Subject: Urgent Call for Change in APTA Representation

Dear Executive Staff of the APTA,

Our profession, specifically outpatient physical therapy, finds itself at a critical crossroads. Large corporations like ATI are grappling with substantial quarterly losses, while 70% of outpatient facilities—comprising small private practices—face challenges such as ongoing Medicare cuts, labor-intensive authorization requests, and poor reimbursement from extremely profitable insurers and third-party administrators. Moreover, the growing payment disparity and control of where a patient seeks care, between private outpatient settings and physician-owned or hospital-based practices, is squeezing out smaller, privately owned practices.

This communication is a plea for change within our professional association, particularly concerning representation in the House of Delegates and, ultimately, the Board of Directors.

An analysis of the House of Delegates Demographics report as of June 30, 2023, highlights a significant imbalance. The largest practice setting in the House of Delegates in participation and representation is academic. This has ranged from 30 to 40% with an average of 35% over the 10-year period of 2013 to 2022…. This is significantly different than APTA membership at large and data on the profession collected by government agencies. Outpatient practice is the primary practice setting in three other data sets: APTA membership at large is 39%, U.S. census data is 42%, and the Bureau of Labor Statistics is 43% for the profession. The academic setting is significantly lower among APTA members at 7.5% and less than 1% of the profession is in the academic setting.”

This disparity underscores the urgency for a more proportional representation reflecting the actual demographics of our profession.

A review of the House of Delegates actions over the past five years reveals a misalignment between the association's direction and the needs of practicing clinicians. This discord contributes to stagnant association membership growth, with non-members expressing dissatisfaction and a reluctance to join due to a perceived lack of benefit.

While acknowledging the association's efforts with regards to advocacy on our behalf, it is apparent that resources are often diverted to motions voted on by the House, which do not address the issues affecting clinicians—payment, documentation requirements, authorizations, TPAs, Medicare regulations, and other obstacles hindering effective patient care.  For example, although significant strides have been made with direct access, the requirement for a physician's signature on a Plan of Care for Medicare patients remains a significant barrier to achieving true autonomy.

Our chief concerns include:

• Inadequate reimbursement rates, reaching as low as $55/visit, especially from profitable insurers.
• Burdensome documentation requirements.
• Lack of autonomy with Medicare.
• Supervision requirements for PTAs.
• Proliferation of Third-Party Administrators, exacerbating reimbursement challenges.
• Compensation for acting as Clinical Instructors for students.
• Difficulty in hiring and retaining PTs due to crushing college debt.
• Ongoing Medicare cuts.
• Inability to pay PTs and PTAs commensurate with their education/experience.

Recent House discussions have primarily centered on matters such as..

•​Equal pay regardless of gender or gender identity    ​

•​Pay Transparency by Employers

•​Recognition of subspecialties​

•​Exploration of Alternative models for PTA education

•​Streamlined credentialing for PTs and PTAs

•​Affirmation that jurisdictional statutes and regulations take precedence over TPA policies

•​Better support of component social media-based marketing efforts

•​Support of initiatives to improve rural health issues

•​Promote role of PT in treatment of long COVID

•​Increased education on indicators of human trafficking

•​More mention of PT referral in published clinical practice guidelines

•​Resources to help PTs and PTAs take a more prominent role in referring patients for participation in community-based health programs.

These issues do not align with the issues affecting the clinician.  It is time for a change.

We strongly urge a reevaluation of the association's policies concerning representation in the House of Delegates, making it a requirement that the House delegation accurately reflects the percentage of members in each practice setting. Your attention to these critical matters is vital for the growth and prosperity of our profession.