Any optometrist will tell you that 20/20 vision means great eyesight, but when it comes to physical therapy, 2020 refers to a different goal.
Vision 2020, adopted by the American Physical Therapy Association (APTA) in 2000, sets out six broad goals for the profession to achieve by the year 2020, and with 13 years to go, the progress has been significant.
“We felt that 20 years was an appropriate horizon. We already had a mission, but we needed a vision of where we believe the association and the profession need to go,” recalled Stephen M Levine, PT, DPT, MSHA, speaker of the APTA’s House of Delegates, the highest policy-making body of the profession. “We recognized that we never as a profession had come to a consensus so that we could galvanize around a single point.”
That single point is Vision 2020, which outlines six specific goals of the physical therapy profession:
- Autonomous practice, meaning physical therapists hold all privileges of other medical practices and may be assisted by PT assistants who are educated and licensed to provide physical therapist-directed and supervised care.
- Direct access, allowing physical therapists to legally treat patients without a referral from a medical doctor.
- Doctor of physical therapy, recognizing that the knowledge and training required in today’s healthcare environment requires doctoral-level studies.
- Evidence-based practice, recognizing that changing standards require life-long study.
- Practitioner of choice, placing PT-patient relationships on par with other provider-patient relationships.
- Professionalism, setting out core values for the industry.
For two of those objectives, progress is measurable and dramatic: In 44 states, physical therapists now may see a patient without a physician referral, and about 88 percent of university physical therapy programs are doctoral programs. “It’s very hard now to find a program that is not a doctoral program,” Levine pointed out. “So someone who’s interested now in a career in physical therapy would go four years as an undergraduate, and then a doctoral program.” That’s usually an additional three years.
Yet, Levine said APTA recognizes that “a transition” is required. “We did not believe that it was appropriate to wave a magic wand like other professions did — for instance, podiatrists used to be chiropodists and with a stroke of the wand all of a sudden they went from chiropodists to doctors of podiatric medicine,” he noted. “We decided after doing a lot of research not to go in that direction, we had to ensure that the educational programs were there, that the universities accelerated their education to that level.” Levine said APTA believed the goal was achievable by 2020. “In fact, the market has far exceeded that,” he noted.
Levine pointed to himself as an example of a physical therapist “transitioning” with the profession. He graduated with a bachelor’s degree in physical therapy in 1984 and later earned a master’s in health administration. “But I went back to school to get my clinical doctorate, because I believe absolutely there are things that are taught now, for instance in the areas of radiology and pharmacology, that were not part of physical therapist education back in the 1980s. To have that structured, didactic knowledge, I felt it was critical to go back,” he admitted.
While all but six states now allow a PT to see a patient without a medical referral, Levine acknowledged that third-party payers are slower to adopt the concept.
“Insurance companies many times still believe the physician is the gatekeeper. Although you can legally provide care in those states, oftentimes the third-party payers will not pay for that care,” Levine said. “So the APTA is very, very focused on working with third-party payers to try to get them to understand that the requirement for physician referral provides no medical necessity issues. In fact, it actually causes the insurance company greater costs because it’s requiring the patient to go see a physician and incur a visit to that physician and a fee for that visit when there’s no evidence that shows that that visit provides anything necessary for the physical therapist to appropriately evaluate and manage the patient.”
Levine pointed to the professionalism principle of the Vision as critical to the career of physical therapy. “Just because a group of people are deemed ‘professionals’ by society doesn’t mean they have, maintain or promote all of the qualities of professionalism,” he said. “We have an entire set of core values for professionalism that deal with various tenets that we, in fact, believe identify true professionalism.” Those core values include accountability, altruism, compassion and caring, excellence, integrity, professional duty and social responsibility. “There is a whole conceptual framework of professionalism that I believe is embedded in the entire vision. I would love to see all professional groups really focus toward aspects of professionalism as we’ve defined them,” he said.
Levine acknowledged that “it’s a little bit hard to measure some of these and easier to measure others” when it comes to Vision 2020’s six goals, but he added, “I’ll tell you without a doubt that, in my opinion as both a member of the board of directors and speaker of the House, the Vision is probably the single-most significant thing that we’ve accomplished in the last decade to really galvanize all of our activities and our goals and objectives to achieving what you see written in the Vision statement. I think it’s been extremely effective. I believe that we will reach the tenets of Vision 2020 before that year, and then we’ll be moving on to the vision for physical therapy in 2040.”
Levine sold his private physical-therapy practice nearly three years, and now is a partner in the Rehabilitation Consulting & Resource Institute in Plantation, Fla. The Institute works with therapists in practice management and reimbursement and with the federal government in areas of fraud and abuse, over-utilization and medical necessity.