years. This ensures that physical therapists will have a direct impact on the practice of physical therapy. In addition, the TBPTE continues to allow an outside entity to administer the CCAP program, which ensures the highest level of review, and will undergo a bid process in 2018.

DIRECT PATIENT ACCESS Recap The direct patient access bill, SB 728, was filed in the Senate by Senator Van Taylor on February 3rd, and was co-authored by Senator Jose Rodriguez. The House bill, HB 2118, was filed by Representative Stephanie Klick on February 20th, and was co-authored by Representatives Garnet Coleman, Briscoe Cain, Matt Rinaldi, Matt Schaefer, and James White. The filed bill would have allowed for direct patient access for 30 calendar days by physical therapists who have been licensed to practice for at least one year, were covered by professional liability insurance in the minimum amount required by board rule, and either hold a doctoral degree in physical therapy or completed at least 30 hours of continuing competence activities in the area of differential diagnosis. The Senate bill was assigned to the Business and Commerce Committee, chaired by Senator Kelly Hancock. TPTA members testified at a committee hearing on March 21st; however, the bill was left pending in committee. The

House bill was assigned to the Public Health Committee, chaired by Representative Four Price. TPTA members testified at a committee hearing on April 18th, and the vote on the bill failed on May 4th. How does this impact the profession? While this bill was not passed by either legislative body, TPTA’s direct patient access bill made it farther this session than previous years, and received the first ever hearing in the Senate this session. Many members engaged in targeted constituent visits and calls, which helped to advance the bill. In addition, our legislative flyer campaign was successful with increasing visibility of the issue at the Capitol. We have already started planning for the 2019 Legislative Session, and we need members to get engaged now so we can successfully pass the bill in 2019 (for more information on how to get involved, please refer to the “How to Get Involved” article on page 16).

page 13

Fall 2017


Legislative

Protecting and Advancing the

COMPACT Recap In April 2014, an advisory task force was assembled by the Federation of State Boards of Physical Therapy, with the goal of drafting a proposal for the Physical Therapy Licensure Compact (“Compact”). Ten states needed to pass specific language in their practice acts in order to enact and participate in the Compact. Oregon became the first state to pass the Compact in March 2016.

Business and Commerce Committee on May 9th. TPTA members testified before the Senate committee on May 16th, and it was reported favorably from committee the next day. The bill was placed on the Local & Uncontested Calendar on May 24th, and passed by the Senate the same day. Governor Abbott signed the bill on June 9th, ensuring Texas’ participation in the Compact.

TPTA started preparing for a Compact bill in early 2016, with the goal of becoming one of the first ten states to enact the Compact. Those states would then be eligible to have a representative on the Compact’s Commission, who set the rules regarding the compact.

How does this impact the profession? As of July 1, 2017, 14 states have passed the Compact. Texas was amongst the 12 states to pass the compact before the June 2017 deadline, and Harvey Aikman, PT, Dip MDT, FAAOMPT, serves as the TBPTE representative on the Compact Commission. TPTA worked directly with the Governor Abbott’s office to ensure a quick (“out of order”) signing of HB 2765 so that Texas physical therapists would have this seat at the table.

While the Compact language was included in the Sunset bills, TPTA decided to pursue a stand-alone bill to ensure that the language was appropriately adopted (any changes to the language would make it void and not allow the state to participate in the Compact). Representative Travis Clardy filed HB 2765 in the House on March 2nd, and the bill was referred to the Public Health Committee. TPTA members testified in support of the bill on April 18, and it was reported favorably from committee without amendments on April 25th. The bill was placed on the Local & Consent Calendar on May 4th, and passed by the House that day. The bill was then referred to the Senate

Fall 2017

The goal of the Compact is reduce regulatory barriers to interstate mobility and cross-state practice, and the Compact Commission has been meeting since June to begin the rule-making process. Passage of this bill means that Texas will have a voice in the rule-making process as the Compact is enacted. For more information regarding the Compact, please refer to the Compact Commission article on page 20.

page 14


2017 Recap

e Practice of Physical Therapy

MEDICAID RATES & APPROPRIATION BILLS

Medicaid therapy services have been the subject of proposed and adopted Appropriations bill riders since 2013. These riders have resulted in continuous reductions in Medicaid therapy rates, as well as policy changes to decrease spending. These changes and cuts have reduced access to physical therapy services, and negatively impacted children and people with disabilities who rely on Medicaid therapy services. Both the Appropriations Bill SB1 and the Supplemental Appropriations Bill HB 2 proposed partial rate restorations on Medicaid therapy services reductions proposed for 2017. The final passed Appropriations Bill included a 25% restoration of rates for the 2018-19 biennium, and included several riders to study therapy services and ensure continued access to care, and additional funds to delay reductions for PTA-rendered services. The final passed Supplemental Appropriations Bill included a 50% restoration of rates for the remaining 2017 budget (through August 31, 2017).

How does this impact the profession? Medicaid therapy providers have been significantly impacted by the repeated reductions and policy changes. These changes and rate reductions impact the entire profession, as Medicaid rates and policies can be adopted by other payers, and then impact access to care for all physical therapy patients. Many TPTA members were very engaged in these activities, and continued to be involved in the special session restoration efforts (HB 25), authored by Representative Sarah Davis, which passed the House but was not able to make it through the Senate during the 30-day special session) and the proposed changes by the Texas Health and Human Services Commission. All members need to engage with their elected officials in support of the profession, and should contact the TPTA office for more information on how to get involved.

page 15

Fall 2017


How to get involved?

GAC

We need every TPTA member to get engaged in the advocacy process if we are to ensure continued access to physical therapy services and advance the profession of physical therapy. There are many ways for you to get involved. Participate in Member Calls-to-Action Member calls-to-action are not limited to legislative sessions. Throughout the year, proposed regulatory changes often require member engagement. Be sure to stay current with TPTA emails, especially those identified in the subject as a “call-to-action” – your participation is critical to preventing changes that will negatively impact access to care and the profession. Become a Key Contact Key Contacts play a crucial role in establishing relationships with legislators. Key Contacts are assigned to a specific legislator, and are responsible for building a relationship with that legislator and educating them on the profession and its impact on the health and wellbeing of Texans. We need at least 181 volunteers to ensure coverage of every legislative district, and encourage every member to consider serving in this role. Your participation may be the key to passing Direct Patient Access, advancing the physical therapy profession, and preserving Medicaid therapy services access. Serve on a Committee Engaged in Advocacy Efforts Two TPTA committees are directly engaged in advocacy efforts – the Governmental Affairs Committee (GAC) and the Payment and Policy Committee. The GAC focuses on legislative activity, and builds on Key Contact and TPTA PAC activities. The Payment Policy Committee advocates on changes to payment and regulatory policies. Both committees rely on members who work with staff to protect access and advance the profession. Members interested in serving on either committee should contact the TPTA office for more information.

Fall 2017

page 16


PAC

Political Action Committee

TPTA PAC Looks to Repeat 2016 Success

T

here is nothing more true than the saying “Money is the life blood of politics.” To run a successful campaign for the Texas Legislature takes a great deal of money and those running for office are in need of contributions. The goal of the TPTA PAC is to raise enough money so that we might make significant contributions to those office holders who will be helpful to the physical therapy profession. A political contribution never guarantees that the politician will vote a certain way on any particular issue, but it does help to open doors so that we may communicate the important role of physical therapy in patient care and gives us an opportunity to educate legislators about the issues of importance to all TPTA members.

and with fair reimbursement. If you don't protect your own practice, no one else will, " Tim Lyons, PT and PAC Committee member.

The TPTA PAC surpassed its $100,000 fundraising goal in 2016, more than doubling the 2015 fundraising amounts. "PAC giving is about turning passion for our profession into action. Please give today, our profession needs you," Jerre van den Bent, PT, PAC President.

Your support is crucial to support TPTA’s advocacy efforts. We took a giant step forward in 2016 and it is imperative that we not waste that effort and continue to move forward. Help us to take another big step in the 2018 elections.

The TPTA PAC is planning to repeat their success by continuing to engage members in giving to the PAC. "Giving to the PAC is an act of helping others....we will only be able to continue to practice our chosen profession of helping others if we help ourselves by protecting our ability to practice without restrictions

The TPTA PAC Board challenges every member to contribute to the TPTA PAC in 2017. Even a small contribution of $20, $50 or $100 can make a big difference. If you were to make a small contribution like that to a State Representative or Senator it might not make much of an impact. But if each of you will contribute in that amount to TPTA PAC we will be able to pool the money and make much larger, more meaningful impact; contributions that will be noticed and will help open doors for us to be able to take the TPTA message to the Capitol.

Contributions can be made online at tpta.org, by mail at 900 Congress Ave. Suite 410 Austin, TX 78701, or contact the TPTA office. (Contributions to TPTA PAC are not tax deductible.) Together, we will accomplish our goal and make a difference.

page 17

Fall 2017


All About Sp

by VENITA LOVELACE-CHANDLER, PT, P

T

he APTA and other workforce sources estimate that over 200,000 physical therapists are likely to be in practice currently, but did you know that only approximately 10% are ABPTS certified specialists? The American Board of Physical Therapy Specialties (ABPTS) began as a concept with House of Delegates approval in 1976. The processes and documents to establish specialties and to certify specialists continued until a Specialty Council on Cardiopulmonary Physical Therapy offered the first certification examination in 1985. Since then, eight additional specialty areas - Clinical Electrophysiology, Geriatrics, Neurology, Oncology, Orthopaedics, Pediatrics, Sports, and Women's Health Physical Therapy - have been established. Over 22,000 specialists in all specialty areas are recognized as having advanced knowledge, skills and experience. ABPTS certified specialists are allowed to use the title below their names as follows: Specialty Area – Certified –Specialist. For example, pediatric specialists are Pediatric Certified Specialists and orthopaedic specialists are Orthopaedic Certified Specialists. The 2016 House of Delegates passed a motion asking therapists to stop using abbreviations such as PCS or OCS or GCS because the public would better understand specialization if the terms were written out fully. Did you know that Texas has over 1,200 specialists? Ten Texans are Cardiovascular and Pulmonary Specialists, 6 are Clinical Electrophysiologic Specialists, 104 are Geriatric Specialists, 177 are Neurologic Specialists, 639 are Orthopaedic Specialists, 91 are Pediatric specialists, 177 are Sports Specialists, and 29 are Women's Health Specialists. In 2017, 170 Texans were newly certified as specialists. Only one state, California, has more specialists!! The process for becoming a specialist can be found at http://www.abpts.org/home.aspx. The majority of existing specialists achieved that goal by fulfilling Fall 2017

the minimum requirements, including being a licensed physical therapist and having 2,000 hours of practice in the clinical specialty, and passing the examination. Additional requirements vary across specialty areas. In recent years, therapists have entered post entry-level clinical residencies as a mechanism to enhance advanced clinical competence in a specialty area. Participation in a residency program represents one avenue for obtaining such advanced competence and reduces the practice hour requirement. All physical therapists might consider referring a patient to a colleague who is a specialist if the patient’s needs seem to warrant a therapist with advanced skill. Keep reading to get insight from current TPTA members who are specialists! When asked why they became a specialist and what specialization meant to them, several of your colleagues shared their views. Past President Cynthia Fisher, PT, DPT, MS, Pediatric Certified Specialist, said that she became a specialist to challenge herself and to avoid becoming complacent or obsolete in her practice. She never intended to specialize in pediatric physical therapy, “but when I moved to El Paso, fate intervened and led me in that direction. The pediatric specialization pushed me to learn about all aspects of pediatric physical therapy . . . and many subspecialties within the practice of pediatric physical therapy.” She experienced many nights of late night studying after the children went to bed. “I became a specialist in 1994 (and) was encouraged by Georgia Blessey (one of the first pediatric certified specialists).” She took the test when it was still a pencil and paper exam, and she has recertified 2 times. Her son called her at work to tell her the letter had come in the mail. “I was afraid to open it, and so my son opened it and told me I had failed. He then said ‘Just kidding, Mom. You passed.’ It was such a great feeling of accomplishment being the first pediatric certified specialist in El Paso.”

page 18


pecialization

PhD, PEDIATRIC CERTIFIED SPECIALIST Mark Milligan, PT, DPT, FAAOMPT, Orthopaedic Certified Specialist is employed in a practice that has more specialists than any other practice in Texas. His “primary reason in choosing to become an OCS was to be the best physical therapist that I could be for my patients. Studying and preparing for the specialist exam forced me to dive into the literature and become familiar with best practices and best evidence for orthopedic conditions.” Dr. Milligan noticed an improvement in his care of patients as he started to study and prepare for the exam. He decided to complete an orthopedic residency program that culminated in an Orthopaedic Specialization Preparation Course. During the residency, he tracked outcomes using FOTO, Focus on Therapeutic Outcomes, a data collection system that focuses on outcomes but includes patient satisfaction and other metrics. Dr. Milligan “. . . saw my average scores in all domains improve during the time I was studying and preparing for the exam and continue to improve after I took the exam.” Mark David Sales Basco, PT, DPT, CEEAA, Geriatric Certified Specialist, was newly certified in 2015. He wanted to advance his professional career and demonstrate his commitment to excellence in clinical practice, not only to patients, but also to colleagues and society. “As a foreign-trained physical therapist, ... I saw board certification as an opportunity to become more involved in the profession. I decided to become board certified in geriatrics because of two reasons: I love geriatric physical therapy and I saw the shortage of well-trained geriatric therapists in comparison to the rapidly increasing growth of the older adult population. My practice has changed since becoming a specialist. My knowledge and skill set in relation to geriatric physical therapy has increased significantly. My patients benefit from advanced clinical decision-making; colleagues in and out of the department consult and actively seek my opinion; some referral sources and patients specifically

ask for my name prior to scheduling their appointment; opportunities for involvement in the APTA and its different sections opened up; and I strive even harder to make sure that my treatment approaches are consistent with evidence-based practice.” Yasser Salem, PT, PhD, MS, Neurology Certified Specialist, Pediatric Certified Specialist, is in the 1% of PTs who are dually certified. He wanted to be consistent with the professional goals of expecting higher qualifications. He completed his pediatric specialization first, and then he began to engage in more adult clinical practice. He decided that he should commit to the additional requirements and earn his specialization in neurology. As a faculty member, he believes that he teaches more confidently and that he includes best practice content at a high, but appropriate, level for entry level students. All of these TPTA members seem to agree that other Texas members should be encouraged to engage in the specialization process. They all gained professional and personal satisfaction from the process. Dr. Salem says that having only 10% of PTs as specialists is not enough to meet patient needs. Dr. Basco agrees that “We owe our patients, their families, and the American public excellence and compassionate care in exchange for the trust they endow upon us each time we lay our hands on them.” Dr. Milligan shared that all each practitioner should be “. . .a voracious consumer of the literature as it applies to the areas you practice.” Dr. Fisher shared that “Specialization is the future of our profession. The knowledge base for our profession is overwhelming and specialization is a means to focus on one area and develop skills and knowledge in that area. I would encourage specialization for anyone as it makes you more accountable to continue developing in that area in order to maintain your specialization and to shows a commitment for professional growth.” Evidence-based practice (EBP) is expected of all physical therapists, and

page 19

Fall 2017


All About Sp

by VENITA LOVELACE-CHANDLER, PT, P the process of achieving specialization appears to be one way to document that you are acquiring the skills necessary for EBP. Dr. Basco considers “becoming a board certified specialist not the end, but the start of my journey towards expert

clinical practice.” Dr. Fisher is proud that her daughter, a PT, completed a residency and attained orthopaedic specialization early in her career. Additionally, Dr. Fisher is thrilled to have mentored two therapists who successfully became specialists.

Of the specialists newly certified in 2017, did you know that 170 are Texans? Congratulations to the Texas PTs who became specialists in 2017! *List available from ABPTS athttp://www.abpts.org/uploadedFiles/ABPTSorg/About_ABPTS/Statistics/CertifiedSpecialistsbyState.pdf

Kimberly Lynn Akers, PT, DPT Nicholas Timothy Allen, PT, DPT Elizabeth Renee Anderl, PT, DPT Amanda Christine Anderson, PT Angela C. Anderson, PT, DPT Sarah Frances Anderson, PT, DPT, MDT Nicholas Michael Andreas, PT Angela Austin, PT, DPT Devin Noel Bailey, PT Jared Wayne Barnes, PT, DPT Dianne Marie Barraza, PT, DPT Jeanne Kanene Battles, PT, DPT Lorna C. Bautista, PT Caitlyn Beltrani, PT, DPT David Joseph Benson, PT, DPT Dustin Ken Bessire, PT, DPT Dulce Flores Bhatt, PT, DPT Justin Time Bickford, PT, DPT, COMT Lauren Kay Blanton, PT Jamie Beth Bolt, PT, DPT Shannon Luttrell Bowling, PT Julie A. Bowman, PT, DPT

Fall 2017

Millie Bradley, PT, DPT William Dan Breazeale, PT, DPT Amber N. Brown, PT, DPT Nathaniel Alden Brown, PT, DPT Clinton R. Buol, PT, DPT Anne Clarice Butler, PT Nathaniel Jack Byford, PT, DPT Sheri Monique Byrd, PT Jose Antonio Cadena, PT, DPT Deborah Campbell, PT, DPT Aaron Brice Carr, PT Benjamin Thomas Carroll, PT, DPT Elna Taypen Centeno, PT Nichole Elizabeth Chandler, PT Santiago Israel Chavez, PT, DPT Christopher William Chenault, PT Taryn Ashley Cocallas, PT Leslie Michelle Cook, PT Anne Marie Cope, PT Brian Vergara Cornejo, PT, DPT, CWS, WCC Rougina Hristova Coumanova, PT, DPT

page 18

Daniel Robert Crowe, PT, DPT Catherine Lacson Cuenca-Torres, PT, DPT, CWS Adam Michael Culiver, PT, DPT Alicia Marie Danto, PT, DPT Natasha Darbar-Woodland, PT, DPT Meaghan Dayton, PT, DPT Megan Ann DeBlieck, PT, DPT Kelsey Anne DeLave, PT, DPT Natasha Marie Desa, PT, DPT Michael David Detten, DPT, MPH Han Doan, PT, MPT Julietta Douglas, PT, DPT Austin Barton Drake, PT, DPT Molly Skiles Dubow, PT Saida Ebrahim, PT Rebecca M. Engberg, PT Marc Alan Gardner, PT Stephanie Cole Garza, PT, DPT Theodore W. Gehrig, PT, DPT Lauren Alyssa Geiger, PT Max Reginald Gilot, PT, DPT


pecialization

PhD, PEDIATRIC CERTIFIED SPECIALIST Mason Gist, PT Adrienne Wood Gobe, PT, DPT Jacqueline Keller Goldberg, PT Megan Elyse Graff, PT, DPT Megan Claire Graham, PT Daniel Grassi, PT, DPT Cindy Schlandt Gravell, PT Amy Michelle Gremillion, PT, DPT Ashley Danielle Guerra, PT Chastity Guillory, PT, DPT Jarod Hall, PT, DPT Cassidy Joseph Hallagin, PT, DPT Amanda Harris, PT, DPT Danny Harris, PT Sean Michael Harris, PT Albina Heidebrecht, PT, DPT Shelly Renee Heilman, PT Brian Robert Heiser, PT, DPT Rachel Elizabeth Herbeck, PT, DPT Jeffrey Brian Ho, PT, DPT Stephen Daniel Hollek, PT, DPT Autumne E. Hollingsworth, PT Jolee Michelle Hotop, PT, DPT, AT-Ret Melissa K. Howard, PT Timothy Hu, PT, DPT Megan Christine Irvin, Jason Lamont Jackson, PT Jill Jackson, PT, DPT Kimberly Michelle James, PT, DPT Jennifer Dawn Jenkins, PT, DPT Anne Jesse, PT, DPT Charles Clayton Jowers, PT, DPT Jill Danielle Jumper, PT, DPT Amanda Jo Kayser, PT, DPT Colleen Keenan, PT, DPT Lane Kelley Kimbrough, PT

Amanda Lee Koenning, PT, DPT Frederick James Kunde, PT Caitlyn Lee Lang, PT, DPT Maggie Lastukhin, PT, DPT Ronata Renee Lewis, PT, DPT Stephanie Nicole Lewis, PT, DPT Andres Lopez, PT, DPT Cinnamon Michelle Martin, PT, DPT, MSE Edgar Ivan Martinez, PT, DPT John Anthony McCadden, PT, MPT Sara Guttilla McLean, PT, DPT Delesa Renae Monroe, PT, DPT Crystal M. Murray, PT, DPT Andrew J. Nasr, PT, DPT Melanie Licardo Navos, PT Tracey Nweze, PT Brandon Michael O'Malley, PT, DPT Ommar Simon Ortuvia, PT Amelia Padilla, PT, MPT, PhD Thanos Papavasiliou, PT Chemetra Denise Patrick, PT, DPT Jentry Pearson, PT, DPT Kimberly Anne Phelps, PT, DPT Samantha Kidd Pittsford, PT Leddy McCall Priddy, PT, DPT Nicholas Keith Purcell, PT, DPT Lauren Queenan, PT Kristi McCormick Radfar, PT, DPT Justin Rebber, PT, DPT Katherine Wright Reinecke, PT, DPT, CertDN Katherine Anne Resop, PT, DPT RANDY ORTIZ REYES, PT Crystalyn R. Richard, PT, DPT Tony Lee Richards, PT Zane B. Richardson, PT, DPT

page 19

Samantha Jane Richter, PT Damian Celestino Rodriguez, PT, DPT Danielle LeeAnn Rodriguez, PT Melissa R. Rueda, PT, DPT Elise Ruffin, PT, DPT Michelle Sauer, PT, DPT Heather Marie Schorken, PT, DPT Katherine Elizabeth Schweitzer, PT, DPT, TPS Samantha Marie Sells, PT, DPT Kirstin Tracy Sippel, PT, DPT Corbin Blaine Skinner, PT, DPT Katelyn Joy Smith, PT, DPT Melvin Jeffery Spence, PT, DPT Christina Driscoll Stafford, PT, DPT Shawn Stoute, PT, DPT Jamie Marie Thurman, PT, DPT Steven D. Tietze, PT, MPT Renee Tomko, PT, DPT Garin Mark Tranberg, PT Lara Lee Trevett, PT Natalie Jade Turner, PT, DPT Lindsey Umlauf, PT, DPT Emily Marie Valdes, PT, DPT, RYT Tyler Louis Vander Zanden, PT, DPT Angela Diane Wagner, PT Amy Lynn Walters, PT, DPT Gary Stephen Ward, PT Kaitlyn Warren, PT, DPT Malessa Latrice Warren, PT Sarah Nicole Wells, PT, DPT Laura Nguyen Wilson, PT Chelsea Allyn Wolfe, PT, DPT Ryan Wooley, PT Francisco S. Yap, PT Jennille Christine Zabierek, PT, DPT,

Fall 2017


Licensure Compact N

ow that the Physical Therapy Licensure Compact (“Compact”) has been enacted, many members are unaware of the next steps for the Compact. Here is everything you need to know to stay current on the Compact. The Compact is governed by the Physical Therapy Compact Commission (“Commission”), which is made up of representatives from the 12 states who passed the Compact language prior to the Commission’s June 2017 deadline. Licensing board representatives from the following states serve as delegates to the Commission: Arizona; Kentucky; Missouri; Mississippi; Montana; North Carolina; North Dakota; Oregon; Tennessee; Texas; Utah; and Washington. In addition, there is one ex-officio delegate from the Federation of State Boards of Physical Therapy (FSBPT) and the American Physical Therapy Association (APTA). At the Commission’s first meeting on June 14th, the delegates elected Executive Committee members. Texas Board of Physical Therapy Examiners Board Chairman Harvey Aikman, PT, FAAOMPT was elected to serve as a member of the Executive Committee and the Rules Task Force. Aikman states that he is very excited to participate in the pioneering process of developing a new and simplified method for physical therapists and physical therapist assistants to increase interstate mobility. He further stated that he was looking forward to representing the physical therapy professionals of the state of Texas and working to ensure that the process to obtain a compact privilege to practice in other states would be streamlined and

Fall 2017

at a much lower cost than obtaining a traditional license in a secondary state. In order to implement the Compact, the Commission must adopt bylaws and rules. To accomplish this, the Commission has two task forces working concurrently on these areas. The Bylaws Task Force met in July to review the initial draft of the Commission’s bylaws, and the final bylaws were recommended for approval and were sent to the full Commission for review and potential adoption. The Rules Task Force met July 22nd and 23rd to begin the rulemaking process. Areas of the Compact requiring rules include definitions, process to obtain compact privileges, fees, and adverse actions. The Rules Task Force has two additional meetings planned to complete the process of drafting rules for consideration and adoption by the full Commission at its November 5th meeting. During this process there will be an initial review of the compact rules by the member boards followed by publication of proposed rules which should take place no later than October 5th which will start a 30 day comment period prior to final changes and adoption at the annual meeting of the full commission on November 5th. In addition to these activities, the FSBPT has been developing a Commission website (www.ptcompact. org) and creating a system to allow for the processing of Compact privileges. They anticipate that the website will be launched by late August, and that testing on the system will begin by the first quarter of 2018. According to Aikman the opportunity to obtain Compact Privileges in member states should start early in the second quarter of 2018.

page 20


House of Delegates Boston 2017

The APTA House of Delegates met June 18-21 in Boston, and 26 TPTA members served as Texas Delegates and PTA Caucus and Student Representatives. Thank you to the following members who served as a part of the TPTA Delegation: Janet Bezner, PT, DPT, PhD – Chief Delegate Denise Gobert, PT, PhD, CEEAA, NCS – Vice President & Delegate-at-Large Mark Armstrong, PT, DPT, MS, OCS – District Delegate Michael Geelhoed, PT, DPT, MTC, OCS – District Delegate Steve Goffar, PT, PhD, OCS – District Delegate Rubye Kendrick, PT, MS, CEEAA, GCS – District Delegate Herman Koster, PT – District Delegate Sara Lohmann, PT, DPT, OCS, FAAOMPT – District Delegate Rupal Patel, PT, PhD – District Delegate Martha Sneary, PT, DPT, MS – District Delegate Jan Spigner, PT – District Delegate Emili Traylor, PT – District Delegate Seth Watson, PT, DPT, OCS – District Delegate Kim Broderick, PT, CFMT, ATC, SCS – Delegate-at-Large Manuel Domenech, PT, EdD, FAAOMPT, OCS – Delegate-at-Large Jennifer Frerich, PT, DPT, OCS – Delegate-at-Large Peggy Gleeson, PT, PhD – Delegate-at-Large Venita Lovelace-Chandler, PT, PhD, PCS – Delegate-at-Large Janna McGaugh, PT, ScD, OCS – Delegate-at-Large Colette Pientok, PT, DPT, CFMT, OCS – Delegate-at-Large Robert Sandoval, PT, PhD – Delegate-at-Large Dana Tew, PT, DPT, FAAOMPT, OCS – Delegate-at-Large Burke Wilson, PT, DPT, SCS – Delegate-at-Large Deborah Nicole Volek, PTA – PTA Caucus Representative Mark Garcia, PTA – Student PTA Representative Ari Witkin, SPT – Student PT Representative

The delegation was actively engaged in the work of the House, including work to adopt a change to the APTA bylaws enabling PTAs to have a full vote in the Texas Assembly, consistent with the chapter bylaws, and a motion that defines the physical therapist scope of practice. TPTA Chief Delegate Janet Bezner, PT, DPT, PhD, FAPT, added "The experience of the House of Delegates was extremely positive. The delegates were focused on meaningful discussion and actions to achieve APTA's strategic goals and vision, and worked collboratively to adopt contemporary policies that support our role in promoting movement." Please see TPTA's new Facebook page for photos from HOD 2017; www.facebook.com/texasphysicaltherapyassoc

page 21

Fall 2017


Calendar MONDAY, 9/11/17

6:30pm - 7:30pm

SATURDAY, 9/16/17

8:00am - 12:00pm

The Power of Patient Communication (CAD)

Exercise as Medicine: Updates to our Parkinson's Rehab Paradigm (CAD) Austin, TX

SATURDAY, 9/16/17

SATURDAY, 10/7/17

9:00am - 7:00pm

THURSDAY, 10/26/17

10:00am - 3:00pm

Kickball Classic: Kickoff Month (SED) Houston, TX

4th Quarter Board of Directors Meeting (at Annual Conference) Corpus Christi, TX

8:00am - 5:00pm

Medical Screening for the PT & PTA: Upper and Lower Quarter Screening (PHD) Amarillo, TX

FRIDAY, 10/27/17 - SUNDAY, 10/29/17

TUESDAY, 9/26/17

*Please see the TPTA webiste for new calendar events.

TPTA Annual Conference Corpus Christi, TX

7:00pm - 9:00pm

Assessing and Adressing Mobility and Fall Risk in Persons with Cognitive Impairment (NTD) Dallas, TX

1

PoP Quiz - Answers The Physical Therapy Practice Act does not give the Board specific authority to address record retention. However, you may refer to the Texas Medical Board’s record retention rules as guidelines. Those rules can be accessed at www.tmb.state.tx.us Additionally, the following information regarding medical records may be helpful: I. II. III.

IV.

V. VI.

Fall 2017

Age of Majority (legally defined age at which a person is considered an adult) a. Eighteen (18) years old Patient Record Retention for Adults & Minors a. Adults: Seven (7) years from the date of the last treatment b. Minors: Seven (7) years from the date of the last treatment or until the patient reaches age 21, whichever is later Response Time for a Patient’s Request for Access to or Copies of Records a. A Physician must respond to a written request for medical records no later than the Fifteenth (15) business day after receipt of the request Maximum Fee for Copying Records Title 22 Part 9 Chapter 165 Rule 165.2 (Doctors) a. Paper Charts: i. Twenty-five dollars ($25.00) flat fee for 1 through 20 pages (including retrieval or processing fee) ii. Per Page after 20 pages is $.50 per page for 21 and over b. Electronic Format i. Twenty-five dollars ($25.00) for the first 500 pages or fifty dollars ($50) 501+ pages ii. Records Requested for Social Security Claims/Appeals – Free for SSC, SSA Ownership of Patient Records a. Healthcare provider owns the medical records Breach Notification by Covered Entity a. No legislation specifically pertaining to security breach notification in no case later than 60 calendar days after discovery of the breach.

2 3 4 5

page 22

No. If a patient is receiving physical therapy services, only licensed physical therapy personnel may supervise the treatment of the patient, regardless of the setting. More information may be found in the TBPTE Board Rules, §322.3(c) Providers should be able to obtain any US physician’s NPI number through NPPES (www.npiregistry.cms.hhs. gov). Most providers in Texas include the referrer’s NPI in Field 17a of the claim even though that has not been specifically stated as a requirement for payers other than Medicare. There is no frequency stipulated by Medicare. It depends on how long between discharge and the new visit, if ≤ 30 days, you may just want to do a re-evaluation, if it’s truly for the same condition. You may collect upfront payment from a patient when providing a service that is not covered by Medicare. You do not need an ABN to collect payment for a noncovered service. If you still choose to use an Advance Beneficiary Notice of Noncoverage (ABN), you may still collect up-front payment from the patient, so long as the ABN specifies that the patient will be responsible. Please review APTA’s APTA Cash-Based Practice Resource for more details.