A comparison of two states, Nevada and Virginia, demonstrates the advantages of having operational metrics.
Policymakers created occupational licensing to protect the public and ensure quality of services. Regulations governing occupational licensing have grown significantly over the past sixty years. Recently, there have been concerns that some regulations have become overly broad or burdensome, creating poor licensure cost-benefit ratios and restricting occupational mobility. State regulatory agencies often face pushback on state board decisions, restructuring, or de-regulation. Operational metrics can be a good tool to demonstrate each boards’ value and effectiveness. A comparison of two states, Nevada and Virginia, will shed light on the advantages of having operational metrics.
In late 2015 and early 2016, the Nevada Board of Physical Therapy identified significant areas of concern in regards to its operational efficiency. As the current Board Chair, I began to question the lack of transparency, accountability, and effectiveness of the board. The results of my relentless pursuit of answers led to the resignation of our executive director. The years to follow would prove to be challenging, yet rewarding, as Nevada dealt with the growing pains of a complete transformation of the board.
During the 2018 sunset report process, Nevada's Sunset Subcommittee of the Legislative Commission reviewed twenty-three professional and occupational licensing boards, including the Nevada Board of Physical Therapy. This process brought our already identified deficiencies into the spotlight. Our biannual audit revealed a lack of internal controls, lack of approved budgets, and expenditures exceeding revenues. The board also had a number of concerns including, but not limited to, a large backlog of investigative cases, higher than average attorney fees given the work completed, and the revelation of the executive director making unauthorized payments to herself.
It was very embarrassing to have to sit in front of the Sunset Subcommittee of the Legislative Commission and respond to questions regarding our lack of fiduciary responsibility to the board. As one might expect, I felt as if the committee members blamed the current board for its state of disarray. The spotlight and accolades will go to the people that correct that problem and not necessarily to the ones that expose it.
In Virginia, we have a different experience. Virginia has ongoing State Board assessments and the development of operational metrics have helped to prove the value of professional boards on their effectiveness of maintaining public protection and ensuring quality of services.
The Virginia Board of Physical Therapy uses acquired data to inform board decision making by assessing board performance. Staff presents the collection of data on licensing, disciplinary actions, and customer satisfaction surveys at each quarterly business meeting. Board members receive data on the number of current licensees, the status of licensing applications, the number of disciplinary cases received and closed, and the results of customer satisfaction surveys (conducted by the agency and collected by the Federation of State Boards of Physical Therapy from National Physical Therapy Examination candidates). During each biennial license renewal cycle, licensees complete standardized workforce surveys with a range of questions aimed at collecting data on areas such as demographics, education, and practice. Staff compiles that information in biennial Workforce Reports for PTs and PTAs, which are available online. Workforce survey data identifies geographic areas where access to physical therapy services is or may be limited. Recently, the board used the data to track the prevalence of dry needling as a treatment modality in PT practice.
To allow newly appointed board members to become knowledgeable regarding the board, comprehensive reports compiled every two years reflect key accomplishments and performance data for all of the boards within the Department of Health Professions (DHP). The most recent biennial report (for FY 2017 - FY2018) is available online. DHP updates reports regarding Key Performance Measures (KPMs) quarterly and posts the information on their website. The KPMs represent key data points that the state requires the boards within DHP to collect as a representation of performance (e.g., time for processing cases, responsiveness, etc.).
The Virginia Board of Physical Therapy is able to substantiate disciplinary board decisions by using sanctioning reference points. In November 2009, the Virginia board first adopted a model sanctioning process for disciplinary cases. The Virginia Department of Health Professions and an independent consulting firm developed the Sanctioning Reference Points (SRP) system using an analysis of data from all cases resulting in disciplinary action between 2001 and 2009. During the data analysis process, researchers created a database of the case and respondent factors that factored most heavily into the board’s decision-making process. Researchers then correlated the most prevalent factors to the sanctions imposed, creating a range of possible sanctions to apply with almost 75 percent accuracy to the cases that were presented before the board. Applying this same range to future cases enhances consistency of sanctioning based upon the most common case and respondent factors. In November 2018, the board adopted an updated SRP tool, reflecting additional data and analysis for cases from 2012 through early 2017. The most recent SRP is available online. Board members use the SRPs as a reference tool for all informal hearings before the board, and they often use the sanctioning ranges in determining appropriate sanctions for consent orders. Based upon data from November 2018, the board’s agreement rate with the tool is approximately 83 percent—meaning in approximately 83 percent of cases, board members sanction within the range suggested by the SRP tool.
When the Virginia Board of Physical Therapy considered legislation to join the PT Compact in May 2018, the board considered the potential impact on revenue, professional benefits, and public protection. As part of that discussion, the immediate data collection focused on revenue first. The board reviewed and analyzed data to approximate the cost and determine whether participation in the Compact would be financially viable. The board based their unanimous decision to support the PT Compact on the outcome of the data analysis.
Our advice to board members is to always be proactive. Board chairs should enable those who come after them to look for ways to improve the efficiency of the board and never fall into complacency. Do not fall into the dangerous mode of accepting the status quo. Stay involved and educated in the current trends in occupational licensing to evaluate the need for ongoing operational efficiency.
The establishment of operational metrics would have made the Nevada Board experience much more palatable. The Sunset Subcommittee of the Legislative Commission specifically asked the Nevada board about licensing fees, renewal costs, and the frequency of renewals across similar professions and neighboring states. These statistics were easy to gather and submit. The board was able to submit statistics that had changed over the past two years, such as, reduction in number of active cases and decreased amount of legal fees. The new Nevada executive director also put in place improved internal policies and procedures involving the establishment of segregation of duties, the timely review of financial reports, and hiring an outside financial audit agency for annual reviews.
Fortunately, the Nevada Sunset Subcommittee of the Legislative Commission opted to retain the Physical Therapy Board. Author Tina Baum owes this successful decision to the current executive director and board members for their leadership and organization during this difficult time.
Although the regulatory environment is founded on a common principle of public protection and retention of high-quality services, the optimal path to meet this goal is constantly changing. Jurisdictions should strive to share foundational standards while being able to preserve the unique rules and regulations of their state. Keeping operational metrics is an objective way to communicate the board’s value and effectiveness.
Tina Baum, PT, DPT, WCS, ATC, CLT
Tina served on the Nevada Board of Physical Therapy for six years and was the Chair for the last two years. In addition to receiving the Outstanding Service Award in 2017 and 2019, she serves the FSBPT as the current Chair of the Ethics and Legislation Committee and was appointed to the Practice Analysis Task Force Committee in 2016. Tina received a BS in Athletic Training in 1993, MPT in 1997, and a DPT in 2014. She has been in private practice since 2001 and is a Board Certified Clinical Specialist in Women’s Health.
Dr. Arkena L. Dailey, PT, DPT, CIMT, FMT
Dr. Arkena Dailey, PT, is a graduate of the Doctor of Physical Therapy program from the University of St Augustine, Allied Health. She is an Alumnae of Hampton University and Longwood University. She currently works for Sentara Healthcare system as a Clinical Rehab Specialist. Arkena specializes in sports management, orthopedics, and neurology. She has 18 years of clinical experience in various settings including Inpatient Rehabilitation, Home Health, Nursing Home, and Outpatient Care. She has served in management roles and as an adjunct professor for Old Dominion University Physical Therapy and Sports Medicine Program. Arkena was Governor appointed to the Virginia Board of Physical Therapy in 2015. She serves as the President for the Virginia Board of Physical Therapy for a second term. She served three years as an appointed member of the Education Committee, and she has recently been appointed to The Ethics and Legislative Committee and The Boundaries Violation Task Force. She is community service oriented with 25 active years of membership in Alpha Kappa Alpha Sorority, Incorporated and she is active with The Hampton Chapter of the Links, Incorporated, and The Chesapeake Chapter of the Carats, Incorporated. She enjoys world travel and spending time with her family.
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