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Oregon LogThe Role of the Acute Care PT/PTA Treating Patients Undergoing Autologous Stem Cell Transplant ..............................4
What Should you Expect from Your OPTA Membership? .............6
Four Days in Baltimore: My Trip to the 2009 House of Delegates ......10
House of Delegates 2009 – Lessons and Insights for a PTA Student ....11
Health Care Reform Moves Forward ............................ 13
Comparative Effectiveness Research Could Change PT Profession ....... 14
Licensing Board Updates ............ 17
Oregon Physical Therapy Association
What’s Inside
A Component of the American Physical Therapy Association • www.opta.org Summer 2009
September 26, 2009 OPTA Fall Workshop on Diabetes Management and Business Meeting Portland, OR
October 17, 2009 Foot Biomechanics Workshop Portland, OR
March 12-14, 2010 Annual Conference Eugene, OR
All course listings are on our website: www.opta.org
* All listings are subject to change
OPTA ContinuingEducation Calendar
President’s MessageBy Susan Bamberger, PT, MPT
Preparing ourselves for changePhysical Therapy so far has been spared from mass layoffs
and furloughs during this economic recession. However, every practitioner I speak with has reported changes in coverage of Physical Therapy. Recently, I was shocked to have a patient cancel an initial evaluation because his insurance covers PT only after surgery or a hospitalization. If insurance does cover PT, many co-pays have increased from $15 to $30-$50 per visit. As a consumer, if I am paying $50 per visit, I better feel like I am receiving a valuable service. The message I get from these changes is that we must justify our services and provide quick and lasting results to have a place in the US health care system as it reforms.
Health care reform is the buzz word of the year. Changes in coverage are an indication that we all must be acutely attentive to how we treat. Adam Stadtlander, in his research committee report, discusses how the government is motivated to find cost effective care. This makes our efforts to educate the public and “brand” our profession very timely and essential. By comparing our services to more expensive interventions such as surgery, imaging and pharmaceuticals, we can surely stand out as a reasonable way to save health care dollars.
We must be our own advocates in Congress and with insurers by telling them that cutting PT services will in no way provide any effective long term health care cost savings. We provide cost effective outcomes with care that focuses on functional improvement and self sufficiency. If we do not educate the lawmakers and insurers, Physical Therapy may not be included in the services that provide essential care, and our services may not be covered by health care reform.
We have seen many physical therapy services excluded in Canada, a country that is well known to strive for cost effective care. However, in England and other European countries that are adequately educated in the value of our services, Physical Therapy is included as part of a team effort to produce cost effective, quality results. This is why the APTA is working so hard to make sure we have a place in health care reform.
In his Health Care Reform report, Chris Murphy is right to say that health care reform is in some ways changing quickly, and in others,
Continued on page 2
Page 2 - Summer 2009 OPTA OREGON LOG www.opta.org
OPTA BoardPresidentSusan Bamberger, PT 503.251.6100Portland, [email protected]
Past-PresidentKaren Walz, PT, MA, OCS, FAAOMPTRedmond, OR [email protected]
Vice PresidentChris Murphy, PTPortland, OR [email protected]
SecretaryMary Fajer, PTGleneden Beach, OR [email protected]
TreasurerJerry Cain, MPTPortland, OR [email protected]
Board Members at LargeDylan Hogan, PT, DPT - Member At Large #1
Portland, OR 503.215.0299 [email protected]
Jeffrey Cox, PT - Member At Large #2 Portland, OR 503.777.1983 [email protected]
Sandra Gallagher, PT - Member at Large #3 Portland, OR 503.494.3151 [email protected]
Stacey Cochran-Comstock, PT, DPT - Chief Delegate Portland, OR 503.233.3163 [email protected]
Stacy Mosbrucker, PTA - PTA Representative Corvallis, OR 541.768.5110 [email protected]
Committee Chairs Ricci Susick, MPT - Government Affairs
Portland, OR 503.215.6202 [email protected]
Dode Jackson PT - Continuing Education and Nominating Vancouver, WA 800.321.7862 ext. 738 [email protected]
Carol Schunk, PT - Ethics Bend, OR 541.480.8221 [email protected]
Bob Thomas, PT - Reimbursement Portland, OR 503.783.2473 [email protected] Stadtlander, PT - Research Portland, OR 503.331.3049 [email protected]
OPTA Office: 503.262.9247Toll Free: 877.452.4919E-mail: [email protected]
not as quickly as it should. Chris outlines how we can have influence with lawmakers in DC. However, with the anticipated changes coming, there is more we can do as clinicians:
1. Clean up your documentation. Make sure everything you do has a reason; with a clear path towards discharge. Explain your reasoning in your notes. “Progressing well” is no longer sufficient.
2. Remember, you can’t help everyone, and if you are not getting the results you anticipate, resist throwing your whole bag of tricks at them. If your intervention does not have a clinical reason and some evidence to back it up, it is not justified, and may not be reimbursed.
3. If you are not getting the results you anticipate, either send them to a colleague for a second opinion, or send them back to their referrer.
Patients will be grateful if you are honest and do not waste their time.
4. Establish a collaborative relationship with your referrers. If you are stuck with a patient, call them up and be honest. Tell them why you do not think they are responding to therapy, and offer options. Be assertive, if they just want to send them back for palliative care, help them understand that billing insurance for palliative care is not justified.
As lawmakers in DC work to change the big picture, you can work to be part of the solution. Do your due diligence in providing the quality, effective care we are obliged to perform.
Remember, what you do affects how we all appear, and our future in health care.
ReferencesOn Canada www.physiotherapy.ca.On the UK www.csp.org.uk
OPTA immediate past president Karen Walz, PT and APTA director and Oregon liaison Aimee Klein, PT at the APTA CSM president’s lunch.
President’s Message, continued from page 1
OPTA OREGON LOG Page 3 - Summer 2009www.opta.org
Update on Worker’s Compensation Issues By Karen Walz, PT, OCS, FAAOMPT
The Workers’ Compensation Division will be proposing only a few changes to the medical rules effective by January 1, 2010. Two of these are necessary to implement law changes from the 2009 Legislative Session. A hearing will be scheduled in November or December 2009. These changes are:
1) HB 2197. Health care providers will have a minimum of 30 days to treat workers from the “first visit on the initial claim” rather than 30 days from the date of injury. (affects OAR 436-010)
2) HB 2045. Chiropractors may make findings of impairment. (affects OAR 436-010)
3) OAR 436-009-0010 is unclear that use of the CMS 1500 form is required in all cases,
even for IME providers and MCO panel members.
The next general changes to OAR 436-009, “Oregon Medical Fee and Payment Rules,” are scheduled to be effective July 1, 2010. Hearings likely will be scheduled next spring. OPTA continues to monitor this WCD activity and coordinate with other stakeholders for appropriate action.
Current conversion factors that affect Physical Therapy practice are Physical Medicine: $65.79, and Oregon Specific Codes: $60.00. The Physical Medicine conversion factors were last increased around five years ago. Hearings earlier this year addressed a concern on PPO contract discounted fees. Legal battles continue regarding
this issue. The Worker’s Compensation Division did agree, effective January 1, 2009, that PPO contract discounts could no longer be used to reduce medical providers (PTs and others) bills.
To view the current revised Workers Compensation Division rules governing Physical Therapy go to http://oregonwcd.org, click on Laws and Rules, then follow to Division 9 (fees) and Division 10 rules (Medical Services).
For more information on WCD or to voice your thoughts contact Fred Bruyns, Policy Analyst, Rules Coordinator at:
Department of Consumer and Business Services
Workers’ Compensation Division
503.947.7717; fax 503.947.7514Email: fred.h.bruyns@state.
or.us
WC Related Continuing Education
Work Injury Management Association of Oregon (WIMAO), a multidisciplinary group of providers in WC fields including OPTA member participants, is sponsoring a course. They are hosting a fall 2009 presentation “Assessing Functional Performance: what’s the law got to do with it?” Friday, September 18, 2009, 12:45-5:00 PM at Wellspring Medical Center, Woodburn, OR. Fee $40. For further information or to register contact [email protected].
Darci Adams, SPTAVictoria Black, SPTAshley Buffington, PTJonathan Burke, PTAJessica Crawford, SPTMichael Crawford, SPTEmily DeCarlo, PTJudy Ellis, PTJulianna Harder, PTJerry Henderson, PTMary Hlady, PT, OCSGlenn Hussey, PTChristiane Jones, PTChristopher Lewis, SPT
Leslie MacLaggan, PTEvan Mcleod, PTDebra Nelson, SPTARobin Nelson, PTBryan Pasternak, PTAmanda Payne, PTMelissa Schussman, SPTBeth Smith, PTRebecca Sousa, PTJoyce Steele, PTJustin Stehr, SPTRodney Stewart, PTKaryn Trivette, PT
Welcome New and Returning Members
Page 4 - Summer 2009 OPTA OREGON LOG www.opta.org
The Role of the Acute Care PT/PTA Treating Patients Undergoing Autologous Stem Cell TransplantBy Emily Lighthipe, DPT, Providence Portland Medical Center
In the media, the topic of fetal stem cell research evokes controversy and ethical discussion, however no one can dispel the crucial role stem cells play in health care today. The stem cells used in Autologous Stem Cell Transplants or ASCT are stem cells that have been reinfused into their original donor for the purpose of curing immune system disorders, bone marrow deficiency diseases, inadequate blood cell production and specific cancers, namely leukemia, lymphoma and myeloma.
Prior to transplantation (conditioning phase), patients undergo several cycles of chemotherapy to decrease the overall tumor burden. Their stem cells are then harvested via hemapheresis and treated for infectious diseases, malignant cells and reduction of T-lymphocytes. This is done approximately two months ahead of hospitalization.
Upon admission to the oncology ward, patients are started on high-dose chemotherapy regimens lasting 3-7 days. Patient’s typical stay is 6-8 weeks depending on success of engraftment and complications. Side effects of chemo include nausea, vomiting, lethargy, headaches, mucositis, weakness and in some cases temporary peripheral neuropathy. Once chemo is completed, intravenous reinfusion of the patient’s stem cells occurs over the course of 1-2 days (aplastic phase). Engraftment typically takes 1-3 weeks (engraftment phase). Discharge is when the patient is hemodynamically stable, afebrile, able to maintain a sufficient diet care for the central venous catheter, and manage medications.
Where does the acute care physical therapist come in? In all phases of the ASCT. Patients will do well to make their frequency at least 2-3 times per week due to the risk of becoming deconditioned. Prior to reinfusion, the PT performs the initial evaluation including: past medical history, prior level of function, assistance available upon discharge from the hospital, overall strength and ROM, current functional mobility, cardiopulmonary endurance, and goals for rehab.
A crucial component of this first encounter is impressing upon the patient and his/her caregivers the importance of staying active. Educating caregivers, family, friends and nursing staff about
a self-directed exercise program increases the patient’s compliance, increasing chances of a more successful recovery. Most ASCT hospital rooms are equipped with a stationary bike and bathroom to allow patient to perform independent activities of daily living (ADLs). The therapist’s role is to guide activity parameters and an exercise program that considers the needs of the patient, their activity tolerance, vital signs and daily lab values.
Another important part of the evaluation is educating the patient on the safe parameters of activity with regards to platelet levels. Platelets and other blood counts will be decreased (sometimes severely so) around the time reinfusion occurs. Platelets, hematocrit, hemoglobin and absolute neutrophil counts decrease in response to chemo but do build back up once engraftment occurs. When platelets are low, the risk of internal and external bleeding increases. A table of activity parameters depending on platelet levels follows.
In treatment sessions, the therapist determines compliance with the exercise program, tolerance to activity and adherence to activity precautions
PLATELET COUNT ACTIVITYLess than 5,000 Strict bed restplatelets/microliterof blood
5,000-20,000 Light daily activities; in-room walking only unless with nurse or nurse assistant (exceptions: H&H below 25&8, neutropenic fever, dizziness, confusion, high fall risk, needing walker)
20,000-50,000 Walking as tolerated, light resistance training, stationary bike
50,000-150,000 Walking as tolerated, moderate resistance training, stationary bike
150,000-450,000 Normal activity
Continued on page 5
OPTA OREGON LOG Page 5 - Summer 2009www.opta.org
as they relate to platelet levels. Immobility is common during the aplastic phase due to side effects of chemo, however the therapist, and the rest of the medical staff, must remain vigilant and insist that the patient stay active. It is helpful to remind the patient of the detrimental side effects of prolonged bed rest: weakness, bone loss, increase cortisol levels which expedite sarcopenia and osteopenia, and risk for blood clots.
Lastly, it is important to remind patients to contact their PT or PTA for any of the following: increased difficulty with any functional mobility, need for an assistive device to walk safely, increased pain with any exercises or feeling overly tired or out of breath after simple activities.
ReferencesDimeo FC, Tilmann MH,
Bertz H, Kanz L, Mertelsmann R, Keul J. Aerobic exercise in rehabilitation of cancer patients
after high dose chemotherapy and autologous peripheral stem cell transplantation. Cancer. 1997, May; 79(9): 1717-22.
Dimeo FC, Fetscher S, Lange W, Mertelsmann R, Keul J. Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high dose chemotherapy. Blood. 1997, November; 90(9): 3390-94.
Dimeo FC, Schwartz S, Fietz T, Wanjura T, Boning D, Theil, E. Effects of endurance training on the physical performance of patients with hematological malignancies during chemotherapy. Support Care Cancer. 2003, October; 11(10): 623-28.
Goodman CC, Boissenault WG, Fuller KS. Pathology: Implications for the Physical Therapist. 2nd Edition, WB Saunders, 2003
Mello M, Tanka C, Dulley F. Effects of an exercise program on muscle performance in patients undergoing allogenic bone marrow transplantation. Bone
Marrow Transplantation. 2003; 32: 723-728.
Hergenroeder AL. Implementation of a compentency-based assessment for interpretation of laboratory values. Acute Care Perspectives.
2006, Spring: 7-15.
Change of Address or Phone?
If you have a change of address, phone, fax or e-mail, you can send it to the OPTA office online at www.opta.org. When you log on to the site, choose the “members only” section on the left side of the screen. Once there, you will need to enter the correct passcodes to get into that portion of the site. Select the link to “Update Your Contact Information with OPTA.” Once there, fill in all the boxes and send it! It is as easy as that. Or, you can always call the OPTA office at 503.262.9247 or tollfree at 877.452.4919.
OPTA Members Only Section Log-In
It’s just like your log-in for the APTA website. Your APTA membership number is your User Name. Your last name is your Password. In the members only sections of the site you have access to: the membership directory, media contact lists, past Log Newsletters, government affairs information, PR branding campaign, and be able to update your contact information.
Take a look for yourself atwww.opta.org.
Find a PT is compiled and published by the American Physical Therapy Association (“APTA”) as a reference source of demographic and professional information on individual licensed physical therapists in the United States for consumers to access. If you are not taking advantage of this tremendous member benefit, you should check it out! Consumers can use the directory to find physical therapists located in any of the 50 United States. Consumers can also
use the directory to narrow their search for specialty areas of practice. This portion of the APTA website describes who physical therapists are and what they do, different areas of specialty in physical therapy and the code of conduct that therapists work under.
For more information on this program go to http://www.apta.org/Consumer/findapt and click on the “members sign up for find a PT” to get on the list.
Take Advantage of this Great Member Benefit to be Listed as a Physical Therapist Via the Internet
“Find a PT” Member Benefit Program
Acute Care, continued from page 4
Page 6 - Summer 2009 OPTA OREGON LOG www.opta.org
KAISER PERMANENTE IS AN AA/EEO EMPLOYER.
I dance to
COME JOIN OUR PT TEAM PORTLAND, VANCOUVER, CLACKAMAS COUNTY, AND SALEM
At Kaiser Permanente, you’ll play an important role on our integrated health care team.Our physical therapists enjoy autonomy not found within other health care organizations.They spend less time worrying about insurance and justifying treatment, but more timetreating the whole patient, designing and delivering the right treatment.
We are actively recruiting physical therapists who share our values and believe in qualityof care. Kaiser Permanente seeks graduates of accredited schools of physical therapywho are licensed in Oregon or Washington. We are looking for therapists who canprovide excellent service in outpatient orthopedics, acute care, worker’s compensation,neuro-rehabilitation, and home health.
For more information about career opportunities, please contact us at {(503) 813-3601or (800) 845-4875. Visit jobs.kp.org for complete qualifications and job submission details.Individuals who are bilingual or have multicultural or diverse patient populationexperience are encouraged to apply. Drug-Free Workplace.
jobs.kp.org
I value my freedom. Believe in the work I do. And aim to bring out thebest in everyone—myself included. Being a physical therapist enablesme to enhance the lives of those in my care. Kaiser Permanente sharesthat mission and wants the same for me. If you believe that qualitycare and quality of life go hand in hand, this is the place to put yourbeliefs into practice.
KHOWARD
do
4.5 x 7.5
KAI003815B 5/12/2008
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KAI904031
OREGON PHYSICAL THERAPY ASSOCIATION
MY OWN MUSIC
What Should you Expect from Your OPTA Membership?By Jeff Cox, PT, Membership Committee Chair
Being a member of your professional association is an important part of being a part of the physical therapy profession. By being a paying member, you are actively helping to support the legislative and
public relations efforts of the association to protect and advance our profession during an important time in healthcare reform. Those who volunteer their time and effort are taking the next step of actively being a
member. All Physical Therapist and Physical Therapist Assistants in the state of Oregon benefit from the actions and support of the members.
So what should you, as a member of the OPTA, expect from your membership that nonmembers do not have access to? Does the association adequately address your needs? You should expect from the OPTA an opportunity to develop peer relationships among other members. These relationships may provide you with an opportunity to mentor a fellow member to ensure the next generation of clinicians keeps the profession strong. You can expect to be mentored as you begin your career so that you have the opportunity to learn real life skills in the profession as well as learn about the issues that affect our profession.
These peer-to-peer interactions should help you to keep abreast of the most pressing issues in our profession as well as be a source of support in whatever questions you have regarding practice. There are several committees, legislative, ethics, reimbursement just to name a few which are here to answer your questions. These peer-to-peer interactions should also provide you with the opportunity to socialize with those who are similar to you in their expectations and hopes for our profession.
Your membership should provide you with access to research and other relevant
Continued on page 7
OPTA OREGON LOG Page 7 - Summer 2009www.opta.org
literature. It should provide you with the opportunity to attend, at a reduced rate, quality continuing education.
Perhaps most important, your professional association should make you feel like you have an influence on our profession and the direction we go. By being a member you should feel empowered to address the challenges that lie ahead. You should also be recognized for your effort and dedication to the
profession. So, do you feel that your
current membership meets these needs? Are there other needs that you feel should be addressed? If so, let me know. Is it reasonable to think that every member will be happy with every aspect of the association? No, but challenges to better serve its members is what makes the association stronger. Let me know what the association is doing well. Let me know what you would like to see changed.
As your Chair to the Membership Committee, I strive to recruit members, but also retain members to strengthen our association.
To better serve all members across areas of practice, as well as age and years of practice send any questions or comments to [email protected]. Please include in your response how long you have been practicing, how long you have been a member, your area of practice, and if you would like, your age.
Oregon Facility Highlight100% Membership
VISITOUR
WEBSITE ATwww.opta.org
Membership, continued from page 6
Northwest Rehabilitation Associates3270 Liberty St. S Salem
Clinicians:
Mike Studer, MHS, PT, NCS
Rene’e Brandt, MPT
Brady Whetten, DPT
OPTA: As a clinic, what advantages are there to having all clinicians be members of the Oregon Physical Therapy Association?
Northwest Rehabilitation Associates: We have a clinic that strives to serve clients with evidence-based PT. Research in rehabilitation continues to advance. We find the best way to stay in touch with and contribute to this body of knowledge. Through our APTA and OPTA memberships, we receive many continuing education discounts and – perhaps most importantly – are supporting those that advocate for our profession.
OPTA: What do the clinicians at your facility think are the biggest challenges the OPTA faces?
Northwest Rehabilitation Associates: Physician owned PT and insurance plan limitations (including Medicare) for visits per calendar year. When patients have multiple conditions, surgeries or complications – they need to be served beyond these limitations at times. Fortunately, exceptions processes are advancing.
OPTA: How do they think we should approach these issues?
Northwest Rehabilitation Associates: We feel that a greater level of awareness in the PT community is the answer. OPTA and the APTA are doing a great job advocating at the Federal and State levels…yet more PTs need to be members and more members need to become involved.
OPTA: How do your clinicians encourage other PTs/PTAs to become members?
Northwest Rehabilitation Associates: Several therapists on our staff are continuing education presenters on a national and international level. It is primarily through these efforts that we reach other therapists. We are clear in our support of APTA and chapter membership due to the benefits available to self and the greater good of the profession.
Page 8 - Summer 2009 OPTA OREGON LOG www.opta.org
PHYSICAL THERAPIST OWNED AND DIRECTED
Opportunity. Independence. Support. Tradition.
Therapeutic Associates, Inc. (TAI) was founded in 1952 and has always been privately owned and directed by physical therapists. TAI clinics are independently operated, orthopaedic and manual therapy-based, with a variety of specialty programs. Our history, resources, and professional administrative staff afford endless support to our facilities. TAI’s Key Person Career Track, Leadership Development Training Program, One-On-One Manual Therapy Mentorship Program, and Orthopaedic Residency Training Program are among our unique company advantages.
www.therapeuticassociates.com/careers
For more information on current Physical Therapist and PTA openings in WA, OR, ID, and CA Contact Lori Dillon, Recruitment Director at [email protected] or 800-249-9020 ext. 2221
Congratulations to all Oregon clinics currently participating in the APTA’s Facility Challenge. We would like to recognize and commend the following facilities for having 100% of their clinicians members of the OPTA.
• Back in Action Physical Therapy
• Broadway Physical Therapy and Sports Rehabilitation
• ProActive Orthopedic and Sports Physical Therapy-Gresham
• ProActive Orthopedic and Sports Physical Therapy-Oregon City
• Mitchell Physical Therapy
• Northwest Rehabilitation Associates
• Oregon State University’s Student Health Services
• Providence North Portland Rehabilitation
• PT Northwest-McNary
• PT Northwest-Monmouth
• PT Northwest-Stayton
• PT Northwest-West Salem
• Synergy Physical Therapy
If your clinic has 100% membership among its clinicians, you are encouraged to sign up with APTA’s Facility Challenge and receive the recognition your clinic deserves for its commitment to better serving our profession. If you would like to sign your clinic up you can find the application on the APTA website, www.apta.org. Go to Membership Benefits and Services. Then click on the link to Facility Challenge.
APTA’s Facility Challenge By Jeff Cox, PT, Membership Committee Chair
Employment Opportunities?
Check out OPTA's website for employment postings at www.opta.org. From the home page click on Job Postings and then review the opportunities that are posted.
If you have a job listing that you would like posted, please visit the OPTA website at www.opta.org. Job posting rates are $100 for a 30 day posting. All job postings must be done online. Take advantage of this great opportunity to market your position!
OPTA OREGON LOG Page 9 - Summer 2009www.opta.org
PTA Representative ReportBy Stacy Mosbrucker, PTA, PTA Representative
There was much to celebrate at this year’s House of Delegates. The 40th year anniversary of the first graduating PTA class continued to be an exciting event. To recognize the occasion, the PTA Caucus this year raised over $27,000, and presented a check to the PT-PAC at the conclusion of the House. This is an example of how PTAs are becoming more involved in the association.
One of the highlighted motions brought to the House floor this year, was the expansion and modification of the “Code of Ethics” for PTs, as well as the “Standards of Ethical Conduct for the Physical Therapist Assistant”. These will be adopted by July of 2010, with a model for academia on how to teach the new Standards and Code. Both will now include our profession’s core values, however it is still being decided whether PT’s and PTA’s will have the same core values.
This year the APTA Board of Directors provided a report to the House regarding last year’s Rules Change (RC) 14-08, “Identification of the Role of the Physical Therapist Assistant in 2020”. There
was a 6 hour Mega Issues Discussion within the Board. One result of this meeting was the development of a new position in the APTA called Associate Director of PTA Services. Janet Crosier has been appointed to the position and will serve as liaison within APTA for all PTA related issues. Among her many objectives are proofreading all APTA publications having to do with PTAs, and making changes to more inclusive language.
Here in Oregon I am proud to announce that the first member-based listserv for PTA’s will be launching soon. The OPTA Board of Directors has agreed to test a PTA listserv within our membership. This will allow all PTA members to discuss PTA issues openly, and receive feedback and advise from other PTAs across the state. I am excited to be able to reach so many members at once, and keep us all connected. Be checking your e-mail inbox for the first letter and introduction to the listserv, as well as instructions and regulations on how it is properly used.
This will allow a wonderful way to continue the discussion for next years upcoming House of Delegates. On the agenda of course is the full vote for PTAs at the chapter level. No other professional association gives any of its members a ½ vote. It is time to take a more “visionary” perspective on PTA inclusion!
Once again, I thank you all for any input and welcome all feedback. As always, I can be reached at [email protected]. Enjoy your summer.
Oregon delegates at APTA’s House of Delegates meeting
Page 10 - Summer 2009 OPTA OREGON LOG www.opta.org
Four Days in Baltimore: My Trip to the 2009 House of DelegatesBy Leigh H. Reece, SPT
The large ballroom at the Hilton hotel in Baltimore, MD, was overwhelming, a little intimidating, when I first walked through its doors. Inside, row upon row of long tables held placards for each of the 50 states and the District of Columbia. Several more tables were set for individual sections and groups, such as the PTA caucus and the Student Assembly. At the end of the long room, two large screens flanked a podium on a tall stage. Even with two days of preparatory meetings, I still didn’t really know what to expect that first morning. The mood in the room was electric, filled with the excitement and importance
of the tasks that lay ahead for the APTA House of Delegates.
The overwhelming buzz for this year’s session focused mostly on Rules Change (RC) 4-09 and Rules Change (RC) 5-09. These motions were brought forward with the intention of making major changes to the Codes of Ethics for both PTs and PTAs. Meetings were held before the session began, often including members of several delegations as well as members of the Board of Directors, in an attempt to resolve as many differences as possible before the House met as a whole. These preparatory meetings are crucial to keeping the House on task so that as
many agenda items can be covered as possible. However, even with preparation, debate on these two motions lasted the entire first afternoon and well into the next day. Emotions ran high as delegates expressed their opinions, wrangled with potential legal implications of the new Codes, and wrestled with seemingly simple questions about word choices like “should” versus “shall.” In the end, RC 4-09 and RC 5-09 both passed and two new Codes of Ethics were adopted by the House. The hope is that these new documents, which are much more detailed than the previous Codes, will be inspirational to PTs and PTAs and will help better protect the public and the profession.
Throughout my four days in Baltimore, I was awed by the devotion of so many people to the advancement and continued success of the physical therapy profession. With every topic, there was great discussion as to how a particular issue might affect Vision 2020 or the current national healthcare debate. As a third year PT student, I am aware that I am about to graduate into a rapidly changing professional environment that will require flexibility and creativity to overcome the challenges that lie ahead. I was lucky to be able to observe and interact with an amazing group of people at the 2009 House of Delegates, knowing that they are at the helm of the APTA, gives me confidence in the future of the physical therapy profession.
$50 Invested Each Year in the OPA POPAC (Psychologists of Oregon Political Action Committee) becomes a $50
Oregon State Tax Credit to you.
OPA POPAC serves all Oregon psychologists by educating legislators and supporting bills important to all Oregon
pyschologists.
Support our goal to support you. To make an investment, contactCliff Johannsen at 503.246.5986.
OPTA OREGON LOG Page 11 - Summer 2009www.opta.org
House of Delegates 2009 – Lessons and Insights for a PTA StudentBy Mike Mulligan, SPTA
What does RC stand for and who was this Roberts guy making such complicated rules? So went some of the serious and not so serious questions in my mind as I embarked on my 2009 House of Delegates (HoD) adventure.
The fun began when I downloaded the voluminous bylaws, schedules, proposed RCs, and supporting documents off the APTA website. “Comprehensive” aptly describes these materials. For the eager but slightly naïve PTA student, “overwhelming” was a better descriptor. And it made me start to wonder, just a wee bit, what exactly I’d gotten myself into.
But these worries were unfounded as the members of Oregon’s delegation were very willing to mentor me. Both at the two delegate meetings I attended before the trip and in Baltimore, every representative willingly and insightfully answered my questions and fostered my understanding of the HoD and how it really works. I owe a special thanks to PTA Representative Stacy Mosbrucker who shepherded me the most.
Upon arrival I was immediately off to the PTA Caucus meetings. I learned about issues of special concern to PTAs and of the overall goals of the Caucus going into 2010. I got to hear the candidates vying for the various officer positions within the Caucus, address their fellow members, explain their positions on specific issues and answer questions. What struck me was the variety of backgrounds people bring to this body, the diversity of practice settings, and the differences in how PTAs are perceived and utilized around the country.
We continued on to an astounding whirlwind of caucus meetings -- for Oregon, all the western states,
and students. We attended Motion Discussion Group meetings and listened to the Mega-Issue Discussion - and that was before we even got to the real HoD proceedings! This event required stamina. The rich discussions these meetings generated impressed upon me just how dedicated and passionate our profession is about guiding its own destiny.
Change – it’s a word that’s recently gotten a lot of use in our country. The 2009 HoD was not immune to this word or the excitement -- and nervousness -- it can elicit. This was the first HoD for new House Speaker, Shawne Soper. Immediately, RC 4-09 and RC 5-09 provided her with opportunities to negotiate the full gambit of parliamentary procedures at her disposal. The house wrestled with the form and intent of these proposals, as well as the nuances of the language they contained. It was a grinding process that ultimately yielded the new Codes of Ethics and an accompanying round of well deserved self-congratulatory applause by the delegates. Having observed this process for many hours, I felt a real investment in this process and connection to the legislation. I’ll answer to this new code for PTAs when I graduate next summer and I was there to see its creation.
What struck me initially, when the dust of the 2009 HoD had settled, was something I think I knew going in: Democracy, regardless of the circumstance in which it is applied, can be a complicated, convoluted and even contentious process. The passionate discussions on the house floor and the apparent late night negotiation sessions that yielded new ideas for the delegates to consider each morning proved this. Yet no better form of governance exists to choose the course for an organization as diverse and complex as the APTA.
What I didn’t fully appreciate going into this experience, but what I now value the most coming out, is the profound sense of belonging I feel within the field of physical therapy. I’m proud of the career path I’m pursuing and recognize the importance of my continued involvement in the governance process when I graduate.
Our field offers many opportunities and will face many challenges as it pursues the Vision 2020 goals. What’s now clear to me is that we should not treat this process as a spectator sport. Rather, each of us needs to be on the field, actively engaged in the process. That is how we will ensure we steer our profession on a course of our own choosing.
Thanks to OurOPTA Gold Sponsors
Kaiser Permanente
PT Northwest, LLC
PT on Call, PS
Salem & West Valley Hospitals
Therapeutic Associates
Page 12 - Summer 2009 OPTA OREGON LOG www.opta.org
Government Affairs Committee ReportBy Ricci Susick, PT, Government Affairs Committee Chair
The 2009 Oregon Legislative session is over and it was a busy time. Please read the full report of the OPTA activities this session as well as a synopsis of various bills that will have an impact on the Physical Therapy profession on the OPTA website www.opta.org.
Generally the bulk of the session was spent working on budget issues and healthcare legislation. We were successful in getting a bill passed that allows PT’s to use the title Dr. under specific circumstances. We also opposed a chiropractor bill that would have defined subluxation in their licensing statute in a very broad way that might have had implications regarding our ability to do spinal manipulation.
Also of interest to PTs are the
various bills related to healthcare reform in Oregon, and changes in laws for licensing boards, including the Oregon Physical Therapist Licensing Board.
The committee took the summer months off as far as meeting, but members have attended various town halls and meetings with legislators. The OPTA was represented in Washington D.C. at the Federal Government Affairs conference. Our members lobbied congress on several issues including repeal of the Medicare Cap, Direct access for Medicare patients, and inclusion of PTs in the National Health Services Corps which would allow some loan forgiveness funds for PT’s working in under-served areas of the country.
Some of our next steps for
advocacy include attending the APTA State Government Affairs conference in Phoenix, Arizona in September and meeting with the chiropractors in August to discuss how we can better work together. Other steps for the interim, include identifying the role of PTs in the various healthcare reform initiatives, continued monitoring of the Chiropractic ballot initiative, and ideas for possible bills to introduce in the 2011 session. Protection of the term Physical Therapy is a high priority.
Please call me or email me if you have questions.
Ricci Susick 503.215.6202 [email protected]
OPTA OREGON LOG Page 13 - Summer 2009www.opta.org
By the time you read this article, it will surely be out of date. Health care reform is moving quickly on some fronts and not at all on others. The President and Congress are seeking to contain the accelerating cost of health care and provide coverage for the growing numbers of uninsured and underinsured Americans.
The House of Representatives released HR3200 in mid-July and it has passed through the Ways and Means Committee and the Education and Labor Committee. Across the Capitol, the Senate Health, Education, Labor and Pensions Committee completed one of the longest markups in legislative history and released its Affordable Health Choices Act with a partisan committee vote. Meanwhile, we are still awaiting the Senate Finance Committee’s bill which was supposed to have been released before Memorial
Day, but has been held up in committee as Senator Baucus seeks some bipartisan support. Oregon’s Senator Ron Wyden continues to play a prominent role in the process. He has been tasked with finding common ground between the progressive Democrats, who favor a public health plan, and the conservative “Blue Dog” Democrats and moderate Republicans, who are concerned about the costs of these proposed plans.
At the time of this writing the House has already adjourned for the August recess and the Senate is likely to follow without a complete health care reform bill on the table. The August recess will be a critical period for members of Congress to hear from constituents about their needs and expectations in this matter. There are several ways that you can help to ensure that physical therapy is noted as an effective, efficient and essential component
of any new health care system.• Keep up to date on APTA’s
involvement by joining the PTeam – APTA’s grassroots organization (www.apta.org/pteam)
• Visit APTA’s Health Reform web page for the latest developments (http://www.apta.org/healthcarereform)
• Attend a town hall held by your Congressional Representative or Senators and speak out about the value of physical therapy in reducing health care costs
• Host a visit to your clinic, help organize a town hall or throw a fundraiser for your Representative or Senators
The OPTA Government Affairs Committee continues to work with APTA staff and our own lobbyists to monitor the progress of reform in Washington and Salem. We welcome your input or feedback.
Health Care Reform Moves Forward By Chris Murphy, PT
If you are interested in joining the PT Northwest family, please contact Mike Hmura, MSPT at 503.371.8860 or email [email protected] can also check us out at:
www.ptnorthwest.com
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PT NORTHWEST is a growing, indepen-dent, and progressive physical rehabilitation group with 30 years of experience in Oregon. Therapist owned and operated, PT Northwest strives to provide the leading physical rehab services in the Pacific Northwest, while nurturing a family-friendly atmosphere. Our highly motivated rehab team provides physical, occupational, and speech therapy in the following settings:
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Page 14 - Summer 2009 OPTA OREGON LOG www.opta.org
In President Obama’s recent stimulus bill, 1.1 billion dollars were earmarked for comparative effectiveness research in healthcare. The reason for the large allocation is due to the surprising lack of research comparing treatments. This lack partially is because Medicare does not use the results of these studies to make decisions about coverage and reimbursement.
With the current focus on cost reduction in the health care system, the phrase “comparative effectiveness” could soon change our profession. This research focuses on showing the relative benefit versus risks or benefit versus cost for a given treatment for a specific diagnosis (i.e. the best outcome for the lowest price with the lowest risk). Because Physical Therapy is a noninvasive and low risk option of treatment and/or prevention for many
conditions, this new focus may help demonstrate the value of PT evaluation and interventions. On the other hand, some of the treatments that have weaker evidence may become harder to get reimbursed.
A relevant example of comparative effectiveness due to the focus on the cost of health care is a study published in 2006 that compared the accuracy of MRI versus clinical (PT) assessment of an acute hamstring injury1. This cohort study compared the accuracy of MRI versus Clinician assessment in predicting duration of rehab of 58 professional soccer players with hamstring strains. The result of this study showed that a MRI was not significantly more efficient in estimating the duration of a mild to moderate hamstring injuries.
The APTA has been supporting comparative effectiveness for PT
for years having implemented “hooked on evidence” that has 5,000 articles and has had over 47,000 visitors. The APTA recently submitted a statement to the Federal Coordinating Council on Comparative Effectiveness recommending more equitable funding & research for physical therapy interventions (versus surgery or drug therapy).
Scott Ward recently wrote about this on Moving Forward blog (Click here to read).
To learn more about this and how the APTA is involved in other aspects of health reform click here.
1. Schneider-Kolsky, M.E. et al “A Comparison Between Clinical Assessment and Magnetic Resonance Imaging of Acute Hamstring Injuries” The American Journal of Sports Medicine June 2006 vol. 34 no. 6 1008-1015.
Comparative Effectiveness Could Change PT ProfessionBy Adam Stadtlander, PT, Research Committee Chair
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Currently under our plan Verizon users receive a 10% discount off the monthly access fee on all Verizon’s published consumer voice rate plans of $34.99 and above as well as having a basic plan of $11.99/mo. Discounts are available on data products as well. As our number of phones with Verizon grows so does the discount to our members.
Update Services has contracted with Verizon Wireless to offer discounted plans and equipment to our members.
Take advantage of this great wireless program with Verizon as a member benefit of your association.
Verizon offers: Great “roam like home” and
“in-network” coverage.Terrific FREE phone replacement
programsFree long distance on most plans
Dedicated Corporate customer serviceWireless Broadband Service
Plus much more!We are excited about this program and believe you will be also.
For additional information, contact us and we will give you all the great details.Or you can contact our Verizon Account Representative,
Braden Beisse • 360.624.1035 • [email protected](make sure to mention Update Services)
UPDATE SERVICES, INC. - 503.253.9385 or [email protected]
OPTA OREGON LOG Page 15 - Summer 2009www.opta.org
Special Olympics Update - How You Can HelpBy Johnny Galver, PT
In the spring 2009 issue of the Oregon Log I described my experience working with Nick, a 19 year old Special Olympics athlete. I highlighted the training program we did and the success Nick had with the program. Although many athletes can compete in the Special Olympics, the role of providing physical conditioning and training is left up to the individual athlete. They lack specific goals and parameters to optimize their performance. Exercise physiology texts discuss several different types of training protocols or practice schedules which are optimum for performance, yet these athletes are not required to follow any particular schedule or program. You may be asking yourself, “Why?”. Well, that is the
reason for our project.Last year we trained six
different athletes in Salem. Three other sites and my own clinic partnered with the Regional Field representative for Special Olympics, the athletes’ parents, and the athletes for a six month training program. The training programs were developed at the individual sites depending on the needs of the athletes. At our clinic, I recruited a student from our local college to be the one-on-one trainer with the athletes. I trained her to be safe in the use of all equipment, plus I was present during the training sessions. All the athletes improved in one area or another, and the parent feedback was glowing. The pilot process was a success.
My vision for this project is to
pair a Special Olympics athlete with a local physical therapy clinic or outpatient facility willing to supervise an individual to train the athlete. These individuals may include staff PT aide, students from a local college or high school interested in the special needs population, or community volunteer. They would be trained in use of all equipment and exercises to be used for the individuals training program. The suggested frequency would be twice a week, and the duration is dependent on the sport season. My goal is to create a life long partnership with the athlete and to encourage them to continue with a regular exercise program for the rest of their lives. My goal for Nick is to help him understand how regular exercise will assist him through out his lifetime.
I am looking for individuals to help make this a reality. Presently, I need assistance developing a document to protect the athlete and the supervising clinics, to create a nonprofit organization, and to seek funding to offset the cost to operate these training programs. Individuals at OSU and Corban College would help in the development of a standardized training program, but they require funds to proceed. I know times are tough, but the possibilities of giving something back to our communities and creating a fitness model for these individuals are the driving forces which motivate me.
If you are interested in helping, have more to add or suggest about the project, or want to give encouragement, contact me at [email protected].
At the Fall Business Meeting on Saturday, September 26th, we will elect 3 new Active Delegates, a Chief Delegate and a PTA Representative. If you cannot attend the Fall Business Meeting, please SUBMIT your ABSENTEE BALLOT by September 24 to the OPTA office. These individuals will be members of the team that represent Oregon at the APTA House of Delegates.
At the OPTA Spring conference on Saturday, March 13th, 2010 at the Eugene Hilton, our members will elect a Vice President, President Elect and a nominating committee member. To find out more information
about each position and the qualifications please look on the OPTA website: www.opta.org/elections.htm.
Help us identify future emerging leaders who are passionate about our profession. If you think you may be interested in running or would like to nominate someone for a position please contact one of the nominating committee members:
Dode Jackson, PT (1.800.321.PTOC (7862) extension 744) [email protected]
Rebecca Reisch, PT [email protected]
Diane Shiffer, PT [email protected]
Nominating Committee ReportBy Dode Jackson, PT, Nominating Committee Chair
Page 16 - Summer 2009 OPTA OREGON LOG www.opta.org
The Results are In! A Membership Survey OPTA Reimbursement CommitteeBy Bob Thomas, PT, Reimbursement Committee Chair
In May, the OPTA Reimbursement Committee sought your response on reimbursement issues. An on-line survey was sent to all members. We received 194 completed surveys for an 18% response rate. This report outlines the results of this survey.
Question 1: In what practice setting(s) do you spend the majority of your working time? If multiple settings, identify those in which you spend more than 40% of your working time.
Twenty percent (20%) of respondents practiced in inpatient settings including acute hospital (10%), IRF (1%) and skilled nursing facilities (9%). The majority of respondents (76%) practiced in outpatient settings. This included PT in private practice clinics (45%), hospital outpatient (26%) and rehab agency, CORF or physician owned clinics (5%). The remainder of respondents came from settings including home health, schools/pediatrics and academic institutions.
Question 2: Rank the top three (3) payer types with which you work:
(1) Managed Care Organizations (PPO and Point
of Service Plans)(2) Medicare Part B and Managed Care
Organizations (HMO) tied for second(3) Workers CompensationQuestion 3: Rate your agreement with the
statement “I am confident in understanding the reimbursement methodologies of the payer types with which I most frequently work”.
Fifty-nine percent (59%) of you Agreed or Strongly Agreed with this statement (strong agreement represented only 10% of total respondents). One quarter of respondents Disagreed or Strongly Disagreed with this statement while the remainder were undecided. In summary, slightly more than 40% of respondents were not confident in their understanding of payment methodologies associated with frequently accessed payer types.
Question 4: Rate your agreement with the statement “I need/desire education and training on …” the following reimbursement issues. (See Figure 1)
Question 5: Rate your experience with being denied payment for the following procedures.
Percentage of Respondents indicated Occasional to Frequent denials for:
Any Thermal or Nonthermal Modalities — 58%
Other * — 56%
97002 — Reevaluation — 51%
97112 — Neuromuscular Reeducation — 40%
97530 — Therapeutic Activitied — 26%
97140 — Manual Therapy — 21%
97110 — Therapeutic Exercise — 9%
*Other denied procedures included aquatic therapy (97113), Physical Performance evaluation (97750), iontophoresis, biofeedback and traction.
To all who responded to this survey, I thank you. Your participation and response will continue to help our committee identify and construct events and education that meet your reimbursement concerns and needs. Please contact me if you have any questions.
Bob Thomas, PT, MSPT503.783.2473
Reimbursement Issue Percentage that Agree or Strongly Agree on Need/ Desire for Education (Percentage if Undecided Responses are counted as need/desire)...........................................................................
Medicare Payment Methodologies .......... 61% (80%)
Documentation ......................................... 61% (74%)
Payer Coverage Determinations ............. 60% (82%) and Restrictions
Appealing Denials ..................................... 59% (76%)
Workers Compensation ............................ 53% (74%)
Payer Edits ................................................ 52% (81%)
CPT Coding ............................................... 51% (68%)
Billing Claims ........................................... 47% (59%)
Credentialing ............................................ 45% (71%)
Contracting with Managed Care .............. 44% (66%)
Meeting with Payer Representatives ....... 43% (74%)
Provider Identification Number ............... 30% (59%)
Figure 1
OPTA OREGON LOG Page 17 - Summer 2009www.opta.org
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The Oregon Physical Therapy Licensing Board (OPTLB) has several updates for PT/PTA’s in Oregon. The Legislature has also passed some laws which will effect PT/PTAs, most of which will go into effect January 1, 2010, after new rules have been written.
First, the Board has determined that dry needling is in the scope of PT as long as the licensee has the appropriate training. Also, a law passed which now allows a PT
with a DPT degree to use the title doctor.
On a different note, HB2059 will require health professionals to report prohibited or unprofessional conduct of another licensee, with punishments for failing to report. It also requires the Board to report prohibited conduct to law enforcement agencies. It requires licensees arrested for felony or convicted of misdemeanor or felony to report
the conviction to the licensee’s Board.
Lastly, SB 670 adds professions (including PT) to the list of officials required to report abuse of elderly persons or children. Look for the upcoming OPTLB newsletter to list in further detail the new laws affecting PT/PTA’s practicing in Oregon. The OPTLB will also be convening a Rules Advisory Committee to address the rules changes that will be required to comply with the new legislation.
Oregon Physical Therapy Licensing Board UpdatesBy Dylan Hogan, PT, DPT, Licensing Board Liaison
APTA Names Jeff Cox, PT as an Emerging Leader
APTA recently selected Oregon’s Jeff Cox as a recipient of this year’s Emerging Leader Award. This award honors individuals that have demonstrated extraordinary service to the profession early in their careers. Recipient’s are regarded by the state association as individual’s who have made exceptional accomplishments and contributions to the association.
Here is how Jeff is viewed by OPTA:
“Jeff has proven to be a valuable resource and a tremendous team member. As a member of the board, the comments he makes are well respected. I often see Jeff at chapter meetings with his students; he serves as a great role model for up and coming clinicians.” - Susan Bamberger, PT, OPTA President
Congratulations Jeff and thank you for your many contributions to OPTA and APTA.
Page 18 - Summer 2009 OPTA OREGON LOG www.opta.org
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Education Committee ReportBy Dode Jackson, PT, Education Committee Chair
Check out the OPTA Continuing Education Calendar and mark your calendars. Your education committee works hard to arrange excellent education opportunities for you in Oregon. You asked and we listened. We are bringing Tom O’Donnell PT back for a full day, hands on workshop, Therapeutic Management of the HIP on January 30th.
Watch for announcements for more webinars that you can receive anywhere in the state, in the comfort of your own home or office! Dr. Glasser, a nationally recognized podiatrist, will be here in Portland on October 17th.
We have something for everyone at Spring Conference 2010 in Eugene. We are planning a unique ‘Manual Therapy Forum” with Mackenzie, NAIMOT and Kaiser/Hayward presenters. Steve Tepper MD will present the Medically Complex patient.
Check the OPTA website www.opta.org for more information.
OPTA Offers a Medical Screening for the Physical Therapist Home
Study Course!
OPTA offers a Medical Screening course in a home study format! You can now purchase the DVD home study program and take the
course when it is convenient for you.
A home study course offers you the advantages of...Self-paced—you can take the course at your own pace at your office
or at home (must have DVD access on your computer or through your TV)
Comprehensive—the course is identical to the “live” version of the courses that we have offered including all of the handout materials
Time Saving—you can take the course when it is convenient for you—24 hours a day, seven days a week
CE Credits—the course is a great way to earn CE credits on your time and schedule.
The full course is a 12 hour course
The refresher course is a 6 hour course
If you are interested in purchasing a home study program contact Stacey Barrett at OPTA at 503.262.9247 or tollfree at 877.452.4919 or
order on-line at www.opta.org
OPTA503.262.9247Or tollfree at 877.452.4919E-mail: [email protected] site: www.opta.org
Oregon Log Advertising Policy The Oregon Log is published quarterly (four issues per year) in March,
June, September and December: the deadlines are: November 9. All display ads must be pre-sized in camera ready form. OPTA reserves the right to not publish advertisements or articles of OPTA’s choosing.
Ad Size Per IssueFull Page - 10" high by 7.5" wide $350.00Half Page - 4.5" high by 7.5" wide $200.00Quarter Page - 4.5" high by 3.5" wide $125.00
OPTA Announces Advertising Package Opportunities! The OPTA publications committee has created a new advertising package plan that offers a variety of advertising opportunities. If you are interested in purchasing a package, please contact Sandra Fisher at the OPTA office at 503.262.9247 or 877.452.4919 or via e-mail at [email protected].
Advertising PackagesPackage Includes Gold SilverWeb site logo & link 1 year N/AWeb site employment advertisement of 100 words 1 year 1 yearNewsletter display ads 1/2 pg ad for 1 year 1/4 pg ad for 1 yearVendor listing in newsletter 4 issues 2 issuesConference exhibit space 1 booth 25% off feeConference brochure vendor listing 1 listing 1 listingConference name displayed on vendor list 1 listing 1 listingPackage prices: $2,000 $1,000
Classified: Classified advertising for employment opportunities or sales items are charged at the rate of $35.00 per ad plus $2.00 per line of type (approx. 45-50 characters including spaces and punctuation). One line complimentary heading is included.
Oregon Log Editorial Policy: The Oregon Log is the newsletter of the Oregon Physical Therapy Association and is published quarterly. Opinions expressed in this publication are those of the attributed author and do not necessarily represent those of the Association or the Board of Directors. Reprint of any article or information published herein is available only by permission of the editorial office. Circulation is to OPTA members. Copies are available to non-members at $4.00 each, post paid. OPTA reserves the right to not publish advertisements or articles of OPTA’s choosing.
OREGON LOG147 SE 102nd Ave.Portland, OR 97216
