WSR 06-12-111

PROPOSED RULES

DEPARTMENT OF HEALTH


(Board of Physical Therapy)

[ Filed June 7, 2006, 9:59 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 05-19-049.

Title of Rule and Other Identifying Information: WAC 246-915-360 Sharp debridement and 246-915-370 Electroneuromyographic examinations.

Hearing Location(s): Yakima Community Center, 10 North 8th Street, Yakima, WA 98901, on July 11, 2006, at 9:30 a.m.

Date of Intended Adoption: July 11, 2006.

Submit Written Comments to: Kris Waidely, P.O. Box 47867, Olympia, WA 98504-7867, web site http://www3.doh.wa.gov/policyreview/, fax (360) 664-9077, by June 30, 2006.

Assistance for Persons with Disabilities: Contact Kris Waidely by June 30, 2006, TTY (800) 833-6388 or 711.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: HB 1137 passed in 2005 required the board to develop rules for education and training requirements for physical therapists (PTs) performing sharp debridement and electroneuromyographic (EMG) examinations. The proposed rules will assure licensed PTs demonstrate adequate training and education before performing these tasks. These rules would only apply to newly licensed PTs or PTs that have not signed a waiver and want to perform these tasks.

Reasons Supporting Proposal: The legislation requires rules to be created to establish adequate education and training for licensed physical therapists to perform sharp debridement. The legislation also requires rules to be created establishing licensed physical therapists to demonstrate further education and training in EMG examinations. The proposed rules are necessary to implement the legislation, and will help protect the public by assuring only trained and qualified PTs perform sharp debridement and EMG on patients.

Statutory Authority for Adoption: RCW 18.74.023, 18.74.010(11), and 18.74.160.

Statute Being Implemented: RCW 18.74.010(11) and 18.74.160.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Department of health, governmental.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Kris Waidely, 310 Israel Road S.E., (360) 236-4847.

A small business economic impact statement has been prepared under chapter 19.85 RCW.

Small Business Economic Impact Statement

1. Briefly describe the proposed rule: HB 1137 (chapter 501, Laws of 2005) passed during the 2005 legislative session. The new legislation authorizes a physical therapist to perform sharp debridement, to include the use of a scalpel only upon showing evidence of adequate education and training. The new legislation also requires licensed physical therapists that perform EMG examinations for the purpose of testing neuromuscular function to demonstrate further education and training in EMG examinations as established by rule.

The proposed rules do the following:

1. They identify the requirements for adequate education and training for licensed physical therapists to perform sharp debridement;

2. They identify the requirements for licensed physical therapists to demonstrate further education and training in EMG examinations.

2. Is a small business economic impact statement (SBEIS) required for this rule? Yes.

3. Which industries are affected by this rule? In preparing this SBEIS, the department of health used the following SIC codes:


SIC Description MINOR IMPACT THRESHOLD
8051 Skilled nursing care facilities $ 195.64
8052 Intermediate care facilities $ 66.10
8059 Nursing and personal care, nec $ 66.10
8062 General medical and surgical hospital $ 396.57
8069 Specialty hospitals exc. Psychiatric $ 237.94
8082 Home health care services $ 122.94
8093 Specialty outpatient clinics, nec $ 116.33
8099 Health and allied services, nec $ 66.10

4. What are the costs of complying with this rule for small businesses (those with fifty or fewer employees) and for the largest 10% of businesses affected? If the licensed physical therapist is working for a small business, the physical therapist would need to go off site to get the required training to comply with this rule. If a licensed physical therapist is working for a large business, they would most likely have access to cases that would provide on-the-job training and would impose no additional costs.

These are the costs to comply with the rule:

If a licensed physical therapist working in private practice, without certification as a wound care specialist, wanted to perform sharp debridement and needed to obtain the twenty hours of mentored training the approximate cost to the licensed physical therapist would be $600 @ $30 an hour for twenty hours of mentored training.

If a licensed physical therapist wanted to become certified as a wound care specialist the initial certification cost to the licensed physical therapist is $330 ($30 application fee and $300 for initial certification which includes taking the national examination).

If a licensed physical therapist working in private practice, without board certification in clinical electrophysiology, wanted to perform EMG examinations and needed to obtain the minimum four hundred hours of training in EMG examinations the approximate cost to the licensed physical therapist would be $60,000 @ $150 an hour (for training provided by a physician) for four hundred hours of training or $12,000 @ $30 an hour (for training provided by a licensed physical therapist) for four hundred hours of training. This would be a rare situation as Washington state currently has approximately five licensed physical therapists that perform EMG examinations out of 4,500 licensed PTs.

5. Does the rule impose a disproportionate impact on small businesses? Yes. If the licensed physical therapist is working for a small business, the physical therapist would need to go off site to get the required training to comply with this rule. If the licensed physical therapist works for large businesses the licensed physical therapist would be able to get this training on the job posing no costs to the licensed physical therapist to comply with this rule.


Labor Market and Economic Analysis

June 14, 2001


SIZE OF FIRM BY SIC INDUSTRY CODE

FOR ALL OWNERSHIPS, INCLUDING MULTIPLE ESTABLISHMENTS


Total

Units

Total Employees Avg. Employees Avg.

Employees

Avg.

Employees

SIC DESCRIPTION < 50 > = 50 Top 10%
TOTAL INDUSTRY DESCRIPTION 213,459 2,650,166 5.0 190.3 94.1
8051 Skilled nursing care facilities 281 26,407 14.7 116.0 144.2
8052 Intermediate care facilities 29 1,651 22.3 99.8 146.6
8059 Nursing and personal care, nec 110 4,081 18.0 98.8 98.8
8062 General medical and surgical hospital 146 78,593 11.1 758.4 2,027.7
8069 Specialty hospitals exc. psychiatric 23 4,106 15.4 167.7 167.7
8082 Home health care services 169 7,408 14.2 109.3 162.6
8093 Specialty outpatient clinics, nec 245 7,530 9.3 113.5 113.5
8099 Health and allied services, nec 93 1,484 7.0 64.3 37.7

6. If the rule imposes a disproportionate impact on small businesses, what efforts were taken to reduce that impact (or why is it not "legal and feasible" to do so) by: Parts of the proposed rule impose a disproportionate impact to small businesses. In order to mitigate the impact of these costs, the department focused on reducing costs associated with the following parts of the rule.

If a licensed physical therapist working in private practice, without certification as a wound care specialist, wanted to perform sharp debridement and needed to obtain the twenty hours of mentored training the approximate cost to the licensed PT would be $600 @ $30 an hour for twenty hours of mentored training. The board received correspondence requesting an increase in the number of hours of mentored training to two hundred hours. At $30 an hour for two hundred hours of mentored training the cost to the licensed PT would be $6,000.

The board feels twenty hours of mentored training is sufficient to ensure patient safety because there have been no adverse actions taken against licensed PTs performing sharp debridement prior to this legislation. These twenty hours of mentored training is in addition to the wound care education that the PT received prior to becoming licensed. The twenty hours of mentored training would normally be completed by the licensed physical therapist on the job posing no additional costs to the licensed PT to comply with this rule. The board believes this rule satisfies the legislative mandate to assure professional competence.

The proposed rule requires a minimum of four hundred hours of instruction in EMG examinations including at least two hundred needle EMG studies under direct supervision from a qualified provider. The board received correspondence requesting the board increase the minimum hours to 1,000. The cost would be $150,000 @ $150 an hour for 1,000 hours. Approximately five out of 4,500 licensed PTs currently perform EMG examinations in Washington. Licensed PTs have been safely performing EMG for approximately forty years prior to this legislation. The department of health has not received any complaints regarding patient safety involving EMG examinations. Therefore, the board feels the minimum proposal of four hundred hours of instruction in EMG examinations including at least two hundred needle EMG studies under direct supervision will ensure the public is protected against unqualified and untrained licensed PTs.

There is an exemption to the education and training requirements for individuals who are board certified in clinical electrophysiology from the American Board of Physical Therapy Specialties. They are considered to have met the education and training qualifications to perform EMG examinations defined in this rule.

Although the rule causes a disproportionate impact to small businesses, the benefit to the public outweighs the cost.

7. How are small businesses involved in the development of this rule? During the comment period, town meetings were held and draft rules were sent to all interested parties.

A copy of the statement may be obtained by contacting Kris Waidely, P.O. Box 47867, Olympia, WA 98504-7867, phone (360) 236-4847, fax (360) 664-9077, e-mail kris.waidely@doh.wa.gov.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Kris Waidely, P.O. Box 47867, Olympia, WA 98504-7867, phone (360) 236-4847, fax (360) 664-9077, e-mail kris.waidely@doh.wa.gov.

June 2, 2006

Kris Waidely

Program Manager

OTS-8749.2


NEW SECTION
WAC 246-915-360   Sharp debridement education and training.   Licensed physical therapists may perform sharp debridement upon showing evidence of adequate education and training. Physical therapists may not delegate sharp debridement. The board will accept the following as adequate education and training:

(1) Twenty hours of mentored sharp debridement training - mentored training includes observation, cotreatment, and supervised treatment. Twenty hours mentored training in a clinical setting must include a case mix similar to the physical therapists' expected practice; or

(2) Certification as a wound care specialist by the American Academy of Wound Management; the National Alliance of Wound Care; or other organizations approved by the board, meets the requirements of this section; or

(3) An affidavit submitted prior to July 1, 2006, by a physical therapist licensed in Washington demonstrating education and training in sharp debridement, including the use of a scalpel.

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OTS-8750.2


NEW SECTION
WAC 246-915-370   Electroneuromyographic examinations education and training.   A physical therapist may perform electroneuromyographic (EMG) examinations, which may include needle EMG and nerve conduction studies, to test neuromuscular function only if the physical therapist has received a referral from an authorized health care practitioner identified in RCW 18.74.010(7) and only upon demonstrating education and training in EMG examinations. The board will accept the following as evidence of education and training:

(1) A minimum of four hundred hours of instruction in electroneuromyographic examinations including at least two hundred needle EMG studies under direct supervision from a qualified provider. A qualified provider includes a physical therapist with board certification in clinical electrophysiology from the American Board of Physical Therapy Specialties, a neurologist, or a physiatrist; or

(2) A person who is board certified in clinical electrophysiology from the American Board of Physical Therapy Specialties meets the requirements of this section; or

(3) A written attestation submitted prior to July 1, 2007, by a physical therapist licensed in Washington demonstrating that the physical therapist has performed EMG examinations.

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Washington State Code Reviser's Office