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Williams 1 Malcolm Williams Dr. Steffen Guenzel ENC 1102.A005 7 June 2013 Rhetorical Analysis Revised Final Draft Examining the Impact of the Health Care Reform Law to Physical Therapists INTRODUCTION In the essay, ““Health Reform Law and its Impact on Physical Therapists: Value across the spectrum of care.” Dr. Zoher Kapasi examines the potential impact of the health care reform (HCR) law to the occupational outlook for physical therapist in America. On January 1, 2014 a major and significant portion of the Patient Protection and Affordable Care Act (PPACA) better known as Health Care Reform (HCR), the Affordable Care Act (ACA) or Obamacare will be implemented. For anyone in the medical fields, this law will have the most impact on health care in America since the implementation of Medicare and Medicaid in the 1960s. The law has been the subject of a heated debate that has divided the country. However, it is the law of the land and several key aspects of the law have already been implemented. On New Year’s Day 2014, two major provisions will be implemented: most Americans will be required to have insurance and no one will be denied coverage because of pre-existing condition (“Patient Protection”). Dr. Kapasi is a professor of physical therapy and the interim director of the Division of Physical Therapy at Emory University in Atlanta, GA. He is an authoritative figure and versed in the internal and external issues confronting the physical therapy profession. He is the author of several medical articles concerning human immunology and movement therapy. The purpose and thesis of Dr. Kapasi’s essay is to reassure his students that their future career will not be

Williams 2 adversely affected by the new law. He claims there will be many new opportunities for physical therapies in the area of preventative and wellness care, increase direct access to patients, reengineering of physical therapists roles and increase advocacy and participation in the healthcare implementation. To support his claims, he uses data from juried studies, the CBO and APTA and other scholars. His warrant is the actual statement that HCR will have a positive impact on the physical therapy profession. His piece is scholarly. He presents his information concerning the impact of the healthcare reform law to the physical therapy industry in a clear and concise format. SUMMARY OF THE ESSAY Dr. Kapasi begins his essay by discussing what he feels are the most important issues affecting health care in America today. According to him there is not a healthcare crisis, but a health insurance and healthcare costs crisis. For instance concerning his claim about high cost of health insurance, he states that Americans do not care about the cost of their health care because it is always paid by someone one, either an employer, an insurance company or the government. He cites a 2007 study by a Herrick and Goodman to support his claims. In his second claim about the high costs of healthcare, he points out to two driving forces: the threat of obesity and use of emergency rooms as a primary source of health delivery. He presents several supporting statements how the growing healthcare costs are actually related to the problems of obesity. From his research, almost 50% of Americans suffer from one or more chronic diseases. Many of these diseases are the direct results of obesity. He support his claims with research from Kenneth Thorpe of the Rollins School of Public Health who states that “doubled obesity rates are responsible for one-third of the rise in health care costs since the mid-1980s, and our spending on health care costs attributable to obesity will quadruple -- to $344 billion – by 2018 (Kapasi).”

Williams 3 This has made the threat of obesity a major factor in America’s health care woes. In addition, many Americans receive their healthcare through the emergency room, the most expensive healthcare delivery system in the country. Americans are forced to use emergency rooms because a lack of health insurance. Up to this point, he essay has been about the cost of insurance and healthcare in America. He states that any health care reform law must address affordable coverage for all Americans and controlling the cost of health care. Whereas, with the advent of healthcare reform many more people will have access to health insurance and will be able to use primary care physicians. However, will it be to control or reduce health care costs? Dr. Kapasi then makes another move and do a “180.” He moves from discussing the cost issues and changes the subject of his discourse to his essay title, health care reform and the future of physical therapy and “how…this legislation going to impact their [his students] chosen profession of physical therapy (Kapasi)?” He goes on to state that his essay will not debate the merits or demerits of these two issues (the high cost of health insurance and health care) but will focus on what is on the minds of his students and audience, how the law will impact their future? Dr. Kapasi makes another move; he goes on to explain the current role and state of physical therapists. According to him, physical therapists are the leaders in rehabilitation medicine that allows individuals with chronic illnesses to live productive lives. Next he summarizes the health care law. He discusses the expanded coverage for all Americans, the employer and individual mandates and the newly created health exchanges which will create an organized and competitive market for health insurance. He supports his claim with data from the Congressional Budget Office (CBO) which states that 95% of Americans will receive coverage from the HCR law. According to Dr. Kapasi, these key provisions will directly impact physical

Williams 4 therapists, because with access to coverage more Americans will seek physical therapy services. In addition, the law will affect physical therapy practices and other health care facilities such as home health, nursing home and/or organizations that employ 50 or more employees, because these employers must now provide insurance coverage for their employees and hence physical therapists employed at these facilities. He then states that the law will be instrumental in controlling costs through prevention and lowering the cost of health delivery methods. Physical therapists will be in a good position to take advantage of these provisions by being the lower-cost health provider and conducting, developing and implementing employer-based wellness and prevention programs. Next Dr. Kapasi moves toward addressing the importance of controlling Medicare costs. A key objective of HCR is reducing healthcare costs. According to Dr. Kapasi over two plus trillion dollars is spent on health care in America. This represents 16% of our GDP. In addition, he states Medicare and Medicare like government spending accounts for 47% of the national budget. HCR has provisions to control Medicare by authorizing the implementation of an independent payment advisory board (IBAP). Furthermore, the Center for Medicare and Medicaid Services (CMS) has sought ways to decreased hospital readmission rates. HCR offers an opportunity for the hospitalists to examine “bundling” payments. Bundling is payment to hospitals that cover episodic costs both acute and post-acute over a 30 or 60 days’ time frame. The hospital will either deliver the cost themselves or pay a third-party provider. While it will seem logical to coordinate pre-acute, acute and postacute, this was not required until HCR. HCR requires for the Department of Health and Human Services (HHS) to develop a voluntary national pilot program to improve patient outcomes and

Williams 5 create a viable bundled payment model. Dr. Kapasi states that is very important for physical therapist to be an integral part of this pilot program. His next move is to wrap everything up. He uses his previous claims to make the following assumptions: 1) physical therapists should be diligent in changing their roles from support function to primary care provider 2) eliminate or reduce physician-owned physical therapy services (POPTS) and ensure 3) direct access to patients Dr. Kapasi states it very important to “advocate for a patient’s right to directly access the services of a physical therapist without needing the referral of a physician, and we might prevent self-referral by physicians to physician-owned physical therapy practices.” All of these positions are shared by the American Physical Therapy Association (APTA) the professional and organizational advocacy group for physical therapist. He sums up his essay by charging his student to play an integral role as across the spectrum of care as various provision of the new law is implemented. He stress they should remain knowledgeable and actively advocate for the value they provide patients. Overall, his essay is aligned with his thesis examining how HCR will affect physical therapist, but throughout his discourse he goes back to the issues initially introduced in his essay: reducing the cost of health insurance and reducing the cost of health care. For example, he states that physical therapists are the low-cost providers, they offer cost-effective value to patients and are placed in an advantageous position, by “showing our patients the value we offer. Value is a ratio of benefits over costs. As long as we achieve comparable or better outcomes for our patients at lower costs compared to surgery and other more costly interventions, there will be a market for our services and patients willing to pay for them (Kapasi).”

Williams 6 ARISTOTLE ’S M ETHOD OF APPEALS: ETHOS, PATHOS AND LOGOS Dr. Kapasi’s primary audience is his students and the faculty discourse community of Emory University. Dr. Kapasi applies of all of Aristotle’s three methods of appeals and persuasion to present his argument and validate his thesis. For example, he uses Ethos because his current and professional writings establish his credibility as an informed writer. He identifies himself as a person of authority. He is not only a professor but the acting director of the Physical Therapy Department. As a professor his students will respect him and be very attentive to his every word. In terms of Pathos which appeals to the emotion of the audience, he appeals to the uncertainty, fears and self-interest of his students. He does an excellent job alleviating their fears and letting them know that everything will be alright. Overall, he motivates his students to continue their chosen careers and not be alarmed by what some extremists and rational voices call “Obamacare.” He does this in a professional professorial tone. It is very matter of fact and to the point. He never uses the term “Obamacare.” In this way, Dr. Kapasi is applying Aristotle’s third method of appeal in an argument which is Logos. He appeals to his students’ intelligent and others in his discourse community, a collegiate setting. As a matter of fact, his essay is a part of Emory University Academic Exchange forum for academic discourse and engagement among faculty and staff. CONCLUSION In conclusion, Dr. Kapasi’s essay is very effective in educating his students about their future and the impact of the new legislation to their futures. It is well-organized. He explicitly states in his thesis that he wish to reassure his students concerning HCR to their profession. His entire piece is scholarly and informative. He concludes his essay by charging his students to be advocates and active participants in the health care reform discourse. In addition, he reiterates his main points of cost control by being the lower cost health delivery system with positive and

Williams 7 effective outcomes; participation in employer-based and individual-based wellness and preventative care and opportunity to move from support care to primary care. Dr. Kapasi has relieved my own misgivings about my future career and I am very appreciative of his essay.

Williams 8 Works Cited Department of Rehabilitation Medicine. Faculty: Dr. Zoher Kapasi. Emory.edu. Emory University School of Medicine. 2013. Web. 4 June 2013. . Kapasi, Zoher. “Health Reform Law and its Impact on Physical Therapists: Value across the spectrum of care.” Emory University: Academic Exchange Vol. 13.1 (Fall 2010). Web. 25 May 2013. < http://www.emory.edu/ACAD_EXCHANGE/2010/fall/kapasi.html>. National Institutes of Health: US National Library of Medicine. Pub Med: Kapasi ZF. Nih.org. National Institutes of Health. 2013. Web. 4 June 2013. . “Patient Protection and Affordable Care Act.” Wikipedia.com. Wikipedia: The Free Encyclopedia. Wikimedia Foundation, Inc. 27 May 2013. Web. 27 May 2013. .