Vermont Legislature SmartTranscripts:

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: Thank you, Chair Black, for having us.

[Rep. Alyssa Black (Chair)]: Hi, welcome everybody. It is Thursday, March 19. And this morning we have in, it's advocacy day for the American Physical Therapy Association. So we invited them in. I'm really excited to have you here. Just finally, since yesterday we reported out five eighty three, which had some site neutral payments specifically around physical therapy. Five So eighty five, sorry, eighty three is today. Debra, I'm

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: I am Heidi Wilhelm. I'm a doctor of physical therapy. I'm the president of the Vermont Chapter of the American Physical Therapy Association.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: I'm Alyssa Sargent. I'm a physical therapist. I've been in Vermont for about thirty years practicing physical therapy. I'm board certified fellowship trained in orthopedics, And I am a doctor of physical therapy educator.

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: Hi, I'm Estelle LeClaire. I am a physical therapy practice owner in Essex and also Georgia, Vermont, and On the Move Physical Therapy, which is a mobile division. And are also, I took a recent role in the advisory board of the Green Mountain Care Board. Fantastic. I am a boots on the ground clinician.

[Rep. Alyssa Black (Chair)]: You said that you were an

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: educator. I've been core physical therapy faculty at UVM for about eight or nine years. I recently made a switch to a hybrid program in Appalachia. I'm still adjunct at UVM, so I teach in both programs.

[Rep. Alyssa Black (Chair)]: Do we have physical therapy programs at

[Rep. Francis McFaun (Vice Chair)]: You have

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: a at UVM or at UVM?

[Rep. Alyssa Black (Chair)]: Oh, great. That was all I was thinking. Do we have

[Rep. Francis McFaun (Vice Chair)]: any? Thank

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: you. It's the only one in the state.

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: Yeah, no, that's great. So, as a chapter, we represent over 400 physical therapists, PTAs, and students in the state. And they work in all sectors for all ages. We are here to help educate and help guide the state to save money and to help increase the overall health of our people and our society. So my story, again, I'm a doctorate of physical therapy. I've been practicing in Vermont physical therapy for over twenty years. For the last twelve years, I've had my own practice. My own practice is in early intervention and young babies, birth to three. I'm in Addison County and Rutland County. It is not the easiest job. It is very difficult to work with babies, and especially in rural homes in our state. So it is very difficult to find people to do my job. Physical therapy for babies, a lot of people don't realize that they need physical therapy. Some people are very familiar with adults that might have had a stroke and they need rehabilitation. But a lot of people don't understand that babies can have a lot of complications, either before birth or at birth. And if they have a stroke, could lead to lifelong impairments. If we don't give them services, it can really decrease their functional ability later. Right now, have a problem with our school budgets and our school budgets being high because of health care costs and because of their special education department's needs. If we don't have proper early intervention, we are going to have skyrocketing budgets for the schools. They're going to have increased needs. We're going to have more kids in wheelchairs. If they can get a wheelchair because you need a physical therapist to get a wheelchair through insurance. We have, I have patients waiting. I only take Vermont Medicaid, and that's how I've been set up for twelve years. Unfortunately, there's not enough providers. So I have a waiting list. I have to say no to families that call me, which is really tricky when families call me and they can't find a provider and they're willing to drive to me, you know, over an hour just to get their child physical therapy. And I have to say no, knowing that I know what could help this child, and it could help lifelong impairments and we just don't have services. There has been a change from Medicaid recently. I've barely been able to keep my business open. And now with the change from federal coming down that we can't use this evaluation code, the T1023 code that I've been using for my in home evaluations for the early intervention program, that cuts my payment from $350 for that in home evaluation to $84 And unfortunately, that is going to change so that I'm no longer going to be able to take just Medicaid and not see babies in their homes. As a business owner, it makes it really tricky because for me to be able to keep my business open so I can feed my own children as a single mom, I have to make these tricky decisions. So even though I know that care should go to these babies, I have to now start to look at more cash based clients, which is a huge equity piece, which is why I kind of started my business just Medicaid from the beginning. But it's also why I took over the presidency of the chapter and took this on so I can help lead some change in the state. Right now it's so tricky. I don't even have health insurance myself, which is tricky. I have to reschedule my mammogram because I just can't afford it. Which is tricky as a healthcare provider, telling other people, Hey, you should do these preventative medicine things when I can't afford it.

[Rep. Alyssa Black (Chair)]: Can I interrupt you for just a minute? Because as you were sitting here, I was thinking, wait a minute, I have an email from you. I believe you reached out to your local representative and forwarded. Have you spoken with anyone at Diva?

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: Do you

[Rep. Alyssa Black (Chair)]: know the reason they have

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: said I agree. Yeah, I had some emails with Jill, and I'm meeting with Brendan later today. So the reason they took it off is because of the federal mandates. So federally, they're saying that the individual provider is not allowed to use that evaluation code, and that it's just to be used once in the whole care plan of deciding if a child needs early intervention. So they said that we're just not allowed to use the code. Is there not

[Rep. Alyssa Black (Chair)]: an equivalent or a replacement code or evaluation? Nope, they want us

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: to use the regular physical therapy evaluation code, which is the $83 reimbursement or payment. And there's no differentiation between in home visit. For me to see children in their natural environment. So, I mean, if they spend five days a week at grandma's, I go to grandma's and I teach grandma how to do the things with the baby so that we can have the most outcomes. If they're at daycare full time, I go to the daycare, I train all the daycare staff to make sure they're, you know, positioning the child and working on the proper strength things so that they have the most outcomes. But no, it's really, really tricky to be providing these services.

[Rep. Alyssa Black (Chair)]: And they can't have a different I mean, I'll ask them all these questions. They can't have a different reimbursement in place of service.

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: This is what we're trying to kind of advocate for. And I gotta say Vermont Medicaid in general has been super fantastic about supporting PT, OT and speech so far and decreasing our administrative burdens, because that has been a big piece of the paperwork. And I'm a one person show, right? So I do I get all my referrals. I have to contact people. Unfortunately, I have to tell a lot of people, no. I set up the schedule. I go see them. I do all the billing. I have to deal with my denials and try to put in appeals. And lots of times, it's really not worth it. I'm losing a lot of money. And there's always so much time in the day also, especially if I have patients that are waiting. It's hard for me to go and fight for $34 when I should just go see another patient.

[Rep. Alyssa Black (Chair)]: You'll be in the building a lot today? Yeah, we'll be here all If I reach out to you at some point during the day, because I'd really like to get information so that I can speak to

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: people. Yeah, absolutely. And I think it's the children and it's the complex neurological cases that we deal with, especially for having to do in the home. I have a patient or somebody is asking, a 30 year old that's in a wheelchair and he needs occupational therapy so that he can become more independent. He's been looking for six months, he cannot find an OT to help him get more independent. So he's relying on his parents, and his parents are getting older, and there's just no services. And it's really sad. So and I think if we can really realize how much bang for your buck per se, getting rehabilitation services to people as soon as they need it, it can save our overall healthcare a lot of money and increase outcomes. Operator, is your question?

[Rep. Francis McFaun (Vice Chair)]: Thank you, Madam Chair. Is this not able to use a certain code? Does this apply to just independent practitioners? So home health and hospice?

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: The parent child centers, they call them the fiscal agents for early intervention. It is for anyone who is billing for these services. Because we've all been able to use this same one code and it's PT, OT speech and it's across the board. So a lot of the parent child centers and the early intervention programs are having difficulties with that. And they're hoping we can collaborate and figure out because they understand how important it is. I mean, we don't have a speech therapist in Addison County for birth to three. So a lot of these kids that have speech impairments, if we could have caught them early, they wouldn't have a speech impairment, but now they have to wait till they're three and their brain is 75% solidified. So we're not going to have as good of outcomes as we would have if we caught them when they were babies. And I think the early intervention program is fantastic. And I brag about it around the country actually. But it's really, really hard to stay in business right now. What is the in your email, didn't you indicated the reimbursement, but not the code.

[Rep. Alyssa Black (Chair)]: What is the code? Do you know?

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: Oh, T1023. No, no, no. Not the T.

[Rep. Alyssa Black (Chair)]: What the code that they want you to use now?

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: Oh, you know what? I don't have that on me right It's

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: just the PUT eval codes. 97161 or 9700163. Yeah. So they had separated into three different complexity codes, but they all pay the same. And that payment is quite a bit less than it was twenty years ago. And the thing is,

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: is it was tricky to keep our businesses open before, and this just kind of put us over the edge. Thank you.

[Rep. Alyssa Black (Chair)]: Thank you. We'll talk more about that. Yes, let's say.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: So I just wanted to talk a little bit about the doctoral preparation for physical therapists, because the PTs need to be considered as part of that primary care team. As a practice manager, I'm sure you can appreciate that thirty five percent to forty percent of all visits to primary care are for musculoskeletal complaints. So things like shoulder pain, back pain, etcetera, etcetera. And as a provider in primary care, my physician and nurse practitioner colleagues tell me we are not prepared, we are not trained to do the physical exam and diagnosis and management for these cases. So they're referring them to PT, which is wonderful. But there are all these barriers, arbitrary barriers, to having patients get access to PT. So some of those barriers are due to arguments about the educational preparation for that role. And if you look at didactic curricula across from nurse practitioner to medical physician to PT, the in classroom training is you can't differentiate between the three. They're more similar than different. And in the US military, for example, physical therapists have been primary care providers since 1972. We have fifty years of safety data to suggest that we can take care of patients with no adverse events, no cancer diagnoses are being missed, fractures are not being missed, infections are not being missed because we are capable of doing that clinical exam and getting the patient to the right provider at the right time, which is what a primary care provider does. When the patient sees a physical therapist as a primary care provider, we have increased patient satisfaction, better clinical outcomes. People are getting back to work faster, and we are saving the healthcare system billions of dollars. We have an economic value of PT report that was generated by our national organization. That's been incredibly valuable to us because I love data. I like to show you the numbers. And when a single patient sees a physical therapist instead of an MD or a NP for, let's say, knee osteoarthritis, they're going to save the health care system $10,000 When it's a carpal tunnel syndrome case, they save the system for a single patient $40,000 And that's documented and well studied. So the numbers are there, the numbers support it. And we're just trying to knock down these arbitrary barriers to helping Vermonters get access to the essential care that they need. So that's my view. Thanks. Thank you. So in private practice, the number of challenges are 10 deep. I'd like to focus on two

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: of them. Overall affordability, if you have gotten your insurance not in a great program, you'll see that your deductible has gone up significantly over the last ten years. So we have patients every week coming into our clinic for a new evaluation. Can't continue because they don't have the resources to continue to do the actual care that we know they need to avoid surgery. Oftentimes that is the case, but the change in healthcare over the last decade with the premium costs, the deductibles, all of it for certain pockets of our communities has gone up so significantly that they can't afford the care. So that's a huge problem. So we're treating people differently than we did even two years ago. That's a challenge for my staff. Keeping staff. Elizabeth noted that there's a UVMDP program. Out of the last class, two people stayed in Vermont. Why is that? The affordability in our state overall is so huge. Young people cannot afford to be here. There's housing challenges. There's so many challenges between health care costs. Property taxes have gone exorbitantly high. So just yesterday, I received a resignation. Three times in the last year, my practice has had people leave the state to go out of state. That is hard. I don't have three new bodies to bring back in. In Chittenden County, we have an access issue, four to six, sometimes eight weeks to actually get in for care. These are postoperative people that didn't make their appointment before they had surgery. They need the care postoperatively. There's no place to put them. It's a challenge for us. We've already spoken to the savings, the number of people. I am still a clinician. So just this week, I saw some clients, which was really great preparatory for coming here today. People who are non weight bearing get in our pool facility. They can walk in a pool before they can walk on land postoperatively. That's a huge saving to the number of times they have to come in because they're more normal when they go to weight bear again. So that pool facility in Vermont, imagine how much that cost. So when we don't get change from reimbursements for ten years with our favorite companies, we have a hard time staying in business in Vermont with the cost of everything else rising substantially year after year after year. With that said, 3.5% of my gross revenue is now being spent in addition to what was already on the revenue budget in health care dollars for my employees. Small businesses do not have good access to employee coverage for health care in the state of Vermont. It is very difficult. Many of my colleagues have reached out. I started doing some consulting because I love seeing people succeed in business. My colleagues are reaching out. Do you want to buy my practice? I don't want to buy more practices. I want to see those like Heidi, solo practitioners succeed, small group practices succeed. They cannot succeed if we do not see changes in reimbursement for over a decade. The four main companies that I work with directly, we don't have an in network provider relationship with one of the main companies commercially based, because we can't afford to. I'd rather tell my employee, here's $20 go get yourself lunch, go for a good walk, reset for the afternoon. But we can't afford to see those clients if we don't see a change in reimbursement.

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: I think it's hard, because, you know, sometimes if somebody hasn't had physical therapy or had somebody in their family that had to have it, we're kind of a small kind of percentage of the budget. We don't have a lot of people that can come all the time. But we can really help get people back to work. If they're out on workman's comp for three months waiting, that's more money the state is paying. We can get people off of opiates. We have an opiate issue. We can teach people how to mitigate their pain without medications. We can avoid some of the unnecessary surgeries.

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: And ER visits. That's one of the big price lines. There's two things that people often go. I have a best friend who's an ER physician. Two things that are our wheelhouse, vertigo and low back pain. We can be the primary care provider for those and avoid the ER visits. That's a huge cost to the system in Vermont. And just knowing, just educating our communities that those are populations that we serve direct access, you don't have to go to a physician. You just need to come to the physical therapist. Elizabeth spoke to the DPT level of education. We see that first evaluation is so thorough. Many patients say, I've never had something this thorough as an evaluation. We have a lot more time in our current system to be able to evaluate our patients.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: And our colleagues in medicine are asking for our help. They want to have us on that team just to help them. And it's hard for the physicians too, if they have no PTs, to refer to at all. Yeah.

[Rep. Francis McFaun (Vice Chair)]: Just as an informational thing, how prevalent is, well, won't say it that well, I'll say it this way. People that go through the college in a train, how many bodies are we down in terms of the need for physical therapists?

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: What is the shortage?

[Rep. Alyssa Black (Chair)]: Yeah.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: So the census takers that are part of the state organization have not had an opportunity to do any study on those numbers in the last decade. They've been busy with other disciplines. So when the state is putting out between thirty and forty a year and the majority of them are leaving, and then we have an entire generation of physical therapists who are retiring, We are losing more than we're gaining. So our organization statewide is for you said 400. And so if those numbers need to be, I would say, doubled, that's just my opinion. That's not based on data. And I like to have data instead. So forgive me for that.

[Rep. Francis McFaun (Vice Chair)]: But I

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: love data. And Elizabeth, if I can piggyback on in my practice, we look at what percentage of the business is each type of insurance Every year, every month, we look at that data. In the last decade, my business has grown in Medicare population by 12%. Because what's happening in Vermont, people are older, they have higher health care needs because this is a beautiful state. But our young population is diminishing because people cannot afford to live here, unfortunately. So with that said, when you ask the question about how short is our population of physical therapists? Extremely. The person that just gave notice yesterday, I will not be able to fill that very easily because people cannot afford to live in our state. We cannot successfully recruit from other states to come to Vermont because you know why? When people look up Vermont, we are third in the tax burden in The United States. We are number one in health care cost. Just recently, a person interviewed at UVM to go work at UVM happens to be in my clinic and says to me, I can't believe they didn't take the job, but they said it was because of health care costs. And I said, that's really funny. UVM actually has really good insurance for their staff, but the person researched what's going on in Vermont when they came for their interview from out of state. It was because of health care that they did not move here. I think some property taxes, that's the other one. So the top two are property taxes and health care. Vermont is now the number one state.

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: We do want to gather some more data on what we're lacking, what we're missing for PTs. But I think sometimes that goes on advertising and a lot of places that I know have stopped advertising because they've advertised for three to six years with zero physical therapists coming in. And Addison County, I work with Addison County Home Health and Hospice. We talk a lot because they take private insurance and I don't. And they've been looking for therapists for years. And she said they just can't afford to even advertise anymore. It's just an ongoing open position. So it's really tricky.

[Rep. Francis McFaun (Vice Chair)]: What it's worth, my wife is going through physical therapy. She's been going for it for a while. But what we've noticed is the visits, which sometimes she used to go like maybe three or four times a month, now it's like once a month. And unless she does that on the, when she's not going to PT, unless she does it, she doesn't gain anything with once a month.

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: That's what having to do, right? So like these patients deserve and medically itate multiple visits per month, and we just can't provide it. I have these little babies that have had strokes, and they deserve weekly PT visits. And I'm lucky if I can do twice a month. And it's really, really hard on the patients. And so our outcomes are less.

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: And I love the question because remember the healthcare crisis with nurses.

[Rep. Francis McFaun (Vice Chair)]: Yep, and all of us are too.

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: We're hitting it with physical therapy. It's existential. Yeah, because again, older people, we have rotator cuff repairs. The surgeons are still doing the surgery. But unless you've made your appointment prior to surgery, it's difficult for us in Chittenden County, at least to get those patients appropriately scheduled. And guess what the referral says? Two to three times a week. So the patient is expecting two to three times a week. That's not going to happen. So we have to explain that day one.

[Rep. Francis McFaun (Vice Chair)]: The other problem is teaching people how to do this.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: So what is, can you say a little bit more?

[Rep. Francis McFaun (Vice Chair)]: In the nursing area, they don't have enough people in the colleges that are teaching the people.

[Rep. Alyssa Black (Chair)]: Correct, yeah.

[Rep. Francis McFaun (Vice Chair)]: Nursing, same thing for

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: Education, on the education side, we are having a difficult time meeting the need because the cost of higher education has spun out of control. And most colleges, like for example, the College of Nursing and Health Sciences at the University of Vermont balances their budget on the backs of our students. So nursing is in the black, PT is in the black, every other program in the college is in the red. So they're depending on our twelve month program and our very high tuition to put the other disciplines through their programs and try to get the balance budget. And there's less and less people that are going into college for physical therapy and the therapies in general because investment just isn't there right now, even though we know that we can supply really, really good healthcare.

[Rep. Allen "Penny" Demar (Member)]: Hearing you say this, and I feel I understand it, I hope that this building does, the affordability of staying here in Vermont. If we could make it affordable with our taxes, with our healthcare and everything, it might not be so hard for you folks to fill your positions. And I don't know if we're addressing that properly. Sorry to say that to you. I know the need, and until we draw people here, then we're going to be fighting this. I almost apologize to you.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: Well, it's sort of that multifaceted nature of thinking you have to figure out which is the chicken and which is the egg. How are we gonna entice people to come? And we know that physical therapists need to be paid appropriately for their expertise, And that continues to decline over the last twenty years. And all the metrics that you're talking about are going up. And it's just this vicious cycle. I think it's pretty

[Rep. Allen "Penny" Demar (Member)]: much Thank you for being here.

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: But I also think that there is some movement that is positive in our state. Like to shine the black And light on I think that there are some changes with the Green Mountain Care Board that have been favorable to address some of the issues that really drive health care costs up. And one of the communities as we get older, I didn't speak to this earlier, nursing homes. The number one reason why females go into nursing homes is because of pelvic floor incontinence. If you can't hold your bladder, you end up with UTIs. Where do you go? The ER. It's very costly. So that one piece is another piece of the puzzle that we address in physical therapy.

[Rep. Allen "Penny" Demar (Member)]: We've done pretty good here. Green Mountain Care Board is one of them. And I think the reference based pricing is coming up next year, maybe. I think there's some strides, but

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: Those strides are important.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: They are.

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: They are very important for sure to small businesses and to our profession, for sure.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: And I think if I would leave you with a take home, it'd be anytime you see any kind of barriers to or objections to identifying physical therapists as primary care providers, please understand that we are the best equipped to provide the essential care that many patients are going to need. And we can do it at a much lower cost than any other provider. That has a D in their credential.

[Rep. Allen "Penny" Demar (Member)]: I've got one more question. I do some physical therapy. My primary doctor has sent me to a place, but But are all the primary doctors on the same page with going to physical therapy first?

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: No, no, no. So part of our advocacy work is working with the Vermont Medical Society. I've started conversations with the dean of the primary care or the family practice residency at the Larner College of Medicine. Those folks are very much on board. I think given the diversity of thought in the state and how rural we are, we've got some folks in in different regions that are still very physician centric. But that's outdated, unfortunately. And so just like in federally qualified health centers, we have added behavioral health, mental health, substance abuse counselors, and even dental because those primary care physicians and nurse practitioners understand when something is outside their scope of practice and essential musculoskeletal care is outside their scope of practice and they need our help. So I think some physicians, many physicians, especially the ones coming up, recognize it. Some not everybody does. Okay. I do want to make a point

[Rep. Alyssa Black (Chair)]: on that. I have to go. And this is not a criticism, but coming a practice where physicians refer all the time to physical therapy. But there's also a reluctance a lot of times on the part of patients. 100%. Because they want a quick fix. 100%. So there's that dynamic too.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: Cultural didn't marry her as well. 100%. And because of that, when the patient gets to see the PT in that visit, we get the warm handoff from the physician. The physician says, Oh, you have back pain, please come speak to my colleague. Then the patient learns in that moment, in that visit, the benefit of what we can offer. So it's not a great remedy. It's not a pill, but it helps.

[Rep. Alyssa Black (Chair)]: I'm gonna Daisy, you had a question? And then I'm gonna pass it off

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: to Tucker.

[Rep. Alyssa Black (Chair)]: Thank you so Thank you. Thank you for coming.

[Rep. Leslie Goldman (Member)]: I didn't have a question,

[Rep. Alyssa Black (Chair)]: but just a comment. I just, I so enjoyed this testimony and learned a lot and just really appreciate the work that all of you do in Vermont. It's so important. Thank you so much.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: We feel very fortunate today. It feels fairly well received. And I think a lot of it is because PT is quite familiar to people who need it. I

[Rep. Leslie Goldman (Member)]: think every doctor when someone goes in with vertigo should be referred to PT right off the bat. I've talked with it for a month before and it was like fifteen minutes later. Amazing. Wouldn't it have

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: been great if it had been in that visit? Yes, we can do that. And When they she told told medication. What's Did you get medication? Did they

[Rep. Leslie Goldman (Member)]: get, through the time before that I did, did nothing. I did nothing, I did nothing. I wasn't free.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: The healthcare system had to I take on

[Rep. Leslie Goldman (Member)]: go back twice and then finally there was a nurse practitioner that I had to see because my doctor wasn't available and she said, you tried physical therapy? You're like, what? Boring to me. I was like, what can they possibly do? Fifteen minutes. It

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: was It's debilitating. It is debilitating. It is debilitating. Sadly, know because I put my head back swimming with my knees and ended up with vertigo. I was like, wow, I see why people go to the ER. But I know how to treat this. And so I did. That's amazing.

[Rep. Allen "Penny" Demar (Member)]: Any last question? The other thing, thank you again. I think one of you mentioned advertising or education. I don't know if the general public realizes what physical therapy

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: That's would why we're here today. The more people

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: that know what this is. But I don't know

[Rep. Allen "Penny" Demar (Member)]: how would you get out there and let the general public know, like vertigo, I would have never thought.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: So we work, collaborate with our national organization. We have somebody representing our national organization here with us today. Because PTs in general, we've been pretty lousy public relations people communicating what we do, what we know. And it's actually more what we know than what we do. But yeah, it's definitely, it's been a challenge and something we are actively working on is educating the public.

[Rep. Francis McFaun (Vice Chair)]: Thank you. Yeah. Other questions? Comments?

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: The only thing I wanted to say is, kind of keeping us in mind for all other types of bills too, because it's the workforce, it's bringing young people here, it's keeping young families here, even helping the education no services out. Physical therapists can go into the schools and do education, we can educate the teachers so that they can be doing some of this for all of the students and not just waiting until a kid hits a 20 or 40% delay to get services. PD can go into the workforce and do ergonomic screens and assessments to minimize injuries. So just kind of keeping us in your front mind. We are essential.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: Physical therapists just consider that official primary care provider. They are eligible for loan forgiveness and loan repayment through programs that provide that when you work for a nonprofit as a physician, for example, in an underserved area. It would allow a physical therapist to be part of that as well. Yep. Yep.

[Rep. Allen "Penny" Demar (Member)]: Another question? Yes, I do. Have you ever been into the career centers in our

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: Yes. Here I do. In local estimates, we participate in the career day. It's a whole day where the kids can go through and learn about all the different professions, whether it's automotive, electrical, all the banking, like it's a really well done day. And we participate in that every year to help students decide where do they want to go and work with a tech center there in essence.

[Rep. Allen "Penny" Demar (Member)]: Has any of them taken on a program with physical therapy?

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: It's really hard to take that on. Are you asking this

[Rep. Allen "Penny" Demar (Member)]: In the career centers, I don't know.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: Oh, like a pre

[Rep. Alyssa Black (Chair)]: physical therapy? There I it

[Rep. Allen "Penny" Demar (Member)]: have a son that's a director of a career center in Petersburg, and he's looking for a lot of things. Of course, money's a problem, and they've done nursing programs, they've done birding programs, and they're always looking for need. Not a big community, but I was just wondering if anybody's ever I don't know what the cost is, and I think it was a culinary program immediately, so we can't do that because we don't have the money for that. But I don't know.

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: And six Tech does have a program which is more than just physical therapy. It's like health care

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: resources or something. Yes, I'm just curious.

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: Burlington, I believe does. Because I

[Rep. Allen "Penny" Demar (Member)]: think the career centers are very much more important and used than ever before. I

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: would agree.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: And I know Memorial County has one. Does Franklin County have a tech program, tech center?

[Rep. Allen "Penny" Demar (Member)]: We got one in St. Albans and Amesburg has a career center.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: Okay, gotcha. That's good to know. That just would help with outreach.

[Rep. Leslie Goldman (Member)]: Other questions? One comment. When I was in nursing school one hundred years ago, Went to GBM, and we were doing our finals, just to give some appreciation of the physical, which we shared a cadaver with. And from what we, I remember going in one day and it was our cadaver, and then the next day it was the tiny little, they used toothpicks back then. Don't do that anymore. There must have been a thousand toothpicks with little flags numbered, they had to identify ligaments.

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: The origin.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: Crazy. So much appreciation

[Rep. Leslie Goldman (Member)]: for your profession. I just have to say.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: Well, we often follow nursing as an example of how, in terms of advocacy and people who've done it, and a profession that's done it well, we're like, all right, we need to do what

[Rep. Alyssa Black (Chair)]: they did. So it is hard.

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: I think somebody here on our panel mentioned the return on investment. I still love what I do. I love the patient care part of my business. What I do every day, I have staff that I help manage and mentor. But one of my favorite pieces of what I do is actually the patient care. But it's difficult for me after thirty five years this year to look at a student who is 17 and says, I want to be a physical therapist. And so now we have this conversation of, well, do you have someone that's paying for your college education experience? Because these students are coming out with 150,000 to 2 and $25,000 of debt. And making $80,000 a year. How are you going to live in Vermont if you have those student loans to pay back? You're not going to live in Vermont. So there's the problem, right? You're trying to educate kids right in the UVM. They have a PT program, but they can't afford to stay here with the debt that they have to get to schooling, to be able to do what we do. And we love what we do. I've never met somebody that doesn't.

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: I've been practicing twenty three years and I came out with 130,000. And with the interest rates, I now still owe 48,000, even though I've paid 120 back. And I can't even afford my health insurance. So that's just sitting and waiting. Don't forget us that are still practicing too.

[Rep. Francis McFaun (Vice Chair)]: You are eligible for the is that?

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: AHEC? AHEC.

[Rep. Francis McFaun (Vice Chair)]: Yes. You are.

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: So it's all in and that's what's nice about AHEC is that it's all providers. A lot of programs are limited to MDs and so AHEC reaches out to all health professions, which is wonderful.

[Rep. Francis McFaun (Vice Chair)]: Okay, good. Alright, any other comments, questions?

[Alyssa Sargent, DPT (Physical Therapist and Educator)]: Thank you for your time.

[Rep. Leslie Goldman (Member)]: Thank you

[Rep. Alyssa Black (Chair)]: very much for coming in. Let

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: us know if you want more information.

[Estelle LeClaire, PT (Practice Owner; GMCB Advisory Board Member)]: We appreciate your help.

[Rep. Leslie Goldman (Member)]: You've got

[Rep. Alyssa Black (Chair)]: to work collectively as a group. Thank you. Have a

[Rep. Leslie Goldman (Member)]: good day. Thank you. Have a great day.

[Rep. Allen "Penny" Demar (Member)]: All right, committee.

[Rep. Francis McFaun (Vice Chair)]: We will take a break. Be back at 11:00. Show us a nice long break. I like

[Rep. Alyssa Black (Chair)]: that. So

[Rep. Francis McFaun (Vice Chair)]: can't, we're gonna have public book. Oh, you gotta do an offloading book. Let's

[Heidi Wilhelm, DPT (President, APTA Vermont Chapter)]: go