Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board

Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board Retreat December 13, 2005 9:05 a.m. Members Present Donna Baker (Left @ 2:30 p.m.) Raymond Bilecky Beth Gustafson Mike Herbert Janet Howells Barbara Kraynik Averell Overby (Arrived @ 10:20 a.m.) Members Absent Thomas Caldwell Robert Frampton Staff Present Joseph Kirk, Administrative Assistant Jeffrey Rosa, Executive Director Legal Counsel Steven McGann, Assistant Attorney General (Absent) Guests Nancy Garland Call To Order The meeting was called to order by Section Chairperson, Barbara Kraynik, at 9:05 a.m. Administrative Matters Action: Janet Howells moved that the education of Angelica Echavez meets the requirements established in section 4755.42 (A)(3) of the Ohio Revised Code and rule 4755-23-03 (E) of the Ohio Administrative Code and is substantially equivalent to an accredited physical therapy program in the United States. Mike Herbert seconded the motion. The motion carried. Action: Mike Herbert moved to grant a 90 day extension to Sheldon Gold to comply with the continuing education requirements of rule 4755-23-08 of the Ohio Administrative Code. Donna Baker seconded the motion. Averell Overby was absent. The motion carried. Mr. Gold must submit proof of completion of twenty-four hours of continuing education to the Board no later than March 31, 2006. Action: Janet Howells moved to waive the English equivalency requirement of paragraph (E) of rule 4755-23-03 of the Ohio Administrative Code for Fatema Kapasi due to submission of proof of prior passage of the required English equivalency examinations. Raymond Bilecky seconded the motion. Averell Overby was absent. The motion carried. Barbara Kraynik announced that Marian Over, an Ohio licensed physical therapist, was selected by the Federation of State Boards of Physical Therapy (FSBPT) to serve on the Federation s PTA Analysis of Practice Task Force. The Section reviewed the credential evaluation for Olga Kehoe and requested that the Executive Director ask FCCPT for copies of Ms. Kehoe s transcripts and course descriptions. Discussion of Issues Medicaid/Reimbursement The Section would like to establish relationships with several other state agencies to begin the process of educating other agencies that pay for physical therapy services on the practice of physical therapy, as well as educating the Section on how reimbursement impacts and relates to allied health care services. Mike Herbert stated that regulatory entities will find that over the next five years, issues related to the business of medicine will start becoming larger than those tied to the actual practice of medicine. In addition, issues related to billing will become a large issue facing both the Board and the Ohio Physical Therapy Association (OPTA). Page 1

The three agencies the Section seeks to establish a liaison relationship with are: the Ohio Department of Insurance (ODI), the Ohio Bureau of Workers Compensation (BWC), and the Ohio Department of Job and Family Services (ODJFS). Mike Herbert stated that these relationships should help the Section better understand how other agencies function regarding reimbursement. This knowledge will help the Section better protect the public, especially as it relates to fraud and abuse issues that will likely come to the Board over the next few years. The Executive Director will write a letter and invite representatives from those agencies to attend Board meetings and ask those agencies to invite Section members to meetings focusing on reimbursement issues. If these agencies are willing, the Section will ask for members to volunteer to attend the appropriate meetings of those state agencies. Raymond Bilecky stated that any opportunity to educate third party reimbursement entities is a positive step. Nancy Garland stated that a representative from the Ohio Department of Health attended the OPTA insurance forum in 2005. OPTA plans to reach out to BWC in 2006. According to Ms. Garland, the purpose of these sessions is to educate third party payers on what activities are appropriate for a physical therapist to perform versus what s appropriate for chiropractors and/or other practitioners to perform. Fraud/Abuse Janet Howells attended a presentation on abuse and fraud at the 2005 FSBPT annual meeting. Ms. Howells stated that the presentation reported on physical therapy mills in New York and Massachusetts that were committing fraud related to automobile injury insurance claims. In New York and Florida, it is estimated that 50% of all automobile injury claims are fraudulent. It was unclear if this problem silently exists in Ohio. Ms. Howells stated that some of the factors leading to the rise in fraudulent billing were the growth of HMO s and declining reimbursement rates. The physical therapy culture has produced an attitude where physical therapists do not directly perform billing, instead leaving billing services to be performed by other staff. This can lead to a situation where a physical therapist has no idea what is going on with the business side of physical therapy. According to the presentation, there has been exponential growth in the number of physical therapy clinics in low income areas in these states. In addition, there were even cases of staged accidents to defraud insurance companies of money for physical therapy services. Raymond Bilecky asked how Massachusetts found out about the problem existing in their state, and how could the Ohio Board find out this information if no one is filing complaints with the board. Under a recently enacted Massachusetts law, the Massachusetts Physical Therapy Board must annually review automobile injury insurance data collected by that state s Department of Insurance to determine if any physical therapists are illegally soliciting clients and/or committing insurance fraud. The Massachusetts PT Board looks for patterns of CPT code usage with high reimbursement rates. In addition, Massachusetts requires mandatory continuing education in fraud and abuse for physical therapists. Janet Howells suggested a change in the Section s long standing position regarding how to answer questions related to reimbursement issues as the Section moves forward and these questions become more prevalent. The Section should look at reimbursement issues, especially as it relates to fraud and abuse, as a valid role of the regulatory process and within the jurisdiction of the Board. The Section discussed who needs to be educated on the issues of fraud and abuse. Should the Board educate the public? Are consumers going to complain about something they are not paying for in the first place? The Section felt that third party payors need to be educated, as well as licensees, as to what is appropriate. Physical therapy practitioners need to know that they have a responsibility to understand and be involved in the business aspect of the delivery of physical therapy services, not just the clinical provision of care. According to Nancy Garland, the American Physical Therapy Association (APTA) currently tells its members to be responsible and know what is being billed and reimbursed for the physical therapy services they render. The Section would support a continuing education change requiring licensees to complete a minimum number of hours of continuing education in certain areas as part of the renewal requirement. Barbara Kraynik, Robert Page 2

Frampton, and Raymond Bilecky will look at establishing the framework for proposed changes to continuing education. After completing their analysis, the Section will discuss any changes needed to the continuing education rule to implement the proposed changes. The Executive Director will determine what other states have requirements that licensees complete a specific number of hours of continuing education in different categories. Ms. Garland stated that OPTA would welcome the Section s guidance if the Section wants to make continuing education requirements more stringent to assist OPTA in the approval process. Life Experience/ Portfolio Review for Foreign Education Applicants Beth Gustafson brought examples of portfolios that have been completed at Clark State Community College. Ms. Gustafson is unsure if the Section wants to head in this direction, but went on to explain the procedure at Clark State. The applicant is given a packet of instructions and works with an adviser, who helps the applicant gather the information used to construct the portfolio. Clark State charges $75.00 for a 3 credit hour course; which is why Ms. Gustafson believes that community colleges would be more economical for those applicants only looking to gain general education hours from a portfolio review. The portfolio process uses an applicant s life experience or knowledge gained in previous classes to earn credit in a course that would satisfy the education requirements contained in Chapter 4755. of the Revised Code. The applicant must demonstrate how the experiences meet the requirements of the course syllabus and course content of the class for which the applicant wishes to gain credit through the portfolio review. Averell Overby brought in a copy of the Physical Therapist Evaluation Tool (PTET) that is designed for individuals applying to transitional DPT programs. The tool asks what percentage of time the applicant has spent on certain activities in the clinic, and asks the applicant to describe his or her knowledge on a subject, as well as how the individual obtained the knowledge. Dr. Overby argues that simply because they do not have the course content, or the professor did not list certain activities that were contained in the class in the course syllabus, does not mean that the applicant does not possess the minimum knowledge required to be a licensed physical therapist. If implemented, the Section plans to limit acceptance of portfolio reviews only from educational institutions with accredited physical therapy or physical therapist assisting programs in Ohio. The Executive Director will contact program directors to ascertain which institutions with accredited physical therapy programs in Ohio have a portfolio review program. The Section wants to see if this path will give applicants enough choices of where to obtain portfolio reviews. The programs will also be asked to send any literature they have on their process to the Board. Education Oversight The Education Oversight Liaisons wanted to clear up confusion that may exist regarding the difference between a refresher course and a review course. A refresher course is comprised of a list of topics for an individual to cover prior to reentering the workforce. Refresher courses are for re-entry applicants. A review course, which helps an applicant identify weaknesses and how to answer exam questions, is designed for exam candidates who are retaking the national physical therapy examination. The staff will ensure that all forms are clear on the differences between review and refresher courses. To address the issue of the Education Oversight Liaisons caseloads, the following changes to the Education Oversight process are effective immediately: On the 4 th examination application, the applicant must complete the examination preparation questionnaire and the office staff will offer counseling, if requested. On the 5 th examination application, the applicant must complete a remediation plan. Although a face to face meeting between the applicant and EO liaison is strongly preferred, a conference call is acceptable if the applicant cannot make it to Columbus for the meeting. On the 6 th examination application, the applicant must sign a conditional grant of licensure agreement before being approved to sit for the national physical therapy examination. A conditional license would be Page 3

issued once the applicant passes the examination. The terms of the agreement would include, but would not be limited to, 250 hours of supervised practice in the first three months of licensure and completion of the APTA Clinical Performance Indicator (CPI). The Executive Director will research the Board s contract with the FSBPT regarding mandatory retakes for individuals out of practice for three or more years. In addition, the office will place on the website the policy that requires an applicant out of practice ten or more years to automatically re-take and pass the national physical therapy examination before an Ohio license is issued. APTA DPT Task Force Averell Overby reported on the American Physical Therapy Association s DPT task force. The purpose of the task force is to determine if the clinical designation for a physical therapist should change from PT to DPT. Dr. Overby was selected by APTA to represent entry-level DPT educational programs. The general feeling of the task force members was to not change the terminology from PT to DPT. A representative from the pharmacology association presented on the issues and challenges that faced the pharmacy profession when that profession moved to the PharmD degree. According to this individual, the clinical designation of the pharmacist did not change when the profession switched to the entry-level doctorate degree. After additional brainstorming, the panel discussed the possibility of adopting the clinical designation of PTD. It was felt that this designation would make the distinction between the academic degree (DPT) and the clinical designation (PTD). The Section discussed how licensees should identify themselves if the PTD, or those with DPT degrees, were implemented. Dr. Overby mentioned that at Ohio University, DPT graduates are told to follow the conventions used at their facility. For example, if everyone introduces themselves by their first name, a DPT graduate should not introduce themselves as Dr. Smith. In addition, if the doctor title is used, it should be made clear to the patient that the individual is a doctor of physical therapy to ensure that the patient is not mislead into thinking that the physical therapist is a medical doctor. The Section also felt that if the PTD were adopted, the level of continuing competency required to renew a license would need to be enhanced. Post Disciplinary Tracking At the FSBPT annual meeting, Ms. Howells attended a presentation discussing post disciplinary tracking to ensure compliance with adjudication and/or consent orders. One of the presenters, James Angliot, described the external monitoring services performed by his company. The cost of this monitoring is paid for by the licensee as a part of the consent agreement. The Section asked the Executive Director to invite Mr. Angliot to a Section meeting in 2006 to educate the Section on the services his company offers. Even if the Section decides against using his services, his presentation may provide the Section with new ideas that could be implemented internally. It was determined that there are options available that would enhance the Board s ability to monitor licensees whose licenses were disciplined by the Board. Negligent Hiring/Program Admissions The Section discussed whether criminal background checks should be required as part of the licensure process. The Executive Director reported that as part of the board consolidation work, various Board directors discussed the idea of collectively seeking a law change to implement this requirement across all boards. The Board stated that it would be supportive of a law change to require criminal background checks prior to licensure. Dr. Overby reported that Ohio University started requiring applicants to go through a pre-admission criminal screening to ensure that no problems arise while those students are completing the clinical requirements of the program. The Executive Director stated that he believed that within ten years, all regulatory boards will require criminal background screenings prior to granting licensure. The Section also discussed whether recruiting individuals into the profession of physical therapy was a public protection issue that falls within the jurisdiction of the regulatory board. It was felt that proactive measures to deal Page 4

with the pending shortage of physical therapy practitioners is a public protection issue. Ensuring an adequate supply of practitioners to provide services in the underserved areas of the state is a public safety issue. The Section asked Nancy Garland if OPTA and/or APTA were currently doing anything to get more people to enter the profession. Ms. Garland reported that APTA is working on providing financial assistance to individuals entering physical therapy programs. Next Meeting Date The next meeting date of the is scheduled for Thursday, January 5, 2005 at 9:00 a.m. Adjournment Raymond Bilecky moved that the meeting be adjourned. Janet Howells seconded the motion. The motion carried. The meeting adjourned at 2:55 p.m. Respectfully submitted, Joseph Kirk Barbara Kraynik, PT, Chairperson Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board, PT Section Donna Baker, PT, Secretary Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board, PT Section Jeffrey M. Rosa, Executive Director Ohio Occupational Therapy, Physical Therapy and Athletic Trainers Board DB:jmr:jak Page 5