Physical Therapy Legislation: End-of-Session Summary

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The 85th Texas Legislature has finished its standard interval and is now in special session.  Unfortunately, legislation pertaining to Physical Therapy was not moved forward into law during this session.  Over the last few months, Symmetry has been actively supporting and following the progress of Senate Bill 728 and House Bill 2118 – companion bills that would have allowed Texas citizens to directly access physical therapists for the prevention and treatment of conditions affecting movement and function by removing the requirement of obtaining a referral prior to beginning physical therapy treatment.  (If you are not familiar with this issue, you can read more about it in this blog post from the beginning of the 2017 Legislative Session.)

As of the end of the Session, neither Senate Bill 728 nor House Bill 2118 was forwarded out of committee.  Thus, the bills were not heard on the floor of either the Senate or the House by the entirety of either legislative body.  Within the committees of both the Senate and the House, legislators reportedly voiced support for the bills privately to the Texas Physical Therapy Association.  However, there was not sufficient willingness on the part of these legislators to publicly cast votes in favor of the measures.  This lack of political will – at least on the Senate side – has traditionally been related to lawmakers’ desire to avoid taking a position on the issue of access to physical therapy that is out of favor with the opinion of other powerful committee members.  Legislators were hesitant to risk their individual political leverage within their committee on this particular issue.

The lack of progress for Senate Bill 728 and House Bill 2118 this Session is extremely disappointing and frustrating.  Allowing Texas citizens unfettered access to physical therapy as a part of a health care network should not be a complicated issue.  In fact, in light of many health-related statistics in Texas, it seems that the Texas Legislature would be serving its citizenry better if they were actively encouraging the removal of barriers to entry into the health care system.

According to America’s Health Rankings’ 2016 report, Texas ranks 45th in the nation when considering the availability of primary care providers.  There are large swaths of the state that have a dire need for health professionals of all sorts and which are designated by the U.S. Department of Health and Human Services as “Health Professional Shortage Areas”.   If physical therapists were directly accessible to the public, they could be an option for entry into this overloaded primary health care system for patients with mobility issues and musculoskeletal disorders.  Wait times for initial physician appointments in many areas of Texas can be at least 2 weeks, and in many cases up to 30-35 days.  It is not unusual for patients with musculoskeletal pain issues to be less productive during their daily lives and more reliant on pain medications during these extended wait times.  A physical therapist can often schedule a new patient into their day within 24-48 hours.  During the 2-4 week interval that this patient might have been waiting for a primary care appointment from another provider, they could instead be actively addressing their dysfunction and significantly shortening the interval of their recovery under the direction of their physical therapist.

Texas is ranked 42nd in the nation for the proportion of Physical Inactivity.  We are 40th in the nation in terms of Obesity.  We are 37th in the prevalence of Diabetes and 34th in the percentage of deaths due to Cardiovascular Disease.  It is well-documented across medical literature that even moderate levels of consistent physical activity are positively correlated with multiple positive health indicators, such as longer life spans, reduced risk of chronic disease, better capacity to maintain independent living when aging, and a diminished incidence of falls.  Enabling participation in physical activity is precisely what a physical therapist does.  We are movement experts.  At a foundational level, we enable people to walk, get up from their chairs or off of the floor, carry their groceries, maintain their balance in a dynamic environment, and participate successfully in their daily lives – whatever their chosen activities may be.  We help people to participate in their community, care for their youngest and oldest relatives, function at their work places, and achieve success in their various recreational pursuits – from gardening to golf, and from social dance to professional sports.  That the Texas Legislature fails to find it appropriate that their citizens have access to physical therapy as a tool to maintaining a healthy lifestyle is incredible – not in a good way.

The unwillingness of the Texas Legislature to move forward with this issue cannot be explained by there being a lack of precedence regarding Access to Physical Therapy.  47 other states have already created health care systems where physical therapy can be accessed without barriers like those that still exist in Texas.  The U.S. Military has long utilized physical therapists as primary care providers – even to the point where military therapists have prescription-writing privileges for imaging exams and some medications.  Other states have documented that health care expenses are NOT increased by allowing patients to choose to see a physical therapist directly.  In fact, there is ample data that suggest that health care expenses for a given episode of care go down when physical therapy treatment is initiated early in the cycle of care.  Even Texas’ own State Health Plan recommends that a policy of allowing direct access to physical therapists be implemented – with the goal of reducing Texas’ shortage of primary care medical providers.

So now there will be a two-year span before the next Texas Legislature convenes in 2019. By that time, will Texas be the last state in the union to continue to be perpetuating barriers to access to physical therapy?  Will the state be losing more Texas-licensed physical therapists to other states with more encouraging practice environments – thus contributing further to a dearth in health care for Texas citizens?  Will we be watching our elected officials continue to be hesitant to have productive conversations with their peers so as to create a healthier environment for their constituents?

It is my hope that the answers to the above questions will be “No”.  However, there is apparently going to have to be lots of ongoing work to move forward in this case.  It is consistently said that developing relationships with your elected officials (and their staffers) is something that needs to be done in an ongoing manner – even and perhaps particularly between lawmaking sessions.  In this manner perhaps better understanding of the issues that are important to constituents can be achieved, and a louder voice for the public can be transmitted to those that are charged with legislating on our behalf.  So back Symmetry and I will go to our process of letter writing and solicitation of opportunities for conversation with our representatives within the Texas Senate and House.  Perhaps some of you – the physical therapy and health care consumers of Texas – will also lend your voices and share your stories.  The message “Give Texans Access to Physical Therapy” deserves to be heard.

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