Advocating for Patients and Advancing the Physical Therapy Profession
Definition and Functional Framework of Professional Advocacy
Professional advocacy is defined as the communication of a viewpoint for or against a specific policy or issue. It is a strategic tool used to influence change in public policy, legislation, and regulations. This process involves executing the necessary steps to achieve intended changes. Advocacy generally bifurcates into two main streams:
Advocacy for Patients: Focuses on ensuring timely access to care and addressing payment issues. Goals include securing better insurance coverage and lower costs for patients, which ultimately leads to improved health outcomes.
Advocacy for the Profession: Centers on the American Physical Therapy Association (APTA) and various advocacy pathways at national, state, and local levels. It involves the intersection of patient and professional advocacy and the education of key stakeholders regarding the value of physical therapy.
The Role and Strategic Framework of the American Physical Therapy Association (APTA)
The APTA serves as the primary professional organization that sets the standards guiding the physical therapy profession. It operates based on four core functions:
Advocacy and Policy Reform: Working to improve healthcare policies, seek fair insurance reimbursements, and ensure patient access.
Education and Certification: Overseeing standards for PT and PTA programs and recognized physical therapy specialist certifications.
Research and Practice: Funding critical research, developing Clinical Practice Guidelines (CPGs), and providing Evidence-Based Practice (EBP) resources.
Professional Community: Connecting members via state chapters and special interest groups.
APTA Strategic Framework 2030
The association's long-term vision focuses on three pillars:
Advancing Our Payment: Increasing economic opportunities for physical therapists (PTs) and physical therapist assistants (PTAs). The goal is to establish the profession as an integral, outcomes-driven component of the U.S. health system.
Empowering Our Members: Providing a high-impact member experience relevant at every career stage and setting.
Evolving Our Practice: Transforming practice models and services to better serve both society and the profession.
Governance and Leadership in Physical Therapy
Leadership is essential for professional advancement. Key leadership structures include:
House of Delegates: The primary governing body of the APTA, which meets during the Leadership Congress (e.g., House 2025 and House 2026 events).
Executive Leadership: Kyle Covington, PT, DPT, PhD, serves as the APTA President.
State Leadership (Georgia): Teresa Pierce, PT, DPT, PhD, acts as the Chief Delegate for APTA GA.
Primary Care Physical Therapy (PCPT)
Primary Care Physical Therapy represents a professional practice area where physical therapists serve as the first point of contact and provide broad-spectrum preventive and reactive health management. They function as integral members of the primary healthcare team. The 11th specialty area in the profession focuses on person-centered, team-based, and community-aligned care with the goal of improving health quality while lowering costs.
Scope and Expertise of PCPTs
PTs in primary care address pain, disability, function, health, and wellness to optimize participation in life activities. Their qualifications and roles include:
Doctoral Training: PTs are doctoral-trained providers specializing in neuromuscular conditions.
Diagnostic Skills: Educated in differential diagnosis and medical screening, they identify when a referral to another practitioner is appropriate. They practice within their scope and do not make pathological diagnoses.
Early Intervention: PTs advocate for early intervention to improve outcomes.
Legislative Examples and International Models
Utah Code \$\$31A-22-624 (2025)\$\$: Effective May 7, 2025, this legislation recognizes physical therapists alongside primary care physicians and physician assistants.
Utah's Progress: Advocacy at the state level led to a change in recognition and expansion of opportunity without requiring a change in the legal scope of practice.
International and Federal Comparisons: Internationally, PTs are recognized as "First Contact Practitioners" who can order imaging, provide injections, and prescribe medication. In the United States, this model is currently active in the military, the Veterans Affairs (VA) system, and certain employee health settings.
Urgent Care Physical Therapy
Urgent care PT is an emerging model addressing patients' immediate needs for answers and access. Proponents of this model, such as Samantha Smith (owner of five clinics in Montana, including two urgent care clinics), emphasize that PTs provide direction, relief, and confidence when a patient seeks immediate help for issues like back pain. The movement is supported by existing evidence, high accessibility, and positive outcomes.
National Advocacy and Legislative Progress
National advocacy involves expert analysis, a consistent lobbying presence, and member participation to influence bills in the House and Senate.
Recent Advocacy Milestones
Medicare Physician Fee Schedule: Secured a $3.26\%$ conversion factor increase.
Prior Authorization Reform: Collaborative efforts with rehabilitation and advocacy groups to reduce patient service delays.
Telehealth Expansion: Medicare telehealth coverage has been extended through 2027 via H.R. 1614.
Insurance Reform (Aetna): In June 2025, Aetna updated its Medical Clinical Policy Bulletin to expand direct access. Changes included removing the mandate for prescriptions/signed plans of care for outpatient PT, removing "homebound" restrictions, and reducing PTA supervision requirements.
Professional Student Degree Act
H.B. 6718 aims to amend the Higher Education Act of 1965 to include physical therapy on the list of professional degrees for loan limit purposes. On June 25th, a federal judge temporarily blocked a U.S. Department of Education rule (set for July 1, 2026) that would have excluded the DPT from the definition of a "professional degree." While the judge blocked the narrowing of the definition of "professional degree," the new loan caps remain in effect, though using the broader 2007 definition for eligibility.
Access Levels and State Advocacy
Direct access to physical therapy varies significantly across the United States:
Unrestricted Direct Access: Patients can see a PT without any referral or restrictions.
Direct Access with Provisions: Patients have access but must meet certain criteria (e.g., time limits or referral requirements).
State-Specific Activities: State chapters like APTA Georgia organize events such as "PT Day at the Capitol" (e.g., February 23rd) to influence state legislators.
Local Advocacy and Social Determinants of Health
Advocacy at the local level focuses on health and wellness initiatives that impact the community. This includes policies related to:
Environmental and Infrastructure Factors: Housing, transportation, and neighborhood resources.
Community Health: Food and nutrition, medication access, free clinics, and senior day care.
Youth Programs: After-school programs, sports, arts, and tutoring via organizations like Boys & Girls Clubs.
"PT for Future Me": A strategy to encourage potential patients to seek care earlier to prevent injury or decline.
Educating Stakeholders
To overcome identity problems within the profession, physical therapists must clarify their roles to two main groups:
The Public
PTs should be defined as:
Movement Specialists and Rehabilitation Experts: Independent practitioners managing neuromuscular conditions in various settings like primary or emergency care.
Wellness Consultants: Promoting a wellness mindset and health promotion on the front end of care.
The Medical Community and Payers
Partnerships: Establishing relationships with Physicians, Accountable Care Organizations (ACOs), and Value-Based Care partnerships.
Outcome-Based Care: Measuring patient satisfaction and treatment results to reduce the total number of visits per episode.
Payer Communication: Using industry-specific language such as Total Cost of Care (TCOC) and Per Member Per Month (PMPM). Rather than vilifying insurers, therapists should assume individuals within those companies are trying to do the right thing and communicate clinical value in their terms.
Tools and Resources for Advocacy
Members can engage in advocacy through several digital and organizational tools:
APTA Legislative Action Center: For tracking bills and completing advocate profiles.
APTA Advocacy App: Available for download to facilitate mobile advocacy activities.
APTA Letter Center: Useful for identifying legislators and sending pre-formatted or custom letters.
Student Advocacy Challenge: A competition where programs submit record of advocacy activities to vie for recognition.
Pluralpolicy.com: A resource used to find specific legislators and compose targeted letters.