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Scope of practice expansion is a long-standing, continuous and complex concern in the health care field. AAPM&R is aware of the various concerns specifically plaguing physiatrists, from non-physicians to non-physiatrists, intent on expanding their scope of practice beyond their level of education, training and experience. 

AAPM&R is taking action.

Your Academy remains vigilant about ongoing efforts by non-physician and non-PM&R providers to expand their scope of practice beyond their level of education, training and experience, which may threaten the health and safety of patients and impact the livelihood of physiatrists.

Federal and State Advocacy Actions in 2023:

  • In August, AAPM&R launched an ongoing federal grassroots campaign to contact members of Congress and express opposition to H.R. 2713, the Improving Care and Access to Nurses (ICAN) Act. This legislation would inappropriately expand scope of practice for non-physician practitioners including nurse practitioners, certified nurse midwives, certified registered nurse anesthetists, clinical nurse specialists and physician assistants. Academy members, click here to participate in this campaign.
  • In June, AAPM&R joined the American Medical Association (AMA) and more than ninety medical societies and associations in submitting a letter to congressional leadership in opposition to H.R. 2713.
  • In May, AAPM&R organized an ongoing Federal grassroots campaign to contact members of Congress and express opposition to S. 131/H.R. 618. To date, Academy members have responded strongly to this campaign, sending more than 560 letters to Congress to stop the expansion of scope of practice for nurse practitioners and physician assistants under the federal Worker’s Compensation Program. Academy members, click here to participate in this campaign.
  • In March, AAPM&R launched a grassroots campaign for Academy members in New York to stop the elimination of oversight of physician assistants in Part W of the Governor’s proposed Health and Mental Hygiene Budget (A.3007/S.4007). Academy members sent more than 80 letters to state officials in this ultimately successful advocacy effort. The final budget was signed by the Governor on May 3 and the provision eliminating the oversight of physician assistants was removed.

AAPM&R's Scope of Practice Workgroup

Recognizing the growing concern of non-physician (and non-PM&R) scope of practice expansion, your Academy is addressing this issue through multiple committees, including a new Scope of Practice Workgroup. This workgroup is comprised of representatives from the Quality, Practice, Policy, and Research (QPPR) Committee, the Health Policy and Legislation (HP&L) Committee, and the Reimbursement and Policy Review Committee (RPRC), and AAPM&R’s representative to the AMA Scope of Practice Partnership (SOPP).

Scope of Practice Partnership with the American Medical Association (AMA)

Your Academy, as a member of the AMA Scope of Practice Partnership (SOPP), actively engages in the collaborative effort of the AMA, American Osteopathic Association (AOA), national medical societies, state medical associations and state osteopathic medical associations to oppose scope of practice expansions by non-physician providers that threaten the health and safety of patients. The SOPP achieves this goal through legislative activities, regulatory activities, judicial advocacy, and programs of information, research and education. Active participation in this collaborative ensures physiatry is represented and contributes to SOPP’s goal to protect the health and safety of patients whose well-being may be threatened by health care practitioners who lack the education, training or experience to perform procedures for which they seek licensure or recognition.

Resources

From ongoing collaborations with the American Medical Association (AMA) to a full toolkit of position statements, we plan to continue developing tangible resources to assist physiatrists in addressing scope of practice issues.

Your Academy's Latest Efforts to Defend Physiatrists' Scope of Practice

View the full list of AAPM&R advocacy letters.


BREAKING: AAPM&R Leads Effort to Unite Team Physiatry to Score an Enormous Advocacy Win

Aug 04, 2020

AAPM&R is thrilled to announce that our leadership efforts have resulted in a BIG WIN for physiatry! By bringing together the unified voice of 2,377 physiatrists, 123 patient advocacy groups, state and medical specialties, and large IRF hospitals, as well as 97 of your patients, and gaining support from key Congressional offices, we have successfully defeated a dangerous CMS proposal that would have had a detrimental impact on patient care, the specialty, and the future of inpatient rehabilitation.

CMS heard us! In the rule released today, August 4, 2020, CMS did NOT finalize their proposal, as written, to amend the IRF coverage requirements to allow non-physician practitioners (NPPs) to perform certain duties that are currently required to be performed by a rehabilitation physician. CMS is finalizing that an NPP may perform one of the three required face-to-face visits in lieu of the rehabilitation physician in the second and later weeks of a patient’s IRF stay, when consistent with the NPP’s scope of practice under applicable state law. Rehabilitation physicians will continue to have the flexibility to see the patient on three or more occasions per week, as is currently permitted. CMS is continuing the requirements that a rehabilitation physician review and concur with the preadmission screening for the IRF admission, establish and implement the overall plan of care, and lead the weekly interdisciplinary team conferences, which include rehabilitation nurses, social workers or case managers, and treating therapists carrying out the patient’s care plan.

"Those of us leading this advocacy effort are so pleased that CMS heard our voice and heeded our concerns. There is still work ahead but we are so thankful to everyone who helped us in this effort. Our patients and our specialty are better for it."

Darryl Kaelin, MD, FAAPMR
AAPM&R Past President
Co-Chair, Future of Inpatient Rehabilitation Workgroup

By leading this effort, and with your help and support, AAPM&R successfully united all physiatrists and other stakeholders to keep inpatient rehabilitative care duties in the hands of the rehabilitation physician. This is a monumental win and would not have been possible without the engagement of our members and other key supporters. Thank you!

We are also thrilled to announce CMS’ decision to remove the post-admission physician evaluation (PAPE) documentation requirement, effective October 1, 2020. Your Academy has long advocated to reduce burden for physiatrists by streamlining administrative documentation. CMS’ decision to remove the PAPE is a direct result of our persistent advocacy. As proposed, CMS has also codified into regulation certain elements of the pre-admission screening (PAS); however, they have removed three elements from the Medicare Benefit Policy Manual including expected frequency and duration of treatment in the IRF, any anticipated post-discharge treatments, and other information relevant to the patient’s care needs.

AAPM&R’s advocacy work provides what individual PM&R physicians cannot easily do alone — influence the trajectory of PM&R in health care and help advance the future of the specialty. We track and influence legislation and policy issues; advocating on behalf of our members and positioning PM&R doctors as leaders across the health care continuum.

Our advocacy does not stop here. AAPM&R actively asserts our position that physiatry-led, patient-centered, team-based care is the best approach to providing optimized medical rehabilitation care for patients. Physiatrists are necessary and integral leaders of the rehabilitation care team within the IRF setting and we will continue to advocate for the long-term interests of physiatrists in IRFs and patients in need of intensive, coordinated, interdisciplinary inpatient hospital rehabilitation.

Collaboration, open dialogue, and a united voice among physiatrists will be essential to our success. In the weeks and months ahead, please watch for updates from our Future of Inpatient Rehabilitation Workgroup and requests from AAPM&R for you to stay involved and support future efforts.

Team Physiatry’s success is driven by you. Thank you for being a #PMRAdvocate and getting involved! We couldn’t do it without you.

AAPM&R will continue to review the final rule in its entirety and to share further updates with you. To read the finalized IRF Prospective Payment System Rule for 2021, click here.