So, You Want To Keep Your Job?

1
So, You Want ToKeep Your Job?

• How the CMS Decision
• Affects You
• January 2006

2
Impact of CMS Decisionon Athletic Trainers

• More than 1,000 athletic trainers have lost their
  jobs
• 800 outreach/clinical ATs (high school and
  college based)
• 300 physician extenders ATs (physician office
  based)
• These were jobs in core athletic training
  settingsnot necessarily reimbursement jobs.

3
Why Is CMS Recognition Important?

• CMS sets the national health care agendaalmost
  50 of every health care dollar!
• Drives who can practice where
• By default, credentials who is qualified
• Commercial insurance follows its rules (usually)
• Sets reimbursement rates
• Gatekeeper to patient access
• Gatekeeper to quality health care for all ages
  (youth through seniors)

4
If You Cant Bill,You Cant Do Therapy

• CMS Therapy-Incident To rule says that only
  physical therapists, occupational therapists and
  speech/language therapists are qualified to
  provide therapy.
• CMS rule implies that all others are unqualified
  to provide therapy and rehabilitation services.
• CMS rule implies that athletic trainer education
  is inadequate.
• CMS rule includes all physical medicine and
  rehabilitation services.
• Athletic training services are physical medicine
  and rehabilitation services.

5
If You Cant Do Therapy,You Must Not Be Qualified

• The CMS rule is based on educational
  qualifications (not licensing). It says that in
  order to be reimbursed when providing therapy
  services, you must have graduated from a PT
  program (or OT/SLP).
• It essentially says that athletic trainers are
  not qualified to provide therapy services.
• Did you waste your education? Will you have to go
  back to school to get a new degree to practice
  what youve been doing?

6
If You Are Not Qualified,Then Someone Else Is

• If Medicare doesnt recognize that you are
  qualified, then who is qualified to do your job?
• Professionals and therapists are reimbursable.
• Aides are not reimbursable.
• For collegiate and high school ATs, it is not
  about reimbursement, its about qualifications.

7
APTA Responseto NATA Efforts

•   I wanted to email you today to clarify that
  this briefing is not being coordinated by the
  American Physical Therapy Association and to give
  you more background information on the subject
  matter
• ..about the delivery of services by those who are
  not trained and educated as physical therapists
  that would like to provide their services within
  a physician office under special incident to
  rules given that their services are not
  recognized as an established benefit under the
  Medicare program.   
• The basic issue is whether a Medicare beneficiary
  should have to question whether their physical
  therapy services, provided in a physician office
  or any other practice setting under Medicare, are
  provided by qualified professionals.  CMS and
  APTA believe that the patient should not have to
  question this point given that physical therapy
  is a covered benefit under the Medicare program.
• CMS and APTA felt this standard was not in line
  with requirements for other Medicare practice
  settings and sought to protect beneficiaries by
  requiring the use of qualified physical
  therapists to deliver physical therapy services
  in physician offices.
•  there is more

8
Whats Been Done to Reversethe Therapy-Incident
To Rule

• Aggressive work on CMS policy on restricting who
  can provide therapy services incident to.
• Continued negotiations with the Centers for
  Medicare and Medicaid Services (CMS) -- ongoing
• Grassroots campaigns to members of Congress
• Targeted campaigns to selected members of
  Congress
• Federal lawsuit now on appeal at the Fifth
  Circuit Court of Appeals.
• Appeal hearing expected in second or third
  quarter 2006
• Established Coalition to Preserve Patient Access
  to Physical Medicine and Rehabilitation Services
  (24 members)
• Wide variety of members outside of sports
  medicine has made it less of a turf battle, has
  broadened grassroots and congressional reach.

9
How You Can Help

• Know and understand that this is both a patients
  access to quality of care issue as well as
  athletic training jobs issue.
• Sign up for the NATA Legislative Alert Center.
  (http//www.nata.org/members1/login-members.cfm)
• Write and CALL your members of Congress both
  Senators and Representative.
• Be sure they understand the issue is not the
  physical therapy cap or physical therapy
  direct access issue. Keep after them until they
  get it.
• Get your AT friends to write and call their
  legislators.
• Get your physicians to write their legislators
  about the issue.
• Get local and state chapters of the medical
  societies, patient advocacy groups to support our
  cause.
• Alert the media get talking points and help
  from NATA.

10
Key Contacts

• Marje Albohm, NATA Vice President
• mjalbohm_at_aol.com
• Cate Brennan Lisak, NATA Director of External
  Affairs
• catel_at_nata.org
• Teresa Foster Welch, NATA Assistant Executive
  Director
• teresa_at_nata.org

11
THANK YOU