AOPA, Academy Differ on PT Direct Access

The hot-button issue of physical therapist Direct Access legislation has ignited an exchange of letters between the American Orthotic & Prosthetic Association (AOPA) and the American Academy of Orthotists & Prosthetists.

Triggering a letter March 11 from AOPA to its members was a letter written by Academy President David Moretto, CP, FAAOP, February 11 to Ben F. Massey Jr., PT, MA, president of the American Physical Therapy Association (APTA), saying that the Academy, based on the recommendation of its Professional Issues Council, would "not oppose APTA's legislation at this time." The letter went on to suggest a collaborative project looking at the progress of patients undergoing physical therapy after receiving orthotic and prosthetic care.

The letter said, "The treatments our members provide work most effectively when delivered in conjunction with the services provided by your members. Conversely, physical therapy goals are frequently enhanced by orthotic and prosthetic intervention."

The letter suggested two specific possible studies: One on patients who have been fit with an initial prosthesis following amputation, comparing the functional outcomes of this population to a control group that does not receive therapy. Another possible example cited was a study of stroke patients following fitting of an AFO in the same manner.

Michael E. Hamontree, AOPA president, in a letter to AOPA members March 11, described AOPA's strong efforts to oppose the APTA Direct Access Initiative. "We have battled against Direct Access at the federal level when legislation supported by the APTA was introduced last year. We are involved in that same battle again this year. And we have worked at the state level with O&P associations to fight against initiatives by the APTA to broaden the PT scope of practice laws.

Hamontree's letter continued, "Now our efforts have been undermined because the American Academy of Orthotists & Prosthetists recently announced to the APTA that the Academy is not currently opposed to direct access legislation. This announcement occurred in a letter to the APTA in mid-February completely unbeknownst to AOPA."

The letter went on to say, "The APTA has made the letter from the Academy public and now congressional lawmakers have confronted AOPA with the apparent inconsistency in the views of the O&P community."

The AOPA letter named three points in which AOPA feels that the Academy's position on Direct Access negatively impacts the O&P community:

1.  "At the state level, PTs will make use of the Academy letter to counter our efforts in preventing them from obtaining prescriptive rights for non-Medicare patients.
2. " At the federal level, the Academy's position will be used to enhance the PTs' arguments in favor of giving them prescriptive rights for Medicare patients.
3. "At CMS [Centers for Medicare & Medicaid Services], the Academy's correspondence to the APTA will undercut AOPA's efforts to convince agency officials that PTs are not qualified to provide the full range of O&P services."

Academy President Moretto then posted a letter on the Academy's website to clarify the Academy's position. "I would like to clearly state the position of the Academy Board as it currently exists, based upon our understanding of the legislation and our meetings with the APTA."

Moretto continued, "In 2003 we joined in formal opposition against the Direct Access Initiative. In late 2004 Academy leadership met with the APTA, and we determined this legislative proposal would not impact orthotic and prosthetic services, as the provision of such care will continue to require a physician's prescription to be covered. We indicated to the APTA that we would not oppose this legislation at this time.

The letter emphasized in bold type that "The Academy will not, and does not, support any legislation that compromises the quality of orthotic and prosthetic services, and we believe that these services must be provided by appropriately educated orthotists and prosthetists."

Moretto noted that the Academy disagrees with the APTA on many issues, but that it believes the best approach is to underscore points of agreement rather than continuously emphasize differences.

Moretto said, "AOPA's letter to their membership misrepresented the Academy's position and intent, but we would agree with them that communication between our organizations on such issues should improve. Disagreements in how best to achieve our shared goals are inevitable, but they need not be a reason to divide two organizations that share a common concern. We will increase our efforts and continue our commitment to working with all the other national organizations to improve communication."

More developments in this issue are expected, and The O&P EDGE will provide updates as they happen.