Helping Others, Simplicity the Hallmarks of PT at Seattle King County Clinic

From left: Physical therapists Andi Love and Mandie Majerus

My name is Andi Love. I am a physical therapist and owner of Salmon Bay Physical Therapy in Ballard. My husband and I work hard to make sure our clinic is involved in charitable events. Every year we have food drives, make Thanksgiving baskets and participate in YWCA’s adopt-a-family. I love to see how our wonderful community gets behind these events to help those in need. Lately, however, I’ve had the feeling that there is more that I should and can do, as a human, a community member, and as a PT. That is why on Saturday, October 29 I volunteered at the Seattle King County Clinic at the Key Arena.

Seattle’s free clinic is one of the largest in the country. Due to the persistence of Matt Currier, PT, of Group Health, physical therapy was included this year for the first time. I learned of the clinic via an email that circulated through the close knit Seattle physical therapy world. I responded with an emphatic “YES.” However, the unknown started to make me nervous. Salmon Bay PT is a small, outpatient orthopedic clinic. Would I be treating wounds?  Amputees? What if I couldn’t provide the best care for people who were seeking my help?

The clinic is run like a well-oiled machine. There are people who line up the night before to get in for care the following day. If they don’t get to everything they need, they get back in line for the next day. The treatment areas are set up in suites. There are clinics from PT, to blood labs, to HIV testing to acupuncture. The floor of the arena seemed to be all dentist’s chairs with the hum of constant drilling in the background.

As physical therapy was new to this venue, we only had one suite with two massage tables. The day I was there, we were a team of four for most of the afternoon. We were cramped, but we made do. We would share the tables, treat on the floor, or treat people out in the hallway. We routinely had a line of five to eight people waiting for treatment. Towels, Theraband, reflex hammers, mobilization belts and all other equipment was brought by the volunteering therapists.

We saw everything from old spinal-cord injuries to low back pain to sprained ankles. Most of the people I saw did not have insurance and those who did, could not afford the deductible. A good percentage of the people I saw needed an interpreter. 100% of the people I saw were kind and so so grateful for what we were doing. The toughest part was not handing over my card and telling these people I would just see them for free. Forever. (Because I wanted to.)

Physical therapists have a gift to give people. We aren’t offering a passive treatment. Every person who walked into that room, including their family members, was educated about how to help themselves. While I referred many to social work for future care, everyone went home with stretches, exercises, stick figure drawings, posture instructions – something that they could do for themselves. On Saturday, we had so many people who wanted to get into PT, that they closed the line early because the wait was so long.

My hope for next year is that we have so many therapists who volunteer that we get the same four to five treatment rooms that the acupuncturists and chiropractors had. I hope we get one treatment table per volunteering PT. I hope that we don’t have to close the line early and turn people away because we don’t have enough PTs to handle the volume of people who need our care. I hope that there is a waiting line of PTs who want to volunteer their time. I hope that all volunteers can work without judgement or questions in order to give this community the care they need.

To end, I would like to thank Matt Currier, PT, once again for seeing the need for us to be there and fighting to get PT included. He was there all day, every day from Thursday through Sunday. Because of Matt, I know we will have a bigger presence next year!

And from Andy Lodato:

From left: Physical therapists Matt Currier and Andy Lodato

The Seattle King County Clinic (SKCC) is the biggest free medical clinic in the country. The event encompasses four days and provides various services to the uninsured and underinsured in the area. For the first time (thanks to Matt Currier), physical therapy was a service provided during this clinic. I had the privilege of volunteering for the first day of the clinic on October 27^th.

It was an amazing experience to volunteer and provide a needed service to so many who were so grateful we were there. I could probably ramble on for days about what the experience was like for me, but I felt there were three overriding themes to my day volunteering:

1. Helping Others – At one time or another, PTs ultimately get the question: “Why did you want to get into physical therapy?” Typically, that answer circles around to the desire to help others. That theme has stuck with me for the past 16 years, but through the other requirements of the profession, it can get lost. All of the other outside noise such as PQRS, pre-auth, productivity, etc. can get in the way of what this profession is really about – which is helping others. My volunteer time at the SKCC brought home why I do this for a living. Shuffling in patients every 20-30 minutes and providing them with an exercise, a little education or a little motivation without the administrative burden our normal clinical life was profoundly powerful.
2. Simplicity – Since it was the first time for PT, there was no script or template of equipment to provide, resources available or how we were going to manage the workflow. We literally had zero equipment other than two treatment tables. We documented everything with pen and paper. My world famous stick figure drawings translated well for HEPs. It was a nice break for a day to step away from the EMR system and to use just my head and hands to provide care to so many.
3. Everyone has a Story – I was blown away by the stories of our patients on that day. 90 percent of our patients had full time jobs where it was cheaper for them to take an unpaid day off to receive medical care than to use whatever insurance they had. Many of our patients were in line at 4 a.m. to reserve a spot, some were in line from midnight. We got so backed up, that some patients waited 30-40 minutes to be seen. Each of them was grateful for our services and for volunteering our time.

It was a long day of treating patients (11 hours to be exact), but it flew by. After the end of the weekend I spoke with Matt and PT treated 174 patients roughly providing around $30,000 of free care. I would encourage anyone who is interested to volunteer at an event like this one, it is a great way to give back and to grow as a PT.

State of the Association 2016

I would like to start by thanking you for your professional membership and your commitment to professionalism. Your commitment to professionalism matters; it does make a difference.

PTWA has had an eventful year. Many hands have helped with “the lift.”

Our Accomplishments
We’re #3! Each year APTA ranks states in the United States regarding which is the best state in which to practice physical therapy. We are on the rise from last year’s ranking of 11.

We had a record number of conference registrants in Tacoma this year. Our conference had diverse educational offerings with excellent speakers. This year’s conference featured a new Student Conclave. APTA President Sharon Dunn kicked off the Student Conclave festivities. It was a thrill for the students. Studies show that engaged students and new professionals stay engaged in professional associations. We felt a Student Conclave was well worth our professional investment. Ten of the students were “sponsored” to attend the Friday night WPT-PAC party.

This is the first full year after the rule-making for spinal manipulation was finalized for PTs in the state of Washington. This has been a long and drawn out task. Your prolonged commitment to the process paid off.

This was the first year that the PTA had a full vote in elections and at our state conference. No more half votes to count.

We have had many of our members/leaders representing us at APTA meetings including the federal and state legislative forums, the membership conference and the house of delegates. These volunteer efforts on your behalf have been invaluable to ensure Washington is up to date with national trends and initiatives. You benefit from this as a member of PTWA.

You should also know that your PTWA leaders are highly respected on the national scene.  They are task force members, committee members, directors, invited speakers and much more.  Their knowledge and skills are at the front of the APTA.

PTWA has held numerous district meetings and webinars. These meetings and webinars have included CEUs for sports/ortho, pediatrics and admin. This is a membership benefit for your continuing education efforts.

We have had numerous meetings with state and federal legislators on your behalf. These have included a recent King County District Town Hall meeting with multiple legislators, a fundraiser for Representative Eileen Cody hosted by Sound PT, attendance at fundraisers for Governor Inslee, Congressman Heck, Senator Becker and the new Democrats (multiple federal legislators). These behind the scenes work benefits you by making legislative relationships that benefit the profession of physical therapy.

Our Unexpected News
We received news from the Department of Health (DOH) regarding the Sunrise Review of dry needling. It was not positive. PTWA and members have sent in rebuttals to the draft summary.  It should go without saying that tireless and voluminous work has gone into this effort. Stay tuned and be prepared to engage when the time is right. You can become involved. Join our Legislative Committee and Dry Needling Task Force for future work regarding this issue.

Our Goals
It wouldn’t be physical therapy without having goals.

We as a state association need to regrow our financial reserves. We will be evaluating opportunities to increase our non-dues revenue and membership.

New evaluation codes go into effect January 1, 2017. APTA will keep you up to date with code implications and their appropriate use in your practices.

Payment:  if we don’t get paid, we can’t run businesses. We will continue working toward legislative initiatives and collaboration with third party payers. We want to ensure that our patients can have access to the care they need and that we as professionals are compensated fairly for our evidence-based interventions.

We will be pursuing the licensure compact legislation in this upcoming legislative session. Our neighbors in Oregon were the first state in our nation to pass this legislation. We hope to join them as early adopters. This benefits our state as early adopters will be part of the rule making process right from the beginning.

We are committed to our school-based physical therapists. We are supporting legislation to ensure they are compensated fairly for their years of service. This will help ensure our children in state-funded schools will get the care they need to successfully navigate their education experience.

PTWA will petition the DOH to add PTs to the Health Professional Conditional Scholarship Program (RCW 28B.115). This program encourages health care professionals to serve in shortage areas. This is currently offered to medical students but we will work to make this available for PT students too. This is a non-legislative process that can be requested through the DOH. This idea came from a recent discussion with a state senator.

We encouraged you to participate in National Physical Therapy Month and PT Day of Service. PTWA hosted the exhibition of falls prevention exercise programs at our recent conference as a means of providing members with some ideas to promote #healthyaging and #ChoosePT. Please share your PT Day of Service and PT month activities with PTWA. We would like to feature and celebrate your efforts.

PTWA will provide suicide assessment training this coming spring 2017. Suicide assessment training is now part of your license requirement.

I would like to recognize the excellent efforts with regards to our PTWA staff. They are excellent, creative, resourceful and incredibly hard working.  Please meet them and thank them for their work.

We thank you for your membership and your commitments toward being excellent health care professionals in the state of Washington and beyond.

Erik Moen PT
PTWA President

What Emilie Said About PTs Performing a Singular Technique – Dry Needling

PTWA Legislative Committee Chair Emilie Jones delivered this eloquent testimony during yesterday’s dry needling sunrise review at the Washington State Department of Health.

My name is Emilie Jones and I’m a physical therapist and legislative chair for PTWA.

We are here today to discuss whether physical therapists can perform a singular technique – dry needling.

In the American Academy of Medical Acupuncture’s website, Dr. Joseph Helms describes acupuncture as “one discipline extracted from a complex heritage of Chinese medicine – a tradition that also includes massage and manipulation, stretching and breathing exercises, and herbal formulae.” Physical therapists do not desire to perform acupuncture. We do not want to treat patients for allergies, stress, fatigue, poor digestion, menstrual discomfort, hormonal issues, ileus, asthma, hiccups, constipation or sleep disorders.  These patients are not seen in our practice.

Acupuncture is a well-respected profession with a long history and extensive body of knowledge.

We do not ask massage therapists to go to physical therapy school to perform manual therapy techniques.

We do not ask phlebotomists to go to nursing school to puncture veins.

We do not ask nurses or medical assistants to go to medical school to give injections.

None of these practitioners are performing acupuncture when they insert a needle into a patient’s arm to give them a TB test. They do not know whether they are interacting with an acupuncture point when they do this.

Physical therapists do not need to go to medical acupuncture school to perform a single technique just because the tool is the same. We desire to use our extensive background in anatomy, physiology and manual treatment techniques to assist the patients we are already treating with myofascial trigger points to get better, faster. This is allowing patients to receive care in the model they choose, helping the most patients by improving their access to care, and  help us provide the most effective care to our patients with neuromuscular dysfunction.

What (a) Summer?

Summer is the busiest time of the year in my niche’ private practice. I watch from social medias’ window of peoples and families on vacations and fun adventures. It looks like many of you have exercised your mileage plans and hiked many peaks!

Summer has not been a vacation time for your Legislative Committee and Dry Needling (DN) Task Force. They/we have been hard at work preparing for the August 2^nd Sunrise Review regarding a physical therapist’s use of DN as a treatment modality in the state of Washington. We have met with legislators and collected and organized volumes of evidence that we hope the Washington State Department of Health will find compelling and convincing. We will inform you of “the next steps” following the proceedings/outcome of the review.

I want to personally thank Emilie Jones and the entire DN Task Force. They have put in endless hours in preparation for the August 2^nd hearing. You may find our sound and exhaustive evidence on the DOH Sunrise Review web page.

Summer also includes the continuation of planning for an awesome PTWA Conference. Our 2016 PTWA Conference will include our APTA President Sharon Dunn and other invited dignitaries and guests. We will be awarding PTWA honors to our leaders (PTWA and non-PTWA). We will host most excellent continuing education. We will host our first PTWA Student Conclave this year. Thank you Carley Rissman and student SIG leadership for their time and energy.

The 2016 PTWA Conference will be great and I think you should participate! SIGN UP NOW! Come to the party!

Speaking of parties, on Friday, September 30 after conference education ends, the WPT-PAC will host its annual conference happy hour. You can buy a ticket when you register for the conference. Or just RSVP to legislative@ptwa.org if you’re not planning to attend the conference continuing education.

Summer is also the beginning of the election cycle. This means PTWA engagement in helping those who’ve helped the profession get elected or reelected to office. PTWA will be attending fundraisers for the next few months.

I would encourage you to do the same. Discover your local state representative or senator and attend one of their fundraisers. Their political party does not matter.  PTs need friends that are Rs (Republicans) and Ds (Democrats). Get to know the issues that affect you and them.  Issues should be related to health care and how they affect you and your patients, but you can and should include those issues that affect you personally.

Have a safe rest of the summer and find a way to engage on behalf of your profession.

Thank you!

Erik Moen, PT
PTWA President

Exhilarated by Passion and Brain Power as APTA House of Delegates Comes to Life

Earlier this month I had the opportunity to represent the state of Washington as a first time delegate for the APTA House of Delegates (HOD). Despite preparing for the week with monthly conference calls with my fellow delegates and reading through material posted on the APTA website beforehand, I initially felt overwhelmed but was quickly swept up in the excitement of the house.

For the months prior to HOD, I listened to the voices that were my fellow Washington delegates on monthly conference calls, during which we discussed the motions and candidates that we would be voting for at the HOD. Soon after arriving in Nashville, I was in a room putting faces to voices. It was exhilarating to be in a room with so much brain power, vision and passion for the profession of physical therapy.

As we later entered the HOD, the excitement was palpable. Again, I felt energized and in awe of the amount of passion and intellectual power of the delegates from across the country. Over the course of the next four days, it was fascinating to see the visions of the APTA Board of Directors and HOD come to life. The most exciting was to see the HOD and APTA enthusiastically support a recent Center for Disease Control report on opioids, which listed physical therapy as a safe and effective alternative for pain management. Before the HOD even commenced we had seen a billboard in Nashville on the way to the hotel from the airport with the APTA campaign. With a swift unanimous vote, the #ChoosePT campaign was promoted with a press release; the action of the HOD visible the next day on Twitter feeds everywhere and even a Washington Post article.

Over the course of the week, I felt I was taking ownership for the direction of my profession, playing my small part in steering our ship to safe and secure waters. The HOD voted on motions supporting PT’s role in diagnostic imaging, to the role PTs ought to play in promoting active lifestyle options in communities, to investigating the burden that student debt places on those of us who are new in the profession. In a rapidly changing healthcare environment, this involvement in the direction the APTA is going feels like an integral and necessary part of shaping a secure and prosperous future for the PT profession.

The HOD seemed to end as quickly as it started. I left Nashville feeling more connected than ever to the profession and to the APTA. I left knowing that there are avenues for change and advocacy out there and that there are brilliant PTs working so hard to represent our profession every day. Thank you PTWA for allowing me to serve you in the HOD!

Amanda Scharen
PTWA Delegate to APTA House of Delegates

Members are Everywhere

Minding my own business at the baggage claim a few Sundays ago, I was approached….”are you..?”

Erik Moen and Teri Jo Lientz at SeaTac baggage claim

PTWA member Teri Jo Lientz shared the same flight from Chicago. I was so glad she said hi.

Teri Jo had been in Chicago attending a Northwestern University Physical Therapy Alumni Association board meeting, her first after being appointed to that board in April.

Teri Jo’s practice in Washington has a large injured worker component. She is also an ATC. I was excited to hear about her aspects of practice. She has been part of our Legislative Committee and is currently helping set a concussion protocol for her child’s school in Tacoma. She related her practice challenges and we “problem solved” peer to peer.

We had the chance to talk about legislative efforts within our state in comparison to her peers from other states she had spent the weekend with, such as dry needling.

All that while waiting for luggage!

I value chance meetings with our professional members. I find inspiration by who members are and what they are doing. We at PTWA hope to increase the awareness of our awesome members to the public as well as within our membership.

See you out there!

PTWA President Erik Moen

Five PTWA Members Advocate in Other Washington

About 250 physical therapists, physical therapist assistants and students from all over the country visited Washington, DC for APTA’s Federal Advocacy Forum and Private Practice Section legislative fly-in On April 3-5, 2016. Five PTWA members, Steve Anderson, Randy Johnson, Jeanine Gunn, Jennifer Lesko and myself, attended this two+ day event. APTA sponsored attendance by key contacts for specific targeted members of Congress and the Senate but the event was open to all members.

During this event we received training on key issues impacting our profession, we heard speakers discuss how to lobby and listened to speakers who shared information about the current political climate. We also received information about specific bills that APTA supports: Medicare Access to Rehabilitation (repeal of the Medicare CAP), Expand Access to PT Services in Rural and Underserved Areas (including physical therapists in the National Health Service Corps Loan Repayment Program, which offers loan repayment related to service in underserved areas) and  Support the Prevent Interruptions in Physical Therapy Act (allowing physical therapists to enter into locum tenens arrangement under Medicare).

On Tuesday, we hit the hill. Most of our congress-people were back in their districts, but we were able to meet with the congressional staff health liaisons about our issues. Making connections with staff is just as important as the connection we make with our congress-people and senators. They often are the ones who are in the know on specific topics and act in an advisory capacity to their congress person or senator. A few of us also were able to meet with Senator Maria Cantwell and staff for Senator Patty Murray. Our goals: To get co-sponsorship of our bills, to thank our reps and senators for their support and to ask for other ways that they can support or move our bills forward. I can assure you that we were well represented and we were heard.

In addition, we also heard disheartening news about the PT-PAC (the APTA Political Action Committee). The number of contributors and the total contributions has decreased significantly over the past year. The importance of PT-PAC is the power that we gain by contributing to individual campaigns. Power that gets us a spot at the table vs. a view from the sidelines! Did you know that if every member of APTA gave just $20, we would be the LARGEST healthcare related PAC in the nation? If you have contributed—thank you! If you have not—why not? The issues that we lobbied for impact ALL PTs in ALL settings.

SO I have a challenge for all PTWA members:
1) Advocate for your profession. There is an APTA Action app that you can download that gives you all the information you need to be a part of this process. You may also find information on the APTA website: http://www.apta.org/FederalIssues/
2) Contribute to the PT-PAC. $20 from each member is a doable amount!  http://www.ptpac.org/

Susan Chalcraft
PTWA Legislative Committee member

Field Trip to APTA Headquarters

PTWA President Erik Moen

I attended a leadership symposium at the American Physical Therapy Association headquarters in Alexandria, Virginia last Friday and Saturday with our Executive Director (ED) Jackie Barry. This meeting was intended for training new chapter and section presidents and their EDs. We had the opportunity to meet and network with new presidents/EDs from Utah, Tennessee, Rhode Island, Vermont, Massachusetts and the Oncology and Sports Sections, and the ED from PPS. These networking opportunities remind me of the excellent resource we have in our ED Jackie Barry. She does a lot for PTWA and is viewed as a leader among her peers. You probably already know this. It is well worth mentioning it again.

 

Friday’s session was dedicated to the introduction of APTA staff and their programs. I am always impressed at the depth of involvement and true passion our APTA staff has for the support of PT/PTA practice. It continues to demonstrate that there are true benefits of membership in the APTA. We hope to emphasize/demonstrate that to you over the next year or so. Membership does matter.

We had an early breakfast with the current APTA Board of Directors on Saturday morning. It was nice to see our WA member Jeanine Gunn who is currently serving as an APTA director (and is Washington’s liaison to the APTA board) and former PTWA member Roger Herr. Roger is running for APTA Secretary. We thank him for his consent to run and willingness to serve. He is an excellent candidate and an ardent supporter of PTWA.

Susan Meier facilitated conversations during Saturday’s session. Susan’s expertise is with governance and effective board work. In other words…getting stuff done and doing meaningful work for PTWA.

The time away from work and family was worth the investment on behalf of PTWA and APTA. It’s experiences like this that give me greater appreciation for our profession, and the resources and value we have in APTA. We are better working together to ensure physical therapy is truly a great profession.

More Third Party Managed Care: Is PTWA Doing Anything About This?

I’m as disappointed as you are that on July 1 another large payer in Washington will start using eviCore to provide utilization management for outpatient rehabilitation. I’m fortunate to be a bit of an insider so I get cced on the email conversations between our volunteer leaders about these topics and I receive all of the committee reports throughout the year – so I can tell you that PTWA is doing something about this and has been for some time. If I were to reiterate every detail I know, you would need to spend several hours reading this post so I’ll provide some highlights and hope you will read between the lines and assume that it’s not realistic for us to say everything.

Highlight #1:
Our Reimbursement Chair, Pete Rigby, and Elise Latawiec from APTA have been meeting monthly with Regence and eviCore (formerly Care Core) for more than a year. As you can imagine, these conversations are not as simple as a conversation you might have with a friendly neighbor where you tell him that his dog has been digging up your flower beds. It’s more down the communication continuum toward President Barack Obama discussing an issue with President Raul Castro.

Highlight #2:
Pete, Elise, PTWA Payer Liaison Scott Spradling and others have been working on an eviCore/Regence survey, the results of which we think will inform these monthly conversations. We hope to have the survey link sent to you within two weeks. Please answer it.

Highlight #3:
You may also remember that we passed insurance reform legislation during the 2015 legislative session. We continue to advocate for insurance and third party administrator reform and regulation during every legislative session.

Highlight #4 – and perhaps the crown jewel:
And we’re part of the outcomes registry movement that APTA has embraced to package what physical therapists and physical therapist assistants do so that other practitioners with whom we partner, such as primary care physicians and surgeons, know what to expect when we’re part of their networks. This is a forward-thinking strategic initiative that will help shift the emphasis away from “them” doing things to “us” and put us in more of an offensive rather than defensive mode.

There is much that is being done that we cannot talk about for reasons of diplomacy as well as reasons of strategy.

Please take a few minutes to scan emails when we send them to you and to read newsletter articles. There will be at least two related articles with more details in our May newsletter.

I am always happy to hear your thoughts.

Erik Moen
PTWA President
president@ptwa.org

Ride the wave? Or make the waves!

PTWA President Erik Moen

I hope you have noticed all of the messages from APTA over the last month in PT Bulletin, PT Magazine, MoveForwardPT.com, Facebook and Twitter? Messages and news have been pushed out regarding the CDC opinion for use of PT prior to opioids for pain and the utilization of early PT intervention with low back pain improves outcomes. There have also been many messages regarding the concept of #GetPT1st.

There is certainly a swell of excitement around these messages. You can chose to ride the wave of excitement but I would prefer that you make some new waves.

You don’t make waves by keeping our messages to ourselves. We have to inform the consumer about our great story. Consumers/voters will ultimately choose to see you if your worth has been demonstrated. Contemporary medical referral sources are somewhat conflicted by their established organizations and contracts. I would encourage you to educate the consumer. Make them smarter consumers of physical therapy.

 

We also have an obligation to respond to all news regarding our profession. Noridian has identified that some SNF businesses are unusual high in their utilization of physical therapy. PTs don’t typical own/operate SNFs thus there are some administrative mandates that are out of their control. PTs can and should ensure that their treatment interventions are warranted and skilled. PTs should work collaboratively with business owners to ensure defensible and appropriate interventions surrounding given diagnostic classification.

 

Make the waves! Educate and excite our consumers. Tell our story…it is a great one.  #GetPT1st