Пълният препис на E26 - Chapter Updates with President Nick Weber

--> 00:02:28.240 Yeah, it's funny you ask. 00:02:28.479 --> 00:02:31.840 I just took uh my daughter yesterday. 00:02:32.000 --> 00:02:36.719 She was adamant that she needed to go with when the fireworks were picked out this year, right? 00:02:36.879 --> 00:02:37.199 Okay. 00:02:37.439 --> 00:02:40.960 Uh, and we carried around a little basket, you know, as as people do. 00:02:41.199 --> 00:02:43.199 And man, that thing was full. 00:02:43.520 --> 00:02:54.719 And you know, despite it saying, you know, 75% off, or you know how it goes, like it's three for one for a while, then it's four, you know, buy one, get four free, all the things, but yeah, it was full. 00:02:54.879 --> 00:03:00.159 And uh yeah, we're just gonna burn off a few hundred dollars, I think, at the Weber household this year. 00:03:00.319 --> 00:03:02.000 So should be a fun event. 00:03:02.159 --> 00:03:10.159 It I mean, if you're if you're gonna burn your money, uh, you know, at least seeing it it go up in in pretty sparkles is worth it, right? 00:03:10.639 --> 00:03:11.120 For sure. 00:03:11.280 --> 00:03:14.719 As long as the you know, as long as the kids are happy, that's all that matters. 00:03:14.879 --> 00:03:15.919 Keep them safe too, right? 00:03:16.080 --> 00:03:19.520 But yeah, enjoy the enjoy their smiles in the process. 00:03:19.840 --> 00:03:20.479 I love that. 00:03:20.639 --> 00:03:21.280 I love that. 00:03:21.360 --> 00:03:23.439 Uh any vacations planned? 00:03:24.240 --> 00:03:33.199 Yeah, we're gonna get out uh to Colorado and then uh we're hoping to get a few camping trips in still uh before the end of the summer as well. 00:03:33.759 --> 00:03:40.560 Yeah, we're uh we're also kind of round in the corner hoping to do one or two camping trips. 00:03:40.719 --> 00:03:44.319 Uh summer camping trips around Nebraska are a little tough sometimes. 00:03:44.400 --> 00:03:46.159 You don't know what the weather's gonna do. 00:03:46.400 --> 00:03:50.879 Um, but Minnesota, Colorado, a little better space. 00:03:51.759 --> 00:03:54.639 If you can get out of that humidity, that's that's a key. 00:03:55.439 --> 00:03:55.919 Absolutely. 00:03:56.159 --> 00:03:58.080 All right, hey, enough chit chat. 00:03:58.159 --> 00:04:04.719 There's no snack talk today, um just vacations and and summers so far. 00:04:04.879 --> 00:04:10.159 Um, Nick, can we get into a few of the things that uh have been going on in the life of the chapter? 00:04:10.319 --> 00:04:12.719 I know uh we've gotten some good news lately. 00:04:12.800 --> 00:04:16.319 Um why don't we start off uh maybe more of a national level? 00:04:16.480 --> 00:04:28.879 The RISE Act is something that we had talked about that was encapsulated into the big beautiful bill, and it was impacting um the, well, I guess who could be labeled as a professional. 00:04:29.040 --> 00:04:32.399 Um and so can you talk just a little bit more about that? 00:04:32.560 --> 00:04:40.000 Maybe give us a brief reminder and then uh talk about where things have landed here as we've rounded the corner into July. 00:04:40.480 --> 00:04:41.759 Yeah, you're right. 00:04:41.839 --> 00:04:43.600 You know, you mentioned the SOAP note coming out. 00:04:43.680 --> 00:04:52.879 And I think just in the like maybe the two weeks since that's been published, uh, we've had at least two or three kind of major events uh professionally happen since then. 00:04:53.040 --> 00:04:57.439 So uh related to the RISE Act, uh, yeah, so the courts stepped in. 00:04:57.519 --> 00:05:00.879 Um, some were predicting this might happen. 00:05:00.959 --> 00:05:08.879 Uh, but essentially the court said, you know, you can't pick and choose which definition of professional that you use. 00:05:09.120 --> 00:05:18.639 Uh, you can certainly go and change the definitions if you want, but when the most kind of recent precedent establishes some professions as professionals, you can't just ignore that. 00:05:18.800 --> 00:05:26.240 So essentially uh what's happened now at this point is uh the caps for loans have stayed in place. 00:05:26.639 --> 00:05:42.560 But the professions like physical therapy that had precedent and had been previously defined as a professional program are now going to be uh held to that standard or push, you know, labeled as such uh until something changes, right? 00:05:42.639 --> 00:05:47.040 So of course uh legislation could occur and remove that label. 00:05:47.199 --> 00:05:50.560 But yeah, we we were moved into the professional designation. 00:05:50.639 --> 00:05:58.000 So now uh rather than our students being capped at$20,000 annually, uh they'll be in that larger group at the$50,000. 00:05:58.160 --> 00:06:05.920 So uh I know we're excited about just the change and and the opportunity that that gives uh more students to get into the profession. 00:06:06.000 --> 00:06:12.160 So hopefully that removes some of the stress and anxiety, especially for those students that we're getting ready to start here just in the fall. 00:06:12.959 --> 00:06:22.000 Yeah, you know, a lot of um, I don't know, we always we always talk about like intended and unintended consequences of legislation a lot of the time, right? 00:06:22.240 --> 00:06:33.120 You know, so some of what's behind that legislation in the first place is um trying to regulate some of the spending uh from an educational standpoint, right? 00:06:33.199 --> 00:06:37.120 And just recognizing that it's getting really expensive for students. 00:06:37.279 --> 00:06:39.680 And so that is that is an issue, right? 00:06:40.000 --> 00:06:53.040 Um, but there were some really unintended consequences for particularly our profession and some of the students um being able to access uh funds to attend a DPT program at this point, too. 00:06:53.519 --> 00:07:15.360 Yeah, and I think you know, to that point, as stressful as this process has been and trying to work with the Department of Education and consider that what you're saying about you know getting tuition costs under

control and trying to advocate for that reason, uh, but then also not hinder future generations and giving everyone equal opportunities to kind of get into the profession of their choosing. 00:07:15.600 --> 00:07:28.959 Um my hope, I think, you know, what I saw happen in the in the interim was that schools started to to do more and create more um education around, you know, do you need to take out all these loans? 00:07:29.040 --> 00:07:39.439 Trying to inform students, like make wise decisions, uh recognize that maybe even though FAFSA grants you so much money that you don't have to take it all out. 00:07:39.519 --> 00:07:43.040 Or if you want to go back and take it later, you know, you don't you couldn't do that. 00:07:43.199 --> 00:07:51.120 Um so there's a lot of education that came about um trying to inform students to make better decisions around their loans. 00:07:51.279 --> 00:08:05.680 Um and and now hopefully with the caps still in place, um, they continue to do that and be thoughtful about you know what is the appropriate amount of money to take out and what's reasonable, what can I pay back based on my trajectory? 00:08:05.920 --> 00:08:07.120 Yeah, that's great. 00:08:07.199 --> 00:08:08.560 Uh let's shift gears a little bit. 00:08:08.639 --> 00:08:12.639 We'll come um more state uh focused now. 00:08:12.959 --> 00:08:16.800 And uh maybe a couple wins in the Medicaid front, right? 00:08:16.959 --> 00:08:22.240 So uh you were telling me that Nebraska's acquired federal funds for uh the Medicaid program. 00:08:22.319 --> 00:08:24.639 Do you want to share a little bit more information with us? 00:08:25.199 --> 00:08:26.879 Yeah, this is a big win for us. 00:08:27.040 --> 00:08:42.799 Um so this really goes back to 2025, and there's a lot of details into this story, but even if you go back to 2024, uh there was some legislation in 2024 to really support uh the hospital systems in Nebraska. 00:08:42.960 --> 00:08:52.320 Um, as you as you will recall, there was some uh concern that we might lose some critical access hospitals just due to the financial troubles they were in around that time. 00:08:52.480 --> 00:09:00.639 So then when 2025 came around, um, we recognized, hey, now it's time to support the non-hospital providers. 00:09:00.879 --> 00:09:17.840 Uh and so, in working with uh the Nebraska Medical Association, the Hospital Association, and all the other different uh professional associations in our state, one of the things we were trying to do was to boost the Medicaid rates, recognizing that a lot of providers were losing were leaving the Medicaid system. 00:09:18.080 --> 00:09:35.600 Uh, but at the same time, recognizing that the situation the state was in with the budget deficits and stuff that we've heard a lot about, and not being just like, you know, naive and going to the state and saying, hey, we need increases in the Medicaid system, but trying to help the state find resources to support those programs. 00:09:35.679 --> 00:09:47.679 And so uh there was legislation back in 25, I think it was LB527, that looked at the opportunity of doing certain assessments that other states were already doing to draw down federal funds. 00:09:48.240 --> 00:09:50.559 And that legislation passed. 00:09:51.519 --> 00:10:06.879 And when it passed, I think it was kind of late spring, early summer in 25, big victory for the state, thinking, hey, we're gonna be able to draw down all these federal funds, and and then that should support the Medicaid system, and we'll see provider rates go it go up. 00:10:07.200 --> 00:10:26.480 Well, then, you know, right July 1, I think it was, uh, HR1 dropped the one big beautiful bill that summer, and it kind of put a hold on all those kind of programs where the administration said, hey, we're not that you know, states are taking advantage uh in certain ways of federal funding and we're gonna crack down on this. 00:10:26.559 --> 00:10:31.840 And so not to say that Nebraska was trying to pull any strings, we were just trying to draw down funds that were there. 00:10:32.000 --> 00:10:35.759 Uh but then this kind of this big hold got put on everything. 00:10:35.840 --> 00:10:42.879 And so for honestly, almost 18 months, we kind of thought we're never gonna be able to get these funds out. 00:10:43.039 --> 00:10:46.399 Um, and I was kind of worried that just it was never gonna come to be. 00:10:46.799 --> 00:10:56.879 Well, like two weeks ago, I got notification that the administration had released the funds to the state and to be on the lookout for any potential increases. 00:10:57.120 --> 00:11:03.519 Well, just so happened right around July 1st is when uh the state releases the new uh Medicaid fee schedules. 00:11:03.600 --> 00:11:08.000 And sure enough, uh there was a 20% increase across all the therapy codes. 00:11:08.159 --> 00:11:09.759 So huge victory for us. 00:11:09.919 --> 00:11:27.039 Great to see the state um utilize resources and work with the administration um to demonstrate need and you know, put things in place to make sure the funds get utilized appropriately and really support a good cause because uh we were losing a lot of providers in the Medicaid system. 00:11:27.200 --> 00:11:39.919 So uh hopefully this will bring providers back to it and definitely uh support those providers out there that are already taking patients with Medicaid insurance and looking forward to this kind of support, help those private practices, especially. 00:11:40.240 --> 00:11:46.720 Yeah, you know, if I actually had a button for the podcast, it would it would have cued the applause as you were talking there. 00:11:46.799 --> 00:11:54.320 Uh instead, you just got the screen effects from me with you know the the confetti uh excitement as you were talking there. 00:11:54.559 --> 00:12:02.000 Hey, um this isn't something that just right happens behind the scenes or sorry, just happens without uh a ton of work going into it. 00:12:02.159 --> 00:12:08.159 You said

it it is really tied to some of the work that was done in 2025 and groundwork was laid before that. 00:12:08.399 --> 00:12:18.000 Uh I'm putting you on the spot a little bit, but do you want to do you want to drop any names of people that have really helped to support this or get on board with it, um help move it forward? 00:12:19.279 --> 00:12:23.120 Well, you know, I think it there's a there's a lot. 00:12:23.279 --> 00:12:24.080 Let me start with that. 00:12:24.159 --> 00:12:28.879 Uh I'm sure I won't do it justice by uh trying to name people because I'm sure I'll leave people off. 00:12:29.039 --> 00:12:30.399 But let me say this. 00:12:30.559 --> 00:12:42.320 I think the well, the lesson that's learned from this was that uh with every uh opportunity to communicate to legislators or to other professions, I'll give you an example. 00:12:42.639 --> 00:12:50.960 We kind of have just a couple check-ins with like the Rural Health Association, the hospital association, the medical association on an annual basis. 00:12:51.759 --> 00:13:07.440 And just using those opportunities where maybe the agenda has different topics, but to bring awareness to them that hey, I know I know physicians have these provider provider deserts throughout the state, but so do other professions like PT, OT, speech. 00:13:07.840 --> 00:13:16.080 Um and and share with them, like, hey, you know, if you're referring someone to physical therapy, but there's no provider there. 00:13:16.399 --> 00:13:18.480 Like that affects your patient. 00:13:18.639 --> 00:13:23.840 Um and so, you know, they have as an example, the medical association has way more resources. 00:13:23.919 --> 00:13:27.200 I mean, they have paid people that advocate for them, right? 00:13:27.360 --> 00:13:30.240 Um, versus on our side, everything's volunteer-based. 00:13:30.559 --> 00:13:37.360 That by just informing them, we were able to kind of motivate them to support our cause here. 00:13:37.759 --> 00:13:44.240 Uh, and and really they they did a lot of the legwork here and and getting this legislation across the finish line. 00:13:44.320 --> 00:13:53.679 And so, you know, my hats off to them for all their work on this kind of stuff and making, you know, really working even nationally to pull down these funds and and not giving up on this issue. 00:13:53.919 --> 00:14:09.440 Um, so really thankful for them, but very thankful for the people on our side that took advantage of those opportunities to inform not just legislators, but other providers in our state uh on what's kind of going on within our profession and the challenges that we face. 00:14:09.519 --> 00:14:13.039 And like I said, utilizing their resources to support us. 00:14:14.159 --> 00:14:15.840 Hey, well, well said. 00:14:16.080 --> 00:14:23.519 Um, one of the things I just picked up as you're talking there is uh just the value of uh interprofessional conversations, right? 00:14:23.679 --> 00:14:25.519 Um understanding one another. 00:14:25.600 --> 00:14:45.279 Uh it's easy to operate in silos at times, but uh doing the work to try to uh really collaborate and work interprofessionally is is crucial, um not just in our day-to-day work, but certainly um in some of the avenues that you're talking about, the conversations that you're having, um, it's really valuable and that goes a really, really long way. 00:14:45.519 --> 00:14:48.080 So um hey, thanks for your work there. 00:14:48.240 --> 00:14:49.519 I know there's many others too. 00:14:49.759 --> 00:14:59.360 So um, and then another thing that we were talking about, Nick, was uh some of the language around adult Medicaid recipients. 00:14:59.440 --> 00:15:18.320 So one of the issues that has been present in the past, you know, if if if adult Medicaid recipients have uh 60 visits annually, um typically, even if primary insurance would pick up a visit, you were losing a visit with that Medicaid patient, correct? 00:15:18.879 --> 00:15:19.440 That's right. 00:15:19.519 --> 00:15:26.320 So there are scenarios where uh patient will have Medicaid insurance, but it'll be secondary, right? 00:15:26.480 --> 00:15:39.039 And so um in those pre in previous years, uh no matter who which payer was really picking up the tab on a certain visit, it was counting against the visits in the Medicaid system. 00:15:39.120 --> 00:15:52.559 So the the state kind of clarified that language for 26, 27 fiscal year and said that unless Medicaid essentially pays part of the tab for that visit, it's not going to count against the visits. 00:15:53.279 --> 00:15:58.799 Which, you know, there's a lot of scenarios out there where an adult actually needs 60 plus visits. 00:15:58.960 --> 00:16:08.799 Um and so if if there's any reason where um uh the primary insurance is is exhausted, then Medicaid will kick in and not also be exhausted. 00:16:08.879 --> 00:16:13.120 Um so it's there for those people that have medical necessity and need extended care. 00:16:13.279 --> 00:16:15.120 So excited for the state. 00:16:15.200 --> 00:16:21.679 Um you know, just the fact that they they listened to those scenarios again, they're probably rare. 00:16:21.919 --> 00:16:32.559 Um, but when they're there, important that those individuals can get the care that they need uh and not have their visits exhausted when a payer wasn't even really contributing to their care prior to that. 00:16:32.879 --> 00:16:33.279 Yeah. 00:16:33.519 --> 00:16:34.720 Uh it's great stuff. 00:16:34.879 --> 00:16:35.519 Big wins. 00:16:35.600 --> 00:16:37.120 Uh this is this is a great episode. 00:16:37.200 --> 00:16:38.960 There's lots of good stuff going on. 00:16:39.440 --> 00:16:40.080 I love it. 00:16:40.320 --> 00:16:42.720 Yeah, we just feel like we got a little momentum right now. 00:16:42.879 --> 00:16:51.840 Hopefully we can continue to build on this and uh looking forward to getting the legislative committee together here soon and and see what should be on tap for 27. 00:16:52.399 --> 00:16:54.799

Should shoot off some fireworks to celebrate. 00:16:55.200 --> 00:16:57.200 I think that's that's gonna happen, right? 00:16:57.279 --> 00:16:57.519 Yeah. 00:16:58.720 --> 00:16:59.200 That's right. 00:16:59.360 --> 00:17:03.919 Hey, uh just to kind of wrap things up, House of Delegates is coming up. 00:17:04.079 --> 00:17:07.200 Um, I think you guys are traveling out what next week or the week following? 00:17:07.279 --> 00:17:07.680 Is that right? 00:17:08.000 --> 00:17:08.400 Next week. 00:17:08.559 --> 00:17:09.359 Yeah, next week. 00:17:09.680 --> 00:17:17.839 Um is there anything that's on the docket that you're kind of excited to to listen to or speak into? 00:17:18.160 --> 00:17:20.720 Um anything that you're looking forward to? 00:17:21.279 --> 00:17:22.640 Well, there's just a lot going on. 00:17:22.720 --> 00:17:30.720 Uh so we'll be in Portland and the two days prior to House of Delegates, uh, APTA is hosting a state payment advocacy forum this year. 00:17:30.880 --> 00:17:36.319 Uh I'm thankful to have been invited to speak uh about some of our Medicaid wins. 00:17:36.400 --> 00:17:45.839 And that's really what this kind of event is about is states sharing how they achieved their their victories with an up so for like an opportunity to learn from each other. 00:17:45.920 --> 00:18:01.039 And so we've got a group of people going from Nebraska, uh, and hopefully we can learn a lot and bring back what other states have done and things that maybe we haven't accomplished yet, and try to utilize that in future years to see if we can continue to kind of use this momentum to move forward. 00:18:01.119 --> 00:18:03.119 So looking forward to that event. 00:18:03.200 --> 00:18:06.880 And then immediately following, we got the two days for House of Delegates. 00:18:07.039 --> 00:18:09.119 Uh a lot of good things on the docket this year. 00:18:09.359 --> 00:18:14.880 You know, again, um, like previous years, there's a lot of stuff that's proposed. 00:18:15.039 --> 00:18:17.839 I doubt we'll get to maybe even half of it, but that's okay. 00:18:17.920 --> 00:18:24.000 Hopefully, we have a lot of good discussions and some fruitful things come out of it, and then we'll kind of see where that goes. 00:18:24.400 --> 00:18:24.960 Excellent. 00:18:25.200 --> 00:18:32.000 Well, uh, for our audience, we'll have a recap of House of Delegates later in July or early August. 00:18:32.079 --> 00:18:41.920 Um, we'll have a podcast that comes out with some of our delegates from their time out there and just some of the work that's being done at a national level, too. 00:18:42.079 --> 00:18:45.920 Uh, Nick, before we sign off, anything else you want to leave the audience with? 00:18:46.799 --> 00:18:50.720 Hope everyone has a happy fourth and a safe fourth. 00:18:50.799 --> 00:18:54.319 You know, don't be one of those people that blows up a firework in your hand, please. 00:18:54.640 --> 00:18:55.680 Hate when that happens. 00:18:55.759 --> 00:18:56.400 No, kidding. 00:18:56.559 --> 00:18:58.480 Uh, hopefully that doesn't happen to anyone. 00:18:58.799 --> 00:19:01.039 I actually have to tell you the story really quick, Brad. 00:19:01.440 --> 00:19:05.599 Uh I went to visit this surgeon, hand surgeon, one time. 00:19:05.920 --> 00:19:08.880 And I was just spending some time in the clinic with him. 00:19:09.440 --> 00:19:16.720 And his administration comes in, like, this is probably like early spring, and they're like, hey, you know, someone else needs the fourth of July off. 00:19:16.799 --> 00:19:19.200 Would you be willing to work this day? 00:19:19.519 --> 00:19:22.720 And in my head, I was like, There's no way this guy's saying yes to this. 00:19:22.880 --> 00:19:25.279 Like, I'm sure he's got holiday plans already. 00:19:25.599 --> 00:19:30.480 But he like joyfully was like, Yes, absolutely, I will work the 4th of July. 00:19:30.559 --> 00:19:31.359 And I was like, What? 00:19:31.599 --> 00:19:34.880 So I asked him after the person left, like, wow, that was really nice of you. 00:19:35.039 --> 00:19:38.319 Like, I can't, you know, guys, uh, you're pretty flexible. 00:19:38.559 --> 00:19:40.960 It's nice of you to see you work that way with your administration and stuff. 00:19:41.039 --> 00:19:41.680 She's like, Oh no. 00:19:41.759 --> 00:19:47.359 He's like, listen, the best, you know, hand injuries come in on the fourth of July. 00:19:47.599 --> 00:19:51.680 And it's a great opportunity as a hand surgeon to really hone in your skills. 00:19:51.839 --> 00:19:56.240 And I was like, okay, that's that's a little bit sadistic, but I got it. 00:19:56.400 --> 00:20:05.359 Uh uh, because I personally don't love managing those conditions post-surgically, they're super challenging, but it's all in the eye of the beholder, right? 00:20:05.440 --> 00:20:07.119 And kind of the lens you work through. 00:20:07.279 --> 00:20:08.480 So oh man. 00:20:08.720 --> 00:20:14.480 But just it has forever made me just cringe at the thought of you know, or just the fear of fireworks. 00:20:14.720 --> 00:20:16.880 So be safe. 00:20:17.119 --> 00:20:18.480 Yeah, everyone be safe. 00:20:18.640 --> 00:20:26.319 Um, hopefully, by the time this podcast posts, um the US has moved into the round of eight in the World Cup. 00:20:26.400 --> 00:20:28.319 That would be fantastic, right? 00:20:28.480 --> 00:20:29.839 Big win last night. 00:20:30.000 --> 00:20:32.640 Um, to do it without one of their best players, but we'll see. 00:20:32.880 --> 00:20:38.160 Yeah, they're gonna have to do it without one of their best players, but uh they've exceeded expectations to this point. 00:20:38.319 --> 00:20:39.920 So it's fantastic. 00:20:40.319 --> 00:20:41.039 I love it. 00:20:41.279 --> 00:20:41.680 All right. 00:20:41.759 --> 00:20:43.200 Well, thank you everyone for joining. 00:20:43.279 --> 00:20:44.319 Thank you for listening, Nick. 00:20:44.400 --> 00:20:49.039 Thanks for the great work you're doing, and and to many others uh in the chapter as well. 00:20:49.279 --> 00:20:54.079 Um look forward to continuing to bring you guys more podcasts here in the future. 00:20:54.400 --> 00:20:55.440 Thanks, Brett. 00:20:56.079 --> 00:20:59.279 Thanks for tuning in to the APTA Nebraska podcast. 00:20:59.440 --> 00:21:05.680 Stay connected with us for more conversations that elevate our profession and improve the lives of Nebraskans. 00:21:05.920 --> 00:21:09.119 Don't forget to subscribe, share, and join the discussion. 00:21:09.279 --> 00:21:13.119 Because together, we're driving the future of physical therapy forward.