Flipping through the Yellow Pages, on the way to "Chimney Sweeps" or "Churches - Free Will Baptist", your eyes are drawn to the subtle, understated print ads under "Chiropractic".
You notice a preponderance of chiropractic ads list "Physical Therapy" as a service offered in the clinic. Your natural reaction is to:
A) Exclaim "Wow. How great to see a physical therapist and chiropractor working together in harmony for the good of the patient";
B) Call the APTA to report improper use of the protected term "physical therapy"; or,
C) Pick up the phone, cloak the receiver with a Kleenex, call the chiropractor, challenge the receptionist to produce a license number of the physical therapist on staff (feeling confident that there is no physical therapist and that the chiropractor has reduced the sum total of your profession to the application of heat, cold and e-stim), chicken out and hang up at the point she starts repeating "Who is this", forgetful of the fact that you live in the day of "Caller ID", and must now move from your home.
On the way out the door of your condo/apartment/abode, you stop and pick up the day's mail.
Sandwiched between "You may have already won six million dollars, (fill in your incorrectly spelled name)" and "You are already approved for your (fourth, 22.5% interest) VISA card", you find a magazine from your professional organization.
You read with interest the column on an upcoming congressional bill which is strongly supported by massage practitioners and strongly opposed by physical therapists. Your natural propensity is to:
A) Call the massage practitioners you have worked with in the past and ask them to explain their "take" on the bill;
B) Call your Congressman and explain the need for opposing this particular piece of legislation; or,
C) Practice your meridian needle placement on a miniature doll dressed as a massage therapist.
Now late for the office, you figure it won't make a significant difference if you stop at Hardees for their Texas Toast breakfast sandwich. Sitting in line at the drive-through, you browse a brochure for an upcoming aquatic therapy course.
You notice that there is now available a certification for the"Aquatic Therapy and Rehabilitation Practitioner". This certification process will be available to physical and occupational therapists, athletic trainers, exercise physiologists, aquatic fitness instructors and therapeutic recreational specialists, as well as individuals with "life experience". You:
A) Plan on attending the lecture and asking salient questions about the intent of such a broad certification before making a decision about its appropriateness;
B) Plan to write a note to the instructor regarding your doubts about how such a certification would be implemented and policed in light of the multiple baseline levels of knowledge;
C) Dream of boycotts and protests and jabbing individuals who wish to enter the meeting room with Aqua Noodles and the Hydrotone Bell.
Mutidisciplinary Care
Multidisciplinary or interdisciplinary care is more prevalent today as practitioners attempt to treat patients as a whole and not just an injured part.
However, health care is by no means exempt from the squabbling and turf battles which arise whenever there is low demand (creating by reduction in reimbursement) and an abundance of suppliers. The system, by its very nature, forces its constituents to battle for a significant portion of the proverbially limited "pie".
This is not necessarily an evil. Competition is the soul of the market place; it keeps us from stagnating. But is there an argument to be made for establishing multidisciplinary teams?
One of the more obvious territorial wars appears to be in the realm of aquatic intervention. Over the last five years, with the appearance of a CPT Code for "Aquatic Therapy", there have been numerous border squirmishes over who can provide therapy services in the water. Individuals who would not have felt comfortable billing insurance under CPT codes for "Therapeutic Exercise" or "Gait" are now billing under the Aquatic Therapy code. It has not helped that the term "therapy" is not legally defined or protected.
Insurance companies are confused, and are reacting to the influx of "aquatic therapy" charges with skepticism. This skepticism has lead many companies to begin a policy of denying all aquatic intervention, irrespective of the provider.
Kiki Mayer, a pediatric PT based in Hudson, Wisconsin, is frustrated. "I have received numerous denials from Medicaid stating that aquatic therapy is not necessary. It has gotten so bad that they no longer care if the provider is a PT or not. They just deny across-the-board."
Exactly what is an aquatic therapist?
An "aquatic therapist" is an odd duck, with no legal backing and no practice act. This has led the APTA to their current practice of calling PTs who work in the pool "physical therapists with expertise in the field of aquatic therapy" in an attempt to educate payers about the difference in aquatic services.
The Aquatic Therapy and Rehabilitation Institute (ATRI) based in Chassell, Michigan, has provided a yearly conference which brings together the best of all disciplines which treat patients in the water. More recently, ATRI created standards of practice for the "aquatic therapy and rehabilitation practitioner". This movement has been met with mixed reactions.
Many disciplines who practice in the water, but do not have their own licensing boards, are delighted. The standards begin the process of defining a knowledge base for the "aquatic therapist". It lends credibility to their practice and provides employers with standards for the industry.
But the process which was designed to build bridges between the disciplines (over their one commonality, water), has created some deep-felt schisms as well.
One ATC, discussing the ATRI certification (now run by the International Council of Aquatic Therapy and Rehabilitation Industry), exclaimed, "How can you certify a group of individuals with no common education? We all have such a variety of didactic backgrounds, it would be impossible to test anything above the lowest common denominator of knowledge." Readers can find more information on what is currently happening with this certification at www.icatric.org
Putting it All Together
One facility where the disciplines come together to place the patient, and not the profession, as center, is the Hetrick Center in Middletown, Pennsylvania. Over 15 years ago, Paul Hetrick, D.C. started his chiropractic practice in Middletown, Pennsylvania.
At that time, he felt strongly that although spinal manipulation was a powerful tool, it should be followed by exercise and education. Unfortunately, chiropractors were unable to refer to physical therapists in the state of Pennsylvania. He was, however, able to hire an exercise physiologist and the Hetrick Center was born.
Several years ago, the Center brought on Dr. David Frank, board certified in Family Medicine and Sports Medicine. With the arrival of Dr. Frank, the rehabilitation options at the center exploded.
Recently, the Hetrick Center has expanded to include physical therapists and assistants, a licensed practical nurse, a massage therapist and a practitioner of traditional Chinese Medicine on staff. They provide services ranging from aquatic rehabilitation to acupuncture, chiropractic and the Feldenkrais® Method.
"The beauty of it is that we can treat all aspects of musculoskeletal ailments. If a patient walks in with a script which requests physical therapy, we can send the person directly to the PT," states Dr. Frank.
"If the patient wishes to see the chiropractor, we shuttle them off to the D.C. If the person walks in and says 'I hurt' and doesn't know what to do, I can see him and decide which of our interventions is appropriate."
At the Hetrick Center, the patient participates fully in his care. "If the patient has had good success with an aquatic program in the past, I'm a big believer in allowing him to choose what has worked," reports Frank. And the staff has a good working relationship.
"We always make fun of each other," chuckles the physician. "I'm always accused of getting the free stuff. We all work well together. I think problems among the disciplines must be personality-based. There are huge turf wars in the state of Pennsylvania between chiropractors and physical therapists. There's a lot of overlap in practice and a lot of feuding."
"But you don't see that here. Perhaps, it's because we work side by side, and respect each other's strengths. Ultimately, our patients are better off with us focusing our energies working for the patient and not against each other. Isn't that what you would want from your health care team?"
Professional Associations and Organizations
American Academy of Orthotists and Prosthetists 1650 King St., Suite 500, Alexandria, VA 22315 Phone 703/836-7118
American Kinesiotherapy Association PO Box 614, Wheeling, IL 60090-0614 Phone 800/296-2582
American Physical Therapy Association 1111 N Fairfax St., Alexandria, VA 22314-1488 Phone 800/999-2782
American Occupational Therapy Association 4720 Montgomery Lane, PO Box 31220, Bethesda, MD 20824-1220 Phone 301/652-2682
American Speech-Language-Hearing Association 10801 Rockville Pike, Rockville, MD 20852 Phone 301/897-5700
American Therapeutic Recreation Association PO Box 15215, Hattisburg, MS 39404-5215 Phone 601/264-3413
Aquatic Resources Network 302 160th St., Suite 200, Amery, WI 54001 Phone 715/248-7258
Associated Bodywork and Massage Professionals 28677 Buffalo Park Rd., Evergreen Park, CO 80439-8478 Phone 303/674-8478
National Athletic Trainers' Association 2952 Stemmons Freeway, Dallas, TX 75247 Phone 214/637-6282
National Therapeutic Recreation Association 2775 South Quincy St., Suite 300, Arlington, VA 22206-2204 Phone 703/578-5548
Disclaimer
The information presented in this article is meant to be a summary and educational in nature. It is not meant to serve as a substitute for legal advice.
Author Bio
Andrea Poteat Salzman, MS, PT is the owner of two businesses, the Aquatic Resources Network and Concepts in Physical Therapy. She has received both the prestiguous Aquatic Therapy Professional of the Year Award (Aquatic Therapy and Rehabilitation Institute) and the Tsunami Aquatic Therapy Award.
Salzman is well-regarded within the industry as:
- Editor-in-Chief of an aquatic therapy trade journal and newsletter;
- Author of over a dozen publications, including the soon-to-be-released Evidence-Based Aquatic Therapy textbook;
- Freelance author and columnist;
- Aquatic therapy seminar instructor;
- Adjunct faculty and research advisor, St. Catherine Physical Therapy Program, Minneapolis, MN;
- Immediate past manager of therapeutic aquatics, St. Paul Ramsey Medical Center, St. Paul, MN;
- Researcher and grant recipient examining aquatic exercise vs. land-based exercise.
She may be reached via e-mail at asalzman@aquaticnet.com
