By Charlene K. MacDonald, MPP, and Diane Przepiorski

Fight is expected to resume in 2009

The California Orthopaedic Association (COA) this year successfully thwarted an attempt by the California Physical Therapy Association (CPTA) to expand physical therapists’ scope of practice and allow them direct access to patients without a physician’s diagnosis. COA, however, fully expects the legislation to be reintroduced next year.

This legislative victory marks an important step in the COA’s efforts to educate legislators and the public on the importance of a patient-centered approach to health care, based on a strong physician-patient relationship and complemented by physician-recommended physical therapy. The effort began in 2007, when Assembly Bill 1444, sponsored by the CPTA, was introduced. COA delayed the progress of that bill on a technicality and began to mobilize.

The first strategy
Realizing that the CPTA did not represent the interests of all of the state’s physical therapists, COA developed a network of physical therapists opposed to the bill. In addition, COA members held meetings in legislative districts and in Sacramento with key legislators, as well as with the author of the bill, the leadership of the CPTA, and their lobbyist. It quickly became clear, however, that the CPTA would accept nothing less than unfettered access to patients.

“During the negotiations, we were struck by the lack of appreciation of the CPTA leadership of the important role that a physician and surgeon plays in ruling out other medical conditions that could be the source of the pain, before referring the patient for physical therapy treatments” stated Diane Przepiorski, COA’s Executive Director.

When the bill was scheduled for a hearing in December 2007, COA leaders activated the network of allied physical therapists and their Legislative Key Contact system. Members across the state were urged to contact legislators on the Assembly Business & Professions Committee to vote “No” on the bill. The resulting flood of calls and e-mails, as well as a final push by COA and the California Medical Association’s lobbyist, ultimately resulted in having the bill pulled from its scheduled hearing so that it missed its legislative deadlines.

New efforts by the CPTA
In 2008, the CPTA returned to the legislature with a more subtle approach to expand physical therapists’ scope of practice. Assembly Bill 2111 not only revised licensure fees for physical therapists but also included a provision to revise their licensure examination. Under the revised licensure requirements, physical therapists would have been required to pass entry-level competence testing in the areas of “examination and evaluation, diagnosis, prognosis, treatment intervention, prevention, and consultation skills.”

COA objected to this new testing requirement on the grounds that the Physical Therapy Board would be testing physical therapists on areas outside of their scope of practice. COA argued that such testing was unnecessary, would detract from required physical therapy training, and would later let physical therapists claim that their education and training qualified them to make a medical diagnosis.

Working with the bill’s author, COA was successful in having the onerous language removed and the bill is proceeding through the legislative process without further opposition.

The need to stay vigilant
Although the COA is satisfied by the progress made, it continues to monitor amendments to pending legislation to ensure that the CPTA does not insert direct access language attesting to physical therapists’ ability to make a medical diagnosis in any other legislation. The CPTA president is encouraging CPTA members to urge legislators to support direct access to patients and promises to introduce a direct access bill in 2009. COA will continue to oppose these efforts with strong support from the AAOS.

“If there truly is a problem with patients gaining access to physical therapy services following a relapse, COA remains willing to work with the CPTA to find a solution that does not jeopardize patient care,” said COA President Mark Wellisch, MD.

“We have successfully worked with other nonphysician groups to resolve scope of practice issues.” The AAOS Health Policy Action Fund and the Scope of Practice Partnership, a coalition of physician specialty societies in which AAOS is an active member, supported the COA’s efforts. The AAOS encourages other state orthopaedic society leaders to take advantage of these resources by contacting Charlene MacDonald in the AAOS office of government relations at macdonald@aaos.org

Charlene K. MacDonald, MPP, is manager, state legislative affairs, in the AAOS office of government relations; Diane Przepiorski is executive director of the California Orthopaedic Association.