Division of Medical Quality Assurance REPORT DRY NEEDLING Governor State Surgeon General RON DESANTIS JOSEPH A. LADAPO, MD, PHD 2022 PHYSICAL THERAPY
TO PROTECT, PROMOTE, AND IMPROVE THE HEALTH OF ALL PEOPLE IN FLORIDA THROUGH INTEGRATED STATE, COUNTY, AND COMMUNITY EFFORTS. Mission Vision TO BE THE HEALTHIEST STATE IN THE NATION. Values Innovation We search for creative solutions and manage resources wisely. Collaboration We use teamwork to achieve common goals and solve problems. Accountability We perform with integrity and respect. Responsiveness We achieve our mission by serving our customers and engaging our partners. Excellence We promote quality outcomes through learning and continuous performance improvement.
01 02 03 04 INTRODUCTION Creation of § 486.117, Florida Statutes, and Department implementation efforts. DRY NEEDLING STATISTICS Data collection, analysis, findings, and discussion. APPENDIX A Florida Board of Physical Therapy Practice overview, structure, qualifications, and contacts. APPENDIX B Data tables, including total licensed physical therapists, physical therapist licenses by service region and county, and dry needling practitioners by service region and county. CONTENTS TABLE OF 05 CONTACT US Reach out to staff with questions.
The number of licensed physical therapists in the state. The number of licensed physical therapists in the state performing dry needling. Any increases or decreases in the number of licensed physical therapists in the state by geographic area. Any adverse medical incidents involving Florida licensed physical therapists performing dry needling. As required by section 486.117, Florida Statutes, the Florida Department of Health (Department) must prepare a Physical Therapy Dry Needling Report to be submitted to the President of the Senate and Speaker of the House of Representatives on or before December 31, 2022. “Dry needling” is a skilled intervention, based on Western Medicine, that uses filiform needles and other apparatus or equipment to stimulate a myofascial trigger point for the evaluation and management of neuromusculoskeletal conditions, movement impairments, and disabilities. “Myofascial trigger points” are an irritable section of soft tissue often associated with palpable nodules in taut bands of muscle fibers. This report includes a summary of statutory requirements and administrative rules created for the minimal safe practice of dry needling by licensed physical therapists, the actions performed by the Board of Physical Therapy Practice (Board) to implement a new rule, and an analysis of data gathered by the Division of Medical Quality Assurance (Division) as specifically requested by the Florida Legislature. By statute, the data included in this report must specify: 1. 2. 3. 4. The analyses and findings in this report detail mostly demographic data, including registered dry needling practitioners, as well as specifics on the steady growth of the number of licensed physical therapists across the state, and in most geographic sub-regions of the state, over the three previous fiscal years. p.1 INTRODUCTION 01
Requiring practitioners to complete two years of licensed practice as a physical therapist. 50 hours of face-to-face continuing education related to the practice of dry needling. A minimum of 25 patient sessions of dry needling under the supervision of a physical therapist with the appropriate qualifications and experience to practice dry needling. A minimum of 25 patient sessions of dry needling performed as a licensed physical therapist in any state or the United States Armed Forces. On June 29, 2020, Governor Ron DeSantis signed House Bill (HB) 467, creating § 486.117, Florida Statutes, which established minimum standards of practice for physical therapists performing dry needling in Florida. In April 2021, the Board of Physical Therapy Practice (Board) enacted rule 64B17-6.008, Florida Administrative Code, Minimum Standards of Practice for the Performance of Dry Needling. The minimum standards for qualification to perform the procedure as established by § 486.117, Florida Statutes, include: 1. 2. Practitioners must also prove completion of either: 1. 2. To better protect Florida patients and consumers, the statute established the state’s public interest in the safe practice of dry needling. Statutory and administrative guidelines were implemented with the intent to prevent, monitor, and report adverse medical incidents that may occur during treatment. An “adverse medical incident” is defined by rule 64B17-6.008, Florida Administrative Code, as “an event over which the physical therapist could exercise control and which is associated in whole or in part with the performance of dry needling, rather than the condition for which dry needling occurred, and which resulted in any prolonged and/or emergent neurological, pulmonary, vascular, or musculoskeletal condition that required the transfer of the patient to a hospital and/or referral to a physician for treatment of the resulting condition.” Creation of Florida Statute § 486.117 p.2
Specific topics to be included in continuing education materials. Defining key terms such as adverse medical incident, competency requirements, and supervision. Obligations of a qualified physical therapist supervising another practitioner during the required 25 patient sessions. Supervision of the procedure by telemedicine between a qualified physical therapist and a training practitioner. Identifying specific unqualified personnel such as physical therapy assistants whom the procedure may not be delegated to by the qualified physical therapist. Upon the approval and signing of HB 467 (2020), the Department, in conjunction with the Board, began implementation efforts and initiated the rulemaking process. Areas addressed during the implementation included educational outreach to practitioners, updating licensure applicant systems, and developing new tracking and reporting mechanisms for adverse incidents. Effective April 19, 2021, rule 64B17-6.008, Florida Administrative Code, implemented the provisions of the newly created § 486.117, Florida Statutes, including the necessary qualifications for the practice of dry needling and the requirement of patient consent. Supplementary guidelines include: 1. 2. 3. 4. 5. The passage of HB 467 (2020) required the Department to update two systems used to track applicant and license information. The Licensing and Enforcement Information Database System (LEIDS), and the license verification website were updated to include the specialty designation of dry needling for physical therapists. Additionally, the Board created and adopted the Physical Therapy Dry Needling Attestation form (Form #DH5057-MQA) to identify physical therapists performing dry needling in Florida. Form #DH5057-MQA became effective with the administrative rule. Rule 64B17-6.008, Florida Administrative Code, further requires that any adverse medical incident occurring as direct result of treatment involving dry needling be reported to the Board within 15 days of the incident using the Physical Therapy Dry Needling Adverse Medical Incident Report form (Form #DH5053-MQA). The adverse medical incident reporting requirement mandated the creation and addition of a new enforcement investigatory case code to the LEIDS system to track adverse incidents by the Department. Form #DH5053-MQA was incorporated by the Board and had an effective date matching that of the administrative rule. Department Implementation Efforts p.3 p.3
The number of physical therapists in the state. Increases or decreases of their number by geographic region. The number of dry needling practitioners in Florida. The number of adverse medical incidents resulting from dry needling. The Department extracted data from LEIDS annually to fulfill the report requirements, beginning in 2020. This report provides a summary of the data extracted during the reporting period, Fiscal Year (FY) 2019-20 to FY 2021-22, and includes the following: 1. 2. 3. 4. This analysis reflects the number of physical therapist licenses issued by the Department and the number of physical therapists qualified to perform dry needling in the state of Florida. While this dataset captures the number of dry needling practitioners in FY 2020-21 and FY 2021-22, the performance of dry needling was not recorded in FY 2019-20 as this predated the authority granted by the legislation. As a result, FY 2019-20 serves as a baseline for this comparative analysis. The data captured in this analysis is also reflected geographically according to the 11 service regions of the Division.* The Department received one report of an adverse medical incident related to the practice of dry needling during the reporting period; the Department is prohibited from publicizing complaints or allegations against health care practitioners in accordance with section 456.073, Florida Statutes, until 10 days after a determination of probable cause exists. No further analysis of adverse medical incidents was conducted or contained within this report. DRY NEEDLING STATISTICS 02 Data Collection and Analysis p.4 *Please note that these data were extracted from a dynamic database and may be amended at a later date. p.4
Figure 2: Service Regions Source: LEIDS Database These data are categorized by county and service region of the Division, the details of which may be located in Appendix B of this report. The data illustrates the growth of physical therapy licenses issued and the number of physical therapists performing dry needling in the state of Florida for each fiscal year in this reporting period. The number of physical therapists licensed in the state of Florida increased by 7.3%, growing from 19,241 in FY 2019-20 to 20,649 in FY 2021-22, as portrayed in Figure 1.* With three years of data, a net positive pattern of growth is shown, and each of the 11 service regions experienced some degree of growth ranging from single digit to low double-digit percentages. Region 1 and Region 6 experienced the greatest amount of growth as both expanded in the number of physical therapists licensed by over 8%. Region 2 experienced the smallest amount of growth at 1.4%. Findings and Discussion Licensed Physical Therapists Figure 1: Physical Therapist Licenses, by Service Region, by Fiscal Year p.5 *Please note that these data were extracted from a dynamic database and may be amended at a later date.
Source: LEIDS Database *Please note that these data were extracted from a dynamic database and may be amended at a later date. Dry needling practitioners increased significantly from FY 2020-21 to FY 2021-22 as illustrated by Figure 3. The number of practitioners over the last two fiscal years increased by over 133%, growing to 247 the first year and to 576 the second year. Region 4 possesses the highest concentration of this growth, increasing from 46 practitioners to 127 practitioners from FY 2020-21 to FY 2021-22. By comparison, Region 2 and Region 3 both experienced a high percentage of growth. However, when reviewing the actual number of practitioners, their net growth was measured by an increase from single digits to double digits, which artificially inflates the percentages. One adverse medical incident was reported to the Department during the reporting period. No further analysis was conducted on adverse medical incidents, and thus does not appear in the data tables of Appendix B. All information and details pertaining to the incident are confidential. Dry Needling Practitioners Adverse Medical Incidents Figure 3: Dry Needling Practitioners, by Region, by Fiscal Year p.6
The Florida Board of Physical Therapy Practice (Board) plays a leading role in the ever-changing health care environment through dialogue with the public, the state legislature, academia, and the therapeutic community. APPENDIX A: Florida Board of Physical Therapy Practice Overview 03 Overview Structure Qualifications The Division serves as the principal administrative unit for the Board which is supported by a full-time professional staff based in Tallahassee. Board activities are supported in full by fees paid by its licensees. The Board is composed of seven members appointed by the Governor and subject to confirmation by the Senate. As Board member terms expire, the Governor appoints successors for a term of four years, and members serve until successors are appointed or resign. Five Board members are licensed physical therapists in good standing in this state who are residents of Florida and who have been engaged in the practice of physical therapy for at least four years immediately before their appointment. One licensed physical therapist Board member may be a full-time faculty member teaching a physical therapy curriculum at an educational institution in the state. The two remaining Board members are residents of Florida who have never been licensed health care practitioners. p.7
APPENDIX B: Data Tables 04 Figure 4: Total Practitioners, Rate of Change by Fiscal Year Figure 5: Practitioners* by Service Region KEY: PTL = Licensed Physical Therapists DRN = Dry Needling Practitioners p.8 *Please note that Figure 5 excludes records which are confidential, out of state, military active, and retired. These data were extracted from a dynamic database and may be amended at a later date.
Figure 6: Physical Therapist Licenses by Region and County p.9
Figure 6: Physical Therapist Licenses by Region and County, Continued p.10
Figure 6: Physical Therapist Licenses by Region and County, Continued p.11 Source: LEIDS Database *Please note that these data were extracted from a dynamic database and may be amended at a later date.
Figure 7: Dry Needling Practitioners by Region and County p.12
Figure 7: Dry Needling Practitioners by Region and County, Continued p.13
Figure 7: Dry Needling Practitioners by Region and County, Continued p.14 Source: LEIDS Database *Please note that these data were extracted from a dynamic database and may be amended at a later date.
p.15 Steve Chenoweth PT Board Chair Dr. Ellen K. Donald PT, PhD Board Vice-Chair Dr. Andrew Koenig PT, DPT, MHA, OCS Board Member Dr. Paul Kleponis BSEd, BSPT, DPT, LtCol (ret.) Board Member For more information about the Division, visit: https://flhealthsource.gov/ For questions or comments, contact: Florida Department of Health Board of Physical Therapy Practice 4052 Bald Cypress Way Bin C-05 Tallahassee, FL 32399-3255 850-245-4373 CONTACT US 05 Florida Board of Physical Therapy Practice
December 2022. Prepared by the Division of Medical Quality Assurance, Florida Department of Health, in partnership with the Florida Board of Physical Therapy Practice.
Division of Medical Quality Assurance
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