Nick, welcome back to the show.
Thanks for having me, Jimmy.
Good to be here.
I feel like every time you come,
it's like,
something's going on and I
need you to pay attention
and I need you to do something.
And that's, that can't be easy, right?
Like you're constantly
listening to the profession,
paying attention to what's
going on in DC.
I mean, just before we hit record,
you said, Hey man,
just got off a plane for DC
and then next week I'm going back to DC.
And that's where decisions
are fortunately or
unfortunately made like it or not.
That's where things happen.
So I feel like you're the
guy who's always like, Hey everybody,
I need you to pay attention to this.
And then in a few weeks,
it's this other thing.
Things are always happening.
That can't be easy for you.
Easy?
No,
because no one can stay on top of
what's going on in DC.
So I don't think it would be
easy for anybody.
However, is it needed?
Yeah.
And is it something that we
as a profession need to do
a better job at it, right?
Things happen all the time that affect us.
as therapists or as
healthcare providers from
decisions that are made in
Washington and other state
houses around the country.
And not being on top of
those things sometimes can hurt you.
And so, yeah, it's on all of us to say,
hey, look at what's going on here.
Hey,
just find out this is going on and
bring that out to the masses.
And one of the beautiful things is, though,
that
You know,
we're we got people like you
who've got great reach and, you know,
we can get on to do a podcast.
We've got companies who are
just killing on social
media right now so we can
get the message out much better.
So we're learning and we're
doing much better at it.
All right.
So of importance right now,
we'll start off with the big stuff,
the SAFE Act.
That's H.R.
eleven seventy one.
And now that bill aims to
prevent falls and reduce
opioid use amongst older adults.
So far, Nick, I'm all I'm all in.
I like both of those things.
I'd like both of those
things to to go away.
Why is it such a game changer?
And what can physical therapists do?
The people listening right
now to help push this thing forward?
Well,
the reason it's a game changer is it
positions therapists as
really the experts in fall prevention.
Because, I mean, that's what we are.
And I think I've talked to
you about this before,
but I wish you could change
your name to Fallologist, right?
Because then everyone would
know what we do and everyone would know,
like, that's us.
But the reason why it's
important right now is because, you know,
there's this stuff going on
that you guys may have heard of,
which is called a reconciliation bill.
And the president wants to
have this really huge bill
that comes out that says,
A lot of things.
They're trying to put an
extension of the tax brackets in there.
That's a huge thing in and of itself.
But they're trying to put
Medicaid reform in there.
There's going to be health
care provisions.
There's going to be
provisions for things that
stand way beyond taxes.
We have a commitment.
uh that they're also going
to try to address fee
schedule inside
reconciliation but the
problem is all this stuff
costs money and where the
safe act can be positioned
and what I just basically
spent the last few days in
dc doing with some of our
other aptqi board members
was saying hey look we
understand you have to pay
for a lot of this stuff
that's coming out and
here's an idea we spend
fifty billion dollars a
year on falls it'll be a
hundred billion by the end
of the decade at the way
the slope of the curve is going
We can save some of that
money because if we prevent
some of these falls from happening,
that ambulance ride, that ER visit,
that hip replacement surgery,
all those expenses start to
dissipate and you spend
less money on that all in
exchange for a hundred and
forty dollar PT or OT fall
risk assessment.
Right.
So in the country right now
with the current rates,
this assessment we're
talking about would cost
about one hundred and forty bucks.
We want to make that free to the patient.
but one injury from a fall
that results in medical
costs is ten thousand dollars.
So the premise is pretty simple.
If a PT as a whole can bat
better than one for seventy,
this bill starts to save us money.
And we know that we are
better than one for seventy.
So we're positioning this as a solution.
So when we go to Congress,
we're not saying pay us more,
pay us more and get in line
with everybody else who wants more money.
We're saying here's
something that you can use
as an offset to save money.
It's better for patients.
One of the things we're
really excited about is
You know,
it's easy to position this as
it's good for therapists,
but we're not going to have
a windfall from this.
But it's really great for
patients and it's not just us saying so.
We got a public statement of
support from AARP saying
that they support this bill.
So it really is better for the patient.
And oh, by the way,
it happens to be helpful
for what Congress is trying
to do right now with the
reconciliation bill.
So that's why it's important.
What can folks do?
We've been talking about it constantly,
contacting your members of
Congress saying, here's the bill number,
eleven seventy one.
Please support it.
Get your patients on board.
You as a therapist, you're one person,
but you treat dozens of people a day,
multiple dozens a week.
I'm sure all of them either
are at risk for falling
themselves or have a loved one that is.
your father, your mother,
your grandparents, your in-laws,
this affects everybody.
So start getting other people involved.
You'll be surprised how easy
it is to get some folks, you know,
relating to this because
everyone probably knows
somebody who is at risk or
has already fallen and that
fall has completely changed
somebody's life.
Yeah.
And with baseball season,
just a couple of hours away,
one for seventy is point
zero one for two.
I think we can bet better
than I'm pretty sure I have faith.
I have faith.
So that is the way, like it or not,
but contacting the people
that represent you is the
way to make change.
Now,
a little bit of a different
organization or maybe some crossover,
Medicare cuts in the future of PT.
Ongoing reductions in
Medicare reimbursement
rates have been a huge
concern for the profession.
Just go into any Facebook
group and you hear that left and right,
people complaining about that.
Can you break down the
latest developments and
what they mean for PT clinics and,
of course, ultimately their patients?
Yeah, where we are right now,
it's a pretty precarious state.
I mean,
people are talking about it's a two
point eight percent cut for this year,
but that's just looking at it too narrow.
In the last five years,
we're talking about five
consecutive years of cuts.
This is like eleven percent cumulatively,
and we've done nothing wrong.
This is this is not in
response to a punishment.
This is that therapists are
doing bad things.
You hear these terms flung around, fraud,
waste.
We're not we're not part of
the abuse of the fraud.
That's not us.
But we're still getting this huge cut.
So where things currently
stand as it comes to
Medicare reimbursement is I
was alluding to it earlier.
We're trying to make sure
that it's addressed in this
huge bill that they're
trying to put together on the tax cuts.
And we received some
commitments that they're
trying their best to put it in there.
However, again,
it's not done until it's done.
And it could still take a while.
I don't think anything's imminent.
This build they're trying to
put together will likely
drag on into the summer.
And one of the messages that
we took to the Hill this week was, hey,
if you do...
if you are able to come
together to give us a
little bit of a reprieve on
the fee schedule for a
short-term fix and a patch
like they've done in the past,
If it happens near the end of the year,
like,
should we just look at maybe making
it for all of twenty twenty six too?
Because why should we come
right back in December and say, hey,
we have a problem.
And again,
so we're getting we're getting
that word out that like we
understand these things take time.
But then maybe the trade off
is we didn't we didn't get
relief in the first half of
twenty twenty five to maybe
try to take care of twenty
twenty six while we're at
it and just give us some
more breathing room.
Long-term,
I think we've got to start
looking at things like how
do we protect ourselves
from cuts in the future?
Because we can't keep
getting on this
merry-go-round of we got cut bad,
now let's try to get cut a
little bit less and get a
little bit money back.
But at the end of the day, again,
you look backwards and
we're down double digits in
a short amount of time.
It's not sustainable.
It's not fair to our
therapists over the long term.
Who's going to want to
become a therapist at that
rate and go to school for
the length of time you have
to go to school when you
could do any number of
other health care
professions that are great
professions and that help a
lot of people.
But the risk reward is a lot
better for your degree.
Right.
The cost to get your degree.
So we have a problem here
and we need to start
thinking long term about
where do we go from here in
terms of how do we solidify
the value of therapy and in
the eyes of the folks who
make these decisions to say
we should start protecting
this service instead of
looking for ways to cut it,
especially when it's not much left.
There's not much meat left in our bone,
unfortunately.
Yeah.
Yeah, I think you're right.
Let's go to a different bill,
Medicare Patient Access and
Practice Stabilization Act
for those keeping score at home.
That's H.R.
eight seventy nine.
Now,
that bill has major implications for
both practitioners and patients.
What are the key points PT
should understand and how
can they help push it through?
Yeah,
this is a really important bill
because it's highlighting the fact that,
you know, like I said,
we've had these cuts.
at a time when inflation is
run rampant and everyone's costs,
if you run a clinic
You're paying more for your rent.
You're paying more for your supplies.
You want to be a good employer.
You're trying to give
everyone as big a raise as
possible for your wages.
You can't run a business
where your expense line is
going straight up and your
income line is going straight down.
And that's what's happening.
So what eight seventy nine
is trying to bring to the
to the to the masses is
look for beyond the fact
that we keep getting cut.
We need to start
incorporating inflation
into the equation here
because it has not occurred.
And unfortunately,
in the office space setting,
so it's not just therapists,
but anyone paid on that fee schedule,
which is a lot of physicians as well.
Our schedule has been frozen
from any kind of
inflationary update at all.
So again, same thing.
You have the bill number.
We need to get folks to
understand that our fee
schedule is not keeping up
with inflation.
And again, for the long term,
we have to at least start
getting to where every year
it's a given that
providers' expenses are
going up and that payment
should go up to at least
try to offset some of that.
Yeah.
And we'll reiterate,
many PTs feel sometimes
like policy is someone else's job.
It's not just the job of big
organizations or people
whose job it is to go to the Hill.
It's crucial for every
clinician to get involved
when representatives can
hear these messages from
multiple voices in their
communities from patients
that may or may not vote to
get them back into office.
They tend to they tend to
pay attention and it is an
effective way that they can
make an impact.
If I asked you to look into a crystal ball,
if PTs and OTs don't take action now,
where might you see our
profession or our
professions in five years?
I mean,
I don't want to I don't want to
rattle the saber and fear monger,
but you do want to make
sure people understand the
tension in the story over
things that might happen.
What's at stake if if some
of these legislative
efforts don't succeed?
Well, here's what we're looking at,
and I appreciate your point
about let's not get too morose,
but let's look at what the
trends currently are.
I mentioned this a little bit earlier.
wants to go to pt school in
in five years if uh um if
the situation is that you
continuously get cut and
and and oh by the way in
five years if anyone thinks
that tuition will go down
you're I'd love to talk to
you I don't know how you
would get that so whatever
the cost is today every
year from now in the next
five years the cost to
become a pt will go up
But also every year or the next five years,
the salaries to be a PT may
not be moving much.
And again, as those widen,
we're going to have a workforce problem.
And the APTA published a
nice paper kind of highlighting that, hey,
we're starting to see
projecting shortages.
And I think that will only exacerbate,
actually, because we have a pipeline.
that we're used to getting
new grads every year to
replace people who retire
or cut back on their hours.
But what happens when your
pipeline dries up?
And also, separate from the workforce,
let's just talk about access.
Our members are closing
clinics that have twenty
patients a day coming in.
We're not we're not closing
clinics because we have no
one coming in and there's
no there's no demand for
our services in our country.
There is absolutely a chunk
of baby boomers coming into
Medicare every single day, and they
they will guzzle pt
resources if they can and
services if they can
however if the payment we
get for those services
can't meet um our costs
we're gonna have to shut
down clinics so when you
have a service that people
want and will come in and
you have the volume but you
actually have to close the
clinic anyway what's what's
going to happen to your
patients who need those
low-cost services um
they're going to fall more
they're going to have more
surgeries than they
probably needed they're
going to be less independent
Maybe they're living with their kids more.
Maybe they're living in nursing homes.
I mean, think about this.
If every household,
there's not enough
Generation X folks to tell the boomers,
you can come live with me.
And when someone does,
if they're in that
situation where they can do that,
someone's got to stay at home with them.
Now you're taking people out
of the workforce.
There's a whole add-on effect.
And I know I'm maybe drawing
some lines that you think, OK,
that might be a stretch, but it's not.
When we're talking about not
having an independent,
healthy senior population,
these things happen and if
you talk to anyone with an
older uh a person in their
home or they're they're a
caretaker for someone
elderly they are probably
shaking their heads to know
exactly what I'm talking
about yeah yeah when access
goes down uh when
reimbursement goes down
that is going to close
clinics and that's going to
reduce access and then
quality of life I mean we
want to start with finish
with the end which is
quality of life will go
down for those who need it the most
Some people,
I ran into some bigwigs this
last weekend.
I was away at a conference.
Some people actually, like bigwigs,
people who run companies,
listen to this show.
Wow, amazing.
Who knew?
APTQI is an organization
that brings together
organizations to do a lot
of the work that Nick is talking about.
So Nick, I'll give you,
since we know big fancy,
sometimes big fancy people
listen to this as well.
What's your pitch for
organizations who are not
members of APTQI of why they should join?
What would they get out of it?
What would our profession get out of it?
Sure.
So if you're a leader of a
company that and it doesn't
even have to be a company
that is a provider of care.
If you're a leader of a
company that has any stake
in the profession,
maybe you sell equipment to therapists,
maybe you sell software to therapists,
maybe you sell a platform
or you have a digital platform.
whatever it happens to be.
If as therapy goes, your company goes,
there's a place for you at APTQI.
And what I mean by that is
we have a structure to
where we have membership.
If you're a provider group,
we have a structure.
We have a membership tier if you're
sort of like a vendor for
therapy providers.
And what we do with our members is one,
we educate them on what's going on.
But two,
we take all of them to DC and we
have them talk directly to
lawmakers and say,
this is what's going on.
So you were mentioning,
I just got back from DC yesterday.
I was there with about seven
of our CEOs and I'm going back next week.
The plan is about, you know,
another five or six of our
companies are sending representatives to,
and we will take you on a hill.
What we do with your dues money is
We, you know, we get materials.
We get, you know,
lobbyists that help push our cause.
And we take you on the hill and we say,
this is what we need to do.
And this is we need to talk to you.
And this is what we need to say.
And it doesn't matter if
you've never done it before.
We will show you what to do.
A-P-T-Q-I dot com is where
you can find out more information.
Always informative.
Thanks for keeping us
abreast of the situation.
Would love to hear more.
Maybe we'll bring you back
in a couple of months to
hear where these things
that we talked about now,
how they played out.
Update,
and then I know this is going to be
a shock to the audience.
I bet there'll be something
new we need to pay attention to.
Probably.
Good job security for you,
but that just highlights
that there's always stuff
going on that we need to
pay attention to and we
have to stay vigilant or we
don't get represented.
That's it in a nutshell.