Whatcha UPTA?

[00:00:00] Welcome back to Untold Physio Stories. I'm your host, Dr. E with Modern Manual Therapy and Edge Mobility System. And today I have a very special guest, Dr. Scott Gardner. Dr. E? Yes, correct. All right. So yeah, I'm going to title this episode, Whatcha UpTA? Because I think someone actually posted that on Lance's profile. If you guys don't know, I've had Lance, Dr. Lance Mabry on the podcast a bunch of times.

[00:00:24] And Lance posted something awesome that I think hopefully many of you guys have been waiting for. But Scott, why don't you introduce yourself and tell people why you formed the UPTA? My name is Scott Gardner. I've been practicing since 1996. I'm a private practice owner here in Maryland. I've been an outpatient almost entirely throughout my career.

[00:00:46] And, you know, I'll kind of give you the 30,000 foot overview of what's going on. After many, many years of dealing with the struggle and outpatient, I decided I would try to get involved in the APTA. So I ran for vice president of my local chapter, which is Maryland. I won the election for vice president and I got involved. And, you know, they're doing their best they can. But I asked a lot of questions about different things. And I find that, you know, really, I was really happy with all the answers I was getting.

[00:01:16] There was a lot of individuals that really didn't understand the reimbursement rates that we're dealing with across the country. And I was disheartened. So, you know, I just said, well, I'll try to run for the board of the APTA. You know, maybe I can make a difference at the national level. It was kind of crazy and change. And I got nominated by a lot of people. The way the process works, you get nominated. But there is a committee of five individuals that are selected by the House of Delegates that determine who gets slated.

[00:01:43] Now, if you look at the board of the APTA, it's 15 individuals and seven right now are from academia. Many are from administrative roles. And there are a couple of practice owners in private practice. So if you look at the makeup of our profession, 43 percent of us work in the outpatient. Sector. But that's only two of the 15 that are represented on the board. Academia makes up one percent of our profession, but they they make up seven out of 15 positions on the board.

[00:02:12] So that would be like me sitting on an academia board trying to understand their issues. I wouldn't know what their problems are. So why is the APTA having so many people from academia representing all of us? Of course, they deserve a seat at the table, but not a majority seat. And the in the House of Delegates is the same way. So I wasn't slated to be, you know, I wasn't slated to be a candidate for the board. And basically, I was told my resume wasn't long enough.

[00:02:42] So I apologize for opening a practice. I apologize for being embedded in my community for many years. I apologize for taking care of my community and raising a family and not having a resume that's 20 pages long. That doesn't mean I'm not qualified. So I got really disenchanted and I realized there was no place for myself or others like me that wanted to be a voice. So I signed up all my employees to be members of the APTA at a cost of probably about $4,000.

[00:03:12] I wrote the board a letter, told them I'm resigning from Maryland. I'm canceling all my membership for all my employees and I'm starting a new association. Nobody ever tells me I can't do anything. That's not how it works. So I decided to use my own money. And I know there's people that question the founding board of the APTA. Let's realize that when the APTA started 104 years ago, most likely it was a bunch of people that knew each other.

[00:03:39] And they got together and said, we should probably do something for the profession. And they formed the APTA. This is no different. Like five random strangers who say, hey, let's do this thing. There's problems. Right. So I know people within my network of physical, which is a franchise company. Physical Corporation has nothing to do with what I'm doing. They gave no financial support to this. It was me. I founded it. And I knew a lot of people within the franchise system because they're my colleagues. So they were interested in getting us started.

[00:04:06] I found some other people that were engaging with me online that were interested in starting as well. And we got together and we formed it. There's 10 of us. There's space open on the board. Our board, when it finally gets established, right now it's a founding board. When it finally gets established, it will be reflective of the profession. So 43% of the board seats are from outpatient. 20% will be from home health. 20% will be from subacute rehab. It will be based on where people work.

[00:04:35] There are non-clinicians on our board and there are PT assistants on our board. Everybody has a seat. So everybody has a voice. And our goal is advocacy. Now, will we grow and do other things? Of course, we hope to. But right now we're grassroots. We're small. Our goal is advocacy. We're going to try to meet as many legislators as we can over the next few months to advocate for better reimbursement for Medicare as a rule at the federal level.

[00:05:05] We've also started to look at some other means of finding out what negotiated rates are from insurers through machine-readable files, which are available online from every major insurance. So that way I can see what you're getting across the street compared to what I'm getting. And I can say and bring it to the insurance company when I negotiate and say, why does that person over there getting $10 per unit more than what I am where we're providing the same service? I don't know what we get in Buffalo. I don't want to know. I'm sure it's terrible.

[00:05:34] Yeah, it's like, I think last I heard $55 on average. Yeah, it's embarrassing. Well, when I went cash-based 14 years ago, we were making about $37.50 on average. That's just terrible. It is terrible. It's terrible. So we need to – the problem is we all need to stand up and we need to speak up and be a stronger voice. The problem with our profession is we're altruistic. We care too much. So we can't neglect our patience. It's, I'll take care of Mr. Smith.

[00:06:04] I know he can't afford it. I'll take $20. Meanwhile, we have to put food on our own tables and pay for a roof over our head. And we went to school for a long time to do this, and the cost of education has become a barrier to people wanting to become physical therapists. Yeah, the cost is crazy. It's crazy. And that was – that harkens back to the APTA. They created that under the guise that we're going to have autonomy. We don't. We really don't.

[00:06:32] There have been a lot of discussions on LinkedIn lately just about like can we even be a trade? It's like do we need – I love being called doctor, but I mean do we need all the fluff? But that's a higher education problem too, you know? But, you know, you mentioned something actually when I actually were just chatting. I said, hey, you know what? Let's record this. You mentioned where the dollars go, and that's why I thought it was really interesting too. You want to talk about a little bit about where your membership goes?

[00:06:59] So when you – when they – when I started to have more barriers placed in front of me to really serve and assist, I found the 990 for the American Physical Therapy Association. So every nonprofit has a 990 online. That's basically their tax return for the year. It's public knowledge. It's out there for everybody to see. So when the APTA publishes their first nonprofit, you will see that there are actually $0 spent on employees. We're entirely volunteer.

[00:07:27] So up to 80% of our dues will go toward advocacy. Now the 20%, of course, I've got some fees. I've got a website I've got to keep up. I've got a Google workspace I have to keep up. There's, you know, materials that we have to publish and things like that for marketing and advocacy work, what have you. But we're going to spend up to 80% of our money on advocacy if we can. And so we look at the APTA. It's $295 to join the National Association. Then on top of that, your state dues.

[00:07:55] So if you look at their membership in 2022, $16 million was brought in dues for members for the APTA. I think it was 45,000 PTs. That being said, if you go and you look at the lobbying side of the profit and loss statement or the tax return, I should say, it shows $1 million spent. So if you just do the math, $1 million of 16, $1 million of 16, $1 million of 16, $1 million of 16, $7 million.

[00:08:21] So 7% of your dues that comes in was spent on lobbying efforts in the year 2022. Now, in the year 2022, I took a 15% differential in my PTAs treating a Medicare patient plus another cut on top of that. So since 2021, I've taken a 13% cut for any PT service for Medicare and a 29% cut for any PTA service for Medicare. Our rates are now consistently, I think, consistent with what we got in 1996.

[00:08:51] It's terrible. So when I see an association that supposedly works for us, only spending 7% of the dues on lobbying with a payroll that's expensive and exorbitant benefits for their staff, I take that to heart. Because I'm giving you money to work for us and to help us, and you're not doing it.

[00:09:18] If you look at their bank account, at a picture in time, I think it's up to $13 million. Do you know what you can do with $13 million in terms of advocacy? It's a nonprofit. It costs you $1 million to do a rally in D.C. with upwards of 10,000 people. You can hire companies to do rallies for you. I've investigated all this stuff.

[00:09:43] So for $1 million, you can march on Capitol Hill to ask for fair payment. And I think you'd probably get some news coverage, which would be well worth more than $1 million. So it's things like that that just aren't being done that can be done. There could be a nationwide educational blitz on why costs are so expensive in health care. Talk about the medical loss ratio in insurance companies and how that drives up the cost to the consumer.

[00:10:14] Talk about site-neutral payments, how a hospital outpatient can get $300 to treat an ACL, whereas I get $75 from the same insurance company. These are issues that the public needs to know about and our professionals need to know about because it's wrong. It's name any other profession or anything you get into in business where everything you do goes down in value, and I can't change that. And I have no recourse. It's an unlevel playing field.

[00:10:41] And the way it's designed right now with health systems basically taking over areas, they're monopolizing everything, and they're driving independent practitioners out of business, forcing those to have the wherewithal to go into cash, cash-based business. There's nothing wrong with cash-based business, but not everybody can survive on a cash-based business in the areas they're practicing. So that's what the UPTA is about. It's 100% about advocacy. It's grassroots. It's people that are interested in making a difference. You have to want to go meet your legislator.

[00:11:11] You have to want to go sit in their office and give them information and educate them on what the issues are. Bring your patients with you. Have your patients write emails. Have them call. And voices can make a difference, and that's what we need to do. So that's why I formed it, and I hope the message gets out. We are just trying to make a difference. We're trying to do what they're not doing and to be another seat at the table to advocate. Right. That's awesome. I love the story.

[00:11:41] So it's definitely needed. And just FYI, guys, I joined. Yeah, thank you. Yeah, no problem. I joined. It was, hey, it's $149. And if 80% of it goes to advocacy versus 7%, that would be money well spent. It's $21 for the other association in 2022. $21 of your $295. And I think most people thought more of their dues were going toward advocacy. Now, a political action committee is-

[00:12:11] Have a yoga studio? Hmm? Not a yoga studio? Well, they had that downstairs, I believe, too. Yeah. It's a very nice place on the Potomac that they operate out of. Yeah, yeah. With excellent work environment for those staffers there. But yeah, so $21 is what's going toward advocacy. Now, we haven't founded a PAC yet, and a PACs where you can give campaign contributions. But the different thing, the one thing about the APTA's PAC is it's connected to the APTA.

[00:12:40] So you have to be a member to give. So when you're asking people for $400 to join, most aren't going to give an extra $100 or $200 for a PAC because they're already giving you $400. So we haven't gotten to the point of forming a PAC. We've talked about it. But we're thinking that our PAC might be disconnected where anybody can donate to us. So you could put a tip jar out in the lobby and ask for contributions from your patients.

[00:13:05] Say, please help support our profession as we advocate and campaign for better reimbursement and better access to care for you. So that's a path we're going to go down. This is a heavy lift. I'm not going to lie. This takes up a lot of my time when I'm not busy in my practice. But I don't mind. I have a daughter that's in physical therapy school, and I want this profession to be as good to her as it has been to myself and as to you as well. So it's a wonderful profession what we do.

[00:13:36] People love us. And I want this to be a viable profession 25 years from now. And that's why I'm doing this. So all self-funded by myself. No contributions. People wonder, like, if they see a lot of physical names on the board. It's only because those are the people I knew and they're my colleagues. Nothing from corporate. All self-funded by me. So all the money to create the 501c6, to establish the website, to get it up and running, it was all my money.

[00:14:06] So I'm not asking for a dime from this association. Not looking to get paid for it. I'm just looking to do it for the profession. That's why I'm here. That's amazing. All right. Hey, so how can people join if they're interested? UnitedPTA.org. And you can read about what we're doing and what our pillars of the association are and what we're trying to do. We call it the clinician determinants of health.

[00:14:32] You know, poor pay, basically high debt, you know, administrative burdens, things like that. That's what we're trying to focus on. It's a lot of work. I can't do it by myself. But if we get thousands of members, we'll have a lot of money that we can use to advocate. Plus, we'll have a lot of voices. And at that point, we'll have more seats at a table and we will be better able to represent our position.

[00:14:58] And I don't look to be adversarial, per se, to the APTA. I look at it to be more complimentary. And if we grow large enough, we will have a seat with them and they will have to listen to what we're saying and help assist us in our advocacy efforts. And that's the goal. Work together. Be united to make a difference. Wow. I love it. Thank you. All right. Hey, thanks for coming on the podcast. Hopefully I can drum up some members for you. I appreciate it. Thank you so much and have a wonderful day. Yeah.

[00:15:28] All right. Take care. If you guys like this episode, make sure to rate Untold Physio Stories five stars wherever you listen to podcasts, especially on Spotify and Apple as that helps our discoverability. Definitely check out the APTA. I think it's something that is desperately needed in our profession and consider donating some of your hard-earned dollars to support our profession. And as always, you guys have a great day. Thank you. Thank you. Thank you.