Message From the President

Another year has come and gone into the history archives since our last formal newsletter and my letter to you the VAAT membership. As life and our profession have shown me, changes in all areas of both have occurred and are occurring. In the professional arena two issues which were topics of my letter to you last year are still in the forefront of the Executive Committee’s (EC) effort and time.  So paraphrasing and use some information from the NATA Governmental Affairs website (http://www.nata.org/members1/gov_affairs), here is an update on legislative issues nationally and in Vermont.

With regard to the CMS issue and Medicare reimbursement, the NATA national office and Board of Directors are still working diligently and legislatively to overturn a federal court ruling pertaining to the CMS (Centers for Medicare and Medicaid Services) June 2005 ruling pertaining to the prohibition of Medicare reimbursement for therapy services provided “incident to a physician’s services” by anyone other than a physical therapist, occupational therapist or speech and language pathologist.

NATA’s challenge of the Centers for Medicare and Medicaid Services (CMS) “incident to” rule sustained a setback in July as the Fifth Circuit Court of Appeals affirmed a lower court’s ruling that it did not have jurisdiction to hear the case. The CMS rule improperly restricts who may provide therapy services “incident to” – or under the supervision of a physician. In its July 3 decision, the Court of Appeals confirmed that NATA has standing to challenge the CMS rule, a positive finding, but determined the district court does not have jurisdiction to consider NATA’s claims. The Court reasoned that physicians have adequate incentives to challenge the rule on behalf of adversely affected athletic trainers, even though athletic trainers cannot themselves appeal directly to CMS.Importantly, the Court of Appeals did not determine that the CMS rule is lawful or that it would survive a legal challenge. That has yet to be decided.

With this as a backdrop and mild detour in overcoming this setback, on another larger front, new legislation was proposed which may make the above issue moot. Sen. Craig Thomas, R-Wyoming, has proposed federal legislation to add athletic trainers as covered providers of Medicare services. The bill, S. 3963, was introduced in the U.S. Senate Sept. 28. Called “Access to Physical Medicine and Rehabilitation Services Improvement Act of 2006,” the bill aims to make health care services more easily available to Medicare patients. The bill does two things:

1. Essentially overturns the challenged CMS incident-to rule and is consistent with existing law;

2. Makes athletic trainers and lymphedema therapists covered providers under Medicare.

As NATA President Chuck Kimmell, ATC has said “Any opportunity for reimbursement begins with Medicare,” he said. “If Medicare doesn’t pay for athletic training services, which are part of the physical medicine and rehabilitation codes, then [some private insurers] won’t, either. As we’ve already seen with the incident-to ruling, athletic trainers lose their jobs as a result.” For more information and ways you can and need to get involved in this issue, please go to: http://www.nata.org/members1/gov_affairs/bill3963/calltoaction.cfm

On another legislative front closer to home and with a more direct and potentially negative impact on VAAT members is a proposed change to the Physical Therapy Practice Act by the Office of Professional Regulation (OPR). On November 17th members of the VAAT EC, Tim Tourville, ATC- Vice President; Mike Landsberg, ATC--Legislative Affairs Committee Chair; and myself with our lobbyist, Allison Demag, met with representatives of the OPR, Chris Winters, Director and Kevin Leahy, Staff Attorney, to discuss the OPR’s upcoming proposal for the VT 2007 Legislative session to remove the “assistive personnel” wording from the VT Physical Therapy practice act. The rational they explained to us, which makes administrative and practical sense, is by removing the clause they want to prevent potential administrative and legal conflicts with regard to a VT licensed profession, Certified Athletic Trainers, being supervised and in effect reporting to another VT licensed profession, Physical Therapy. Although this occurs in other aspects of medical and healthcare professions (physicians, nurses, physician assistants), the major difference for ATC’s and PT’s is they are not in the same chapter of OPR rules where physicians, nurses and PA’s are. In effect our practice act is in Title 26, Chapter 83 where PT’s are in Chapter 38. This disconnect is what could create legal and administrative difficulties for each clinician involved.

As rationale as it may be, this radical change will have a negative impact on VAAT members working in the clinical setting to the point where these people will cease to be able to work in this setting. We have attempted to discuss this issue with the Vermont Physical Therapy Association (VPTA) in the past with no cooperation or resolution. We have brought this fact to the attention of the OPR as well as our desire for the parties involved to devise a wording change or develop new wording to maintain and protect the ability of ATCs to continue their positive and valuable work in the clinical setting. We are currently waiting to hear back from the OPR as to what their next step may be.

The above two issues are somewhat concerning to our profession and individuals alike. It highlights the need and importance for us as an organization to work together in effort, communication of facts and truths, and public awareness of our great and unique skills we have as health care providers. The continual importance of each of us to promote ourselves and the NATA as a medical profession to those we work with is also something we probably do well, but please don’t take it for granted.

In closing I can assure you the Executive Committee and I will and are working hard in your and the VAAT’s behalf. But in reality like most of you the job, family, and life in general always seems to be there as well. So we are asking you to get involved in contacting anyone you know or have connections with in the Vermont legislature and inform them as to what’s going on and to ask for their support for you and the VAAT with regard to the OPR and if we need to propose any additional legislation. Members of the EC will be going to 5 parts of the state in the new year to meet face to face with the members and to have an old fashioned “association / town meeting” to update you with information we have and to get personal feedback from you. We are looking at the Bennington, Rutland, St Johnsbury, Northfield and Burlington areas to have these meetings. As we have more definite dates, location and times we will be contacting you.

Let me or the EC know what you are thinking, concerned with, want to see happen, and make suggestions. The VAAT is only good and effective when EACH OF YOU get involved by input, feedback and involvement through out the State of Vermont. We are about to enter into a crucial and vitally important phase in the VAAT’s history and ability to move forward as a tremendous healthcare profession. Please give of yourself, time, energy and dedication to ensure we are successful for the members of today and the future.

Please check out the Announcements section for additional information and updates of VAAT happenings.

Finally all the best to you and your families in the upcoming holidays; may they be safe, full of love, happiness, peace of mind, spirit and body.              

Jim

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